Mountain: Lexapro and me

[Mountain]

I have been on SSRI's for over 20 years for anxiety and depression.  I started first with Paxil back in 1996 and then switched to 20 mg Lexapro.  Twice now I have attempted to taper off Lexapro because I can't really remember life without it.  However, the experience has been much harder than anticipated.  What is most difficult for me, other than feeling like crap, is the fact that I loose all my patience and tolerance. During withdrawl I have shocked myself by how agitatated I get with my wife and others - this truely scares me and is not who I am.  I'm writing now because at this point I have been breaking in half 20mg Lexapro tablets.  I have been on 10mgs now for over a month and definately feel down and unable to focus other than reading a book.  After reading through this site I'm torn between accepting the fact that I will need SSRI's for life or if I should attempt the long arduous road to become free of them.  I also smoke cannabis daily, and have gone to a an 30 day recovery program to try and stop.  I did stop for 2.5 months only to discover that I was unhappy and not addressing other issues.  At this point I don't have a doctor other than my general doc.  Any suggestions of psych in Fresno or the San Francisco Bay Area?  

[Gridley]

Hello, Mountain, and welcome to SA.

 

You don't have to be on SSRI's for life, but, as you said, to get off them is a lengthy and often arduous process.  You will have to choose what you want to do.

 

First , you tapered far too fast, with a 50% cut from 20mg to 10, which has caused the withdrawal symptoms you wrote about.  We recommend tapering a maximum of 10% of current dose every four weeks.  That now is water under the bridge, but this link explains the ;protocol SA recommends.

Why taper by 10% of my dosage?

 

Brain Remodelling

 

To help you understand the symptoms you are experiencing, here is some information on withdrawal.  The withdrawal time doesn't necessarily correlate with the time you were on the drug.  These drugs alter the architecture of the brain, and the time necessary to heal the brain and return to homeostasis is, unfortunately, impossible to predict.  

 

What is withdrawal syndrome.

 

Glenmullen’s withdrawal symptom list.

 

When we take medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.  

 

Youtube video, 4 minutes: Healing from antidepressants

 

Reinstatement of a very small dose of the original drug is the only known way to help alleviate withdrawal syndrome.  The only other alternative is to try and wait out the symptoms and manage as best you can until your central nervous system returns to homeostasis.  Unfortunately no one can give you an exact timeline as to when you will start feeling better and while some do recover relatively easily, for others it can take many months or longer.  Please read:

 

About reinstating and stabilizing to reduce withdrawal symptoms. -- at least the first page of the topic

 

Reinstatement isn’t a guarantee of diminished symptoms for everyone, but it’s the best tactic available.  You’re still in the time period where reinstatement predictably works, up to three months after last dose or dose reduction.  We usually suggest a much smaller reinstatement dose than your last dose.  These drugs are strong, and when updosing/reinstating it is better to start with a small amount and increase of symptoms remain unbearable.  If you take too much it may be too much for your brain and can cause you become unstable.  Sometimes it can be hard to regain stability after this happens.

 

It takes about 4 days for a dose change to get to full state in the blood and a bit longer for it to register in the brain. 

 

I would suggest reinstating an additional 1 mg of Lexapro for a total of 11mg.  You would then stabilize there, which can take several months, and then taper at the 10% method described in the link above.

 

The link below explains how to make nonstandard doses of Lexapro, such as the additional 1% you would need for reinstatement

 

Tips for tapering off Lexapro (escitalopram)

 

Please let us know what you want to do and how we may help you.

 

 

 

 

 

 

 

 

 

 

Edited June 18, 2018 by Gridley

[Mountain]

Gridley,

Thank you for your response - it really made my day to hear from someone who understands what is going on.  

 

Now that I've been on a half dose (10mg) Lexapro for over a month, I do feel a bit low and depressed, but it is not the unbearable feeling I felt when I went to a 1/4 pill.  I'm thinking that perhaps I will stay at a half dose for another month just to see if there is any improvement.  After that I need to find a doctor who can prescribe drops.  I'm in my early 50's so my mind is probably not as plastic as say a 20 year old.  Also I have the summers off but come fall, I need to be able to concentrate to do my job which can be quite intense.   Have others been able to taper successfully and still go to work?   

[Altostrata]

Welcome, Mountain.

 

Any doctor can prescribe psychiatric drugs, it doesn't have to be a psychiatrist.

 

You'll want to be stable for a good while before sneaking off Lexapro. Yes, we have people here who are working and tapering.