DemonOfSarila: Tapering lexapro & trazodone

[DemonOfSarila]

I go by Jacq/DemonOfSarila/Sarila/she/her.

• Currently taking: 10mg Lexapro (escitalopram) & 50mg Trazodone & tracking them in a google spreadsheet
• Starting dose: 20mg Lexapro & 100mg Trazodone
• Taper started: July 2020
• Max dose: 20mg Lexapro & 150mg Trazodone
• Meds started: 2014

 

Anyway, as far as detailed history, I guess let's start at the very beginning?

• Issues with depression symptoms started in high school, some time 2002-2006.
• Major depressive episode in 2014, about March to November. Saw a few doctors, tried a few pills and amounts, and ended up on 20mg Lexapro and 100mg Trazodone.
• Stayed like that for years. Sometimes I needed to take 150mg of trazodone or only 50mg to keep me sleeping enough for long enough without leaving me super exhausted at all times. 
• In either 2016 or the first half of 2017: failed taper attempt under doctor's orders of something like 20mg-10mg-5mg-2.5mg-0mg over the course of like a month, maybe two. Can't remember if I took 15mg or 7.5mg during that process. Withdrawals were just too much, I was majorly upset and felt like crap (surprise, surprise). So I ended up back on the 20mg & 100mg combo, both taken at bedtime. 
• Found this site/form in or before July 2020.
• By Aug 1, 2020 I started to taper without doctor's orders or knowledge (previous doctor was too far away, and I didn't have insurance, but I had refills and goodRx). To be clear: I do NOT recommend doing this. 
• Please see this google spreadsheet for more details & graphs of my journey since Aug 2020. Basically I was alt dosing (another thing I do NOT recommend) the lexapro sometimes: Aug was 20mg & 15mg. Sept was all 15mg. Stayed at 15mg only until the last half of Oct was 15mg & 10mg, until Nov 17. Since Nov 17, 2020 I've been taking 10mg as half of a 20mg pill. Around that same time in Nov, I felt very tired and foggy at all times, and it felt it was the Trazodone. So I switched to taking just 1 of my 50mg pills instead of 2 of them, which completely fixed the "tired as hell cuz trazodone" feeling without causing other issues.
• I read about how bad alt dosing is, wanted to give everything some extra time to normalize, did not want to risk dealing with symptoms during the holidays, and knew I would have insurance in Jan, so I stayed with the 10mg of lexapro and therefore the 50mg of trazodone for more than 4 weeks. 
• Jan 2021 I've (finally) gotten insurance again and found a new PCP/GP that isn't too far away. As of this writing, I'm scheduled to see him to talk about decreasing my med in less than a week. In my previous appointment (as a brand new patient), his was dismissive of 10% tapering & wants to stop the trazodone first, and I'm not sure how I feel about either of those. But he did not like the alt dosing, so maybe he'll work out? I don't know at this time. 

 

[Gridley]

Welcome to SA, DemonofSarila.  Thank you for completing your drug signature.

 

It's very good you've stopped the alternate dosing, which can be very disruptive to your system.

 

We recommend tapering only one drug at a time.  Otherwise, if there are problems, you won't know the cause.  Regarding tapering the Trazodone first vs. Lexapro, we generally recommend tapering the more activating drug first, leaving the more sedating drug in place to support sleep.  Lexapro, like other SSRI's, is activating.  Trazodone is a bit of a mixture in that it can aid sleep but can also cause anxiety.  To prepare for your visit to the new doctor, here are links on tapering Lexapro and Trazodone to help with your decision.

 

Tips for tapering off trazodone (Desyrel)

 

Tips for tapering off escitalopram (Lexapro)

 

The vast majority of doctors know nothing about safe tapering and almost invariably try to taper their patients too fast.  As you know we recommend tapering by no more than 10% of your current dose every four weeks.  Some can go faster; many have to taper more slowly.  We recommend going slowly to avoid or minimize withdrawal (which most doctors don't believe exists).

 

Why taper by 10% of my dosage?

 

Never skip doses when tapering.  This causes the amount of the drug in your blood stream to go up and down and makes withdrawal worse.  For some reason this method is recommended by many doctors.  It is a very poor approach.

 

 

What is withdrawal syndrome.

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

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

 

These explain the healing process really well.

 

Brain Remodelling 

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

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. Get supplements that ae single ingredient (not mixed with other types of supplements).

 

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

 

 

 

 

 

 

 

 

[DemonOfSarila]

Yeah, my current doctor earlier today tried to recommend I go from 10mg (half of a 20mg pill) down to a 5mg pill, despite me saying that's when everything started to go badly last time I tried to taper. But thankfully he was also a bit hands off and said he would write the script for whatever I wanted to do. He didn't want to recommend the liquid lexapro, but I convinced him to write me a script for 9mg of liquid lexapro (or 9mL? it's 1:1). I also still have a lot of the 20mg lexapro pills, and plan to try dissolving one in water to see how that goes (or doesn't). Because I might actually take 10mg of the liquid, at least at first, so I'm not changing too many things at once on my poor brain. 

 

I'm planning to taper the lexapro first, for the most part. The trazodone is help counter the sleeplessness of the lexapro, so as I get to lower doses of lexapro, I'll sometimes need to hold the lexapro at the same dose and instead lower the trazodone.

[Gridley]

On 1/27/2021 at 10:38 AM, DemonOfSarila said:

Because I might actually take 10mg of the liquid, at least at first, so I'm not changing too many things at once on my poor brain. 

 

Whichever method you use (prescription liquid or making the quid yourself), we recommend completing the crossover from tablet to liquid before beginning tapering (as you said, it's good to avoid changing too many things at once).  We also recommend a gradual crossover from tablet to liquid:

 

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

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

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

all liquid thereafter

 

As you're planning, it's good to taper the Lexapro first to preserve sleep with the trazodone.

 

It's also very good you resisted the doctor's suggestion to drop from 10mg to 5mg.  Lexapro is the most potent SSRI on the market, and is especially so once you get to 10mg and below.

 

It sounds like you have a good plan in place.

[Krisseyb]

@DemonOfSarilaI have recently switched to liquid Lexapro (Escitalopram) and have started my taper....hang in there. We CAN do this!!! 💪

[Heath]

@DemonOfSarila welcome to SA! I too am tapering with liquid. 1ml to 1mg it makes it easier for me. Transfer over slowly. Before tapering make sure you have an assortment of syringes - 1ml, 5ml and 10 ml on hand so you can get correct dose and just incase you have to adjust dose a little during taper. Listen to your body and hold when you feel you need to. Slow steady stable! Wish you well during your journey! 

[DemonOfSarila]

@Gridley @Krisseyb @Heath Thank you everyone ☺️  ya'll so sweet, supportive, and awesome 😀

 

At first my doctor sent the liquid lex as taking only 5mL daily 🙄  even though he said he would send it as 9mL. I tried 10mL of DIY liquid, and it made my stomach upset. Plus I was afraid the liquid lex might taste horrible (turns out it's not so bad, but whatever I didn't know that 2-3wks ago). I decided to transition to 5mg & 5mL so I can then slowly taper down to just 5mg. Then someday I want to transition that to just 5mL and then taper that down. I want to keep part of my dose as a pill while it is still practical to do so with whole pills. 

So about 2wks ago when I called his office, I got the nurse to re-send my lexapro as 5mL & 5mg (I don't think she even talked to the doc, just checked his notes in my file about how I said I've been taking 10mg as half of 20mg). Turns out my new health insurance covers the liquid lexapro nicely, it was only $10 for 150mL (1 month supply). It also has 2 refills, so my plan is to just keep refilling them at the 5mL & 5mg level for a little while even once I start tapering to 4mL & 5mg for 9mg total. 

 

My plan was to give myself 2 weeks of 5mL & 5mg of lexapro, then move to 4mL & 5mg of lexapro. And now it's been about 2 weeks, but I was starting to get the trazodone-zombie-fog tired thing again (honestly this past shift I was super impressed how much of my job I can do on automatic without my brain really being there, I kept surprising myself lol), so I've lowered the trazodone again to 1/2 of a 50mg pill (so 25mg) to see what that does. Trazodone has a much shorter half-life, but I'm still going to give it some time to see how the 25mg of trad goes before changing the lex again. So far, I feel much better on only 25mg of trazodone, but I haven't even made it through 1 whole day yet, so we'll see if I pass out at some point today or not 🙃  (I always give changes to the trad at least 24hrs before passing any judgement on said changes because sometimes I take too little, feel great when I wake up, then lose consciousness later that same afternoon.... pills r great!). 

 

Oh, and I have updated my google spreadsheet with data from these past few weeks. So if anyone like graphs, go to that same link I put in my first post to see all changes (that same link will always go to the newest version of the spreadsheet, whatever that happens to be at that moment). 

[DemonOfSarila]

I guess this is overdue for an update, so here we go: nothing exciting has happened. I've been updating the google spreadsheet as I go (again, that same link will always show you the very newest version of it).

 

Basically I just have been lowering the lexapro while staying on 25mg of trazodone. Right now I'm trying having the dose changes closer to each other, 3wks and then 2wks instead of 4. I'm not going to go down to only 1wk with the lexapro because of the super long half life it has. According to what I've read, it can take up to 10 days for it to completely leave the body, so I want to give myself more than 10 days between dose changes. 

 

Feb 24 I switched to 9mg (as 4mL & 5mg). I didn't have any issues or symptoms. March 20 I switched to 8.2mg (as 3.2mL & 5mg) and so far (as of Mar 26) I've had no issues or symptoms. I know technically a 10% drop from 9mg would be 8.1mg, but my oral syringe for over 3mL only measures to 0.2mL and doesn't have 0.1mL marks. I have some other more precise oral syringes, but I'm saving them for later on when it's going to matter more (i.e. when the doses are smaller).

 

I've made a sheet/tab in the google spreadsheet (named "Predictions") where I looked at how the math works out for a prefect always 10% drop, but the numbers start to get like 3.87420489 and I won't be able to measure to that many decimal places. So to the right of that, I made more columns looking at what the math of a 10% drop looks like, then put in a realistic amount I can measure out, and then looked at a 10% drop from that realistic amount to put in the next realistic amount. Each time I looked at what was 90% of the last number I entered so that each planned dose change will be 10% of the last actual dose, and not just 10% of what the math worked out to. 

 

Right now, I plan to switch to 7.4mL of lexapro (as 2.4mL & 5mg) on April 3. If that goes well, I'll go to 6.6mg (as 1.6mL & 5mg) on April 17. 

 

I plan to stay at 25mg of trazodone until, well, either it doesn't work (aka I get too tired to function) or I'm off lexapro entirely (aka the trazodone is all that's left). I think it's more likely I'll have that "tired as hell cuz trazodone" zombie state thing happen to me again, and I'll figure that out if/when I get there. I'll probably try to cut the trazodone 50mg pills into 1/4 for a 12.5mg dose, or ask my doctor for the 25mg pills he mentioned to cut them in 1/2 (assuming they can be cut), or updose the lexapro to get my brain back so I can think clearly enough to fix the problem in some other fashion. 

[DemonOfSarila]

I'm still tracking this with my spreadsheet: https://docs.google.com/spreadsheets/d/1HnOb-1xITxrJdTUpOpLZGKNX0zONFXLKdvRKYnXh1tA and I guess most of what I have to say at this point about my tapering is that life is messy and all over the place? See attached image of one of the graphs from the spreadsheet. The random spikes to 0 aren't on purpose (sometimes I pass out & forget to take the liquid lex), and sometimes I end up on the same dose for well over 2 weeks when I don't need to because I just don't sit down and take any time to think about adjusting it (so I just take whatever I took yesterday... for like a month straight). 

 

Sometimes I just feel frustrated because it is taking so freaking long (partly because I keep needing to hold doses from my own mistakes/screw up's), but at those times I cope by reframing it as like what else am I supposed to do? Give up on tapering and take more? I find it helpful to think about how some day it'll be [whatever year number is the next year right now], and I can either be taking less Lexapro by then or not. Sometimes it feels like 0 will never happen, and when that happens I try to appreciate that I'm taking less than I was before ("At least I'm not still taking [dose amt from 6 months or more ago]" or something like that). For example, right now it looks something like: "Ug, this is never gonna work, but like at least 2.2mL of Lex is less than the 3mL from Feb or the like 8mg for before or the 20mg from when I started this whole thing. And unless I wanna probably end up in the hospital, I can either keep doing this and be on less Lex when 2023 gets here or give up and go back to pills for higher doses of Lex that will probably require going back on Trad. Bleg, I don't want that sh!t at all." and in future, the numbers will just change as I think this same basic message to myself.

 

But yeah, it's now May 2022 & I'm on 0 Trad and 2.2mL (mg) of Lex. 

 

Edit: Oh yeah, I dropped that doctor entirely. He wouldn't listen to me, not just about the Lex but about everything. He was requiring this battery of blood tests every 6 months or he was going to stop writing the scripts entirely. Even after all my numbers came back in the healthy range TWICE in the same year. He told me to stop the changes to my diet that caused me to lose weight, have more energy, and just generally feel way WAY better. He wouldn't listen to anything I said, thought he knew better about literally everything, didn't trust that I had been on these pills as long as I say I have (even though he has MY MEDICAL FILES THAT PROVE THAT). He just tried to shove his opinion down my throat and berated me for not telling him about literally every tiny dose change before actually doing it. 

 

So I paid him for services rendered and basically fired his ass by getting another doctor that trusts that I've been on these pills for like a decade and therefore know how my body reacts to them, she's totally supportive & decided to just write my script/refills for 5mL so I can get all the liquid Lex I need (and I still have that same insurance that makes the liquid Lex like $10 and makes appts with said doc affordable too). She totally knows I'm not taking 5mL and is cool with just letting me handle all the tiny details. She also writes the refills for a year out instead of only 6 months at a time. She supports me having control over my medical needs, me being in the driver's seat so to speak. She agrees he was nuts for the blood work requirement. 

 

So if your doc tells you that you can't do what you want? Fire them and get another one. You don't have to agree with any opinion, medical or otherwise. Some people don't know what they're talking about, and your doctor doesn't have to live with or through the crap your brain & body will do in response to their advice. They get to say whatever and get paid for it without living the consequences their words. 

Edited May 28, 2022 by DemonOfSarila
forgot I changed doctors

[ChessieCat]

Please try to be more consistent with your doses and times of dosing.  I had to put systems in place to try and help myself not to make mistakes, and even that wasn't perfect.  Lexapro is a very strong drug so the effect of missing doses/inaccurate dosing will probably have a bigger impact on your nervous system than some other drugs might.

 

By the way, please update your drug signature.  Account Settings – Create or Edit a signature

 

That's good that you found a doctor who is willing to "help" you get off, by providing what you need and letting you do your taper your own way.  I was fortunate to have the same type of doctor.

 

And I totally agree with what you say about us not having to agree with them.  I was diagnosed with diabetes and high cholesterol (and I also had high blood pressure) last October and the doctor wanted me to start Metformin, a statin and change my diet (most probably low fat) all at the same time.  I told her that you don't change more than one thing at a time and that I was going to try diet first.  Thankfully when I was researching diabetes I found about about low carb and did that and after only 3 months I was non-diabetic, my cholesterol improved (and has improved even more) and I have had to reduce my blood pressure drug to only 2.5mg and even when I had it measured in the doctor's surgery (which can make it rise) it was classed as normal.  I also lost 1/8th of my body weight without even trying.  Now if I had followed the doctor's advice and taken the drugs, the changes would most likely have been attributed to the drugs and not the diet and I would have been on those drugs for life with the side effects when they was no need for me to be.  I thank SA for teaching me to do my own research.  With another doctor I refused to take a fluuroquinoline antibiotic which had 3 FDAs warnings, one being for elderly people with the risk of ruptured tendons.  I took nothing and the infection cleared by itself.