Niknaks: Escitalopram and weight gain

[Niknaks]

Hi there :)

 

I was started on antidepressants in 2019 after 3 years of struggling with stress and anxiety induced by a toxic romantic relationship and a stressful environment at university. I was initially started on 10mg escitalopram daily, and uptitrated to 30mg daily within that year. I started getting symptoms that the dose was too high: emotional blunting, insomnia, agitation etc so I started tapering mid-2020. I have been tapering 5mg every 6 months since then and am currently on 10mg again. 
 

I have gained 10kg since starting the antidepressants: I was underweight for my height at 52kg and now I weigh 63kg and have a bit of flab around the tummy and things whereas I’ve always been skinny. 
 

I’m considering switching over to bupropion or fluoxetine to try avoid the weight side effects (I eat a healthy diet and am relatively active). Any advice?

[Go2zero]

Hi Niknaks,

 

Welcome to this support site. Before we can answer your questions, please give us more information first. Good that you came to this website. There is a lot of knowledge to be found and shared here. Also the members can support each other here.

 

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/

 

1 hour ago, Niknaks said:

I have been tapering 5mg every 6 months since then and am currently on 10mg again. 

 

What was the reason for going up in dosage of 10mg again?

1 hour ago, Niknaks said:

I’m considering switching over to bupropion or fluoxetine to try avoid the weight side effects (I eat a healthy diet and am relatively active). Any advice?

 

Do I understand you want to stay on antidepressants? Or would you like to stop totally?

 

Switching to other antidepressants is not without a risk. Quite often one still goes through (sometimes very heavy and long lasting) withdrawal (from the med one was taking before) when making a switch to another AD.

 

I do understand that the weight gain is an issue for you. But is the risk for heavy withdrawal symptoms worth the risk.

 

Watch out for adding bupropion to a SSRI. Bupropion slows down the metabolism of nearly all SSRI's. The effect is that the amount of SSRI in the body increases, as if one is taking a much higher dose....

 

Here is some interesting info:

 

https://www.survivingantidepressants.org/topic/6632-the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable/?tab=comments#comment-525233

 

https://www.survivingantidepressants.org/topic/19373-the-prozac-switch-or-bridging-with-fluoxetine/

 

[Niknaks]

Hi there

 

I joined this forum a while ago when I first started experiencing withdrawal symptoms trying to taper my medication. After a hiatus, I’m back and hoping to get valuable insight from people going through the same experience. 
 

I was started on escitalopram 10mg daily in 2019 for burnout. I was in an emotionally abusive relationship with a narcissist in 2015 which lasted until early 2016. As a result of the relationship he isolated me from my friends and family and I lost a lot of weight from the stress (I weighed 47kg at my lightest). On top of this, I had a grueling degree that was putting its own pressure on me (I am a medical doctor and was studying medicine at the time) and the distraction of the relationship meant my grades were suffering. I broke things off with the guy early 2016 and started the process to rebuild my friendships and work on my grades but my body was physically not in a state to support the emotional stress I was under and studying medicine is in itself a challenging task with many associated stressors. I became depressed and anxious and eventually started having regular panic attacks a year or two later.

 

After pushing through for two years and trying to manage by myself my GP prescribed Urbanol (clobazam, a benzodiazepine) in 2018 which he recommended I take whenever I felt stressed or when I was likely to have a panic attack. I wasn’t warned not to take them every day and eventually found I was coping really well using them every day. Fast track a few months later and I was now a depressed zombie with very little emotion (benzos are bad!).

 

Early 2019 I realized I couldn’t go on like this and I went to see another GP who was into wholistic medicine. He recommended I taper off the benzos and gave me an alternative, Stresam (etifoxine, similar action to benzos but not in the same drug class), to use for when I needed to present or for exams only. We tried a few months of meditation, dietary changes, exercise, over the counter natural supplements and a low dose beta blocker (propranolol) but I was still struggling with daily anxiety and at this point we decided to start 10mg Cipralex (escitalopram). 
 

The escitalopram took a while to work but it got me off the beta blocker and the Stresam and I started to feel better. Over 6 months we titrated up to 20mg daily and then 30mg daily when I was still feeling quite anxious (although the panic attacks had somewhat subsided). I very quickly felt better and wanted to come off the medication as it was suppressing my emotions and making me feel like a zombie. The wean process from mid-2020 is detailed below. 
 

I have just been trying to wean off fluoxetine 20mg over the last 5 months and was taking one tablet every 3-4 weeks but the withdrawal symptoms crept up on me. I have no reason to be depressed or anxious and know the feeling from the last time I tried to come off. The fluoxetine 20mg is making me feel a bit like a zombie again and wondering if I should go to 10mg daily and then try using a scale to measure out in microdoses and do a much slower wean. Any advice appreciated. 

Summary:

2018 Clobazam 5-10mg PRN then daily

2019.05 Propranolol and Etifoxine as needed. Over the counter herbal anxiolytics. 
2019.09.07 Escitalopram 10mg daily

2019.09.26 Escitalopram 20mg daily 

2020.01.30 Escitalopram 30mg daily

2020.06.10 Escitalopram 10mg daily and propranolol 40mg as needed. (Was feeling fine, decided to taper off to nothing over a few weeks)

2020.06.11 No medication

2020.07.09 Escitalopram 15mg daily (had withdrawal effects from tapering so quickly, went back up to 15mg)

2021.03 Escitalopram 10mg daily 

2021.04 Escitalopram 5mg daily (became very slow mentally, low mood, dizziness, tinnitus)

2021.06 Escitalopram 2.5mg daily

2021.07 Escitalopram 10mg daily (went back up due to withdrawal effects)

2021.11 Escitalopram 10mg (withdrawal effects gone - finally started feeling mentally faster and euthymic)

2023.04 Escitalopram 9mg daily (decided to wean off 1mg per month - was feeling happy, energetic, motivated and doing well socially and at work. Painting, cooking and exercising again after many years of not being creative.)

2023.05 Changed to Fluoxetine 20mg (equivalent of 10mg escitalopram) due to longer half life and easier to taper off. 
2023.06.22 Fluoxetine 20mg every 3 days (feeling great)

2023.06.30 Fluoxetine 20mg every 2 weeks (feeling great)

2023.09 Fluoxetine 20mg weekly (not feeling great, tired all the time, slow mentation, anxious, apathetic, less sociable, no longer interested in hobbies)

2023.10 Fluoxetine 20mg daily for 3 days then stopped cold turkey 

2023.11.17 Fluoxetine 40mg once off then back to 20mg daily (becoming very anxious at work, brain fuzzy, making mistakes, anti-social, depressed)

[Emonda]

Welcome back, @Niknaks,

I've moved your new post back to your original thread. It's best to keep everything relating to yourself in one spot so we can follow your journey and check what you've been advised previously.

 

The first thing to note is, Never skip doses to taper. 

 

The next thing to implement is the rate at which you taper. The recommendation is a maximum of 10% per month. Why taper by 10% of my dosage? Slow and steady is the way to get off ADs successfully. 

 

However, even when you follow the maximum of 10% per month, you will still experience some WD symptoms. Daily Checklist of Antidepressant Withdrawal Symptoms (PDF). I find it beneficial to reflect on this list so that I am forewarned. When I feel off, I am then able to remind myself it is WD symptoms I am experiencing, not a relapse. Perhaps the WD symptoms may be telling you to reduce by smaller amounts, say 5% per month.

 

You should expect good days and not-so-good days while tapering, and we refer to this as the Windows and waves pattern of stabilization. It's part of the process. Some of us find these Non-drug coping strategies helpful.

 

We don't recommend many supplements, but two that many of us find beneficial are below. You should start with a small amount and increase from there.

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

I've given you quite a bit of info here, but one last thing given you mentioned panic attacks.

 

video: Claire Weekes on Anxiety and Panic

 

Avoid alcohol - I cut it out ~9 months ago as I noticed it seemed to flare up anxiety the following day.

 

Please post any updates here in your thread. It is helpful to keep everything related to your journey in one spot. You are very welcome to jump onto someone else's page and interact with them. The encouragement members give each other on this site is wonderful to see.

 

Sing out with any questions. 

 

Once again, welcome to S.A.

 

Emonda.

[Niknaks]

Thanks so much for the above advice. I think the symptoms chart for WD will be very helpful. 
 

I had two more questions I was hoping for advice on:

 

1. Because I tapered to 20mg fluoxetine every 3 weeks for five months, do you think I should start on a lower daily dose? The residual amount of the drug in my system over that period is a lot lower than I was used to so I may be able to get away with less. I’ve been on 20mg daily for two weeks so it might not be too late to change to say 10mg daily, stabilize on that dose for 4-6 weeks and then try the slow taper from there. 

2. Any recommendations for a good scale that won’t break the bank? Liquid fluoxetine is unfortunately not available in South Africa. 

Thanks  

[Emonda]

Hi @Niknaks,

To answer your second question, here are three suggestions that people here have used.

 

1. Gemini-20
2. A&D EJ-54D2 Dual Range - 22g x 0.0002g / 52g x 0.001g Compact Balance
3. Hanchen Electronic Analytical Balance, 0.1mg 220g Precise Digital Scale for Lab Pharmacy Chemical Plant Jewelry Store 220g/0.0001g

 

As to the first question, I know of another member who was taking 20mg every second day. In that case, 10mg daily seemed reasonable and it worked for them.

 

For you, you've been back at 20mg daily for two weeks. Before that, your dosage seems to have been random.

• 1 tablet every three days in June.
• 1 tablet every two weeks in late June.
• 1 tablet weekly in September.
• 1 tablet for three consecutive days in October, then CTd
• 1 40mg tablet in November
• Now: one 20mg tablet daily

 

Consistency is so important.

 

The risk of jumping straight back to 20mg is kindling:

 

 

Since going straight back to 20mg, you've noticed:

 

On 12/3/2023 at 6:41 AM, Niknaks said:

2023.11.17 Fluoxetine 40mg once off then back to 20mg daily (becoming very anxious at work, brain fuzzy, making mistakes, anti-social, depressed)

 

Will come back to you in ~24 hours after hearing back from the team.

 

Emonda

Edited December 3, 2023 by Emonda
clarifying my response

[Emonda]

Hi @Niknaks,

 

We've noticed the details in your signature are slightly different to what you posted above. Could you please clarify which version is correct?

 

I'm guessing what I have posted below is the correct, more comprehensive version. If so, it'd be best to include the more comprehensive dates/dose in your signature. 

 

Realistically, we can't say for certain if you can go back to 10mg and be fine. You may experience WD symptoms, or you may not. Everyone responds differently. You have been on that dose for two weeks, and they say dependency occurs around 4 weeks...so maybe you will be ok to drop to 10mg-15mg.

 

Whatever you decide, keep notes for yourself as to how you are feeling. Those notes may come in handy in a few weeks time. Going forward, consistency is so important. 

 

I'm sorry I can't be more concrete. 

 

 

On 12/3/2023 at 6:41 AM, Niknaks said:

2023.04 Escitalopram 9mg daily (decided to wean off 1mg per month - was feeling happy, energetic, motivated and doing well socially and at work. Painting, cooking and exercising again after many years of not being creative.)

2023.05 Changed to Fluoxetine 20mg (equivalent of 10mg escitalopram) due to longer half life and easier to taper off. 
2023.06.22 Fluoxetine 20mg every 3 days (feeling great)

2023.06.30 Fluoxetine 20mg every 2 weeks (feeling great)

2023.09 Fluoxetine 20mg weekly (not feeling great, tired all the time, slow mentation, anxious, apathetic, less sociable, no longer interested in hobbies)

2023.10 Fluoxetine 20mg daily for 3 days then stopped cold turkey 

2023.11.17 Fluoxetine 40mg once off then back to 20mg daily (becoming very anxious at work, brain fuzzy, making mistakes, anti-social, depressed)

 

[Niknaks]

Thanks so much for the detailed responses. 
 

The more comprehensive summary is accurate, the signature version only lets me put in 12 lines worth of information so I had to summarize unfortunately. 
 

You’ve made some really good points and I think stability and doing this very slowly and in a measured way is the way to go. I’m going to try 10mg daily at the risk of WD but feel that I have had some kindling symptoms so at this point it’s difficult to say what is the best route. 

[Emonda]

Understood re the signature.

 

You could cull some of the earlier info, such as prior to June 2020, or blend it into a few lines like mine...but you've clarified; thanks.

 

5 minutes ago, Niknaks said:

I think stability and doing this very slowly and in a measured way is the way to go

 

It's taken me two years to get to where I am. I'm guessing I have another 2 years to go. Rushing is not a shortcut; it just makes you feel terrible and puts you back to square one. 

 

3 minutes ago, Niknaks said:

I’m going to try 10mg daily at the risk of WD but feel that I have had some kindling symptoms

 

That's what we were weighing up. The risk of kindling versus the risk of WD.

 

Keep daily notes for yourself, and let us know how you go.

[Niknaks]

Update: finding myself feeling tense and on edge most of the time, even first thing when I wake up in the morning. But it’s mostly muscle tension - all my muscles feel stiff. Could this be the fluoxetine? Not feeling as anxious as I was. And not as depressed. Not at the point where I feel like my mood has stabilized but it’s bearable. Have been static taking 10mg daily since last post. 

[BenD7123]

@Niknaks I have recently developed the muscle stiffness in my hands, arms, and throat.  Did your ever go away or do you have any tips on loosening those muscles up?
Thanks!