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Overcome: Lexapro / escitalopram - a bumpy road

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Overcome

Hi all,

In 2013 I received the diagnosis of Generalized Anxiety Disorder when I started having therapy for the first time in my life - I was 23 then. I've been anxious through my teens and early adulthood, and also suffered from bouts of low mood, but did not think much of it - I thought it was just how I was.

 

In 2013 because I was at a particularly bad phase in college, I went to a psychiatrist through which I started taking 20mg Lexapro (I take the generic - Escitalopram). Everything improved a lot. Anxiety greatly reduced, mood also better, more drive to do stuff. And basically no side effects. So I kept taking it religiously, and basically forgot about it. About 3 years later, it started to bug me that I was taking a drug to keep myself mentally stable. I knew nothing about how bad the withdrawals from this type of drug were, and I felt good, so I just cold turkey'd - 20 to 0. You can imagine how this goes. After some days I was hit by what I thought was the worst flu I had ever had. I could not leave bed. That was odd. Didn't think just stopping that drug would cause that, as the effect of the drug is pretty much non-noticeable (it's not like taking a benzo where you feel drowsy and so on) and you just feel pretty much like the normal you. Either way, just to be safe I went back on the 20mg and all the symptoms disappeared after some time and again I did not think much about it anymore.

 

I think I attempted cold turkeying again after some time just to experience exactly the same symptoms. So I thought "alright, this really is the Lexapro, not a flu". From then on I started being more uncomfortable for taking the Lexapro. Here's this drug that apparently makes me feel stable, but I stop taking it and I'm completely wrecked. This doesn't feel right.

So in 2018 I started a slow tapper, or at least what I considered a slow tapper. I was reducing around 2.5mg every month or every other month. I was going linearly - no percentage reduction. That was the logical thing for me to do as my doctor never told me about the liquid form of Lexapro and with the tablets available where I live it's impossible to do a precise lower division lower than 2.5mg. Throughout the tapper I felt what I now acknowledge as withdrawal symptoms, but again I did not think much of it. I was in a difficult life situation, living abroad and always extremely stressed, so I thought the life situation was what was causing that.

 

In May 2019, I was down to already 2.5mg. Not feeling that well, but that was such a low dose that I thought it was insignificant and dropped to zero. This overlapped with a break-up and with starting a job that was really quite demanding. That's when I got into hell. I started waking up at night with panic attacks. In the morning my arms and legs were burning - I felt the anxiety burning my body. I just wanted to leave my body and my mind, that feeling was just too unbearable. Crying non-stop, huge feelings of rage - I just wanted to destroy stuff and just felt this huge urge sometimes to beat up anyone that did something even mildly annoying (and mind that I've always been quite a controled person - this was not at all me). I also had muscle spasms, couldn't digest anything properly and lost a bunch of weight. I had never been so thin in my life.

 

That's when I started thinking I had to have something serious in my brain - I even forgot about the Lexapro then - I thought I was developing a neurological disease. This person was not me.

 

My psychiatrist had tried to put me on other antidepressants - Fluvoxamine and Mirtazapine. None of them worked. Then I was put back on the Lexapro (only 10mg). And I wasn't seeing much improvement on my state.

 

I started becoming suicidal. I did not want to go through the realization that I had a disease that would invalidate me for the rest of my days. I was going to doctor after doctor, doing exam after exam, and they didn't seem to find anything wrong which left me feeling even more helpless. I thought that was never going to end. I started thinking every day about suicide. That's all I thought about. I just could not bear that reality. That's when I told my parents - "I need to be checked in at the hospital. I won't last much longer like this."

So I was checked in at the hospital. Even the doctors who checked me in did not believe I was in such a bad state - I guess even in that state I kept my composure. I spent 2 weeks there, in what was the most horrible experience of my life. The people there were for sure much worse than I was - most of them had even lost touch with reality. But deep down I know this was the experience I needed to snap out of it. While I was there the doctor who was supervising me increased my Lexapro dose to 20mg. I became reeeaally sleepy after that. Just as I had become the first time I went into 20mg back in 2013. By then I still did not believe I did not have a horrifying disease. It was really hard to believe this was coming just from a psychological source. And it took quite long for me to become convinced that was the case.

 

The months right after the hospital were tough. I was sleeping a lot - around 12 hours a day. Very, very slowly things started improving. Too slowly for me to even notice a difference. But little by little I started sleeping less, recovered my appetite, some days even saw a glimpse of contentment. At some point I was feeling good more often than I was feeling bad. I started exercising every day, having psychotherapy twice a week, taking supplements, getting sun light, meditating. Everything I could do to improve, I did. Around April of this year, I was already entering a pretty stable stage. Some days I still had energy and mood breaks which I had no idea where they came from and were pretty demotivating - now I realize they are likely something akin to the "waves" that I've seen mentioned here at SA. I also still had some lingering symptoms such as some vague leg pain here and there, as well as teeth pain. But those bad days and lingering symptoms started becoming more and more rare.

 

So for some months I was doing really good. Feeling drive and contentment with life. Optimistic. Last month I had an appointment with my psychiatrist, and as I really want to be med-free he suggested that I attempted a new reduction again. At first he suggested me to drop to 15mg, but I thought it was better to go first down to 17.5mg instead. And that's the dosage I'm at right now. The reduction was not that large, but I can for sure feel the withdrawals - even though I know the reduction was larger than the 10% recommended here at SA - my next drops I will follow that guidance.

 

After the drop to 17.5mg, I started having more of those down days. Also the days right afterwards I had rebound anxiety, which has already disappeared. Some days my energy and mood breaks. And I'm more irritable, less drive, etc. Also those lingering pains I mentioned are back sometimes. Furthermore, I feel like I can't train at the gym at the same level I did - even though my body weight and composition is exactly the same as it was before the drop to 17.5mg, I feel significantly less strength some days. So for now I will stick with cardio.

 

Now I know much better than I did in the past and will wait to fully stabilize from the current withdrawal until I attempt another reduction. I am also building a sauna at my place, which I have read has many benefits for mood, so that's another resource I will have to deal with the tapering process.

 

Hope this post can be useful for someone.


-> Started 20mg Lexapro in 2013. Tried cold turkeying a couple of times in the following years - felt like I had been hit by a train. Always went back to 20mg.

-> In 2018 started a "slow tapper", dropping 2.5mg every month or every other month. Relatively stable, but that still was too fast of a taper. May 2019 dropped 2.5mg to 0mg. Overlapped with break-up and start of stressful job.

-> Around July 2019 entered hell. Panic attacks, arms and legs burning, no energy, constant headaches, constant dread, crying spells, feelings of rage towards everything and everyone. Thought I had neurological disease such as MS. Became suicidal; Hospitalized in November 2019. Put back on 20mg Lexapro.

-> Recovered slowly but surely. Around April 2020 already stable, only with some days of unexplained energy and mood breaks.

-> Did everything I could to improve: Psychotherapy twice a week; Physical exercise every day; Supplements: Omega 3, Vitamin D3, Phosphatidylserine, Magnesium Glycinate, Zinc, Vitamin C, Probiotic; Meditation 30 minutes daily; Sunlight daily.

-> Kept improving from then on. Completely stable August 2020.

-> Saw psychiatrist again (FWIW) and dropped to 17.5mg end of August 2020. Some rebound anxiety first couple of days - completely resolved. Energy and mood breaks more frequent. Currently stabilizing before another drop attempt. My gym training suffered a bit with this - currently working on re-establishing my weight training back to 5 days a week.

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Gridley

Welcome to SA, Overcome.  It's very good you've stabilized.

 

As you know, we recommend tapering by 10% of your current dose every four weeks.  A percentage taper is much easier on your system than a straight linear taper.  With a percentage taper, the percentage of your decrease gets smaller and smaller, while with a linear taper it gets larger and larger, putting more stress on your system as you get lower in dose.  

 

Why taper by 10% of my dosage

 

The following link is specifically about tapering Lexapro, including information on how to get the nonstandard doses you'll need for your 10% taper.  I don't know if liquid Lexapro is available in Portugal.  If not, you can make your own liquid if liquid is the method you choose to use.  If you do switch from tablet to liquid, we recommend a gradual crossover.  I can give you more information on this if you wish.  The other method is cutting tablets and weighing doses using the Gemini-20 digital scale.  That's been my method of tapering Lexapro, and I can give you more information on that if you wish.

 

Tips for tapering off escitalopram (Lexapro)

 

It's not surprising that you had a bad reaction to jumping to zero from 2.5mg.  You have some time before thinking about jumping off but for future reference, that's much higher than we recommend as the doses are very potent at the low end.  As you can see from my signature, I'm at 0.1 Lexapro, with a drop to 0.05 planned for later this week.

 

Here is some information on withdrawal and the healing process.

 

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 explain the healing process really well:

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

Brain Remodelling 

 

Regarding exercise, many members in withdrawal find they can't exercise as before.  If the aerobic exercise is working for you, great, but many find strenuous exercise to be too stimulating and do better with gentler modes like a gentle walk in nature.

 

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.

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Edited by Gridley

Gridley Introduction

 

Lexapro 20 mg since 2004.  Began taper using Brassmonkey slide Jan. 2017.   

End 2017 year 1 of taper at 9.25mg 

End 2018 year 2 of taper at 4.1mg

End 2019 year 3 of taper at 1.0mg  

Current from Oct. 21, 2020 at 0.025mg

Taper is 99.875% complete.

 

Lorazepam 1 mg 1986-1991 CT, resumed a few months later. CT 2000.  1 mg 2011-2016.  Sept, 2016 increased to 0.5 X 3 in split dose. Sept. 2019 increased to 0.625 X 3 after crossover to new brand

 

Imipramine 75 mg daily since 1986.  Jan. 2016 began every 3-weeks 10% taper, down to 15mg.  Aug 2016, discovered SA, updosed to 25mg and holding.  Taper is 66% complete.  

  

Supplements: omega, vitamins E and D3, magnesium glycinate, probiotic, melatonin .3mg


I am not a medical professional and this is not medical advice, but simply information based on my own experience, as well as other members who have survived these drugs.

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Overcome

Hi @Gridley

Thanks for your reply!

Regarding the next taper, I have already got a prescription for liquid Lexapro from my doctor. I still haven't picked it up, but it's comes in 20mg/ml. I'm guessing I'll need to get quite a precise pipette in order to measure the dose I need. I'm planning on just using the liquid form to get the dosage I can't measure accurately with tablets. So first I think that even before doing the next taper down I will still go to 15mg from tablets plus 2.5mg from liquid, just to make sure I react well, and only then drop the next 10%.

Regarding the dropping from 2.5mg directly to 0 - I really had no clue. Thank god I found SA. I'm guessing even if I had been followed by a doctor on the taper down he would have adviced to drop just as I did.

I see your initial dose was also 20mg. How would you describe your progress so far? Did your anxiety increase as you tapered down? How is your mood almost out of it vs. on 20mg?


-> Started 20mg Lexapro in 2013. Tried cold turkeying a couple of times in the following years - felt like I had been hit by a train. Always went back to 20mg.

-> In 2018 started a "slow tapper", dropping 2.5mg every month or every other month. Relatively stable, but that still was too fast of a taper. May 2019 dropped 2.5mg to 0mg. Overlapped with break-up and start of stressful job.

-> Around July 2019 entered hell. Panic attacks, arms and legs burning, no energy, constant headaches, constant dread, crying spells, feelings of rage towards everything and everyone. Thought I had neurological disease such as MS. Became suicidal; Hospitalized in November 2019. Put back on 20mg Lexapro.

-> Recovered slowly but surely. Around April 2020 already stable, only with some days of unexplained energy and mood breaks.

-> Did everything I could to improve: Psychotherapy twice a week; Physical exercise every day; Supplements: Omega 3, Vitamin D3, Phosphatidylserine, Magnesium Glycinate, Zinc, Vitamin C, Probiotic; Meditation 30 minutes daily; Sunlight daily.

-> Kept improving from then on. Completely stable August 2020.

-> Saw psychiatrist again (FWIW) and dropped to 17.5mg end of August 2020. Some rebound anxiety first couple of days - completely resolved. Energy and mood breaks more frequent. Currently stabilizing before another drop attempt. My gym training suffered a bit with this - currently working on re-establishing my weight training back to 5 days a week.

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Gridley

@Overcome

 

That's great that you got the liquid.  That's very good idea to start out slow with the liquid. We recommend a gradual crossover from tablet to liquid.  While you're crossing over, wait until you complete the crossover before beginning tapering (our old rule about making only one change at a time).  Here's one model of crossover, although you can modify it as you wish.   

 

3/4 tablet, 1/4 liquid for 3 to 7 days

1/2 tablet, 1/2 liquid for 3 to 7 days

1/4 tablet, 3/4 liquid for 3 to 7 days

All liquid thereafter as you begin your taper

 

The link I gave you earlier

 

 Tips for tapering off escitalopram (Lexapro)

 

has information about syringes, etc.

 

I would say my anxiety decreased as I tapered lower.  There were some dosages along the taper that were were more difficult than others ( recall the 3mg period as one example). This is very individual.  Right now at the very end, due to the limitations of the scale (you won't have to worry about this since you're using the liquid) I'm having to make some large drops, 33%, 50% and I just made another 50% to get from .1mg to .05mg.  I can't say I'm without 

symptoms but they're tolerable.  I'll be very glad to be off

 

It's difficult to compare where I am now with when I was at full 20mg Lexapro since, before discovering SA, I did a too fast taper of Imipramine and was in withdrawal from that when, on SA's advice, switched my taper from the sedating Imipramine to the activating Lexapro.  Once i did, as I said, the anxiety decreased as I got lower and lower from 20mg.

 


Gridley Introduction

 

Lexapro 20 mg since 2004.  Began taper using Brassmonkey slide Jan. 2017.   

End 2017 year 1 of taper at 9.25mg 

End 2018 year 2 of taper at 4.1mg

End 2019 year 3 of taper at 1.0mg  

Current from Oct. 21, 2020 at 0.025mg

Taper is 99.875% complete.

 

Lorazepam 1 mg 1986-1991 CT, resumed a few months later. CT 2000.  1 mg 2011-2016.  Sept, 2016 increased to 0.5 X 3 in split dose. Sept. 2019 increased to 0.625 X 3 after crossover to new brand

 

Imipramine 75 mg daily since 1986.  Jan. 2016 began every 3-weeks 10% taper, down to 15mg.  Aug 2016, discovered SA, updosed to 25mg and holding.  Taper is 66% complete.  

  

Supplements: omega, vitamins E and D3, magnesium glycinate, probiotic, melatonin .3mg


I am not a medical professional and this is not medical advice, but simply information based on my own experience, as well as other members who have survived these drugs.

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Overcome

@Gridley

Do you think it's a good idea to mix tablets and liquid - using the liquid just to complete the dose I can't measure accurately with tablets?

I'm limited on the amount of liquid for now, and it's also more expensive than the tablets as there's no generic available.

Thanks, will have to check the info about syringes before I get the liquid.

I see. Tapering at such low doses without the liquid form is quite challenging, I imagine. I hope your tapering continues going smoothly!


-> Started 20mg Lexapro in 2013. Tried cold turkeying a couple of times in the following years - felt like I had been hit by a train. Always went back to 20mg.

-> In 2018 started a "slow tapper", dropping 2.5mg every month or every other month. Relatively stable, but that still was too fast of a taper. May 2019 dropped 2.5mg to 0mg. Overlapped with break-up and start of stressful job.

-> Around July 2019 entered hell. Panic attacks, arms and legs burning, no energy, constant headaches, constant dread, crying spells, feelings of rage towards everything and everyone. Thought I had neurological disease such as MS. Became suicidal; Hospitalized in November 2019. Put back on 20mg Lexapro.

-> Recovered slowly but surely. Around April 2020 already stable, only with some days of unexplained energy and mood breaks.

-> Did everything I could to improve: Psychotherapy twice a week; Physical exercise every day; Supplements: Omega 3, Vitamin D3, Phosphatidylserine, Magnesium Glycinate, Zinc, Vitamin C, Probiotic; Meditation 30 minutes daily; Sunlight daily.

-> Kept improving from then on. Completely stable August 2020.

-> Saw psychiatrist again (FWIW) and dropped to 17.5mg end of August 2020. Some rebound anxiety first couple of days - completely resolved. Energy and mood breaks more frequent. Currently stabilizing before another drop attempt. My gym training suffered a bit with this - currently working on re-establishing my weight training back to 5 days a week.

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Gridley
8 minutes ago, Overcome said:


Do you think it's a good idea to mix tablets and liquid - using the liquid just to complete the dose I can't measure accurately with tablets?

That's just one suggestion in the link.  It's certainly not mandatory.  You should do what you're comfortable with.  If you're limited on the amount of liquid you can get, that might be an advantage to this method.

 

Is it your plan to switch to all liquid?

 

12 minutes ago, Overcome said:

I hope your tapering continues going smoothly!

Thanks.  I'll see how I feel after four weeks at 0.05mg.  My choice then will be to go still lower, though it's a tiny amount of powder and the dose is obtained by eyeballing, or to jump to zero at that point.  It'll depend on how I feel.


Gridley Introduction

 

Lexapro 20 mg since 2004.  Began taper using Brassmonkey slide Jan. 2017.   

End 2017 year 1 of taper at 9.25mg 

End 2018 year 2 of taper at 4.1mg

End 2019 year 3 of taper at 1.0mg  

Current from Oct. 21, 2020 at 0.025mg

Taper is 99.875% complete.

 

Lorazepam 1 mg 1986-1991 CT, resumed a few months later. CT 2000.  1 mg 2011-2016.  Sept, 2016 increased to 0.5 X 3 in split dose. Sept. 2019 increased to 0.625 X 3 after crossover to new brand

 

Imipramine 75 mg daily since 1986.  Jan. 2016 began every 3-weeks 10% taper, down to 15mg.  Aug 2016, discovered SA, updosed to 25mg and holding.  Taper is 66% complete.  

  

Supplements: omega, vitamins E and D3, magnesium glycinate, probiotic, melatonin .3mg


I am not a medical professional and this is not medical advice, but simply information based on my own experience, as well as other members who have survived these drugs.

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Overcome
18 hours ago, Gridley said:

Is it your plan to switch to all liquid?

 

I think I will switch to all liquid when I reach 10mg.

 

18 hours ago, Gridley said:

Thanks.  I'll see how I feel after four weeks at 0.05mg.  My choice then will be to go still lower, though it's a tiny amount of powder and the dose is obtained by eyeballing, or to jump to zero at that point.  It'll depend on how I feel.

 

That sounds good. I would have thought 1mg was an insignificant dosage to make a difference. I just wish last year I had someone telling me how potent Escitalopram was, I legitimately thought I was going crazy.


-> Started 20mg Lexapro in 2013. Tried cold turkeying a couple of times in the following years - felt like I had been hit by a train. Always went back to 20mg.

-> In 2018 started a "slow tapper", dropping 2.5mg every month or every other month. Relatively stable, but that still was too fast of a taper. May 2019 dropped 2.5mg to 0mg. Overlapped with break-up and start of stressful job.

-> Around July 2019 entered hell. Panic attacks, arms and legs burning, no energy, constant headaches, constant dread, crying spells, feelings of rage towards everything and everyone. Thought I had neurological disease such as MS. Became suicidal; Hospitalized in November 2019. Put back on 20mg Lexapro.

-> Recovered slowly but surely. Around April 2020 already stable, only with some days of unexplained energy and mood breaks.

-> Did everything I could to improve: Psychotherapy twice a week; Physical exercise every day; Supplements: Omega 3, Vitamin D3, Phosphatidylserine, Magnesium Glycinate, Zinc, Vitamin C, Probiotic; Meditation 30 minutes daily; Sunlight daily.

-> Kept improving from then on. Completely stable August 2020.

-> Saw psychiatrist again (FWIW) and dropped to 17.5mg end of August 2020. Some rebound anxiety first couple of days - completely resolved. Energy and mood breaks more frequent. Currently stabilizing before another drop attempt. My gym training suffered a bit with this - currently working on re-establishing my weight training back to 5 days a week.

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Hakn

Gridley wouldnt 0.05 get  mostly metobalised until you take next one?

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Gridley
2 hours ago, Hakn said:

Gridley wouldnt 0.05 get  mostly metobalised until you take next one?

I'm not sure I understand your question.  Could you clarify?  Even this very low dose is very likely having some effect, but there's no way to know if it is and how much effect it's having.  


Gridley Introduction

 

Lexapro 20 mg since 2004.  Began taper using Brassmonkey slide Jan. 2017.   

End 2017 year 1 of taper at 9.25mg 

End 2018 year 2 of taper at 4.1mg

End 2019 year 3 of taper at 1.0mg  

Current from Oct. 21, 2020 at 0.025mg

Taper is 99.875% complete.

 

Lorazepam 1 mg 1986-1991 CT, resumed a few months later. CT 2000.  1 mg 2011-2016.  Sept, 2016 increased to 0.5 X 3 in split dose. Sept. 2019 increased to 0.625 X 3 after crossover to new brand

 

Imipramine 75 mg daily since 1986.  Jan. 2016 began every 3-weeks 10% taper, down to 15mg.  Aug 2016, discovered SA, updosed to 25mg and holding.  Taper is 66% complete.  

  

Supplements: omega, vitamins E and D3, magnesium glycinate, probiotic, melatonin .3mg


I am not a medical professional and this is not medical advice, but simply information based on my own experience, as well as other members who have survived these drugs.

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Hakn
59 minutes ago, Gridley said:

I'm not sure I understand your question.  Could you clarify?  Even this very low dose is very likely having some effect, but there's no way to know if it is and how much effect it's having.  

You likely excrete half of it before taking another so it doesnt stay consistent.

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Gridley
5 minutes ago, Hakn said:

You likely excrete half of it before taking another so it doesnt stay consistent.

The half life of a drug (how long it takes for half the dose to be metabolized and eliminated from the bloodstream) remains the same regardless of dose. Lexapro's half life is 27-32 hours, so there's plenty of the drug still in my system when I take next dose, and the dose would remain consistent between doses.


Gridley Introduction

 

Lexapro 20 mg since 2004.  Began taper using Brassmonkey slide Jan. 2017.   

End 2017 year 1 of taper at 9.25mg 

End 2018 year 2 of taper at 4.1mg

End 2019 year 3 of taper at 1.0mg  

Current from Oct. 21, 2020 at 0.025mg

Taper is 99.875% complete.

 

Lorazepam 1 mg 1986-1991 CT, resumed a few months later. CT 2000.  1 mg 2011-2016.  Sept, 2016 increased to 0.5 X 3 in split dose. Sept. 2019 increased to 0.625 X 3 after crossover to new brand

 

Imipramine 75 mg daily since 1986.  Jan. 2016 began every 3-weeks 10% taper, down to 15mg.  Aug 2016, discovered SA, updosed to 25mg and holding.  Taper is 66% complete.  

  

Supplements: omega, vitamins E and D3, magnesium glycinate, probiotic, melatonin .3mg


I am not a medical professional and this is not medical advice, but simply information based on my own experience, as well as other members who have survived these drugs.

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