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mdwstrx: Lexapro taper or not?

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Gridley

That is great news.

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mdwstrx

Thanks Gridley.  I am anticipating the next wave so as not to get too comfortable.  I see your Lexapro tapering is going well.  Congratulations!  I hope it's not been to rocky of a road to your current 4.1.

Once stabilized, I will again try to lower my dosage maybe using the Brass Monkey slide too.  I have no idea what to expect after 2.5 mg as that as the lowest I'd gotten to. 

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mdwstrx

I need some help please mods and Alto.

 

My doctor's office just called.  He believes I am not tolerating the Lexapro and wants me to do a wash out of by reducing to 2.5 mg daily for the next two weeks and stopping completely.  He'll then reassess at that point what to do. That terrifies me!  

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ChessieCat

Have you been keeping daily symptoms notes?  If you haven't been doing this, I suggest you do this over the next 3 days and post them here before changing anything and the mods can assess your situation.  This is what the mods need in order to do this.  If you already have them, please post.  (Not the graphs)

 

Example:

 

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

 

 

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mdwstrx

Thanks for replying Chessie.  For the first time since this started, I just finished speaking with the Dr. (not the nurses) on the phone. 

 

Here is his take.

  • Withdrawal symptoms do resolve over time and stabilization will occur.
  • No need to wait it out as upping the dose gradually or switching to longer half-life med will stop the symptoms but then you're at the higher dose or risk issues with new med.
  • Part of the problem may be the generic version of the med - I need to check with pharmacy to see if there have been changes.
  • I can either stay at 7.5 mg and wait it out or up-dose to 10 mg to try to shorten the w/d.  (I will wait)
  • Our new goal is to wait several months after this subsides and then began a gradual taper.  We'll address at upcoming appointment in a week.

So essentially, he is saying what SA has said all along.  Except he made it clear that stabilization can occur more quickly by increasing the dose.  So the issue of a wash out is off the table, thank you Lord.  He also told me that in his 20 years, he has never had a patient who couldn't come off the medication, even long-term-ers.  This has given me much needed reassurance.  Lastly, he knows of this website and was very respectful of it.  So am I.

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ChessieCat
29 minutes ago, mdwstrx said:

I can either stay at 7.5 mg and wait it out or up-dose to 10 mg

 

Our suggestion would be to increase by a small amount if needed.  Going from 7.5mg to 10mg is a 25% increase and may be too much for your system.

 

We would probably suggest increasing by 0.25mg or 0.5mg to start.  Lexapro is a strong drug.

 

29 minutes ago, mdwstrx said:

switching to longer half-life med

 

You risk getting withdrawal from the previous drug, start up/side effects/bad reaction to the new one.  You won't know what is causing what.

 

29 minutes ago, mdwstrx said:

Part of the problem may be the generic version of the med

 

Other members have had issues with changing their drug supplier.  It would be worth looking into this first.

 

generic-vs-brand-change-in-drug-manufacturer

 

Edited by ChessieCat

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Altostrata
On 12/21/2018 at 7:38 AM, mdwstrx said:

....

 

Unfortunately, for me, yesterday was a rough one as follows:  

  • 1 am - woke extreme tension and unable to sleep
  • 4 am - took 5 mg Propranolol 
  • 4 am to 6 am - dozed in and out 
  • 6 am - got up.   Nauseous, inner tension, restlessness, slight burning in arms.  Had some yogurt, fruit 
  • 7 am - cancelled morning sport outing due to nausea and restlessness
  • 10 am - took 5 mg Propranolol
  • 11 am - went for ride with friend.  Was hyper sensitive to conversation and car rocking.  Had to return home; the nausea and feelings were overwhelming like I could faint.  Almost felt I needed to stop at hospital.
  • 1- 2 pm  - returned home took anti nausea OTC; had some lunch
  • 2-3:30 pm - napped in and out
  • 3:30 -7 pm- rested on sofa as best as could feeling internal restlessness and nausea - tried mindfulness videos - they helped somewhat
  • 7 pm - had a small dinner
  • 9:30 pm - went to bed and slept until 1:00 am

Today

  • 1 am - woke tense unable to sleep but faded in an out.
  • 5 am - up and feeling almost faint again - took OTC nausea - miserable
  • 5:30 am - laid down and dozed in and out 
  • 7 am - up, had yogurt- fruit and coffee (caffeine did not seem to make a difference)
  • 9 am - feeling about the same as yesterday though I do feel a little ebb and flow of the intensity. 

....

Questions - The link to Propranolol tapering on this site doesn't really talk in terms of dosage/time used.  My Dr.'s nurse told me at 5 mg. (even if used daily for 3 weeks), tapering shouldn't be necessary.  Do the moderators agree?

 

 

 

 

Those are pretty good daily notes -- but you did not note when you took Lexapro, and at what dosage. This is necessary information.

 

Given that your nervous system is sensitized from withdrawal, I wouldn't take any chances with propanolol. If you've been using it regularly, I would taper it when you want to quit. The danger in going off abruptly is rebound hypertension. Propanolol lowers blood pressure.

 

The taper can be 25% of the dose every few days.

 

On 12/23/2018 at 5:57 AM, mdwstrx said:

Good morning. 

 

Should I follow doctor's advice and reduce from 7.5 mg to 5 mg @ 2.5 twice daily to see if the lower dose reduces symptoms? Or will that risk further destabilization - God forbid?  It's been 16 days since up dosing on 12/5.  The chart above shows impact.

  •   2.c. Do not jump around in dosage. For most drugs, it takes about 4 days for the change to fully register in your system. Unless you have an IMMEDIATE bad reaction, wait at least 4-7 days to see how the change affects you.(If you have an immediate bad reaction, go back to the dosage you were taking before.)
    • What if you have a delayed reaction down the road as may be the case here?
  • ""Going through withdrawal so reduce???  Does not compute.  Or in English, does not make sense.  - Chessie
    • I appreciate the response but it's not clear why it doesn't make sense if the higher dose is problematic.  The above seems to suggest that the right reinstatement dose is sometime hard to find and that a change might help?

Thoughts and clarification appreciated.

Thank you.

 

These questions cannot be answered until we see your daily notes showing your symptom pattern before and after you take Lexapro. That is how we determine if you're taking too much Lexapro.

 

Your charts would be so much more helpful if they showed when you made drug changes. They would also be more helpful if they showed number of hours you've slept rather than degree of "insomnia." I don''t know what you mean by "akathisia," how does it feel to you?

 

On 12/23/2018 at 11:57 AM, mdwstrx said:

While I'm waiting for an answer on the above post, I decided this morning to take only 5 mg. of Lexapro and to see how I felt.  I have had a window most of the day with very little symptoms.  Too afraid to destabilize, I took the other 2.5 mg. just now in the afternoon. 

 

Is it purely coincidental that after such an awful wave the last couple of days, including awful insomnia last night, that today seemed so good at the reduced level?  Placebo effect?

 

No, it could be 7.5mg Lexapro was too much for you. It might be that 5mg is enough, it might be that you need some amount between 5mg and 7.5mg.

 

How did you feel after taking the additional 2.5mg?

 

How are you taking Lexapro? Do you have the prescription liquid?

 

If you call your doctor in a panic, it's likely he is going to make some kind of dramatic drug change. He wants to help. Very few doctors adjust dosage as gradually as we do here or have the patience to look at several days of symptom notes before making a guess about dosage change.

 

Yes, many doctors think a switch to Prozac will resolve withdrawal syndrome, but it is by no means certain. I would not take that risk until I am certain a direct taper from Lexapro won't work. From the information you've supplied, I don't think we have enough evidence yet that a low reinstatement of Lexapro has failed.

 

mdw, you seem to have a habit of overthinking things. If you focus on answering our questions, we'll be able to give you answers without mental flailing.

 

We absolutely need to see your daily notes, showing when you take your drugs, their dosages, and your symptoms throughout the day. In your case, please include hours slept.

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mdwstrx

Thank you Alto for your detailed response.  It is very welcome.  Let me address your comments below.

 

8 hours ago, Altostrata said:

 

Those are pretty good daily notes -- but you did not note when you took Lexapro, and at what dosage. This is necessary information.

As of Dec. 6th:

7.5 mg of Lexapro each morning on waking - usually around 6 am. 

 

Given that your nervous system is sensitized from withdrawal, I wouldn't take any chances with Propranolol. If you've been using it regularly, I would taper it when you want to quit. The danger in going off abruptly is rebound hypertension. Propanolol lowers blood pressure. The taper can be 25% of the dose every few days.

Thank you.  I agree.  I have cut the daily Propranolol to 2.5 mg due to nausea.  I will taper as you suggest.

 

These questions cannot be answered until we see your daily notes showing your symptom pattern before and after you take Lexapro. That is how we determine if you're taking too much Lexapro. 

I have been keeping them and will post below.

 

Your charts would be so much more helpful if they showed when you made drug changes. They would also be more helpful if they showed number of hours you've slept rather than degree of "insomnia." I don''t know what you mean by "akathisia," how does it feel to you?

I will track number of hrs slept from here on and modify chart.  Most of my nights (with some deviation for better or worse) consist of a bedtime at 10 pm - waking at 1 am - waking again between 3-5 am.  So on average, maybe 5-6 hrs sleep a night in between waking and dozing in and out.  In a bad wave it is less, in a window, a bit more. 

 

The Akathisia-like symptoms have gradually faded in intensity but are still strong enough daily that I take 2.5 mg of Propranolol in the morning to keep them at bay.  

  • The feeling is an inner tension; a burning pinch on the back of my neck and shoulders and arms . At its strongest, early in this ordeal, it was extreme discomfort/restlessness and unbearable panic. I was horrified to find I was trapped on a medication (or lack of) that could make me feel so desperate, like in a burning room with nowhere out but to jump.
  • In past intense waves, my personality (normally strong and independent) seems to melt down, if you will.
  • Now, I wake every day with this inner tension, nausea, and sometimes waves of anxiety and breathlessness.  I also have pins and needles in arms, sweating palms, numbness and occasional headaches.  This all lessens during the day.    

How did you feel after taking the additional 2.5 mg?

I know you said the chart isn't too helpful as is.  However, hopefully it helps to answer this question.  I began taking the additional 2.5 mg on 12-6 in the middle of a hard wave.  You can see from the chart how symptoms and sleep was affected since.

image.png.ca848a9d366f5830fde6235f80bade9e.png

 

 

9 hours ago, Altostrata said:

How are you taking Lexapro? Do you have the prescription liquid? 

No liquid.  1 whole 5 mg pill and 1 split 5 mg pill.

 

If you call your doctor in a panic, it's likely he is going to make some kind of dramatic drug change. He wants to help. Very few doctors adjust dosage as gradually as we do here or have the patience to look at several days of symptom notes before making a guess about dosage change.

Until yesterday, (hard to believe) I'd dealt with doctor through nurses resulting in confused messaging/direction.  Now that I have spoken directly with him, here  is where we are. 

  • Withdrawal symptoms do resolve over time and stabilization will occur.
  • No need to wait it out as upping the dose gradually or switching to longer half-life med will stop the symptoms but then you're at the higher dose or risk issues with new med.
  • Part of the problem may be the generic version of the med - I need to check with pharmacy to see if there have been changes. (Checked on this today - consistent manufacturer over last 18 months)
  • I can either stay at 7.5 mg and wait it out or up-dose to 10 mg to try to resolve w/d symptoms.  
  • Our new goal is to wait several months after this subsides and then began a gradual taper.  We'll address at upcoming appointment in a week.

Do you agree with the doctor that upping the dose will resolve these symptoms?  He seemed very sure of the route to take but also understands my ultimate goal is to taper off.  Like so many others, I am becoming desperate to end this as you can imagine. 

Yes, many doctors think a switch to Prozac will resolve withdrawal syndrome, but it is by no means certain. I would not take that risk until I am certain a direct taper from Lexapro won't work. From the information you've supplied, I don't think we have enough evidence yet that a low reinstatement of Lexapro has failed. 

What I don't have any more is the dreaded cortisol spiking in the middle of the night or the terrible insomnia wherein I can't sleep but a couple hrs a night.  I also don't have the depth of fear and panic I had at the onset.  As I said above, I am still floating  underwater, but it seems much closer to the surface.  

 

Daily notes from the last week or so. 

 

12-20  7.5 mg Lex   10 mg Prop   (4 hrs sleep?)

  • 1 am - woke extreme tension and unable to sleep
  • 4 am - took 5 mg Propranolol 
  • 4 am to 6 am - dozed in and out 
  • 6 am - got up.   Nauseous, inner tension, restlessness, slight burning in arms.  Had some yogurt, fruit 
  • 7 am - cancelled morning sport outing due to nausea and restlessness  Took 7.25 mg Lex.
  • 10 am - took 5 mg Propranolol
  • 11 am - went for ride with friend.  Was hyper sensitive to conversation and car rocking.  Had to return home; the nausea and feelings were overwhelming like I could faint.  Almost felt I needed to stop at hospital.
  • 1pm  - returned home took anti nausea OTC; had some lunch
  • 2:00 pm - napped in and out
  • 3:30 pm- rested on sofa as best as could feeling internal restlessness and nausea - tried mindfulness videos - they helped somewhat
  • 7 pm - had a small dinner
  • 9:30 pm - went to bed and slept until 1:00 am

12/21  7.5 mg Lex   2.5 mg Prop (reduced Propranolol due to nausea)  (3.5 hrs sleep?)

  • 1 am - woke tense unable to sleep but faded in an out.
  • 5 am - up and feeling almost faint again - took OTC nausea - miserable
  • 5:30 am - laid down and dozed in and out 
  • 7 am - up, had yogurt- fruit and coffee (caffeine did not seem to make a difference) Took meds (7.25 mg Lex and 2.5 mg Prop)
  • 9 am - feeling about the same as yesterday though I do feel a little ebb and flow of the intensity. 
  • Stopped tracking - don't recall why

12/22/2018 - 7.5 mg Lex   2.5 mg Prop  (5 hrs sleep?)

·         3am- woke with inner tension and low cortisol spike.  Dozed in and out uncomfortably.

·         5am- up and got breakfast and took meds (7.25 mg Lex and 2.5 mg Prop)

·         7am- nauseated (Prop?). Took OTC nausea med. Reading news upsets. Skipped bad stories. Praying.  Short of breath as symptoms are less with Prop but still present. Fuzzy head that seems to come with Prop. use.

  • Current  symptoms are:
    • Nausea but getting better w OTC med
    • Dry mouth
    • Short of breath
    • no appetite
    • Fuzzy head
    • Flu-like
    • Diarrhea (occasionally)
    • Sweaty palms
    • Hyper sensitive to noise and sound.
    • Hyper focus on feelings
    • Waves of anxiety if thinking about situation – mindfulness vids help a bit
    • Pins and needles in extremities

·         8am – short of breath it seems due to discomfort.  Dog barked and about went right through me.  Hyper sensitive to noise.

·         9am – terribly uncomfortable and nauseous (propranolol?).  Taking another OTC nausea pill.

·         End of tracking - don't recall why I stopped here.

 

12/23 Reduce Lexapro 5 mg in am – 2.5 in pm -.2.5 Propranolol. (4 hrs sleep?)

·      12:30 am – woke with agitation tried to sleep, dozed in and out

·      2:00 am - took 2.5 Lorazepam as experiment – relaxed and dozed back till 3:30 in and out - Lorazepam doesn't seem as effective as the Propranolol.

·      5:00 am – couldn’t stay in bed longer, too agitated.

·      6:00 am – burning tingling in arms.  Short of breath.  Had breakfast despite no appetite.  Took meds (5 mg Lex and .25 Prop)

·      8:00 am- was getting nauseous. Took OTH med and it helped.  Sinus continues to clear then symptoms abate for a short time.  That has been an ongoing thing and must have something to do with the antihistamine effect.

·      9:30 am – Showered, dressed. Bit of slight sick feeling and fatigued (propranolol?).  

·      11:00 pm – went to family party.  Felt drugged and buzzed. Typing this, I felt a wave of anxiety.  Took med (2.5 mg Lex)

·      3 pm - home from party early.  Feeling fatigued.  Rested on sofa and read.

PM    Rest of evening relatively well. 

·      10 pm - bed 

 

12/24 – Lexapro 7.5 and propranolol - 2.5 (6 hrs sleep?) 🙂

·      1:00 am – woke with tension and wave of anxiety but was able to fall asleep again

·      3:00 am - same

·      6:30 –woke with slight restlessness and although I still feel it, I could lay in bed and pray, didn’t want to get up to face another hard day.

·      7:30 – up and having breakfast – feeling more at peace but symptoms are in background. Took 7.25 mg Lexapro

·      8:55 – time to take .25 propranolol.  Bad feelings of inner tension rising up as I read online of what others are doing this holiday. How could I ever have coped normally and actually felt good about it.  It’s day 40 of w/d.

·      9:30 – breathless and anxiety - 

·      10:30- feeling a bit better – newer symptoms– weak thigh muscle

·      12:00 - went for long walk with friend.  Helped to talk, be out in sun and air.

·      1:00 – Lunch

·      4:00 pm – went to church; met family.  Feeling fuzzy but church distracted and did ok. Not really engaging in social aspect.  Like a zombie on auto pilot.

·      5:30 pm - Returned home, had dinner.  Felt relatively ok but nervous system felt weak.

·      10:00 pm – bed

 

12/25  Lexapro 7.5 and Propranolol - 2.5   (6 hrs sleep?) 🙂

·      2:00 am – woke with thoughts of illness – anxiety and sick at stomach but eventually fell asleep again

·      5:00 am – same – dozed in and out

·      6:45 am– up, breakfast and took meds (7.25 mg Lex and 2.5 mg Propranolol) – mornings seem to be the worst.  

·      10:00 am– visiting family arrives

·      11:00 am  - feeling bad as family opened presents.  Couldn’t really focus due to inner restlessness. 

·      1:00 pm – had lunch and then relaxed in afternoon.  It was uncomfortable with tension and despair over being ill for so long.

·      Rest of night – just relaxed and read tablet. 

·      10:00 pm - to bed

·      Had a bit of a breakthrough laying in bed.  As if my old self confidence surfaced.  

 

12/26  Lexapro 7.5 and Propranolol - 2.5 (6 hrs sleep?) 🙂

·      Forgot to log.  Up at 6:00.  Took meds (7.25 mg Lex and 2.5 mg Prop) 9:00 am meeting.  Operating at about 40% of feel good capacity.   Fuzzy, nauseous, inner focused.  Was able to focus enough to get finish meeting successfully.  

·      Came home and rested all day.  Napped in and out and read.  Felt better.

 

12/27  Lexapro 7.5 and Propranolol - 2.5 (7 hours sleep?) 🙂

·     Forgot to log.

·     Slept pretty well.  Waking up at usual times in night but able to return to sleep.  Still feeling tension and anxiety on waking 

·     Able to lie in bed until 7.  Up and  took meds (7.25 mg Lex and 2.5 mg Prop) Coping seems to be on auto pilot.  No lust for life. Dread of how to face world and responsibilities despite feeling a tad better.  Very nervous about next wave.

·     Felt agitated and nervous as I needed to tend to an unexpected task.  Did so successfully.

·     evening - friends and family texting.  All concerned and keeping me in the loop.  Always feel better in evening. 

·     10 pm bed

 

12/28 Lexapro 7.5 and Propranolol - 2.5  (7 hours sleep?) 🙂

12:30 am - new symptom.  2nd night in row waking with wet bed shirt from sweating. Tense as I changed and then went back to sleep.

5:30 am - woke and dozed in and out.  

6:30 - inner tension and anxiety - got up

7:00 - no appetite but had little breakfast and took meds (7.25 mg Lex and 2.5 mg Prop)

8:00 - showered feeling very nauseous and tense.

9:30 - A bit better but realize I'm developing secondary anxiety about resuming normal activities - when that occurs.  Will stabilization help that? 

10:00 - was hungry - ate some cereal and milk.

1:00 - Feeling less tense but fuzzy.  Just an overall feeling of not being fully well.

 

 

 

 

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Altostrata

Why do you take Lexapro and propanolol together? It's impossible to tell which drug is causing the nausea, or your symptom pattern after you take Lexapro.

 

If you're taking propanolol "as needed," why are you taking it every day at the same time?

 

When you take lorazepam, you introduce a confounding factor. This reduces the value of your daily notes for a couple of days.

 

It looks like your sleep is getting better. Very gradual improvement is to be expected after reinstatement. As 7.5mg seems to be working, there is insufficient evidence for a dosage increase. Looks like taking 7.5mg once a day in the morning is good enough.

 

Do you have a tendency to worry that you're not doing things perfectly? You seem to be generating a lot of anxiety about the process. This can make your actual drug-related symptoms worse.

 

It's a doctor's role to speak authoritatively, even if they're only guessing. For all we know, he's getting his info from this Web site.

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mdwstrx

Thank you for such a quick reply!

 

Why do you take Lexapro and propranolol together? It's impossible to tell which drug is causing the nausea, or your symptom pattern after you take Lexapro.

Very good point.  I'll begin taking the lex later in the day if I still need the prop in am.   I am of the opinion the Propranolol causes the nausea as I feel more clear headed and less queasy without. 

 

If you're taking propranolol "as needed," why are you taking it every day at the same time?

I was taking as needed until the symptoms started becoming so intense every morning upon waking.  So mornings became 'as needed'.

 

When you take Lorazepam, you introduce a confounding factor. This reduces the value of your daily notes for a couple of days.

I can see that now.  I have only taken 2.5 mg twice that I recall over these past 45 days.  I don't find it as effective as the Propranolol so that should be no problem to avoid.

 

It looks like your sleep is getting better. Very gradual improvement is to be expected after reinstatement. As 7.5 mg seems to be working, there is insufficient evidence for a dosage increase. Looks like taking 7.5 mg once a day in the morning is good enough.  Yes, it is getting better I believe.  I will continue to hold at 7.5 mg.

 

Do you have a tendency to worry that you're not doing things perfectly?

I have no wish to muck things up prolonging my current state of vulnerability.  So, I research to the extent I can, listen to the doctor, you and the moderators of this site to do whatever is best. Worried about being perfect, no; but desperate (to avoid back sliding to that place where it felt as thought there was no way out and to improve) yes! 

 

You seem to be generating a lot of anxiety about the process. This can make your actual drug-related symptoms worse.

Yes, I'm anxious.  I don't fully understand the process and have spent the last 45 days learning the process.  I am not even sure I get it yet.  SA seems to suggest the only way out is to hold through 'til stabilization, enduring the discomfort at just about any cost.  My doctor seems certain that he can end the w/d with up-dosing if I wanted to go that route.  So it's confusing for me, for my family and friends. The uncertainty of it all invokes anxiety.  I don't know how anyone in their right mind could avoid being anxious in this predicament.  I read and listen to Claire Weekes and the mindfulness materials.  That helps.  As does you expertise and direct approach.  Thank you.  

 

It's a doctor's role to speak authoritatively, even if they're only guessing. For all we know, he's getting his info from this Web site. 

I just don't know. I want to believe my doctor has credibility.  I am running the info from this site, his office and my research through all concerned to make sure that the process is a success.  

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mdwstrx

Saturday, December 29, 2018 - 6 hrs. sleep 7.5 mgs Lexapro

·         4:30 am – woke in relative peace. Started having anxiety and a sick depressed feeling thinking about not sleeping better and this illness. Used nondrug tools to calm down.

·         6:30 am – Got up and took 7.5 mg of Lexapro - no propranolol - and some yogurt/decaf coffee.

·         7:00 am – Anxiety and symptoms are down this morning thankfully. 

·         10:00 am – Still feeling pretty good. There is tension, slight electrical tingling in my body and some soreness in my arms like neuralgia.  Fuzziness and a very slight ache in head If I focus on it.

·         12:00 pm – lunch.  Appetite is better and I’m no longer losing weight.

·         2:00 pm – Still holding at about same sx level.  Feeling fatigued and a bit bored.  Friends are pushing me to get out to a gathering this eve.  It’s giving me a bit of anxiety but I’ll stop by for a bit.

·         5:00 pm – ready to go and feeling a slight buzz in the back of my head/ears. Tired.

·         10:00 pm - bedtime

Edited by Carmie
Changed Lorazapem to Lexapro

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Altostrata
On 12/28/2018 at 2:16 PM, mdwstrx said:

SA seems to suggest the only way out is to hold through 'til stabilization, enduring the discomfort at just about any cost.

 

This is not true. We want to monitor after a dosage change. As it seems that you are slowly improving -- which is a normal course of stabiization -- for you, it might be best to hold right now and see how far 7.5mg gets you.

 

Something we know that doctors don't is that if your nervous system is sensitized by withdrawal, taking too much of the "hair of the dog" can cause kindling, even if you did fine with higher doses earlier in your drug career. We don't want to overshoot dosing.

 

We have a new member right here who's overshot a reinstatement

 

If after a while, it seems you can do with a higher dose of Lexapro, we'd suggest adding no more than 0.5mg-1mg. A little goes a long way with a sensitized nervous system.

 

It could be that 7.5mg is just fine for a while, when you feel confident, you can taper again.

 

Congratulations on seeing where you were generating your own anxiety and using non-drug coping methods.

 

Please minimize your use of lorazepam.

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mdwstrx

Thank you for comments and clarification, Alto. I understand better now. Yes I intend to hold at 7.5 as you suggest. 

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mdwstrx
On 1/29/2016 at 12:03 PM, Altostrata said:

Even so, some people who taper very, very slowly still may suffer significant withdrawal symptoms, such as some of our members who had been on Paxil, Zoloft, or Prozac for decades.

 

Hello Alto, 

I am one who has been on Lex for decades.  Before this crash, I didn't know about the 10% taper rule.  Over a period of 2 years, I tapered with little difficulty from 20 mgs - 15 mgs - 10 mgs - 7.5 mgs - 5 mgs - 2.5 mgs (with months of holding in between).   I know the charts show that it gets more difficult the lower you go.  I understand why now.  

  • Question:
    • When you say  above that some people who taper very, very slowly still may suffer significant withdrawal symptoms, do you mean while tapering or after stopping the drug at 0
  • Question:
    • How do we know what is an acceptable rate of taper without crossing the uh-oh point?  I have seen comments that some are able to taper a little higher than 10%, especially at the higher dosage like I was.  
  • Question:
    • If I listen to my body, and slowly taper to the extent I am able, will I experience significant w/d after stopping at the given 0 point.

I want to believe I can taper gradually to zero and then have my life back like many success stories have done.

I do not want to believe I am on Lexapro forever because I will suffer debilitating w/d sx or PAWS  after jumping off.

 

Thank you for any answers you may provide given your wealth of knowledge and experience.

 

 

 

 

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ChessieCat

Please make posts in your own Intro topic when they are specifically about your own situation.  This keeps your history in one place and makes it easier for the context and previuos responses to be seen.

 

I have just checked back through your topic and you have already been provided with links to topics which discuss the questions you have asked in the above post.

 

Please read the following post.  If you click on the arrow, topic right of the box it will take you to the topic which it came from.  In the first post in that topic, there are links to helpful topics (Alto mentions it in this quote).

 

On 6/9/2018 at 7:00 AM, Altostrata said:

I have closed comments on this topic because it was attracting too many posts expressing unfounded attitudes of fatalism and self-sabotage that are discouraging to everyone. Many people seek psychiatric drug treatment in the first place because of these attitudes, and even as they choose to go off them, they bring these habits of thinking to this community.

 

Self-defeating or self-sabotaging thinking heightens whatever awful feelings you get from withdrawal itself and puts additional stress on your nervous system. In order to get past taking psychiatric drugs, you need to change your way of thinking, or recovery is going to be much harder for you.

 

In answer to such questions such as "Does nobody ever heal?" -- first, read every link posted above in this topic.

 

Consider this: I and the moderators work very, very hard to help people get past taking drugs and heal from withdrawal syndrome. Fortunately, every day, we see successes.

 

I say fortunately, because once in a while people show up here who will not be reassured that in general, healing does progress -- although in a very slow and frustrating way. Despite our best efforts, they want to be told over and over that they will be fine. One or two or nine success stories are not enough. They want to see a success story from a person who's exactly like them -- same drugs, same length of time on drugs, same method of going off drugs.

 

In short, they want to see their own success story, and they want it now.

 

No, we cannot tell you exactly when YOU will heal, or how it will go. If I or any member of the staff could foretell any individual's future, we'd put that talent to better use than running a forum site.

 

Use some common sense: We wouldn't put all this time and care into responding to people here if we knew everyone was doomed. That would be a terrible waste of time, wouldn't it?

 

Please show some consideration for the staff. If we tell you once or twice that healing will be slow and frustrating, take it on faith that YOUR healing will be slow and frustrating. Seeing one or two success stories from people who are somewhat, but not exactly, like you is evidence that people do heal.

 

Quite often, that's all that we have to reassure you. You will have to find strength and faith within yourself to go the distance.


You will need to learn to cope with the uncertainty of when and how and, as part of your own self-care, do what you can to help your body and nervous system heal. We can't do it for you.

 

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mdwstrx

Hi Chessie.  I will post in my own Intro topic from now on.  Apologies for any confusion.  I wasn't shopping for answers after being given previous links.  I've read the links and still not sure of the answers to my questions.  I truly get what Alto posted above and realize no one has a crystal ball. 

 

Specifically, I would like to ask Alto what she meant by 'significant withdraw symptoms' in her statement that Even so, some people who taper very, very slowly still may suffer significant withdrawal symptoms, such as some of our members who had been on Paxil, Zoloft, or Prozac for decades

 

Does it mean while tapering or after stopping the drug at 0?

 

Thank you.

 

 

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mdwstrx

Thank you for the link, Chessie.  It was helpful.

 

Sunday, December 30, 2018 – 7.5 hrs. sleep – 7.5 mg Lexapro              

·         3:30 am – woke – felt tense, went back to sleep

·         6:00 am – woke, anxious thoughts in general, used nondrug tools to calm

·         6:30 am – up took 7.5 mg of Lexapro- no propranolol – breakfast – sx in background slight electrical tingling in body and some soreness in arms like neuralgia.  Fuzziness. 

·         8:00 am – surfing computer – short of breath, wave of anxiety just hit. Deep breaths…sweaty palms, bathroom run. 

·         12:00 pm – lunch.  sx in background slight electrical tingling in body and some soreness in arms like neuralgia. Fuzziness. 

·         3:00 pm – feeling fatigued. Had another wave of anxiety pass just now.  Learning to float through it.

·         5:30 pm – have been noticing a bit of depression this afternoon.  Also tired.  It seems like sx are ramping up a bit tonight.  Unusual as its normally the opposite this time of day.

·         10:00 pm - bedtime

 

 

Edited by Carmie
Changed lorezapam to lexapro

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mdwstrx

Day 49  - 7 weeks now into w/d.  The past several days, I had the great fortune to be in a window, after a particularly long and tough wave.  I was starting to think stabilization might be near.  Not so.  Normally, the evening hrs are better and much more manageable.  I noticed though, last night that I was feeling si ramping up a little.  Went to bed and woke at 1 am with waves of anxiety.  Arggggh!  Dozed off again between 3 and 4 am.  That was the end of sleep for the night.  This morning has been rough again with the nervous jittery feeling, anxiety and other all too familiar symptoms.  Will post day tracking later.

 

Can anyone say if the anxiety waves go away with stabilization?  I sure hope so.

 

Hoping others are having a good and healing day.

 

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mdwstrx
Posted (edited)

Monday, December 31, 2018 - 4 hrs. sleep

·         1:00 am – woke – waves of anxiety washing over, hot flushing, sweating palms/feet

·         3:00 am– fell asleep

·         4:00 am – woke again – more anxiety waves, not as bad

·         5:30 am – up for day - took 7.5 mg of Lexapro  - sx - slight electrical tingling in body and some soreness in arms like neuralgia.  Fuzziness. – tired - burning in lower arms, tense, Short of breath and nauseous due to anxiety.

·         6:45 am – same symptoms – taking 2.5 mg of propranolol to try to reduce symptoms and nap.

·         7:30 am – propranolol has taken the edge off the symptoms but not able to sleep. Rested a bit.

·         1:00 pm – lunch – out to store and errands.  Feeling very flu-like.

·         5:00 pm – no appetite, sweating, headache, flu-like si continues

·         5:30 pm -  had dinner - feeling just a bit better

·         10:00 pm - bedtime

 

Silly questions after 49 days.  I'm becoming confused as to whether this is withdrawal or relapse.  I've looked over the w/d symptom checklist and the links regarding Is it withdrawal or relapse? Or something else? 

and frankly, I can't tell.  

 

And... 

Thanks Chessie for the link to withdrawal normal. However, I'm not seeing a correlation with the link.  Brassmonkey says he felt better the lower he tapered, seeing improvements in withdrawal normal.  I'm not tapering, I'm trying to stabilize.  When I did taper, unlike Bm, I didn't see improvements in how I felt.  Rather, si emerged as the result of the drop in dosage that tended to clear up as I held the dose.  So my w/d normal seemed to hold steady after symptoms dissipated, not improve.  However, I'm a little distracted with how I feel today so maybe I just missed it.

Edited by Carmie
Changed Lorezapam to Lexapro

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mdwstrx

Mods or alto - can someone please modfy my posts on Dec 29, 30 and 31.  Each entry  states erroneously that I took 7.5 mg of Lorazepam.  It should read Lexapro instead. I did not take Lorazepam on those days.  It was a typo that was cut and pasted.  Thank you. 

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Carmie
17 minutes ago, mdwstrx said:

Mods or alto - can someone please modfy my posts on Dec 29, 30 and 31.  Each entry  states erroneously that I took 7.5 mg of Lorazepam.  It should read Lexapro instead. I did not take Lorazepam on those days.  It was a typo that was cut and pasted.  Thank you. 

 

Hi, mdwstrx, 

 

I put Lexapro where you had written 7.5mg Lorazepam on the 30th n 31st of December. On the 29th, as far as I could see, you already wrote down lexapro. 

 

Take care, sending hugs🤗

 

 

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mdwstrx

Thanks Carmi.  I think you missed 12/31 though.  It still says Lorazepam.  Could you pls. change that one too?  Thanks!

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Carmie

All done mdwstrx, 

 

Hope you’re coping okay. I’m off to bed in a sec. it’s nearly 11pm here in Queensland.

 

Good night😴😴

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mdwstrx

Good night, sleep well and thank you!

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mdwstrx

Daily check in - re-sposting yesterday's with added 8pm and 9 pm entries. 

 

Monday, December 31, 2018 - 4 hrs. sleep

·         1:00 am – woke – waves of anxiety washing over, hot flushing, sweating palms/feet

·         3:00 am– fell asleep

·         4:00 am – woke again – more anxiety waves, not as bad

·         5:30 am – up for day - took 7.5 mg of Lexapro - sx - slight electrical tingling in body and some soreness in arms like neuralgia.  Fuzziness – tired - burning in lower arms, tense, agitated and short of breath, nauseous.

·         6:45 am – same symptoms – taking 2.5 mg of propranolol to try to reduce symptoms and nap.

·         7:30 am – propranolol took edge off the symptoms but not able to sleep. Rested a bit.

·         1:00 pm – lunch – out to store and errand.  Feeling very flu-like.

·         5:00 pm – no appetite, sweating, headache, flu-like sx continues

·         8:00 pm – sx ramped up.  Agitated, breathless and sick.  Took 2.5 mg of propranolol.

·         9:00 pm – Propranolol helped.  Breathlessness went away and sx didn’t feel so sick.

·         10:00 pm – bedtime

 

Tuesday, January 1, 2019 - 4 hrs. sleep

·         12:00 am – woke tossed and turn and fell back asleep eventually

·         3:30 am – woke again. Uncomfortable, agitated– hot and cold – sweating

·         6:00 am – got up.  Again, breathless and feeling agitated. Not as bad as last night. Took 7.5 mg of Lexapro.

·         8:23 am – had breakfast and still breathless. Agitated and very flu-like sick. Slight headache and burning in arms. 

·         10:00 – laid down for an hour but couldn’t sleep. Took 2.5 mg of propranolol. 

·         11:30 am – propranolol helped a lot. No longer feeling agitated.  Took otc nausea med so good there too.

·         12:00 - had lunch…

·         1:30 pm –feeling sx peeking through a bit queasy and ill at ease thinking of them.

·         3:30 pm – up from a 2-hr. nap. Feeling ok. Dull headache in front.

·         5:00 – same except dull headache in front. Hoping things stay this way - unlike last night where sx ramped up.

·         10:00 - bed

 

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mdwstrx

Wednesday, January 2, 2019 6 hrs. sleep

·         2:30 am – woke and used mindfulness to get back to sleep

·         4:30 am – woke and tried mindfulness and positive thoughts. Felt ok and more positive

·         6:00 - up and took 7.5 Lexapro – feeling more positive with a strong will to improve

·         7:00 am – feeling optimistic and not as much inner agitation. Not feeling so overwhelmed. Need to avoid triggers.

·         8:00 am – took 2.5 propranolol to calm low agitation and to allow me to go work out with friends.

·         12:00 pm – worked out for 2 hrs and it went well. Picked up lunch on the way home.  Feeling pretty good.

·         5:00 pm – had dinner.  Still losing weight but it’s slowed.  I look better than I did in HS. 😊

·         6:00 pm – I think today’s exercise really helped.  Have felt pretty good most of day. Yesterday’s nap and last night’s 6 hr. sleep also helped.  The mindfulness techniques (getting back to sleep after waking) worked well for me last night.  The exercise teaches you to relax with deep breaths and count backwards from 10,000.  Yes, you lose track but eventually you fall asleep somewhere in the mix.  Anyway, it worked for me - at least last night.

·         10:00 pm - bed

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mdwstrx

·         1:30 am – woke and tried mindfulness unsuccessfully. Mild waves of anxiety at some points in the night.

·         5:30 am – no sleep, let dog out. Back to bed.

·         7:00 am – slept for an hr. and up. Took 7.5 Lexapro Feeling tense and nauseous.  Mornings are terrible; especially after not sleeping much. No propranolol today.  May contribute to insomnia.

·         10:00 – feeling a bit calmer, sx intensity is easing a bit.  

·         12:00 – Lunch and worked around house. I notice that if I’m busy, sx are kept from forefront. 

·         2:30 – took a much needed 2 hr. nap. Still feeling fatigued. Buzzing, tension and nausea are back. Slight headache.

·         5:30 – dinner – passable day since I can stay in.  Otherwise would have to take 2.5 mg propranolol.

·         10:00 - bed

 

 

 

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mdwstrx

Friday, January 4, 2019 7 hrs. sleep

·         12:30 a.m.  Woke.  First thought was how comfortable I was; then strong anxiety wave. Fell back to sleep.

·         2:30 a.m. Woke.  Anxious thoughts.  Fell back to sleep

·         6:00 a.m. Woke Took 7.5 Lexapro.  Feeling tense, breathless, anxious. Continuing hot flushing.  Normal terrible morning sx.

·         9:30 a.m.  feeling a bit better.

·         11:00 a.m. Still breathless feeling, anxious, unsettled.

·         12:00 p.m. got out, ran errand, had lunch.  Walked on trail, sat in sunshine.  Felt great.

·         3:30 p.m. typing this triggered a little wave of anxiety.

·         5:30 pm dinner, still feeling pretty well but can feel sx in background. 

·         10.00 pm bed

Amazing what a warmer, sunny day mid-winter can do for one’s spirit, even in w/d. 🌞

 

  

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Tom37

Good to see your getting some decent sleep at the moment.

 

Shame the anxiety is still causing you problems. I’m lucky medication induced anxiety isn’t an issue for me so far through this although I know what actual anxiety is like and it’s not fun. Cbt has always been very useful for me.

 

Have to love a nice mid winter day. Great time of year for sleeping too. Middle of summer down here and would gladly swap!

 

Hopefully stabilising isn’t far away for both of us.

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mdwstrx

Saturday, January 5, 2019 7.5 hrs sleep

·         11:30 p.m. (night before) woke briefly, back to sleep

·         6::00 a..m. woke feeling somewhat refreshed and relatively calm

·         6:30 a.m. up, Took 7.5 Lexapro. Sx in background but slight.

·         9:00 a.m sx ramping up a bit. Buzzing, tension and nausea, slight depression.

·         12:00 p.m. Lunch – samesx

·         3:00 p.m.  same sx only temp regulation is acting up – overheating. Minor.

·         6:30 p.m. it has definitely been a window day.  Sx present but manageable.

·         10:00 p.m. bed

 

Grateful for these past couple of days and the sleep I've been getting.  

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mdwstrx

So another window day!  Mornings are still rough but by noon; very manageable and by evening feeling good. I pray this continues but if not, I now know it’s improving. I’ll hang onto this when the next wave comes.

 

sleep good

appetite good

emotions better

sx in background

 

Continuing prayers for all on this site for peace and healing. 

 

 

 

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Tom37

Good work.....encouraging to hear you have had a few better days. Shows you are making progress. If it goes backwards that’s ok as part of the journey. 

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mdwstrx

Thanks Tom!  We are making it through... one day/moment at a time. 

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mdwstrx

Another good day.  Sports workout for a couple of hours, lunch and spent the afternoon with a friend.  Sx showed up in the afternoon but were manageable. Mostly the inner buzz and slight waves of feeling ill. 

 

 

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