☼ Nolongeranxiousbut: Lexapro and Klonopin started Jan 2018

[nolongeranxiousbut]

Moderator note: link to benzo thread - Nolongeranxiousbut: lexapro/klonopin which to taper... see pdoc tomorrow

 

hi all,

 

I'm a new member. I had a medical incident (still dealing with but a lot has gotten better) that caused anxiety and insomnia back in October. Things got worse and I started medicines with a psychiatrist Jan 2nd for the first time.

 

Was started on klonopin and Lexapro. Tapered  lexapro two weeks up to 10mg. Klonopin was also increased to try and help with sleep up to 1.125 mg a day - 1 mg at night and .125 in the morning. Didn't help sleeping through the night. I did have 5 days above 1.125 mg a day  - 1 day at 1.75, 1 day at 1.625 and 3 days at 1.25. Those were nighttime increases to 1.25 and 1.5 which didn't help.

 

My pdoc is new (less than 1.5 years in practice) and had only ever heard of a klonopin withdrawal once when one of her 20+ year patients at .5mg at night didn't get her script refilled. She believes I feel what I feel from my one klonopin cut - down to .75 at night setting alarm to take at 2:30 in the morning as found Feb 21 that I no longer had anxiety keeping me from falling asleep which was a huge improvement and I enjoy sleeping naturally 4 hours... but hate getting up to take the required klonopin - she said... you can cut from 1 mg to 0! so no issue cutting .75 to .5 uhm, no.

 

I had brain fog some of those early post-taper days but now down to headaches mostly from jaw clenching and gassiness (treating with beano and gasX). No increased anxiety. The stomach and jaw clenching (saw dentist and fitted for night lower mouthguard which I'll get this week) but also feel like want to clench and have to focus not to clench during day - started Feb 19th.

 

I dropped the klonopin 10 Feb. I did go back up to 1 mg a night Feb 18 and 19 and .875 at night Feb 20. I had been sleeping with addition of benadryl and it had dried out my mouth so I had stopped and was hoping the klonopin .25 early in the evening would help with falling asleep.

 

Anyhow... my pdoc doesn't think the jaw clenching is from the klonopin drop and wants me to reduce my lexapro. She suggested 10mg to 7.5mg but was open to liquid so I have 5mg pills and 1mg/ml liquid now. I haven't started. I still have good/bad days of headaches and gassiness - mostly don't start until late afternoon and better by the time I go to bed. The last 3 days I had two days completely good and then yesterday with headache and stomach upset from the gassiness.

 

Has anyone here had relief reducing lexapro from 10 to 7.5 for jaw clenching? With two drugs it's hard to really know which it's from.

 

If I drop I'll only do 5 or 10% on the lexapro and hold to wait to see if withdrawal symptoms.

 

But I've also been trying to decide if I should try and reduce the klonopin a little more. So hard to figure out what to do first!

 

And I expect I should wait longer although I read the stomach problems might be long term so not sure I can outwait that if I want to do another taper of something.

 

 

 

Edited March 27, 2018 by Shep
added spacing (ChessieCat), added tags and mod note (Shep)

[Gridley]

Hello, nolongeranxious, and welcome to SA.

 

To give members the best information, we ask them to summarize their medication history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly.

• Any drugs prior to 24 months ago can just be listed with start and stop years. 
• Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago) 
• Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016. 
• Please leave out symptoms and diagnoses. 
• A list is easier to understand than one or multiple paragraphs. 
• Link to Account Settings – Create or Edit a signature.

It's good that you plan to taper the Lexapro by only 5-10%.  At Surviving Antidepressants, it is recommended that a person taper by no more than 10% of their current dose with at least a four week hold in-between decreases.  The 10% taper recommendation is a harm reduction approach to going off psychiatric drugs.  Some people may have to taper at a more conservative rate as they are sensitive to even the smallest drops.
  

Before you begin tapering what you need to know

What is Withdrawal Syndrome?
Why taper by 10% of my dosage?

Tips for tapering off Lexapro (escitalopram)

Brain Remodelling

 

Here is some excellent information on withdrawal:

What is withdrawal syndrome.

Glenmullen’s withdrawal symptom list.

 

We generally advise that you taper only one drug at a time.  That's because if there's a problem, you won't know which drug taper caused it.  Lexapro is activating, and we suggest tapering activating drugs first, with the more sedating drug, Klonopin left in place to act as a buffer to be tapered later.  Please take consistent doses, as your brain craves stability and jumping around in doses outside your taper can further destabilize your nervous system.

Taking multiple psych drugs? Which drug to taper first?

The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable.

 

Here is a link to a thread on jaw-clenching.

Face, jaw, tongue muscle tension and pain - Surviving Antidepressants

 

This is your introduction topic -- the place for you to ask questions, record symptoms, share your progress, and connect with other members of the SA community. I hope you'll find the information in the SA forums helpful for your situation. I'm sorry that you are in the position that you need the information, but I am glad that you found us.

[nolongeranxiousbut]

Yes, I'm sticking with stable doses now and have for the last month.

 

Would it be ok to start the Lexapro slow taper from 10mg to 7.5mg 4 weeks after the 1 time Klonopin drop - getting

it to below 1 mg a day?

 

I'm still having some afternoons of either bad headache and or/gassiness. But my husband,

who keeps track says it's getting better. It's hard when you have a bad afternoon. Bad headache yesterday and he

was able to tell me it had been a week since that happened. And no stomach issues for 3 days.

 

My pdoc wants me to try reducing the lexapro. She's suggested this for weeks but wasn't ready with what I feel are benzo withdrawal from the 1 time drop - she doesn't believe it can be the klonopin and thinks it was the getting to 4 weeks updosing to 10mg on the Lexapro.

[Gridley]

What is your current Klonopin dosage and how long have you been consistently taking that dosage?  Could you please put that in your signature?

 

Regarding starting your slow Lexapro taper 4 weeks after your Klonopin drop, I would throw out the calendar and listen to your body.  You need to be stable before starting the Lexapro taper and your symptoms will tell you when you are ready.  Don't rush it.

[nolongeranxiousbut]

My doctor prescribed me liquid lexapro to be able to taper slower. I have 5mg pills by Torrent (take 10mg a day since January 17 after ramping up for anxiety). The liquid is by Camber. Has anyone had problems mixing the two - I know there are sometimes reports that folk feel a difference switching generics or between generic and name brand. My plan was to keep 1 5mg pill and use the liquid for the tapering as that would maintain part of what I was used to. My psychiatrist has supported me going down from 10 to 7.5 due to side effects that showed up week 4 of 10 mg Lexapro which also was the beginning of the second week of my one time klonopin drop to get it down to .875mg a day... and yes, that drop was higher than recommended) . She doesn't believe the side effects - ones that have stayed after a month post klonopin drop - very gassy stomach despite beano before and gasX after each meal  - gassiness for hours and hours - and jaw clenching although that has gotten better with time - are due to the klonopin drop. I wasn't ready to taper anything until I'd had a month of new stable (it was all over the place as we tried unsuccessfully to get it to work for sleep) klonopin dose.

 

She asked why I didn't just switch to all liquid but I thought it would be better to maintain some of the brand I've been on for the last 2.5 months since I started.

 

I was thinking only 5% taper the first month as I mixed the medicines. So 5mg tablet and 4.95ml liquid (5mg/5ml)... why do they say that instead of 1mg/1ml? so weird.

Edited March 22, 2018 by nolongeranxiousbut
added sentence

[ChessieCat]

It is okay to combine liquid and tablet to get your dose.  However, it is best to only make one change at a time.  That is, don't make a reduction at the same time you introduce liquid.  If you experience an issue you won't know what is causing it.

 

Keep it Simple, Slow and Stable

Keep Notes on Paper

 

From tablets-or-liquid-in-withdrawal:

 

 

On 8/11/2011 at 4:03 AM, Altostrata said:

yes, you can take the tablet and liquid together to get to the full intended dosage

 

[Altostrata]

Good idea to get used to the combination, nolongeranxious. You're on your way.

[nolongeranxiousbut]

How long to get used to the combination? a week or two?

 

[nolongeranxiousbut]

Still struggling with what to taper down first... so lexapro 10 mg 9.5 weeks (2 week ramp up before that) and klonopin which was supposed to be 'temporary' but tried for and failed for sleep during lexapro start up now 12.5 weeks.  10 mg lexapro and .875 mg klonopin (.75 2-3am and .125 1:30pm). How do I know which is actually helping the anxiety right now? (or neither? adjustment disorder). The important thing is that I'm sleeping again and the klonopin is not helping me fall asleep because I don't take it until the middle of the night - because I *have* to take it. And I don't want to take it at beginning because it's so nice to fall asleep quickly again without a nighttime drug. It's not keeping me asleep either. So I feel like I should reduce the klonopin some more maybe leave some to deal with any problems with lexapro taper?... did the one cut and ready to taper one or the other.

help! my doctor just says for me to pick.

 

I guess if I taper the lexapro a little and the side effects get better and the anxiety doesn't get worse than I know the higher 10mg dose compared to 7.5 wasn't really helping me.

 

I'm not talking about stopping the klonopin but I would love to get it down a lot more... it doesn't seem to be giving me much benefit (perhaps anti-anxiety) for how much I'm taking.

 

From what I read the anti-anxiety effects from the klonopin might not be that much anymore either...

I can't afford to stop sleeping! It was the anxiety induced insomnia that made the downward spiral so much worse... Being able to fall asleep again when I go to bed without taking a drug at the time is priceless.

[nolongeranxiousbut]

Well, drat... natural peppermint flavoring... I have serious GERD issues and peppermint is out... it smells extremely pepperminty as well. Will have to call the compounding pharmacy.

[nolongeranxiousbut]

I know this is against the tapering advice but I've decided to work on getting the klonopin down a bit first. It was only supposed to be used starting up the Lexapro in January 2018 and then we upped it trying to unsuccessfully use it for sleep. It's not helping me sleep and I'm only taking it because I don't want withdrawal. My pdoc would actually be happy if I didn't taper anything yet as I was in bad shape mentally when I first saw her Jan 2nd 2018. But she's more supportive of the klonopin at this point getting it lower.

[nolongeranxiousbut]

hi all,

 

I'm back... been over on benzo buddies.

 

As per my profile:

First started psychiatric drugs 2-4 January 2018 for anxiety and insomnia due to a health issue that had resolved. Moved up to 10 mg escitalopram and 1.25 mg of clonazepam that month. Anxiety gone early February. The clonazepam didn't help for sleep and mid February I started tapering. The first drop was too much and had unpleasant withdrawal symptoms - stomach pain/gas/belching, headaches, anxiety, jaw clenching, fuzzy head. I held and then did a slower taper - 0.03 mg per drop the last 12 months starting at 0.555 mg a day early August 2018 - using compounded capsules. Fairly uneventful the last year except for ongoing stomach pain which finally resolved early August. All the other withdrawal symptoms and the insomnia had resolved in 2018.  Most were only a few days each drop before then. Fuzzy head and headaches gone with the .03 mg drops (had been .065 and then a bad attempt at daily liquid microtapering) ... anxiety and jaw clenching were usually days 4-7 after a drop. Gently stepped off 15 August 2019. Last drop was only .015 mg, half of what I'd been dropping, just the way it turned out. Been feeling great the last 8 weeks. Sleeping fine. No withdrawal symptoms.

 

I know this site recommends tapering AD before benzo but the benzo definitely wasn't helping for sleep and I was on Teva and it had been discontinued so I was highly motivated to get off that first. The escitalopram although I'm not sure it helped didn't seem to be hurting me. My compounding pharmacy secured a supply of Teva just for me before it was discontinued so I was able to stay on it the whole taper. The plan was to only stay on the escitalopram 6 months but I didn't expect the clonazepam taper to take so long and didn't want to taper two medications at once. I might have tapered the clonazepam slower than I needed to but I knew the escitalopram was next and I was functioning fine in life and work and didn't want to jeopardize that.

 

Started my escitalopram taper today. I'd been taking two 5 mg pills at 9 am. Now one 5 mg pill and 4 ml = 4 mg (5mg/5ml) of the liquid to start, a 10% drop. The liquid is amazingly bad tasting even added to a small amount of water. Had a cracker cleanse afterwards. I've had a lot of practice with the clonazepam taper. Feeling positive about this one.  I know withdrawal issues tapering one medication don't necessarily translate to issues with another. Starting slower and will listen to my body.

 

Nice that I don't have to keep emailing new prescriptions to be called in as with the compounded capsules - I was allowed to set my own drops and duration for the whole clonazepam taper - and the liquid makes it even more independent.

I know about the 10% recommendation. I've read a lot. I've found the hyperbolic drop articles interesting - the ones by the Royal Dutch Pharmacists Association and Horowitz/Taylor.  I was tempted (but only a little) to try the 50% cut first time with only a 10% reduction in serotonin transporter occupancy which even Horowitz/Taylor say is tolerated well by most patients. But it's not a race and I really don't want stomach pain or any other symptoms to return with any prevalence. I'm blessed with being able to set my own speed so tortoise slow. If I don't have issues I can always decide to shorten the time between drops.

[nolongeranxiousbut]

One week in. Only withdrawal symptom is gassiness - lots of flatulence and some burping. Haven't changed diet. As I switched to 4 ml liquid (=4mg) while keeping the rest at 5mg pill while dropping 10%=1mg I'm happy that's the only symptom. A little nibble of chocolate after the liquid in water dose gets rid of the taste.

[Altostrata]

Hello, nolonger. I merged your latest posts with your existing Introductions topic.

 

Good to hear your benzo taper went well. Please let us know how you're doing.

[nolongeranxiousbut]

Thanks! I couldn't find at first as was looking for the other subject heading. Doing really well with the escitalopram taper. First day I've not been very gassy.

[nolongeranxiousbut]

After 11 days at 9 mg escitalopram I dropped to 8 mg yesterday. Flatulence has been the only withdrawal symptom.

[nolongeranxiousbut]

One week at 8 mg and no issues. Flatulence has decreased a bit.

[nolongeranxiousbut]

Tapered down to 7 mg yesterday. No issues.

Figured can go faster the first part as only 10% drop in receptors for 10 mg to 5 mg dose drop.

started 10 mg

10/14  9 mg

10/25  8 mg

11/5   7 mg

[nolongeranxiousbut]

Tapered down to 6 mg this morning. Doing great. No issues.

started 10 mg

10/14  9 mg

10/25  8 mg

11/05  7 mg

11/16  6 mg

[nolongeranxiousbut]

No issues so continuing with my 11 days per drop. Tapered down to 5 mg this morning, so just a pill no liquid for this dose. After this it will be just liquid, no pill!

started 10 mg

10/14  9 mg

10/25  8 mg

11/05  7 mg

11/16  6 mg

11/27  5 mg

[Gridley]

12 hours ago, nolongeranxiousbut said:

11/16  6 mg

11/27  5 mg

 

I would slow down at this point.  Your last drop was around 15%.  

[nolongeranxiousbut]

Thanks for the concern and warning, Gridley. I really appreciate it! At this point I'm planning on following the hyperbolic drops from The Lancet papers by Horowitz/Taylor and Ruhe & co. where half the dose is suggested for the first drop corresponding to a 10% reduction in serotonin transporter occupancy. They stated most folk tolerate well that first 50% drop but I've broken it up into five 10% of original dose drops to be more conservative. I am aware of this website's recommended 10% of last dose drop taper recommendation.

 

I'll definitely be going slower as I go lower. And not as agressively as the suggested table below. After my clonazepam taper I'm well attuned to my body and will definitely hold/slow if any withdrawal symptoms.

 

hyperbolic discontinuation schedule, example, lexapro/escitalopram

step     dose (mg)

1          10

2          5

3          3

4          2

5          1.5

6          1

7          0.5

8          0.25

9          0

[nolongeranxiousbut]

Still no issues, feeling great. Done with pills. Just liquid from here on down. I tapered to 4.4 mg this morning (which nicely equals 4.4 ml). Slower 12% drop for the switch to entire liquid and uncertainty in the bioavailability between the pill and liquid.

 

started 10 mg

10/14  9 mg

10/25  8 mg

11/05  7 mg

11/16  6 mg

11/27  5 mg

12/08  4.4 mg

[nolongeranxiousbut]

No issues. Happy it's so boring a taper. Down to 3.8 mg this morning. 13.5% drop. Feel like I could do more but staying conservative. Don't want any bad surprises with the holidays coming.

 

started 10 mg

10/14  9 mg

10/25  8 mg

11/05  7 mg

11/16  6 mg

11/27  5 mg

12/08  4.4 mg - all liquid from here down

12/19  3.8 mg

[nolongeranxiousbut]

Another 11 days, another drop this morning to 3.2 mg. 15.8% drop. Last of the 0.6 mg drops. No issues.

 

started 10 mg

10/14  9 mg

10/25  8 mg

11/05  7 mg

11/16  6 mg

11/27  5 mg

12/08  4.4 mg - all liquid from here down

12/19  3.8 mg

12/30  3.2 mg

[nolongeranxiousbut]

Dropped this morning to 2.8 mg, 12.5% drop.  No issues. Got to move to smaller 3 ml syringe.

 

started 10 mg

10/14  9 mg

10/25  8 mg

11/05  7 mg

11/16  6 mg

11/27  5 mg

12/08  4.4 mg - all liquid from here down

12/19  3.8 mg

12/30  3.2 mg

 1/10   2.8 mg

[nolongeranxiousbut]

Dropped this morning after 10 days to 2.4 mg, 14.3% drop. No issues. Won't go less than 10 days per taper.

 

started 10 mg

10/14  9 mg

10/25  8 mg

11/05  7 mg

11/16  6 mg

11/27  5 mg

12/08  4.4 mg - all liquid from here down

12/19  3.8 mg

12/30  3.2 mg

 1/10   2.8 mg

 1/20   2.4 mg

[nolongeranxiousbut]

Down to 2 mg this morning, and another new smaller 2 ml syringe! Everything going fine. 16.7% drop, last of the 0.4 mg drops.

Thankful my household healthy, my nephew is sick with Influenza B... caught right away and got Tamiflu.

 

started 10 mg

10/14  9 mg

10/25  8 mg

11/05  7 mg

11/16  6 mg

11/27  5 mg

12/08  4.4 mg - all liquid from here down

12/19  3.8 mg

12/30  3.2 mg

 1/10   2.8 mg

 1/20   2.4 mg

 1/31   2.0 mg

[nolongeranxiousbut]

Down to 1.7 mg this morning! 15% drop. If halving the citalopram values that takes me to 50% serotonin transporter occupancy - 3.4 mg for citalopram.

Still feeling and sleeping great.

 

started 10 mg

10/14  9 mg

10/25  8 mg

11/05  7 mg

11/16  6 mg

11/27  5 mg

12/08  4.4 mg - all liquid from here down

12/19  3.8 mg

12/30  3.2 mg

 1/10   2.8 mg

 1/20   2.4 mg

 1/31   2.0 mg

 2/11   1.7 mg

[nolongeranxiousbut]

Less than 1.5 mg !! Celebrate every milestone. 🙂

Down to 1.4 mg yesterday! 17.6% drop. Feel great, sleeping fine. No withdrawal symptoms.

 

started 10 mg

10/14  9 mg      10/25  8 mg      11/05  7 mg      11/16  6 mg      11/27  5 mg

12/08  4.4 mg - all liquid from here down

12/19  3.8 mg

12/30  3.2 mg

 1/10   2.8 mg

 1/20   2.4 mg

 1/31   2.0 mg

 2/11   1.7 mg

 2/22   1.4 mg

[nolongeranxiousbut]

Down to 1.1 mg. 21.4% drop. Last dose on the 2 ml syringe and last of the 0.3 mg tapers.

Feeling fine. No withdrawal issues.

 

started 10 mg

10/14  9 mg      10/25  8 mg      11/05  7 mg      11/16  6 mg      11/27  5 mg   (1 mg drops)

all liquid from here down

12/08  4.4 mg      12/19  3.8 mg      12/30  3.2 mg   (0.6 mg drops)

1/10   2.8 mg      1/20   2.4 mg      1/31   2.0 mg   (0.4 mg drops)     

 2/11   1.7 mg      2/22   1.4 mg      3/04   1.1 mg   (0.3 mg drops)

[nolongeranxiousbut]

Down to 0.9 mg yesterday. 18.2% drop. First of the 0.2 mg tapers. Now using 1 ml syringe.

Feeling fine. No withdrawal issues. Sleeping great - averaging over 7.5 hours a night.

 

started 10 mg

10/14  9 mg      10/25  8 mg      11/05  7 mg      11/16  6 mg      11/27  5 mg   (1 mg drops)

all liquid from here down

12/08  4.4 mg      12/19  3.8 mg      12/30  3.2 mg   (0.6 mg drops)

 1/10   2.8 mg        1/20   2.4 mg       1/31   2.0 mg   (0.4 mg drops)     

 2/11   1.7 mg        2/22   1.4 mg       3/04   1.1 mg   (0.3 mg drops)

 3/15   0.9 mg

[nolongeranxiousbut]

Another 11 days, another taper. Down to 0.7 mg today. 22.2% drop. Everything is going great.

 

started 10 mg

10/14  9 mg      10/25  8 mg      11/05  7 mg      11/16  6 mg      11/27  5 mg   (1 mg drops)

all liquid from here down

12/08  4.4 mg      12/19  3.8 mg      12/30  3.2 mg   (0.6 mg drops)

 1/10   2.8 mg        1/20   2.4 mg       1/31   2.0 mg   (0.4 mg drops)     

 2/11   1.7 mg        2/22   1.4 mg       3/04   1.1 mg   (0.3 mg drops)

 3/15   0.9 mg        3/26   0.7 mg

[nolongeranxiousbut]

Down to 0.5 mg today. 28.6% drop. No issues with taper.

 

started 10 mg

10/14  9 mg      10/25  8 mg      11/05  7 mg      11/16  6 mg      11/27  5 mg   (1 mg drops)

all liquid from here down

12/08  4.4 mg      12/19  3.8 mg      12/30  3.2 mg   (0.6 mg drops)

 1/10   2.8 mg        1/20   2.4 mg       1/31   2.0 mg   (0.4 mg drops)     

 2/11   1.7 mg        2/22   1.4 mg       3/04   1.1 mg   (0.3 mg drops)

 3/15   0.9 mg        3/26   0.7 mg       4/06   0.5 mg   (0.2 mg drops)

[nolongeranxiousbut]

Down to 0.4 mg today. 20% drop. Everything going great.

 

started 10 mg

10/14  9 mg      10/25  8 mg      11/05  7 mg      11/16  6 mg      11/27  5 mg   (1 mg drops)

all liquid from here down

12/08  4.4 mg      12/19  3.8 mg      12/30  3.2 mg   (0.6 mg drops)

 1/10   2.8 mg        1/20   2.4 mg       1/31   2.0 mg   (0.4 mg drops)     

 2/11   1.7 mg        2/22   1.4 mg       3/04   1.1 mg   (0.3 mg drops)

 3/15   0.9 mg        3/26   0.7 mg       4/06   0.5 mg   (0.2 mg drops)

 4/17   0.4 mg                                                                  (0.1 mg drops)

[nolongeranxiousbut]

Down to 0.3 mg today! 25% drop.  No issues. Sleeping fine.

 

started 10 mg

10/14  9 mg      10/25  8 mg      11/05  7 mg      11/16  6 mg      11/27  5 mg   (1 mg drops)

all liquid from here down

12/08  4.4 mg      12/19  3.8 mg      12/30  3.2 mg   (0.6 mg drops)

 1/10   2.8 mg        1/20   2.4 mg       1/31   2.0 mg   (0.4 mg drops)     

 2/11   1.7 mg        2/22   1.4 mg       3/04   1.1 mg   (0.3 mg drops)

 3/15   0.9 mg        3/26   0.7 mg       4/06   0.5 mg   (0.2 mg drops)

 4/17   0.4 mg        4/28   0.3 mg                                  (0.1 mg drops)