neverknew: tapering Lexapro

[neverknew]

I am at such a low dose of my Lexapro (1/20th of a miligram). Such a low dose in my body. Anxiety/panic issues but mostly about sleep as I have developed total insomnia. So tired and weary. I can lay down and get comfortable but absolutely no sleep. Medication has gotten to the point it doesn't help. This week I have been taking Lunesta but only this week as it is so addictive. Trazadone would be a good one for me but I have to have such high doses for sleep it gives me a completely stuffed up nose every time! My Dr says the lack of sleep is cause by serotonin deficiency. Of course it would be. Having ready serotonin 24/7 for 16 years, my brain probably doesn't know how to make it on its own. What really infuriates me most about this whole situation is, before I went on the SSRI, I slept like the dead. Once I got to sleep, I could easily go for 9-10 hrs. Never any problem at any time. And I never had any problems with anxiety either. Never. I feel this drug has damaged my brain. I don't have the sense of calm I was once able to enjoy. Now it's agitation, fear, tension, and restlessness.I don't know if I'll ever be normal again.

[Altostrata]

Welcome, neverknew.

 

It sounds like you have withdrawal symptoms already from tapering too fast. Please stop tapering for the time being.

 

When was the last time you made a reduction, from what dosage to 0.2mg? Are you using the liquid?

[neverknew]

I am using the liquid. The last decrease was from .225 on February 23rd. I made another cut to .175 on March 15th. March 22 I started to have anxiety so I went back up to .2mg and have stayed there. March 29th the insomnia started. I try to keep the cuts around 10% but with such tiny amounts and small ticks on the syringe, it's difficult.

 

My therapist wants me to begin a CBT program of sleep hygiene and sleep restriction. No sleep meds of course. The idea being to retrain my brain for sleep and work on the anxiety regarding my sleep. Therapist says my thoughts and actions can accomplish this even given the lack of serotonin in my brain. Needless to say, there will be many totally sleepless nights, which terrifies me. I can either go through this now or try to find a sleep med that works for now and try to come off it later. Or just stay on it the rest of my life. Thoughts?

[nolongeranxiousbut]

Just a note that if actually 1/20th of a mg that's 0.05 mg not 0.2 mg (which is 1/5th of a mg). So 0.05 ml if using the US liquid.

[neverknew]

Sorry for the confusion, math was never my thing. My syringe is a 1milliliter size (in Lexapro, it's a 1 to 1 ratio in the liquid; 1 ml = 1 mg). So the tick marks go: 1 ml, .9 ml, .8 ml, etc. I am at the 1 near the top that says .2. So I guess that would really be 1 fifth of a milligram? 

[neverknew]

I'm interested in what you think about what I said above. Total insomnia in withdrawal, resistant even to medications? Is that really a thing, or just with me? My nervous system is such a wreck; I don't know how to get it better. Has anyone ever supplemented with 5-HTP, tryptophan, or SAM-e? My Dr suggested them to me but at this point I have very little faith in Drs.

[Altostrata]

16 minutes ago, neverknew said:

Total insomnia in withdrawal, resistant even to medications? Is that really a thing, or just with me?

 

It is very much a thing. Many of the people on this site have this. We're very familiar with this.

 

What time of day do you take Lexapro? How do you feel before and after you take it? Are you taking any other drugs?

 

Why did you switch from Prozac to Lexapro?

 

10 hours ago, neverknew said:

March 22 I started to have anxiety so I went back up to .2mg

 

How did you feel after you made this small increase?

 

Please do as much as you can to stay calm. Your therapist's techniques may help.

[neverknew]

 

19 hours ago, Altostrata said:

It is very much a thing. Many of the people on this site have this. We're very familiar with this.

 

Thank you. Makes me feel a little better.

I take the Lexapro around 7 or 8 at night. I can't say I notice any distinguishing feelings before or after; could be because it is a very small amount? I also take a beta blocker at the same time. I associate these 2 medicines with each other, hopefully to help me remember that I actually took them. I also take Synthroid, BCP, finasteride, probiotic, saw palmetto, and another beta blocker, all in the morning. 

 

When I made that tiny increase from .175 mg back up to .20, I thought I felt better. Not like gangbusters, but a little.

 

The reason for switching from Prozac to Lexapro doesn't make much sense now, looking back on it. At the time I had developed tachycardia from a paradoxical reaction when I had to start the Prozac back after a failed taper. I was placed on a beta blocker to control this. I still wasn't feeling well. I wondered if it might have been a reaction to the Prozac itself and if trying a different drug might help. It didn't. Doctors had told me that Prozac was "self-tapering" because it stays in the body for so long. Therefore, the withdrawals wouldn't be as severe. I had never found this to be the case. I had horrible withdrawals on Prozac. But I didn't have the liquid, either. I had to guess at the amount of the pills. When I got the pill down to where I couldn't split it anymore, I would just quit. About a month later the withdrawals would start. I am at a much lower dose now with the Lexapro than I ever got to with the Prozac.  

 

[Altostrata]

The Lexapro may be keeping you awake. I would take it earlier by gradually moving it by an hour each day, until you're taking it at noon.

 

While you're doing this, keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day, including your sleep pattern. Post 24 hours of notes at a time in this topic, in a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right. This will help us figure out what the Lexapro is doing.

 

We have seen when people go on and off psychiatric drugs, their nervous systems often become sensitized. They have reactions to the drugs they never had before. This may have happened to you with Prozac as well.

 

Please put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php
and copy and paste the results or a link to them in this topic.

 

[neverknew]

I will do.

 

I talked to my Dr today and he suggested 3 sleep meds for research to choose one to take intermittently after I'd been awake for  awhile. They are Rozerem, Sonata, or Belsomra. Does anyone have any experience/opinions with those?

 

I have also been thinking that perhaps I have become afraid to sleep. I'll begin to doze off and something jolts me awake like a bad dream. Then I realize my anxiety. Excitatory neurotransmitters, perhaps, that don't want me to sleep. Like I've become my own worst enemy. It's so difficult to get still and quiet enough to even try to sleep. All my body seems to want to do is move and be awake. How do people do this? Do they just get so exhausted they eventually fall down? Or go to the hospital for nervous exhaustion? I wasn't always like this. The bed used to be my friend. I used to want to stay in it because it was so comforting for me. No more.

[Happy2Heal]

9 hours ago, neverknew said:

I have also been thinking that perhaps I have become afraid to sleep. I'll begin to doze off and something jolts me awake like a bad dream. Then I realize my anxiety. Excitatory neurotransmitters, perhaps, that don't want me to sleep. Like I've become my own worst enemy. It's so difficult to get still and quiet enough to even try to sleep. All my body seems to want to do is move and be awake. How do people do this? Do they just get so exhausted they eventually fall down? Or go to the hospital for nervous exhaustion? I wasn't always like this. The bed used to be my friend. I used to want to stay in it because it was so comforting for me. No more.

 

 

I can so relate to this, one of the hardest part of WD recovery was not being able to escape into sleep.

what you are describing is incredibly common for WD and everyone gets thru it in their own, 

thru trial and error sometimes with different methods and sometimes using like melatonin or taking magnesium or epsom salt baths, etc

 

this symptom WILL eventually get better but it may take some time and can be quite frustrating.

 

as you look around at other people's threads you'll see just how common this is and also all the different ways that people cope with it.

You'll find what works for you, and what works for a day or a week or a month, may in time change

and then you'll find something else that will work

 

but in general insomnia improves gradually until you discover that you're sleeping like you used to

 

I personally would not recommend ANY pharmaceutical for sleep. They can mess up your recovery.

 

The anxiety about not falling asleep (or in my case, sometimes, anger!) can interfere a little bit with your sleep but really most of it is just a symptom of your brain healing. It will get better in time.

 

accepting that it's going to be like this for awhile can help. at the very least, it can help you feel less miserable.

 

keeping the bedroom cool and dark, practicing good sleep hygiene, those are all good things to do but don't be disappointed if doing them does not give you the kind of sleep you're used to and want.

 

it does get better though!

 

check out my signature, I was on all kinds of pysch meds for over 40 years and I have recovered. I  did go thru a long period of insomnia, and many others did, and I didn't like it one bit, but the insomnia finally DID go away and now I am fully healed and have a wonderful life.

 

you'll get there too.

[neverknew]

Thank you so much, Happy2Heal.

Do you happen to remember, what was the longest time you went without sleep? At that point, do you just get so exhausted you can't help but sleep?

 

I wonder how my WD symptoms will play out. If this will stick around for awhile but then go away and not come back. I have such a small bit of Lexapro to go (fifth of a mg), to get it down to 0. Surely my brain wouldn't miss it? Oh, I'm taking it down to 0 because I'm afraid not to. I just wonder if I have to go through this every time I make a cut, even though it is very slow.

[Happy2Heal]

3 hours ago, neverknew said:

Do you happen to remember, what was the longest time you went without sleep? At that point, do you just get so exhausted you can't help but sleep?

 

One thing that may help you as it helped me, while I was suffering the worst of insomnia, I read as much about sleep and insomnia as I could. I came across some very reassuring information, sleep is a primary need. Your body needs it so much, it will get it, whether you're aware of it or not. It could be just certain parts of your brain shutting down for sleep while others are active, but it does definitely sleep. It's so vital, it just happens.

 

I initially was awake round the clock for days. I know now that at least part of my brain was sleeping during that time. Even when I knew I was falling asleep for brief periods of maybe 20 mins at a time,  I was not aware of the difference. I would seem as if I'd not fallen asleep at all.

I felt very wired and "on" all the time. I lost a lot of weight. I was miserable because I wanted to sleep but once I accepted that sleep was going to return in it's own time, I was less miserable and found ways to deal with the extra time I had.

At first, what bothered me wasn't just that I couldn't sleep, It was that all my other symptoms were so severe and uncomfortable, that not sleeping meant having much more time to have to struggle with those symptoms. There wasn't the blessed relief and escape in to sleep.

 

being exhausted actually worked against me. I was exhausted, of course, but not finding time to just relax, to lay down and read, to meditate or do yoga or all of those things, that would make it harder to settle at night.

Everyone's pattern is probably different but I quickly learned that I could not consume any caffeine at all.

I could not exercise, not even a leisurely stroll, after a certain time of day, and any aerobic exercise absolutely had to be done before noon or my sleep would be disrupted.

 

But walking at least 20-39 mins per day helped me get the most restful sleep, so long as I did it early in the day

Getting up and getting out of the house, esp walking outdoors, helped to establish a good routine that helped sleep come more easily

 

for me, I had many months of never feeling tired and not feeling as if I was really sleeping at all, even though I knew I was, 

but then a change happened.

I would suddenly get extremely sleepy around say, 7 pm. I didn't fight the urge to sleep, I'd go and lay down and let my body rest. Usually I slept for  at least 30 mins, sometimes an  hour, and on happy days, 90- mins.

 

Then I'd get up and do stuff, and go to bed at my usual time. I didn't have too much trouble getting to sleep later, but I always had trouble staying asleep.

 

Now I have a pattern of sleeping for anywhere from 60 to 90 mins when I first lay down, then getting up and doing minor things around the house, or reading, or watching tv, and then I fall asleep again til a full bladder wakes me up. I've always needed to get  up during the night for bathroom breaks, so this isn't a problem for me

 

well, that was probably WAY more detail than you wanted or needed!! sorry.

 

you will definitely get to the same place that I am at, and hopefully much sooner, as your drug history is not as long or complicated (although I'm not really sure how much of a difference that makes)

everyone is different of course.

YMMV and all that.

 

I know insomnia is one symptom that so many of us have. 

I also know that if you read the success stories you'll see we all got thru it.

 

From what I've read and from what I've experienced with other drugs, one of the hardest ones to come off esp when it comes to  sleep and anxiety issues, is lexapro.

That drug is crazy strong!
I could feel the difference when I made a cut as little as 0.02mgs 

 

that small amount of lexapro you're on now, respect it! It's not really a small amount.

but you'll do well to be rid of it for good

 

 

once you're off, your healing should speed up. That seems to be what happened for a lot of us who got off of lexapro.

 

 

 

 

 

[JackieDecides]

19 hours ago, Happy2Heal said:

One thing that may help you as it helped me, while I was suffering the worst of insomnia, I read as much about sleep and insomnia as I could. I came across some very reassuring information, sleep is a primary need. Your body needs it so much, it will get it, whether you're aware of it or not. It could be just certain parts of your brain shutting down for sleep while others are active, but it does definitely sleep. It's so vital, it just happens.

 

H2H posted a lot of good info !

 

I just wanted to say that I've also read a lot about insomnia and it's absolutely true that people are terrible at knowing how much/if they are sleeping. sleep tests show people show people DO actually sleep when they will tell you they have not, and when they do they underestimate how much they are sleeping.

lack of sleep makes you feel bad but WORRYING about and is even worse. 

 

it's a terrible feeling but as H2H posted, people can get better it just takes longer than you want it to. 

 

keep posting! 

[neverknew]

 

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Drug Interaction Report

This report displays the potential drug interactions for the following 6 drugs:

• levothyroxine
• propranolol
• finasteride
• saw palmetto
• Apri (desogestrel / ethinyl estradiol)
• Lexapro (escitalopram)

Major (0)

Moderate (2)

Minor (2)

Food (5)

Therapeutic Duplication (0)

Interactions between your drugs

Moderate

propranolol ethinyl estradiol

Applies to: propranolol, Apri (desogestrel / ethinyl estradiol)

MONITOR: Oral contraceptives containing ethinyl estradiol may interfere with the first-pass metabolism of certain beta-blockers and increase their plasma concentrations. In one study, young, healthy female subjects receiving a low-dose ethinyl estradiol oral contraceptive (OC) demonstrated higher plasma levels of metoprolol (100 mg), oxprenolol (80 mg), and propranolol (80 mg) following single-dose administration than control subjects who were not receiving an OC. Specifically, mean metoprolol peak plasma concentration (Cmax) and systemic exposure (AUC) were 36% and 71% higher, respectively, in OC users (n=12) than in non-users(n=11); mean oxprenolol Cmax and AUC were 6% and 26% higher, respectively, in OC users (n=7) than in non-users (n=8); and mean propranolol Cmax and AUC were 19% and 42% higher, respectively, in OC users (n=7) than in non-users (n=8). Only the difference in metoprolol AUC reached statistical significance, although the difference in propranolol AUC failed to reach significance by only a narrow margin.

MANAGEMENT: Pharmacologic effects including blood pressure and heart rate changes should be monitored more closely when metoprolol, oxprenolol, and propranolol are coadministered with ethinyl estradiol oral contraceptives, and dosage adjustments made as necessary.

 

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Moderate

ethinyl estradiol levothyroxine

Applies to: Apri (desogestrel / ethinyl estradiol), levothyroxine

MONITOR: Estrogens may increase serum thyrotropin concentration, which could be harmful in patients with thyroid cancer receiving thyroxine for thyrotropin suppression or increase dosage requirements in patients with hypothyroidism receiving thyroxine for replacement therapy. Estrogens are known to increase serum thyroid-binding globulin concentration in a dose-dependent manner. Consequently, there may be a reduction in unbound, or free, thyroxine available for hormone activity, which, in turn, leads to an increase in serum thyrotropin concentration. Normally, thyroxine secretion can increase to compensate for this effect, but patients with hypothyroidism lack the mechanism to adapt. Limited evidence suggests that transdermal estrogen therapy may not affect thyroid-binding globulin concentrations; however, more data are required to confirm that.

MANAGEMENT: In patients treated with thyroxine, serum thyrotropin should be measured approximately 12 weeks after estrogen therapy is initiated, changed or discontinued, and the thyroxine dosage adjusted accordingly. Patients should be advised to contact their physician if clinical manifestations of hypothyroidism occur, such as fatigue, cold intolerance, constipation, unexplained weight gain, depression, joint or muscle pain, thinning hair or hair loss, dry skin, hoarseness, and abnormal menstrual periods.

 

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Minor

propranolol levothyroxine

Applies to: propranolol, levothyroxine

Thyroid hormone therapy may reverse decreased hepatic blood flow associated with hypothyroidism. Increased hepatic metabolism and decreased serum levels of some beta-blockers may result. Data are available for propranolol only. No special precautions are necessary. When hypothyroidism is converted to a euthyroid state, a decrease in beta-blocking effectiveness is possible.

 

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Minor

ethinyl estradiol saw palmetto

Applies to: Apri (desogestrel / ethinyl estradiol), saw palmetto

Theoretically, coadministration with saw palmetto may interfere with the pharmacologic effects of estrogen-containing drugs including oral contraceptives. Saw palmetto has been observed in one study to possess antiestrogenic effects. However, the interaction has not been reported.

 

No other interactions were found between your selected drugs. This does not necessarily mean no other interactions exist. Always consult your healthcare provider.

Drug and food interactions

Moderate

propranolol food

Applies to: propranolol

ADJUST DOSING INTERVAL: The bioavailability of propranolol may be enhanced by food.

MANAGEMENT: Patients may be instructed to take propranolol at the same time each day, preferably with or immediately following meals.

 

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Moderate

levothyroxine food

Applies to: levothyroxine

ADJUST DOSING INTERVAL: Consumption of certain foods as well as the timing of meals relative to dosing may affect the absorption of T4 thyroid hormone (i.e., levothyroxine). T4 absorption is increased by fasting and decreased by foods such as soybean flour (e.g., infant formula), cotton seed meal, walnuts, dietary fiber, calcium, and calcium fortified juices.

MANAGEMENT: Preparations containing T4 thyroid hormone should be administered on a consistent schedule with regard to time of day and relation to meals so as to avoid large fluctuations in serum levels. Foods that may affect T4 absorption should be avoided within several hours of dosing if possible. When administered to patients receiving continuous enteral nutrition for more than 7 days, some experts recommend that the tube feeding should be interrupted for at least 1 hour before and 1 hour after the dose of levothyroxine is given and to monitor patients' thyroid function.

 

Moderate

desogestrel food

Applies to: Apri (desogestrel / ethinyl estradiol)

MONITOR: Grapefruit juice may increase the plasma concentrations of orally administered drugs that are substrates of the CYP450 3A4 isoenzyme. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. Because grapefruit juice inhibits primarily intestinal rather than hepatic CYP450 3A4, the magnitude of interaction is greatest for those drugs that undergo significant presystemic metabolism by CYP450 3A4 (i.e., drugs with low oral bioavailability). In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands. Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition. Pharmacokinetic interactions involving grapefruit juice are also subject to a high degree of interpatient variability, thus the extent to which a given patient may be affected is difficult to predict.

MANAGEMENT: Patients who regularly consume grapefruit or grapefruit juice should be monitored for adverse effects and altered plasma concentrations of drugs that undergo significant presystemic metabolism by CYP450 3A4. Grapefruit and grapefruit juice should be avoided if an interaction is suspected. Orange juice is not expected to interact with these drugs.

 

 

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Moderate

escitalopram food

Applies to: Lexapro (escitalopram)

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

 

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Minor

ethinyl estradiol food

Applies to: Apri (desogestrel / ethinyl estradiol)

Coadministration with grapefruit juice may increase the bioavailability of oral estrogens. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall induced by certain compounds present in grapefruits. In a small, randomized, crossover study, the administration of ethinyl estradiol with grapefruit juice (compared to herbal tea) increased peak plasma drug concentration (Cmax) by 37% and area under the concentration-time curve (AUC) by 28%. Based on these findings, grapefruit juice is unlikely to affect the overall safety profile of ethinyl estradiol. However, as with other drug interactions involving grapefruit juice, the pharmacokinetic alterations are subject to a high degree of interpatient

 

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.

Major	Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate	Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor	Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown	No interaction information available.

 

 

 

[neverknew]

6:30 am took morning meds: no sympoms

probiotic

Apri

levothyroid 125 mcg

propranolol 10 mg

finasteride 5 mg

saw palmetto 900 mg 

 

8 pm, took evening meds: no noticeable symptoms

10 mg propranolol

.2 mg Lexapro

 

10 pm, took bedtime meds: got a little drowsy but still not sleeping

450 mg GABA

355 mg L theanine

2 mg melatonin

[Happy2Heal]

10 minutes ago, neverknew said:

450 mg GABA

355 mg L theanine

if you don't mind me asking, why are you taking these?

how long have your been taking them?

 

 

[neverknew]

I take them for anxiety and sleep. I've taken them in low doses for a year but upped the dose about a month ago.

[Altostrata]

On 4/8/2020 at 6:45 AM, nolongeranxiousbut said:

Just a note that if actually 1/20th of a mg that's 0.05 mg not 0.2 mg (which is 1/5th of a mg). So 0.05 ml if using the US liquid.

 

On 4/8/2020 at 6:55 AM, neverknew said:

Sorry for the confusion, math was never my thing. My syringe is a 1milliliter size (in Lexapro, it's a 1 to 1 ratio in the liquid; 1 ml = 1 mg). So the tick marks go: 1 ml, .9 ml, .8 ml, etc. I am at the 1 near the top that says .2. So I guess that would really be 1 fifth of a milligram? 

 

Sorry for my mistake. Please clarify the amount of Lexapro you're taking, in milligrams. To do this, you have to know how many milligrams are in a milliliter of the liquid and how much you're drawing into your syringe. You may wish to confer with your pharmacist about this.

 

On 4/10/2020 at 12:22 AM, neverknew said:

I will do.

 

I talked to my Dr today and he suggested 3 sleep meds for research to choose one to take intermittently after I'd been awake for  awhile. They are Rozerem, Sonata, or Belsomra. Does anyone have any experience/opinions with those?

....

 

Sleeplessness related to psychiatric drug withdrawal can be very grueling and traumatic. As this is a site to go off psychiatric drugs, we don't recommend any of those sleep drugs. It's your decision if you want to take them. You'll have to talk to your doctor should you get any adverse effects.

 

1 hour ago, neverknew said:

6:30 am took morning meds: no sympoms

probiotic

Apri

levothyroid 125 mcg

propranolol 10 mg

finasteride 5 mg

saw palmetto 900 mg 

 

8 pm, took evening meds: no noticeable symptoms

10 mg propranolol

.2 mg Lexapro

 

10 pm, took bedtime meds: got a little drowsy but still not sleeping

450 mg GABA

355 mg L theanine

2 mg melatonin

 

 

That is quite the drug cocktail. Other than Lexapro withdrawal, there are many potential culprits for causing sleeplessness. For example: Too much thyroid hormone can cause sleeplessness. Some drug-drug interactions can cause sleeplessness (your drug interactions report indicates these drugs are actively interacting with each other). Taking too much "sleep-making" drugs can paradoxically cause sleeplessness.

 

Why are you taking finasteride, saw palmetto, and an estrogen? Manipulating hormones can also cause sleeplessness.

 

Untangling your polypharmacy will be quite time-consuming. Please look up adverse effects for each of your drugs on drugs.com. Which of them can cause sleeplessness?

 

Which of these drugs was most recently added, and when?

[neverknew]

The GABA, L theanine, and melatonin were added most recently, about a year ago at a lower dose but recently raised.

 

I take the finasteride and saw palmetto for hereditary hair loss. I am perimenopausal, hence the Apri.

[Altostrata]

On 4/7/2020 at 3:57 AM, neverknew said:

My Dr says the lack of sleep is cause by serotonin deficiency.

 

No, there's no such thing as a serotonin deficiency.

 

Did you make any other drug changes in mid-March, other than the decrease in Lexapro?

 

What drug changes did you make in December-March? What was your Lexapro tapering method? When was the last time you had your thyroid hormone adjusted?

[neverknew]

I will follow with my Lexapro taper schedule. It's got a little length to it.

I had my thyroid checked at the beginning of March. Dr was good with it. Previously, it's been a couple of years since it's been adjusted. 

I did increase the amounts of GABA and L theanine in March. December-March, it's hard to remember but I was taking doxylamine for sleep. I tried a lot of different things for sleep; didn't stay on any of them for long because I was afraid of dependence and they just didn't work well. Finally settled on doxylamine and melatonin with Dr's ok. 

 

[neverknew]

Dec 23 2018 : starting dose 5 mg to 4.8 mg           

Dec 30, 2018: 4.6 mg

Jan 6, 2019: 4.2 mg

Jan 13, 2019: 3.8 mg

Jan 20, 2019: 3.5 mg

Jan 27, 2019: 3.2 mg

Feb 3, 2019: 2.9 mg

Feb 10, 2019: 2.6 mg

Feb 17, 2019: 2.4 mg

Feb 24, 2019: 2.2 mg

March 3, 2019: 2.0 mg

March 17, 2019: 1.9 mg

March 24, 2019: 1.8 mg

March 31, 2019: 1.7 mg

April 7, 2019: 1.6 mg

April 14, 2019: 1.5 mg

April 21, 2019: 1.4 mg

April 28, 2019: 1.3 mg

May 5, 2019: 1.2 mg

May 12, 2019: 1.1 mg

May 26, 2019: 1.0 mg

June 2, 2019:  .95 mg

June 9, 2019:  .90 mg

June 16, 2019:  .85 mg

June 23, 2019:  .80 mg

June 30, 2019:  .75 mg

July 7, 2019:  .70 mg

July 21, 2019:  .65 mg

August 4, 2019:  .6 mg

August 18, 2019:  .55 mg

Sept 1, 2019:  .5 mg

Sept 15, 2019:  .45 mg

Sept 29, 2019:  .40 mg

Oct 20, 2019:  .35 mg

Nov 17, 2019:  .30 mg

Dec 22, 2019:  .275 mg

Jan 12, 2020:  .25 mg

Feb 23, 2020:  .2 mg

 

March 15, 2020:  cut to .175 mg but March 22 went back up to .2 mg due to anxiety. That's where I am currently.

Edited April 15, 2020 by Altostrata
corrected mispost

[neverknew]

I wonder when I will be able to continue the taper? I stopped because  of the anxiety and insomnia. My GP doesn't think this is withdrawal; he thinks its just me with anxiety. Maybe a GAD. In any event, I would like to resume discontinuation of this medication but now I'm not sure what to do. This is really the first time I've had to stop because of significant trouble.

[Altostrata]

Why are all those dates in 2019?

 

At what point did you start to have trouble sleeping?

 

Your GP doesn't know anything about withdrawal syndrome.

[neverknew]

I wonder when I will be able to continue the taper? I stopped because  of the anxiety and insomnia. My GP doesn't think this is withdrawal; he thinks its just me with anxiety. Maybe a GAD. In any event, I would like to resume discontinuation of this medication but now I'm not sure what to do. This is really the first time I've had to stop because of significant trouble.

[neverknew]

The last 2 in Jan and Feb should be 2020. Sorry I'm not sure if I can edit them now? Thank you, I have always felt doctors don't know anything about withdrawal syndrome.

 

Sleep problems...wow, I have been having sleep problems for years. I used to work 3rd shift for a few years so I thought it might be that. Guess it started about 15 years ago. I wouldn't have any trouble getting to sleep at any time, not even naps. But I would only sleep about 4 hours, wake up and couldn't get back to sleep unless I stayed up a few hours. I also thought maybe it was hormones or not exercising, stress. This most current problem started about a year ago when I had to start back with the Lexapro due to withdrawals. Before that I was able to get to sleep, just not stay asleep. Starting back with the Lexapro created a paradoxical  reaction and gave me tachycardia. I had to go on a beta blocker. I started having to take things to help me get to sleep. About a month ago, the sleep meds weren't working anymore, so, now I have total insomnia and sleep anxiety.

[Altostrata]

I changed the dates.

 

At what point in your taper did this anxiety start?

 

5 hours ago, neverknew said:

Starting back with the Lexapro created a paradoxical  reaction and gave me tachycardia. I had to go on a beta blocker. I started having to take things to help me get to sleep.

 

Was this in November 2018? The Lexapro reinstatement was too stimulating for you.

 

Please add beta blocker, Lunesta, trazodone, etc. to your signature.

 

Did you look up adverse effects for each of your drugs? Which ones can cause nervousness or sleeplessness?

[neverknew]

I wonder when I will be able to continue the taper? I stopped because  of the anxiety and insomnia. My GP doesn't think this is withdrawal; he thinks its just me with anxiety. Maybe a GAD. In any event, I would like to resume discontinuation of this medication but now I'm not sure what to do. This is really the first time I've had to stop because of significant trouble.

 

Actually the Prozac was what I started back first, sometime before December 2018, (which is when I started the taper, after having switched to Lexapro). I'm not surprised it caused a paradoxical reaction, my nervous system was a wreck. I had spent the past 3 years going off and then having to go back on Prozac due to withdrawals, 3 separate times.

 

The birth control can cause some excitement and I know the beta blocker can cause insomnia. Fortunately my dose is very small. The anxiety did In't start until the 3rd week in March of this year.

[Altostrata]

Very few doctors know anything about withdrawal symptoms or tapering.

 

If you're having withdrawal symptoms, I would wait until they subside before you make another reduction, or you could make them worse.

 

I have been trying to get information from you about when these symptoms started. That might be a clue as to whether they are withdrawal symptoms. They might also be adverse effects from the drugs you're taking on and off.

 

Going on and off drugs can make your system sensitive to all drugs. This might have happened to you when you were taking Prozac.

 

You're also taking birth control? Please put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php
and copy and paste the results or a link to them in this topic.

 

Please also update your signature with ALL the drugs you're taking. We need this information to answer your questions.

 

 

 

[neverknew]

These particular anxiety symptoms/attacks started the week of March 22, 2020. I had been on .2 mg of the Lexapro since Feb. 23, 2020 and did not make a cut until March 15, 2020, to .175 mg but once starting with the anxiety symptoms I raised it back up to .2 mg on March 22, 2020. 

 

There is another thought I had. Wonder if this could be a generalized anxiety disorder? I don't know but I have read of a couple of people getting off their antidepressants to find they have anxiety where the depression used to be (if it ever was there to begin with). 

I am afraid to continue the tapering. Especially since I've got to the level where it's really difficult to stay within the 10 percent rule. My syringe doesn't have marks on it that small and it is the smallest syringe I can find. The best I could do is go from .2 mg to .175 mg; .175 mg to .150 mg; .150 mg to .125 mg, etc.

 

I previously put all my medications in the symptoms checker and posted it. What's in my signature is what I'm currently taking. I'm not taking Lunesta anymore. Have you been able to see all of my posts? Maybe some of them didn't get through?

[Altostrata]

Are you taking birth control drugs? When did you start? Did you make any changes in your drugs in early or mid-March?

 

On 4/15/2020 at 5:21 AM, neverknew said:

This most current problem started about a year ago when I had to start back with the Lexapro due to withdrawals. Before that I was able to get to sleep, just not stay asleep. Starting back with the Lexapro created a paradoxical  reaction and gave me tachycardia. I had to go on a beta blocker. I started having to take things to help me get to sleep. About a month ago, the sleep meds weren't working anymore, so, now I have total insomnia and sleep anxiety.

 

So the sleeplessness predates March 15, that's just when the sleep meds stopped working? What sleep meds were you taking at the time?

 

Why do you keep talking about anxiety? I do not see anxiety on your daily symptom pattern; in fact, you report no noticeable symptoms other than sleeplessness.

 

On 4/11/2020 at 6:14 PM, neverknew said:

6:30 am took morning meds: no sympoms

probiotic

Apri

levothyroid 125 mcg

propranolol 10 mg

finasteride 5 mg

saw palmetto 900 mg 

 

8 pm, took evening meds: no noticeable symptoms

10 mg propranolol

.2 mg Lexapro

 

10 pm, took bedtime meds: got a little drowsy but still not sleeping

450 mg GABA

355 mg L theanine

2 mg melatonin

 

58 minutes ago, neverknew said:

Wonder if this could be a generalized anxiety disorder? I don't know but I have read of a couple of people getting off their antidepressants to find they have anxiety where the depression used to be (if it ever was there to begin with). 

 

When people go off their antidepressants, they commonly get misdiagosed withdrawal syndrome, not a new anxiety disorder. We don't treat anxiety disorders here.

 

My guess is your sleeplessness is not from tapering Lexapro, they're adverse effects from the other drugs you're taking.

[neverknew]

I've been on BCP for about 25 years with short amounts of time off of them. No different medication doses except the Lexapro dose change previously referred to on March 15, 2020. There is pretty consistent anxiety mainly triggered by the thought of sleep. Just started March 29, 2020. At that time I was taking Unisom and it had stopped working. No sleep, none at all, on Unisom. I had been taking it every night for about a year.

[Altostrata]

17 minutes ago, neverknew said:

There is pretty consistent anxiety mainly triggered by the thought of sleep.

 

This is your own habit of thinking causing anxiety, not withdrawal. You might try meditating at bedtime, to stop these thoughts that are keeping you from sleeping.

 

It's very common for over-the-counter sleep aids to stop working.

 

How much exercise do you get? You can do other things to help improve your sleep, see

 

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

 

Path to Better Sleep FREE online for everyone from the US Veterans Administration

 

Music for self-care: Calms hyperalertness, anxiety, aids relaxation and sleep

 

What is the sleep cycle?

 

Melatonin for sleep: Many people find it helpful

 

TV or computer use in evening can disrupt sleep: Bright light signals the brain that it's daytime

 

I am doubtful Lexapro or your tapering is involved. If I were you, I'd continue tapering it and go off it completely in the near future. That would take one confounding factor out of the picture.

 

Otherwise, it may be the influence of your other drugs affecting your sleep. The effect of a drug changes as you get older. Is sleep disruption among the adverse effects of your birth control pill? How about finisteride? Are you pre-menopausal?

 

Please consult with your doctor about the potential influence of the other drugs. We don't offer general medicine services here. She gets paid, we don't.

[neverknew]

I walk outside everyday in the sunshine.  I am menopausal. Finasteride and BCP are listed as maybe causing sleeplessness. 

 

Quote

Please consult with your doctor about the potential influence of the other drugs. We don't offer general medicine services here. She gets paid, we don't.

 

Ain't that the truth! Thank you for all the links. Regarding the tapering, is there a small syringe that would allow me to make a 10% cut from .2 mg of Lexapro to .180 mg?

[Altostrata]

Ask your pharmacist for a 1mL or 0.5mL syringe. You may have to ask a veterinarian.

 

Sleep problems are common in menopause.

 

Combinations of drugs such as

On 4/11/2020 at 5:49 PM, neverknew said:

Moderate

propranolol ethinyl estradiol

Applies to: propranolol, Apri (desogestrel / ethinyl estradiol)

MONITOR: Oral contraceptives containing ethinyl estradiol may interfere with the first-pass metabolism of certain beta-blockers and increase their plasma concentrations. In one study, young, healthy female subjects receiving a low-dose ethinyl estradiol oral contraceptive (OC) demonstrated higher plasma levels of metoprolol (100 mg), oxprenolol (80 mg), and propranolol (80 mg) following single-dose administration than control subjects who were not receiving an OC. Specifically, mean metoprolol peak plasma concentration (Cmax) and systemic exposure (AUC) were 36% and 71% higher, respectively, in OC users (n=12) than in non-users(n=11); mean oxprenolol Cmax and AUC were 6% and 26% higher, respectively, in OC users (n=7) than in non-users (n=8); and mean propranolol Cmax and AUC were 19% and 42% higher, respectively, in OC users (n=7) than in non-users (n=8). Only the difference in metoprolol AUC reached statistical significance, although the difference in propranolol AUC failed to reach significance by only a narrow margin.

MANAGEMENT: Pharmacologic effects including blood pressure and heart rate changes should be monitored more closely when metoprolol, oxprenolol, and propranolol are coadministered with ethinyl estradiol oral contraceptives, and dosage adjustments made as necessary.

 

Switch to consumer interaction data

Moderate

ethinyl estradiol levothyroxine

Applies to: Apri (desogestrel / ethinyl estradiol), levothyroxine

MONITOR: Estrogens may increase serum thyrotropin concentration, which could be harmful in patients with thyroid cancer receiving thyroxine for thyrotropin suppression or increase dosage requirements in patients with hypothyroidism receiving thyroxine for replacement therapy. Estrogens are known to increase serum thyroid-binding globulin concentration in a dose-dependent manner. Consequently, there may be a reduction in unbound, or free, thyroxine available for hormone activity, which, in turn, leads to an increase in serum thyrotropin concentration. Normally, thyroxine secretion can increase to compensate for this effect, but patients with hypothyroidism lack the mechanism to adapt. Limited evidence suggests that transdermal estrogen therapy may not affect thyroid-binding globulin concentrations; however, more data are required to confirm that.

MANAGEMENT: In patients treated with thyroxine, serum thyrotropin should be measured approximately 12 weeks after estrogen therapy is initiated, changed or discontinued, and the thyroxine dosage adjusted accordingly. Patients should be advised to contact their physician if clinical manifestations of hypothyroidism occur, such as fatigue, cold intolerance, constipation, unexplained weight gain, depression, joint or muscle pain, thinning hair or hair loss, dry skin, hoarseness, and abnormal menstrual periods.

 

 

may cause paradoxical reactions, such as keep you awake when they're supposed to be calming.

 

To see if your other drugs are contributing to sleeplessness, you'd reduce them one at a time and see what happens. Propanolol requires tapering. Don't know about finasteride.

 

All of this should be stuff your doctor knows.