LeoD: escitalopram protracted tapering

[ChessieCat]

Only you can make the decision about whether to updose.  However, please do not be gung ho and make a large increase.  A small amount might be all you need.

 

As an example, when I tried to reduce from 75mg Pristiq, I did it too soon (I should have held for longer or made a smaller reduction to test to see how I responded - of course hind sight is 20:20).

 

I made a 10% (75mg to 67.5mg) reduction and had very bad withdrawal symptoms.  I did not return to my previous dose, I updosed to 70mg and the withdrawal symptoms lessened.  Knowing what I know now, I may have been able to increase by less.

 

If you read Post #1 of the About reinstating and stabilizing to reduce withdrawal symptoms you will see that it is better to reinstate as soon as bad withdrawal symptoms appear.  The information in the reinstatement topic is also relevant to updosing.

 

But it is best  to make a decision and stick to it.  It's no good updosing and then deciding to reduce again a few days later.

[LeoD]

Hi,

slept ok last night but during the day the wd is bad. Thinking of updosing, but here is the problem: I can only cut the 5 mg excitalopram pill in 4 relatively equal parts. This is how i ended up gaoing from 15 to 13.75 mg. How do i manage to not updose back to 15 mg? Are there fancy pill splitters that can cut a small 5 mm diameter pill in 8 ? Or do i crush a pill and dissolve in water?

thanks for the advice!!!

[ChessieCat]

tips-for-tapering-off-lexapro-escitalopram

[LeoD]

Great, thanks! I found a liquid form of excitalopram from my taper attempt 1 year ago, stored at room temperature.  Is it known how long it is good for? Can I continue using it? I do not think i can get a fresh bottle quickly enough ( i just got my prescription for pills refilled a few days ago). I do have a feeling that the imprecision of cutting 5 mg pills into quoters is contributing to my symptoms. 

 

[ChessieCat]

1 hour ago, LeoD said:

I found a liquid form of excitalopram from my taper attempt 1 year ago, stored at room temperature.  Is it known how long it is good for? Can I continue using it?

 

From:  https://www.lundbeck.com/au/products/our-products/lexapro/lexapro-oral

 

Quote

Storage 

Keep LEXAPRO oral solution in a cool dry place where the temperature stays below 25°C. 

Discard LEXAPRO oral solution 10 mg/mL 3 months after first opening. 

Discard LEXAPRO oral solution 20 mg/mL 2 months after first opening. 

 

Edited February 23, 2019 by ChessieCat

[ChessieCat]

1 hour ago, LeoD said:

I do have a feeling that the imprecision of cutting 5 mg pills into quoters is contributing to my symptoms.  

 

Very likely.  See:

 

On 5/27/2011 at 12:16 PM, Altostrata said:

Special considerations
A significant characteristic of Lexapro is that milligram for milligram, it is much stronger than other SSRIs. Chemically, Lexapro is a variation of Celexa; the molecule was re-engineered to be patentable as Celexa's patent was about to expire. The streamlined molecule is a more potent SSRI, 2 to 4 times stronger than others. (Wikipedia has a good explanation of this at https://secure.wikimedia.org/wikipedia/en/wiki/Escitalopram.)

However, many doctors are unaware that escitalopram is stronger than other SSRIs and dose it as though it were the same strength. Although the so-called usual starting dose of escitalopram, 10mg, is equivalent to 20mg-30mg or more of, for example, paroxetine (Paxil), your doctor may have moved you to an even higher dose. If you are taking 20mg of escitalopram, you are taking a hefty dose of an SSRI.

If you are taking 5mg, it's not tiny, it's equivalent to 10-20mg Paxil or Celexa.

Consequently, when you taper off escitalopram, you should be careful to decrease by small amounts, as each drop is magnified by escitalopram's extra potency. If you find withdrawal symptoms from a 10% decrease to be too difficult, after 3-4 weeks decrease by a smaller amount.

 

[LeoD]

Ok, thank you! So sinse I do not have liquid at this point, and can not cut pills evenly enough, the only path forward is to updose back to 15 mg untill i stabilize and get the liquid?

[ChessieCat]

Q:  What dose are you currently taking?

 

Q:  What dose tablet are you trying to cut up?

[LeoD]

Was taking 15 mg. Cut down to 13.75 mg by taking a 10 mg pill and a half and a quarter of a 5 mg pill. Started feeling bad (brain fog, anxiety, depression, weird thinking) after 4-5 days. Thinking about going back to 15 until this gets better and I aquire liquid to help with the taper.

[ChessieCat]

Yes, I can see your dilemma.  Because there are at least 2 variables it is hard to know if it is the reduction or the inconsistent dose or both.  However, because of the strength of escitalopram, inconsistent dosing would most likely at least a contributing factor.

 

We suggest when changing form of a drug that you do a cross over, 3/4 + 1/4, 1/2 + 1/2, 1/4 + 3/4, each combination for 3 to 7 days.  If would be easier to do this if you were taking 15mg (I'm just providing options - brain storming).  Because of the tablets you have available you will need to change this to 2/3 + 1/3, 1/2 + 1/2, 1/3 + 2/3.  If you increase to 15mg that would be 10mg + 5mg, 7.5mg + 7.5mg, 5mg + 10mg.

[LeoD]

Do you mean going back to 15 mg with pills and then switching to the liquid form using this cross-over method? 

I was thinking about staying on a 10 mg pill and using liquid to taper from 5 to 0 ( from 15 to 10 in total. No cross over because because the 5 mg pill can not be cut further. Does this make sense?

[LeoD]

Ok , i got it, so this will be like doing the 2/3+1/3 crossover and stopping there fot now.

Correct?

Thank you Chessie, it is so valuable to have support while in WD an desperate. No doctor understands this, or at least they pretend not to for whatever weird reason.

[ChessieCat]

5 minutes ago, LeoD said:

Do you mean going back to 15 mg with pills and then switching to the liquid form using this cross-over method? 

 

Yes, that's what I was thinking, because you said you were thinking of going back to 15mg.  And because you want to get the dose consistent now, you would go back to 15mg in tablets straight away, then hold to let things settle down.  Then you would do the cross over as explained above.  Then you would hold before making a reduction.

 

The idea is to give yourself a good stable foundation before you start tapering.  I realise that it is going to add some extra time to your overall taper length, but in the scheme of things it's not going to make too much difference and the aim is to get off the drug as comfortably as possible, not as quickly as possible.

 

However, the other option is to go back to 15mg in tablets straight away, then hold to let things settle down.  Then continue taking 10mg in tablet form and taking 5mg in liquid and hold.  This would be the first stage of the cross over.  Then you would reduce the liquid then once you got to 10mg you would do stage 2 of the cross over, 5mg tablet plus 5mg liquid with a hold before making a reduction.  When you get to 5mg you will need to decide if you are going to go straight from tablet to liquid or cut the tablets in half and do 1/2 + 1/2.

 

The first decision is if you want to take a combination of tablet and liquid, or all liquid.

 

I hope that makes sense.  It's 3.30am and I'm back off to bed.

[LeoD]

Good night! And many thanks!

[LeoD]

Ok, updosed yesterday back to 15 mg. Still feeling bad, much worse than before that small taper. How long untill i know whether the updose is helping with the symptoms?

[Dylanmatthew]

Hey what symptoms do you have 

[ChessieCat]

It's a good idea to check back through your Intro topic to see if you have already been given information:

 

On 2/22/2019 at 7:46 AM, ChessieCat said:

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

 

[LeoD]

-:))) Thank you Chessie. Have I mentioned brain fog and inability to focus and think clearly as one of my main complaints🤪

[LeoD]

This is @Dylanmatthewtoo

[Dylanmatthew]

That sucks. Idk what brain fog is. At least you don't have overwhelming fatigue. I miss talking to you chessie. 

[LeoD]

Hi Chessie 

when you have a chance... just curious, how many members our wonderful site has? I’d assume that most people suffering from protracted withdrawal eventually find it and become members to be able to follow the amasing advice. 

If 10% of the population (at least in so called “developed countries” ) have been prescribed Psyc meds, and 10-20 % of these become addicted and can not quit relatively fast                (Definition of an addiction), then we are talking 10s of millions all over the world? Is this a fair accessment?

Sounds like a health crisis...

L. 

 

[ChessieCat]

about-survivingantidepressantsorg

 

[LeoD]

Chessie,

Thank you for answering my questions! Here is one more, a very important one for me personally. So I had tapered down from 10 mg ol escitalopram too fast (over 6 months). When protracted wd started, i panicked and got back to 15 mg ( 3 months after my last dose). That was before i found SA. Since then wd has been continuing for 7 months, with some waves and windows. Got overexcited after a good window and tried going down to 13.75 mg and was punished for it. Had to go back to 15, still in the wave. Now, finally, the question: how likely is it that i will eventually stabilize in a more or less pleasant place while staying on the 15 mg? In other words, most people who are off the drug go through the wd and eventually recover. What about people like me, who are on the drug and do not seem to be able to taper? Will we recover to a pre- wd level while on the drug if we wait long enough?

Thank you!!!

 

[jozeff]

Hi Leo

That is a very interesting question indeed. We don't know if and when someone will stabilize at any dose. 

 

Tapering can be very destabilizing. You tapered fast and updosed again and now you want to taper again. That's exactly what I did. I want to taper soon and I hope I will be stable but I am waiting for that to happen.

If we will be stable nobody knows. Maybe it will never happen and we will have to taper one day to get rid of the meds.

 

Some sort of stable situation is likely when we will hold but it might take pretty long. 

 

I feel way worse now than before I took these meds for my depression..... Sad but true. The years of tapering ahead ate discouraging but you have to fight and believe in your healing. What else can we do??

 

Good luck and hopefully some has some more insight in this stuff.

 

Cheers

 

Jozeff

 

[LeoD]

Amen. I could not agree more. I feel like an idiot, because i just started getting nice windows and rushed to start tapering. The smallest change, from 15 to 13.75 mg, crushed me. Now I am back at 15 and in a bad wave, which seems to want to stay. If It gets better, i will stay on 15 mg untill i am completely stable. If it does not, i do not know how to survive...

[jozeff]

Hi,

 

Don't blame yourself for this. You tried and didn't succeed. Thank God you didn't jump of CT. 

 

The jump from 15 to 13.75 isn't that small. Escitalopram is very strong stuff if I'm correct. Ok, it's less than a 10 % step but it is not surprising p this caused you trouble to be honest. I've seen worse. Next time go to 14.7 or so for a couple of weeks.

I haven't dropped since August 14th 2018. That's half a year and I'm still struggling. Started tapering almost a year ago and it has been one sh*tty year so far. Panic attack, nausea, severe depression, suicidal thoughts, agressive,you name it and I had it. Feeling normal seems far away some times....

 

Good luck

 

Jozeff

[LeoD]

So how often do you have windows when you feel relatively normal? 

[LeoD]

Chessie or other moderators, do you have an opinion on this? After an unsuccessful taper, getting bad wd and then going back on the drug,  still in wd for months, what is the likelihood of eventual stabilization at the pre-taper lavel? Please read my Monday post for details.

 

 

Thank you!!!

 

[Dylanmatthew]

Hope you get the advice you need

I cold turkied off Lexapro and 3 months later started feeling the effects. Anyways I reinstated to 0.5mg and have felt better. I'm fatigued a lot and I'm not enjoying life due to depression. 

 

I honestly don't see a point in being alive. I'm lonely. I want human touch but too afraid to do anything about it. 

[LeoD]

We all have a long road to recovery. The key is to stay positive and not give in to our sick brains are telling us. We will get through this one day at a time! Consider yourself lucky, you are on only 0.5 mg. Once you stabilize, it will be easy to taper off. 

Stay strong!!!

Do you feel that your depression is related to wd or pre-excising? Have you tried therapy for it?

 

[LeoD]

All, any information on local support groups? Do people meet in person to talk, meditate, encourage each other? 

 

Thanks!!

[ChessieCat]

Check out the pinned topics in this Forum of SA:

 

relationships-and-social-life

[ChessieCat]

Hi Leo,

 

I have just realised that you and Leo1983 both have the same coloured automatically generated avatar.

 

Because you both have the same name and also the same colour, it would be helpful if one, or both of you, change your avatar so the mods and members don't get confused.

 

Hopefully you won't both change to the same or similar one. 🤣

[LeoD]

Pocked around but did not find how to do it. Please guide.

[LeoD]

Are you going to answer my questions about stabilization while on the drug, or is it a tough one😳?

[ChessieCat]

24 minutes ago, LeoD said:

Pocked around but did not find how to do it. Please guide.

 

Click on the drop down arrow next to your name (top right).  Click on Profile.  You will see your avatar at the top of the page.  Just beneath the avatar there is a picture icon.  Click on the icon.