nocturnaldk: escitalopram / Lexapro - trying without cross-taper to fluoxetine

[nocturnaldk]

Hi greetings all!

 

I have been on Escitalopram for many years. Originally like many I started on 10 mg - but later 2,5 mg became my "stable dose" for close to a decade. I discovered this dose when I wanted to reinstate... I remembered getting insomnia the first time I started SSRI's so thought I would start off easy because I was already having insomnia and panick (didn't associate it with WD, it was long after quitting) so started off on 2,5 mg and found it in 1-2 days worked magically and I slept like a baby. Then stayed on it and found it didn't "poop out" like the 10 mg had done.

 

So I took 2,5 mg daily for almost a decade, I have stopped 4 times over this period but not for that long... I have handled WD OK via cross-taper to Prozac but within a few months I develop extremely bad anxiety (even had two full-blown panic attacks the first time), so I would reinstate the 2,5 mg, which always solved everything like magic. As mentioned, these 4 times I always did it by cross-tapering på prozac. So I would take prozac 20 mg for a few days  before quitting for good. This has resulted in typical but weak/tolerable WD (compared to quitting cold turkey, which I have also tried) for about a week. Then I feel fine for a few months, before crashing again. So my theory is that what is happening is that the symptoms return when the prozac is finally about to fully leave the system (which can take months). So this time I would like to do a complete coming off escitalopram, without cross-taper. So at least I know that the drug is now out of my system (within a few days) and I can start adapting from there. Rather than not knowing when I am actually off the drug and thus unable to judge if I have WD or return of original depression (which is what I thought in the past).

 

So during Easter I moved to 1,25 mg. After a few days I got classic WD  (mainly dizzyness, some anxiety, headache, bursts of anger, disturbed sleep) however it was tolerable (not as bad as going off cold-turkey which I have also tried long ago) and it went away after 1 week.

 

Then three weeks ago I went down to 0,6 mg (cutting as best I could). Again some WD, same symptoms as before though no anxiety but a lot of anger/irritability. Symptoms disappeared after 1 week (though there may have been some lingering irritability but hard to say if it was the taper). Anyway there I felt stabilized at 0,6 mg i.e. 1/4th of my stable dose. Since cutting the pills further with precision would be hard, I decided to now completely stop.

 

So yesterday I skipped my dose and same today. Felt fine until 48 hours until the last dose. Started feeling quite bad WD: Bad headache, dizzyness, traces of anxiety etc. So I panicked a bit and took a look in the medicine cabinet: Took (all in sane doses) a vitamin B-complex, Cholone, magnesium, Vitamin D, and 500 mg L-tryptophan (the latter which I happened to have around but have never actually tried before). Didn't do a thing for some hours. Then I went for a run - headache got worse so had to take some breaks... but after 20 minutes or so the headache and the other symptoms subsided. And this is where I am no, feeling sort-of OK Now I don't know if it was the running or the supplements kicking in. But hope to get some good sleep and will see how the symptoms are tomorrow. I have the day off tomorrow to so that is why I am doing the taper now. If it gets bad, I may try for a run first to see if this cures it, then if that doens't work, trying the supplement combo again. However, I hope I am not messing up my adaptation process by doing the supplement - however, the supplements work by raising the serotonin (I would think) whereas escitalopram blocks re-uptake so at least it's not exactly the same effect they have (so adaptation might still occur). 

 

Any thoughts, also regarding my history with cross-taper?

 

 

[nocturnaldk]

By the way I should add that I also have 5-htp in the medicine cabinet (tried a low dose a few times in the past, didn't seem to do much). So I do have some things to try if I should be hit by another wave again - is 5-htp better/worse than L-tryptophan? I went with L-trypto because it seemed more natural and would ensure I wouldn't get unnatural levels of serotonin, which the whole point is to get out of

[Shep]

Hi, NocturnaldK.

 

Welcome to Surviving Antidepressants.

 

First, I want to caution you against adding in so many supplements, especially all at one time. Some of them can cause all sorts of problems for people going through psychiatric drug withdrawal.  Please see:

 

5-HTP (5-hydroxytryptophan) and l-tryptophan

 

Scroll through this list below and you'll see links to individual vitamin topics. 

 

Important topics about tests, supplements, treatments, diet

 

On 6/9/2019 at 5:26 PM, nocturnaldk said:

Any thoughts, also regarding my history with cross-taper?

 

I think you're wise to not cross taper this time, but to come off the escitalopram directly. Some people are able to cross taper, but for others, it doesn't go smoothly. When you cross taper, you go into withdrawal from the previous AD. For some, the Prozac will cover the withdrawal, but not always. 

 

I'm a bit confused about which day you actually stopped the escitalopram. Was it yesterday? If so, you may want to restart it again and taper a bit lower. Antidepressant withdrawal can have a delayed withdrawal for several weeks or even several months. Escitalopram is a very potent SSRI. Please see this thread about occupancy. As you'll read, the lower doses require going especially slow and careful: 

 

Why taper? SERT transporter occupancy studies show importance of gradual change in plasma concentration

 

If you decide to resume taking escitalopram (and i really hope you do), here is some information for your taper, once you've stabilized.

 

Tips for tapering off Lexapro (escitalopram)

 

Why taper by 10% of my dosage?

 

How psychiatric drugs remodel your brain

 

Healing from antidepressants. Patterns of recovery video (4 minutes)

 

The Windows and Waves Pattern of Stabilization

 

On 6/9/2019 at 5:26 PM, nocturnaldk said:

Rather than not knowing when I am actually off the drug and thus unable to judge if I have WD or return of original depression (which is what I thought in the past).

 

If by "original depression", you mean the chemical imbalance, this has been debunked. Please see:

 

Again, chemical imbalance is a myth. Stop the lies, please.

 

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Please continue to use this thread to document your taper and to ask questions. 

[nocturnaldk]

Hi shep thanks for responding. Sorry for being unclear! :) I took last dose Friday evening (so Saturday evening is when I "stopped" by not taking the dose). So when I wrote the post (Sunday evening) I was 48h since last dose but had "solved" the symptoms using the supplements. Monday I felt quite OK - had a bit disturbed sleep but not too bad, and I didn't get brain zaps or other things I usually get with WD. Don't know if the 500 mg trypto from Sunday was still doing anything. But Tuesday morning and midday I felt some WD, mild brainzap-like feelings in the hands etc. So I took another 500 mg l-trypto around 11AM. Didn't do anything immediately but by 7PM I was doing OK again, just a bit tired due to poor sleep.

 

Regarding the taper, you said you think I stopped too early - but I was at 0,6 mg. What target should one go for with escitalopram?

 

I think I will stay the course for at least a few days to see how it plays out. I have still only had mild symptoms and I am early in the withdrawal - by my calculation about 80% of the drug is out of the system now so there's still a bit to go. If I follow the pattern of the last drops and symptoms resolve 1-2 weeks then I will not reinstate. But if my symptoms get much worse than they are not I will reinstate. How does that sound? If I do reinstate, what dose would you take? I was thinking trying 0,6 mg. I would lilke to go lower given that my WD-threshold is probably lower than that, but hard to divide the pills further (I am using 5 mg tabs and 0,6 mg is already 1/8th of a pill!)

[nocturnaldk]

Just an update: It is going really well now. Until Sunday (2 days ago), I continued to have some WD-symptoms, especially a lingering anxiety-feeling and some sleep problems. I tried to control it with L-Tryptophan and it helped somewhat. However sunday afternoon, monday and today I have felt really, really good - so I haven't taken L-tryptophan (or anything else) since Sunday. I sleep well and there's no anxiety. I do note a slight "zap"-like feeling a few times a day that definitely feels WD-related - it's not that bad and it's not even in the brain, more like an occational, small buzz in the left hand... on previous withdrawals I also tended to feel the zap both in the brain - the worst part - and in the left hand... so that I only feel it very slightly in the left hand is really good! I really hope this continues... it seems to be going better than the past WD's with taper to fluoxetine. So far it seems lowering to 0,6 mg/day, stopping, and then covering symptoms with exercise + L-tryptophan was the answer for me. I am not unrealistic, I know I may not be out of the woods because I have in the past relapsed in a few months. But at least this acute phase is going really well and I am feeling better than in over a year, even while on the SSRI. So with this in mind I don't think I need to reinstate now.

 

Wish you all have a good day out there and good luck with your WD-issues -  If OK I would like to continue updating on how it is going! 

[nocturnaldk]

Hi Just to follow up again... to recap, I took the last dose of escitalopram on 7th of June 2019. It was going quite well until around maybe 15th of July where it seems a second "wave" set in. It was completely unlike the main discontinuation syndrome (i.e. brain zaps etc.). The symptoms were:

 

1) General unhappiness - not seeing anything positive in life

2) Difficulty concentrating, memory issues

3) A lingering feeling of anxiety

4) Very low self-esteem. It happened during my vacation and I thought I was a failure, and wouldn't be able to return to work. That I was simply too stupid to do the work etc.

5) Nightmares, poor sleep

 

As mentioned earlier I have previously experienced similar "delayed" symptoms when quitting an SSRI and I thought it was due to the cross-taper to Prozac (meaning the syndrome was delayed), but turns out that's not so, because this time I didn't cross-taper.

 

In the period 15th July and until now it was been a bit up and down. Some days were as described above, other days have been OK. But overall it seems the bad days became worse and worse, especially with regards to the anxiety. I even had a feeling of panic on the plane home when the plane took 120 minutes just to take off and I couldn't go to the toilet (and I already had to go at the gate!). Fortuntately it I managed using old techniques I remembered (and talking intensively to the woman nearby etc.) to fend it off, but it was not fun. Some days I were thinking of re-instating escitalopram. I have tried various things to cover for the symptoms: Vitamin B complex, 5-HTP, L-tryptophan etc. It seems (but high uncertainty) 5HTP (100 mg in morning, one 100 mg in evening) was the most efficient in relieving the sensations, but I took the VitB complex at the same time. But one thing that also helped a lot was self-help CBT techniques. I.e. writing down my concerns and thoughts and trying to put them in perspective etc. Using the 3-3-3 method for pulling my thoughts of the cloud. Trying some positive thinking. Maybe that or some combinatino of it or maybe just time passing helped me through,  because today and yesterday I haven't taken any supplements and I am still feeling OK-ish. I am feeling the best in at least weeks and I still haven't re-instated. My feeling is that my symptoms are to some extent caused by my mind needing to adapt to the world without SSRI - i.e. finding thining patterns to cope withthe daily frustrations/anxieties/uncertainties etc. And that's where in the past I have reinstated. This time I was lucky it happened during my vacation and I actually had the nerve to let it go on and see it develop, knowing that I didn't have to function at a high level.

 

I am returning to work in a week. I will let you know how it goes. Of course any thoughts are welcome but my purpose is also to document this journey. Maybe in the future, someone can find things that they can use just as I have found.

[nocturnaldk]

Just wanted to post another update. Around July 26th (some days after above post) I got a bad relapse in WD symptoms: Anxiety, depression etc. much like I had described for earlier WD waves. Even worse, this time it also contained extremely poor memory and difficulty concentrating. I would forget the simplest thing. Further, I even had trouble speaking. It was like my mouth was sort of frozen and was stiff. It required effort to articulate words. At the same time, my ability to form sentences was also heard. These symptoms were both on workdays and weekends - usually I always improve a bit on the weekend due to the reduced stress, but not so in this case (for the weekend 3rd-4th of August). L-tryptophan and 5-htp seemed to make it worse, if anything.

 

I was seriously considering reinstating but decided I would try everything else before doing so. One of the things I did was to completely quit coffee. I now drink only black tea. I have a mixed history with respect to coffee, but I have found overall it has worked to worsen symptoms, but in good periods (mainly those on AD) I have been able to tolerate it. I don't know if that was it, but it turned around 6th of August. It was almost like a spontaneous remission. I am feeling better, the memory and speech problems are completely gone, I have more energy. In fact, feeling better than before this latest wave started. I don't know if it was the coffee thing or just "waiting it out". There's also another thing I will discuss above.

 

I should add, that on 30th July I have started an extensive resistance training program (I committed to it some weeks before the bad wave set in)... I almost couldn't drag myself in, because I felt so bad. But given many of the new symptoms were with memory and my brain felt toast, I thought I might as well do some physical training, so I dragged myself in. I felt extremely sore everywhere the first days etc. but going better now. I just wanted to add it, because the resolution of my wave came one week after starting this. So it could be it actually triggered some useful adaptations. I am not using any supplements for the time being. 

 

So some advise for future (and others): Consider quitting coffee (replacing with tea worked OK for me), consider some resistance training. Like 4x10 in 4 different types, every other day, enough to make you sweaty and maybe even sore the next day. 

[nocturnaldk]

Hi, don't know if anyone is reading but just wanted to do a quick follow-up. Still doing great, I haven't had any relapses since early since mid-august. As you know, I started tapering in April and quit completely early June, so I am now 4,5 months past quitting. It seems the worst part was 1,5-2 months after quitting (where I was very close to re-instating), and WD symptoms disappeared after 2,5 months. Of course I have ups and downs like everybody else but nothing like WD, and certainly not worse than while on the SSRI. I know everyone is different but at least I can say, even if you feel completely screwed 2 months in (memory seems to be getting worse, bad anxiety etc. and everything I had above - despite a taper) there's hope and it isn't necessarily far away. 

[Len189]

Glad to hear it! I hope everything continues to go smoothly after your taper.