Halcyon: tapering escitalopram - time is not on my side

[Halcyon]

Hello all,

Sorry ahead of time for my book of an introduction.  

I am a 38 year old male who has been on Escitalopram for about 13 years.  I suffer with a family tendency towards neurosis, generalized anxiety disorder, obsessive catastrophic thoughts, IBS, and acid-reflux disease.  Some things trigger me more than others in regards to my anxieties.  Change and medication being big ones.  I've often felt I have what is known as change disorder.  I see a therapist regularly and I have been trying to pursue CBT for my issues but the practitioners around me are a bit lacking for this.

 

I've been in a hard spot lately.  Due to the way the world is right now and due to life circumstances and changing jobs, my anxiety has definitely gotten the better of me.  I've been practicing deep breathing daily, keeping a gratitude journal, biking for 30 minutes to an hour daily, journaling my worry, and trying to sleep better.  

Something good that has come up recently, my wife and I have both decided we want to have a baby.  She is a few months younger than me.  We probably should have started when we were younger, but both of us suffered with anxiety and she suffers with migraines/depression and we were scared about getting off of our medications.  Obviously, we want to start sooner than later.  I know that people have babies in their 40s but as our age increases so does our risk.

I was shocked to find out that the little studies done for men on SSRIs are consistently showing they negatively affect their sperm (low motility, malformed, and more distressing a large increase in DNA damage).  I want the best for my potential baby and the studies on possible problems from DNA damage to sperm are incomplete but not very reassuring.  I would especially like to reduce their chance at autism since I've seen first-hand how hard this can be on parents and children (friends of mine).

 

So, I want to begin tapering off of my escitalopram.  I have spoke with my therapist and have her support (although she thinks I'm worrying more about my sperm than necessary).  I have an appointment coming up with my prescribing psychiatrist.  I've printed out the paper from the Lancet featuring the work of Horrowitz and Taylor.  I am hoping to convince them to allow me to try this and to prescribe me the liquid form of my medication.  Based on what I've read here and what I've read in the Lancet article, I'm thinking of jumping from my 15 mgs to 10 mgs initially to see how it goes.  This would be roughly less than a 5% reduction in SERT occupancy and high enough on the hyperbolic curve that even if more than the normal 10% reduction, it would probably be well tolerated.

I am somewhat terrified of withdraw symptoms.  I've never attempted to come off my SSRI except for when I had only been on one for a few months.  Due to stress over the last couple years, I've already had bouts of anxiety and crying from dealing with change that I would rather not increase.  Lately it had gotten to the point that my therapist and psychiatrist felt my medication might be starting to not work enough.  But I really don't want to drag out the process longer than I need to.  I want to get my sperm healthy enough to be ready to conceive with my wife sooner than later.

 

By my calculations (reducing each dose by 10% rounded up to the nearest .00 - i.e. 5.126 being 5.13) , doing the most (which may be too aggressive) 10% taper method every month, it would take me over 4 years to be completely off of 10 mg.  If using the Horrowitz paper method of doing 10% reductions in SERT occupancy it would be closer to 9 months.  Reading everyone's awful experiences with withdrawal often when having done even the 10% taper or 5% taper has me very concerned.

My goal is to avoid any withdraw symptoms or if I have them for them to be minimal and short lived between tapers.   Ideally, I would like to be off of the drug within a year or at least off of it enough that the damage to my sperm is significantly reduced.  Unfortunately, there doesn't seem to be a lot of information about that.  The science believes the issues are due to SSRIs causing sperm to move slower than normal through the body and getting old.  I also found some studies suggesting higher amounts of serotonin affect sperm motility.  I'm hopeful that getting down to a lower dose will help with the sperm effects, but given the hyperbolic curve of SSRIs in general, I am concerned that even small amounts will still have a large effect.

If anyone has any advice I appreciate it.  Am I incorrectly interpreting how long it takes to wean off of 10 mg? Also, some words of encouragement are welcome.  Seeing so many out here describing awful withdrawal even at a 10% taper has me concerned I will not be able to hack it or will react so poorly I lose a job.  I do not tend to see posts mentioning that they did the 10% taper method and had little to no withdraw.

Stay safe and healthy in these crazy times,
Halcyon

[DataGuy]

Hello @Halcyon, welcome to SA!

 

You have come to the right place. I think you have calculated the time required for withdrawal correctly, but by the end of year one you will be below 3mg, and by the end of year two you'll be below 1mg. You can try to reduce more quickly, going by SERT occupancy, but I would recommend simply taking off 10% for the first month and seeing how that goes. Sometimes if you take off too much it can be hard to put things back together again if your system becomes destabilized (see this article: why taper by 10%?).

 

As a side note, I know people who have had children while taking antidepressants long term and they have all seemed to turn out fine. That being said, these drugs have for the most part only been tested for safety and efficacy for around 3 months, so I would definitely still recommend tapering off. You may want to take a look at our non-drug coping techniques also, as you'll be needing them if you are going to try to get off quickly. I have seen people quit fairly rapidly with not too many consequences, but they were not quite taking the drug for 13 years (more like 6 or 7). But coming off more slowly will help minimize the harm to you and your nervous system and should help keep you functional enough to continue working. 

 

I'm glad you've already done some reading and have looked at the SERT occupancy tables. Please continue to read so you can feel in complete control of this process. Here are specific tips on tapering Escitalopram. Thank you for filling out your signature.

 

One thing I will add is that I don't think you should see your anxiety as a weakness. Anxiety is an adaptive trait, and they have done studies showing that people who have higher levels of anxiety also tend to show increased fertility on average.

 

"Current Evolutionary Adaptiveness of Anxiety: Extreme Phenotypes of Anxiety Predict Increased Fertility Across Multiple Generations

 

Results:

The findings suggested that anxiety had a positive quadratic relationship with the number of children, grandchildren, and great-grandchildren 15 years later. These relationships were not significantly moderated by sex. Moreover, most of the variance between anxiety and the number of greatgrandchildren was explained by anxiety’s influence on the number of children and grandchildren, as opposed to anxiety having an independent direct impact on the number of great-grandchildren.

Conclusion:

These findings suggest that extreme values from the mean anxiety are associated with increased evolutionary fitness within the modern environment."

So although the anxiety might not feel great, it is more a sign of health than not. Also, congratulations to you and your wife on your decision to have a baby : )

Edited August 28, 2020 by DataGuy

[DataGuy]

@Halcyon,

 

Whoops, I misread your current dosage. In actuality, after 1 year you would be close to 4mg and after 2 years you'd be close to 1mg. Everyone handles withdrawal differently, so we can't really know how you'll react until we start reducing. In addition to being different for every person, withdrawal severity can also be different in the same person depending on the drug, the length of use, age, sex, withdrawal history etc. So very hard to know what will happen! That's why it is best to be cautious at all times. 

[Halcyon]

Thanks much @DataGuy.  I appreciate the advise and words of encouragement.

I’m not as concerned about the antidepressant effect on a pregnancy from the female side but I’ve seen studies stating they harm male sperm and cause a large increase in DNA fragmentation for men. The effects seem to be reversible when taken off of drugs. I’m not sure if there are any other options that can help. I’m hoping that reducing to a lower dose at the least might have a good effect. There doesn’t seem to be much if any information on things that help other than removal. And with how SSRIs cover receptors at large amounts in low doses, I’m wondering if the sperm effects will not be helped at lower doses. 
 

I am in general VERY scared of withdraw symptoms. It is why I have never tried to stop my medicine yet. I know everyone is different but I had hoped that a 10% a month taper would eliminate experiencing any bad side effects. I would probably wait much longer (post Covid pandemic) or go even slower but I am concerned about the fertility side of things. 
 

I guess I am very spooked to try to taper because of what I am seeing in these forums. It appears that everyone posting here has tried the 10% taper or less and is still having vicious withdrawal throughout. It is a bit discouraging. 
 

If I can have an effective taper where the worst I have is some headaches, heightened anxiety, nausea, etc. for a week or less. I think I could soldier on. Another problem is like a lot of people with anxiety I have a sensitive gut and medication makes me anxious. I see a lot of people here use supplements and other medications to combat withdraw. But I know I would have a very hard time with it. 
 

Not wanting to sound defeatist. I just want this to work. I am a developer/analyst at a university and things are always very busy. I really need to maintain the job and if I push myself into really bad withdraw effects I could wind up being let go. So I want to avoid that too. 
 

I guess this post is mostly rambling with my concerns. It would just be reassuring to know that plenty on my medication and length of time do the 10% taper and avoid any bad withdrawal effects.

 

[DataGuy]

Quote

He could try the brassmonkey taper WITHOUT the additional 2 week hold.  That is, reducing by 2.5% every week for 4 weeks and then recalculate for the next 4 weeks.  And if he needs to he could hold for extra time, whenever he feels the symptoms warrant it.

 

If he does a regular taper then to start with and so he gains some confidence he could try a 5% reduction first and if after 2 weeks he feels okay he could do another 5%.  And then 2 weeks later start tapering by 10%.

 

As I said, just some of my thoughts.  Sometimes we get so "fixed" with the 10% every 4 weeks we don't think about other options.

 

Hi @Halcyon,

 

Another moderator has suggested the above tapering method for you. This way you can start off slowly and work up to larger decreases (we can modify it to target SERT occupancy rather than mass of active ingredient if you like). It's always best to start slow and see how you react. We tend to urge members to be conservative here, since for people who've never rapid tapered and suffered the resultant PAWS, it can be difficult to appreciate how things can spin out of control. The best thing we can do is protect your health and functionality, and then hope for the best. 

 

I would not be scared off by stories on the forum. Plenty of people taper more rapidly and have fewer problems, but these people just tend to not end up on these forums. Online forums like these tend to suffer from selection bias of people who've had very long term use, egregious polypharmacy, previous difficult withdrawals or failed attempts at withdrawal, substantial difficulties with side effects, health problems caused by the meds etc. so they may not be representative of what you'll experience. 

 

As for the fertility issues, it is tough to know exactly how the drugs will affect outcomes. I think you are right to be concerned, but studies showing DNA fragmentation and motility decreases only suggest increased probability of problems. The actual effect on outcomes as a whole may be quite minor (most medical treatments have only minor effects). If you are interested, you could look up some statistics on birth outcomes to reassure yourself. An example of fetal malformations that might be common to SSRIs are congenital heart defects (this is just from casual reading). Just looking up the statistics, although the rate of defects have been increasing, they still affect less than 1% of babies born, while the use of these drugs has increased from close to zero before 1990 to above 10% of the population. So even with large scale usage, it seems to have only minor effects on birth outcomes. (There's also a myriad of other factors of course, like increasing parental age, other drugs like alcohol, opioids etc, environmental toxins, plastics, hormones, obesity, sedentary lifestyle etc.). So there are many factors you can control beyond simple antidepressant use. Probably the best thing you can do is ramp up your exercise regime. Exercise can help you deal with withdrawal symptoms, plus if you head into the withdrawal in better shape, you are much more likely to deal better. I'm sure it would also have a positive effect on fertility (although not if you are overdoing things, just remember to back off a bit when you are trying to conceive). 

[DataGuy]

It may also help to keep a symptom journal. It can be difficult to remember exactly how we felt a week, month, or year ago, so this can help you make sure you are keeping the withdrawal symptom intensity within a steady range of tolerability without too much guessing or error. You're welcome to keep your symptom journal here and post regular updates as to how you are feeling, concerns etc. This way we can keep an eye on things and if you ever get curious about how you felt in the past you can look at previous posts describing your symptoms and troubles. This also provides a good forum to record symptom triggers, problem solving and keeping track of what interventions worked and what haven't (like how you feel after doing various levels of exercise, or how long withdrawal symptoms last after a cut etc.). 

[Halcyon]

Thanks @DataGuy I appreciate it.

I'm an over-thinker by nature so that will be a struggle during my taper I am sure.  I am trying to get a handle of things with CBT exercises but I'm not that far into it so far.  

I did have another question for you and the community experts at large, my understanding is that the chances of withdrawal and the severity of it generally increases the longer you've been on an SSRI.  I also have read that attempting to taper from the drugs is generally better when you're in a relatively stress free time of life and able to practice good coping mechanisms (i.e. regular exercise, consistent sleep, etc.).  

So, you may have noticed I mentioned one of my big triggers is change.  The job I mentioned is a new one I just took on.  In general I've found that for six months or more it takes me a while to be less anxious and adapt to a new job.  Also, if I do manage to be blessed with a newborn in the next year or so, I am sure that for at least a couple years I will be extra stressed and struggling to keep a consistent sleep schedule.

 

What all this leads me to is, I'm hoping that I can taper successfully and down to at least a lower dose (5 mg for instance).  If at that point, I decide to stay on the lower dose for a year or two (just to not rock the boat while taking on the role of a new parent), am I setting myself up for more issues? I would be down quite a bit from where I am now, but I would also be adding to the overall length of time I'm on the SSRI.  I guess I am wondering if putting the brakes on tapering and staying at a lower dose will still be beneficial to me overall or if being on the drug for a longer length of time will be a worse overall.  Does that make sense? It seems to me like, logically, being on a lower amount will make tapering that much better.  However, reading about how things are generally worse the longer you're on the medicine makes me feel like if I need to pause for a long amount of time it will be detrimental.

 

Much appreciated!

Hal

[Gridley]

1 hour ago, Halcyon said:

I am wondering if putting the brakes on tapering and staying at a lower dose will still be beneficial to me overall or if being on the drug for a longer length of time will be a worse overall.

In my opinion, the benefits of lessening your drug burden by getting to a lower dose and staying there a bit outweighs any costs (which may not necessarily exist) of staying on a drug a little longer so you can get to a stable place where you can more comfortably taper.  

 

 

Edited August 30, 2020 by Gridley

[Halcyon]

Understanding slow taper, withdraw, and what to expect

 

Hi all,

Apologies if this is redundant and/or should be posted somewhere else.  I'm a recent member of the forum.  I've been on 15 mg (was 10 mg until two years ago) of Lexapro (escitalopram) for about 12-13 years.  I'm soon to be 38.  I really want to try existing without this medication, it has helped some but I still suffer with the same anxiety/phobia issues I had before starting treatment.  I also have life circumstances that make me want to eventually get off the medicine (see my introduction).

 

Anyway, I am intensely scared to attempt coming off the medication because of ADS (withdrawal).  Symptoms like mood swings, brain zaps, crying fits, all frighten me.  Not to mention, I'm the main bread winner of my family and really need to be well enough to hold down my job and well, who wants to feel miserable too.

 

Here's where I am confused.  From what I've read, everything sounds like a cold turkey quitting and/or a quick taper off the drugs, has a very high chance of making you experience terrible withdraw that can last for months if not years.  This led me here.  From everything I had read, a gradual slow taper taking months or possibly years made it much more likely you would not have withdraw and that you would be more likely to succeed in your attempt to come off the medicine.

 

However, what I've noticed on this forum is a lot are still struggling with withdraw for the entirety of their slow taper.  Also, I've noticed the posts explaining stabilizing and WDnormal as being a state where you're stable but not feeling especially good or especially bad.  Contrary to this, I've noticed posts stating if you're experiencing any WD symptoms it means you're tapering too fast.  This takes me back to my original thought that the slow taper was supposed to prevent/eliminate experiencing withdraw.

 

I'm trying to figure out if the slow taper method means gentler withdraw but still consistently withdraw symptoms.  Knowing that the slow process will take years to finish is extremely daunting.  But at least if during that process you're avoiding withdraw it sounds bearable.  If however, it's common to spend the duration of the slow taper feeling crummy and going through withdraws still.  That just seems like something I may not be emotionally or physically ready/capable of at this time.  

 

Thoughts?  

 

Again sorry if this is a repost or in a bad spot, I just keep going down the rabbit hole of forum posts, and I'm trying to get some clarity on what the process is.

 

Edited August 31, 2020 by ChessieCat
added topic title

[DataGuy]

Hi @Halcyon,

 

A moderator moved your question here because there are already topics on this subject. You might find an answer to your question in the thread "Why taper by 10%?". If not, you can always ask questions there. If you feel like you have a specific question, it's likely there is already a topic on the subject, which you should be able to find using the search function. If not, you can always ask the question here and if there is a topic, then a moderator will usually be able to link you to it. 

 

If I could sum up the reasons for slow tapering: 1) It will likely improve your health long term. Seems like there is decent evidence these drugs are not good for health, including some of the research you've found and talked about already.

2) Slow tapering keeps you functional. This allows you to go about your daily business, although you may feel a bit worse some days.

3) Rapid tapering seems like it can produce a withdrawal syndrome that can be both more intense and last longer. Slow tapering is designed to help avoid things spinning out of control. If you ever feel this is happening, you can always hold or do a small updose.

 

As to whether now is a good time to taper, I think your anxiety will always tell you it is a bad time to taper. This is how people get trapped on these drugs for long periods. I have seen people say that they would like to get off the medication, but then spend another 7 years taking it because it never "seems like a good time". Life will always interfere, but that is why you taper slowly and carefully, so you can have maximal control over your symptoms.

 

The truth of the matter is that these drugs are only tested for safety and efficacy for a few months. In reality, they could be making you worse off by taking them long term. This is what was found for benzodiazepines, which are still widely prescribed for anxiety and insomnia. They tend to downregulate GABA receptors and leave the person with worse anxiety than when they started the medication and can also negatively affect health outcomes. So while it is true that it is never a good time to taper off, there is no guarantee that it will be easier in the future. I agree with @Gridley, lessening your drug burden would outweigh benefits of waiting. The benefits of these drugs may disappear with tolerance, with the only benefit that remains being avoiding withdrawal symptoms. This is what they are finding with opioids as well. I think once you make a small reduction you will find it is not all that bad. 

 

[ChessieCat]

31 minutes ago, DataGuy said:

As to whether now is a good time to taper, I think your anxiety will always tell you it is a bad time to taper. This is how people get trapped on these drugs for long periods. I have seen people say that they would like to get off the medication, but then spend another 7 years taking it because it never "seems like a good time". Life will always interfere, but that is why you taper slowly and carefully, so you can have maximal control over your symptoms.

 

I suggest you check out these, especially the one on medication spellbinding:

 

Video:  Simple Truths About Psychiatry - Series of 10 by Dr Peter Breggin

[Halcyon]

Thanks everyone.  Sorry for the delayed response.  I've been spooking myself some and had to step away from posting to get my bearings.  

I really would like to slowly taper off of the Lexapro, but it is really important to me to do it as safely as possible and avoid withdrawal as much as possible.  I know my body and me, and some of what I've seen people experience on here, the crashes with bad waves for months to years,  I'm not emotionally/physically ready for that right now.  Especially with starting a new job at a hectic time and big life changes going on.  

 

What I've been considering doing is a slow at least 10% taper (based on previous dose) down to 5 mg.  Hopefully, avoiding any crashes down to this amount.  Then sitting at this amount for a least a year to give my body time to heal/adapt to less of the drug.  Hoping this will make future taper efforts more successful and crashes less likely.  Hoping it will also have a beneficial effect on fertility.  Also hoping to continue to work on my anxiety with non-drug methods.  I'm sure my anxiety which was what I started taking the lexapro for and has still been an issue will need to be dealt with and these coping methods seem the best bet.  At a later point, I'd like to then resume making a slower taper from the 5 mg.  Really, I am trying to mitigate the risk of crashes and withdrawal.  

 

I feel like intuitively this should be smart and help.  It seems like the key here is letting the body slowly adapt to changes. That's why people have to sit for a long time to stabilize when they've gone too far.  Also, this is kind of an inverse of how my body wound up on this medication.  I was apprehensive and on 5 mg for a couple years before upping the medication to 10 mg at the suggestion of my therapist.  Where I get apprehensive is concerns about "poop-out" and overall time on the medication.

 

I'm not sure if I'm currently experiencing poop-out or not.  I went through a lot of big changes over the last couple years and they shook me really bad.  I left a job I had been in for over a decade because people I knew were getting fired left and right.  When this occurred my anxiety went through the roof, i was having cortisol spikes in the mornings a lot, and crying a lot.  I took a new job and the same pattern continued for about 6 months before I settled down.  It was far away and the commute was brutal so I took another job closer to home but they were struggling and laying off people in droves.  I've been shook up by this and fixated on it for the duration of my time there.  I've just gone back to my original work place, things have settled down, and they're more secure than where I was. But I know me, and I know I will be a nervous wreck for at least 6 months until I get used to the new normal there.  I've always been overly sensitive and reacted to changes poorly.  I tried upping the dosage to 20 mg when I first got shook up, but that seemed to have only a minimal placebo effect for a couple weeks and may have made the cortisol issues more pronounced.  I've been on the 15 mg since.  My therapist has suggested me changing medications or upping the current one because she felt it was no longer helping.  I'm not sure if it is poop-out or if it's just being under a lot more stress.

 

So to recap, my concerns about tapering down to 5mg and holding for a year or so.  If I am experiencing the beginnings of poop-out, I worry this means that I will end up going through awful withdrawals while trying to maintain at the lower dose - was hoping it would just mean the lexapro wouldn't be doing much of anything.  If I do decide to hold at 5 mg for a while, it will obviously mean being on medication longer potentially.  At the same time, it seems like when people crash that often sets them back just as long.  Being on the medication longer probably means being harder to get off the medication without withdrawal?

 

Just to test the waters, I did a reduction this week on Tuesday.  It wasn't the wisest.  I cut my 10 mg pill into quarters and took 1 1/4 pills - 12.5 mg.  I've been taking that this week.  I've felt some increased anxiety (some of that might be psychosomatic because I was anxious about cutting the medicine), I've had a tiny bit of dizziness come and go and my taste buds have been odd (a metallic taste to things).  The metallic taste seems to be abating today.  For any future reductions I'll be doing at least 10% of current dosage cuts. I have an appointment with my psychiatrist later this month to talk about getting a liquid.

 

I'd appreciate any constructive thoughts or advice.  Also, I've seen @Altostrata and @brassmonkey weigh in on a lot of stuff here.  I'm not sure if it's wrong to tag them, but I'd just like their feedback if possible.

 

 

[Gridley]

On 8/31/2020 at 4:20 PM, Halcyon said:

Also, I've noticed the posts explaining stabilizing and WDnormal as being a state where you're stable but not feeling especially good or especially bad.  Contrary to this, I've noticed posts stating if you're experiencing any WD symptoms it means you're tapering too fast.  This takes me back to my original thought that the slow taper was supposed to prevent/eliminate experiencing withdraw.

I've seen both views and noticed the contradiction.  My experience has been more  in accordance with the WDnormal approach as you've described it.  As I've tapered from 20mg Lexapro over almost four years down to 0.1mg, I've experienced some withdrawal symptoms but they've been tolerable and generally have resolved before the next taper.  Some spots along the way down have been more symptomatic than others and some have been less. 

 

The taper I used was the Brassmonkey slide, which is more gentle than the straight 10% taper.  This consists of four weekly 2 1/2% reductions followed by a 2-week hold.  You might want to consider this method.

 

The Brassmonkey Slide Method of Micro-tapering

 

You're getting close to the 10mg mark.  The last 10mg are the most potent and call for care in rate of taper.  Longer holds may be necessary.  As we always say, listen to your body.

 

1 hour ago, Halcyon said:

If I am experiencing the beginnings of poop-out, I worry this means that I will end up going through awful withdrawals while trying to maintain at the lower dose - was hoping it would just mean the lexapro wouldn't be doing much of anything.  If I do decide to hold at 5 mg for a while, it will obviously mean being on medication longer potentially.  At the same time, it seems like when people crash that often sets them back just as long.  Being on the medication longer probably means being harder to get off the medication without withdrawal?

 

You have a long way to go before you get to the 5mg mark.  You will know what to do at that time regarding whether to hold for a year or continue on down.  There is no absolute correlation between time on the drug and difficulty of withdrawal.  However, if you're in poop-out that would argue against the one-year hold.

 

 

 

 

 

 

 

 

 

Edited September 4, 2020 by Gridley

[Altostrata]

How did you feel on 15mg Lexapro? If you're starting a job, you may want to wait to taper.

 

What are the symptoms you think indicate you are experiencing poop=out?

 

Cutting up tablets is a very crude way to taper. Are you setting yourself up to fail? If  you want to taper very gradually, Lexapro comes in a liquid.

 

Did you read this?

On 8/28/2020 at 3:02 PM, DataGuy said:

Here are specific tips on tapering Escitalopram.

 

Please read further in the Tapering and Symptoms and Self-Care forums and ask questions about tapering and withdrawal basics in the appropriate topics.

 

Are you seeing a therapist for coaching in stress management or self-soothing, to reduce your tendency to anxiety?

 

People may experience withdrawal symptoms if they taper too fast. One way to deal with this is to hold on the dose until you stabilize, meaning symptoms go away or become dull and predictable. Brassmonkey calls this "withdrawal normal".

[Halcyon]

Thank you @Gridley and @Altostrata!

 

Sorry if I offended or annoyed either of you or anyone else posting in inappropriate places. 

 

@Gridley I appreciate the kind words and the suggestion of the sliding scale method.  I've taken a look at it.  It does sound like a lot of folks have had good results with it, in some ways it sounds harder just because of the extra work and more frequent dosing events.  If I could be stable with the one dose change every month or more, I think it would be nice, but if it's too hard this definitely sounds good too.

Also, @Altostrata, I realize it must also be annoying to have so many of us complaining to you.  I have read through the links provided (perhaps a little obsessively so).  I saw what a pro you've been at all this for so long and I guess that's why I really wanted your opinion.  The description of Lexapro as being one of the strongest SSRIs as well as those posting the misery they've encountered when attempting to do a slow taper and crashing on it were big things that spun me up and brought me to posting.

 

I agree with you Alto, it probably is not the best time to start my taper.  My wife and friends think I should wait at least until I am calm at the job.  I guess I sort of lit a fire under myself because I read that the severity of withdrawal is worse depending on the dosage and length of time someone has taken an SSRI and I read about poop-out withdrawal.  Also, I want to conceive a child with my wife and read studies about how SSRIs negatively affect men's fertility and possibly the development of the baby.  I hate myself for waiting until I was almost 38 to realize this. I, like many others I imagine, am one of those who has never attempted to quit their SSRI because the fear of the withdrawal and losing everything from it has prevented me from doing so.

 

How did you feel on 15 mg Lexapro? If you're starting a job, you may want to wait to taper.

 

I think I felt okay on 15 mg but I'm not sure it was any better than 10 mg.  So, I was on 10 mg for about 10 years.  I really did fine on it I felt.  No side effects and seemed to take the edge off. If I hadn't been scared of withdrawal, I would have probably tried to quit it.  I had a good friend CT on their meds once and almost successfully commit suicide.  I had people tell me how brutal stopping SSRIs and Lexapro are. 

 

A couple years ago, I got shook bad by toxic stuff happening at my work.  I started getting really upset and scared about my job and found myself waking up to shaking (I believe my stress was spiking my cortisol), crying/anxiety attacks about work, and feeling pretty awful until evening when I was about to take my Lexapro.  My therapist had made comments in the past about maybe wanting to see me on a little more Lexapro.  I wanted relief and not realizing the idiocy, upped my dose to 20 mg.  I took a new job.  I thought this would solve my anxiety issues, but the change made me a similar wreck. 

 

I would wake up with the shaky cortisol spikes before work and come home crying off and on for a couple months - usually fine on my weekends.  I've always been emotionally sensitive but not too much of a crier.  I remember having a similar breakdown when I was a teenager and my family moved across country for the first time of my life.  I noticed always feeling better in the evenings around when I take Lexapro and having a lot of the morning anxiety.  I mentioned it to my therapist who suggested I jump down to 15 mg.  I did this with really 0 noticeable side effects.  I don't know if it helped or if just time did.  But I only notice myself getting the shaky mornings and crying when I get myself really upset the days before.  I took a new job closer to home, but did not realize the place was a lot less financially stable than they pretended.  Layoffs/budget cuts were rampant, and I started obsessing/panicking about it frequently.  When layoffs were about to happen, I'd find myself having a similar shaky mornings/crying/anxiety attacks.

 

What are the symptoms you think indicate you are experiencing poop=out?

I am not sure I have poop-out or if the SSRI just doesn't help my anxiety.  I had never really thought much of it or heard of it.  I have a therapist I've seen for about the duration of my time on Lexapro.  I originally went to them because I was having a lot of OCD-like/GAD anxiety about my health.  I've recently been asking to learn more about CBT, but generally they have done talk therapy with me (they say they have also suggested ways of thinking that are CBT - for instance distraction and trying to quiet down the what-if thoughts).  They felt from all their sessions with me and watching me obsess/be anxious about my job for so long that my Lexparo was not working.  Not clear if they thought it was poop-out or just not the right medicine.  They suggested I see a psychiatrist and were hoping they would put me on an SNRI instead.

 

I went to my wife's psychiatrist, who made an offhanded statement about my Lexapro might not be working and suggested I start taking Lamictal to augment my SSRI as well.  I got too nervous throwing more medicine into the mix, so I went back to them and told them I'd rather pursue CBT for now.  

 

I guess I felt with these professionals telling me my medication is no longer working, friends/family saying they don't see me as being any less anxious a person while on the medication, and having the cortisol spikes/crying when tackling scary stressful changes, all made me feel like maybe the SSRI has pooped-out. Also, confiding in my mother about my rough mornings and her thought that it sounded medication related made an impact.

Then when I was reading through all the different stories and forum posts here, I stumbled upon people stating that because their SSRI had pooped out, they experience withdrawal until they can quit.  This made me feel like I won't be able to take things as slowly as I need to (even if it means taking breaks) because the withdrawal will still come.

 

Cutting up tablets is a very crude way to taper. Are you setting yourself up to fail? If  you want to taper very gradually, Lexapro comes in a liquid.

This shook me a bit... I don't believe I was.  Honestly, I've been fretting so badly about this to my mother and wife.  I just felt like maybe if I took an initial small taper I could prove to myself it wouldn't be scary.  I definitely do not intend to continue to taper by pill cutter if I do taper.  I have an appointment with my wife's psychiatrist later this month where I hope they will give me a script for Lexapro liquid.  I also saw that Walgreens Pharmacy does compounding, but I'm not sure it would apply to Lexapro and whether it would cause insurance issues.  Plus, I saw a special on HBO a while back that made the conditions of compounding pharmacies in the United States sound really dismal.

 

Are you seeing a therapist for coaching in stress management or self-soothing, to reduce your tendency to anxiety?

I am trying.  Where I live, we have really limited options for mental health practitioners and doctors.  It makes it very hard to find those that are decent and well trained in these types of things.  I've really wanted a therapist that specializes in CBT for people with anxiety disorders, but unfortunately, there are none around that are not the same as my therapist.  A therapist who does talk therapy and says they practice CBT-ish stuff.  And pretty much all of the doctors/therapists are behind the times when it comes to SSRI withdrawal.

 

People may experience withdrawal symptoms if they taper too fast. One way to deal with this is to hold on the dose until you stabilize, meaning symptoms go away or become dull and predictable. Brassmonkey calls this "withdrawal normal".

So, my understanding was that while the slow taper takes an incredibly long time, the benefit was you had little to no withdrawal symptoms because you're giving your body time to adjust.  I got spooked because I see quite a few posts on here of people who have been on an SSRI like Lexapro for 10 or more years, have gone with a 10% taper or slower, and still wound up going too fast despite their best judgement and having crashes where they go through waves for months to years.  Seeing this just made me feel like even with a slow taper, the experience will be extremely stressful/torturous and that the majority of people in my boat (been on an SSRI for over 10 years) will not have a smooth no problem taper.

[Altostrata]

On 8/28/2020 at 3:02 PM, DataGuy said:

Here are specific tips on tapering Escitalopram.

 

Please read the links the staff gives you. They will answer a lot of your questions and save us all time and effort.

[Halcyon]

Thanks @Altostrata.

 

I have read through the link that was provided. I am not really sure what I have missed?

[Altostrata]

Quartering tablets to taper? Not using a liquid? Going on about compounding when it's very possible you can get the prescription liquid?

 

You need to research your options before asking questions here. We can't tell you if your insurance will cover the prescription liquid. You can make your own.

[Halcyon]

Thanks @Altostrata  I’m sorry. I appear to have annoyed you. i did not mean to offend. 

This whole process terrifies me. It makes me feel hopeless and it’s not easy for me to reach out.

 

I guess I was hoping to hear from someone high up the chain that the slow taper method does result in minimal to no withdrawal for most people (even on Lexapro). And that if I needed to hold on my current dose even if it was not working, it would most likely not result in worse withdrawal. 
 

Again, I wasn’t trying to offend. So apologies if I did...

 

[nolongeranxiousbut]

I did a hyperbolic taper off 10 mg escitalopram (Lexapro) after 21 months on it. Tapered over 7.5 months using 5 mg+liquid at and above 5 mg and just liquid below 5 mg. I highly recommend the prescription liquid for tapering. Can do very precise measurements. No need to get it compounded as prescription liquid version already exists. Mine had a very strong peppermint flavor but was otherwise unobjectionable.

 

Note I'm NOT recommending that you taper or that if you do that you use hyperbolic tapering. It's not actually recommended here.

 

Just read Alostratra's comment... I was lucky my insurance did cover the prescription liquid.

[Altostrata]

What we're about here is empowering you to answer your own questions and take charge of your drugs. Your questions are answered in the Tapering forum. Go take a look.

[Altostrata]

2 minutes ago, nolongeranxiousbut said:

Note I'm NOT recommending that you taper or that if you do that you use hyperbolic tapering. It's not actually recommended here.

 

We do indeed recommend a hyperbolic taper. Whether you want to taper or not is your decision.

[nolongeranxiousbut]

Oh, I thought you only recommended the 10% tapering... good to know the hyperbolic is also recommended.

[Altostrata]

The 10% tapering is an example of hyperbolic tapering, as explained in

 

[DataGuy]

@Halcyon,

 

You will get more comfortable with the process the more experience you gain and the more you read about it. As you say with your job, it is difficult to feel comfortable with things when we are just starting out. You may likely find, like many people who have taken SSRIs long term, that you actually feel better without the drug once you are free and clear for awhile. You may still have anxiety, but this isn't any sort of personal shortcoming. I think making very small cuts at first is a good idea, to get yourself used to the WD normal, as BrassMonkey puts it. This will give you a bit more confidence when making slightly larger cuts. 

 

I have just posted a diagram and link to a study that measures serotonin transporter (SERT) occupancy for escitalopram. Which you can find here. Note that the diagram only shows SERT occupancy after a single dose and not daily dosing, which would be expected to increase SERT occupancy as blood levels increase. Although this is not the be all and end all of the drug's actions, it is the primary action of escitalopram. The diagram shows an average of close to 60% SERT occupancy at around 5mg (single dose) with a standard deviation of 6%, which is fairly high. So you could conceivably have 66% occupancy at 5mg. I think if you are tapering to lower the negative effects the drug has on your body, you may want to consider going lower than 5mg before holding. 

[Gridley]

On 9/5/2020 at 3:09 AM, Halcyon said:

Seeing this just made me feel like even with a slow taper, the experience will be extremely stressful/torturous and that the majority of people in my boat (been on an SSRI for over 10 years) will not have a smooth no problem taper.

I know you're very nervous about the taper and withdrawal.  We're all different so I can't predict you'll have the same experience as I did, but our drugs are the same, so we have that in common, except I've been on the Lexapro a lot longer, 16 years.  As I said earlier, I tapered Lexapro using the Brassmonkey slide from 20mg down to my present 0.1mg, and by no means were my symptoms extremely stressful or torturous.  That said, I can't say they were nonexistent.  I use a daily log to measure the severity of symptoms, morning and afternoon, with zero being no significant symptoms (WDnormal) up to 5, very significant symptoms.  The vast majority of my entire taper were 0's, there were some 1's and 2's during certain spells, not many 3's, a very few 4's and no 5's.  I'm in a little more complicated situation, being polydrugged, so really you're in good shape with just the one drug.

 

From my reading and modding here at SA, I would say most people who follow the SA protocol do fine.  

Edited September 6, 2020 by Gridley

[nolongeranxiousbut]

On 9/5/2020 at 1:36 PM, Altostrata said:

 

We do indeed recommend a hyperbolic taper. Whether you want to taper or not is your decision.

To clarify I meant I didn't recommend the Horowitz/Taylor hyperbolic taper which has larger steps than 10%. Halycon mentioned their paper in his opening post. I followed a conservative version of the Horowitz/Taylor taper doing 22 steps down to 0 instead of the 8 steps in their table with 11 days between drops which is why it only took me 7.5 months to get from 10 mg to 0.  I had zero issues but I also had no drug side effects or symptoms related to stress/anxiety/depression before I started tapering. And everyone is different.

 

 

[Halcyon]

I just wanted to post a quick update. I didn’t want to seem like I was rudely ignoring everyone’s help. I’ve found that reading a lot of the stories here while helpful are a bit triggering for me.  So I’ve been trying to not post some. 
 

So I’ve remained at 12.5 for now with no noticeable physical withdraw symptoms. I have been very anxious/obsessive over what the safest choice is for me in this situation.  But I think that is me and not the reduction. For now on advice of my loved ones, I’ve decided to hold for at least a few months and I am pursuing an online course in CBT to help me better manage my anxieties and obsessive worry. 
 

I would like to resume a slow taper eventually even if it needs to be super slow but I’m wanting to weigh my options and risk.

 

I’ve been very happy to see the advice from the Horowitz and Taylor paper gaining significant traction in the psychiatric community. Im happy it will hopefully help millions be taken off of these drugs safely. 
 

The information being given by Dr. Stuart Shipko has really been the piece that has given me the most pause. Akathisia sounds like a condition that would break me. And I’ve been on my SSRI for over 10 years and a slow taper would add more.  His articles and ebook appear to suggest the condition is very common in those on SSRIs over 10 years regardless of taper speed.

 

Ive also considered the possibility of tapering to a lower dose that’s tolerable and staying there if the risk of full discontinuation is too large. I’m not clear on what the risk of tolerance withdrawal is if one attempts to stay at a low dose. 
 

Just things to contemplate.  It is frustrating we’ve all been put in this place. Ideally I still have another 40 years on this earth and the thought of being stuck on this medicine with no idea what could happen is chilling. 

[Gridley]

23 minutes ago, Halcyon said:

And I’ve been on my SSRI for over 10 years

Everyone is different, of course, but I've been on Lexapro starting at 20mg for 16 years and have tapered down to 0.05 with tolerable symptoms and no sign of akathisia.

[DataGuy]

@Halcyon, I think the risk of akathisia is fairly low if you taper slowly. Most of the cases I have seen seem like they are associated with rapid withdrawal and cold turkey situations. 

 

I'm glad you are continuing to learn. You'll be quite knowledgeable by the end of your journey. I found I have become much more scientifically literate since my withdrawal. Before I would read papers and take their conclusions at face value. Now I tend to question whether their conclusions are warranted given the methods they have used. I like Cochrane for evaluating medical interventions. Here are some Cochrane authors writing about a very large network meta-analysis of antidepressants that was in the news quite a bit: https://bmjopen.bmj.com/content/9/6/e024886

 

Also, in this paper: https://www.karger.com/Article/FullText/506868 ("Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications"), Chouinard et al. note that slow tapering tends to mitigate adverse withdrawal events:

 

"Slow tapering, often extending over a year or more, has been suggested to manage new withdrawal symptoms [78]. However, even a more flexible tapering at a rate that the patient can tolerate, typically in about 3–6 months, has shown to be appropriate [37]." 

[HardTimes]

Hi @Halcyon.

I've just read most of your story here and thought I'd chime in. I haven't been coming here very often myself as I agree with you that it can sometimes be a bit "triggering" or counter-productive. It is VERY helpful to learn about what the hell is happing to us all, and I have no doubt whatsoever that this site has saved lives, but given that the range of drugs and WD symptoms and circumstances is so huge, trying to get a handle on it and read everything can feel overwhelming, like a 24/7 job! It is easy enough just to tell you to go read something, but sometimes the more you read the more confusing things can become, and the more we can start to worry that somebody else's terrible situation might come to be our own, or that we are not doing what is best for our specific situation, that we're screwing things up somehow, and somehow we end up with more anxiety than we started with! Be patient with yourself, and don't worry about offending anybody here. I'm sure everybody is trying to help in their own way even if it is sometimes a little bit abrupt.

 

I have no advice to give about specific tapering schedules or particular drugs (I'm just not qualified at all!). But I would say that, if you can do so without becoming obsessive about it, it is a very good idea to track your symptoms carefully each day so you can begin to find patterns and triggers and such. It is also very helpful if you have a really bad day to be able to look back and see good days in your journal, so you can remember that good days will come again! It is also worth bearing in mind that, because it seems people's experiences can be so different, you might well be somebody who has an easier time of going through the withdrawal process. Naturally enough there are lots of people posting some really difficult situations here, things that make my own experience seem really mild by comparison, but there are also people who go through gradual tapers and feel mostly OK. Maybe you'll be one of them! Why not?  Being as positive as possible rather than worrying about the worst possible scenario is important, though I know it is much easier said than done. 

 

From what I gather, I think you're doing everything right and are in good shape. DEFINITELY don't do any major changes really quickly - that seems to hold for almost everybody. DEFINITELY keep up whatever forms of therapy you have access to. I am also a huge advocate of the benefits of good old fresh air and exercise, healthy-ish eating, and getting as much sleep as you can! And it is great that you can share this all with your family - that is a huge resource not everybody has. 

 

You can do this! Hang in there! 

[jozeff]

Hi halcyon,

 

My wife and I were on venlafaxine when we conceived our first child and I was on citalopram and she on sertraline when we had our second child. Absolutely zero problems so far.

 

I think it's better to raise a child while not in terrible withdrawal than to have a "drug free" child and suffer immensely. That's just my view but I understand that is very personal.

 

I would never ever recommend to taper fast. I've had terrible issues in the past while going too fast.

 

Let us know how you feel. We can discuss this stuff if you want.

 

Cheers

Jozeff

[Halcyon]

Thanks everyone for the responses and advice.  Apologies for the book of a response too.  Please don't think I am being rude if I don't respond for a long while.  I can't explain it but sometimes coming on here and posting triggers my anxiety.  I've tried to limit myself popping in and looking at unhelpful stuff, but I admittedly do still find myself popping in and reading people's introductions and success stories.  I know everyone is different, but I guess I hope to see a lot of the successful people being in my boat (mid to late thirties, on one drug for 12+ years, tapering slowly, and succeeding coming off with no bad effects).  Often times, I'll find a success story here where the person is also chronically taking a benzodiazepine and I wonder if that drug is masking the withdrawal from the SSRI.

 

The articles from Dr. Shipko at MIA have made me feel like trying to do anything at this point is extremely risky.  I saw in earlier years, Alto followed up with him and got clarification from Dr. Shipko that those he was talking about suffering what he has coined "tardive akathisia" was rare but serious (paraphrasing and possibly incorrectly).  But it appears that since then, he has written more articles doubling down on it being a common issue.  His last one stated there's no way to know who gets it but that it appears to be very common on those who've had an SSRI for 10 years or more.

 

I need to pursue the CBT more.  I've not done much of it yet.  I've spent a lot of my time with my therapist just going in circles about my anxieties over withdrawal.  She is only half on-board with what I keep telling her is a very common experience.  Tells me how she's never seen akathisia in any of the people she's worked with who've come off their medicines, tells me she thinks the difficulties I'm describing are pretty uncommon and that I could very likely have no issues.  I get discouraged about the CBT and other therapies being of help, because I've read a lot of people on this forum say that they are not helpful for withdrawal induced problems.

 

I'm considering slowly trying to introduce mag and/or fish oil.  I have a super sensitive gut and acid issues.  Always have.  So, I don't want to rock anything.  I think that's another anxiety I have.  My diet is already fairly limited to bland things and limiting it further by doing things like cutting out all carbs and only eating 100% whole stuff would be pretty daunting.  I'm hoping just cutting out junk food and sugary sweet things can be enough.  They put a little bit of sugar in literally everything (found it listed on baked potato chips the other day at the store).

 

I saw my psychiatrist about getting a liquid prescription.  He's willing to comply and doesn't seem to be pushy about the length of time it can take me (mentioned taking over 2 years being fine), but of course, he thought it could be done in 3-6 months and originally wanted me to go down in 2.5 mg decrements.  He also said that the chance of akathisia was extremely rare.

 

Symptom/taper update

Still sitting at 12.5 mg of escitalopram for now. 

• Made the reduction on September 1st, 2020.  The first couple of days, I had some minimal physical symptoms (altered taste, dizzy, very mild nausea). 
• A week or two later, I started noticing very heightened anxiety.  Hard to tell if this was from the reduction or from me freaking myself out reading about the horror stories.  Things stayed relatively the same with the anxiety coming down a bit here and there. 
• Towards the end of the October, I started noticing myself getting really tense in my legs (thighs and butt) and fidgeting a lot in bed on waking (often bouncing my legs nervously).  That's been fairly recurrent.  I've also noticed that if/when I take a nap, I find myself much more anxious on waking from it than I was before.  I've tried wearing a sleep mask and laying in a dark room to see if it might be cortisol related.  If it is, that hasn't made a difference so far. 
• Had a scary symptom last night that could have been a freak thing.  Just as I was drifting to sleep I popped awake (possibly from some acid reflux) but felt like a millisecond of terror (like falling to my death) and like I might be sick.  It came and passed quickly.  But freaked me out.  If that's the type/level of anxiety I'll have to endure in withdrawal, I'm not sure I could.

 

Trying to determine when I am considered stable to attempt another reduction.  Thinking when I do, I will attempt a 5% reduction possibly using the Brass Monkey Slide method.  Since I'm having this heightened anxiety and leg bouncing/antsy feelings off and on, I'm wondering if that is my body telling me I'm not ready to reduce.  I've read the resources on the site about windows/waves and wd normal.  I've also noticed some others having success only reducing when they have 0 symptoms.

 

Upset/drama continues for me about having a baby.  I feel like if I'm going to successfully come off of this medicine without bad withdrawal, it will probably take me years (anywhere from 3 to 7 probably).  By that point, I will be at 15 to 19 years on the drug which will probably make it harder for my body to give up.  With my wife and I at 38, waiting until I'm off the medicine isn't really an option.  If I could guarantee I could stay stable enough to handle work and the stress of raising a little one, I'd really like to.  But with so much unknown, it feels like I would be acting irresponsibly to have a child.  This is extremely depressing for me and something I am struggling with.

[ChessieCat]

3 hours ago, Halcyon said:

Had a scary symptom last night that could have been a freak thing.  Just as I was drifting to sleep I popped awake (possibly from some acid reflux) but felt like a millisecond of terror (like falling to my death) and like I might be sick.  It came and passed quickly.  But freaked me out.  If that's the type/level of anxiety I'll have to endure in withdrawal, I'm not sure I could.

 

You could try having some soft music playing in the background.

[ChessieCat]

3 hours ago, Halcyon said:

If I could guarantee I could stay stable enough to handle work and the stress of raising a little one, I'd really like to.  But with so much unknown, it feels like I would be acting irresponsibly to have a child.  This is extremely depressing for me and something I am struggling with.

 

And have a guess what?!?!?!?  It could be exactly the opposite and be one of the best things that ever happens to you.

 

And if you are around other people's children and thinking that you couldn't cope with your own, it is completely different.

 

I will admit that it can be a tough gig being a parent but I think the majority of parents would say that it is worth it.

[Halcyon]

Thanks ChessieCat. I appreciate the encouragement. 
 

I’m debating when to try my next decrease. Also got some books on CBT and minimizing catastrophic thinking. My wife is a librarian so she often gives me homework when she sees a problem. 

 

I have a couple questions for you and/or the other knowledgeable folk that maybe should have been clear to me already. 

 

I’ve seen how withdrawal sensitizes peoples CNS to the point that lots of things can be harsh on them that were not before. Generally speaking, if one follows a slow taper does this make the CNS less sensitized?

 

If a slow taper takes a person 10 years or more, does the additional length of time on the drug tend to correlate with the chances of protracted withdrawal? I.e. I’ve been on a drug for 12 years, after 10 years of tapering to 0, does protracted withdrawal seem more likely from being on for a total of 22 years vs. 12. Does that make sense?

 

I know everyone is different. I really want to take my time and be safe. It probably has to do with the fact that many come to the SA site after already being harmed by their physicians suggested way of tapering, but I’ve noticed that a lot of success stories from those on for 10+ years are those that have quit abruptly, suffered for a few years, and then mended back slowly.
 

Just curious what the general trend is for what others have seen here. 
 

Hope everyone is staying well and safe during this trying time.