eljay: back again, withdrawing again

[eljay]

Hiya,

So, 19 years on various SSRI's, last several years on 10mg Lexapro. I've actually done pretty well on them, but decided I wanted to at least cut down to 5mg, d/t severe clenching of jaw/neck/shoulders etc. Also urine retention at night. Oh, and Restless Legs syndrome, exacerbated by the AD's These are all side effects I am very familiar with, but tired of. I've developed occipital neuralgia, probably r/t to the clenching. I've been reading up on brain remodeling, so I really feel it's time to get off these buggers. 

 

Mid March, I cut my 10mg 'bars' (I'm in France) to 3/4's. It always ended up being more like 2/3rds so I just would alternate daily between a 2/3rd tab and two 1/3rd tabs. I had about a week of nausea, dizziness, brain zaps, and then I was fine. I was pleasantly shocked! I stayed on this 0.66mg dose for 3 months, feeling absolutely fine. In mid June, I cut from 0.66mg to 0.5mg daily. Again, a week of zaps, dizziness which mostly went away But I soon noticed my sleep deteriorating, and my RLS was much worse. My mood was becoming flat, then about a week ago I felt the first stirrings of depression. I'm severely worried about everything, I"m weepy and have moments of dread. I have a few external life stressors that seemed to suddenly become overwhelming. (I've quickly found a great therapist, hoping to head off the downward spiral).

 

Now, I was initially prescribed SSRI for anxiety, not depression. I have had brief bouts, but few and far between. What I am left with now basically is moderate depression, anxiety, RLS and insomnia. I have ativan at hand which I use rarely as needed, but took some last night because I needed sleep. Now I just feel groggy. (I take melatonin too). I really don't want to reinstate any, but I'll probably stay at this dose for at least 3 months. Do you think I will stabilize? 😕

(Not sure how to add a med history sig line.) 

Thanks!

eljay

 

[Gridley]

Welcome to SA, eljay.

 

To start, here is how you add a signature:

 

To give members the best information, we ask them to summarize their medication history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly.  A list format is best.

 

Account Settings – Create or Edit a signature.

 

You are experiencing antidepressant withdrawal caused by a too fast taper.  Lexapro is the strongest SSRI on the market, and something like 85% of the drug's effectiveness is contained in the first 10mg.  We recommend tapering by no more than 10% of your current dose every four weeks.  Your first taper was a 33% decrease and your second taper was over 24%.  It's difficult for your nervous system and brain to adapt to such large changes, which accounts for what you're experiencing. It's also very important to take the same dose every day--your nervous system needs stability.  To answer your question, yes, you will stabilize but we can't predict how long it will take.  It might take longer than 3 months--everyone is different, and we just don't know.  You should not taper 

any further until you have stabilized.

 

Why taper by 10% of my dosage?

 

Brain Remodelling 

 

A mathematics correction: if you decreased 10mg by 2/3, your previous dose was 6.6mg, not .66mg, and your current dose is 5mg, not .5mg.  

 

Depression is a common withdrawal symptom, as are the other symptoms you describe.   Psychiatrists don't believe in withdrawal and misdiagnose withdrawal as "return of the underlying condition" and, as you said, you didn't have significant depression before starting these drugs.  

 

What is withdrawal syndrome.

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

When we take psychiatric medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.  

 

You said you didn't want to reinstate (or in this case, updose)  and that is your choice.  However, reinstatement of a very small dose of the original drug is the only known way to help alleviate withdrawal syndrome.  The only other alternative is to try and wait out the symptoms and manage as best you can until your central nervous system returns to homeostasis.  Unfortunately no one can give you an exact timeline as to when you will start feeling better and while some do recover relatively easily, for others it can take many months or longer.  

 

Reinstatement isn't a guarantee of diminished symptoms for everyone but it's the best tactic available.  With respect to your June decrease, you're still in the time period where reinstatement predictably works, up to 3 months after last dose.  We usually suggest a much smaller reinstatement dose than your last dose.  These drugs are strong, your system has become sensitized and If you take too much it may be too much for your brain and can cause you become more unstable.  After you updose and once you've stabilized on the new dosage, which can take several months,  you can begin a 10% per month taper down to zero.   Please read:

 

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

 

If you decide to updose, I would recommend an increase of 1mg Lexapro so your new dose would be 6mg.  It takes a little more than a week for the full effect of the updose to be felt.  If 1mg is enough, it still may take some weeks or months for your nervous system to settle down. You probably will continue to have waves and windows (ups and downs), but symptoms won't be as intense. 

 

This link explains how to get the small dose of Lexapro you'll need for your updose::

 

Tips for tapering off Lexapro (escitalopram)

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems.

 

Please be very careful with the Ativan.  Physical dependency can begin within 2 to 4 weeks of regular use and can also result from intermittent use.

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Edited July 17, 2020 by Gridley

[eljay]

Hi Gridley,

Thanks for the great info. I will explore it all today. I just wanted to quickly add that yes, math error, lol! I am an RN and even helped with tapers on a benzo site a few years ago. Seeing someone make a mistake like that was a huge bugaboo of mine! I meant to write it in fractions of my original dose and accidentally threw a 'mg' on the end. I must be seriously brain-fogged. 😱

Thanks again, I'll finish reading this today. 🙂

[eljay]

Hi, so, I've been struggling to decide to stay put or updose. My RLS is getting ever so worse, so I think I'm going to updose. I'm also so tired and feeling depressed and unmotivated and unhappy. I did have mild COVID 19 3 months ago and there is some new evidence that there can be lingering chronic fatigue. I still have a cough and it's actually getting worse. So may have some overlapping symptoms. 

I quit my new therapist because all she wanted to do is psychoanalyze me! She would stop me every few seconds to ask me why I'm crossing my arms, clenching my fists, not looking her, wiggling my foot, covering my mouth etc. I was just looking for someone to talk to/listen during a moment of emotional 'crisis', and maybe offer some new coping strategies. 🙄

Anyway, I'll liquify my tablet and updose by 1mg. And see how that goes. Thanks again. 

[ChessieCat]

16 minutes ago, eljay said:

Anyway, I'll liquify my tablet and updose by 1mg.

 

What drug will be increasing?

 

What is the current dose of the drug (before increasing)?

 

[ChessieCat]

And how long have you been on the current dose?

[eljay]

26 minutes ago, ChessieCat said:

 

What drug will be increasing?

 

What is the current dose of the drug (before increasing)?

 

Hi Chessiecat! Thanks for responding. It's all in my opening post. In mid March, cut my 10mg Lexapro to 6.6mg (dry cut my pill by 2/3rds) did well aside from a few brain zaps. 3 months later (mid june), cut to 5mg. within a  2 or 3 weeks, I developed rls, insomnia, depression. The primary insomnia has mostly resolved except for the RLS constantly waking me up or not allowing me to fall asleep. Depression is somewhat better, comes and goes. But the rls is intolerable. So I'm updosing to 6mg. I'm familiar with liquid tapers, I used to plan them for folks on a benzo withdrawal site years ago. So as much as I hate messing about with that rather than just cutting, I suppose I'll have to go to the liquid anyway, once I pass 5mg. 

[ChessieCat]

So that we can see your drug history at a glance and not have to read through your posts please update your drug signature so that it shows the dates and doses changes.

 

Thank you.

 

Account Settings – Create or Edit a signature

 

 

[eljay]

23 minutes ago, ChessieCat said:

So that we can see your drug history at a glance and not have to read through your posts please update your drug signature so that it shows the dates and doses changes.

 

Thank you.

 

Account Settings – Create or Edit a signature

 

 

Done.