purple: I'm hoping it's withdrawal and not relapse; also, maybe I should quit now while I'm ahead?

[purple]

I find the greatest irony in all of this is that I didn't experience clinical depression until I was in medical school. I still have some regret over pushing myself and being so ambitious. I know I've got a victim mentality going on and it'll be apparent in the summary below. I'm trying to change my narrative but it's a process.

 

• Fall 2013 - first diagnosed with adjustment disorder, not sure what diagnoses I actually got next but pretty sure it all neatly fit into major depressive disorder
  • successfully treated with therapy, group therapy/support groups, daily exercise, acupuncture, Chinese herbal medicine, meditation, leave of absence from school, spending time with family and friends
  • naively assumed that it was just a one-time thing and that depression does not necessarily have to be "chronic"
• Fall 2017 - started feeling poorly and knew I didn't have time for self-care when working 12+ hours/day and wanted to keep chugging along in my medical career and at least get a license to practice so only solution seemed to be drugs
  • started on zoloft but experienced bad side effects so switched to lexapro 10mg and started therapy again, even took time off work for an intensive month of therapy
• Spring 2018 - decided to leave my toxic medical training program and put in my letter stating I'd be resigning after completing this first year of training, felt immensely better but waited a few weeks to make sure it wasn't a temporary relief before approaching my psychiatrist to wean off medication
  • he agreed it seemed like a situational depression and we tapered off somewhat rapidly, had occasional dizziness but mostly when descending stairs in the hospital
• Fall 2018 - expected to feel so happy after quitting that position but immediately fell into a very deep and the deepest at that point in my life, depression
  • really didn't want to be on medication again, continued therapy, tried to go on runs
  • a doctor I was shadowing and hoping to work with noticed something was off and gave me a sample of the latest antidepressant which he took himself and thought was great; I tried it but had nausea/vomiting each time so only took it for a few days; might have had some dry heaving afterwards too
  • went back to psychiatrist to restart on lexapro and we upped it to 20mg pretty fast since my depression was so severe
  • saw PCP who could manage this as well and wanted to taper but he didn't recommend it; I went against medical advice (yup, docs really do make the worst patients ) and waited for a few months, then planned a really slow taper myself while acquiring healthier habits like exercising again and eating a more plant-based diet; finally off of it completely in February/March 2020
• May 2020 - I think that's when I started stressing again and in July/August, I hit what is now my worst level of depression. I've never had so many and such intense suicidal thoughts. This is the first time I've planned and even attempted. Each time, there was still an essence in me that wanted me to live so here I am. I've also been experiencing a high level of anxiety and what felt like a slow long burning panic attack and panic attacks. I've never had any of this before. I started seeing a new therapist who at first suggested and then strongly urged me to go back on lexapro. I luckily had 1 more refill left on the medication so I didn't have to find a new doctor as I just moved to a new area. Placebo effect or perhaps being back on an SSRI which the body was so used to must be strong because I felt better the first day after I took my first pill. It's still been hard but a lot better too. I've created and been able to stick to a system of getting out of bed and exercising. This time, I've kept more detailed track of my medication and tonight should be day 20 of taking it.

 

I have a pretty immediate question though. I read through the post on whether now is a good time to taper or not and I'm undecided on where I fit. While I am going through a tough transition right now, underemployed and currently interviewing for a better job that will certainly bring back some small level of PTSD since there will be some medical practice involved, I also am "young" in starting this new trial of lexapro so I want to quit while I'm "ahead." I am hopeful I will get this new job and even if I don't, either way will be stressful because I'll either have to learn a new position or I'll have to apply for more jobs (each job search and application leads me to panic attacks and shutting down completely). Perhaps it's better I stay on the medication so I don't even have to worry about withdrawing/relapsing again. Ugh, I'm so confused and lost. I hate this and I feel like ever since I started on medications, I've lost my previous ability level to cope. It's like my emotional pain threshold is lower. Perhaps it's because I have a diagnosis to fall back on and instead of seeing things as just another life stressor or bump in the road, I'm conditioned to see it as another relapse. I don't know. Frustrated and annoyed and hate meds.

[Gridley]

Welcome to SA, purple.

 

If you are really feeling suicidal, you need to seek out local help, and speak to someone trained in dealing with this.    See:  For those who are feeling desperate or suicidal  As an online forum, we're not equipped to deal with this.

 

As you might know from reading around SA, we're a site for tapering off psychiatric drugs and helping members cope with withdrawal from these drugs.  

We recommend tapering by no more than 10% of current dose every four weeks.  To avoid withdrawal, some have to taper more slowly, especially if their systems are sensitized and in disequilibrium from going on and off these drugs.  

 

Why taper by 10% of my dosage?

 

You one month taper of Lexapro in 2018 and your 2-3 month taper of the same drug in January 2020 both are much faster than we recommend and either or both could result in protracted withdrawal symptoms.  The vast majority of doctors don't believe in severe or protracted withdrawal.  Our experience here has been the opposite.  

 

What is withdrawal syndrome.

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

The Windows and Waves Pattern of Stabilization

 

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.  

 

These links explain the healing process really well.

 

Brain Remodelling 

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

Regarding withdrawal vs. relapse, this link should be of some help.

 

How do I know it's withdrawal and not relapse?

 

Here are some link to help cope with anxiety.

 

Audio:  How to Recover from Anxiety - Dr Claire Weekes
 

VIDEO:  Peace from Nervous Suffering - Claire Weekes (1 hour) (http://sendvid.com/vgquc1dg)
 

Anxiety Stuff - all kinds of stuff about anxiety attacks and things that help …

 

10 minute Restorative Yoga for Relaxation | Up the wall

 

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.

 

Regarding your immediate question of whether or not this is a good time to taper, generally, we recommend tapering, if possible, during a time of relative stability. However, you're in danger of withdrawal symptoms generally (this is not a hard and fast rule) after a month of being on the drug.  You're 10 days out from this, so it's possible (but not guaranteed) that if you tapered now you'd escape withdrawal.  As far as just staying indefinitely on the drug to avoid withdrawal, that's a decision some people make, but it's not our approach here.  One point to consider regarding staying on these drugs is that at some point tachyphylaxis (poop-out, wherein the drug no longer works) often sets in.  When it does, increasing the dosage is only a temporary solution and the only way out is down via a slow (10%) taper.  

 

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

 

Edited September 17, 2020 by ChessieCat
removed white space at bottom of post

[purple]

Thank you so much for all the information and resources, @Gridley! Really appreciate it and will be looking through it these next few days

[purple]

Last night, I was journaling and realized I'm at a fork in the road of whether I should continue my current medication (lexapro/escitalopram) or not since I'm apparently still within the window (30 days) to not experience WD. Although I just reread the prior post (am so thankful for this community which I only found a few days ago) and saw it still recommends a slow taper rather than a cold turkey stop. I didn't take my med last night because I decided I'd try the CT stop but now I'm scared. I hate this fear (fear in general) and luckily it's so much less intense than what I was experiencing only a few weeks ago.

 

After exploring some more posts, I've decided that what I went through the past few months was WD and not relapse. What confused me before reading many posts was that I experienced feeling well and returning back to my self and this loving inner being pretty soon after stopping my med earlier this year. Then, the tough life stressor of moving and seeking employment seemed to send me back into a spiral of "depression" (also acknowledging and thankful seeing that people have also questioned the use of this term/label). Although, as people have pointed out in the difference between WD and relapse, this time, it felt so different and it also felt like the darkest period in my life. In addition, I think I've always had a base level of anxiety but I'd never had anxiety this bad before where everyday felt like I was just suppressing this overwhelming sensation and welling up in my body and psyche. I've been really tired recently and my therapist yesterday explained that it's likely because I've gone through so much just recently. I didn't agree at first but I agree now. Also, my savings are dwindling and there's a part of me that wants to quit this therapist so I finally did get up the courage to tell/ask him if I could just text him the next time I needed a session. Probably unwise but I don't know. At least I'm feeling a little more sure in my decisions now.

 

I think I need to sit down and write a letter/oath/agreement with myself even tho part of why all this has been so rough recently is that I've found I can even break commitments with myself. I really really really really really want to be off of drugs. I've never liked the idea of long term medications and as much as I've tried, I cannot accept that what I have is "chronic depression" which would require lifelong meds. It's just not within me. My plan was to stop CT and make sure that everyday, I complete a list of self-care tasks and be diligent with recording my symptoms and activities, recording data so that things are as objective as possible. Now I am a bit worried about the CT thing. I really need to establish a new primary care doctor but I'm so scared they won't take me seriously, even if I am a fellow doc. I mean, I hope that helps somewhat and from what I can remember, most people are sympathetic to my situation but the fear is so ... big, right? Irrational. I even looked up if I could self-prescribe but it seems unlikely for centrally acting drugs. Anyway, I need a doc to help me continue my prescription because this bottle of 30 was just me being lucky that I still had one refill left on my old prescription. The pharmacist even commented that it was last filled in Dec 2019. Luckily I practiced silence and they didn't dig any further.

 

Also, in case anyone is worried, I'm not actively suicidal anymore. I still have some thoughts but it's much easier to brush them aside whereas a few weeks ago, I would dwell and ruminate and seriously consider them. I'm glad to be back in a more normal state. The difference really has been in restarting the lexapro and in making a commitment to my mom that I'll get up at 7/8am every morning, shower, and ride in her car on her way to work where she'll drop me off a mile away from home so I can run/walk back home. Today is day 15 of completing that morning routine. I think the routine has helped more than the medication but it's hard to deny that the drug did have something to do with stabilizing the out of control thoughts and emotions. It's another reason why I feel what I recently experienced was WD and not relapse--reinstating the medication helped.

 

Apologies for things maybe not making sense or flowing in a logical manner. I know my brain tends to not be linear even when I'm at my best and this is not a new low, at least not today, but I know I can do better. For now though, this is my best. I used to tell myself and I still try to tell myself, "I'm doing the best I can, given my current situation and circumstances."

 

Much love to everyone.

[ChessieCat]

2 hours ago, purple said:

saw it still recommends a slow taper rather than a cold turkey stop. I didn't take my med last night because I decided I'd try the CT stop but now I'm scared.

 

August 27, 2020 - back on escitalopram 10mg

 

It can take as little as 1 month for the brain to became physiologically dependent (not physical) on a psychiatric drug.

 

It might be better to do a fast taper off rather than a cold turkey.

 

[purple]

Thank you for the suggestion, @ChessieCat

 

I read around this forum some more and decided I'll try my best to do a slow taper. I'm really hesitant to find a doctor in my network and start the conversation about tapering. I have only about 8 tablets left and funny enough, I was starting to feel antsy/anxious/fearful about having to make an appointment with a doctor soon when the old clinic I used to go to called me and informed me they could not provide a refill unless I saw their doctor within the next month. I told them I moved out of the area so that's okay that they can't see me and refill my med. Then about an hour later, I get a call from my old pharmacy that they've refilled my medication and it's ready for pickup! I wonder if one of the residents at that old clinic recognized my name and gave me a mercy refill I'd like to think that but then again, from experience, it's pretty easy to just click the message box that pops up--would you like to refill x for patient x? Anyway, I'm glad it got refilled but I have yet to call the old pharmacy to let them know to change it to my new address and location. Just glad it is all in one system so the transfer is easy.

 

I know the taper from escitalopram 10mg to 5mg is a drastic shift but I feel better in my mind doing that for now. I'll bump back up if I notice any neuro-emotions that begin to be too much to handle.

 

In the meantime, I am proud of myself for having completed now a consecutive 18 days of running/walking! As much as I'd like to attribute my improved mood and decrease in suicidal thoughts/intentions on the exercise and getting up in the morning, I think reinstating the med helped too.

 

I'm so glad I found this forum. Perhaps it's stubbornness, denial, both, or something else but I really didn't like the alternative explanations as to why I was feeling so horrible this most recent time. Yes, I did have a precipitating stressful event which was moving back in with my parents after being independent for quite awhile but... I already see how I'm being hard on myself. Been contemplating so much and of course overthinking too, but I've come to a few new realizations which I didn't have before when I was trying to work through this mental recovery and self-care journey.

 

1. Ever since I got diagnosed with depression, I started to attribute every bump in the road that I couldn't handle to a possible relapse. I no longer looked at my life in the context of, this is stressful and sucks but maybe I'll just have a little nervous breakdown for a day or two and then I'll get on with life (my "nervous breakdowns" prior to depression usually meant prolonged procrastination and what I considered self-sabotage such as overeating, undereating, binge-watching TV/movies). Then with the context of "I have a medical condition," everything got colored in that light of possible relapse. Something I came to conclude over the past 1.5 years is that depression is a symptom of something else that is deeply wrong. 

 

2. The scariest part of this recent "episode" was just how dark and deep my thoughts became, especially the suicidal ones. I am so relieved they are gone and that even if they do come, it's at such less intensity and that I can easily brush them aside. I guess that's why "intrusive thoughts" are named so, because it's really hard to push those thoughts out or even let them pass and let them go as meditation had constantly taught me. The constant medium-high level anxiety and what I can only describe as a long slow panic attack were also new to me. Something else that's been stressful is that I've been exploring spirituality a lot more and it can be jarring but I also didn't think it explained all of the stuff that I was experiencing. The two main things that actually caused a more dramatic positive shift or perhaps three were 1) reinstating medication and I honestly felt better the day after I took the first pill! (placebo effect can be really strong and/or my body was just very happy to see its drug again) 2) asking my mom for help and starting the environmental system to get up in the morning, shower, and go for a run/walk and 3) admitting to my therapist that I wanted to stop therapy (he still convinced me to book another session but the fact that I finally put it on the table felt good).

 

I guess I'm writing all this mostly to convince myself that this really is true and a good explanation that I can actually accept and move on with.

 

A few more random notes:

 

A colleague purchased a book called "Process not Perfection" which writes about many different expressive therapies to use for trauma recovery. It made me think about how talk therapy is not the only tool nor may be the best tool for recovery in that therapeutic sense. Made me think about my own experience and how, if I can muster the energy, art is very soothing for me. Putting a pin in all of this and will have to explore it further.

 

My sleep has been "flipped" for quite some time now. I can sleep at night and pretty soundly but I feel the most energy at night. I can't say I'm normally usually either a strict morning or night person but when I've felt at my best, I'm definitely more productive in the morning and sometimes at night, I'll have a burst of energy too but I usually get myself to sleep because sleep has been something I've valued and treasured since I was a kid. Sometimes a little too much. More recently since starting the medication, I've been taking naps throughout the day. My therapist says it's a normal reaction to all that I've been through recently and that makes sense but I feel there's something more going on. Adrenal fatigue crosses my mind but I don't really care to entertain it too much farther. The most important thing for me is less to focus on the disease and every little nuance of what it is and more to focus on the bigger picture of health and supporting myself and my body to heal. Being in the medical world really "brainwashes" you to view things and become really disease-focused. I've been recalibrating. All to say that I started my lexapro nightly (I had always taken previous ADs in the morning) because I was so desperate to feel better and start that afternoon that I picked up my medication. Also, found it was an easier way to not let my parents, esp my mom, see me taking medications again (it's very hard for them to accept that there is something so wrong with their daughter that she needs medication). I'm going to switch to taking in the morning now though just to see if that makes any difference in the daytime sleepiness. Another theory I have is that because I willfully made myself sleep to escape panic attacks just over a month ago, my body automatically does it now. I've been procrastinating lots (I'll make another post on that sometimes) and the napping adds to it but I really do just feel so tired and sleepy during the day...

 

Anyway, that's all for now. Will continue to update. Thanks for reading!

[composter]

Hello purple. Your story intrigued me. I wonder how many other medical students/residents find themselves trapped in a hamster wheel of psych medications, not knowing any better. 
 

One of my parents is a physician but not in a specialty that prescribes psych meds. They were horrified by the withdrawal I went through and regularly would exclaim: “Doctors don’t know anything about these drugs! These patients (on the forum) are much smarter!”

 

Perhaps you can become an educator within your field in time. There are notable MDs who speak out against AD and benzo withdrawal. To name a few if you are not familiar: Kelly Brogan, Stuart Shipko, Christy Huff, Joseph Glenmullen, Peter Breggin. You can Google any one of these names and read their blog posts or books. 
 

For now, I do agree with you that you continually confused withdrawal with relapse. I think your decision to stabilize first and then do a slow taper is a wise one, given that your taper in January was actually too fast (faster than our truly evidence-based recommendations).
 

May I ask why you tapered from 10 to 5 mg very recently? Were you feeling stable on the 10 mg or was it too activating for you? It’s likely that a reinstatement dose of less than 10 mg would be better for you. This process is a long one and so it would help for you to do what you can to build your support system and continue those healthy behaviors. Nutrition and gentle exercise were two key tools for me when I reinstated and stabilized. Glad you are working on these things. 

Edited September 22, 2020 by composter

[purple]

Hi @composter, I'm glad it intrigued you! I've been thinking that this can be the start of me becoming a doctor who can specialize in and treat AD withdrawal Thank you so much for those names! I came across one of Kelly Brogran's books awhile back. I'll need to do more research and reading!

 

I bet many med students/residents/doctors are on medications or can be diagnosed with a mental disorder but are in great denial about it. We've got a really high suicide rate unfortunately. And yes, I bet the ones on meds are trapped in that hamster wheel.

 

Haha, to be fair, there's so many medications these days it is hard for docs to keep track of them all. The pharmaceutical companies keep trying to maker newer, better stuff for us to push out and for patients to ask us about because of their promising and numerous TV ads. On the other hand, I'm one who trusts patients a bit too much and frequently would've given the truly "drug-seeking" ones their choice of narcotics had my supervising physician not been more skeptical and stopped it. It's still hard to tell who is right (sometimes I still felt I was right but perhaps I fell for the crocodile tears) and it's a fine balance of having enough experience, just the right amount of skepticism, and being aware of any biases that could affect our judgments and actions.

 

Thank you for confirming my thinking and reasoning. In hindsight, the decision to go from 10mg to 5mg was too soon. I felt somewhat stable on the 10mg and was considering that rapid taper/felt at a fork in the road of really wanting to get off this medication again. I felt the morning overwhelm come over me this morning so I took a 10mg then and will stay on it until I find a doctor who can prescribe me some liquid solution. I realized I really should not rush this, as much as I really want to. Proud of myself for being able to overcome this morning's anxiety and still get up for a shower and walk.

[composter]

18 hours ago, purple said:

I've been thinking that this can be the start of me becoming a doctor who can specialize in and treat AD withdrawal Thank you so much for those names! I came across one of Kelly Brogran's books awhile back. I'll need to do more research and reading!

That would be much needed, honestly. Our founder @Altostrata is always looking to connect with medical doctors who’s “eyes are opened” to this to become leaders in the field of deprescribing. 
 

AD withdrawal has got to be some of the worst medication withdrawal out there, and is vastly underreported, underdocumented, and misunderstood...especially by the medical establishment. What other types of prescription medication withdrawal have you heard of that can last years and years? And likely a huge factor in untold number of suicides and violent outbursts. 
 

I would add David Healy to the list of AD aware docs. He has a pretty eye opening blog and also documents supposed cases in the news of AD induced violence and suicide on SSRIstories.org. Warning to only read this when you’re in a good place mentally.  
 

Keep taking care of yourself and treating yourself gently!
 

18 hours ago, purple said:

I felt somewhat stable on the 10mg and was considering that rapid taper/felt at a fork in the road of really wanting to get off this medication again. I felt the morning overwhelm come over me this morning so I took a 10mg then and will stay on it until I find a doctor who can prescribe me some liquid solution.

Hopefully 10 mg is a good dose for you to stabilize. If it was the last dose at which you felt stable, that’s a good sign. 

[purple]

34 minutes ago, composter said:

That would be much needed, honestly. Our founder @Altostrata is always looking to connect with medical doctors who’s “eyes are opened” to this to become leaders in the field of deprescribing. 

 

Wonderful! I was wondering how to step into this when I'm ready! (Then again, when is "ready?" :P)

 

35 minutes ago, composter said:

AD withdrawal has got to be some of the worst medication withdrawal out there, and is vastly underreported, underdocumented, and misunderstood...especially by the medical establishment. What other types of prescription medication withdrawal have you heard of that can last years and years? And likely a huge factor in untold number of suicides and violent outbursts. 

 

Yes, for sure! I still remember one of my first patients in intern year telling me that she had been on an SSRI for years, got off of it, and now suffered chronic constipation. When I thought about it, it made a lot of sense because there are serotonin receptors in the gut. I was horrified. She reported, "No one ever told me about this, that it could happen." Again makes me think of how difficult it is to practice medicine--when prescribing a medication and discussing the risks, benefits, and side-effects, do we give the entire list? No one (doctor or patient) would remember all of it. There's tons of side effects to every medication and in our reference databases, they get sorted into into common, uncommon, rare. Also, does bringing up the side effects prime the patient to notice those kinds of symptoms more even if they're unrelated to the medication? Haha, not expecting anyone to answer this but those are the kinds of thoughts and questions that I tend to have and wish I had colleagues to discuss them with.

[purple]

An update on finding a new doctor after having moved to a new area: although I was able to transfer my prescription to this local pharmacy, they called saying my old doc still had to approve it and I'm not sure that they will. Even if they do, I'd still have to eventually find a doc here anyway.

 

I have one of those high deductible insurance plans through the healthcare marketplace (yay for being insured, boo for having to hit a deductible of about $7000). I had set a new primary care doctor with the insurance but when I tried to call last week, it took me through the usual phone tree and then a long wait time. I looked around for other docs and found a psychiatric group so hung up and called them only to find out they have a 2 week waiting period for even an initial phone call to schedule an appointment. I'm running out meds soon and when I got the call today that my med may not be filled, I started looking again. Having been through the healthcare system already as a patient, I'm pretty wary but still don't know the best way to navigate all of it while trying to somewhat save money. I came across onemedical and found out if I sign up for their yearly membership $199, I can immediately book a same-day or next-day appointment so I'll be seeing an NP tomorrow through video. Fingers crossed that she'll be understanding and cool with a plan to taper.

 

I've been thinking about starting a blog to document everything, including medical expenses. I have a track record of starting blogs and not committing to them tho. We'll see. One day at a time. 

[ChessieCat]

You might be interested in my website.  It was to provide extra information for my Email Campaign documented here:  Email Campaign

https://adwithdrawal.weebly.com/ 

 

There are particularly eye opening/interesting/concerning.  Gwen Olsen was a pharmaceutical representative for 15 years.

 

Interview:  Confessions of an Rx Drug Pusher (51 minutes Gwen Olsen - ex pharmaceutical representative)
 

Video:  Ex-Big Pharma Rep:  We’re Trained To Misinform -The Drugs ARE Dangerous (6 minute video)
 

Video:  Ex-Big Pharma Rep:  Manipulating Doctors to Sell More Drugs (10 minute video)

[purple]

Thank you, @ChessieCat!

[purple]

Silly me, I don't know why I didn't use the providers list that this forum posted. I had it open in one of my tabs. Guess if tomorrow's practitioner doesn't work out, I'll reach out to one of the docs on the list. Really wish they would list their fees/rates. The financial strain and consequences of poor mental health sucks, even worse that I'm "high-functioning."

[ShiningLight]

Purple,

 

Medical school is notorious for being toxic. I have a friend who knows something about it and is always talking about that. She didn't go herself but seems to know a lot about it.

 

Sadly and probably not unrelated, many healthcare settings can be some of the most toxic places to work.

 

Amazing if you would become an expert tapering MD!

[composter]

6 hours ago, purple said:

I came across onemedical and found out if I sign up for their yearly membership $199, I can immediately book a same-day or next-day appointment so I'll be seeing an NP tomorrow through video. Fingers crossed that she'll be understanding and cool with a plan to taper.

I’ve heard of OneMedical. Also Parsley Health is a similar model with doctors who are more integrative in approach. 
 

I feel you on this process being quite a drain financially. 
 

Have you considered prescribing for yourself? Or asking a trusted friend to prescribe? Heck even prescribing for a family member but for you to take? I know it’s not condoned and I also want to be clear this is not an SA recommendation, but I also know doctors will sometimes do this, and as long as its not an FDA scheduled drug it doesn’t seem to raise flags. 

Edited September 24, 2020 by composter

[purple]

@ShiningLight, yeah the whole system is pretty messed up. I still remember feeling like I got put on a conveyor belt at the beginning of med school, the school being a factory, and me becoming another zombie doctor at the end of it. Dunno why I dismissed that feeling and didn't run away sooner I'm glad I made it through and did enough training to get licensed tho! Didn't completely shoot myself in the foot.

 

@composter, great to hear they are more integrative. I was hoping so and will get to experience it in a few hours! And yes, I have considered self-prescribing but from what I could find, it'd depend on the pharmacist to grant it or not especially with central nervous system acting medications. I thought about asking friends too but feel uncomfortable putting them in that position. Good idea!--I had forgotten about that to prescribe for someone else but now I'm worried it'll show up on their medical record somehow and affect their insurance rates. Keeping my fingers crossed that this NP will understand and write me a script that I can keep refilling.

[arbor]

Hi Purple, Wow, congratulations for both seeing through the conveyor belt disfunction of our medical schools (so highly funded by the Pharmaceutical Industry) and finishing your training to get licensed.  All this while you were dealing with the effects of escitalopram.  I had found this interesting statistic:  

Indefatigable healthy-physician advocate Dr Pam Wible reports that 75% of American medical students and residents are taking stimulants, antidepressants, or other psychiatric medications.Oct 23, 2017

 

Use of Psych Meds in Medical Students and Residents

I wish you my co-best as we cope with the aftermath of AD's,

Arbor

[Altostrata]

Hello, purple. Did you get your MD?

 

I'm sorry this has been so difficult for you. Any MD or DO can prescribe liquid escitalopram. Once you stabilize on 10mg, you can consider tapering more gradually.

 

Tips for tapering off escitalopram (Lexapro)

[purple]

@arbor, thank you! Wow, that statistic is mind-blowing, thanks for the link!

 

@Altostrata, yes! Fortunately, she seems to be on the same page as me after telling her my history. The plan now is to stabilize on the 10mg and then taper more gradually. She said probably to taper over 6 months but we'll see when the time comes

 

Thank you all so much for the support!

[bubbles]

Did you get the liquid Lexapro? I had it some years ago. It tastes absolutely disgusting! It did make for easy dosing though. I went much too fast, but that wasn't the fault of the liquid formulation!

 

 

[composter]

4 hours ago, arbor said:

healthy-physician advocate Dr Pam Wible reports that 75% of American medical students and residents are taking stimulants, antidepressants, or other psychiatric medications.

 
Coincidentally, Purple and I were just talking about Dr. Wible in a private message conversation! She has certainly led the way in advocating for better teaching and training environments for the medical profession. 
 

3 hours ago, Altostrata said:

Hello, purple. Did you get your MD?

Purple mentioned earlier that she has her medical degree and medical license (will defer to her whether she wants to state MD or DO although they’re virtually the same thing). 
 

2 hours ago, purple said:

Fortunately, she seems to be on the same page as me after telling her my history. The plan now is to stabilize on the 10mg and then taper more gradually. She said probably to taper over 6 months but we'll see when the time comes

Great news! Typically we find that providers don’t seem to bat an eye if it’s just one drug/Rx that needs to be reinstated. The trouble comes when it’s a more complex case involving a mess of psych drugs. 
 

Yeah 6 months is definitely not a good idea from a withdrawal-aware perspective. Still that’s a longer timeline than other doctors give. The 10% per month is our recommended tapering rate, with many of us going slower than that. 
 

In my experience it may take around a year to stabilize from a reinstatement so time and patience will really help with the process. For tapering, don’t be afraid to take your sweet time. Better slow and safe than sorry. It personally took me 8 months to stabilize from a reinstatement and now 1.5 years later I’ve reduced from 10 mg to 4.8 mg. Just for perspective. 

[ShiningLight]

8 hours ago, arbor said:

 

Indefatigable healthy-physician advocate Dr Pam Wible reports that 75% of American medical students and residents are taking stimulants, antidepressants, or other psychiatric medications.Oct 23, 2017

 

 

Yeah, and 100% of Google employees 😆 and everyone else in Silicon Valley. Especially the stimulants.

 

What's really sad is when the society is so dysfunctional that anyone with a brain and heart needs to disable them pharmaceutically in order to survive the pain. [did I regurgitate that from Dr. Breggin or Robert Whitaker? Sometimes when I hear things, they stick and I parrot them. I think it was Breggin.]

Edited September 25, 2020 by ShiningLight

[ShiningLight]

22 hours ago, composter said:

I’ve heard of OneMedical. Also Parsley Health is a similar model with doctors who are more integrative in approach. 
 

 

Hadn't heard of OneMedical before. Looked them up. Concierge medicine for the middle incomes. Another layer of bureaucracy. They are selling longer appts and nicer environments? God I'm cynical. I wish the MAIN system would just be fixed, instead of tacking on more layers of fees and bureaucracy, whose main function is to protect you from the underlying broken system.

 

[This is a criticism of the system, not people who are interested in trying a different model or easing their pain in interacting with the behemoth medical industrial complex. Lord knows we need a different model.]

 

Edited. Looked again: agree that 24/7 access to video visits is a helpful benefit. Potentially avoiding an emergency room visit. Still stand by statements about the overall system. Traditional insurers should have that. It would be very cost effective in preventing some ER visits. 

 

Edited September 25, 2020 by ShiningLight

[purple]

Oh! I thought @Altostrata was asking if I got my MD, like my primary care doctor haha! Yes, I got my medical degree and license. I'm technically a DO but yeah, virtually the same except I should be able to do some cool stuff with my hands. I definitely want to take more courses on the even more esoteric osteopathic stuff--I tend to be drawn to the more soulful, spiritual, energetic aspect of things.

 

Yes, I've actually taken some of Dr. Wible's courses and retreats! I was trying to follow her model of opening up a private practice but my trauma with medical training and subsequent total lack of faith in myself definitely got in the way of building a business. So grateful for everything she has done though and for really speaking up and being there for the lost, burnt out (I know she hates that term ;p), and empathetic healthcare practitioners.

 

I'm so naive haha. I remember being so surprised in college too when they told us what percentage of students use stimulants! And of course the Silicon Valley would have tons on them, yikes! No wonder my friend's yoga business is doing so well

 

I totally agree that society and its "norms" are more the issue. I had a personal theory that the people who turn to alcohol and drugs are actually more sensitive souls who are looking to escape their pain and turning to substances was the only way they could accomplish that. I also wonder if many people are actually more sensitive than they let on, either in denial, coping in some unhealthy way, or being medicated in whichever form--street drugs, alcohol, weed, pharmaceutical drugs.

 

I do wish the main system would get fixed too. I was really drawn in by Pamela Wible's creativity with creating her own little system and teaching us how to replicate it and/or adapt it to how we wanted to practice, but it doesn't solve the overall problem. I do hope it eventually creates a tipping point or something.

 

I don't think I made a super sound position going with OneMedical. I'm usually more thorough in my research before putting money down but my desperation for a med refill... yeah. I'm happy with what I got tho. @bubbles, I did not but I will ask for it when I'm ready to start tapering. For now, I'll stick with my lexapro 10mg tablets until my life situation is more stable, meaning I get a solid job and adjust well to it.

[Gridley]

10 hours ago, purple said:

I definitely want to take more courses on the even more esoteric osteopathic stuff--I tend to be drawn to the more soulful, spiritual, energetic aspect of things.

 

purple,

 

There's a cranio-sacral therapist in my tiny village that I see weekly.  Very gentle, subtle work.  When I had novocaine at the dentist (no other anesthetic available here), I became very agitated.  She did some work on my adrenals and lymph flow and the improvement was vast.  This might be an area to explore.

[Altostrata]

Osteopathic manual therapy is much under-recognized. It's a wonderful form of treatment. We have a couple osteopaths offering it here in San Francisco who are booked for many months in advance, and they're cash-only. Don't hesitate to pursue it!

 

Good to hear you've got a handle on your tapering now.

[purple]

@Gridley, yes, that's actually what I'm specifically interested in! There a bit of split in the schools/organizations that teach it but hoping I can take an intro class next year

 

@Altostrata, nice! Before I applied to DO school, I shadowed a DO who practiced OMM/NMM in SF!

 

@composter, thanks for sharing your timeline! That really gives me more perspective and a good reminder for myself to be patient and gentle.

 

Thanks, I'm really glad I have a plan in place. My next steps are to get a "better" job and really stabilize my mental health more. (I'm happy with my current one because my boss is so understanding and amazing but it only allows for part-time hours and I'm completely remote now due to the pandemic and because I moved but she was sweet enough to let me stay on for awhile longer.)

 

I'm proud of myself for getting up and moving for 22 days in a row now. I plan to continue it and develop it completely into a long-term habit. Excited to go camping in a few days with some friends, really looking to time being immersed in nature!

 

Something I really need to explore and I'll look around this forum to see if anyone else has discussed it, is my "laziness." The first time I brought it up to a really experienced therapist, he noted that what I labeled as laziness was actually better worded as "active resistance." This recent withdrawal period has brought it up with great great intensity coupled with massive anxiety. For example, I knew that to feel better, I should get up out of bed and move around but I just kept resisting and trying to force myself to sleep to escape it all. The huge anxiety has subsided but I'm still not as regimented/productive as I used to be. In taking care of things like paying bills or responding to emails, I wait until the last minute. I've never procrastinated to this extent before. I'm guessing it's best to just let it be for awhile and continue to take care of the things that are absolutely necessary. But wondering if anyone else encounters this inner resistance--most recent therapist called it the "rebellion" which sounds accurate too. It kind of feels like an inner child that just refuses to do anything they're being told. At the same time, I've been pretty tired and weary these past few weeks, likely recovering from that intense withdrawal and activated nervous system. I don't value productivity and busy-ness as much as I used to and to the unfortnately great extent that society does, but I would really like to establish a better routine and schedule beyond my current morning one. The rest of the day, I'm usually binging on youtube videos and falling asleep while watching them. One of my goals is to set a time and amount of time that I visit this forum It's so helpful being here and sharing, feeling heard and supported.

 

[Altostrata]

We all need to get into the habit of putting self-care first. If getting up and moving around makes you feel better, that's self-care.

 

It sounds like you do a lot of self-blaming, which is holding you back. Just tell that inner voice to shut up so you can take care of yourself.

[purple]

On 9/26/2020 at 1:11 PM, Altostrata said:

It sounds like you do a lot of self-blaming, which is holding you back. Just tell that inner voice to shut up so you can take care of yourself.

Thank you, yes so much to this!!!

 

Checking in since I have been gone for awhile. I am feeling more "normal" as in there continues to not be heavy panic, intrusive thoughts, suicidal thoughts, and other things I was experiencing just a few months ago. Crazy that it's already October.

 

Currently just on the 10mg escitalopram (lexapro) and stabilizing on it. Not seeing the therapist anymore because I can't really afford it and although they were helpful in some ways, I think I need a better fit or just something different. Also remembering that I can talk to some of my friends about what I'm going through.

 

My current struggle is very behavioral I think. I continue to procrastinate to the max (have had low to medium levels of procrastination in the past, never this extensive) and in general, kind of avoiding many things. I bury my head in the sand currently with news and politics both of which I was never very interested in before as I found out at a younger age that my empathy is too strong to even read/hear about news of other people suffering. Yet for some reason, I am gravitating towards it now, almost as if I want to suffer or am self-sabotaging, creating anxiety because that's something that was familiar to me in the recent past. I'm trying to escape responsibility, I realize. It's easier to accept and not judge myself too much for it now though. Trying to slowly build a new routine. I'm still at the morning run/walk and nothing else really planned. Giving myself time, being gentle.

[Altostrata]

That's good. It can be hard to reshape your routine and thinking.

[Bruci]

On 9/22/2020 at 9:37 PM, composter said:

Perhaps you can become an educator within your field in time. There are notable MDs who speak out against AD and benzo withdrawal. To name a few if you are not familiar: Kelly Brogan, Stuart Shipko, Christy Huff, Joseph Glenmullen, Peter Breggin. You can Google any one of these names and read their blog posts or books. 

PLEASE SEE SA's response to Bruci's comment.

 

Heads up warning about Dr. Kelly Brogan. She is a high-level quack, antivaxxer, and a promoter of pseudoscience.

Unfortunately, through social media, she has become a high profile “holistic psychiatrist“ in antidepressant withdrawal advice and alternative treatment of depression. You can read more about her here. Be warned. (Be sure to read the comments)

https://sciencebasedmedicine.org/the-pseudoscience-of-kelly-brogan/

I also do not trust Peter Breggin, who is extreme antipsychiatry. Anyone who believes that schizophrenics should not be treated with medication should not be trusted.
 

In fact, I would not trust anyone on either extreme of this complex discussion. That means no medication advocates (e.g. Breggin) or only medication advocates (Most biological psychiatrists.)

 

In my opinion, Joseph Glenn Mullen and David Healey are the good guys. Sound, rational advice without extremism.

 

Bruci

 

Edited October 23, 2020 by ChessieCat
added link to response

[Shep]

19 hours ago, Bruci said:

Anyone who believes that schizophrenics should not be treated with medication should not be trusted.

 

Bruci, I've addressed the problem with your comment here in your book thread. 

[Altostrata]

Unfortunately, Dr. Brogan has taken some questionable positions lately. She is a Covid-19 doubter.

 

https://kellybroganmd.com/message-to-dispel-fear/

 

Please return this thread to Purple. Take off-topic discussions elsewhere.

[purple]

Thank you all for the input.

 

I'm feeling pretty stable on the lexapro 10mg now, which is nice. I'm renewing a commitment to meditation--it's something that has been transformational for me in the past and I believe establishing a solid practice will go a long way for me. My next step is finding a stable source of income whether that is being employed full-time or trying self-employment again. I feel more faith and confidence in myself now, though still with trepidation.

[Gridley]

@purple

 

That all sounds very positive. The meditation is transformational.  I feel you have a great future ahead in cranio-sacral (or related areas) and that your experiences now will be invaluable and will be transmuted to the gold of healing for others.