Cigale: reinstating help

[Gridley]

11 minutes ago, Cigale said:

 

On the whole, I would say I am not better and a little worse, especially this last week and a half. I'm so sorry.

There are so many factors at work here.  You had an adverse reaction to Paxil in February, and the symptoms of an adverse reaction are very similar to withdrawal.  Then you reinstated at a fairly high dose for a RI, so your system might have been overwhelmed by the RI.   Or a combination. It seems to me you have two choices: hold on the Lexapro and hope and wait to stabilize.  Or begin a very slow 10% taper of the Lexapro.  See which feels right to you.

[Cigale]

3 minutes ago, Gridley said:

See which feels right to you.

 

I appreciate your guidance @Gridley. I have some thinking to do. Take care, Cigale

[Cigale]

Huge apologies @Gridley for an earlier misstatement on my part. I just finished reading about, and watching videos on akathisia and SI, and I want you to know I am not experiencing that. Thank you again for all you have done for me.

[Cigale]

Here’s a quick update for the record. I had a couple of windows this past weekend - Saturday and Sunday. I was even able to spend a little time with some dear friends. Sunday night was rough (3 hours sleep, nightmares) and yesterday, Monday, I crashed with intense fear, anxiety, depression. I had to cancel all my appointments for the day, couldn’t eat, and wasn’t able to bring myself to talk to my family and friends. Last night, I got about 5 hours of sleep, and this morning I have been pushing through the anxiety by moving to the next task. I’m in the fourth month of reinstatement and wonder if this just ‘normal’ waves and windows of ADWD and also reinstatement, or if Lexapro has ‘pooped-out’ for me. Though I know full well there are no hard and fast, black and white answers, I wonder if others have these sorts of questions. Thank you!

[ChessieCat]

Windows and waves appear/disappear suddenly whereas tolerance/poop out appears gradually.

 

[Cigale]

Thank you @ChessieCat for the fast reply. Another question then: Could I be going through WD and poop out at the same time? I ask because when I restarted Lexapro 5mg in Feb 2019 (increasing to 10mg in July 2019), I had anxiety and insomnia issues that I didn't have before when I took Lexapro. When my dosage was increased to 10mg in July, the anxiety/insomnia increased and depression set in. All this prompted my uninformed WAY TOO FAST taper at the end of 2019, followed by a wonderful 50 drug-free days of feeling okay, and then the CRASH, then an uninformed reinstate of Lexapro 5mg. And then finally, discovering this community, thank goodness.

 

Again, I know there aren't any certainties in this process, but like all of us here I am trying to give myself the best shot at recovery. Though I will say the symptoms I have experienced since CT/reinstatement are way way more intense than those I went through in 2019. So I think that indicates more WD than poop out, which would mean I need to just continue to hold at 5mg . That's really what I am trying to figure out now: Do I hold and hope for more stability or do I start a taper? But as Gridley advised above, I need to determine what feels right for me.

 

Thank you for your guidance.

[sunnysideup69]

Hey @Cigale, thanks for dropping by my thread. I'll pm you about yin yoga xxx

[Erell]

Bonjour Cigale, 

 

On 6/16/2020 at 1:07 PM, Cigale said:

Again, I know there aren't any certainties in this process, but like all of us here I am trying to give myself the best shot at recovery. Though I will say the symptoms I have experienced since CT/reinstatement are way way more intense than those I went through in 2019. So I think that indicates more WD than poop out, which would mean I need to just continue to hold at 5mg . That's really what I am trying to figure out now: Do I hold and hope for more stability or do I start a taper? But as Gridley advised above, I need to determine what feels right for me.

 

As Gridley said, there are many factors here, so it is hard to determine what is causing symptoms.

 

However, you reinstated last February so it is still early in terms of stabilisation. I know how hard those early months can be, but it does get better.

Since you reinstated, do you feel like you're going through a waves and windows pattern ?

 

I was moved when I read your post on my thread : going through WD in a foreign country must be challenging. You sound like a very strong person !

Where are you in France ?

 

Thinking of you ❤️ 

 

[Cigale]

Thank you @Erell for your support. Even in a second language, you write so well and with so much compassion!

 

I do think I am going through windows and waves, and feel like I am ever so slowly experiencing little improvements. The anxiety/fear, insomnia and loss of appetite are fairly constant, but every day I try to push through to do what I can for my own healing. I try to mediate at least 10 minute a day, get some sort of exercise, eat three meals (need to gain at least 3 kilos), do yoga in the evening and practice gratitude. And I have an incredibly supportive and loving husband (married 30 years) who is far kinder to me than I am to myself some times.

 

One thing that I haven’t figured out yet is how to handle social invitations and obligations. With the de-confinement and beautiful weather, everyone wants to gather and celebrate. But I am so afraid I will have a bad day and have to cancel everything, that I avoid socializing. I also can’t drink alcohol since it triggers my anxiety, something I never experienced before. I just wish I knew that all this is temporary and I will be my usual outgoing self again.

 

Do you have any tips for stabilisation? Anything that helped you when things were hard?

 

I am in southern France, in the Vaucluse region in a small village near Mont Ventoux. I try to appreciate how fortunate I am to have such a beautiful surroundings in which to heal.

 

Merci - Cigale

[Erell]

Cigale, I'm relieved to read that you're not alone in France while going through WD.

 

3 hours ago, Cigale said:

I do think I am going through windows and waves, and feel like I am ever so slowly experiencing little improvements. 

 

That sounds like stabilisation process more than poop out. Good news is it does get better as time passes  

Hard to believe while in the middle of a wave, but slowly, gradually we do get better.
Everyone told me this when I first came to SA, and it happened to be true...like for everyone else  

 

3 hours ago, Cigale said:

Do you have any tips for stabilisation? Anything that helped you when things were hard?

 

I don't have any particular tips, you seem to already have nice practices

There is no tips that will make disappear symptoms : our CNS needs time to do his repair work. 

However, we can help our CNS by taking care of it and not adding more stress : gentle walk, bed routine, meditation, try to focus on the positive and the beauty, ...

 

Sometimes, when symptoms are too intense, I'm not able to do much except for lying in bed and listening to relaxing music. And that's ok, we need to try not feeling guilty about it

We are already facing a big challenge with courage, that's enough for one person

 

3 hours ago, Cigale said:

One thing that I haven’t figured out yet is how to handle social invitations and obligations. With the de-confinement and beautiful weather, everyone wants to gather and celebrate. But I am so afraid I will have a bad day and have to cancel everything, that I avoid socializing. I also can’t drink alcohol since it triggers my anxiety, something I never experienced before.

 

Can't help you on that one, struggling with this too. But when I read SA testimonies, I can see that all folks in WD deal with loneliness and isolation.

Again, time will help : as months pass we find that we are progressively able to be more confident and do more things

 

Good things to avoid alcohol : it triggers my anxiety too, and lot of folks here can say the same

 

3 hours ago, Cigale said:

I just wish I knew that all this is temporary and I will be my usual outgoing self again.

 

Actually, we do know that all this is temporary  

According to thousand testimonies here, we do know that WD is temporary.

It sometimes feels like eternity, especially during those early months. And it is true that it can take a lot of time for our CNS to adjuts and repair.

But we do heal

People who went through WD often say that they didn't think they would heal either. But time passes, and they healed eventually.

What a wonderful news, right ?

 

Must be pretty hot right now in South France ! I live in Britanny, near the sea, and I deeply appreciate the sweet and fresh wind

 

Take care ❤️

 

[sunnysideup69]

Hello @Cigale, I am dropping by to say hello and thank you for the lovely article on meditation. I hope you are having a good day and if not, then that you will have a good day tomorrow  

[Cigale]

On 6/24/2020 at 1:35 PM, Erell said:

Sometimes, when symptoms are too intense, I'm not able to do much except for lying in bed and listening to relaxing music. And that's ok, we need to try not feeling guilty about it

We are already facing a big challenge with courage, that's enough for one person

 

Merci beaucoup @Erell for taking the time to share your advice and support with me! You are truly amazing, working through your own journey while supporting others in a second language. I can't tell you how much I appreciate your kindness. And I need this sort of advice - that is is okay to do nothing but take care of ourselves. This morning, my psychotherapist advised me to do exactly this.

 

Yes it is very hot, dry and sunny here, and I am a little envious of your gentle ocean breezes. Thank you again for your guidance. Bisous!

[Cigale]

Thank you @sunnysideup69 for your sweet hello. I am hanging in there. After five average, relatively stable days with some little windows, I crashed hard this morning and am having a rough day. So I am working on accepting and floating and trying to slow down and take Erell's advice to just be kind to myself.

 

I hope you have a wonderful visit with your parents. Take care!

 

[Gridley]

4 minutes ago, Cigale said:

am having a rough day.

Cigale,

 

I'm sorry you're having a rough day.  It's very good you had 5 relatively stable days.  Healing is happening all the time, including during the bad days.

 

Gridley

[Cigale]

1 minute ago, Gridley said:

Healing is happening all the time, including during the bad days.

 

Thank you Gridley. I needed to hear this. I hope you are healthy and safe.

[sunnysideup69]

@Cigale, thank you, looking forward to my visit. Hoping you have some more windows these next few days  

[Cigale]

Though I am not ready to start my taper, I am researching the pill crushing vs making my own liquid approach. I would prefer to just get a liquid escitalopram (seroplex) prescription, but it comes in the worst 20mg/ml dose here in France and I have no idea how I would taper (Brass Monkey slide) from 5 mg using that. Can it be safely watered down?

 

I am leaning towards DIY liquid, and think I read somewhere that it is best to use an isotonic solution (9g salt + 100 ml water) instead of straight water because escitalopram doesn’t dissolve well. I did experiment with dissolving a pill in just water yesterday, and there were lots of particles. I will try experimenting with the isotonic solution today. Note that I am not taking these experimental liquid doses, just seeing how they turn out. 

 

I do also think the crushed pill approach could be an option. One thing I like about it is that I would not be changing the nature of the drug like I would do with a DIY liquid. I do worry about introducing more challenges with a switch to liquid (over the recommended four week of course). I know my friend Gridley takes this approach and uses two spoons to crush and 00 gel capsules. I need to find an alternative scale here since the recommended one isn’t available in France. 

 

Any one have tips or preferences on pills vs liquid for a escitalopram taper? I have read through the specific info on this and hope it is okay I ask this question as part of my introduction. 

 

Thank you, Cigale

[brassmonkey]

Which method you use will be somewhat dependent on how your body reacts. If you are currently using tablets making the switch to liquid can sometimes cause problems. You won't know until you try.

 

When making your own liquid there will be some sediment on the bottom of the container or cloudiness in the liquid. This is is just the filler material.  After the liquid has been left to stand for a couple of hours the medication will dissolve out of the filler and into the liquid, if you are using the right liquid.  The isotonic saline will work well for this, but plain water won't. If you are nervous about getting all the medication then you can mix the liquid well just as you draw out your dose so you get some of the sediment mixed in.

 

It is possible to do a Brassmonkey Slide using the 20mg/mL commercial liquid.  There will be several steps involved making different dilutions, but it is pretty straight forward. If you're interested, when I get a chance I'll write up some directions on how to do it.

[Cigale]

Thank you so so much @brassmonkey for your guidance! I can’t tell you how much I appreciate all the information and wisdom you have shared on tapering through this community. I have tried to gather all your tips as I plan for the next phase of this journey. I do have a couple of follow-up questions, but there’s no rush at all on a reply.

 

1) There might not be an answer for this because we’re all so different, but I am wondering about the risks of changing from my current tablet to liquid. I plan to do the 4-week crossover approach, and wonder how long it would take for me to realize it is or isn’t a good approach for me. Maybe if I held each cross - starting with 3/4 pill + 1/4 liquid - for 7-10 days, I would have a better idea? And then, if it doesn’t work, how do I reverse couse? Just go back to full tablet?

 

2) In your opinion is the DIY or the prescribed liquid better? Also, I would like your directions on how to use the 20mg/ml liquid, though again, no rush at all on this. I am still in the planning/dreaming mode.

 

3) Could you tell me what I should look for in a scale? (I’m in France and can’t find the recommended scale here.) I think it needs to weigh down to .001 mg, right? Are there other features I should look for? I know Gridley mentioned scales that come with tongs that allow you to place the powder on the scale. 

 

I have to say I really love the idea of a liquid taper since it sounds simpler, but I also want to be as gentle and conservative as possible for this final phase. This will be my third attempt at withdrawal and I really want it to be the last.  I am just so lucky to have such options, thanks to your pioneering work and the generosity of this community. 

 

Thank you for your help!

[Cigale]

Trying to do a better job of updating here, though I have to admit that posting here does some times trigger difficulties. Most of my days are filled with low to medium waves that I try to acknowledge, accept and float on. Distractions that help are walking, cooking, cleaning, backgammon, talking to friends and family. A pattern of late has been one to two days with waves that are manageable followed by a difficult day where I work to move forward from moment to moment.

 

Thursday, June 25 was a hard day, perhaps kicked off by a difficult session with my psychotherapist. She is trying to help me find tools to cope with the intense anxiety and depression but also believes I am using WD as a crutch, blaming my struggles on something I can control. This always throws me off, and leaves me thinking that I am creating this madness in my head. If I am tired, I spiral off into a place where I can't see beyond idea that this will never end.

 

Friday, June 26 was a better day. I actually went for a bicycle ride with a friend and managed to eat three meals. Then Saturday, June 27 I had trouble getting out of bed with intense fear and dread. Eating was difficult and I managed a banana and a piece of ham. But in the afternoon, I did manage to push myself to buy groceries and ate a good dinner.

 

Sunday and Monday were decent days. I got up and kept going both days, eating normally, walking my two dogs, and cleaning the house. I did some remote work and put on fun music while doing the dishes. And today has been somewhat challenging, though I have managed to push myself to do some cleaning and some remote work. Still planning to walk my dogs, which always provides relief.

 

I know every day I am one day closer to starting my taper.

 

 

[Cigale]

You know, I just noticed something by rereading my post. Maybe I am trying to do too much when I feel better. Maybe that is why good days are followed by hard days. And yet, I feel like doing stuff helps me have better days. Any one have this sort of experience?

[Erell]

Dear Cigale (love your name !), 

 

1 hour ago, Cigale said:

Trying to do a better job of updating here, though I have to admit that posting here does some times trigger difficulties.

 

Don't feel obligated to post here if you think you need to limit your time here. We will still be there when you'll need us.

Remember, yourself first

 

1 hour ago, Cigale said:

Most of my days are filled with low to medium waves

 

This is huge ! I know it can still be hard, but low or medium waves are a good sign. You're on the good path

 

1 hour ago, Cigale said:

Thursday, June 25 was a hard day, perhaps kicked off by a difficult session with my psychotherapist. She is trying to help me find tools to cope with the intense anxiety and depression but also believes I am using WD as a crutch, blaming my struggles on something I can control. This always throws me off, and leaves me thinking that I am creating this madness in my head.

 

Unfortunately most psychotherapists deny WD syndrome, they believe the common beliefs claimed by psychiatry and pharma industry.

When I crashed months ago, I was wearing myself trying to convince those around me.

I don't try anymore : it consumed me and it is not helping.

This is why we are blessed to have a place like SA to share with other folks

You may never convince your psychotherapist : you'll have to decide if you can work with her/him despite this.

 

You are NOT creating this "madness in your head"...or it would mean we are all mad here 

 

1 hour ago, Cigale said:

Eating was difficult and I managed a banana and a piece of ham.

 Smiled on this one : banana and ham are the only thing I can eat when anxiety is too intense !

 

1 hour ago, Cigale said:

You know, I just noticed something by rereading my post. Maybe I am trying to do too much when I feel better. Maybe that is why good days are followed by hard days. And yet, I feel like doing stuff helps me have better days. Any one have this sort of experience?

 

A lot of folks here report that doing too much often trigger symptoms.

I sometimes make this mistake myself : I love to garden the days I feel able to because it helps to change the channel. But I also have to limit my work because I'm often exhausted after.

Like it is often said : we have to treat our CNS and bodies like a baby and be gentle with them

 

Take care ❤️

 

[Cigale]

Merci beaucoup @Erell for your support! It means so much to me. I really appreciate your advice on my therapist. I have had to redirect her a couple of times already and have been thinking I might need to take a long break. She is really nice and well-meaning, but I don't feel like these sessions help me right now.

 

5 minutes ago, Erell said:

Smiled on this one : banana and ham are the only thing I can eat when anxiety is too intense !

 

Yes! This made me so happy to hear!

 

4 minutes ago, Erell said:

Cigale (love your name !),

 

I love the overwhelming sounds of cigales in the summer here. I swear I am going to get a cigale tattoo when this is all done.

 

I hope you are doing okay. Sending hugs your way!

[Cigale]

Hello @brassmonkey - You don't need to reply to all my questions above. I will just look for your update to the endgame taper section. I really appreciate all the work you have put into helping this community. Thank you!

 

[brassmonkey]

Hi Cigale-- sorry it's taken so long to get back to you.

 

1) There might not be an answer for this because we’re all so different, but I am wondering about the risks of changing from my current tablet to liquid. I plan to do the 4-week crossover approach, and wonder how long it would take for me to realize it is or isn’t a good approach for me. Maybe if I held each cross - starting with 3/4 pill + 1/4 liquid - for 7-10 days, I would have a better idea? And then, if it doesn’t work, how do I reverse couse? Just go back to full tablet?

 

The major risk of changing to a liquid would be that your body doesn't like it and there is a spike in symptoms. We highly recommend doing a cross taper like you describe to "ease your body" into the transition. If there are problems the reversing the cross taper and gong back to the tablet is the best thing. Erell is in the middle of a cross taper between different medications and may have some insight that will help.

 

2) In your opinion is the DIY or the prescribed liquid better? Also, I would like your directions on how to use the 20mg/ml liquid, though again, no rush at all on this. I am still in the planning/dreaming mode.

 

There is very little difference between a commercial and a DIY liquid.  The commercial liquid will last longer once the bottle is opened, but if you modify it by adding water you can only keep it a few days. DIY liquids may give you more control over the dilution ratio, but they are only good for a few days before you have to discard them.

 

3) Could you tell me what I should look for in a scale? (I’m in France and can’t find the recommended scale here.) I think it needs to weigh down to .001 mg, right? Are there other features I should look for? I know Gridley mentioned scales that come with tongs that allow you to place the powder on the scale. 

 

There are a number of scales available that will fill the bill.  The important thing is that they be capable of weighting by the milligram, this would be a designation of  .001g or 0.001g resolution in the product description. Any other features don't really matter.

[Cigale]

Hello @brassmonkey - I really appreciate you taking the time to reply to my questions! I am still on the fence between doing my taper with crushed tablet vs DIY liquid, but have time to weigh (no pun intended) the pros and cons of each. I do plan to take your updated ‘endgame taper’ into consideration. As I understand it now, it seems to be easier to micro-dose with liquid as the doses get very small. Though I probably should check in with @Gridley to see how the endgame is working with tablets.

 

Thank you again for your guidance! I hope you are well and safe.

 

 

[Gridley]

11 hours ago, Cigale said:

Though I probably should check in with @Gridley to see how the endgame is working with tablets.

Hello, Cigale.

 

My endgame is working fine with tablets.  The smallest decrease you can make with a scale with a lower limit of.001g (1mg) is 1mgpw ( pill weight). When   I went from 10mgpw, which with my tablet is 1mgai (active ingredient), that was my last 10% cut due to the limits of the scale.  From 9mgpw to 8 was 11%, 8 to 7 was 12%, 7 to 6 was 14%, 6 to 5 was 16%, 5 to 4 was 20%, 4 to 3 (where I am now) was 25%.  3 to 2 will be 33%, 2 to 1 will be 50%.  

 

The scale is accurate only to 4mgpw.  Brassmonkey divided his 4mgpw dose into 1mgpw doses by eyeballing to get the lower doses.  I've able to continue using the scale beyond the 4mgpw point by putting the 10g weight that comes with the Gemini scale (I know it's not available in France) on the scale, so it reads 10.000. Then to I add powder to get my dose.  For example, my current dose  has a readout of 10.003mgpw.  Once I get to 1, I will have to eyeball my 1mgpw dose and divide it in half to get 0.5mgpw, which would be a dose of .05mgai.  I may jump off here or I may make one further 50% cut down to 0.025mgai.

 

 

 

[Cigale]

Thank you @Gridley for sharing your endgame taper details. I was leaning toward staying with tablets, but your post helped me make a decision. And your timing is perfect because you prompted me to check again on the Gemini scale. Not only is it available now, the price has been reduced. It should arrive mid to late July.

[Gridley]

11 minutes ago, Cigale said:

It should arrive mid to late July.

That's great, Cigale.  I'm glad my post helped.

[street129]

@Gridley

Brassmonkey is also helping me with my taper I'm doing the scale, I thank brassmonkey for his help all the time and his knowledge.

so I finally decided to do this. I've been on this site since 2017, and was really scared to start back then and reading about WD was very scary.

next week will be one month doing my taper and Im glad and look forward to my taper.

Frogie is also a beautiful person. I find her so snoothing, anyways have a great evening.

[Gridley]

11 hours ago, street129 said:

next week will be one month doing my taper and Im glad and look forward to my taper.

You will do great, Street!  And Frogie is a beautiful person.

[Cigale]

Funny how I usually only come here to write an update when I am in a wave.

 

But today is not great so far. I did get six hours of sleep, which is good. But woke with dread and buzzing anxious head. Managed to make and eat a breakfast of eggs and toast. Went back to bed and tried reading but couldn't concentrate. Then just went with listening to my dog Stella snore, always a good thing. Need to try and eat some lunch.

 

What makes all waves hard for me is that they logically follow on some medium okay days. Yes, I think I had a window on Friday, July 3! For the first time in over a year, I woke up without dread. The day was pretty easy and calm with a little, sunny bike ride, nap (30-minutes) for the first time in months, and good meals. Saturday and Sunday were medium days with nagging anxiety and baby cortisol surges throughout the day. I feel like I have learned to tolerate those sorts of days. And then wham, today, I am down and out. When I get this down I find it hard to reach for and use my tools. But this is when I have to be kinder and more accepting of my situation. Along with acceptance, acknowledge and float, I need to practice self-compassion.

 

And like @Gridley wrote here so many weeks ago, I need to savor my windows. Healing is happening.

[Cigale]

Day three of one of the worst waves I have had since reinstating Lexapro. Insomnia, anxiety/depression, fear and terror that is hard to shake, SI is back, and I can't focus or read to distract myself. And I am experiencing nausea, something completely new. Reinstatement has been challenging. I just hope I am doing the right thing by holding at 5mg and waiting to start a BM taper.

[sunnysideup69]

48 minutes ago, Cigale said:

Day three of one of the worst waves I have had since reinstating Lexapro. Insomnia, anxiety/depression, fear and terror that is hard to shake, SI is back, and I can't focus or read to distract myself. And I am experiencing nausea, something completely new. Reinstatement has been challenging. I just hope I am doing the right thing by holding at 5mg and waiting to start a BM taper.

 

You're doing the right thing by holding. Sorry you're having a bad wave right now, it absolutely sucks, I know. Unfortunately, it's also part of the process of healing. Brain and CNS are making some adjustments, by the sounds of it...hang on in there @Cigale. Sending hug from London.

[sunnysideup69]

@Cigale, I also just opened my tapering spreadsheet that you made and I wanna say THANK YOU SO MUCH for doing that. It's very helpful and useful. How did you do that? I'd be interested in making one for doing a ten percent cut and holding for 4 weeks, also. 

 

How are you doing today in that wave? I'm also having a few gloomy days, since Sunday. Mood a bit up and down, generally improves as we go towards the end of the day/evening.

[Cigale]

Hello @sunnysideup69 - I am hanging in there and just trying to accept what I can't control and distract myself with things that I know I used to love to do. And keep taking this one moment at a time, something that is SUPER challenging for me. I love to plan and know where I am going. I hope you have some better days. I love what you are doing with your videos, and hope you keep that up. You are so dang inspiring!

 

I am glad you like the spreadsheet, but I can't take any credit for it at all. SA member Jozeff made the downloadable version from this online calculator - which is also pretty cool. I am going to use this extra fancy version that member @Iowan created because it includes both mgai (active ingredient) and mgpw (pill weight). I need mgpw because I am going with crushed tablets vs liquid. I am forever incredibly thankful for these resources from this smart and generous community.

 

And to help you with a possible 10% cut and hold for 4 weeks total, I updated the jozeff spreadsheet. All I did to update is change the row3: percentage per week to 10, row4: weeks taper to 1, and row5: weeks hold to 3 (to get 4 weeks hold). So if you decided you wanted to hold longer than 4 weeks, you would just add weeks to row5. When you are ready to start, you just need to change the starting date in row12. Hope this helps!

Sunny_Taperspreadsheet-10pct.xls