jon1: Cipralex / Lexapro withdrawal - longer time with each taper?

[jon1]

Hello everyone.

 

I’ve been tapering using Cipralex drops for several months, and I’m currently on 5 mg per day, down from 10 mg.

 

I expected the withdrawal symptoms to get a little worse with each taper, as the overall percentage cut is higher each time.

 

However, I’ve also noticed my recovery back to a balanced state is getting a little longer too, by about a week.

 

It took about 4 weeks to ‘level off’ after my first taper, but my most recent (7 mg to 6mg) took around 7 weeks.

 

Is this to be expected?

[getofflex]

Hello Jon, and welcome to SA.  Kudos to you for doing the hard work of tapering off Cipralex.  I commend you for that.  We are a peer owned and run forum of people who have been or are getting off of psychiatric drugs.  

 

First of all, can you please give us specific information about your drug history?  Please read the link below for instructions.  This will allow us to give you the best guidance.  

 

How to List Drug History in Signature

 

The probable reason you are taking longer to level off, or stabilize, after each dose, is that even as you get to low levels of the drug, your receptors in your brain are still being very much affected.  We suggest that each time you taper, you reduce by 10% of the previous dose, not the current dose.  That means we taper by a smaller and smaller amount the lower we go.  So we taper hyperbolically.  Please read this link for more info on this: 

 

 Why Taper by 10% of my Dosage  

 

This link helps you understand on a scientific level why the reduction must get smaller as we get farther along in our taper: 

Taper Occupancy Studies

 

This helps you understand what withdrawal syndrome is: 

 

What is Withdrawal Syndrome?

 

Here is some information about how these drugs actually work.  

 

How Psychiatric Drugs Remodel Your Brain

 

 

When we recover, there are times of feeling OK mixed in with times of feeling bad.  This is called waves and windows.  

 

Windows and Waves Pattern of Stabilization

 

Here are some techniques to cope with symptoms: 

 

Non Drug Ways to Cope with Withdrawal Symptoms

 

We don't suggest many supplements, but 3 that we do find helpful are magnesium, omega-3, and melatonin. Here are the links for info about those. 

Magnesium

Omega 3 Fish Oil

Melatonin

 

I've given you quite a bit of information here.  Please read through it, and mull it over, and we will take it from there. In the meantime, take care of yourself, and take heart.  We in this forum have been through this, and we understand first hand the pain and discomfort you are going through.  Please know that the brain is amazing in it's healing abilities.  It takes time, but healing can and will happen. 

Edited March 12, 2021 by getofflex
inserted link on occupancy studies, and softened working and removed word "recommend"

[Yesyes123]

I think you'll be interested in giving this a read. SA recommends tapering by 10% of your current dosage you might be aware of this already.

 

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30182-8/fulltext

 

Hope you are doing fine!

[getofflex]

@Yesyes123excellent article - thanks for posting. 

 

[Yesyes123]

The link I had previously posted above seems to go to an incomplete page, so I just updated it. Try again now, there's more info!

[jon1]

Thanks so much, all of those articles are very useful indeed, and very interesting reading.

 

I have one practical question!

 

My Cipralex drops are tiny. I see that getting an oral syringe is recommended when getting to very small doses, but it’s really hard to imagine getting that tiny drop into an even tinier drop.

 

When getting to the really small amounts of Cipralex, what the best approach for managing the dosage?

[getofflex]

I suggest getting and using syringes now.  (I'm currently using a 1 ml syringe that has 0.01 ml increments but syringes come in various sizes.)  It's probably not best to measure by drops, because that may not be accurate.  Drops of liquid are not consistent in size.  Consistency is important and you will have an easier withdrawal being consistent. 

 

If it were me, I would wait and stabilize, meaning manageable symptoms to no symptoms.  Then, I would drop from 5 ml. to 4.5 ml.  That based on 10% of your current dose. (5.0 x .9 = 4.5). 

 

Here is a thread about what stabilizing means to different people. 

 

Stabilizing - What Does that Mean?

Edited March 12, 2021 by getofflex
softened the wording to temper suggestions

[jon1]

Thanks so much for the advice @getofflex.

 

Just so I’m clear in my head how it works. Do I draw an amount of Cipralex into the syringe, then use it to dispense the smaller dosage each day?

[getofflex]

Yes, you do.  There will be a small air bubble in the syringe.  Hold the syringe with the open end facing upward, and flick the syringe a few times with your finger to get the air bubble to the top, then expel it.  This way you will get the necessary accurate dose.  

[jon1]

Great, thanks very much!

[jon1]

How much water to mix drops with?

 

I've been taking Cipralex drops for the last couple of years, and slowly tapering off.

 

I'm currently on 3 drops, down from 10. It occurred to me that I'm putting the drops in a glass full of water like I did when I was on the full dose. Does this make any difference in the absorption of drug, should I use less water?

 

On the same note, if the water doesn't make much difference, will I get the same result by putting the 3 drops on a teaspoon and putting that in my mouth?

 

Edited February 27, 2022 by ChessieCat
added topic title before merging with intro topic

[Onmyway]

Hi Jon, 

welcome to SA. You are doing a good job tapering slowly but at the low dosages that you are at, you may want to consider going slower. The following two threads explain why that is important. 

 

Why taper by 10% of my dosage? - Tapering - Surviving Antidepressants

Why taper? SERT transporter occupancy studies show importance of gradual change in plasma concentration - Tapering - Surviving Antidepressants

 

I would also suggest that you start using a syringe instead of a dropper - the droppers are not accurate and variation in dose from day to day can make your nervous system even more sensitized to further drops. You can get a 1ml syringe from the pharmacy and use that to measure the dose that you're currently on. 

 

There is no problem with dissolving the liquid in water - it gets dissolved in your stomach anyway. I would suggest that it is probably the better way to do it rather than put them on a spoon and lick them as some portion may remain on the spoon but if you can lick the spoon really well, I guess it is fine. 

 

It is really important at the low doses to be careful as a tiny change when you are in the low doses may mean a high percentage change in receptor occupancy (some research showing that - pls see above). 

 

Kudos on doing such a good job tapering. 
OMW

[jon1]

Thanks so much for the advice!

 

A quick question about the syringes. I’ve found a few on Amazon that get good reviews, but how do I get the liquid out of the Cipralex bottles easily?

 

They’re so tiny I’m not sure I could dip a syringe in to fill it. Or are they filled from the top or a different way?

[jon1]

I'm getting more curious as to how these drugs work.

 

I've been on 3 mg Cipralex (Lexapro liquid) for three months, and have had a pretty rough few weeks, but slowly improving. A couple of days ago I had an event that I was stressed about, so took 1 extra drop in the morning (I didn't think it would work, but gave it a try).

 

Within around 3-4 hours most of my WD symptoms were gone and I felt better than I had in months. My mood lifted, normal energy levels. Almost 'normal'.

 

So I'm curious. When we first take these drugs, they take around 6-8 weeks to work, and I've read a few times that reinstatement can also take several weeks to have an effect.

 

So it seems unusual that a quick increase in dose can have such a marked effect within hours. Does anyone else experience this?

[Altostrata]

@jon1 your experience suggests your taper to 3mg escitalopram was too fast, you have been in a withdrawal state since, and an updose may get you back to baseline.

 

If I were you, I'd updose to 3.5mg daily, stabilize at that dose, and then plan to taper by much smaller amounts from there. See Tips for tapering off escitalopram (Lexapro)

 

I suggest 3.5mg rather than 4mg because an increase in dosage will ramp up over 4 days to a week.

 

This is not about the drug "working". It is well known that reinstatement of the drug will stop withdrawal symptoms, sometimes very quickly. Your dosage increase demonstrated you were suffering from withdrawal. 

 

It's claimed that it takes 6-8 weeks for antidepressants to "work" because many people are discouraged by the adverse effects they feel on startup. It takes 6-8 weeks for the nervous system to stop fighting the drug. Even so, antidepressants don't always "work" in the sense of elevating mood; their track record is quite dismal, in fact. But after 6-8 weeks, your nervous system has molded itself around the drug, and that's when withdrawal risk becomes prominent.

[ChessieCat]

  

6 hours ago, jon1 said:

Sound sensitive and the anger it produces (when the sound is made by other people) has been the most debilitating withdrawal symptom for me.

 

It’s happened with every taper, lasting a few weeks each time. I took my final dose 7 weeks ago and this time it’s almost unbearable. I feel like I can hear everything all at the same time.

 

I have my AirPods on in the gym, but I can still hear other people talking over the top of my music, even when I turn it up. Nobody has changed their behaviour, it’s WD, but knowing that doesn’t help.

 

Currently I think there must be a special place in hell for people who use speakerphone in public places.

Q:  What was the last dose that you took when you stopped the drug in January 2022?

 

Please add this information to your drug signature.  Thank you.

 

Account Settings – Create or Edit a signature

 

I'm assuming that because you were reducing by 1mg each time that your last dose was possibly 1mg.  Escitalopram is a very strong drug so stopping at 1mg was much too high.  Even with psychiatric drugs which are not strong SA suggests getting your dose down to at least 0.025mg before considering stopping.

 

If this is a correct assumption then what you describe in the above quote is most likely a withdrawal symptom.  You may be experiencing others that you do not attribute to withdrawal.  See:

 

Dr Joseph Glenmullen's WD Symptoms Checklist

 

Getting through withdrawal has nothing to do with how strong or determined you are as a person.  The brain was used to getting the drug and when the drug was taken away too quickly then withdrawal symptoms can happen as the brain is trying to work without the drug that it had been getting and regain homeostasis.  The faster the drug was taken away then the brain has more work to do.

 

If the symptoms are unbearable, then you might consider making a very small dose reinstatement of the Cipralex / escitalopram.  Taking a dose as small as 0.1mg to 0.25mg might be enough to reduce your withdrawal symptoms.

 

Please read Post #1 of the following topic:

 

About reinstating and stabilizing to reduce withdrawal symptoms

 

 

Edited February 28, 2022 by ChessieCat

[jon1]

2nd Intro topic title:  jon1: Tapering off Lexapro

 

Hi all, I’m a bit late adding my intro, as I’ve now stopped taking Lexapro (Escitalopram) completely, but I thought I should add some context.

 

I’ve always had something called  ‘anticipatory anxiety’. When I was a kid, it was called being ‘over excited’. Which is probably a more accurate definition.

 

It doesn’t matter if I’m looking forward to something or not, it can be a holiday, a night out with friends, or anything enjoyable. In the days leading up to the event I start to get anxious feelings, my heart starts racing and I suffer from insomnia, churning stomach and agitation.

 

I need to stress that I’m not anxious about anything in specific, I’m not afraid of anything, or have any phobias. It’s simply knowing I have something coming up that I’m looking forward to, that causes my body to go into overdrive.

 

I’d liken it to a remote controlled car hitting a wall, and the wheels keep spinning. It’s desperately wanting to move forward but can’t, and all that energy gets pent up.

 

Over the years I’ve had therapy, but honestly nothing really works, as more than likely it’s just the way my body reacts to excitement. Whether it releases too much adrenaline I don’t know, but because I was the same when I was very small and had no comprehension of anxiety, it looks like that’s the case.

 

As I’ve got older, it’s become more noticeable. Probably because I can’t cope with a sleepless night as well as I used to. I’ve visited doctors several times, and have been prescribed all sorts of drugs, from sleeping pills to beta blockers. They helped to an extent, but only with side effects almost as bad as the original issue.

 

In recent years I visited a doctor with the same issue again, and on both occasion I was given antidepressants. This is despite saying I only experience these symptoms occasionally and very short term (about 2 weeks in an entire year), so I didn’t want a long prescription of anything. I threw the script in the bin both times.

 

Then, four years ago I had a bad experience on a trip away. It was the perfect storm of many factors, the ‘anticipatory anxiety’ leading up to the holiday, losing my place of work a couple of days before leaving, then 10 hours of delays at the airport, where we kept getting called up to the flight and sent away again.

 

Then when we arrived at our hotel, it wasn’t what we wanted, and the resort itself was pretty horrible. All this combined causes my anxiety to stick at ‘on’ and I couldn't turn it off.

 

We called out a doctor who gave me a mega dose of diazepam and we agreed to return home as the holiday was a bust by this point.

 

When I returned I visited the doctor, explained everything, and was prescribed Lexapro. I told him I didn’t want anything long term, and he told me Escitalopram was a ‘low dose’ drug and it would only take 6 weeks to taper off. So I reluctantly agreed.

 

This is all despite feeling much better anyway by this point.

 

Of course now I know that escitalopram is actually only ‘low dose’ because it’s much stronger than other SSRI’s. It’s taken me over two years to taper off the medication. It’s been extremely life-limiting in that time.

 

I took my last dose in January of this year (2022) and I’m still suffering from withdrawal. It makes me angry at the doctor for giving me this drug even after being told I didn’t want anything long term and my condition didn’t need it.

 

And angry at myself for taking it to begin with, as I was already starting to recover naturally.

 

Edited September 21, 2022 by ChessieCat
added Intro topic title before merging with intro topic

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  You have come to the right place.  Are Lexapro and diazepam the only psychiatric drugs you have been on?  Can you please add the diazepam to your drug signature?  Thank you. 

 

How to List Drug History in Signature

 

Here is some information about how these drugs actually work.  This explains why we get symptoms from going off of these medications. 

 

How Psychiatric Drugs Remodel Your Brain

 

 

This helps you understand what withdrawal syndrome is: 

 

Video on Recovery from Psych Drugs

 

Windows and Waves Pattern of Stabilization

 

I looks like you did a linear 10% taper, instead of an exponential taper.  We suggest an exponential taper, meaning we reduce by a smaller and smaller amount, because at lower doses, these drugs have a disproportionately larger effect on our nervous systems.  

 

 Why Taper by 10% of my Dosage  

 

In this next link, pay special attention to the chart.  It shows how at low doses, the number of receptors affected drops precipitously.  

 

SERT Occupancy Studies Show Importance of Exponential Tapers

 

Here is a link with checklists of common WD symptoms: 

 

Dr Joseph Glenmullen Withdrawal Symptom Checklists

 

 

Here are some techniques to cope with symptoms: 

 

Non Drug Ways to Cope with Withdrawal Symptoms

 

Stability is really important when we are tapering off psych meds.  Please read the link about stability:

 

Keep It Simple, Slow, and Stable

 

 

We don't suggest many supplements, but 2 that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. It is suggested to add one at a time, and start with a low dose to see how it affects you. 

Magnesium

Omega 3 Fish Oil

 

If you want to, you could reinstate by a very small amount to try and lessen your symptoms.  Going back on a small dose of your drug, or increasing your dose, which we call reinstatement, is best done very carefully.  This is temporary, and after stabilizing you would then taper gradually off of this.  There is some risk involved.  Here is some information about reinstatement.  

 

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

 

You may try reinstating at 0.25 to 0.5 mg of Lexapro. Please let us know what you decide to do. 

 

 

[Greatful]

@jon1

Hi jon I thought I would hop over to your thread.  I see you jumped off at 2mg of lexapro.  Do you notice if your withdrawal got worse or did you stay about the same as when you were tapering? How did your taper go?  I am at 2.5mg of lexapro with adr and I do see a decrease of the adr as I go down.  

 

I am also curious if you had a talk with your doctor about his low dose drug? 😡 

 

I encourage you to learn meditation and practice vagus nerve  breathing exercises for your anxiety.  I can send you some links if you are interested?

[jon1]

Hey @Greatful,

 

After jumping off completely, the first couple of weeks were definitely more intense, with high agitation being a big part of it. Overall it was initially definitely worse than my previous tapers, but nothing I couldn't handle as I knew what symptoms to expect. I was getting worn down by the constant cycle of tapering, and felt I just wanted it to be over by that point, and I was prepared to risk a larger drop.

 

The most noticeable symptom I've had that I didn't when tapering is the sound sensitivity. It's really quite limiting, as even going for a walk outside and hearing people talk can be uncomfortable at times. I've mitigated it somewhat with noise cancelling AirPods when out and about, but obviously that's not a solution when being unable to talk with my other half. I'm not even able to talk to explain why I can't talk. So we're texting a lot at the moment!

 

Of course, it's very likely I'd have had these symptoms after taking my last dose even if I'd continued to taper.

 

That doctor moved on just after giving my first prescription, so I haven't been able to talk (or yell) to him about it. 😁

 

Would I do the same thing and stop completely again, despite all the issues? Probably yes. it's not been pleasant, but at least I know I'm off the drugs and every day is a step closer to healing.

 

Thanks for the offer of links, I'm already dabbling in a spot of meditation and it's helpful.

 

I'm also going to see my therapist (I saw her a couple of years ago when I first started on the drug) again - as I feel that taking the drug 'blocked' my ability to process things properly at the time.

 

I've been holding off seeing her again, as I've had so many 'pseudo emotions' (thoughts and feelings caused by withdrawal and not real issues) that I felt it was pointless to see her until they started to calm down a bit.

 

 

[jon1]

Is severe physical and mental fatigue normal several months after quitting?

 

I took my last dose of Lexapro back in January this year. For the first six months or so I went through the usual acute symptoms of anxiety, depression, mood swings and irritability I was familiar with from tapering.

 

Those seem to have faded somewhat, but now I find myself going through periods of sudden, severe, and debilitating fatigue. I can sleep for hours (albeit with vivid dreams), but can’t wake up, I have zero physical energy, and zero mental energy. It’s horrible.

 

I had my first experience of this back in June, it improved after a few weeks and then I actually felt better than I have all year, but now it’s happened again and I can barely move and even talking is an effort. It’s like having bad flu without the runny nose.

 

I understand the ‘waves and windows’ concept, but I was expecting the waves to be similar to the initial symptoms I had, but this is quite different.

 

Does all this come under the umbrella of withdrawal symptoms?

 

Edited September 21, 2022 by ChessieCat
added topic title before merging with intro topic

[ChessieCat]

2 Introduction topics merged as well as merged new topic posted in Symptoms and Self Care forum.

[ChessieCat]

Sep 2021 - Jan 2022: Taper to 2 mg.

Jan 2022: Stopped taking altogether.

 

Q:  What was the last dose you took?  If you stopped at 2mg that is a very high dose especially of Lexapro because it is a very strong drug.

 

From Post #1 of the Tips for Tapering Lexapro topic:

 

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.

 

 

 

3 hours ago, jon1 said:

I had my first experience of this back in June, it improved after a few weeks and then I actually felt better than I have all year, but now it’s happened again and I can barely move and even talking is an effort. It’s like having bad flu without the runny nose.

 

Sometimes withdrawal symptoms can be delayed.  When I cold turkeyed citalopram (a milder cousin drug of Lexapro/escitalopram) I felt really great for about 2 months and then became bedridden for 2.5 weeks with what felt a bit like the flu but it wasn't.  I was not able to eat and lost 8kgs in that time.  When I saw my medical professional I was told that I "needed an AD for life like a diabetic needs insulin" and was prescribed Pristiq which did cover the withdrawal symptoms.  It wasn't until I found SA (after going onto Pristiq and then trying to get off it) that I realised that it was withdrawal.

[ChessieCat]

The jump off dose for most ADs is generally about 0.025mg.  For Lexapro the amount would be even less because of how strong it is.

Edited September 21, 2022 by ChessieCat

[jon1]

Thanks @ChessieCat.

 

Yeah, I know my final dose was high, but I made the decision at the time that I’d stop (with the agreement of my partner).

 

Overall my symptoms have improved, it’s just these new, sudden flu-like effects that have taken me by surprise. They do fit the wave and windows theory, but as I didn’t really have flu-like symptoms before I wondered if they were connected to withdrawal or not.

[ChessieCat]

You might just have a virus.

[ChessieCat]

And having a virus is a stress on the body and can cause a worsening of symptoms.

[jon1]

I may do. I'll see how it goes and maybe go to the doctor if it doesn't improve.

[ChessieCat]

On 9/21/2022 at 10:09 PM, jon1 said:

I may do. I'll see how it goes and maybe go to the doctor if it doesn't improve.

 

Be aware that sometimes doctors will prescribe an antibiotic.  Antibiotics are given for bacterial issues which can generally be confirmed by a test; it is not a good idea to take an antibiotic "just in case".  Personally I won't take an antibiotic unless I have definitive proof that it is required; a doctor wanted to give my a fluroquinoline because I had raised infection markers in a blood test; I refused and a follow up test showed a reduction in the infection markers so my body had fought it without risking bad side effects (3 FDA warnings about this drug).  Viruses are not bacteria.  If an antibiotic is suggested I would more questions about why and what is it for and ask for a relevant test.

[Altostrata]

Hello, @jon1 How are you doing?

[jon1]

Hey @Altostrata, thanks for asking!

 

I'm still experiencing withdrawal symptoms, but (fingers crossed) they appear to have improved in some respects.

 

My primary symptom is exercise intolerance. If I do too much on one day, I'm completely floored the next. If I walk just a bit too far in the morning, that evening I'll start to feel a little irritable and edgy, and then the next day I'm exhausted.

 

A few months ago I'd probably feel terrible for almost a week, whereas now it tends to be confined to just the next day, as long as I rest on that day.

 

I've had all the blood tests under the sun, including cortisol, and everything is healthy. So I can only assume it's still being caused by my brain chemicals trying to heal themselves.

 

One thing I can say is I haven't really experienced 'waves and windows' in my recovery. It's felt more incremental than that. Just feeling that little bit better this month than last.

 

I was happily going to the gym 3-4 times a week up until just after I took my final dose, that's a no-go for now. but hopefully I'll be able to go back again at some stage in the future.

[Altostrata]

Good to hear you're seeing slow improvement. 

 

Many people find these to be helpful:

 

Magnesium, nature's calcium channel blocker 

Omega-3 fatty acids (fish oil) 

 

You might try a low dose of one at a time to see what it does for you. Please let us know how you're doing.

[jon1]

Thanks @Altostrata.

[EasyGoing]

Hi Jon,

 

I have been following your journey coming off Lexapro and exercise intolerance in particular. Very similar to you, I enjoyed very active life style, running in particular, but since coming off Lexapro, the most I can do these days is walk. Even some active yoga sessions make me sick for a day or two.

 

Have you tried magnesium as per Altrostratas suggestion and did it make a difference in your post workouts recovery? I did notice that my heart rate during my walks a lot lower and overall I feel better if I take magnesium, but I’m not sure if this translates to more intense work outs.

 

Thanks,

Maria

 

 

[jon1]

On 6/19/2023 at 1:46 AM, EasyGoing said:

Hi Jon,

 

I have been following your journey coming off Lexapro and exercise intolerance in particular. Very similar to you, I enjoyed very active life style, running in particular, but since coming off Lexapro, the most I can do these days is walk. Even some active yoga sessions make me sick for a day or two.

 

Have you tried magnesium as per Altrostratas suggestion and did it make a difference in your post workouts recovery? I did notice that my heart rate during my walks a lot lower and overall I feel better if I take magnesium, but I’m not sure if this translates to more intense work outs.

 

Thanks,

Maria

 

 

 

Hey Maria, thanks for your message!

 

Unfortunately, magnesium doesn't agree with me. It makes me very sleepy and depressed within hours, no matter which form I take it in. This has been a lifelong thing though, not related to antidepressants.

 

I did try again after @Altostrata's suggestion, but the result was the same.

 

Interestingly though, I've noticed my resting heart rate has been slowly falling over the last 6 months, and this has coincided with my exercise tolerance increasing slightly. It's too soon to tell, and I don't want to tempt fate, but I'm hoping it's a sign that my CNS is starting to calm down a bit.

 

I haven't attempted a proper gym workout yet though, that will be the big test!

[Altostrata]

7 hours ago, jon1 said:

Unfortunately, magnesium doesn't agree with me. It makes me very sleepy and depressed within hours, no matter which form I take it in.

 

If you want to get sleepy and relaxed, take a smaller dose.