KaraDawn: breast cancer treatment and tapering off 10 mg generic escitalopram (brand Lexapro)

[KaraDawn]

Hi!  I just joined this site.  I'm currently on my 9th out of 25 radiation treatments for stage 2b breast cancer.  I've completed a double mascetomy, 4 bi-weekly treatments of A/C Chemo treatments, 12 weekly treatments of Taxo (Chemotherapy) and am now going through radiation treatment.  Afterwards, I will be on AI, a type of hormone blockers for estrogen/progesterone positive, HER2-, breast cancer.  I started on 10 mg of lexapro while going through chemotherapy.  I don't want to be on this forever.  I would like some advise for anyone else that is in my situation.  I know my brain is starting to heal from the chemo and I'd like it to heal also from using lexapro.  What is the safest way to get off of this?  Is there any tapering strips that are available for us in the U.S.?  Or is measuring the dry pill powder and liquid versions the only way.  It all seems so complicated.  I started at the beginning of October 2019.  This will be my sixth month being on it.  Please help?  My mind is so consumed with not only cancer but now this drug.  I just want the easiest way to do it and from what I've read, reducing by 10% weight seems the best way to do this.  But, do I need to purchase empty gel capsules to make at least four weeks of one dose for each taper?  Thanks for any help and suggestions!

[Gridley]

Welcome to SA, KaraDawn.  I'm sorry you're going through all of this.  We'll be happy to help you taper off Lexapro.

 

Is there a point in your treatment when you'll be under a bit less physical stress, perhaps after the radiation?  That's not to say you can't start tapering now, but if you're under less physical stress, it might be more comfortable for you.  It's to your advantage that you've been on the drug for such a short time --and that you contacted us before beginning your taper.

 

Regarding the tapering strips, they're not made in the U.S,, only in the Netherlands.  You'd need a prescription from a cooperative doctor to send to them.  Here's a link so you can learn more.

Tapering strips for psychiatric drugs being produced in ...

We recommend tapering by no more than 10% of your current dose every four weeks.  

 

Why taper by 10% of my dosage?

 

An alternative tapering schedule that we also recommend is four weekly reductions followed by a 2-week hold.  It's gentler but a little slower.  I've used this method to taper Lexapro.

 

The Brassmonkey Slide Method of Micro-tapering

 

4 hours ago, KaraDawn said:

I just want the easiest way to do it and from what I've read, reducing by 10% weight seems the best way to do this.  But, do I need to purchase empty gel capsules to make at least four weeks of one dose for each taper? 

 

The following link is specifically about tapering Lexapro, including how to get the non-standard doses you'll need for your taper.

Basically, it's a choice between weighing using a digital scale (this was my method), making your own liquid or having a compounding pharmacy make your doses.  The latter is the easiest method but can be expensive ad may not be covered by insurance.

 

Tips for tapering off Lexapro (escitalopram)

 

I can't say which is easier between liquid and weighing since I've only had experience with weighing.  Read the link above and see which seems more do-able for you.  If you decide to go with weighing, many members (including me) use the AWS Gemini-20 scale, available Amazon.  It's accurate and not difficult to use.

 

The GEMINI-20 Scale

 

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 (glycinate is a good form) 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) 

 

When you're ready to taper, 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.

Edited March 3, 2020 by manymoretodays
removed excess white space

[KaraDawn]

So, first step is to get the scale.  Get an average weight of a few pills.  Then, lower the weight by 10%.  Stay at this weight for how long? Four weeks?  If so, I would have to make gel capsules of that amount for four weeks right.  Then drop again another 10% weight for another four weeks?  Does this sound right?

 

 

[manymoretodays]

Hi KaraDawn,

And welcome aboard from me too.

 

9 hours ago, KaraDawn said:

Hi!  I just joined this site.  I'm currently on my 9th out of 25 radiation treatments for stage 2b breast cancer.  I've completed a double mascetomy, 4 bi-weekly treatments of A/C Chemo treatments, 12 weekly treatments of Taxo (Chemotherapy) and am now going through radiation treatment.  Afterwards, I will be on AI, a type of hormone blockers for estrogen/progesterone positive, HER2-, breast cancer.  I started on 10 mg of lexapro while going through chemotherapy.  I don't want to be on this forever.  I would like some advise for anyone else that is in my situation.  I know my brain is starting to heal from the chemo and I'd like it to heal also from using lexapro.  What is the safest way to get off of this?  Is there any tapering strips that are available for us in the U.S.?  Or is measuring the dry pill powder and liquid versions the only way.  It all seems so complicated.  I started at the beginning of October 2019.  This will be my sixth month being on it.  Please help?  My mind is so consumed with not only cancer but now this drug.  I just want the easiest way to do it and from what I've read, reducing by 10% weight seems the best way to do this.  But, do I need to purchase empty gel capsules to make at least four weeks of one dose for each taper?  Thanks for any help and suggestions!

 

Please put your withdrawal and medication history in your signature

Just take a look at the link ^, and it will tell you how to do so. 

I'm seeing 6 months on the Lexapro 10 mg, just give a date estimate, on that, and if any other psychotropic drugs used, especially in the last 2 years.  Very helpful for us to know.

It's all explained in the link.

Afterwards, I will be on AI, a type of hormone blockers for estrogen/progesterone positive, HER2-, breast cancer.

This is good information too ^, and you can add this when you get started with it.

 

7 hours ago, Gridley said:

Is there a point in your treatment when you'll be under a bit less physical stress, perhaps after the radiation?  That's not to say you can't start tapering now, but if you're under less physical stress, it might be more comfortable for you.  It's to your advantage that you've been on the drug for such a short time --and that you contacted us before beginning your taper.

 

Oh, and I'm so sorry that you've had to go through this all.  Very trying.  I do have a friend, on the ground(locally) who is doing radiation now too, after her masectomy.  But, have not had the same experience myself.  I'm glad the Chemo is all done.

When do you expect to be finished with the 25 radiation treatments?

 

7 hours ago, KaraDawn said:

So, first step is to get the scale.  Get an average weight of a few pills.  Then, lower the weight by 10%.  Stay at this weight for how long? Four weeks?  If so, I would have to make gel capsules of that amount for four weeks right.  Then drop again another 10% weight for another four weeks?  Does this sound right?

 

Sounds like you have had a chance to look at some of the links that Gridley gave you, which is good.  And yes, you can do careful 10% reductions using the scale.  The usual time between tapers is generally 4-6 weeks.  And then, if stabilized, with what we call withdrawal stable, you can reduce again, 10% from your new dose.  Each 10% taper is based on the previous dose. 

So:

10 mg X .90= 9 mg   This would be your first taper dose.

Then:

9 mg X .90 = 8.1 mg  This would be your second taper dose.

(just showing you how that all works)

You can get the scale via Amazon fairly cheaply, around $20.00 USD.  And then the 00 big capsules can also be gotten there, or I have found some, in some of the natural food stores locally.  And yes, on making capsules in advance.  That would work.  Generally, the crushed tablet/pill contains are stored in a marked container too, so that there is no wastage.

 

And I don't know of any members off hand, who have tapered while still undergoing Breast Cancer Treatment.  Perhaps one will respond though.  This is your introduction page, and you have introduced yourself to the community now, here.

 

  We do often have people HOLD, during times of stress, or surgeries, or necessary medical treatments.  HOLD just means stay put with their present dose.  You may do okay with beginning a taper, however, it's up to you really.  And it is always good to minimize the dosages of these drugs.  

 

How have you done with the Lexapro so far?  Any side effects or adverse reactions that you could notice, apart from the Breast Cancer Treatment?  Of course, anyone would be scared and "depressed" after a Cancer diagnosis.......oh my........it's crazy sometimes, how much they use these drugs.

Anyway......all from me, for now.

And please let us know what you decide, and we can point you to more information, and/or make suggestions for you too.  And do our best to answer any further questions.

Update regularly and ask any specifics around your unique case, right here, on your introduction.

 

Welcome again,

Love, peace, healing, and growth,

mmt

 

p.s.  let us know too, if you would like some more information around, in general, what is withdrawal syndrome, and possible symptoms to expect, etc.   I don't know, if you have found some stuff on your own now yet, or not.   We do have a ton of information on this site.  I just don't want to overload you with TMI in the way of links right now.  But happy to give you more links, right here, if you would like them.  Thanks.

 

Edited March 3, 2020 by manymoretodays
additional, in black, after, and tried for some more clarity to my comments

[KaraDawn]

Since I've only been on 10 mg for about 5/6 months, do you think it would be possible to cut the pill in half, then the half in half again and take 7.5 mg, of course it would be with a pill splitter which isn't the most accurate way to do this. Or, do you think the liquid version of lexapro is better than weighing out crushed lexapro.  With the liquid, I hear it gets absorbed faster and is harder to get more of an accurate measure of the liquid as some of it sticks to the pipet or doesn't all come out.  If measuring the dry out, is there any video's of people doing this so I can see how they do it and what tools they use for it?

 

Thanks you!  Sorry if my questions are all over the place!  I just don't like being on antidepressants.  But today, felt anxiety, while still on it! 

 

Are these all the supplements that you take to help with depression/anxiety?

Omega3's, EPA+DHA = 1800:  What brand?

Magnesium complex:  What brand?

Vit C  How much?

D3:  How much?

Vit E  How much?

Trace mineral drops:  What brand and how much?>

L-lysine:  How much and what brand

L-methylfolate=400 mcg What brand

 

 

 

 

 

[Gridley]

9 hours ago, KaraDawn said:

Since I've only been on 10 mg for about 5/6 months, do you think it would be possible to cut the pill in half, then the half in half again and take 7.5 mg, of course it would be with a pill splitter which isn't the most accurate way to do this. Or, do you think the liquid version of lexapro is better than weighing out crushed lexapro.  With the liquid, I hear it gets absorbed faster and is harder to get more of an accurate measure of the liquid as some of it sticks to the pipet or doesn't all come out.  If measuring the dry out, is there any video's of people doing this so I can see how they do it and what tools they use for it?

 

5-6 months is not that short a time.  7.5mg is too fast a drop--it's 25% instead of the 10% we recommend.  And the doses of Lexapro from 10mg down are the most potent and should be tapered slowly.  potent and should be tapered slowly.  Also, as

you mentioned, the pill cutter isn't a very accurate way to measure, and you'd likely be getting inconsistent doses.  So, no, I wouldn't recommend this.

 

Liquid vs. weighing is a matter of personal preference.  You've been on the dry, and some people don't do well with the liquid, while others do fine. If you choose liquid, you should do a crossover (which I can explain) before you taper.  There are some intricacies involved with the liquid and getting the full dose.  

 

I haven't seen any videos of the scale.  Here's the link to the Gemini scale.  It's pretty simple.  The tools that come with the scale are tweezers and a little spoon for adding/subtracting powder to the scale to get your weight.  You can also use a bent post-it to pour the powder into the size 00 gelatin capsule, or you can use LabExact Grade WW weighing paper, available on Amazon, as are the capsules.  You can use two spoons to grind the tablet into powder for weighing.  

 

The GEMINI-20 Scale

 

 

9 hours ago, KaraDawn said:

Are these all the supplements that you take to help with depression/anxiety?

Omega3's, EPA+DHA = 1800:  What brand?

Magnesium complex:  What brand?

Vit C  How much?

D3:  How much?

Vit E  How much?

Trace mineral drops:  What brand and how much?>

L-lysine:  How much and what brand

L-methylfolate=400 mcg What brand

 

 

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 (glycinate is a good form) 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.

 

I use KAL Magnesium Glycinate from VitaCost.  It comes in 200mg capsules that you can cut down to 50mg to start.  I don't have a brand of Omegas to recommend; I only take about 1200 EPA-DHA, but other take more.  I use NOW Vitamin E 400 IU.

I don't take C.  I take D3 but some find it activating.  As to the others, again, we don't recommend a lot of supplements.  Try them if you want but introduce only one at a time and at a low dose.

 

These links are helpful for anxiety.

 

Audio:  How to Recover from Anxiety - Dr Claire Weekes
 

VIDEO:  Peace from Nervous Suffering - Claire Weekes (1 hour) (http://sendvid.com/vgquc1dg)
 

Anxiety Stuff - all kinds of stuff about anxiety attacks and things that help …

 

10 minute Restorative Yoga for Relaxation | Up the wall

 

Please feel free to ask any other questions you may have.

 

[KaraDawn]

To Gridley, are you completely off lexapro?  Have you been crushing the 10 mg pills and cutting by 10%?  Would it be easier to use two 5 mg pills to make it more accurate until I get to or below 5 mg of lexapro? 

 

Thanks,

 

Kara

 

 

[KaraDawn]

Please explain how to cross over using liquid generic lexapro versus dry generic lexapro?

 

Thanks,

 

Kara

 

[KaraDawn]

Can someone please share how you decrease by 10% of your dry pill.  The 10 mg lexapro pill is so small already, so you'd have to put the reduced amount in a new capsule.  What are you using to put the other crushed powder in to save, the 10% you decrease by.  

 

Thanks!

 

Kara

[Frogie]

On 3/4/2020 at 4:53 PM, KaraDawn said:

Can someone please share how you decrease by 10% of your dry pill.  The 10 mg lexapro pill is so small already, so you'd have to put the reduced amount in a new capsule.  What are you using to put the other crushed powder in to save, the 10% you decrease by.  

 

Thanks!

 

Kara

This is how I’m tapering my Xanax (I had liquid Lexapro).

 

 I weighed 10 tablets to get an average weight. Then I purchased a pill grinder from Amazon. It’s well worth the money. It stores the powder in the bottom. You can also use an empty pill bottle. You can also use the back of a spoon to crush the tablets.

 

I weigh the powder and put it in gel caps I bought on Amazon too. I think they are “00” in size. You put the powder in them.

 

Does that make sense? I hope I could help a little.

 

Good luck!

 

Take care,

 Frogie xx

[Terry]

On 3/4/2020 at 5:53 PM, KaraDawn said:

Can someone please share how you decrease by 10% of your dry pill. 

I'm sorry, I can't advise about decreasing a dry pill.  However, I can say that if you have a chance to switch to a liquid, it's quite easy (in my humble opinion) to taper easily and quite accurately.  I switched from a sertraline tablet to liquid without any problem.  It seems that some on this forum have had difficulty with transitioning from pill to liquid, so it would be wise to consult with your doctor about this should you decide you'd like to use the liquid form.

 

Take care,

Terry

[KaraDawn]

Please share!  I haven't been on 10 mg lexapro (generic version) for very long, maybe 6 months.  According to Dr. Briggs, if you've been on the antidepressant for less than a year, it seems that you could taper more quickly by lowering doses by 10% of the original weight/ml and waiting 7-10 days between decreases.  I really don't want my taper to last two years when I've only been on it less than six months.

 

My oncologist suggested not taking a 10 mg lexapro for one day, do this for two weeks, then don't take it for two days of the week, for two weeks, and so on.  This is the taper he suggested.  So  cutting a day each week every two weeks.  From what I've read, its better on our bodies to taper by taking some everyday.  

 

Please share your experience and knowledge with me!

 

Thanks,

 

Kara

 

Also, as a side note, I am the mother of five kids.  This year has been the hardest on our family as our oldest has went to college two hours away and our youngest has started pre-K at the same time I was diagnosed with breast cancer.  I currently have seven more daily radiation treatments and then will most likely be put on a type of hormone blockers (AI's) for post menopausal women with estrogen/progesterone positive breast cancer.  I'm really struggling with being home alone while the kids are at school.  I've been a stay at home mom since I've had kids, so for at least 20 years.  I would like some advise.  Sometimes I wonder if I went up to 20 mg of the lexapro, if that would help me in being alone.  But, I want off antidepessant because I don't want my brain to be effected or my body to be effected by any more drugs.  I'm hoping my brain will continue to heal from five months of being injected with chemo drugs for breast cancer and radiation.  Any advise is really appreciated!

 

Thanks,

 

Kara

[KaraDawn]

57 minutes ago, Terry said:

I'm sorry, I can't advise about decreasing a dry pill.  However, I can say that if you have a chance to switch to a liquid, it's quite easy (in my humble opinion) to taper easily and quite accurately.  I switched from a sertraline tablet to liquid without any problem.  It seems that some on this forum have had difficulty with transitioning from pill to liquid, so it would be wise to consult with your doctor about this should you decide you'd like to use the liquid form.

 

Take care,

Terry

 

Hi Terry,

 

Thanks for your advise and suggestion.  Did you make your own liquid sertraline or buy it as a liquid?  Where you able to completely get off of this?  If so, how did you taper off?

 

Thanks,

 

Kara

[Gridley]

16 hours ago, KaraDawn said:

According to Dr. Briggs, if you've been on the antidepressant for less than a year, it seems that you could taper more quickly by lowering doses by 10% of the original weight/ml and waiting 7-10 days between decreases.  I really don't want my taper to last two years when I've only been on it less than six months.

 

Dr. Briggs' advice runs counter to what we advise. He's advising a 30% to 40% taper every four weeks.  We advise 10%.  You are at risk of lengthy withdrawal symptoms after one month on an antidepressant.  There are many members whose taper period is longer than the time they were on the drug.  It doesn't seem right, and it isn't.  But it's the reality we deal with. As I said previously,

 

On 3/4/2020 at 7:47 AM, Gridley said:

5-6 months is not that short a time.   And the doses of Lexapro from 10mg down are the most potent and should be tapered slowly

 

It is your decision how fast you want to taper.  If you haven't already, please do read the reasoning behind this approach in the following link.  

 

Why taper by 10% of my dosage?

 

I just don't you want to wind up in withdrawal, which can last a long time.

 

What is withdrawal syndrome.

 

On 3/4/2020 at 6:08 PM, KaraDawn said:

To Gridley, are you completely off lexapro?  Have you been crushing the 10 mg pills and cutting by 10%?  Would it be easier to use two 5 mg pills to make it more accurate until I get to or below 5 mg of lexapro? 

 

I'm sorry, I didn't see your question until now.  I am down from 20mg to 0.7.  I've been crushing 20mg pills because that's what I have.  It doesn't really matter what mg pill you crush.  If you continue using the pill method, once you get down to 5mg, then it would make sense to use 5mg pills.

On 3/4/2020 at 6:53 PM, KaraDawn said:

What are you using to put the other crushed powder in to save, the 10% you decrease by.  

I use up all the powder to make new capsules.  But any that's left over, you can store in an empty pill bottle,

 

16 hours ago, KaraDawn said:

 

My oncologist suggested not taking a 10 mg lexapro for one day, do this for two weeks, then don't take it for two days of the week, for two weeks, and so on.  This is the taper he suggested.  So  cutting a day each week every two weeks.  From what I've read, its better on our bodies to taper by taking some everyday.  

 

 

This is a terrible tapering method.  Skipping doses causes the medication in your bloodstream to go up and down, battering your nervous system and making withdrawal worse.  

On 3/4/2020 at 6:21 PM, KaraDawn said:

Please explain how to cross over using liquid generic lexapro versus dry generic lexapro?

 

We recommend a gradual crossover:

 

3/4 tablet, 1/4 liquid for 3 to 7 days

1/2, 1/2 for 3 to 7 days

3/4 liquid, 1/4 tablet for 3 to 7 days

all liquid thereafter 

 

Edited March 15, 2020 by Gridley

[Terry]

5 hours ago, KaraDawn said:

Thanks for your advise and suggestion.  Did you make your own liquid sertraline or buy it as a liquid?  Where you able to completely get off of this?  If so, how did you taper off?

I requested a liquid prescription when I got down to around 12.5 mg.  I'm still tapering, I'm down to 0.84 mg, so still have a ways to go.  I started off tapering a little too fast, but then settled into a 10% taper.  Currently I'm doing the brassmonkey slide (2.5% per week).

 

Take care,

Terry

[KaraDawn]

Yeah, I have successfully dissolved my 10 mg pill into 10 ml of water.  I have been taking 10 ml of the liquid for four days.  Today, Sunday 3/15/2020 is that first day I took 1 ml out of my solution, so I took 9 ml of the

liquid lexapro.  Would it be okay if I did 9 ml for two weeks and continued like that.  Is it necessary to go for a full month between tapers if you've only been on lexapro for 6 months?

 

Thanks,

 

Kara

[Gridley]

22 minutes ago, KaraDawn said:

s it necessary to go for a full month between tapers if you've only been on lexapro for 6 months?

Yes.  6 months is definitely long enough to have become physiologically dependent (one month is enough).

 

 If you dropped every two weeks, that would be twice as much as you recommend, and, as I said, you don't want to get into withdrawal, which will delay you more than a 10% taper if you have to updose and then have to wait months to stabilize before you can begin your taper again.  Going slowly is the fastest method.

 

As I said, from 10mg down has a much stronger effect than the higher doses, and Lexapro is the most powerful antidepressant on the market. The lower you go, the slower you should go.  The graphs in this topic might help to explain the reason for this:

 

Why taper paper: dose-occupancy curves

 

30 minutes ago, KaraDawn said:

9 ml

 

Going from 10 to 9ml is fine but as you continue to drop it's important to stay with the 10% of current dose taper rather than decreasing a ml every taper.  Something like 85% of the drug's effectiveness happens in the first 10 mg, so making even a small change can have a big effect symptom wise. Decreasing by a straight 1mg also accelerates the amount that you  would be decreasing each time making it rougher and rougher with each drop. Decreasing by a percentage however decelerates the amount of each drop and makes things gentler on your system.

 

 

[Frogie]

Just popping in to see how you are doing?