Canigou: Introduction, concern about medication change/withdrawal

[Canigou]

 

Hi everyone,

 

Very happy to have found this forum, as I feel my doctor has been a bit too aggressive with medication changes recently and I am not sure what to do.

 

As history, I was put on 10 mg of Zyprexa when hospitalized for a psychotic episode Spring 2017. That was followed by 10 mg of Lexapro for depression and anxiety. When I later had insomnia the Lexapro was increased to 20 mg. I gradually reduced the Zyprexa to 2.5 mg with the support of my doctor.

 

I recently moved across the country and began seeing a new psychiatrist for general support but also due to continued depression, anxiety and a new bout of insomnia. She had me stop the Zyprexa 2.5 mg and replaced it with Seroquel (same class, more sedating), but I had a paradoxical reaction to the Seroquel (has also happened to me with every sleep med), so we discontinued it and never resumed the Zyprexa, so I am withdrawing.

 

She also had me change from Lexapro to Zoloft to try to assist with sleep about 2.5 weeks ago--stopped Lexapro and started Zoloft at 25 mg with intent to quickly increase to 100 (equivalent to Lexapro 20). I immediately started having palpitations which only increased as I increased the dosage to 100, insomnia worsened, so we reduced it back to 25. The palpitations continued (though not as badly) and I developed allergy type symptoms (sneezing, cough, runny nose) and increased anxiety. I felt I was reacting to the Zoloft, so we decided after less than 2 weeks to switch me back to the Lexapro--a known entity.

 

We did a quick taper of the Zoloft (12.5 mg one day, nothing the next) then resumed Lexapro at 10 mg for 2 days five days ago. My doctor advised me to decide whether to increase it more thereafter depending on how I felt. I was still having palpitations at 2 days on 10 mg Lexapro and thought perhaps I was having Lexapro withdrawal from the change attempt and low dose of Zoloft so increased to 15 mg, have been there for 3 days. Palpitations and anxiety are worse (I have had them medically checked and my heart is ok) and then I found this site and realized I have probably been withdrawing from Lexapro over the last 3 weeks and reinstating at a high-ish dose might not be the best idea.

 

I have also taken 1 mg of Ativan a few times in desperation to relieve anxiety and insomnia, but do not want to become dependent on it. I am lost here! Not sure whether to go up or down on the Lexapro (intuitively down feels best, with the possibility of increasing later). I would be grateful for any suggestions. Thanks so much for reading!

Edited September 8, 2018 by SkyBlue
paragraph breaks for readability

[SkyBlue]

Hello and welcome to SA.

 

You've certainly been through a lot. Information on this site can help you get stable and proceed from there. 

 

Please help us by creating a drug history signature, listing your recent dosages and changes in list form: https://www.survivingantidepressants.org/topic/18343-please-put-your-withdrawal-history-in-your-signature/ 

This will help people see at a glance where you're at. 

 

Switching drugs so quickly is more of a cold-turkey, not a taper. Changes like this can set the nervous system into turmoil, so it's no wonder you're having symptoms of anxiety and insomnia. 

 

Insomnia is incredibly common in withdrawal: https://www.survivingantidepressants.org/topic/53-tips-to-help-sleep-so-many-of-us-have-that-awful-withdrawal-insomnia/

 

Yes, reinstating at a very low dose can actually be more helpful than a high dose--here is information on reinstatement (the first post especially): https://www.survivingantidepressants.org/topic/7562-about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/

 

This will be your introductory thread, for asking questions, receiving support, and sharing your journey. Please also keep daily records on paper about your dosages and symptom pattern throughout the day. 

Again, welcome. : ) 

 

 

 

[Canigou]

Dear Sky Blue,

 

Thank you so much for your reply and welcome. I am glad to be here.  

 

I just created my signature and in doing so realized what a wild ride the last few weeks have been and how destabilized I feel (and I was already feeling destabilized!). I had already read the post on reinstatement before posting here (found it via a Google search, which is how I found you), and that led me to decrease from 15 mg of Escitalopram back to to 10, where I've been for 2 days, but I am feeling like that might still be too high. If the brief change to Sertraline (replete with near daily dosage changes then discontinuation) was in fact a cold turkey from Escitalopram, as you say, seems resuming Escitalopram lower would have been best. Would you recommend reducing now to 5 mg from 10? That would also be more in line with where I was with the Sertraline most of the time (25 mg Sertraline roughly = 5 of Escitalopram). 

 

It also seems to me discontinuing Olanzapine from 2.5 mg was too fast and I should have tapered more slowly. I am considering reintroducing it at 1.25 mg but don't know if that would do more harm than good, given all the adjustments I am already in the midst of. Then it might be difficult to know what is causing what symptoms. But that is something else to consider. It's been 4 weeks since I discontinued it. 

 

I have been trying various natural remedies for sleep with varying levels of success. At least I am sleeping 4-5 hours a night now. I will check out the link to see if there is more I can try. 

 

Thanks so much again!

 

[Canigou]

Hi again,

 

An update that I tried going down to 5 mg of Escitalopram last Saturday and had such bad palpitations and anxiety in Uber (I seem hyper reactive--every small stimulus or potential stressor or negative thought creates a feeling of extreme anxiety that is often accompanied by extreme palpitations) that I thought I would pass out and I had to take 1 mg of Ativan to calm down and stop the palpitations. I then also took another 5 mg of Escitalopram to keep me at the dose I had been at, for some measure of consistency. I took 10 mg again Sunday and have stayed there since.

 

When I take the medication, within an hour the palpitations, hot flushes and overstimulation/hyper anxiety start--I feel like I'm on speed (or what I imagine that is like) and the only way I can function now (go out or work) is to take some Ativan when this happens. I am really afraid I will not be able to tolerate the Esctialopram at any dose now; I have no idea whether to stay where I am (and for how long to wait it out and see if I adjust to it), increase the dose or decrease it (since it seems maybe a lower reinstatement dose would have been better, can I drop significantly now or is it too late for that?). It's been 2 weeks since I reinstated it at 10 mg (I had been on 20 originally, but then there was the intervening 2 weeks of experimenting with Sertraline) and my body does not seem to be adjusting to it at all so far, and yet I am not relishing the idea of switching things up again. My doctor is at least now realizing how sensitive my system is and that we changed too much too fast and her feeling is we should keep me where I am for another 10 days or so to see if I adjust and then consider VERY slowly tapering, using a liquid version of the med. Another potential strategy.

 

Any shared experiences, impressions or recommendations are welcome! Thanks. 

[Altostrata]

Hello, Canigou.

 

I am confused as to why your doctor think the antidepressants are sleep aids. Quite frequently, people find them activating.

 

Going on and off psychiatric drugs is wearing on the nervous system. Adverse reactions such as paradoxical reactions and withdrawal symptoms can make you hypersensitive to drugs. The more drugs you take, the worse it gets. Escalating the dosage will cause even more serious adverse reactions.

 

If I were you, I would assume your nervous system is hypersensitive to drugs and stress, maybe light and sound.

 

On 9/14/2018 at 11:16 AM, Canigou said:

When I take the medication, within an hour the palpitations, hot flushes and overstimulation/hyper anxiety start--I feel like I'm on speed

 

The dosage is too high for you. I know when you reduced to 5mg, it seemed you got a bad reaction, but your nervous system is saying the dosage is too strong.

 

Do you also get this reaction when you take 5mg escilatopram?

 

I see Escilatopram --> Zoloft --> Escilatopram; you had bad symptoms all the while you were on Zoloft, is that correct?

 

What happened August 9 -- August 19, when you went off olanzapine and were still on escilatopram? Did you stop sleeping when you quit olanzapine?

[Canigou]

Hello, Altostrata and thanks so much for your response. 

 

I first came to my doctor very depressed and already starting to not sleep well on the Escitalopram and  Olanzapine, with the sense they had stopped working and were actually exacerbating my depressive symptoms. She initially tried to change me from Olanzapine to Seroquel because it was sedating, but that attempt lasted one night (didn't note that in my signature)--the Seroquel kept me awake and we stopped it and never reinstated any Olanzapine. Yes, my sleep worsened off of the Olanzapine. I tried to manage it naturally to no avail August 10-19, then called my doctor pretty desperate for sleep and she suggested the change to Zoloft and also had me try Ambien (did not work). She had said she had many patients find Zoloft sedating and also thought it might help my depression (she thought the sleeplessness was caused by depression, so wanted to treat the depression primarily). I was hoping to just gradually get off of everything, but alas, I let her convince me to try a change.

 

I did have bad symptoms on the Zoloft--from the minute I stopped the Lexapro and started the Zoloft I had symptoms, primarily palpitations and allergy symptoms, and continued sleeplessness. I thought it was a reaction to the Zoloft but now realize it might have been that, plus withdrawal from the Escitalopram, plus, potentially, drug interactions. We also tried a couple other sleeping medications during this time, none of which helped/I tolerated--abandoned each after a night or 2. 

 

I do get the same reaction when I take 5 mg escitalopram--broke the 10 mg into 2 doses of 5 yesterday and got a bad reaction after the first 5. Today I re-read the SA reinstatement guidelines carefully for probably the 5th time, sat quietly and tuned into my body, and came to the same conclusion as you--that my body is telling me this is too much drug, even the 5 mg. So today I tried 2.5 mg of Escitalopram--don't know if that is too much of a jump down from 10, but I've tried 5 and this is my attempt to reinstate at a low dose now, since I didn't initially. I also took .5 mg of Ativan just after because I had to (or I chose to) go out and my sensitivity has made it impossible to tolerate much stimulation without the Ativan, but so far, no ill effects--a few palpitations, but of course there is Ativan in my system. (Later, I got nervous about the jump down and took another 2.5, so that was 5 mg today in 2 doses). 

 

What is frightening is that I have been getting heart arrhythmias together with unbearable anxiety (I agree, my nervous system is hypersensitive to drugs, stress and sound), hence the Ativan, but I would like to not be using it, or at least not daily. The reinstatement seems to be causing hormone changes as well, as my breasts are sore this month (unusual for me)--that might be part of the reason for the hot flashes and palpitations. And of course I'm 47, so going through hormone changes naturally, to boot, though never had symptoms like this until the drug changes.

 

I am sleeping better now, in short spurts at a time, but for quite a few hours overall and am dreaming. I am using inositol powder, magnesium and melatonin, and I imagine the Ativan I take during the day helps, but I am not taking extra at night. I'm trying to keep it to .5 mg, though have taken a full mg a few times. I'm also taking some supplements (B complex for stress, fish oil, vitamin D (tested low), probiotic). I have tried L theanine with mixed results but it seems it can increase serotonin, so have stayed away from it in the last week or so. 

 

I hope that wasn't too long. Thank you again!