MomM Short term high dose Escitalopram

[MomM]

Hi,

I am researching and advocating for my 27 year old daughter.   She was prescribed Lexapro/Escitalopram 10mg on May 14th, 2021 by primary care doc for anxiety/depression.  She broke up with her boyfriend after a short but very intense relationship.  He didn't take it well, and she ended up very anxious and not sleeping.  No change at 2 weeks so doctor upped Lexapro to 20mg, then to 30 mg at 3 weeks.  Her insomnia had progressed and she was sleeping only 2 hours at most despite trying 3 different meds for sleep.

 

She only took 30mg Lexapro for 5 days before we saw a different doctor who lowered it to 20mg.  She felt she wasn't able to function anymore, took a leave from work, felt her "body was shutting down" and that she was dying.  A couple days later she became almost catatonic and was hospitalized.  She had urinary retention requiring catheterization for 1.5 days, delusions, strange smells and taste and almost catatonic episodes.  Those symptoms resolved, but she became very flat and hopeless.  After 5 days in the hospital she was moved to an inpatient facility.  Where she has been for 10 days.

  

Her meds:

Lexapro was dc'd when she was admitted to the hospital  

Low dose Zoloft was started 4 days later then switched to Cymbalta on 6/16 which was increased to 60mg. 

Ativan 1mg TID was started in the hospital, it may be PRN now. 

Methylin was added 6/16 as a stimulant during the day (? dose). 

Rexulti was added 6/18 and upped to 2mg (for thought blocking/psychosis)

Temazepam 30mg was added 6/18 for sleep.

 

She is not getting any better in the facility and we are bringing her home this evening.  I am currently not working so will be able to be with her throughout the day.  Currently, her mood is very flat, her responses are short and delayed (though she doesn't show typical thought blocking), she has some paranoid thinking.  

 

We asked the psychiatrist if what she is experiencing and they are medicating is from the Lexapro being too much, too quick and then being dc'd.  He didn't seem to think so.  I've been researching, looking for how we can safely get her off the meds.  We are supposed to be scheduled with a Psychiatrist to follow meds, but I am not sure how soon that will be.  Any advice is appreciated.

 

My main questions are:

Could what she is experiencing be from the Lexapro?  From what I've read SSRI's can cause psychosis.

Does Lexapro need to be reinstated at a low dose or is the Cymbalta (an SRNI) adequate?

What order should meds be stopped, and can they be stopped cold turkey?

     Rexulti (been on 1 week), Methylin (been on 9 days) Temazepam (1 week)

 

Essentially, for the veterans: If this was your daughter, how would you proceed?

 

Thanks for any advice you can give or resources you can point us to.  

[MomM]

Update,

We picked my daughter up last evening.  She was less flat and more engaged than I was expecting.  She has the delusion that the inpatient facility was "fake", some of the patients weren't really patients and didn't need to be there, and that she was somehow responsible for what was going on there.

 

It happened that the pharmacy closed earlier than we expected so she did not get the Rexulti or the Temazepam last night.  Expecting sleep issues, we gave her a Unisom.  She slept but woke up saying she couldn't sleep.  I slept with her and she appeared to be sleeping, even snoring at one point.

 

[Altostrata]

Welcome, @MomM

 

It sounds like your daughter was suffering from adverse effects of too much Lexapro, which caused her insomnia.

 

Some people do not get along well with any antidepressants, they're sensitive to serotonergics.

 

When people have adverse reactions to psychiatric drugs, especially over an extended period of time, their nervous systems can become sensitized to all psychiatric drugs. This can result in odd reactions.

 

She is taking a remarkable cocktail of drugs. They may be affecting her cognition and she may also be severely traumatized by her experience. What sounds like babbling may be her trying to make sense of it. She may be correct that people did not need to be there -- that's certainly true for her.

 

What is her daily drug schedule, with their dosages? Please put ALL your drugs in this Interactions Checker and post the report or a link to it in this topic.

 

If I were your daughter, I would skip the Rexulti and Temazepam prescription. Temazapam is redundant to the the Ativan she's been taking. If her main problem was insomnia, the Methylin may be exacerbating that. 60mg Cymbalta is a high dose that might be causing insomnia as well.

 

To help us out, follow these instructions for your daughter's history Please put your drug and withdrawal history in your signature You may need to use a computer to do this.

[MomM]

Thanks for the response, Altostrata.

 

I added the drug history in the signature.  

 

Since we have her home her affect has improved and her thinking is clear.  She doesn't complain of anxiety but seems a bit down.  She does still firmly believe the delusions she has about the inpatient facility not being a legitimate facility, people there were talking about her, she was responsible for other people being there... Thankfully, she doesn't seem to have any new delusional thoughts.

 

Does anyone have personal experience of delusions related to a SSRI/SNRI?  We are hoping they are drug related.

 

We stopped the Rexulti.  We had reservations about her need for it and the side effects, then when we learned that even with her insurance benefits it would be about $850/month we didn't get it filled.

 

We stopped the Temazepam.  She has taken Unisom the last 2 nights and falls asleep quickly and appears to be sleeping the whole night, even snoring a little.  Though when she wakes she thinks she hasn't been sleeping.  I am wondering if the meds have affected her sleep cycle.

 

We would like to get her off the Cymbalta ASAP and hope that over time the delusional thinking will go away.  She is on 60mg ER capsules.  Today, I emptied about 1/3 of the beads from the capsule, (I know that's probably not the recommended way but want to get her off).  I ordered a scale which should come today.  Having been on Lexapro and ramped to a high dose but only for four weeks and now on a SNRI, how quickly can we taper?  

 

Also, we are hesitant going against the meds ordered by the inpatient psychiatrist.  We aren't able to get in with a psychiatrist for about 2.5 weeks, but have a telemed appt with a random psychiatrist online in a couple days.  How do we approach the psychiatrists with the fact that we aren't following the prescribed orders?  

 

[Greatful]

@MomMHi,  I am sorry your daughter went through all that, and how hard as a mother watching it.

You will get great help from Altostrata.  

I just wanted to let you know how to tag someone so the get a notice that you want the to see your post.

Hit the @  button then start typing the name then you want click on the name. 

 

[MomM]

 

@Greatful Thank you!

 

[MomM]

@Altostrata 

Also, Here's the drug interaction report for what she is now taking.

https://www.drugs.com/interactions-check.php?drug_list=949-2273,1488-899,1606-975

 

[Altostrata]

23 hours ago, MomM said:

Also, we are hesitant going against the meds ordered by the inpatient psychiatrist.  We aren't able to get in with a psychiatrist for about 2.5 weeks, but have a telemed appt with a random psychiatrist online in a couple days.  How do we approach the psychiatrists with the fact that we aren't following the prescribed orders? 

 

You might say you think your daughter had an adverse reaction to Lexapro verging on serotonin toxicity, this was misdiagnosed, and her drug regimen escalated out of all reason.

 

23 hours ago, MomM said:

She does still firmly believe the delusions she has about the inpatient facility not being a legitimate facility, people there were talking about her, she was responsible for other people being there... Thankfully, she doesn't seem to have any new delusional thoughts.

 

Frankly, this does not seem all that delusional to me. I can understand how you might feel a psychiatric facility was fake and be threatened by strangers. But yes, she could be very confused by that miscellaneous boatload of drugs she was taking. Even for psychosis, it is excessive. You need help minimizing her drugs.

 

Her sleep may be upset by all the drug changes and need some time to settle down. She is also taking 2 "accelerators", Cymbalta and methylphenidate, which may interfere with her sleep. This makes it all the more absurd that Ativan is in the mix.

 

What is her daily drug schedule (times o'clock), with their dosages?

 

Cymbalta comes in lower dosages, see 

 

[MomM]

@Altostrata

18 hours ago, Altostrata said:

What is her daily drug schedule (times o'clock), with their dosages?

We never filled the Rexulti or the Temazepam prescriptions. 

We filled the Ativan but she hasn't need to take it.

 

I have been giving her 10 mg of the Methylin only at 9:00 AM the last 3 days, and didn't give it to her today.  Plan to stop it.

I have decreased the 60mg Cymbalta by about 1/3 the last 2 days and by 1/2 today, taking it about 9:00AM.

She is taking a generic Unisom (doxylamine) 25mg at 10:00.  She now seems to feel like she is actually sleeping, saying she slept OK.

 

What do you think about decreasing the Cymbalta at this rate?  My hope is we can move more quickly since she only started the Lexapro 5/14 then Cymbalta 6/16 and hasn't been on the meds too long.

 

She hasn't been bothered by the delusions r/t the facility the last 2 days and hasn't brought it up so I haven't asked her.  She says she feels like she doesn't care about anything, doesn't have any motivation and thinks this is her new normal.  Thankfully, she has an appt with a therapist tomorrow, and we are praying it is a good fit.  

 

Is there a resource/link that is a good place to start for dealing with depression without meds? 

 

 

Thank you so much for input and advice.  This forum has been very helpful.

[Altostrata]

8 hours ago, MomM said:

What do you think about decreasing the Cymbalta at this rate?  My hope is we can move more quickly since she only started the Lexapro 5/14 then Cymbalta 6/16 and hasn't been on the meds too long.

 

She's been on Cymbalta only since 6/16. My guess is you can quickly reduce to at least 30mg or 20mg. See how she feels. She may need to taper more gradually after that.

 

Generally, people become physiologically dependent on psychiatric drugs within a month -- except for benzos, where dependence can happen in a week. How did quitting the temazepam affect her?

 

So she's taking only duloxetine and Methylin now, and you're dropping the Methylin?

 

Please keep careful notes of her dosing every day and changes in her symptom pattern after that.

 

8 hours ago, MomM said:

She hasn't been bothered by the delusions r/t the facility the last 2 days and hasn't brought it up so I haven't asked her.  She says she feels like she doesn't care about anything, doesn't have any motivation and thinks this is her new normal. 

 

This is a very common effect after people have had mishaps with psychiatric drugs. Her nervous system took a beating. It may need some time to recover. I would not call it "depression" and I would look forward to it very gradually going away over months.

 

She may need to be patient and accept that it might take time for her to recover. Over-reacting to it as a psychiatric condition may get her into  trouble again. If you recall, her original problem was being upset over a break-up, which is a normal life event, not an episode of psychosis.

 

Good to hear she's thinking more clearly with fewer drugs. 

 

If I were you, I'd keep careful notes for a long, detailed letter of complaint to your state medical board.

[Greatful]

@MomM  How are things going with your daughter?