mdwstrx: Lexapro / escitalopram taper or not?

[planifolia]

8 hours ago, mdwstrx said:

Hello again Planifolia.  I just checked your thread and see that things are still very rocky.  I am sorry.  I wish I knew more so I could give you the advice needed to help things settle.  We're all so different and many things factor into recovery.  But, I can tell you what worked for me.  

 

Within the first month of stopping 2.5 mg. escitalopram, I made several dosage changes. 

• SA (Alto and mods) recommended I stay at 2.5 mg since I had already reinstated that amount before finding SA. 
• My doctor recommended creeping back up to 10 mg. over a several weeks.  SA respectfully disagreed. 
• I opted to follow the doctors advice and up-dosed to 5 mg and then to 7.5 mg.  Not only did it not help, it seemed to make things a bit worse. 
• Alto then suggested I reduce to 7 mg.   As things started to settle a bit, I opted to switch from tablet to liquid (in order to later resume tapering).  In so doing, symptoms spiked a bit. 
• Alto recommended I might be able to lower the dosage again to compensate for the faster metabolizing liquid.  I reduced and held at 6.5 mg.   
• I stabilized pretty quickly then over the next month.  All in all, for me, it was about a 4 month ordeal from reinstating to stabilizing.  

I found the following things helpful in order of what I believe resulted in  my healing.

1. Faith in God and in the ability to recover quickly
2. Prayers to God, in the name of Jesus
3. Self advocating by researching and learning
4. Finding this website and it's unbelievably caring/knowledgeable administrator and team; as well as the other members who are able to share there similar experience.  It helped tremendously to know I wasn't alone.
5. 2.5 mg of propranolol PRN during the first 2 months (for the akathesia like symptoms I experienced ) I believe this kept me from having to take a benzo.  I also had to take OTC nausea meds to counteract nausea from the Propanlol.
6. NO other drugs (including alcohol and caffeine) 
7. NO supplements other than the fish oil and magnesium recommended by SA.  The fish oil really helped me to sleep if I took it right before bed.
8. No stress in my life (I'm retired)
9. Knowing I had family and friends in the background
10. Routine 10:00 bedtime
11. Relatively healthy diet
12. Mindfulness (Headspace.com)
13. ASMR videos (especially Christian artists reading scripture - it calmed and reassured me)
14. Daily exercising (raquet sports) which incorporated a social aspect (There was a 2-3 week period where symptoms didn't allow)

So this is probably TMI but hopefully, something above will help you and/or others. 🙏

I’m very grateful for your thorough reply, 🙏 thank you. I may possibly try to take a propranolol to for a few days, to help me through this very difficult patch.

[mdwstrx]

Hi Alto, 

 

Seeking your further advice on starting a taper.  I had planned to begin tomorrow, April 1 per our earlier posts.  You may recall I entered into a pretty rough wd in November that lasted approx. 4 months before stabilizing around the end of Feb/beginning of March.  

• I don't believe I've had waves necessarily through the month of March, but have noticed slight traces of withdrawal. For example: I've experienced slight wd headaches that don't last long; aching in joints; slight neuro fear and other 'little' reminders.  However, I've also had stress lately considering downsizing and moving. 
• I'd say I'm 85-95% symptom free.  I don't know if I should or can expect to be 100%  symptom free before beginning a taper. 
• I would greatly appreciate your thoughts on whether it's safe to try a taper now and if so, how much to reduce from 6.5 mg escitalopram?  In tapering before wd, I went from 20 to 2.5 over the course of almost 2 years with very little symptoms.  

Bottom line is I'm afraid I could set off a wd again, yet like others, anxious to be off. 

Thank you!

[mdwstrx]

Hello, 

Seeking some advice on tapering.  Not hearing back from Alto regarding my question above, I opted to try a small 3% reduction from 6.5 mg escitalopram to 6.3 mg. on 3/31.  Today would be day 4.  I am noticing some symptoms.  Notably, physical flu-like headache, achiness in shoulders and neck, etc.  Should I be concerned and consider any change or hold?  Thank you.

[Carmie]

Hi mdwstrx, 

 

Just wanted to let you know that after I do a drop I start feeling the drop on day five. It doesn’t matter how slow I taper, I’m tapering under 4% now and I’m still going through waves. I always stabilise eventually though. You will too, it just takes time. 

 

I try and distract myself with hobbies, DVDs and Netflix, music etc. I’m in a wave at the moment and it’s day 26 since I tapered. I know I’ll stabilise though, and then I’ll do the next taper. 

 

Sending hugs🤗

[mdwstrx]

Thanks for your response Carmie. 

I tapered larger cuts before crashing with few symptoms mostly.

This was a first tiny test taper since I'm concerned about having just come out of a 4 month withdrawal with only a month of stability behind me.  

Could such a small amount destabilize things again?  I'm very nervous resuming the taper.

[Carmie]

19 minutes ago, mdwstrx said:

Thanks for your response Carmie. 

I tapered larger cuts before crashing with few symptoms mostly.

This was a first tiny test taper since I'm concerned about having just come out of a 4 month withdrawal with only a month of stability behind me.  

Could such a small amount destabilize things again?  I'm very nervous resuming the taper.

 

Yes mdwstrx, 

 

Small tapers can still destabilise. There’s someone on here that is down to 0.000 something, or even less, and every tiny little cut puts them into withdrawal. 

 

Also, when we get down to the smaller doses we can find that our tapering percentage has to become smaller as well. 

 

You could try the Brassmonkey slide. 

 

Sending hugs🤗

Edited April 4, 2019 by Carmie

[Frogie]

Hi mdwstrx:

 

I want to apologize for being so rude on my thread. I only talked about my symptoms and feelings and never asked you how you were doing? I hope well.

 

Take care,

 Frogie xx

[mdwstrx]

Oh Frogie. I don’t think you’re rude at all. I thought nothing of it. I am doing very well!  Thanks for asking. I was paranoid about my first taper this month after crashing but it was a tiny 3% and overall, no real issue.  

 

 

[Frogie]

19 hours ago, mdwstrx said:

Oh Frogie. I don’t think you’re rude at all. I thought nothing of it. I am doing very well!  Thanks for asking. I was paranoid about my first taper this month after crashing but it was a tiny 3% and overall, no real issue.  

 

 

I’m glad you thought I wasn’t rude because I felt I was. I’m so glad you are doing well on your taper. Mine was a very slow taper as you know. 

 

Please keep me informed. I’d love to hear how you are doing.

 

Take care,

 Frogie xx

[mdwstrx]

Would appreciate input from a mod. 

 

I resumed tapering 3/31 but was treading cautiously to see how I reacted. So far schedule has been:

 

3/31   6.5 to 6.3   or 3.125%

4/10   6.3 to 6.2   or 1.6 %

 

Total April taper to date is .3 mg or 4.725%

 

Since it seems to be going well, I think I would like to try the 10% monthly reductions until I get to the lower amounts.  My concern is how best to transition to that for May.  I could hold now until May and then reduce by 10%.  Or is there room to safely add in another one or two tapers in April.  Any thoughts would be appreciated. 

Thanks!

 

[brassmonkey]

Hi mdwstrx--  in the long run of a taper making an extra reduction in April isn't going to make much of a difference.  It would be better to hold the extra week or so and then start off with a solid plan.  Doing a 10% reduction all in one shot will quite possibly give a real shock to your body and kick off some strong symptoms.  I would suggest doing a Brassmonkey Slide.2.5% a week for 4 weeks and then an additional 2 week hold.  This will reduce you at a rate of 10% every 6 weeks but will also minimize the symptoms from each drop.  We have a lot of members using this system with great success.

[mdwstrx]

Hi BrassM.  

Thanks for weighing in from your travels. 

The above sounds like good advice. So I think we have a plan!  Hold at 6.2 and begin the Slide on May 1.

I will be on holiday for a week mid May but so far, the reductions have caused little problem.  🙏

 

I'm also curious about your statement in an earlier message that tapering long term users is controversial.  However, I think there's plenty of time for you to reply when you return if you're too busy to address now.  Either way, I definitely appreciate your help!  

[brassmonkey]

I'm not finding the reference that you're mentioning, but I'm pretty sure what you're talking about.  There were some statements made several months ago by a leading authority on ADWD that he would not recommend going off of ADs for patients who had been taking them for many years.  We here at SA know for a fact that patients who have taken these drugs for 15-20 years or more can be successfully tapered off of them.  The crux of the matter was that such a taper could not be done in an entirely pain free manner, not that the taper would be ineffective. So it ended up being a discussion about  "Informed Consent" from the patient and not the effectiveness of the taper.

 

From reading around the forum you probably have realized that no taper is going to be free of symptoms.  Our aim is to try and keep those symptoms to a minimum so the member doing the taper can maintain some quality of life and dignity while undertaking what at times can be a rather unpleasant journey.  SA does not tell a person to do something, rather we try to provide as much information as possible and let them make the final decisions on their way forward.

 

I hope that helps clear things up.

[mdwstrx]

Thanks for your quick response BrassM. 

 

I'm familiar with a Dr. Shipko who told me in a pm (and gave me permission to quote) that it was a big risk for long term users going off.  He cautions people against it, using informed consent in his practice.  His concern was not a pain free taper.  Rather it was intractable tardive akithisia-like symptoms suffered by many of his patients who have claimed long tapers.   He speaks about it in a 3-part article on MIA called "Shooting the Odds".   

 

His statement to me,

• "Tapering slowly is preferred because it is a lot more comfortable.  However, it does not guarantee that tardive akathisia will not occur.  I have not seen any akathisia in my practice that did not get better when reinstatement is prompt. Recently a patient on 12 years of Lexapro tapered over about a year and a half without ever having any symptoms.  Six months later she abruptly developed akathisia.  However, it responded well to reinstatement."

I have wondered if this patient's "akathisia" might actually have been the 7-10 month wave you speak about? However, waiting for 2-5 weeks to see if it was a wave might have cost her the opportunity to promptly reinstate - resulting in the untreatable tardive akathisia Dr. Shipko warns about.  Or, it could have been her chance to wait out the wave and have been successful in her attempt at stopping ADs?   How would one know?  The thought of late onset akithisia like symptoms is more than frightening.  Is it really 'shooting the odds' to taper'?

 

I haven't seen many long term taper success stories on here other than you and two others, one of who just stopped.  But I've only been exploring the sight since Nov. ‘18.

 

Alto and two other mods weighed  in when I first posted Dr Shipko’s reply. The message I came away with from their replies was that no one knows for sure.  I plan to taper to as low as I can but that final jump scares me, mostly for the reason above. 

 

 

 

[brassmonkey]

There really isn't enough information in that one little statement to draw hard conclusions, but I really doubt that it was a 7-10 months wave.  It was more than likely a crash caused by tapering too fast.  A too fast taper will give a person a "honeymoon period" that can last from three to six months and then they crash.  Using the 10% rule that we recommend the taper should have taken more like two or three times that long, depending on the starting dosage, and the chances of that sort of a crash would have been at a minimum.  But again there really isn't enough information in that statement to draw real conclusions.

[Leo1983]

@brassmonkey

 

Hope your enjoying your trip.

 

This is exactly what happened to me i felt fine for 10 weeks after stopping meds or so then boom i entered a place i have never been before " withdrawal". I completly agree this happens, as im evidence myself. 

 

Will a crash get better in time? Does the body stabalise eventually after a crash? Is a crash what also happens in too big of a reduction during tapering? 

 

Thanks

 

Lee. 

 

Ps - mdw, hope your well. Hope what you decide to do works. 

 

Tc 

Lee.

 

 

[brassmonkey]

To fast or too large a reduction are two of the leading causes of crashes. Yes, a person will stabilize after a crash, but it can take a very long time.

[Leo1983]

Thanks. 

 

Im assuming CT falls into that too.

[mdwstrx]

@brassmonkey

 

Hello. 

I hope your travels are going well and that you're experiencing and learning a lot.    Today, I'm seeking advice on a reset of my escitalopram taper plans and hoping you might find a down time to respond.  I attempted to modify  the April taper schedule due to an unexpected mid-May holiday that is now planned.  April's taper was as follows.

 

3/31   6.5 to 6.3   or 3.125% 

4/10   6.3 to 6.2   or 1.6%

4/17   6.2 to 6.1   or 1.6%

4/24   6.1 to 5.9   or 2.5%

4/25   back up from 5.9 to 6.1  Holding at 6.1 

 

Thankfully, I seemed to do ok with the 4/17 drop to 6.1.  However, the night of the 4/24 drop to 5.9 mg, I felt increased wd symptoms.  It scared me so I resumed taking 6.1 mg the next morning on 4/25. 

 

Tomorrow will be two weeks since a 'real' drop given the failed drop on 4/24.  I'm not quite certain how to proceed from here.  I am still experiencing nagging wd issues, even though slight.  Neuro fear, slight headaches, slight neuralgia, occasional lower gi issues, hot flushing and some feelings of doom in the background but they are interspersed lots of glimmers of hope and feeling good.  I seem to be on the edge.

 

I will be on holiday for the week of May 15-22 and, of course, hoping not to incur large wd issues during that time.  

 

Since I've just begun the slide taper, I'm not sure  what to expect.  I know eventually the symptoms form a pattern  that I will learn.  But until I get more data/experience with this taper, I am taking baby steps and seeking your input along the way.  Thank you!  

[brassmonkey]

The simplest thing would just be to hold until you get back from holiday.  If you start a taper in the couple of weeks before then you stand a chance of having symptoms while traveling, which would not be any fun.

 

Usually with a slide the symptoms start up about day two or three after the reduction and are most of the way resolved by day seven.  The symptoms tend to be a lot milder than with a 10% reduction.

[mdwstrx]

3 hours ago, brassmonkey said:

Usually with a slide the symptoms start up about day two or three after the reduction and are most of the way resolved by day seven.  The symptoms tend to be a lot milder than with a 10% reduction.

 

Thanks.  That's why I'm a bit concerned about continuing symptoms not resolving since it's been over seven days.  I don't yet know what wd normal is I guess.

 

I agree that holding would be the simplest thing. But, on the other hand, I really dislike the idea of delaying the taper for a month.   I feel compelled to do something.   I'm half inclined to try a 2.5% taper tomorrow to see how it goes but have to admit I'm afraid of kicking off another crash.  

 

 

[brassmonkey]

On 4/30/2019 at 6:56 PM, mdwstrx said:

I don't yet know what wd normal is I guess.

 

That's the key right there. The symptoms you get after a reduction are a spike above the WDnormal level and as they resolve you return to WDnormal.

 

Doing a hold is in fact  conscience decision to do nothing which actually amounts to doing something.  Holds are a very important part of the tapering process.  There is a lot of healing that goes on in the background that we don't feel. During a hold that healing is allowed to happen with out the affects of the reduction getting in the way.  This puts you in a stronger position the next time you make a reduction.  Plus, why risk feeling bad on you Holls.  During the last part of my taper when we started traveling greatly, I would never do a reduction before a trip, even though I was feeling fine and doing tiny reductions. I would much rather enjoy the trip than worry about speeding up my taper by a month.  Doing a proper taper takes a very long time and the end point is variable in the long run that month won't make much difference at all.

[mdwstrx]

@brassmonkey

Thanks for replying while you're recuperating.  Amazing and very appreciated! 💜 

 

I get the importance of holds.  Since I'd held for two weeks, I did reduce by 2.5% (before your reply) and things are relatively smooth.  A slight uptick in symptoms but nothing too bad so far and today is day 4.  I have another 2 weeks before departure which would give me a three week hold if I don't drop next week or during trip.  Curious, after a hold, when resuming the taper,  did you feel the symptoms progressed in severity after each successive before the next hold?  I'll go back over your intro to see.  

 

Pls. keep us informed of how you're feeling.  Wishing you a speed recovery.

[Tom37]

Glad your doing well with the taper so far.

 

I would even suggest after a certain amount of reductions to have a longer than normal hold to make sure the reductions aren’t catching up with you. Sometimes crashes happen that way even when you think all is going well. An extra month or two of holding at times is nothing.

 

Take care.

[mdwstrx]

Thanks @Tom37! 

Good to see your post. 😊

But... I'm so glad we don't have to correspond much these days because we're both doing so much better!  🤗🤸‍♀️

I plan to be very careful with the taper and agree that your suggestions sounds good!  Thanks for posting and take care yourself.

[mdwstrx]

Hello. Checking in with tapering schedule. Have been doing pretty well with minimal sx. 

 

On the Brassmonkey slide. Have done 3 cuts this month with another scheduled for tomorrow. Last cut was a little larger than 2.5%. Was planning on decreasing from 5.6 mg to 5.5 mg tomorrow and then holding for two weeks which would total 10% for the month. However, the last couple of days; I’ve been feeling some wd symptoms.  

 

Not sure if I should taper tomorrow or hold.  If I hold, for how long? 

 

Thoughts would be appreciated. Thanks!

[Gridley]

It's hard to say whether the symptoms are from your last cut being a little larger than 2.5%.  To be safe and to allow yourself to catch up, why don't you hold an addition 3-4 days before your next drop?

[mdwstrx]

Thanks Gridley.  Will do. 

[mdwstrx]

Hello.  Checking in with a question about the Brassmonkey Slide.  

 

My first month of May on the slide looked like this.

 

5/1/2019 5.900 3.28% 5/8/2019 5.750 2.54% 5/15/2019 5.600 2.61% 5/22/2019 5.500 1.79%   mo total 10.22%

 

As you can see, I took some liberty with the cuts in rounding to whole/half numbers and seemed to do ok... so far.  I have experienced some wd symptoms but still functioning at about 85% or better and now on the two week hold, per the schedule.  I'm hoping to continue to be able to adjust cuts rounding to whole/half marks for simplicity and keeping total to around 10%.  I'd appreciate thoughts on how risky this is and whether my body will warn me BEFORE a crash. 

 

Thanks.

 

[Tom37]

Hi Md,

 

Cant comment on the tapering but as someone who crashed hard I can about that.

 

Looking back I didn’t get any warning that I was going to crash as such. I was feeling what I thought were the normal increase in symptoms after a drop and expected them to settle down but instead one night it hit me really really hard and that was that.

 

i would suggest if your getting anything other than your normal symptoms after a drop then you need to hold and sticking to the same percentage each drop should help you avoid a bad crash. 

 

Remember holding can be your best friend in this journey.

[mdwstrx]

Hi Tom! 💜 It's good to hear from you!   Thank you for your sound advice.  I was specifically thinking of you when I asked my question as I know you were dropping normally by mg.  7-6-5-4-3 etc. before your crash.  I'm trying to be sure I don't exceed 10% (by much).  In May, it was 10.22%. 

 

These drugs are horrific!  I'm bummed about how long the taper will take now that I'm 'awake' to the dangers.  Wished I'd held like you did but panicked and frankly, couldn't get my mind around an online group having more credible advice than the medical community.  Still feels like the twilight zone, doesn't it.  I have to ask if it's fraud or incompetence.  Hard to believe either.  Maybe a bit of both .... who knows.

 

How are you?  Haven't seen an update but haven't checked for a few days.  Job going well? 

[Tom37]

I’m doing ok....not in a wave at the moment just at current baseline. Improving but it seems one area gets ‘fixed’ then it moves onto another all while baseline keeps slowly improving.

 

I’ll get there but I guess it shows how bad my crash was.

 

Yip, keep to 10 percent max as your reductions and staggering that to start with seems the way to go. Just take it nice and easy as your probably still a bit sensitised from your RI.

 

Job is safe and secure now so that is all good....work significantly easier than at the beginning of WD so that helps.

[mdwstrx]

I'm so happy that you're doing ok and job is easier now.  🤗 I'll keep checking in and continue 🙏.  Hope that you can fully stabilize and then consider tapering, if that is your plan.  I know your crash was bad but I suspect the longer stabilization period may have had more to do with holding at a lower dose.  I think I stabilized sooner after up-dosing but at the trade-off of a longer taper. ☹️ Just my thoughts....

[mdwstrx]

I've partially answered my own question above about inconsistent weekly cuts even thought they add to around 10% a month.  After reading about more severe cases, a recent one in particular, I plan to proceed more cautiously.  If I round, it will be up, not down from now on to stay at or below 2.5% weekly for no more than the recommended 10% taper.  I'm still concerned about how to recognize if I'm going too fast so I can avoid crashing. One poster indicated that after a taper (above the recommended 10%), his routine post-cut symptoms progressed into a severe crash without warning. 

 

My symptoms from tapering reach highest levels 5-6 days into the cut. For example, my last cut was 5/24 (mistake in above post that says 5/22. I held two days extra for symptom abatement per Gridley's suggestion.  If a moderator could correct, it would be greatly appreciated.)  It's now day 6 of the cut and am feeling stronger symptoms.  According to the Brassmonkey slide schedule, I'm will hold for another 8 days before next cut.  

 

Before stopping at 2.5 mg and crashing in 11/18, I successfully made much larger cuts.  I can tell my system is more sensitive now.   I'm taking baby steps seeking reassurance along the way.  I hope it becomes more routine but this is a scary journey.  I'm very grateful for the ability to seek guidance here.  Thank you to all!

[planifolia]

Seems like you are in good control of your taper, and hopefully the symptom intensity will ease soon. I wish you a smooth way down! 😁

[mdwstrx]

Hi Planifolia.

Thanks for stopping by and for your well wishes.  I just read your update and am so happy for you and  am encouraged to hear things are improving, if even just a tiny bit.  If I'm any example (only the mods know, not me), then holding is the absolute best you can do for now it seems.  Be very careful about TMS or ECT.  I suspect those things are similar to dose changes.  Hopefully the mods will weigh in to guide you on that.  💜