Indario55: Escitalopram, Duloxetine and Alprazolam withdrawal

[indario55]

Hello, I am indario55, 36 year old (male)
 

I'm suffering from anxiety since childhood. In 2011 I was prescribed with Escitalopram 10 mg and since then I've been on various medications with failed attempts to discontinue medication. I can't recall exactly but I think I had three attempts, one in 2012, second in 2013 and third in 2017. I managed to be without meds for max 3-4 months before having to start again.

Every time, I crashed- anxiety spiked with feelings of depression.  Sobbing, fear, suicadal toughts (with no plans to commit), difficulty talking, restlesness, stomach pain, tiredness, inability to focus etc.

However, in December 2020 I was diagnosed with macroadenoma on pituitary gland, with very high prolactin levels. Before that (all during 2019 and 2020), I was also diagnosed with Hyperinsulinemia and Hashimoto disease. I also found out I have bulging discs in lower back. My mental condition worsened, and now I realised for the first time that my physical health is impaired. Before it was all ''just anxiety'' and now...

Doctor said in order to start with Cabergoline medication (for prolactin and pituitary gland), I would need to come off my anti-anxiety drugs because they increase prolactin levels and that we need to do it alot faster than in usual circumstances. Tapering was 15 days I think. I agreed because meds no longer help me enough and I think they are worsening my physical health.

Today is Day 16 with no meds. I feel almost exactly like prevous times I stopped using medication. Racing thoughts,suicadal toughts (with no plans to commit) inability to focus, stomach pain, throat pain, fear, crying often, feeling like a failure, thinking constantly about my health and so on...I am going to try to hold on, wish me luck!

[Altostrata]

Welcome, @indario55

 

You came off duloxetine and alprazolam? Duloxetine is not an anti-anxiety drug, why did you come off that?

[indario55]

4 hours ago, Altostrata said:

Welcome, @indario55

 

You came off duloxetine and alprazolam? Duloxetine is not an anti-anxiety drug, why did you come off that?

Hello, 

Both my psichiatryist and endocrinologist said Duloxetine(Cymbalta) increase prolactin levels and therefore is not suitable to use alongside Cabergoline medication for pituitary tumor and hyperprolactinemia.

[Altostrata]

I am sorry you had to come off your drugs so fast to deal with this other health issue.

 

Please hold on, your symptoms should gradually improve. Tell your doctors you are experiencing withdrawal syndrome so they are away of the source of your symptoms so they are not confused by them if they should continue. If I were you, I'd inform myself about adverse effects of cabergoline in case they are added to your withdrawal symptoms.

 

Please let us know how you're doing.

[indario55]

Day 27 with no antidepressants...It's like world falling apart. Few days ago I was diagnosed with another physical contidion- polyneuropathy (I have constant burning and tingling in my feet). Neurologist thinks it may be caused by my autoimmmune disorders.

I am death scared with all these conditions. Instead of living happiest moments of my life and forming my own family, as a 36 year old I'm visiting doctors and getting new diagnosis. My job is also demanding and stressful and it is questionable if I can continue. Doctor said quiting my job would be a mistake.

 

My GP doctor suggested Pergabalin for polyneuropathy. She said it's not antidepressant and not addictive. I don't know much about this med but I think she's wrong. Really at loss what to do, it's like all doors are closed. I just quit Cymbalta and Alprazolam and having to go on Pergabalin would seem like two steps back.I know my withdrawall amplifies my worries but even without it I think all of this would be devestating for me. 

 

For my conditions currently I'm using prescribed supplemetns -Vitamin D, Inositol, Zinc, Selenium, Cobalamin B12, Alpha Lipoic acid and Magnesium. And Cabergoline for prolactin.

Sometimes inulin (probiotic).

[indario55]

Day 35...Unfortunately, it seems unbearable. Trouble at work, mobbing, thinking of quitting...Health concerns, new symptom appeared after stressfull fight with the boss, my hands are tingling and hurting.  Neuropathy or stress? Don't know.

I have an appointment with my psychyatrist. Going back on med is an option unfortunately.

[indario55]

After unsuccesful rapid taper (thanks doctor), after a while I've decided to try Escitalopram taper again, this time slowly. In August last year I've finished successful benzo taper and figured it's time to try SSSRI taper.

 

I'm on 10 mg and started with 5% reduction on 4 week basis, using Gemini 20 scale with shaving metod to reduce pill weight.

 

It's been four days on 9.5 mg.

 

Interesting how this drug is so strong, even with 0,5 mg I feel the reduction. Medium anxiety spike, heaviness in chest and medium increase to my already diagnosed metabolic polyneuropathy. Nothing horrible but managable.

 

Still considering making my own liquid escitalopram (can't buy it in my country) or maybe empty capsules, to get better accuracy.

 

 

[indario55]

I'm trying to find some good calculator plan for liquid taper, I've come across several but for scale taper.

Can anyone recommend me something similar for liquid taper, that would calculate liquid dosages based on percentage reductions of last dose?

 

 

[ChessieCat]

You don't really need a calculator.  You need to know the last dose your took, in your case 9.5mg and multiply it by the amount you want to reduce by.  For a 10% reduction, multiply by 0.9, for 5% multiply by 0.95.  The you need to know what strength your liquid is.  If you put a 10mg tablet in 10mL of water then it is a 1:1 ratio, where 1mL of liquid = 1mg dose (divide both sides by 10).  But you can make it weaker by using more water, eg 10mg tablet in 20mL water so 1mL = 0.5mg dose or 2mL = 1mg.

 

Escitalopram is a very strong drug compared to most other antidepressants.

 

From Post #1 of this topic:  Tips for tapering off escitalopram (Lexapro)

 

On 5/27/2011 at 12:16 PM, Altostrata said:

If you are taking 5mg of Lexapro, it's not tiny, it's equivalent to 10-20mg Paxil or Celexa.

Consequently, when you taper off escitalopram, you should be careful to decrease by small amounts, as each drop is magnified by escitalopram's extra potency. If you find withdrawal symptoms from a 10% decrease to be too difficult, after 3-4 weeks decrease by a smaller amount.

 

Have you seen this method of tapering?  It's a weekly reduction for 4 weeks with an extra 2 weeks before you reduce again (so the last dose you stay on for 3 weeks).  This method gives you more control over your taper and allows you to hold for longer at any time during the reduction period:

 

Brass Monkey Slide

[indario55]

Thank you, I've seen it. At first glance, it seemed scary to make reductions weekly but I'll probably give it a go.

 

Plan would be to make homemade escitalopram liquid with 10 mg in 20 ml saline solution. Since I've already started tapering using scale, I'll try to stay on 9.5mg for a month,

Then 5 % per month taper  with 1.25 % reductions weekly. then two-three week hold. So first week dose would be 9.38 mg or 18.76 ml liquid.

I guess 1 ml or 2 ml syringe can do the job.

 

I'm hoping though that WD symptoms after my first reduction would start to diminish, I've read that after few days or weeks that is what it's supposed to happen.

[ChessieCat]

cross-over-changing-form-eg-tablet-to-liquid-of-drug-or-changing-brand-of-same-drug

 

[Altostrata]

How to calculate dosages and dilutions? Spreadsheets and calculators

[indario55]

Thanks. 

 

It's Day 7 since my reduction from 10 mg to 9.5 mg. 

I'm definitely feeling WD symptoms, mostly increased polyneuropathy symptoms and increased anxiety and irritability, slight nausea.

 

I don't want to get in a trap of constantly changing doses back and forth, but my dilemma right now is whether it's a wise course to

 - stick with 9.5mg so hopefully symptoms would lessen in coming days or

- jump to 9,875 mg which would be 1,25 % of my original dose

 

Reading guides on other sub forums, as I understood it , it says it's expected to have increased symptoms after a cut that should lessen in couple of days or weeks when stabilization can be expected.

 

However, regarding reinstatement it says it's advisable to be done as soon as possible when WD symptoms appear, that is to avoid postponing it.

 

What do you think would be the wisest choice? 

 

Thanks in advance, I know you guys have and have had hundreds of similar questions from hundreds of users.

 

P.S. Is it possible to change the name of my introduction topic to remove duloxetine and alprazolam from the title as I have come off those long time ago?

[Altostrata]

12 hours ago, indario55 said:

 - stick with 9.5mg so hopefully symptoms would lessen in coming days

 

Correct, see how it goes. If you find the symptoms tolerable and they start fading, your system is accommodating to the decrease. When the symptoms go away completely, you might consider another decrease -- but a smaller one so you don't go through this again.

 

If the symptoms get more severe, you may wish to updose slightly.

[mdwstrx]

Hi @indario55

Popping over to read you page. It sounds similar to my story only a condensed version. 

It's sad that the medical community continues to create havoc with fast tapers and lack

of recognition of withdrawal. The good news is that many here have successfully done custom

slow tapers. You can too💪 Alto and the mods know what they're doing and are the reason I'm as 

low as I am. One of the mods advised me to focus on life - with slow reductions as I'm able over time

rather than the end goal. Time marches on and before you know it, you'll be where I am and below!

md

🌼

 

[indario55]

Thank you for your kind words.

I've came off benzos (alprazolam and bromazepam) rather successfully, it wasn't that hard but antidepressants are on another level for me.

 

I'm in a process of cross over to liquid because scale gives me inconsistent results. After that I'll  consider possible small reinstatement. Every symptom seems managable, however, my previously diagnosed metabolic polyneuropathy  in arms and shoulders increased. Is it because of increased anxiety or ''just polyneuropathy by itself'' it's hard to tell.

So, my physical condition is kind of holding me back.  

I'll see how it goes.

 

Good luck with your almost finished taper