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Fizer

Hello everyone,

Background:
I took Escitalopram (10mg) for about 22 months starting in January 2017. I got burned out around July 2016 which led to a panic disorder which got worse until I chose to go for the meds in january 2017. So the main reason for treatment was anxiety & panic. August 2019 I decided to start tapering down, as the panic attacks had worn off for quite some time, and I wanted to get rid of the fog the Escitalopram gave me. As I saw in other introduction posts, it was suggested to add my dosages/dates in the signature so you can find them there. In short I first tapered from 10->5 mg (which I stayed on for about 2 months, and then took about 6 weeks to taper from 5 to 0mg using liquid drops.

I did not experience many side or withdrawal effects during the tapering, or in the first month after discontinuation. However after about a month (half december 2019) I started to feel a sadness/emptiness which gave me a little concern. This has slowly gotten worse over the past 6 weeks where it really feels like a full depression. (vulnerable to negative emotions, sudden crying spell - I hardly ever cry/cried, racing negative thoughts, worrying about my health) which in turn leads to me getting nervous over possibly relapsing. I have been to my GP to talk about this, and she has suggested that with previous clients of her on Escitalopram, some have also experienced a 'rebound depression''. We have agreed to keep a close eye on it for the coming months to see how it resolves itself.

Now what gives me a little hope is that the symptoms I'm experiencing currently are mainly depressive, whilst my inititial treatment was for anxiety and panic. I have no trouble being in crowds or outside, but instead have trouble being alone (which is pretty much the opposite of my situation before meds). What worries me is that it's getting worse, and I'm not sure what i'm in for. I hope I can find some people on here to learn from some similar experiences, possible outlook and advice if possible.

Fizer

 

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Gridley

Welcome to SA, Fizzier.  I'm sorry you're going through this.

 

Your taper from 10mg escitalopram to zero over approximately 12 weeks was much faster than what we recommend (which is  no more than 10% of current dose every four weeks)., resulting in the withdrawal symptoms you are now suffering.  Withdrawal symptoms are often delayed after a too-fast taper.  

 

Delayed onset of withdrawal symptoms

 

Depression is a common withdrawal symptom. The vast majority of doctors know nothing about safe tapering or withdrawal, which they don't believe exists, and will almost invariably attribute symptoms to something like "return of the underlying condition" or, as in your case, "rebound depression."  That will lead them to prescribe another drug, then when that doesn't work, yet another drug, putting you on the drug merry-go-round from which many many patients never emerge.  The fact that you never before experienced the symptoms you describe strongly argues they are due to withdrawal and not "relapse." (How can you relapse into something you never had before?)

 

So that you have a better understanding of what you're experiencing, here is some information on withdrawal and healing.

 

What is withdrawal syndrome.

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF)

 

When we take medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.  

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

Reinstatement of a very small dose of the original drug is the only known way to help alleviate withdrawal syndrome.  The only other alternative is to try and wait out the symptoms and manage as best you can until your central nervous system returns to homeostasis.  Unfortunately no one can give you an exact timeline as to when you will start feeling better and while some do recover relatively easily, for others it can take many months or longer.  

 

Reinstatement isn't a guarantee of diminished symptoms for everyone but it's the best tactic available.  If 'm reading your post correctly, your last dose was in mid-November, so you're still in the time period where reinstatement predictably works, up to 3 months after last dose.  We usually suggest a much smaller reinstatement dose than your last dose.  These drugs are strong, your system has become sensitized and If you take too much it may be too much for your brain.  Then, once you've stabilized on the reinstated  dosage, which can take several months,  you can begin a 10% per month taper down to zero.  Why taper by 10% of my dosage?

 

Please read:

 

About reinstating and stabilizing to reduce withdrawal symptoms. -- at least the first page of the topic

 

If you are interested in reinstatement, I would suggest a reinstatement of 1mg escitalolpram--no.more.  It takes a little more than a week for the reinstated dose to reach full state in your blood.  The following link explains how to get the 1mg dose of escitalopram, either making your own liquid from the tablet or cutting and weighing the tablet.

 

Tips for tapering off Lexapro (escitalopram)

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems.

 

This is your Introduction topic, where you can ask questions and connect with other members.  We're glad you found your way here.

 


 

 

 

 

 

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Fizer

Thanks alot for the information provided!


It is good to know I have a different option than waiting it out. I will take this into account when I discuss it with my doctor this week. My doctor has been quite supportive in how I wanted to get off the medication switching to the drops etc. (in a way it was my own lack of research that caused not doing a slower taper, most easily found sources suggest tapering but in a much shorter time). So I think we can have a sensible conversation about it and go from there.

 

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Fizer

Hello, I have a question regarding reinstatement which I would like some advice on so I can use this in my discussion with the doctor. 

 

- I switched halfway my tapering from tablets to liquid drops (at the 5 mg point). Which of the two would you guys recommend if I want to possibly re-instate at a very small dose (0.5mg or 1mg)? And how do I get the smaller doses (the liquid I still have is 20 mg/ml which translates to 1 mg per drop) 

 

And a Withdrawal-related question: 

- I am a (pack a day) smoker, and have noticed my tolerance for cigarettes seems to have decreased. Smoking my regular amount seems to intensify my symptoms, and my body is fighting it if I smoke more than a few  a day (I'll develop a bad cough  even just thinking about the next cigarette). Just out of interest, has anyone experienced something like this? Could of be the hightened sensitivity to substances?

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Gridley
36 minutes ago, Fizer said:

Which of the two would you guys recommend if I want to possibly re-instate at a very small dose (0.5mg or 1mg)? And how do I get the smaller doses (the liquid I still have is 20 mg/ml which translates to 1 mg per drop) 

 

I would suggest the liquid since that is what your body was accustomed to when you stopped and also because it's easier to get the precise very small amounts you'll need for your reinstatement.

 

How to get the smaller doses is explained in the following link.

 

Tips for tapering off Lexapro (escitalopram)

 

 

36 minutes ago, Fizer said:

Could of be the hightened sensitivity to substances?

 

If we have heightened sensitivities in WD to supplements, food, caffeine and alcohol, it stands to reason that the same principle would to apply to nicotine.  One of the posters in the following thread, GiaK, wrote about her heightened sensitivity to cigarettes.

 

Smoking cessation, nicotine, e-cigs - Surviving Antidepressants

 

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Fizer

Little update: 

 

I have decided to re-instate 1 mg of escitalopram. It took some convincing of my doctor (she was pretty certain it will only have effect from 5mg upward and suggested that) but she is ok with me trying 1mg anyway.

 

Is it correct that if reinstatement is effective I should experience some sort of improvement of symptoms around the 4-7 day mark?

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Fizer

Small update: started re-instatement of 1mg on tuesday, so now on 5th day.

 

Good: The general nervousness and spiralling thoughts have greatly diminished since friday. I am much more relaxed than weeks before. Brain is even a bit sluggish, but prefer that over the 400% speed it was running. 

 

Bad: with the 'mental improvement' comes quite strong fatigue/ muscle weakness. A 10 minute walk tires me out physically (try do like 3 a day) also since friday. Probably the withdrawal has tired me out quite a bit and I need some extra rest. I hope this will improve coming days. 

 

Think I'll keep it at 1mg for now and see where it goes. Good idea?

 

 

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Gridley
26 minutes ago, Fizer said:

hink I'll keep it at 1mg for now and see where it goes. Good idea?

 

The updose is working.  Yes, stay at 1mg.  Symptoms will slowly improve.  You'll have windows and waves (ups and downs).

It'll be a gradual process.  If you are tired, pay attention to your body and don't push it.  

 

Doctors don't know anything about reinstatement dosages but it was good she let you try it.  5mg would've been way too much.

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Fizer

Update: day 9 on 1mg. 

 

Nervousness and feeling down has decreased I'd say on average about 30% since re-instating. Some days better than others. However I've also taken a break from work for the past 1,5 weeks which probably also relieves some stress. 

 

Energy/tiredness has improved since the weekend. 

 

I think I will need more to get to a level that is balanced enough to be able to pick up work a bit again, Re-instating 1mg didn't give bad (mental) side effects except for nausea and tiredness, so it doesn't feel like I'm extremely sensitive.

 

Would updosing to 2 or 3mg be a good idea to see where that takes me? Or should I wait this out longer? I'm discussing with my doctor again tomorrow.

 

 

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Gridley
2 hours ago, Fizer said:

Or should I wait this out longer?

 

I would wait it out a bit longer.  The update seems to be working but I'd give it a few more days to see how things go.  You can always updose a small amount more (2mg, definitely not 3 but let's wait).

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Fizer
27 minutes ago, Gridley said:

 

I would wait it out a bit longer.  The update seems to be working but I'd give it a few more days to see how things go.  You can always updose a small amount more (2mg, definitely not 3 but let's wait).

 

Ok I'll give it some more time and see how it progresses. I'll check back in at the 2- week mark.

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Fizer
On 2/19/2020 at 11:21 PM, Gridley said:

 

I would wait it out a bit longer.  The update seems to be working but I'd give it a few more days to see how things go.  You can always updose a small amount more (2mg, definitely not 3 but let's wait).

 

I had some ok days but the underlaying feeling of somberness/restlessness remains. Get quite upset over small setbacks. Went to work yesterday for a little bit which was pretty scary. I think I need a bit more to really stabalize. 

 

2mg?

 

 

 

 

 

 

 

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Gridley
1 hour ago, Fizer said:

 

2mg?

Sounds fine.

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Fizer

Update: did some very short days at work this week, but the days after I'm feeling much worse again. I have stints of feeling very depersonalized/flat like my brain is numb. Now 10 Days on 2mg. Not sure what to do. Right now I don't know this re-instatement is working (or if I really should give it more time). Could it be that I need to give it atleast 6 weeks for it to really make a difference or might this just be a too small dose to fight my depressive symptoms? 

 

In other words: is it more common that I should be noticing improvement by now or is it normal that takes much longer?

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