RedRosa: 20+ years on AD, trying to live without them (Lexapro/escitalopram)

[RedRosa]

Hello! You can call me Rosa. I'm 35, live in the western US and I've been on antidepressants since I was about 14 years old. Most of this time, I've been on a steady dose of 10mg of Lexapro. 

 

***skip to the bottom for TL;DR tapering question***

 

I knew about AD withdrawal syndrome pretty early on as I was switching medications a lot before getting settled on Lexapro. With Lexapro, I was able to stay alive and not flunk out of high school while also not feeling drugged, like I had on some of the other stuff I took.

 

As the years went on, I assumed it was something that I would just have to take forever. My mother has a mental illness, her grandmother had a mental illness -- this was my genetic destiny and the only way to break the cycle was to take my medicine (and not have kids).

 

After a hospitalization in my late 20s, I was bumped up to 20mg for a little while and instructed on how to taper back down to 10mg. My anxiety went through the roof, along with other unpleasant feelings like "brain zaps" and fatigue. Then is when I realized that it would be hard to get off ADs entirely, even if I wanted to. It would never be a "good time" to feel like that.

 

In the last 3 years or so is when I started giving serious thought to getting off Lexapro. I was feeling better most of the time and even when I did feel bad, it only made me wonder if the Lex was even working. I started getting the strange zapping sensations sometimes, to the point where I would check to make sure I took my meds -- and I had. The fear of withdrawal and of how bad my depression and anxiety could possibly get kept me on it.

 

Then I found a partner. Then I lost a friend to depression. Then COVID. Then job loss. Then the general uncertainty of a career change and a brave new mean world turned upside down. A doctor wanted to up my Lexapro to 20mg in August 2020 (on the day I was let go from my job) but given the difficulty I'd had before, I didn't do it. However, in January 2021, I was experiencing such severe symptoms of mental illness that I had to do something. 

 

The experience of having one of the worst years in history and then experiencing little relief/added side effects from the Lexapro cemented my desire to get off it. I tapered down to 10mg in a month, with Buspar added to help. It went fine and I thought I had gotten away with it...until I found myself feeling like microwaved **** last weekend after a week of holding at 10mg. 

 

Today, I went to a psych and outlined my plan why I wanted to taper. 

 

1. I've been on ADs since before I was fully grown

2. I don't think they're working anymore

3. Sexual disfunction, which sucks for the first time because I'm with someone I love

 

He agreed it was good to get off them. The plan is to stay on 10mg of Lex until I feel better and then switch to liquid Celexa/citalopram for a taper that's as slow as I want/need it to be. This does raise a question that I hope someone might be able to help with.

 

The dose of the liquid I'm supposed to start with is 5ml, which is equivalent to 10mg of citalopram. However, based on what I've read, a dose of Lexapro is equal to two doses of citalopram. Shouldn't I be starting at 2.5ml/5mg of citalopram?

 

If anyone has experience switching to citalopram to taper from Lexapro, I'd also love to hear from you.

[Go2zero]

Hi RedRosa,

 

Welcome to this support site. You have been using lexapro (escitalopram) for 21 years since you were 14. That means that your body is really used to taking it. Good that you decided to get off them. 

 

There is a lot of knowledge and information to be found on this website. And where possible the members can advise you how to taper. Since you made a fast taper from 20 mg to 10mg, I guess it is a good idea to stay on 10 mg for a while. Good that you have a doctor who agrees that it is good to get off the meds.

 

I do not agree that it would be a good thing to switch to Citalopram. Lexapro (escitalopram) is also available in liquid. Given the fact that you have been so long on lexapro it could be a big extra factor on withdrawal when you would switch to another drug. lexapro and citalopram really differ!!! And changing drugs is often not a good idea when you want to start tapering.

 

So I advice that you ask your doctor for liquid lexapro or escitalopram. When you would make the switch from pill to liquid, it would be advisable to make a crossover over a few weeks. For example 5 days 75% pill and 25% liquid, then 5 days 50%/50%, then 5 days 25% pill and 75% liquid , and then over to 100% liquid. Do this before you start tapering and let it settle for at least 2 weeks before you start tapering.

[RedRosa]

Thank you, @Go2zero. Unfortunately, my doctor would not give me liquid escitalopram; it's not covered by my insurance. Liquid citalopram is the path I have to walk.

[Go2zero]

As alternative you can make your own liquid from lexapro or escitalopram pills. This works very good and is not difficult to do. I do the same with Prozac and I even prefer it over liquid Prozac since that has to be used within 1 month after opening and the liquid is so thick so that it is not easy to handle in a syringe.

 

 

[RedRosa]

Thank you, @go2zero. I will consider that if I start to have trouble.

[Go2zero]

OK. I strongly advise you to stay with escitalopram. Switching to citalopram may cause (even very heavy) WD effects. This can start months after switching. I am not saying it will, but there is a reasonable risk there. Citalopram is a total different drug then escitalopram. The names sound very similar, but they are not at all.

 

It is really easy to make your own liquid. We can assist you when you have questions there.

[RedRosa]

@go2zero I will seriously consider this. I plan to hold steady on my current 10mg of Lexapro for at least another month or when I start to feel more stabilized, so I have time to learn and make a choice.

[Onmyway]

Hi RedRosa, 

I agree with @Go2Zero that you should stick with escitalopram. The two drugs are different enough - citalopram contains two stereoisomers (molecules that have the same atoms but differ in how they are arranged) S-citalopram and R-citalopram, whereas escitalopram contains only S-citalopram. The assumption is that the R-citalopram is not doing much but in a sensitized system with so many years on the drug, better not mess with it. 

 

Escitalopram is already available as a generic so it might be possible for you to get the liquid version by paying for it yourself. It may not be as cheap as the insurance coverage - in the US it probably isn't but you should check and check various pharmacies as they differ widely. 

 

 

[RedRosa]

I thought I would provide an update (although there's not much to share).

 

I'm still holding steady on 10mg of Lexapro and 5mg of Buspar twice a day. Almost all of the extreme depression, panic and dizziness/flu-like sick feeling has gone. The fatigue went away but is back a bit -- still not as bad at the "Hell Weekend" in of July 17-18 where everything was at its worse. Headaches back today too but that may be the bad air quality. Anxiety up (heart palpitations, ruminating/intrusive thoughts, trouble focusing, sleep disturbances) but I can handle it.  Not as bad at either the "Hell Weekend" or January, which made me go up to 20mg on Lexapro.

 

Being busy (but not too busy) at work, resuming exercise, new housemates moving in and quality time with partner all helping to support. Increase in concern about COVID, anxieties about my place in life and doom spirals online are bad things. I can at least control doom spirals.

 

Alcohol should probably still be avoided but it's hard. I only have a beer occasionally but having NO BEER (in the summer! when there's pizza!) is proving difficult. Also avoiding caffeine which has been easier (only had it once and had no side effects). Should probably do better to avoid sugar (might be the cause of the heart palpitations?) 

[Go2zero]

1 hour ago, RedRosa said:

Anxiety up (heart palpitations, ruminating/intrusive thoughts, trouble focusing, sleep disturbances) but I can handle it.

These are all typical WD symptoms. Heart palpitations as well!

 

It seems you are doing well with stabilizing on 10mg. Give it more time until you feel better. Then you could start slowly tapering.

 

Thanks for the update! Be very careful with alcohol (better not at all when in WD). Why don't you take alcohol free beer? Some brands fast quite OK. Especially when you drink them extremely cold ;). Sugar and caffeine can also be mean triggers in WD. Personally I listen to my body. Sometimes I can handle sugar or coffee, sometimes not. 

[RedRosa]

Thank you for taking the time to check in again @Go2zero. I hope you are well.

 

It seems I spoke too soon with my update. Yesterday and today, I'm feeling fairly terrible. Depression/anxiety on high, sleep getting bad, dizziness, stomach pain/nausea. I'm afraid to speak about this with my therapist, PCP or psych because I know they'll want me to try another med or go back up to 20mg on my Lexapro. As it seems I'm falling into a windows/waves pattern and not a steadily-getting-better pattern, I'm considering a slight reinstatement. Considering what I've read here, I'm still in the time frame where it might work and I can try just a little bump. 

 

I'm trying to remind myself that this is the WD, this is not me or how things are. Today, it's hard.

[Go2zero]

Hi RedRosa,

 

Sorry to read you are not doing well today. Alls symptoms you mention are typical WD. Yes, doctors would probably advise to go to 20 mg again. That is what they nearly always advise in these circumstances. But you will probably know by now that going up and down in dosages and/or changing meds only deregulates our CNS further.

 

You need time to heal! This will happen most often with the windows and waves pattern. You should know that Lexapro/escitalopram is one of the most potent SSRI's. 10mg is already has a very strong effect, although it is seen as the standard dose. It is said that Lexapro (in standard dose) is 2-3 times stronger than most other SSRI's.

 

It is not the most easy SSRI to get off. Not the worst either, because some other well known SSRI's are much more difficult. So yes, WD comes with tapering. You went quit fast from 20mg to 10 mg. 

 

You could reinstate to a higher dose again, but I am not sure if that would be clever. The serotonin receptor occupancy at 10 mg is around 78%. At 20 mg this would be around 82%. So a small update will not have much effect. And a high update to 20mg will probably just upset your CNS more.

 

As said, you need to stabilize! It is not fun, having these WD symptoms. Most member her know. But the symptoms will go. Not in a "steadily-getting-better pattern". Unfortunately WD from AD's does not work that way most of the times. Time is a big healer. Give it time to stabilize!

 

[RedRosa]

I appreciate all the suggestions people have made. I'm back with another update. Unfortunately, a bittersweet one.

 

I have reinstated at 15mg. The WD symptoms were more than I could handle, particularly the stomach issues. This was the last dose at which I experienced little to no WD symptoms as well as fewer side effects than when I was taking 20mg. It feels like a step back, but for 4 days I have been taking 15mg, my WD symptoms have mostly disappeared and I can function again. I will be holding here until I stabilize.

 

Current symptoms/side effects: slight stomach issues, lack of focus, mild fatigue, emotional numbness,

Symptoms that have dissipated upon going back to 15mg: headaches, dizziness, severe lack of appetite/nausea 

Unsure: anxiety more manageable but depression a little loud (feel like a complete loser), my pelvic pain is lessened (ADs and other neuro drugs are used to treat this)

[Go2zero]

Sorry to hear that you were feeling so bad.

 

I hope you will stabilize and will stay on this dose for a while. Please know that the more often we go up and down in dosage, the more upset our CNS may get!

 

The more you go up and down and/or change meds, may pay out negatively. Also when tapering. This may become more difficult the more changes we make. So please be careful and do not continue going up and down again. 

 

If there are important issues you want to discuss, you can ask here. Better to do that before reinstating or other important changes

Edited August 10, 2021 by Go2zero

[RedRosa]

I understand that changes in doses will further destabilize me and make things worse, so I am keeping this dose for awhile. Looking back, it was going from 15 to 10 that seemed to cause me to crash. Since it hasn't been very long since I did so, going back to 15 has been easy for me. I will want to feel 100% again and/or wait awhile before even thinking about a taper again.

[Go2zero]

34 minutes ago, RedRosa said:

I will want to feel 100% again and/or wait awhile before even thinking about a taper again.

Good thought!  

Do it slowly and careful!  The faster and easier it will go.  (although it my take a while)

[Surviving82]

19 hours ago, RedRosa said:

I have reinstated at 15mg. The WD symptoms were more than I could handle, particularly the stomach issues. This was the last dose at which I experienced little to no WD symptoms as well as fewer side effects than when I was taking 20mg. It feels like a step back, but for 4 days I have been taking 15mg, my WD symptoms have mostly disappeared and I can function again. I will be holding here until I stabilize.

 

This is awesome news! Not everyone is that lucky when they increase the dose. But this is great, if I were you I'd hold at 15 for the time being and see how things go. When you decide to start lowering the dose, as others have said, I think that the safest way is to stay on escitalopram and not switch to anything. Tapering in itself is stressful enough, so it is better to not add a medication change on top of it if you can avoid it. 

 

I hope that things keep getting better for you!  

[RedRosa]

Today's update: still holding steady at 15mg. Physical symptoms of WD are still being kept at bay but emotionally I'm not doing well. Attachment wounds/CPTSD triggers being uncovered in my relationship, leading to conflict. Severe depression -- crying spells, everything seems empty and useless, doom spirals about aging/death/the terror of existence, hard to do even basic things like get out of bed, just want to sleep all day. I feel better after crying sometimes; haven't really cried much since I was a teenager and often felt too numb to cry. However, it's getting a little annoying at this point. Cortisol spikes in the morning leading to some stomach issues but very minor; pales in comparison to the depression (state of the world isn't helping).

 

I definitely have stuff I need to heal so unsure if these are neuro-emotions or not. 

[Go2zero]

Everything you mention seems to be typical WD Symptoms. This will probably happen in waves and windows patterns.

 

https://www.survivingantidepressants.org/topic/82-the-windows-and-waves-pattern-of-stabilization/

 

It needs to settle out and stabilize. This takes time. I cannot make the message more beautiful. We have to go through this. After stabilizing you need to taper very slowly to try to get as little as possible WD symptoms.

 

6 hours ago, RedRosa said:

I definitely have stuff I need to heal so unsure if these are neuro-emotions or not.

 

This is often quite difficult to decide if it is WD symptoms (neuro emotions) or something we have to work on. When these symptoms disappear during a window it nearly always is WD symptoms. When they still exist during a window it is clearly something we should look at. If needed with a psychotherapist .

[RedRosa]

Just updating as I'm using this as a tracker thread as a tracker for my symptoms.

 

Still holding at 15mg Lexapro/5mg Buspar. Was doing better but have been sliding back into depression. Early morning awakenings are back as of three days ago, along with severe nausea. Today is probably the worst I've ever felt in my life. Usually, even when my depression was bad, I kept stubborn hope that it was just my situation, that I could make a change and it would make things better. Lately, it feels as if the entire world is just awful and there's no way I could possibly be happy and functional like I used to be. Everything seems to "trigger" me -- I regret almost everything I've ever done that has led me here, I feel bad for or envious of others and don't understand how anyone could want to live in this world. A sense of pain, sadness, bitterness, dread and terror is in my body whenever I'm awake.

 

I feel like I need to keep moving, keep changing since the mistakes I've made came from laziness. However, I've also made mistakes in haste so I need to weigh my decisions as if my entire future depends on it -- because it does.

 

My parents are visiting this week and I wish I could feel better for them. I wish I could feel better for my partner. I do not want to be me right now. I'm writing this so I can see if I feel better tomorrow.

[Go2zero]

Hi RedRosa,

 

Sorry to read how you are feeling. Why did you add the Buspar in June? What did this adding of Buspar for you in how you are feeling?

[RedRosa]

@go2zero The Buspar was added because my anxiety was bad and it was thought it would take the edge off as I tapered. I had no unpleasant side effects from it and actually did feel better. They actually advised me to take it twice a day but I had trouble remembering to take it in the evening and was worried about what forgetting would do to my stability. 5mg is a very, very small dose so I'm considering going back to taking it as prescribed. 

[Go2zero]

OK, I was just wandering looking at your signature. I could be seen there as if you started to feel worse after you started the Buspar. And since you are still not feeling well, I had the thought if the Buspar could have to do with that. 

 

What do you think?

[RedRosa]

@go2zero I did not start feeling bad until mid-July and I attributed that to a too-fast taper.

[RedRosa]

I'm back again to track how I'm feeling. Unfortunately, not much has changed.

 

I'm staying awake more during the day but still have trouble sleeping at night, with early morning panic awakenings. Got up early this morning instead of staying in bed for hours like usual. Used my partner's finger pulse/oximeter after getting up -- it showed I was tachycardic, with my heart beating 115+ beats per minute. I obviously knew my heart has been freaking out but it was somewhat comforting to get confirmation.

 

I'm having trouble taking care of myself (remembering to take meds on time, changing clothes/showering, eating and drinking water regularly) but still functioning (I'm good at hiding). If I wasn't working mostly from home, I think I would be in trouble. My view of the world/life is still bad, the worst it has ever been. Trying to open up more to my partner but finding it hard. I don't know what talking about it will solve. And I feel so bad that I've been some sort of mentally ***** up since we started seeing each other.

 

I'll note that I felt like this before uping my dose and trying to go down again. How do you separate withdrawal from mental illness?

[RedRosa]

Back again with another update.

 

I've had to switch from the tablet version of Lexapro/escitalopram to the liquid version of Celexa/citalopram. I tried to avoid it, but here I am. It's been only two days so far and I'm feeling fine, but I'm still wary of the prescribed dose. Everything I've read points to escitalopram being considered two times as potent as citalopram:

 

Quote

The equivalent dose of Lexapro is approximately half of that of Celexa. This means the dosing range of Lexapro is 10-20 mg/day and the dosing range for Celexa is 20-40 mg/day.

 

Right now, I'm taking the equivalent of 10mg of Celexa, down from 15mg of Lexapro. But shouldn't I be taking 30mg? 10mg isn't even in the dosing range for Celexa.

[RedRosa]

Unsure how to edit my post but slight update -- was able to message my doc yesterday and he advised to step up my Celexa to 20mg/10mL and then 30mg/15mL.

 

Trying to hold on.

[RedRosa]

I'm back to taking 15mg of Lexapro. Too many side effects from the Celexa. Even though I was only on it a week, it felt like much longer.

[RedRosa]

I'm not sure why I come back here. I've been holding steady on 15mg of Lex and the Buspar 2x a day. My depression and anxiety are horrible. I don't think it's the meds. I think this is just how I am.

[lfran]

@RedRosahow are you doing now? I hope you’ve found some relief. I also have cptsd- definitely makes this whole process more complex.