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

[Ariel]

@purple

Thinking of you <3

[purple]

Life is so mysterious. I was in a wave (of course! 😂) and came out of it a few days ago. Now I feel like the version of myself that I like much better. One who feels productive and wanting to get things done and doing things. One who can't sit still to watch a TV episode because I have better things to do.

 

This morning, I decided to finally decrease my dose even though it's scary to do so and there's a teeny part of me worried it'll send me into a wave again. But I guess having survived through quite a few waves already, I'm less scared to have to deal with them again.

 

I haven't found/gotten a job yet but did just apply to three today! Fingers crossed I'll get something soon-ish!

[purple]

It's also been hard to find a pattern to things. I did stop taking this other brand of omega-3's several days ago and wonder if that helped? Sigh, causation and correlation, such hard things to tease apart.

[Ariel]

@purple

Congrats on making another drop, and good luck with it! 

 

Personally I have found vitamin D and omega-3 supplements activating. I can't speak to your experience but can share that I have sometimes found quitting a supplement to be the thing that helped bring me out of a wave. Can't say whether they ever caused a wave but they certainly did make things worse sometimes. 

 

Glad you're feeling better. Enjoy <3

[purple]

Haha a brief window but oh well. Things aren't too bad yet and hope they can just stay this way.

[Ariel]

@purple

Thinking of you <3

[purple]

Thank you @Ariel ❤️

I'm happy to report I got a job offer and accepted it. Hoping my on-boarding process goes smoothly and no hiccups.

I'm still having low mood and motivation but it's become so normal now I'm just going with it so it's not really bothersome to me anymore.

[purple]

Also I've been thinking about how I'm pretty used to these symptoms that I can probably go a little faster on the tapering than I have been. I guess I'm feeling a little impatient but I think it's more that I feel like I can handle it?

[Ariel]

@purple

Congrats on the new job! 

Hope it's a good fit. 

 

6 hours ago, purple said:

Also I've been thinking about how I'm pretty used to these symptoms that I can probably go a little faster on the tapering than I have been. I guess I'm feeling a little impatient but I think it's more that I feel like I can handle it?

 

I'm not a mod, the following is just my personal opinion. 

You're about to start a new job (or have just started?). That's always demanding and can be stressful, even without WD.

The idea in WD is to reduce undue stress on the system, with external stressors at a minimum. 

Also, the recommendation is to only ever make one change at a time, then wait to assess/address any possible reaction. 

Keep it slow, simple, stable. 

Given the above, it seems to me that now would not be the best time to accelerate a taper.

New job is a change; any dosage cut is a change; a higher percentage dosage drop is a more significant change. 

I'd be very careful if I were you and not make any changes to the rate of taper. 

In fact, why not consider a longer hold for a few months while you get started in your new job, to give yourself some breathing room? 

The effects of stress are cumulative. (Not to mention that impatience/sense of urgency can be viewed as a WD symptom in and of itself.)

You want to set yourself up for success, both work-wise and taper-wise. It's the long game. 

Sounds like overall you're feeling like your WD symptoms are manageable and somewhat stable. That's good, that's where you want to be.

Why rock the boat? 

 

Good luck with the new job, take care <3

 

[purple]

Thank you for the reminder, @Ariel. Yeah the impatience is real. I did make a drop to 5.8 a little while ago and feeling it now I think. Interestingly though, even while I'd been on the long hold at 6.4, I felt like I'd made a drop when my previously job ended. Guess it's all that stress.

 

Currently doing a lot of paperwork to onboard with this new job. Unfortunately feeling a lot of "laziness"/resistance/procrastination against moving forward with it. It's amazing how strong it's been. Trying to not look at my past self and seeing it as better or comparing myself to when I was able to do more.

 

Day by day...

[AndyPants]

I think holding until you've got a couple months in at your new job is a good idea. Glad you found something!  

[purple]

It's so damn hard. These past 2 days especially. So much anxiety and thoughts racing around. And the threat of my job offer being rescinded. So many things on my plate and me just procrastinating on them. Feeling like things are my fault like that I'm self-sabotaging and forgetting how big of an effect this drug has on me and my functioning.

[purple]

There's a cat that I've played with a few times since I moved into this neighborhood at the beginning of this year. The cat's a bit chonky so I like to call it chonky cat. I was so happy to come across chonky today and played with her(?) for a long time. It was so nice. I'm so touch deprived. There's a dog park near me and I want to ask the owners if I can pet their dogs but I'm scared to. I hate how scared I've become and unable to get past it. I used to have fear and anxiety before I started on ADs but I was able to overcome them. Now, I kind of just let them get the better of me? I don't have the energy to fight. Anyway, I really just wanted to post about how happy I was to be able to pet chonky and play with her today. I hope I can bump into her everyday and have it be a routine.

[Ariel]

Hi @purple

 

5 hours ago, purple said:

It's so damn hard. These past 2 days especially. So much anxiety and thoughts racing around. And the threat of my job offer being rescinded. So many things on my plate and me just procrastinating on them. Feeling like things are my fault like that I'm self-sabotaging and forgetting how big of an effect this drug has on me and my functioning.

 

It sounds like you're dealing with intense WD symptoms. 

Neuro-anxiety, racing thoughts, neuro-self-blame and neuro-self-criticism can all be so exhausting to contend with. 

Be kind to yourself. Go gently. This is a challenging time, treat yourself with tender loving care. 

 

I'm not a mod, but I'm noticing in your drug signature that you updosed on August 10th to 6mg. 

Have you considered doing a significantly longer hold in the name of facilitating stability? 

 

I'm sorry to hear that your job offer might be rescinded. That's something that might feel stressful to anyone, regardless of ADs or WD. 

Hope the situation resolves for you soon. 

 

32 minutes ago, purple said:

There's a cat that I've played with a few times since I moved into this neighborhood at the beginning of this year. The cat's a bit chonky so I like to call it chonky cat. I was so happy to come across chonky today and played with her(?) for a long time. It was so nice. I'm so touch deprived. There's a dog park near me and I want to ask the owners if I can pet their dogs but I'm scared to. I hate how scared I've become and unable to get past it. I used to have fear and anxiety before I started on ADs but I was able to overcome them. Now, I kind of just let them get the better of me? I don't have the energy to fight. Anyway, I really just wanted to post about how happy I was to be able to pet chonky and play with her today. I hope I can bump into her everyday and have it be a routine.

 

This sounds lovely. 

I can certainly related to feeling touch-deprived. 

When I go for walks in the park I'm always delighted to come across a friendly cat or pet a dog. 

Sometimes I daydream about volunteering at an animal shelter when I feel a bit better. 

It's great that you're getting out of the house. 

Good idea to ask humans at the dog park whether they'd mind your petting the dogs.

Maybe this could be a constructive challenge for you, a little goal to work up to -- overcoming the shyness to ask.

I do this sometimes, set myself little challenges to do things I'm scared of. It might take me a while to do it, but when I do it feels meaningful. 

 

Thinking of you, purple. 

Peace and healing vibes <3

A.

 

[purple]

1 minute ago, Ariel said:

Have you considered doing a significantly longer hold in the name of facilitating stability? 

That's a good point. I guess I've been pretty impatient. Holding at 6.4mg for what felt like forever made me more eager to decrease sooner, especially when I noticed that I seem to have windows and waves regardless. I'll try my best to hold at this 6.0mg for at least 2 months. So frustrated at my body's sensitivity. But like you reminded me, the way is to be gentle and kind to oneself.

 

5 minutes ago, Ariel said:

Maybe this could be a constructive challenge for you, a little goal to work up to -- overcoming the shyness to ask.

I do this sometimes, set myself little challenges to do things I'm scared of. It might take me a while to do it, but when I do it feels meaningful. 

Yes, that sounds like a great way to reframe it. Thank you. I like that it does make it more meaningful when one does meet the challenge.

 

Thank you so much for your kindness, @Ariel ❤️

[Ariel]

@purple

 

1 hour ago, purple said:

That's a good point. I guess I've been pretty impatient. Holding at 6.4mg for what felt like forever made me more eager to decrease sooner, especially when I noticed that I seem to have windows and waves regardless. I'll try my best to hold at this 6.0mg for at least 2 months. So frustrated at my body's sensitivity. But like you reminded me, the way is to be gentle and kind to oneself.

 

Escitalopram is a very powerful drug, one of the most potent SSRIs. 

You may already be familiar with the drug info provided in Tips for tapering escitalopram

 

I was on escitalopram, too, so even though I'm not a mod I pay particular attention to the stories of members coming off of this drug. 

It's a tricky one, not least because it's notorious for delayed-onset withdrawal symptoms. 

What this means in practice is that the cumulative effect of cuts can catch up with you. It might seem like things are going okay reducing at a steady clip, and then bam! 

 

From your drug signature I see that you had two previous fast tapers off of escitalopram in 2018 and 2020, followed by restarting the drug. Prior to that, in late 2017 you switched from sertraline to escitalopram. I'm guessing that amounted to a fast taper or CT off of sertraline? I've heard that sertraline can also be difficult to come off of. 

All in all it looks like you've had some major drug changes in the past five years, going on and off two strong SSRIs at the rate of a rapid taper or what might be considered equivalent to CT. This is not negligible. Any of these could contribute to destabilizing your nervous system, potentially causing hypersensitivity and kindling. Taking into account the possible cumulative effect of these drug changes, I'd emphasize the importance of treating your system very gently moving forward. 

 

It looks like you held at 6.4mg for three months. I totally get how this may have felt like forever, but this is not an especially long hold in the scheme of things. Many members find they sometimes need to do much longer holds along the way, e.g. for six months or a year, to give their system a chance to settle down and stabilize before they then resume their taper. Some of the mods have done this during their tapers as well (getofflex and ChessieCat come to mind). It's quite common for a reason: because it works. Resuming a sufficiently slow taper from a place of stability following an adequate hold seems to be a much better, more sustainable process. Some people find they are then able to proceed with their taper experiencing the bare minimum of withdrawal symptoms, gradually reducing the drug while maintaining a decent, steady level of day-to-day functioning. 

 

I can certainly relate to feelings of impatience and frustration.

I did not taper correctly; under the supervision of my psychiatrist at the time, who considered my taper plan to be very conservative, I did a rapid taper from 10mg to zero over six months. Turns out that's tantamount to a CT, and I've been in protracted withdrawal ever since. This was in 2018, so I'm currently in my fifth year of protracted withdrawal. I don't recommend it. 

My psychiatrist was ignorant, and I was ignorant. You know what I did not know. You have a fighting chance. 

 

You are in a position to set yourself up for long-term success getting off of escitalopram using a harm reduction approach. This may entail longer holds than you'd like and slower tapering than you'd like, but it seems to me that ultimately it's worth it to go slower if it means both the process and end result are more sustainable. The alternative is going faster (there are really only two options, "too fast" and "slow enough"), experiencing difficult withdrawal symptoms along the way, and then getting slammed at the end with protracted withdrawal (PAWS) that lasts for an unknown period of time. I don't see anything appealing about that. It doesn't necessarily shorten the total duration of WD (on the contrary, sometimes it extends it), and PAWS brings with it its own impatience and frustration. 

 

There is really only one appropriate pace at which to reduce the drug, and that's the body's own pace. We simply don't get to impose our will here, as much as we try or would like to. The body heals in its own time. We need to learn to listen to our bodies and work with them to facilitate optimal conditions for healing. 

 

I'm saying all of this because I want to see you succeed, and I believe you can. 

In the name of care and clarity, I will be blunt: it might be time to check your mindset. Please know I say that with love. 

This is the long game. A two-month hold is not that long at all, and may not nearly be long enough given your drug history and where you're at with WD symptoms. I don't know, I'm not in your body, I'm not a mod. I'm just saying, it might be helpful to start wrapping your mind around the reality of what it actually is to responsibly, sustainably come off of a potent SSRI such as escitalopram -- and adjust your expectations accordingly. This is all part of moving into acceptance, which helps immeasurably with practicing patience (and vice versa). 

You may feel "frustrated at" your "body's sensitivity", but that's not going to help you moving forward. The body is, sensitivity is.

We ignore what is at our own peril. This seems to be a very human thing we all do, our hyperactive minds wanting to decide and override reality, to our own detriment.  

 

Anyway, I think you get my point. 

It's your body, your life, your taper, your choice, your consequences. 

You decide what's right for you.

I believe in you and I'm rooting for you all the way!

 

In solidarity and support,

A.

[Ariel]

Hello again @purple

 

I know I've already written a lot above and I don't mean to overwhelm you with information or unsolicited (attempts at) support. 

Please peruse at your own pace and feel free to disregard as you see fit. 

That being said, there is something i forgot to mention, and I think it's important, so here it is in a little P.S.

 

One thing that might be tripping you up in your taper, or a contributing factor as to why the cuts are hitting hard, in addition to any possible cumulative catch-up effect, is: it may get more challenging to taper as the dosage lowers because of receptor occupancy ratio. 

 

You may have already seen this, but just in case: 

 

Quoting brassmonkey from Post #1 of the help topic above: 

 

(...) at the lower doses (10mg and below) a very small change in dose will result in a very large change in occupancy. A large decrease in occupancy means that there is a lot of healing to be done and a large increase in symptoms is most likely. The curve also shows why it is so important to go slowly at the lower doses as a very small change in dose causes a very large change in occupancy.

 

Wishing you a relatively peaceful day today, hoping you receive some respite, maybe some pleasant moments with chonky cat. 

I am thinking of you and I'm sorry if my posts have been on the bombastic side. I trust you know I mean well. 

Sending healing vibes, in solidarity and support <3

A. 

 

[purple]

@Ariel, I thank you for the tough love. I needed that. I forgot that despite the general 10% per month guideline, that Lexapro is such a nastily strong drug.

 

After reading and reflecting on your words, I've decided that my body deserves kindness, respect, patience, love, routine, stability, etc etc.

 

I didn't sleep much last night. When I did wake up and try to sleep more, I couldn't because of the anxiety (akasthisa?) mainly due to this job that I'm hoping I don't lose. They said they just need a verification email and then I'll be good. But I know I also haven't finished this one training and exam and I hope that won't count against me. Going to work on that training now. Crossing my fingers and toes and hoping and praying. The build-up from all the things I've been procrastinating on is so bad. I want to run away from it all. I want to let go of my license which I know would be so hard to obtain again (but maybe I'll be willing to go through the trouble in the future if I really do want it back??) so I'm just trying to do what I can to maintain it... which requires more online learning hours... Anyways, enough of this. I'm going to get some work done and hope for the best.

[Ariel]

Thinking of you @purple

Healing vibes <3

 

[purple]

Just wanted to update that I've been at the new job for over a month now. It's been hard and stressful. I often ask myself why I chose this profession. The good thing about this job is that the people are nice. I wish there was more clinical support and guidance though.

 

Still holding at 6.0mg and doing so-so. As best as I can be I guess. Continued anhedonia. Had pretty bad panic and nausea the first week of my job. So tempted to CT but know I shouldn't. Been reading other people's stories. Noticing my sentences are disjointed and probably don't make any sense in flow but that's ok. Just wanted to give an update and wish everyone well. Hanging onto the thread of hope that one day things will be better.

[purple]

It's been almost a year since my last update. I'm no longer at the "new job" I talked about in the previous post. When I keep not being able to keep jobs, I can't help but wonder if I'm the problem. I know I have issues but I also have to keep reminding myself that being a doctor is a hard job made harder by our healthcare system and greed.

 

Just read the previous post and glad to say I'm doing better now than I was when writing that. I did end up returning to therapy because I could afford it and because I was in a place where I knew I needed and could accept the help. However, I'm having doubts now about this therapist. Still contemplating on it and probably overthinking it...

 

Anyway, just wanted to say hi. To all those struggling through the darker days, please hang on. Promise yourself one more year like I did. I promised myself that in 2020 and while it's still been a bumpy ride, my relationship with it has changed and it seems to be less bumpy as time goes on. I also very much pace myself with my decreases as you can see in my updated sig. I don't want to chance things again and get close to that edge.

[composter]

I'm glad to hear you are doing better compared to last year and that you have been able to afford therapy. I know the feeling of not being sure if the therapist is the right fit. I think if you're deriving even some benefit from your therapy sessions that is better than nothing!

 

I hear you on the doubts about jobs and the dumpster fire of a healthcare system in general. I am finding that I am feeling more apathetic and cynical about things, but maybe that's just part of growing up. Hopefully we both get to places in our careers where we are able to feel autonomy, some degree of fulfilment, and a sense that we are helping people lead better lives.

 

Yes, we all have to hold on. I want to see you (and I) live long and healthy lives. Good work on the slow reductions. I am reducing about 0.1 mg every month these days (I'm very close to the 1 mg mark). Let me know if you have any questions, but it sounds like you've figured out a good system. Slow and steady.

[Rosetta]

Hi, Purple, I hope you are doing ok.  I thought I would stop by and tell you that you are seen, heard, and you matter.  This WD is no joke, but you are finding the info you need, and I hope you are making it through ok.

 

🧚‍♀️Rosetta

[purple]

On 9/22/2023 at 12:00 PM, Rosetta said:

Hi, Purple, I hope you are doing ok.  I thought I would stop by and tell you that you are seen, heard, and you matter.  This WD is no joke, but you are finding the info you need, and I hope you are making it through ok.

 

🧚‍♀️Rosetta

Thank you so much, @Rosetta. I'm sorry I didn't see your post until now! It felt so good to read your words of seeing and hearing me and telling me I matter. I'm realizing more and more how important those kind of affirmations are for me.

 

I was going through a pretty bad wave the past few months but finally stabilizing/coming out of it. Still hard to clean up my room and try to re-establish healthy habits and routines again. I'm so frustrated by how long this is taking. I wish for some miracle so I can be off of it by the end of this year! Sigh