Sunwillcomeout: reinstating after cold turkey before symptoms occur

[Sunwillcomeout]

Hello everyone,

This may seem unusual, but I am asking for guidance in helping my 23 year old daughter who went off 10 mg. of Lexapro (cold turkey) 2 months ago.  She had been on it for one year and before that she was on Prozac for a year.  The transition went well (a week or two of the usual anxiety).  While she had planned to start tapering off this summer, she ran out of medication while vacationing and didn't get in to refill the prescription.  I found out 17 days later that she had stopped cold turkey.  She went through a stage of lightheadedness and foggy thinking, over emotional at times, but seems to have moved through all of that nicely.  I asked a couple different pharmacists if she should reinstate after 17 days and they said no.  I realize that they think it has cleared her system and she is out of the woods ,even after I asked about problems with her 

brain trying to reach homeostasis after relying on the drug.  You can imagine their reaction, blank stares.  

I found this forum while researching about antidepressant withdrawal and have read a LOT of what people have experienced along with the advice on tapering, natural ways to help yourself, and the post about reinstating at a small dose to test the water .  I also found James Healey's posts.   I noticed he has different advice about the amount to reinstate (10% reduction of original dose for every month you were off).  I understand this should have been a 10% taper, but what to do after the fact?  As a precaution, she has an appointment scheduled with her family doctor and is going to ask  for liquid Lexapro just in case she needs to reinstate at a very low dose.  In addition, she started on Magnesium and fish oil.

She is doing really well right now at two months out.  I am, however, a nervous wreck.  

I have several questions.

1.  Does going on AND off SSRIs while one's brain is still developing make the recovery easier?  I can't find any research on that at all.

2.  Most importantly, should she reinstate when she is not having any symptoms of withdrawal, just to prevent a post withdrawal?

3.  She has only been on Lexapro (Prozac before that) for a year, and did fine on it.  Could it be that she will not go through PAWS?  From what I can gather, 60% of people quitting cold turkey will have withdrawal symptoms, but does that mean EXTENDED withdrawal?  Does this sound right to you?

4.  She is on a medication for hypothyroidism and just had it checked.  If the doctor said it needs adjusted, would it be wise to stay put for awhile?  I have always wondered if her thyroid was the root problem all along.

Thank you for the work you are doing.  I am disgusted that so many people are suffering without knowing the risks of this antidepressants.  Any advice you can give is very much appreciated.

 

 

 

 

 

 

 

[brassmonkey]

Hi Sun-- welcome to SA, I'm so glad you found us.  We have a number of parents helping their children get off of these drugs so you're not alone. Thank you for doing a signature block, that is really helpful.  It sounds like you have a lot of questions, well we have a lot of answers.  Before you get overloaded with links for specific information it would be a good idea to read through this one to get a general idea of what is going on.  It's quite long, but has a lot of good information.

 

It's going to raise a lot more questions about your specific situation, but don't hesitate to ask.

 

Brassmonkey

[Sunwillcomeout]

Thank you, @brassmonkey, for your response and the link.  I read through it all.  I see that age can make a difference, some positive, some not.  Her thyroid test came back normal, so there will not be any adjustments to her thyroid medicine.  Her doctor also gave her a prescription for liquid Lexapro, which she is holding on to for now.  In case things get crazy.

That’s the big question.  Is there any advantage to reinstating Lexapro at a low dose to avoid POSSIBLE complications in the future?  Would that possibly cause more problems after two months for no reason?  I don’t know the statistics of what percent of people experience the post acute symptoms. She feels great right now and doesn’t want to reinstate.  

While I know she has done some reading on the subject, I don’t know if she realizes the severity of the symptoms others have experienced.  

 

[brassmonkey]

A new members first few post need to be approved by a moderator before they can be seen.  We do this so we can get and give proper information right off the bat, before other members can confuse the situation with a lot of "help and support".  Their contributions are very valuable but we need to get certain information to get things going in the right direction.

 

I thing reinstating a very small dose would be a good idea.  After a person goes CT there is frequently a "honeymoon period" of feeling great that lasts about three months.  It usually ends with a very bad crash that can take a very long time to recover from.  Avoiding that crash is very important.  Here is our link on reinstatement.

 

https://www.survivingantidepressants.org/topic/7562-about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/

 

and out tips on tapering Lexapro:

 

https://www.survivingantidepressants.org/topic/406-tips-for-tapering-off-lexapro-escitalopram/

 

It's a very good thing that her thyroid labs came back normal, many of our members have had problems in this area.

[Sunwillcomeout]

Thanks for the quick response. I’m sorry I have so many questions.

 

1. If she reinstated at 1 mg., how would we know that would be enough to ward off the crash?  There are no symptoms to eliminate, so how to find a starting point?

 

2.If if she took 1 mg. on the first day of the crash, do you think it would be a worse recovery than taking 1 mg.  now?

 

3. When you say “usually ends with a very bad crash”, what are the odds (approximately)? I know everyone on this site has experienced a crash.  Is there anyone who doesn’t crash after two years?

 

Thanks for the links.   Lots of good information in them.  I will share them with my daughter.

[Eastcoastgirl]

Why would you want to put her back on medication and run the risk of kindling/a more difficult withdrawal in the future if she is doing so well now ? I don't see the logic. I see reinstatement as an option for people who need to get out of uncomfortable withdrawal symptoms, not people who are doing very well. She is lucky. 

[Sunwillcomeout]

Hi @Eastcoastgirl,

Thanks for responding!  The reason I am wondering about reinstating at a low dose is because she went cold turkey and I am scared that she will have the crash after three months or so that is so often talked about here.  Maybe she is lucky, maybe not.  I don't know the likelihood of that happening, but it seems very common.  Does anyone have any facts/percentages on this?  Can anyone tell me if the kindling is more common than the crash that might be in her future?  Right now she is at the two month mark and we want to make an educated decision.

I hope you are doing well.

Sun

 

Edited November 13, 2021 by Karma
name update

[puthappinessfirst]

Hi Sun,

 

I see your predicament here. 

I crashed after my CT something like 4 or 5 months AFTER my last dose and I had no idea it was coming. 

I literally was fine one second and then the next I was suicidal and hysterical. No exaggeration. 

 

Your daughter may be lucky and quite resilient, she may not experience protracted WD. 

In my personal, non professional opinion, I probably wouldn't reinstate, but if WD symptoms do start to emerge, then you can be diligent and reinstate something small... 

I have no idea what the mg amount should be, that's just my personal opinion. 

 

If you do decide together to reinstate, then she must be diligent as to not reinstate and then go cold turkey again. 

No more jumping on and off... 

It's a hard path to navigate, but you are doing great!

 

❤️ 

[Sunwillcomeout]

Hi @puthappinessfirst ,

Thanks for responding! 🙂 I read a little of your history.  I hope your grandma is okay and things are going well!  

Your crash after so long being off is crazy to me.  It must have been a complete shock.  I'm sorry you experienced that.  It is exactly what I am worried might happen to my daughter.  However, I have not seen many histories of people on here who have been on medication for two years at the average dose.  I may be wrong about that, and would like to hear from them if they are here. You are right about no more jumping off!  Another thing I have learned on here is that it is best to reinstate the original medication if you can, and at a low dose.

I just wish I had a statistic to go by, how many have the crash happen to them.  Another thing Im wondering is if she is okay to start straight on the liquid version of lexapro since she has been off for two months.  No crossover from pills to liquid.

Have a great day.  I wish all the best for you.

 

[puthappinessfirst]

My crash was definitely crazy, yes, a complete shock. 

I immediately had to take 2 weeks off of work and I am still building myself back up from that horrific incident. 

I had never dealt with depression like that before, so it definitely wasn't a "relapse" as doctors like to say or think. 

It was protracted WD. Luckily I know that now. 

 

32 minutes ago, Sunwillcomeout said:

I just wish I had a statistic to go by, how many have the crash happen to them.

 

This is the problem. 

Doctors do not believe in long term WDs.

They also do not know proper tapering protocols and think it is ok to cold switch people from med to med. 

They're also very ill informed on side effects and adverse reactions. 

Because of this, we don't have any accurate statistics at all. Very unfortunate and misleading. 

[Kostas]

1 hour ago, Sunwillcomeout said:

Hi @puthappinessfirst ,

Thanks for responding! 🙂 I read a little of your history.  I hope your grandma is okay and things are going well!  

Your crash after so long being off is crazy to me.  It must have been a complete shock.  I'm sorry you experienced that.  It is exactly what I am worried might happen to my daughter.  However, I have not seen many histories of people on here who have been on medication for two years at the average dose.  I may be wrong about that, and would like to hear from them if they are here. You are right about no more jumping off!  Another thing I have learned on here is that it is best to reinstate the original medication if you can, and at a low dose.

I just wish I had a statistic to go by, how many have the crash happen to them.  Another thing Im wondering is if she is okay to start straight on the liquid version of lexapro since she has been off for two months.  No crossover from pills to liquid.

Have a great day.  I wish all the best for you.

 

Hi 

 I had been on citalopram 20 mg for a couple of years on average on and off. 

 

I was feeling fine on it, but after some time I was deciding to be off it, since I was worried about the long term effects. 

 

I tried to stay off 3 times, and within a year I was forced to go back to the original dose, since gradually the withdrawal symptoms were building up, becoming unbearable. 

 

Fortunately, every time and within a month from reinstating , I was fine again! 

 

Finally in my fourth attempt, I weaned it very very gradually in a period of 6 years and it was possible to be off it. 

 

Now 7 years after without any drug I am fine, although I had a crash on 4 years off, lasting few months! 

 

Fortunately, I understood what was going on, and I did not reinstated this time. 

 

[brassmonkey]

Statistics and hard evidence are the one thing no one can provide.  Up until recently ADWD wasn't even recognized by the medical community, and even now most doctors will say it doesn't exist.  This is slowly changing, but it will be many years until proper studies have been conducted and patterns start to be accepted.  For now we are using past information from dealing with the WD experiences reported here and on other sites to build a system that seem to be working.

 

I can't give you numbers on how often a crash follows a ct.  But having worked with many thousands of members we have found that most of the time an unexpected crash will happen three to six months after a CT. That crash will usually be very sever and take many months to stabilize and then several years to resolve. During that time the symptoms will range from bad to debilitating.  Our aim is to make ADWD as "comfortable" as possible.  We can't eliminate the symptoms, but there are many good ways to minimize their impact.

 

After a CT there is a very short window during which a reinstatement holds a good chance of being successful.  However, that reinstatement can not be at the original full dose, as that can cause what is known as "kindeling".  This is a very sever reaction to the drug that will be debilitating for a very long time.  We don't wish it on anyone.  Because of the nature of how these drugs work a very small reinstatement dose, generally in the 1mg range, seems to do the trick to reduce symptoms, satisfy the body, and lower the risk of a future crash.

 

If you do a search and read the stories of members who have CTed you will find almost to the person they wished they hadn't.  CT can be a very long and unpleasant recovery.  Frequently taking longer than it takes to do a reinstatement, stabilization and proper taper.

 

[Leo1983]

If you read the CT success stories not all have taken SEVEN years to recover. 

 

There are quite a few that have recovered within 2 years. 

 

Good luck.

[Leo1983]

Aeroman is a good 1 he took 3 years.

 

Undiagnosed 1. He took 2 years.

 

Pug he took 2 and a half years.

 

Ethan he was on Lexapro 9 years and cold turkeyed. Recovered in 2 years. 

 

 

[Leo1983]

I am not saying CT is a good option. Just all these people above recovered before seven years. 

[Sunwillcomeout]

@brassmonkey, is that window 3 months?  If she reinsured at 1 mg., I’m assuming she could feel the affects, but how to know whether to increase from there for a taper or taper from there?

[Sunwillcomeout]

Thanks @Leo1983.  I have read Aeroman’s posts.  I’ll look at the others.  Thanks for pointing me there. I feel sick about this and reading what people have gone through.  I wonder if there are people who crashed after 6 months.

[Leo1983]

i crashed at 3 month. it was hell twice over! 12 month out i still aint back to normal. BUT im off the drug!

[brassmonkey]

Hi Sun-- I've asked for assistance from the other mods as this isn't a typical situation where reinstatement is concerned.  We usually get people who have experienced the crash and want to get back on track.  Let's see what the others have to say.

[Sunwillcomeout]

Thank you @brassmonkey.  I appreciate your help and asking for further opinions.  I have a lot of respect for the work all of you do here.

 

[Dejavu]

I'm someone who was on 50mg sertraline for a few months shy of two years, when I did a rapid taper (3-4 weeks, which is viewed as a cold turkey) on my doctor's advice. In a way I was lucky in that I crashed one month later rather than three, so it was not too late to reinstate. I may have reinstated at too high a dose (50% of my dose - 25mg), but I hadn't yet found this site. At any rate, it took me a good 5 months to see even the beginning signs of stabilization. I am now 7 months on, and finally improving.

 

I'm not trying to alarm you, but I must stress that it has been quite hellish at times. I have had all of the following symptoms to varying degrees: anxiety, depression, suicidal ideation, dizziness, balance problems, blurry and skewed vision, eye floaters, derealization, depersonalization, loss of appetite, dramatic weight loss, tremors, weakness, fatigue, insomnia, full-bladder sensation (like a bladder infection feels), internal tremors, burning mouth, muscle aches and twitches, acne breakouts, extreme dry eyes, hair loss, cold symptoms, and morning cortisol surges. Many of these have eased considerably, some have completely resolved, but none have been pleasant. I was bedridden, unable to work, and unable to even sit up for quite a while. I even had to eat lying down. This is no exaggeration. Although I've improved trememdously, I'm still not stable enough to begin a taper yet.  

 

Just to give you the full picture, here are some factors in my situation that may differ from your daughter's. I am more than twice her age. Also, I was a year post-withdrawal from klonopin when I crashed (I was put on klonopin in 2016 for grief - several close loved ones passed within a short time). I was put on sertraline to "help" with klonopin withdrawal. I have never had mental health issues prior to this. And finally, I had genetic testing done several months ago which indicates I'm a very slow metabolizer of all SSRIs. I have no idea whether any of this plays into the difficulties I've experienced, since, as Brassmonkey has stated, little to no research has been undertaken up to now by the medical community on this epidemic.

 

Forgive the length of this message. I just wanted to give you as much anecdotal information as possible. I have so far lived a very good life with few regrets. However, I do deeply regret stopping this med so abruptly. Had I known what was in store for me, I'd never have done it. 

 

The frustrating bit of this is that there are no definitive answers. Each case is individual. But that being said, it seems more likely than not that a crash will result from a cold turkey. I believe that, if she were my daughter, I'd want to try to head that off if at all possible. I wouldn't wish this on my worst enemy, much less my child. I advocate a tiny reinstatement, and if that is well-tolerated, a 3 or 4 month hold, and then a slow, gradual taper. Better safe than sorry, in my opinion.

 

I'd be glad to answer any other questions you have about my situation. But Brassmonkey and  the rest of the mods here are much more knowledgable and able to make recommendations based specifically on your daughter's case. I have learned the hard way to listen to the advice they give. It works. 

[Sunwillcomeout]

Quote

 

Hi @puthappinessfirst ,

Thanks for responding! 🙂 I read a little of your history.  I hope your grandma is okay and things are going well!  

Your crash after so long being off is crazy to me.  It must have been a complete shock.  I'm sorry you experienced that.  It is exactly what I am worried might happen to my daughter.  However, I have not seen many histories of people on here who have been on medication for two years at the average dose.  I may be wrong about that, and would like to hear from them if they are here. You are right about no more jumping off!  Another thing I have learned on here is that it is best to reinstate the original medication if you can, and at a low dose.

I just wish I had a statistic to go by, how many have the crash happen to them.  Another thing Im wondering is if she is okay to start straight on the liquid version of lexapro since she has been off for two months.  No crossover from pills to liquid.

Have a great day.  I wish all the best for you.

 

[Sunwillcomeout]

@Dejavu,

Thank you for your reply and taking the time to explain your situation.  I am sorry you are experiencing all of this.  I can't believe this antidepressant crisis isn't all over the news.  I think it IS a crisis considering how many people are on an antidepressant.  Stay positive!

The question I need answered, and I don't think it CAN be answered, is how many people are able to go off antidepressants with a fast withdrawal and not suffer a crash.  

Sun

[Sunwillcomeout]

@Dejavu,

I have never heard of a genetic test that shows how you metabolize SSRI's.  What does that mean for you when you say you are a slow metabolizer?  Thank you for reading this.  I don't want to be a bother to you.

Sun

 

[Dejavu]

No bother at all. Ask all the questions you want. That's what this site is here for.

 

Slow metabolizer status means that it takes longer than normal for my body to clear SSRIs from my system. The drug piles up in my system, which can - and does in my case - lead to side effects while taking the drug. It might also explain why people seem to have an initial  "honeymoon period" between cessation of the drug and the onset of withdrawal. In my case, I felt fantastic for a month after stopping. I mean off-the-charts wonderful. Until the moment I didn't. Withdrawal didn't sneak up; one minute I was great, the next I was slammed with crippling anxiety and visual disturbance. So please don't read anything into the fact that she's feeling well now. 

 

Your daughter's MD can order genetics testing. Insurance covered mine, but if hers does not, the cost is about $350. One very important caveat: the test is NOT a predictor of likelihood of withdrawal. It was designed as a guide to determine which drug is best suited to a patient. Mine was only done after the fact because my doctor was contemplating switching me to another drug, which, thank goodness, I ultimately declined to do. I don't know that it would change anything in your daughter's case. 

 

I really don't mean to come across as all doom and gloom. I just don't want anyone to go through what I and many others have. 

[Dejavu]

53 minutes ago, Sunwillcomeout said:

The question I need answered, and I don't think it CAN be answered, is how many people are able to go off antidepressants with a fast withdrawal and not suffer a crash.  

Sun

You are correct that it cannot be answered. However, I think it is more likely than not that, if not an outright crash, withdrawal in at least  some form will occur, and it is generally quite unpleasant. It is also well-documented that slow tapering tends to provide a much smoother ride down than an abrupt cessation. The only known method to alleviate withdrawal symptoms is reinstatement of a small amount of the same drug that was cold-turkeyed. The sooner reinstatement occurs, the better chance it has of working. 

[Sunwillcomeout]

@Dejavu,

Thanks for that great explanation!  I was thinking that 3-6 months after stopping an antidepressant was the average time for a crash to happen.  If you crashed one month after you stopped, that seems fast.  Am I missing something?

I'm so glad you are starting to feel better.  

Thank you!

[Dejavu]

No, you aren't missing anything. I have no explanation as to why I crashed so quickly, except that I was on and off and changing doses for the last few months before stopping, and my central nervous system was probably so destabilized by that and by all my grief. I'm glad it happened quickly, though. Some people crash months afterward and it's then too late to reinstate. And looking back, I can see that I actually WAS having withdrawal symptoms that I mistook for grief and stress at the time. Increased anxiety and muscle tension, for instance.

[Sunwillcomeout]

Hello @brassmonkey,

im wondering if you have had a chance to discuss this with the other mods?

i feel like her age, the duration of the meds, and the fact that she hasn’t gone off, on, or switched (kept it simple), may be in her favor.  It may also be hopeful thinking.  I’ll be looking forward to hearing from you.

[Sunwillcomeout]

Hello.  I am wondering, brass monkey, if you have any further thoughts about reinstating vs. waiting.  You mentioned speaking to the other moderators about this situation, and I'm wondering if you gathered any further advice.  My daughter is 69 days off Lexapro and is feeling good.  We are creeping closer to the 3 month mark, however.   Reinstating seems like a risk, especially when she feels good,  yet so does not reinstating.  Any further help is appreciated.

[brassmonkey]

Hi Sun-- sorry it's taken so long getting back to you. We've been totally crushed with a wave of new members.  I did get to discuss things with some of the other mods. The general thinking is to ride it out and see what develops.  If she is feeling fine right now, just leave things as they are.  Then if symptoms start to show up down the road a very small reinstatement, like in the 1-2mg range should take the edge off of things.  It's a really tough call because I would hate to see a crash later, but it would be just as bad to see her have a bad reaction to an unnecessary reinstatement now.  This is where her gut instinct will come into play.  How does she feel about it?  When it comes down to it it's her call to make.

[Sunwillcomeout]

Thanks for the reply and for checking with the others as well.  I think everyone that I’ve talked to personally thinks I am overreacting and everything will be fine.  My daughter seems content with the way it’s going now.  We will leave it at that, then.  If anything goes awry, I’ll check back for advice.  Thanks so much.