Cigale: reinstating help

[Cigale]

First I want to thank this community for providing such critical support to so many in need of informed guidance.

 

I am here to seek advice for reinstating after having tapered of Lexapro WAY too fast (throwing my brain off a bridge). This was my second time on Lexapro for anxiety/depression with a starting dose of 5 mg for 5 months, increase to 10 mg for 5 months. Though Lexapro worked for me the first time (from 2008-2016 at 10 mg) , this second time around it hasn't worked nearly as well to address my anxiety and associated light insomnia. As a result, I decided to take myself off Lexapro (which I realize I should not have done without guidance.)

 

After my taper, I felt okay for about 5 weeks. But around week 6 I started having anxiety and insomnia like I have never experienced before. I tried to ride it out but when severe depression set it, I decided I needed help. Since we had moved overseas during this time, I had to find a new psychiatrist. She put me on Paxil 10 mg, which significantly increased my anxiety and depression so much she took me off after a week. She then put me back on Lexapro 5 mg, which seemed to kick off severe insomnia - 5 nights with less than 2 hours sleep. Now she wants me to stop Lexapro and start Mirtazapine 15 mg since she says it will help with insomnia and weight loss (I am about 8 pounds underweight.).

 

Having read through several SA threads and guides, I think it might be better if I just try and stabilize with the Lexapro. Though perhaps that window has closed and I should just switch to Mirtazapine and stabilize on that for several months before planning your advised 10% taper.

 

I appreciate any guidance.

[Gridley]

Welcome to SA, Cigale.

 

You said that around week 6 you started experiencing extreme insomnia.  Then when you went back of Lexapro, it seemed to kick off extreme insomnia.  Was this insomnia more extreme than what you began experiencing around week 6 off the Lexapro?

When you were on the Lexapro before your fast taper did it seem to cause insomnia?

 

Insomnia is one of the most common withdrawal symptoms, and the most likely explanation for the insomnia you're experiencing ithe very fast taper of Lexapro rather than the reinstatement.  Regarding the window for reinstatement of the Lexapro, you were well within the time when reinstatement predictably works (within 3 months of last dose) and the fact that you reinstated so fast is to your advantage. 

 

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

 

What is withdrawal syndrome.

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

When we take psychiatric 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.  

 

   On 8/30/2011 at 2:28 PM,  Rhiannon said: 

When we stop taking the drug, we have a brain that has designed itself so that it works in the presence of the drug; now it can't work properly without the drug because it's designed itself so that the drug is part of its chemistry and structure. It's like a plant that has grown on a trellis; you can't just yank out the trellis and expect the plant to be okay. When the drug is removed, the remodeling process has to take place in reverse. SO--it's not a matter of just getting the drug out of your system and moving on. If it were that simple, none of us would be here. It's a matter of, as I describe it, having to grow a new brain. I believe this growing-a-new-brain happens throughout the taper process if the taper is slow enough. (If it's too fast, then there's not a lot of time for actually rebalancing things, and basically the brain is just pedaling fast trying to keep us alive.) It also continues to happen, probably for longer than the symptoms actually last, throughout the time of recovery after we are completely off the drug, which is why recovery takes so long.

 

In situations like this, when there are so many variables (very fast taper, Paxil for one week, reinstatement) it's hard to pinpoint what causes what.  It's clear, however, that your system is very sensitized and what it needs now is stability and not more changes.  It's going to time for your system to stabilize after your fast taper, likely several months.  I would recommend you hold at 5mg Lexapro and make no further changes.  It's not our policy to recommend trying different drugs to deal with withdrawal (what we call drug Russian roulette) and any decision try mirtazapine or any other drug would have to be between you and your doctor.

 

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.

 

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

 

[Cigale]

I really, really appreciate your prompt and thorough reply @Gridley!

 

Your insomnia question is an excellent one, and I will try to give my different insomnia episodes some context. First, I typically sleep on average about 8-8.5 hours/night with one interruption, with a 30-40 nap in the afternoon. So I've normally been someone who gets good sleep, especially since I am very physically active.

 

After starting Lexapro in February, 2019, my sleep reduced to about 5-6 hours/night with a couple of interruptions and rarely could I nap. When I couldn't nap, I would try to meditate for 15-30 minutes. For the first five weeks after my too-fast taper off Lexapro, I was able to get about 6-7 hours sleep with regular naps. Then when insomnia hit around week 6 post taper, my sleep was reduced to about 3-4 hours with no naps. That sent me back to the drawing board. And finally, when I recently reinstated Lexapro, the insomnia became horrible, with less than 2 hours of sleep for five days. Since that recent episode, I have been able to get about 5-6 hours of sleep at night though can't nap - much like I was when I started Lexapro a year ago.

 

I do feel very fragile, kind of broken even, which is hard to accept. But I am fortunate to have this community and your guidance to start to rebuild and establish my stability. I am taking Omega 3 and will look in to the recommended magnesium supplements. I am also going to look into melatonin at SA's low recommended dose. I tried it last year at a much higher does and it had the opposite effect on me.

 

My instinct is to stick with the Lexapro. Even with its downsides - some insomnia and anxiety - Lexapro allows me to function on a day-to-day basis. Throwing a whole new drug in the mix just seems too risky - definitely drug Russian roulette.

 

I don't have any questions at this point. Thank you again for welcoming here. I am grateful for all that you and the SA team does for this community.

[Gridley]

1 hour ago, Cigale said:

My instinct is to stick with the Lexapro.

I think that's best.

 

One thought: What time do you take the Lexapro?  If you take it at night, you might try moving it to the morning to see if that helps with sleep. If you do this, I would move it earlier one hour each day until you get your dose to the time in the morning you want.

 

[Cigale]

Hello @Gridley - I appreciate the suggestions but I take Lexapro in the morning with breakfast. When I do all I should do to prepare for sleep - like yoga, exercise and meditation - I do better. Just got to keep reaching for my tools! 

[Cigale]

Hello @Gridley - If possible, I need some advice for how to talk to my psychiatrist who is really pushing me to switch to Mirtazapine 15 mg. She is concerned that the Lexapro 5 mg no longer works for me and is not treating my anxiety and causing insomnia. Having read a few threads here, I am worried that such a switch after a stupid-fast taper will not help at all, that I will still have "break-through" withdrawal symptoms from the Lexapro, and as a result, the Mirtazapine will not work correctly. To me it seems that I am choosing between a known situation - take Lexapro 5mg and cope with anxiety and insomnia - and an unknown but possible far worse situation that involves WD from Lexapro. At the same time, I realize there are no black and white answers. I have to make the most informed decision I can and advocate for myself. Any relevant experience or guidance is truly appreciated.

[Gridley]

1 hour ago, Cigale said:

I need some advice

I wouldn't mention withdrawal, which psychiatrists don't believe exists.  And I wouldn't mention your fast taper, side they don't see anything wrong with a fast taper.  I would say that you are coping well with the Lexapro and are dealing with the anxiety and insomnia.  Say that you are really uncomfortable switching to a new drug and would rather stay with the Lexapro for now.  

[Cigale]

Thank you @Gridley for this advice.

[Cigale]

Since I last checked in, I have gone down hill quite a bit. I have been really struggling with intense anxiety which is kicking in depressive thoughts like I've never experienced before. The mornings (between 8-11 am) are especially difficult and it feels like hot toxins are running through my body and brain. I honestly don't recognize myself, and am having difficultly completing simple tasks - like eating, cleaning, cooking. Though I had some anxiety with Lexapro when I was on it in 2019, it wasn't nearly as debilitating as what I am experiencing now.

 

I have been reading SA reinstating guidance and found a mention of "alerting" that says symptoms of hyper-reactivity or alerting could indicate "you may be too sensitive for reinstatement." I am wondering what that means, if that describes my situation, and whether I am too sensitive for the reinstatement of Lexapro at 5mg on Feb 18. If I am too sensitive, then what are my options? I am scared I am not on the right path to stabilization. I appreciate any guidance or support.

[Cigale]

Hello @Gridley - I would like to find out if it is possible that the reinstatement process can mirror withdrawals with waves and windows. I am six weeks into reinstatement with Lexapro 5mg and continue to really struggle with anxiety and depression. But maybe it can take longer to stabilize when reinstating? I am so afraid that I am on the wrong track and that the Lexapro is making me worse. I have been keeping a journal but it hasn't been hour-by-hour, which I think you need in order to advise me. Any guidance you might have is appreciated. Thank you for all you do.

[Gridley]

28 minutes ago, Cigale said:

continue to really struggle with anxiety and depression. But maybe it can take longer to stabilize when reinstating?

Yes, it can take take quite a while--sometimes several months--to stabilize from a reinstatement.  Six weeks is really not that long.

You could also still be suffering from WD from your fast taper from November to February.

 

How would you say you are doing now as compared to when you reinstated on Feb. 18?

[Cigale]

Thank you @Gridley for getting back to me so quickly. Looking back through my journal, I would say that I have declined over the past two weeks. When I started in February, I had more windows during the day and didn't have trouble eating. Since March 14, I've had fewer and shorter windows and the waves are deeper, increased anxiety is also making it hard to eat.

[Gridley]

1 hour ago, Cigale said:

Since March 14, I've had fewer and shorter windows and the waves are deeper, increased anxiety is also making it hard to eat.

I'm sorry you're feeling bad.  There are going to be windows and waves for some time, unfortunately.   It can take a while, as I said, for things to level off.

 

Have you tried the magnesium or omegas I mentioned earlier?  They are helpful in calming 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.

 

 

 

 

 

 

 

[Cigale]

Hello @Gridley - I started a magnesium supplement (50 mg magnesium) three days ago (need to add to my signature) but wonder if it is helpful since it contains other supplements (vitamins C & D, calcium, potassium and boron). I tried an Omega 3 supplement (1 capsule 500 mg - EPA 33% DHA 22%) last week but it really upset my stomach, so I am a little hesitant about that. I am VERY sensitive to medications, so try to always start super low with any doses. Can you give me your opinion on the Natural Vitality magnesium supplement? Looking at the links you sent, I am considering purchasing Doctor's Best Magnesium if that might be better. With appreciation!

[Gridley]

3 hours ago, Cigale said:

Natural Vitality magnesium

It would be better if you took a magnesium supplement that had no other ingredients.  The Doctor's Best 100mg you linked to sounds fine.  Start low.  If the omega made you sick, I would avoid it.

[Cigale]

Hello @Gridley - Just a check in to let you know I have been trying harder to manage my anxiety by pushing myself to do things like garden, walk, and meditate. Though sleeping (currently about 5 hours/night) and eating are still daily challenges. I did try 50 mg of Doctor’s Best and though I believe it helped a bit with sleep, it also caused light diarrhea. So I am wondering if I should try 25 mg (1/4 pill) or go back to the Calm drink mix, which didn’t cause gastrointestinal issues though hasn’t helped much with sleep. I would also like to ask @Altostrata for advice on magnesium options. Thank you both for your guidance.

[Gridley]

5 hours ago, Cigale said:

if I should try 25 mg

Yes, I would try 25mg of the Doctor's Best.  Magnesium can cause diarrhea if you take too much.  Everybody's ability to tolerate magnesium is different and obviously 50mg was too much.  I don't know how well you can divide the 50mg pill, but you if you can you might try 3/4 of a pill (cut the pill in half and then cut the half in half, if possible).  If not possible, just go to the 25mg.

[Cigale]

Sorry for the delayed reply @Gridley. Thank you for your support. Unfortunately it appears that my system is too sensitive for now at least so I need to hold off on the magnesium. Sleep is still a challenge but I am trying to work through this difficult phase with other tools. I appreciate your time.

 

[Cigale]

One quick question for you @Gridley: Are you using liquid Lexapro for your taper? I know I am a ways off - a few months - from that step, but want to research options. I am in France currently and it appears that the only liquid form is 20mg/ml, which might not work well for a taper? Thanks again!

[Gridley]

13 minutes ago, Cigale said:

Are you using liquid Lexapro for your taper?

I've been using the tablet form and weighing powder.

[Cigale]

Thank you @Gridley!

[Cigale]

Hello @Gridley - I hope you are safe and sound this Easter Sunday. I am so so sorry to bother you but could really use some encouragement when you have a chance. The last couple of days have been pretty rough with about 2 hours sleep/night and some dark thoughts. I have been looking at the resources here and trying to work on accepting (Claire Weeke's approach) my anxiety and insomnia. But the lack of sleep leaves me so fragile that some times the anxiety just engulfs me. And then I struggle to eat or sleep or even think clearly. I know that I am the only one who can get me through this and I really try to push myself to meditate and exercise and do yoga, which do bring moments of relief. But I am really struggling to stabilize.

 

I see how far you have come since you joined SA in 2016 and wanted to find out if there are any approaches or ideas that you call up when you find yourself struggling. What gives you the courage and hope to keep moving forward?

[Gridley]

3 hours ago, Cigale said:

. What gives you the courage and hope to keep moving forward?

I'm sorry you're feeling bad, Cigale.  It really is every day, every minute, every moment at a time.  Just take your next breath and tour next breath.  You will come out of this bad place and into something wonderful, a place as high as you are low right now.  Yes, accepting is very important.  

 

I say to myself every morning, what is, is and I accept it -- and I will make the best of it - and, most important, I go with God.  You may not feel the Spirit's presence but it is there surrounding and filling and protecting you.  You could pray, "Father Mother God, I ask for the highest Light of God to surround and fill and protect and heal me, for the highest good.  And I ask for strength and courage and hope for the highest good.  I ask for the Light in my sleep and with my anxiety and for healing in all parts of my being, including my brain and my central nervous system and I ask for the Light for the highest good in my reinstatement."

 

For anxiety I have found the best tool to be the restorative yoga pose in the following link.  If you can't get your legs all the way up on the wall, you can just hook them over a chair as you lie on the floor.  Make yourself comfortable and cozy with a pillow or two and a duvet to cover you and let yourself just sink into the pose.  Here's the link:

 

10 minute Restorative Yoga for Relaxation | Up the wall

[Cigale]

2 hours ago, Gridley said:

You will come out of this bad place and into something wonderful, a place as high as you are low right now.

 

Thank you so much @Gridley for taking the time to help me out. I really needed to hear that, to know there is hope and it might be just one more breath away. I am so grateful to have your support and your belief in me and my recovery. It has been really difficult to work through this in a foreign country and language. So this community is my guiding light.

 

2 hours ago, Gridley said:

I ask for strength and courage and hope for the highest good.  I ask for the Light in my sleep and with my anxiety and for healing in all parts of my being, including my brain and my central nervous system and I ask for the Light for the highest good in my reinstatement.

 

This prayer you wrote for me is beautiful and I will take it with me tonight as I ask for help and guidance and sleep tonight and every night. I also really appreciate the yoga video you sent. I was able to do one session and plan to do it again before bed.

 

I do have so much to be thankful for and you are at the top of my list. Bless you for guiding me through this difficult time.

 

 

[Cigale]

Hello @Gridley - I want to let you know that I got 5.5 hours of sleep last night. I did the series of restorative yoga pose for 10 minutes and then recited your prayer. As I was drifting off, I thought about the good things from the hard day - two falcons flying over our yard, all the wild red poppies sprouting from walls and sidewalks, my husband’s limitless patience for my struggles, and your generous and kind support. Thank you again. 

[Gridley]

3 hours ago, Cigale said:

Hello @Gridley - I want to let you know that I got 5.5 hours of sleep last night. I did the series of restorative yoga pose for 10 minutes and then recited your prayer. As I was drifting off, I thought about the good things from the hard day - two falcons flying over our yard, all the wild red poppies sprouting from walls and sidewalks, my husband’s limitless patience for my struggles, and your generous and kind support. Thank you again. 

That ;s fantastic, Cigale!

[Cigale]

TGIF @Gridley! I hope you are doing well and staying healthy and safe. As a thank you for your support this week - which really meant the world to me - I am sending a little 'bouquet.'

[Gridley]

3 hours ago, Cigale said:

le 'bouquet.'

Beautiful.  Thank you, Cigale.

[Cigale]

Hello @Gridley - I hope you are doing well. I want to check in with you for just a little encouragement, a virtual hug even. Mid-April I had five moderate days (using the daily checklist for WD symptoms) in a row and thought I was actually starting to stabilize on the 5 mg of Lexapro. And then starting April 22, constant anxiety with rapid heart rate and cortisol surges, and insomnia kicked in hard, and I assume this is WD not the Lexapro. It's been a very difficult wave and I have gotten about 8 hours sleep over the past 4 days, and have lost more weight. The only thing I have been doing differently is doing guided mindfulness meditations. I would think that is a good thing but maybe it's too much right now. My doctor wants me to try a different AD or at least take something for sleep. But I know this not a good idea at all. My soul aches for relief. I welcome your wisdom.

[Gridley]

1 hour ago, Cigale said:

just a little encouragement,

Of course you can have a big virtual hug.  You're going to be just fine.  The five moderate days you had is a very encouraging sign.  There are going to be wave and windows, and you're still stabilizing from the drug changes.  I know getting just 8 hours sleep in 4 nights is a strain as is the weight loss, but that's pretty standard for WD.  Doing the meditations is a great practice, and they will help.

 

What you need now is stability, not a new AD and you know sleep drugs are a slippery slope.  You'll have a window (your previous 5 good days shows that it's coming).  You're doing great, Cigale.  Just be kind and gentle to yourself.

[Cigale]

Thank you @gridley for that hug. I really needed it. Plus it makes me feel a bit better to hear you say my moderate days are a good sign. I will try and do more to savor my windows and give myself a break on these hard days. Hugs back to you!

[Cigale]

Hello @Gridley - I hope you are doing well. I am still really struggling to get more than four hours of sleep and starting to get scared that it's the Lexapro that is making me worse. When I lie down, my head starts buzzing and my heart races. I am having more trouble going out in public and am afraid to to talk to family and friends because I am so down. I feel like I am losing myself more and more, and maybe it is just being exhausted from lack of sleep. Plus I am struggling with my weight still - at 97 lbs when I am normally 110. I know I need to stabilize before I start my Lexapro taper, but I am wondering how I can ever do that if I can't rest. I have been trying to meditate for 15 minutes in the morning and 40 minutes in the afternoon, and sometimes I feel less anxious and other times I feel worse. I am so sorry that I feel like I am failing the hardest test of my life.

[Gridley]

4 hours ago, Cigale said:

the hardest test of my life.

You are right in thinking this is the hardest test of your life, but you are not failing.  You are working to get to a place you can taper, you are learning every day more about dealing with this and you will succeed.  I know you want to get off this drug, but let's get stabilized first.

 

What time do you take the Lexapro?

[Cigale]

Hello @Gridley - Thank you again and again. I so appreciate your help. I take the Lexapro 5 mg between 830-9 am with breakfast. And to give you more background, here's my recent day summary:

 

230 am wake up, full sweat, panic, hot feeling in head, try focusing on breath

4 am wake again, hot feeling

615 am wake and try guided meditation, yoga nidra breath and body

715 am get up and feed dogs, go to village for bread

8 am breakfast - croissant, bread, clementine, egg, 1 small espresso, try to read local papers, hot panic feeling in head just try to accept and work through thoughts that I am stuck here

815 am - take 5 mg Lexapro

10 am - computer work, looking for jobs and studying French online; work through constant waves of panic, hot feeling, racing heart that come and go

1230 pm lunch - ham or chicken sandwich with some fruit on side

2 pm  - walk dogs or go for run, usually when I feel okay

4 pm - 40 minute guided meditation

5 pm - try to call family or friends, try to stay positive/focus on their lives and keep panic and sadness in check

6 pm - start dinner, anxiety over messing up meal - though I have been doing this for years

8 pm - grilled chicken and rice, salad, and bread, 1 glass of red wine

9 pm - play backgammon or read fiction - always non-digital format, try not to use any devices after 9 pm

1030 pm - yoga stretching with focus on breathing, legs up wall stretch you recommended

1130 pm - lights out, try to think of ten things I am grateful for as I attempt to let go into sleep

[Gridley]

@Cigale

 

Thank you for your schedule.  I don't want to take any of life's small pleasures from you, but we recommend eliminating caffeine and alcohol while in withdrawal.

 

Here are some links that I hope will be helpful to you regarding sleep.

 

Tips to help sleep - so many of us have that awful withdrawal insomnia

 

Relaxation exercises, guided meditations, calming videos, sleep hypnosis

 

Tricks and tips to fall asleep faster

http://articles.mercola.com/sites/articles/archive/2017/02/16/tips-tricks-fall-asleep-faster.aspx?utm_source=dnl&utm_medium=email&utm_content=art1&utm_campaign=20170216Z1&et_cid=DM133787&et_rid=1889748952

 

This link contains helpful information, including insomnia and also non-drug coping skills.  

 

 Important topics about symptoms, including sleep problems

 

Some members have found Melatonin helpful with insomnia.   

Melatonin for sleep   

It's best to start at a very low dosage, such as .25mg, and gradually increase if needed to the lowest effective dose.  

 

It can be difficult to find very low dosage Melatonin.  I take a 1mg Melatonin and cut it into quarters to get a dosage of 0.25mg.  Too high a dosage of Melatonin can have a paradoxical effect--it can keep you awake.

[Cigale]

Thank you Gridley for your support and these suggestions. I am going to give a low dose of melatonin a try. Plus I have been wanting to learn more about the Buteyko Breathing Method. And I will give up my coffee and wine and see if that helps. I appreciate you!