neverknew: tapering Lexapro

[neverknew]

At this point, sometimes I sleep and sometimes I don't. I am bummed because I talked to my GP the other day and he said he is concerned that I may be serotonin deficient for the rest of my life. Not that it has happened but that it may have happened; he hasn't seen it but he's read about it. Perhaps the SSRI use over 16 years has damaged my brain's ability to make it's own serotonin? I sure didn't need to hear that! He wants me to finish taking the last bit of Lexapro and work with a sleep medicine Dr. I am having trouble finding one in my area. 

[Gridley]

@neverknew

 

The "serotonin deficiency" or "chemical imbalance" theory is a hoax made up by the pharmaceutical companies and has been thoroughly debunked.  The gut produces a huge amount of serotonin and if your brain needed some the gut would supply it.  You have nothing to worry about.

Again, chemical imbalance is a myth. Stop the lies, please ...

[neverknew]

Thank you, Gridley, that's good to know that SD probably doesn't exist. I have always wondered if the AD can cause some permanent level of alteration to the brain, though, even when discontinued. Especially if taken for long periods of time.

[Gridley]

17 minutes ago, neverknew said:

I have always wondered if the AD can cause some permanent level of alteration to the brain, though, even when discontinued. Especially if taken for long periods of time.

Everything I've seen on this site indicates there is no permanent damage or alteration to the brain, even after prolonged use.

[catarina7000]

On 5/11/2020 at 1:54 PM, Gridley said:

Everything I've seen on this site indicates there is no permanent damage or alteration to the brain, even after prolonged use.

 

Can you provide some links? Also, what are the longer times you have seen for recovery?

[Gridley]

@catarina7000

 

Here's a thread on permanent brain damage.

 

Dr. Peter Breggin re: "permanent brain damage ...

 

Re length of time for recovery,  I recall it took Altostrata, the founder of this site, 7 years to recover from Paxil PAWS.  Some of the posts in this thread mention length of time for recovery.

Have you recovered from being on antidepressants long term ...

 

 

Edited January 29, 2021 by Altostrata
masked name

[catarina7000]

On 5/14/2020 at 10:38 AM, Gridley said:

I recall it took Altostrata, the founder of this site, 7 years to recover from Paxil PAWS

 

Wow that's depressing but not permanent. Ugh. Thanks

[Altostrata]

neverknew, how are you doing?

[neverknew]

I wonder if it would be helpful for me to actually increase the dose just a little. I have weaned down to .15 mg over a couple of months, since I've been having the anxiety and insomnia. But since I am having problems which are not going away, maybe I should go up for awhile and not down. Perhaps up to .25? That would be where the dose was right before I started having so much anxiety and sleeplessness. Perhaps I should have done it sooner but I wonder if it might help. 

 

 

[Altostrata]

What problems are you having? What times of day do you take your drugs?

[neverknew]

Sorry for the delay; my email was putting these notifications in junk. I take my med at night. I am having panic attacks during the day. I am concerned about being able to work. I've got FMLA for my job and have had to call out a couple times.

[DataGuy]

Hi @neverknew

 

I've looked over your history. Are you still taking all these same drugs and supplements? I assume you are taking the propranolol, finasteride, thyroid hormone etc. But are you taking the L-theanine and GABA? If you have been taking these for some time they can cause problems, paradoxically, with sleep. It is tough to say what the problem is since you are taking so many different things. My best advice is to continue tapering off the Lexapro and then start getting rid of some of these unnecessary supplements. I believe L-theanine and GABA both suppress the nervous system. GABA does not cross the blood brain barrier when taken in supplement form. Theanine does. Neither of these supplements really has a proven benefit.

 

At this point I think it is much more likely that this cocktail of drugs and supplements is creating more problems than it is solving. If you want, you can hold the Lexapro where it is, or you can do a small updose to 0.2 or 0.25mg, but not more. While you are holding there, you can start to dispense with these supplements, reducing the dosages of them over a period of weeks or months, depending on your symptoms. Can you list what your symptoms are on a daily and nightly basis right now? Anxiety, panic attacks, insomnia? Is there anything else?  

 

Is this still roughly your schedule? Are there any drugs or supplements missing here?

 

Quote

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

 

Edited June 17, 2020 by DataGuy

[neverknew]

@Altostrata 

 

I'm glad I found this about super slow tapers (post moved from: the-slowness-of-slow-tapers-micro-taper) because I've just had to go up on my Lexapro dose (from .15 mg to .20) and I might need to go up on it again, as I'm still having symptoms. I've really not been well the past few weeks. I always get to this point - the drug is almost completely out of my system and then all hell breaks loose. I can never seem to get over the hump. It's been 18 months now since I've started this taper and I'm having the same problems. I just can't seem to hold long enough. And I'm getting to the point where the amounts are so small it's difficult to cut 10%. Or, in my case, I think I may need to cut less than 10%, but is there a way to do that when the amounts are so low? I have a 1 milliliter size syringe and the best I can do is measure out the liquid on the tick marks (using a magnifying glass to see!) which are .01, .02, .03, etc.

 

Couple of days ago, I saw an integrative psychiatrist who confirmed what I've always believed: for many years now (say, 13 or 14?) I have been actually withdrawing from my medication even as I was still taking it. I was on a subtherapeutic dose, unknown to me, which was putting me into withdrawals. I have felt for several years, that's what was causing my insomnia. Still do. So my body has been withdrawing from this poison for, probably, 14 or so years! I just never knew it. That Dr also said my body is just too unstable right now to continue with actively tapering. I need to hold my level for awhile until I can get stronger and hopefully, calm down my nervous system. He suggested I try DHH-B, or magnolia bark, and I don't know about that...I've heard some questionable things. I don't want to make things worse. I've gotten so afraid to try new things because I have paradoxical reactions. When I switched from Prozac to liquid Lexapro, I had a paradoxical reaction. My nervous system was telling me, "I've had it. No more!"

 

Edited June 18, 2020 by ChessieCat
added link from where post was moved for context

[neverknew]

@DataGuy  Everything is the same except I'm not taking the melatonin. It doen't seem to help. I am one of those people who has paradoxical reactions to things so if that's it, melatonin would keep me awake. Why did you say to go up to .25 mg, but not more?

[DataGuy]

7 hours ago, neverknew said:

@DataGuy  Everything is the same except I'm not taking the melatonin. It doesn't seem to help. I am one of those people who has paradoxical reactions to things so if that's it, melatonin would keep me awake. Why did you say to go up to .25 mg, but not more?

 

@neverknew There are a couple reasons you don't want to go up by too much. 1) You don't want to lose the progress you've made. One reason you could be having trouble sleeping is that taking these and other sedating supplements / drugs everyday will cause receptors for inhibitory neurotransmitters (and modulatory ones like serotonin) to downregulate. This means they tend to be absorbed into the cell and disappear, and then you need to create more to recover from the drug use (withdrawal). In the time you have been having trouble with sleep and panic, you have likely done some healing. By this I mean your system has come some way towards restoring the nervous system back to the way it was before the lexapro changed it. Only upping the dose by a small amount helps to avoid undoing any progress you made. Also, the drug takes a few days to build back up into your system. So you won't know if the updose was successful for a few days (maybe give it a week).

 

2) The other reason is that at this point it is tough to tell whether it is the lexapro that is causing your problem. Regardless of what doctors, pharmaceutical companies or supplement companies tell you about drugs and supplements, they are generally not that great for you. Antidepressants for example, don't actually reduce the risk of mortality, so it seems unlikely they are good for you health (they also increase the risk of diabetes, bone fractures, bleeding, dental problems as well as a few other health issues). Supplements also have risks, but they are a bit more untested, so it's hard to say what those are. I think you should start to take the view that the drugs and supplements you take are likely causing more harm than good, and start working to reduce the most unnecessary ones first. I would start with the GABA and Theanine first, since these have psychotropic effects and could be culprits in messing up your sleep. 

 

I think you said you used to sleep fine? Let's try and get back to that. You should start to consider that any of the possible drugs and supplements you take could be the problem. You need to change your thinking and realize most of these things are unnecessary, have little or no proven benefit and could be harming you. 

[DataGuy]

As for how to very slowly taper (maybe a good idea): you can just make a solution with the medication that is less concentrated by dissolving a smaller amount of medication in the same amount of water or alcohol. 

[brassmonkey]

Another way to vary the dilution ratio would be to use the same amount of tablet but increase the amount of liquid. When you make the liquid solution if you double the amount of liquid used you then have to take a dose that is twice as large to get the same amount of medication. For example, if you originally dissolve a 10mg tablet in 10mL of liquid you get a 1:1 dilution ratio. If you take a dose of 1mL you would get 1mg of medication. But if you dissolved the same tablet in 20mL of liquid you would get a dilution ratio of 1:2, meaning that there is 1mg of medication in 2mL of liquid and you would have to take 2mL to get the same dose. By using the 1:2 ratio liquid each mark on the syringe would now contain half of the previous amount of medication making it easier to make small changes in your dose.

[Altostrata]

10 hours ago, neverknew said:

Couple of days ago, I saw an integrative psychiatrist who confirmed what I've always believed: for many years now (say, 13 or 14?) I have been actually withdrawing from my medication even as I was still taking it. I was on a subtherapeutic dose, unknown to me, which was putting me into withdrawals. I have felt for several years, that's what was causing my insomnia. Still do. So my body has been withdrawing from this poison for, probably, 14 or so years! I just never knew it. That Dr also said my body is just too unstable right now to continue with actively tapering. I need to hold my level for awhile until I can get stronger and hopefully, calm down my nervous system. He suggested I try DHH-B, or magnolia bark, and I don't know about that...I've heard some questionable things. I don't want to make things worse. I've gotten so afraid to try new things because I have paradoxical reactions. When I switched from Prozac to liquid Lexapro, I had a paradoxical reaction. My nervous system was telling me, "I've had it. No more!"

 

Maybe. When it comes to withdrawal, there is no such thing as a "subtherapeutic dose", only a dose that is sufficient to forestall withdrawal symptoms. Even a low dose of an SSRI might cause sleeplessness as an adverse effect having nothing to do with withdrawal.

 

On the bright side, this psychiatrist does know the concept of "unstable", so that's promising.

 

I'm not familiar with those supplements.

 

What you think are withdrawal symptoms might be something else, we need to track that down. As @DataGuy indicated, we need to know exactly what you're taking now, at what times of day and dosages. Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. 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.

 

 

 

[neverknew]

@DataGuy  @brassmonkey    Thank you so much for the information. So now I am at .2 mg and I could reduce by one of the .01 tick marks on the syringe I'm using. But when I get to the .1 mg mark I could dilute with water. This is Lexapro liquid I'm using. If I understand correctly, for .1 mg of the liquid Lexapro, I should add .1 mg of water, equaling .2 mg of solution. At that point when I reduce by .01 of my little tick marks on my syringe, it would really be half that amount (not .01 mg but half, which is what I want it to be). Is that correct? You folks have done this before without trouble?

 

At this point I'm not sure when I will be able to resume my taper, as I need to strengthen my nervouse system. I have been advised to "hold" and it's likely to be a decent amount of time. Therefore I have some questions: during these periods of 'hold', is there healing going on? What happens if the hold dose "poops out"(if that ever happens)? How do you know what are acceptable tolerance withdrawals symptoms and when the symptoms would require another updose? 

 

It's always difficult for me to determine when it's ok to go on and make another cut or just to hold the "hold". I have been withdrawing for such a long time I've gotten used to the symptoms. But I do recognize the old feelings of depression and panic attacks. Weird things like not being able to lay down flat in the bed, ride as a passenger in a car (I'm ok if I drive; it seems to be a control thing), listen to certain music or watch certain movies or television because they are too sentimental, or fly on a plane. Too much time having to sit still. My m.o. seems to be lately I'll have anxiety during the day and wind down as the day goes on so that I don't usually have much trouble at night (thank God!). I'm not sure why; I theorized maybe it's cortisol during the day and maybe melatonin (which calms anxiety) is being produced at night.  

[ChessieCat]

50 minutes ago, neverknew said:

At this point I'm not sure when I will be able to resume my taper, as I need to strengthen my nervouse system. I have been advised to "hold" and it's likely to be a decent amount of time. Therefore I have some questions: during these periods of 'hold', is there healing going on?

 

  

On 8/31/2011 at 5:28 AM, Rhiannon said:

This is something I posted somewhere else and then saved. I know it's all stuff I've said before, but it bears repeating and further discussion. A lot of people, including healthcare practitioners; in fact, I guess, most people-- are operating from entirely the wrong paradigm, or way of thinking, about these meds. They're thinking of them like aspirin--as something that has an effect when it's in your system, and then when it gets out of your system the effect goes away.

 

That's not what happens with medications that alter neurotransmitter function, we are learning. What happens when you change the chemistry of the brain is, the brain adjusts its chemistry and structure to try to return to homeostasis, or biochemical and functional balance. It tries to restabilize the chemistry. For example: SSRI antidepressants work as "serotonin reuptake inhibitors." That is, they cause serotonin to remain in the space between neurons, rather than being taken back up into the cells to be re-used, like it would be in a normal healthy nondrugged brain. So the brain, which wants to re-establish normal signaling and function, adapts to the higher level of serotonin between neurons (in the "synapse", the space between neurons where signals get passed along).

 

It does this by removing serotonin receptors, so that the signal is reduced and changed to something closer to normal. It also decreases the amount of serotonin it produces overall. To do that, genes have to be turned on and off; new proteins have to be made; whole cascades of chemical reactions have to be changed, which means turning on and off OTHER genes; cells are destroyed, new cells are made; in other words, a complex physiologic remodeling takes place. This takes place over time. The brain does not grow and change rapidly. This is a vast oversimplification of the amount of adaptation that takes place in the brain when we change its normal chemistry, but that's the principle.

 

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.

 

With multiple drugs and a history of drug changes and cold turkeys, all of this becomes even more complicated. And if a person is started on these kinds of drugs at an early age before the brain has ever completely established normal mature functioning--well, it can't be good. (All of which is why I recommend an extremely slow taper particularly to anyone with a multiple drug history, a history of many years on meds, a history of past cold turkeys or frequent med changes, and a history of being put on drugs at a young age.)

 

This isn't intended to scare people, but hopefully to give you some idea of what's happening, and to help you respect and understand the process so you can work with it; ALSO, because you are likely to encounter many, many people who still believe these drugs work kind of like aspirin, or a glass of wine, and all you need to do is stop and get it out of your system. Now you can explain to them that no, getting it out of your system is not the issue; the issue is, you need to regrow or at least remodel your brain. This is a long, slow, very poorly understood process, and it needs to be respected.

 

[DataGuy]

11 hours ago, neverknew said:

@DataGuy  @brassmonkey    Thank you so much for the information. So now I am at .2 mg and I could reduce by one of the .01 tick marks on the syringe I'm using. But when I get to the .1 mg mark I could dilute with water. This is Lexapro liquid I'm using. If I understand correctly, for .1 mg of the liquid Lexapro, I should add .1 mg of water, equaling .2 mg of solution. At that point when I reduce by .01 of my little tick marks on my syringe, it would really be half that amount (not .01 mg but half, which is what I want it to be). Is that correct? You folks have done this before without trouble?

 

At this point I'm not sure when I will be able to resume my taper, as I need to strengthen my nervouse system. I have been advised to "hold" and it's likely to be a decent amount of time. Therefore I have some questions: during these periods of 'hold', is there healing going on? What happens if the hold dose "poops out"(if that ever happens)? How do you know what are acceptable tolerance withdrawals symptoms and when the symptoms would require another updose? 

 

It's always difficult for me to determine when it's ok to go on and make another cut or just to hold the "hold". I have been withdrawing for such a long time I've gotten used to the symptoms. But I do recognize the old feelings of depression and panic attacks. Weird things like not being able to lay down flat in the bed, ride as a passenger in a car (I'm ok if I drive; it seems to be a control thing), listen to certain music or watch certain movies or television because they are too sentimental, or fly on a plane. Too much time having to sit still. My m.o. seems to be lately I'll have anxiety during the day and wind down as the day goes on so that I don't usually have much trouble at night (thank God!). I'm not sure why; I theorized maybe it's cortisol during the day and maybe melatonin (which calms anxiety) is being produced at night.  

 

Yes @neverknew, healing can happen when you are holding. You may notice your symptoms lessen or you start to feel more stable. As long as this is from holding and not simply increasing the dose of the medication, I think it is safe to take this as a sign of healing. Some of your other questions are a bit more difficult to answer without a symptom journal as @Altostrata requested. Please do so in this format as best you can. With so many drugs and supplements being taken, it is hard to know what is causing what symptom.

 

And yes, the description you provided of dilution and tapering is correct. Doubling the amount of water you have will dilute so that the same liquid dosage you were taking previously will contain 1/2 of the previous dose. 

 

[ChessieCat]

I've moved your post about fish oil to the SA topic:  king-of-supplements-omega-3-fatty-acids-fish-oil

 

I've also responded with the following:

 

42 minutes ago, ChessieCat said:

The easiest way to find out would be to stop taking it for a while and then restart it.  If it happens again them it is most likely the cause.  You would have to make sure that you didn't change anything else during this time.  As you said it may be something else in the capsules or it might be the high concentration.

 

 

 

[neverknew]

On 6/21/2020 at 9:00 AM, DataGuy said:

Yes @neverknew, healing can happen when you are holding. You may notice your symptoms lessen or you start to feel more stable. As long as this is from holding and not simply increasing the dose of the medication, I think it is safe to take this as a sign of healing. Some of your other questions are a bit more difficult to answer without a symptom journal as @Altostrata requested. Please do so in this format as best you can. With so many drugs and supplements being taken, it is hard to know what is causing what symptom.

 

 

@DataGuy I will try to get the information you requested but right now my brain isn't working very well. I've had a very bad night. Didn't sleep at all d/t anxiety. I was on .20 mg  of Lexapro until May 2. Then I started to decrease again, despite being anxious. This was very foolish; I should have known better.  So I went .18 mg for a week, then .16 for 2 weeks, then .15 for 2 weeks. A pharmacist friend suggested I try going up just a little on the med. At this time it was June 17 and I went up to .20. A week later I went up to .23 and that's where I've been since. The anxiety was better and so was sleep during this time, even though I still have occasional sleepless nights. I do not underestimate my anxiety problem; it is significant. But I wonder, how long will that level, .23, last? What happens when people gain tolerance to the raised dose? Do some people fail to stabilize? What do people do? We can't keep going up forever without eventually restarting the drug altogether. 

[DataGuy]

On 7/16/2020 at 6:14 AM, neverknew said:

 

@DataGuy I will try to get the information you requested but right now my brain isn't working very well. I've had a very bad night. Didn't sleep at all d/t anxiety. I was on .20 mg  of Lexapro until May 2. Then I started to decrease again, despite being anxious. This was very foolish; I should have known better.  So I went .18 mg for a week, then .16 for 2 weeks, then .15 for 2 weeks. A pharmacist friend suggested I try going up just a little on the med. At this time it was June 17 and I went up to .20. A week later I went up to .23 and that's where I've been since. The anxiety was better and so was sleep during this time, even though I still have occasional sleepless nights. I do not underestimate my anxiety problem; it is significant. But I wonder, how long will that level, .23, last? What happens when people gain tolerance to the raised dose? Do some people fail to stabilize? What do people do? We can't keep going up forever without eventually restarting the drug altogether. 

 

 

That is ok, @neverknew. I hope you sleep better tonight.

 

Some people do have a difficult time stabilizing. I think if you are sleeping at the current dose, then it is best to just hold there and things should slowly stabilize if you avoid making changes to everything else. If you do change something, make sure to try and only change one thing at once. That makes it easier to identify the cause if something goes wrong (or right!). At a dose of .23mg, it seems unlikely you would gain tolerance to it. Much more likely is that your system is just destabilized from withdrawal. You should be able to rectify that by simply holding. Unfortunately, the instability can last quite awhile, so be patient.