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SurvivingAD : Tapering... or not


SurvivingAD

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Hi All,


First of all THANK YOU so much for this community. It's so helpful...


History.


I'm a 33yo man.


As long as I can remember i've never been very happy in my life. Even my childhood was complicated, issues with school, parents... Not all negative of course, I had good times too, but overall not great.


- Around 10 I was having a bad time and I was put in child hospital for a few days and they put me on AD (for an unknown period of time) as they thought I was having a "nervous breakdown"  (of course I didnt knew it, my mom told me that a few years ago).

 

- Around 23 I decided to go to a psychiatrist because I wanted to go out of this "low mood" I always had, althought never too low to say depressed. I never lost hope in life or things like that. From my point of view I would say that I have social anxiety : every contact with people is difficult and cost me lot of energy. This leads me to have very few friends, and feeling alone.
He put me on Paroxetine, and I can say it was 'one of' or 'the' best time of my life : lots of energy, doing good at work, made a few friends, started learning an instrument, lot of reading, etc...
On the downside I had zero sexuality, which led me to stop taking my pills after 3 years. I made my own tapering but went too fast. 1 or 2 month after last pill I started having lots of anxiety (which I never experienced before). I had to deal with life issues at that time too (lost grandfather, lost a good frient, family issues...) so it didnt help.


This lead me to see another psychiatrist who put me on Escitalopram 5mg for 5 years. It didnt helped me as much as Paroxetine but it made my general anxiety disapear and feeling a bit better maybe.
Since a few month I experience tiredness (maybe not related to AD), my psychiatrist told me to up my dose to 10mg but I told him I prefered to try stopping AD to see if I can live without it. Better to try it now that I'm at 5mg than with a bigger dose.

 

Withdrawal.


He told me to stop over 2 weeks as Escitalopram is not Paroxetine and even if there are withdrawal effects it should be managable (!).

 

I switched from 5mg to 2.5mg 8 days ago (that was before discovering this forum). I experienced strong anxiety for a few hours on day 2 but since then i'm doing from OK to feeling a bit of anxiety, tiredness and a bit dizzy.


I'm planning on staying at 2.5mg as long as those effects are here and then I'll go down a bit. If things get worse I'll go back to 5mg.


I have to add that I'm starting an important new job in october, and expect the birth of my 2nd child in november. So I really dont want to mess things up. If I knew all this things about tapering I would have waited a few month to try it.


What do you think?


On a more general aspect, regarding my background, do you think I could be one of the person that really need AD on a long term to have a better life?
Thats what every doc i've seen told me. However it doesnt seem we really have the choice because it seems to me that lots of people who have took AD are going to take another AD even when they succeed tapering.


English is not my language, so sorry if i'm not using the right words.


Thanks.

Edited by Go2zero

2013 - may 2016 : paroxetine 40mg - too fast tapering (don't remember details) and withdrawal symptoms 2 months later

october 2016 - now : Escitalopram 5mg - 2.5mg since 07-22-2021

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  • Moderator

Hi SurvivingAD,

 

Welcome to this support site. 

 

Can you please give us specific information about your drug history for all drugs you are on and have been on, especially for the past 18-24 months?  It would be especially helpful to have the details of your drugs in a concise list (no symptoms), only drug names, specific dates (as best you can say for example early March if you don't recall the day) and dosages of each medication decrease or increase.  Please read the link below for instructions.  This will allow us to give you the best guidance.  

 

https://www.survivingantidepressants.org/topic/18343-please-summarize-your-withdrawal-history-in-your-signature/

 

Escitalopram is a very very strong SSRI, much stronger than paroxetine. And BOTH are quite difficult to stop. Paroxetine is known to be very difficult to stop. Unfortunately escitalopram can also be difficult. Since it is so strong, the lower dosages need to be tapered very carefully and slow. And one should better not jump to zero from any low dosages above 0,02 mg.  

 

Here is some important information:

 

https://www.survivingantidepressants.org/topic/1024-why-taper-by-10-of-my-dosage/

 

 

https://www.survivingantidepressants.org/topic/406-tips-for-tapering-off-escitalopram-lexapro/

 

 

There are a lot of succes stories on this site. If one tapers in the right way (slowly and not jumping to zero too soon), there is a very good chance that you will never need AD's ever again! These drugs do not heal! They only numb your feelings and give a lot of nasty side effects.

 

 

1993    Anafranil (Clomipramine) for a few months. Later in 1993 Paxil for a few months 1993- 2006      No medication

2006   Effexor, Cymbalta, some Benzo’s. All for short periods. Later in 2006 Lexapro (escitalopram) 10 mg and shortly after Wellbutrin XR 150mg, against side effects Lexapro 

Since 2006 until end of 2015: Several times on and off Lexapro and Wellbutrin and several slight dosage changes. Mostly taken dosages: 5mg Lexapro and 150mg Wellbutrin

2016  Dosage change Lexapro from 5mg to 2,5 mg. Wellbutrin stayed om 150mg

November 2016 – April 2017 Down from 2,5mg to 0,6mg Lexapro (in steps) without much problems. Wellbutrin down from 150mg to 66mg. Also without much problems.

April 2017 – March 2019       Lexapro 0,6 mg        April 2017 - August 2018       Wellbutrin in small steps down from 66mg in to 37,5 mg . Quite heavy WD after each step.

March 2019 – May 2019 Lexapro down from 0,6 to 0,3mg then Prozac to 0,6 mg switch because severe discontinuation effects (may also have been from Wellbutrin..)    

Wellbutrin down from 37,5mg to 35,3mg 

October 2019        Seroquel 12,5 mg for 4 weeks because of extreme sleeping problems, then weaning off in 2 weeks       Prozac up dosage to 1,2 mg

March 2020     Wellbutrin in 2 steps down from 35,3mg to 33,3mg   Extreme withdrawal affects during 8 months. Stopped tapering Wellbutrin  until total off Prozac. February 2020 – November 2020   Prozac down in steps from 1,2mg to 0,57mg. 

Jan 2021 Prozac down to:  0,55> 0,53>0,51mg,   Feb 0,47mg ,  Mar 0,42mg,   Apr 0,37, longer hold because of WD symptoms July 0,36 and hold again, Sept 19 0,35, Sept 26 0,34mg, Oct 3 0,33mg  

 

Supplements: Fish Oil (3000mg), Magnesium 100 mg, 2 drops of Lavender Oil when feeling anxiety. 50mg of L-Theanine when severe discontinuation effects caused by Wellbutrin

 

Please note this is NOT a medical advice. Discuss all your medical issues with a doctor who understands psychical drugs and really knows how to withdraw from them. I wish that you will find one.

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Hi!

 

Thanks for you answer

 

I've never had any other drug than Paroxetine few years ago and now Escitalopram. Added it to my signature.

 

- Do you think the body can adapt and stabilize with a 2.5mg dose for a few months (this will give me time to deal with life changing events I talked before)? I'm wondering because Doctors always told

 me everyone needs a specific dose of SSRI to have best benefits and less side effects.

 

- I'm halving my pills approximately (this means one half could be 2,4 and the other 2,6 for example) they're so small its difficult. Do you think it could be problematic as from what I can read even 0,1mg can be important when tappering ?

 

- I know it's not the purpose of this forum, but how do you think I could understand the fact that I've lived my best years while under SSRI (Paroxetine)? NOT saying i'm happy with taking SSRI (otherwise I would not try to stop it and be here)

2013 - may 2016 : paroxetine 40mg - too fast tapering (don't remember details) and withdrawal symptoms 2 months later

october 2016 - now : Escitalopram 5mg - 2.5mg since 07-22-2021

Link to comment
  • Moderator

Hi SurvivingAD,

 

Thank you for updating your signature. Could you please include also the dosages you take/took per period and also when you tapered. Including the dosages when tapering. This is important for us to see easily what you are/have been using. 

 

You made quite a big taper 11 days ago now, going from 5 mg to 2,5 mg. We recommend to taper not more than 10% of the last taken dosage. 11 days is not that much yet to see what may happen with withdrawal. You may be lucky that it does not get worse, but we cannot tell. Everybody reacts differently.

 

You are with 2,5mg still in high regions of SERT (serotonine receptor occupancy). In the table below you can see that the Escitalopram  SERT at 2,5mg is around 62%. As you can see in the table, the real tapering work often comes at the lower dosages. There you really have to be slow and careful with tapering, since SERT suddenly start dropping very fast with low amounts of tapering. 

 

Some people notice little WD in the higher dosage regions and others have severe WD. We all react differently, so lets hope you get through well with this 50% taper from 5mg to 2,5 mg.

 

If WD would really get out of hand, do NOT go back to 5 mg! Going up and down in dosage may really upset your nervous system. If really needed, you could go up to 3mg or maximum 3,5 mg. But better to see how things settle now on 2,5 mg. 

 

Given the quite extreme taper, I suggest that you hold for at least one month on this dosage of 2,5 mg. Listen to you body carefully. Understand that WD symptoms can come 3-4 months after a big taper or stop. 

 

When you are stable enough to continue tapering, do not taper more than 10% per month!

 

% of 1 pill(20 mg)

Dosage in mg

Escitalopram

% blockage serotonin receptor

(SERT)

100

10

78

50

5

72

25

2,5

62

12,5

1,25

48

10

1

44

7,5

0.75

37

5

0,5

29

4

0,4

25

3

0,3

20

2

0,2

14,5

1,5

0,15

11

1

0,1

8

0,5

0,05

4

0,25

0,025

2

0,1

0,01

0,9

0,05

0,005

0,5

 

7 hours ago, SurvivingAD said:

 

- I'm halving my pills approximately (this means one half could be 2,4 and the other 2,6 for example) they're so small its difficult. Do you think it could be problematic as from what I can read even 0,1mg can be important when tappering ?

 

In the dosages where you are operating now (2,5 mg) it is not a real problem when you have small differences in  dailydosage. Given the relatively high SERT (62%) and a half life of 27-32 hours of escitalopram this will even out over the 4 days that you split one pill. It is however important that you use and split one and the same pill over 4 days, so that you know that you will have the 10 mg of 1 pill divided over exactly 4 days.

 

The lower you go in dosage, the more important exact dosing becomes. You may use therefor special scales that can weigh up to 1 mg. Please understand that pill weight is always much higher than the active ingredient weight. There are several topics to be found on this on SA.

 

 https://www.survivingantidepressants.org/topic/1596-using-a-scale-to-weigh-and-measure-doses/

 

In the more lower dosages it is best to use liquid escitalopram. It is much easier to dosage very accurate with liquids. In most countries this liquid form is available. If not, you can make your own liquid from pills. Also there is much info on this website. If needed we can advise you.

 

https://www.survivingantidepressants.org/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/

 

7 hours ago, SurvivingAD said:

- I know it's not the purpose of this forum, but how do you think I could understand the fact that I've lived my best years while under SSRI (Paroxetine)? NOT saying i'm happy with taking SSRI (otherwise I would not try to stop it and be here)

I cannot answer this question. I really do not know.  I just know that most people do not get better from these kind of drugs. And after time the positive effects (if any) often decrease or disappear. About side effects and WD I guess I do not have to tell you anymore....

 

1993    Anafranil (Clomipramine) for a few months. Later in 1993 Paxil for a few months 1993- 2006      No medication

2006   Effexor, Cymbalta, some Benzo’s. All for short periods. Later in 2006 Lexapro (escitalopram) 10 mg and shortly after Wellbutrin XR 150mg, against side effects Lexapro 

Since 2006 until end of 2015: Several times on and off Lexapro and Wellbutrin and several slight dosage changes. Mostly taken dosages: 5mg Lexapro and 150mg Wellbutrin

2016  Dosage change Lexapro from 5mg to 2,5 mg. Wellbutrin stayed om 150mg

November 2016 – April 2017 Down from 2,5mg to 0,6mg Lexapro (in steps) without much problems. Wellbutrin down from 150mg to 66mg. Also without much problems.

April 2017 – March 2019       Lexapro 0,6 mg        April 2017 - August 2018       Wellbutrin in small steps down from 66mg in to 37,5 mg . Quite heavy WD after each step.

March 2019 – May 2019 Lexapro down from 0,6 to 0,3mg then Prozac to 0,6 mg switch because severe discontinuation effects (may also have been from Wellbutrin..)    

Wellbutrin down from 37,5mg to 35,3mg 

October 2019        Seroquel 12,5 mg for 4 weeks because of extreme sleeping problems, then weaning off in 2 weeks       Prozac up dosage to 1,2 mg

March 2020     Wellbutrin in 2 steps down from 35,3mg to 33,3mg   Extreme withdrawal affects during 8 months. Stopped tapering Wellbutrin  until total off Prozac. February 2020 – November 2020   Prozac down in steps from 1,2mg to 0,57mg. 

Jan 2021 Prozac down to:  0,55> 0,53>0,51mg,   Feb 0,47mg ,  Mar 0,42mg,   Apr 0,37, longer hold because of WD symptoms July 0,36 and hold again, Sept 19 0,35, Sept 26 0,34mg, Oct 3 0,33mg  

 

Supplements: Fish Oil (3000mg), Magnesium 100 mg, 2 drops of Lavender Oil when feeling anxiety. 50mg of L-Theanine when severe discontinuation effects caused by Wellbutrin

 

Please note this is NOT a medical advice. Discuss all your medical issues with a doctor who understands psychical drugs and really knows how to withdraw from them. I wish that you will find one.

Link to comment
12 minutes ago, Go2zero said:
 

- I know it's not the purpose of this forum, but how do you think I could understand the fact that I've lived my best years while under SSRI (Paroxetine)? NOT saying i'm happy with taking SSRI (otherwise I would not try to stop it and be here)

Have you tried counselling? I was unhappy for many years and in a cycle of anxiety followed by anti depressant use for 15 or so years. I was in therapy on and off, sometimes for 2 years at a time, but could never get to the bottom of things. I now know I was telling one therapist I saw for quite some time what I wanted to focus on but she didn’t ‘hear’ me so that was a real lost opportunity.  Finally a few years ago I did get to the root of my unhappiness with a better person and I have confidence that I can now live a full life free of anxiety and certainly not using ADs anymore. 
 

With your new job and baby on the way the best thing to do is taper very slowly- I am using the Brass Monkey Slide which so far has been a very positive experience. Even with 2.5% drops I feel mild side effects, I dread to think what they would be with bigger drops. I decided to take the better safe than sorry approach to getting off these pills and so far it is paying off. Good luck with your taper ☺️

Important petition calling for tapering strips in the UK  - please sign
Mirtazepine 15mg Nov 2018 -April 2019

April - Sept 2019 Mirtazepine 7.5

October 2019 - about 4 Nov 6mg Mirtazepine 

4-13 Nov anxiety & sleep problems caused by change of brand & jumping around with doses

13 Nov 2019 to 7 Dec 2019 10mg Mirtazepine 

8-10 Dec 2019 15mg Mirtazepine 

11 Dec 2019 to date 12.5mg Mirtazepine 

15 December 2019 to 13 June 2021 15mg Mirtazepine 

14 June 2021 started brass monkey Slide.  
2021: 23 August 12.3mg, 28 October 11.1mg, 6 Dec 10mg

 

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Hello!

 

I updated my signature with dosage

 

I was wondering, why don't we have such symptoms when we start taking SSRI? I mean from personal experience, the 2 times I was put on SSRI I had unpleasant side effects (anxiety) but it didn't last very long (I'd say around 2 weeks). Why our brain can adapt very quickly when adding a substance while it's a hell the other way around?

2013 - may 2016 : paroxetine 40mg - too fast tapering (don't remember details) and withdrawal symptoms 2 months later

october 2016 - now : Escitalopram 5mg - 2.5mg since 07-22-2021

Link to comment

You might enjoy this book which is about how anti depressants work and how to come off them. I missed a webinar (which I saw in a thread here) by the author and another doctor who wrote Sedated.  I’ve read Sedated but not the one linked to above. Both may answer some of your questions ☺️

Important petition calling for tapering strips in the UK  - please sign
Mirtazepine 15mg Nov 2018 -April 2019

April - Sept 2019 Mirtazepine 7.5

October 2019 - about 4 Nov 6mg Mirtazepine 

4-13 Nov anxiety & sleep problems caused by change of brand & jumping around with doses

13 Nov 2019 to 7 Dec 2019 10mg Mirtazepine 

8-10 Dec 2019 15mg Mirtazepine 

11 Dec 2019 to date 12.5mg Mirtazepine 

15 December 2019 to 13 June 2021 15mg Mirtazepine 

14 June 2021 started brass monkey Slide.  
2021: 23 August 12.3mg, 28 October 11.1mg, 6 Dec 10mg

 

Link to comment
  • Moderator
4 hours ago, SurvivingAD said:

I was wondering, why don't we have such symptoms when we start taking SSRI? I mean from personal experience, the 2 times I was put on SSRI I had unpleasant side effects (anxiety) but it didn't last very long (I'd say around 2 weeks). Why our brain can adapt very quickly when adding a substance while it's a hell the other way around?

 

As far as I know brain chemistry changes very fast after taking SSRI's, bentos and other psychotropic drugs. Changing back to the natural state takes often a long time and comes often with WD symptoms that have nothing to do how we felt before we started to take these meds.

 

There have been tests on people without any psychiatric or psychological problems who were given these meds. After quitting they developed feelings of depression, anxiety and even suicidal ideation.....

1993    Anafranil (Clomipramine) for a few months. Later in 1993 Paxil for a few months 1993- 2006      No medication

2006   Effexor, Cymbalta, some Benzo’s. All for short periods. Later in 2006 Lexapro (escitalopram) 10 mg and shortly after Wellbutrin XR 150mg, against side effects Lexapro 

Since 2006 until end of 2015: Several times on and off Lexapro and Wellbutrin and several slight dosage changes. Mostly taken dosages: 5mg Lexapro and 150mg Wellbutrin

2016  Dosage change Lexapro from 5mg to 2,5 mg. Wellbutrin stayed om 150mg

November 2016 – April 2017 Down from 2,5mg to 0,6mg Lexapro (in steps) without much problems. Wellbutrin down from 150mg to 66mg. Also without much problems.

April 2017 – March 2019       Lexapro 0,6 mg        April 2017 - August 2018       Wellbutrin in small steps down from 66mg in to 37,5 mg . Quite heavy WD after each step.

March 2019 – May 2019 Lexapro down from 0,6 to 0,3mg then Prozac to 0,6 mg switch because severe discontinuation effects (may also have been from Wellbutrin..)    

Wellbutrin down from 37,5mg to 35,3mg 

October 2019        Seroquel 12,5 mg for 4 weeks because of extreme sleeping problems, then weaning off in 2 weeks       Prozac up dosage to 1,2 mg

March 2020     Wellbutrin in 2 steps down from 35,3mg to 33,3mg   Extreme withdrawal affects during 8 months. Stopped tapering Wellbutrin  until total off Prozac. February 2020 – November 2020   Prozac down in steps from 1,2mg to 0,57mg. 

Jan 2021 Prozac down to:  0,55> 0,53>0,51mg,   Feb 0,47mg ,  Mar 0,42mg,   Apr 0,37, longer hold because of WD symptoms July 0,36 and hold again, Sept 19 0,35, Sept 26 0,34mg, Oct 3 0,33mg  

 

Supplements: Fish Oil (3000mg), Magnesium 100 mg, 2 drops of Lavender Oil when feeling anxiety. 50mg of L-Theanine when severe discontinuation effects caused by Wellbutrin

 

Please note this is NOT a medical advice. Discuss all your medical issues with a doctor who understands psychical drugs and really knows how to withdraw from them. I wish that you will find one.

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Thanks all for the suggestions

 

Now that I know that the chemical imbalance theory and all that kind of stuff is bullsh*t (after all Dr told me this was my issue), I'm starting to think I have to get to the root of my unhappiness to treat it, even if I have no idea where it comes from.

 

Do you think starting psychological therapy/counseling while on AD, and more precisely while tapering is a good idea?

2013 - may 2016 : paroxetine 40mg - too fast tapering (don't remember details) and withdrawal symptoms 2 months later

october 2016 - now : Escitalopram 5mg - 2.5mg since 07-22-2021

Link to comment

Suggest you tag a moderator (type @ plus their name) for advice on this ☺️

Important petition calling for tapering strips in the UK  - please sign
Mirtazepine 15mg Nov 2018 -April 2019

April - Sept 2019 Mirtazepine 7.5

October 2019 - about 4 Nov 6mg Mirtazepine 

4-13 Nov anxiety & sleep problems caused by change of brand & jumping around with doses

13 Nov 2019 to 7 Dec 2019 10mg Mirtazepine 

8-10 Dec 2019 15mg Mirtazepine 

11 Dec 2019 to date 12.5mg Mirtazepine 

15 December 2019 to 13 June 2021 15mg Mirtazepine 

14 June 2021 started brass monkey Slide.  
2021: 23 August 12.3mg, 28 October 11.1mg, 6 Dec 10mg

 

Link to comment
  • Moderator
On 8/6/2021 at 11:12 AM, SurvivingAD said:

Do you think starting psychological therapy/counseling while on AD, and more precisely while tapering is a good idea?

 

I think this might be a good idea. As long as you find a therapist who believes in WD from AD's and who also believes in the need of slowly tapering. This will both be very important. Otherwise a therapist might suggest over and over again that you might have to reinstate or update again. 

 

Furthermore is is important to understand that WD can cause much emotional symptoms like anxiety and feelings like depression. They may come and go together with other WD symptoms. It is sometimes difficult to get clear what emotional problems come from WD or from our beliefs or other deeper issues within our way of thinking.

 

https://www.survivingantidepressants.org/topic/1112-non-drug-techniques-to-cope-with-emotional-symptoms/

 

https://www.survivingantidepressants.org/topic/14397-neuro-emotions/

 

1993    Anafranil (Clomipramine) for a few months. Later in 1993 Paxil for a few months 1993- 2006      No medication

2006   Effexor, Cymbalta, some Benzo’s. All for short periods. Later in 2006 Lexapro (escitalopram) 10 mg and shortly after Wellbutrin XR 150mg, against side effects Lexapro 

Since 2006 until end of 2015: Several times on and off Lexapro and Wellbutrin and several slight dosage changes. Mostly taken dosages: 5mg Lexapro and 150mg Wellbutrin

2016  Dosage change Lexapro from 5mg to 2,5 mg. Wellbutrin stayed om 150mg

November 2016 – April 2017 Down from 2,5mg to 0,6mg Lexapro (in steps) without much problems. Wellbutrin down from 150mg to 66mg. Also without much problems.

April 2017 – March 2019       Lexapro 0,6 mg        April 2017 - August 2018       Wellbutrin in small steps down from 66mg in to 37,5 mg . Quite heavy WD after each step.

March 2019 – May 2019 Lexapro down from 0,6 to 0,3mg then Prozac to 0,6 mg switch because severe discontinuation effects (may also have been from Wellbutrin..)    

Wellbutrin down from 37,5mg to 35,3mg 

October 2019        Seroquel 12,5 mg for 4 weeks because of extreme sleeping problems, then weaning off in 2 weeks       Prozac up dosage to 1,2 mg

March 2020     Wellbutrin in 2 steps down from 35,3mg to 33,3mg   Extreme withdrawal affects during 8 months. Stopped tapering Wellbutrin  until total off Prozac. February 2020 – November 2020   Prozac down in steps from 1,2mg to 0,57mg. 

Jan 2021 Prozac down to:  0,55> 0,53>0,51mg,   Feb 0,47mg ,  Mar 0,42mg,   Apr 0,37, longer hold because of WD symptoms July 0,36 and hold again, Sept 19 0,35, Sept 26 0,34mg, Oct 3 0,33mg  

 

Supplements: Fish Oil (3000mg), Magnesium 100 mg, 2 drops of Lavender Oil when feeling anxiety. 50mg of L-Theanine when severe discontinuation effects caused by Wellbutrin

 

Please note this is NOT a medical advice. Discuss all your medical issues with a doctor who understands psychical drugs and really knows how to withdraw from them. I wish that you will find one.

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