lex1989: escitalopram / Cipralex and clonazepam / Rivotril / Klonopin

October 21, 2021

Excellent job on the notes. They are very concise, yet contain all the pertinent information.

You could try doing a partial updose to try to reduce the symptoms if you wish. I would suggest going up to 4.5 mg. I would do an updose if it were me, because oftentimes, the symptoms will continue to worsen over the course of several weeks or even months after the nervous system has been destabilized from too big of a cut. I wouldn't reinstate back to the previous dose of 5.0, because it's been a week, and your system has probably already made some partial adjustments to the new dose. Lexapro is a very powerful SSRI - it's at least 2 times more powerful than other SSRIs, so it's even more important to be very careful with tapering.

October 22, 2021

Thank you for all the insights. I took 4.5 mg today.

The thing is, I seem to be very very sensitive to everything now, 200% more sensitive than I am normally, today I choose to break up with my fiancée and put me in a big panic, that I never had before, horrible anxiety , panic attacks , a lot of heartburn , stomach burn, tingling, etc. And I barely managed to calm myself down.

I did very well with putting up / accepting the anxiety before, as it's mostly chemical and not adding fear above fear. Using the theory from Claire Weeks and Paul David, usually I do good with that. Now I seem to forget everything, can't control anything and keep reminding myself automatically that I never will be better and will always be like this, I don't know if you understand this feeling.

I barely can sleep, I get heartburn every night, usually in the morning after 5-6 am, can get some hours of sleep, but no more than 6 / day in this situation and this stresses me as well, until probably I get used to it again (as I did with the bladder problem, btw of that I think it's from benzo w/o, many ppl from benzo buddies admitted having a lot of pee in the night because of it)

I am almost 100% that this is happening to the major stress that occurred now , just after 1.5 months my fast taper and barely managed to stabilize for 2-3 weeks and also got a cut from the Escitalopram as well.

But the actual question is :

I managed to be ok for a couple of good hours (from 20:00 to 01:00 Romanian Hour now) , having some windows during the day. But when I am in that hell of symptoms I am in a very dark place, like I never had been before and I seem to can't take it anymore if it happens to often, I really hope will not, because the big step has been made, but still want to be sure. Can I take 1.5 Bromazepam (have it from a former prescribed medication that I never took) ?

I know that treating symptoms created by psychiatric medication with another psychiatric medication is not a good idea, but I need some relief as at some point I seem to cannot take it anymore. Or should I bare with this hell couple of days until it's getting better ?

Or there are any "herbs" / supplements that may take a bit of the edge ? For me it seem to work L-Theanine, L-Tryptophan I read on the forum that it's not ok as it interferes with the A/D (although I tried it these weeks and I was fine), CBD oil (with very low THC 2%) you said it's not ok, Natural Calm did not work for me. I am just trying to find a solution instead of getting another benzo to help at least one of these days when I cannot bare it anymore (if it's the case).

October 23, 2021

21 hours ago, lex1989 said:

The thing is, I seem to be very very sensitive to everything now, 200% more sensitive than I am normally

This is very common with psych med withdrawal, especially if we have done many drug changes in the past. Not only that, you were tapering 2 drugs at once, which can be pretty hard on your nervous system. I'm very sensitive to things too. Given enough time and self care, you will recover from this, but it takes a lot of time. You've done over 10 drug changes in the past 8 months, so your system is probably very destabilized at this time. Please be super careful not to do any more drug changes for a long time, unless advised on this forum. Your system is crying out for stability. Please read:

Considerations About Stability - Stop Jumping Around

WD Nervous System Hypersensitivity

21 hours ago, lex1989 said:

keep reminding myself automatically that I never will be better and will always be like this, I don't know if you understand this feeling.

When we feel so bad because our nervous system is so destabilized, it's very tempting to believe this, but realize it's just a thought coming from a nervous system on fire, and don't believe the thought. Here is a technique that may help:

APPLE Technique

I just came across a very nice technique that really helps me. It's called APPLE. I have printed it and have it where I can see it every day and be reminded of it so I internalize this technique.

A - Acknowledge Notice and acknowledge the thought or uncertainty as it comes to mind.

P - Pause Don't react as you normally do. Don't react at all. Just pause and breathe.

P - Pull Back Tell yourself this is just the thought or worry talking, and this apparent need for worry or analysis or certainty is not helpful and not necessary. It is only a thought or feeling. Don't believe everything you think. Thoughts are not statements or facts.

L - Let Go Let go of the thought or feeling. It will pass. You don't have to respond to it. You might imagine the thought floating away in a bubble or cloud.

E - Explore Explore the present moment, because right now, in this moment, you are OK. Notice your breathing and the sensations of your breathing. Notice the ground beneath you. Look around and notice what you see, what you hear, what you can touch, what you can smell. Right now. Then shift your focus of attention to something else - on what you need to do, on what you were doing before you noticed the thought or worry, or do something else - mindfully - with your full attention.

21 hours ago, lex1989 said:

I took 4.5 mg today.

That's good. It will take at least about a week for the updose to get into steady state in your bloodstream and register in your brain. Then, I would hold on this for at least 3-5 months. You've been through the wringer, between the 20% Lexapro decrease, plus the major stress of breaking up with your fiancee.

22 hours ago, lex1989 said:

Can I take 1.5 Bromazepam (have it from a former prescribed medication that I never took) ?

If it were me, I would not do this. You are already taking another benzodiazepine - clonazepam. Give your updose of Lexapro a chance to work, hopefully in a few days you will feel an improvement. If things get really desperate, I'd rather see you updose on the clonazepam, rather than this new drug, which could further confuse your system. What time do you take your clonazepam?

22 hours ago, lex1989 said:

Or there are any "herbs" / supplements that may take a bit of the edge ? For me it seem to work L-Theanine, L-Tryptophan I read on the forum that it's not ok as it interferes with the A/D (although I tried it these weeks and I was fine), CBD oil (with very low THC 2%) you said it's not ok, Natural Calm did not work for me. I am just trying to find a solution instead of getting another benzo to help at least one of these days when I cannot bare it anymore (if it's the case).

The only 2 we suggest are magnesium, and omega-3, and you can try melatonin for sleep. There are other forms of magnesium besides Natural Calm, please see the link for info.

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

Melatonin

October 23, 2021

Please see Altostrata's post on September 27, there is a link in there about how to help with insomnia.

October 27, 2021

On 10/23/2021 at 10:54 PM, getofflex said:

This is very common with psych med withdrawal, especially if we have done many drug changes in the past. Not only that, you were tapering 2 drugs at once, which can be pretty hard on your nervous system. I'm very sensitive to things too. Given enough time and self care, you will recover from this, but it takes a lot of time. You've done over 10 drug changes in the past 8 months, so your system is probably very destabilized at this time. Please be super careful not to do any more drug changes for a long time, unless advised on this forum. Your system is crying out for stability. Please read:

First of all, If I did not said it before, thanks for your continuously support @getofflex :).

I started to read all brassmonkey's posts : Stability , WDnormal, Reinstatement, Cold Turkey and Too-Fast Tapers, etc.

I decided to document myself even more, after my second mistake, I know you have been posting me links, but now I wanted to dig myself even more to understand why I am where I am.

I did took the medicines for 6 months (starting 27.04), not 8, not that is much of a difference. And indeed more of the changes have been done by the doctors, not that it's much of a difference, again. Indeed I need stability, that is certain.

On 10/23/2021 at 10:54 PM, getofflex said:

That's good. It will take at least about a week for the updose to get into steady state in your bloodstream and register in your brain. Then, I would hold on this for at least 3-5 months. You've been through the wringer, between the 20% Lexapro decrease, plus the major stress of breaking up with your fiancee.

I have realized I made actually 3 mistakes at the same time :

20 % decrease (I may could have handle it without the other 2)
big stressor in withdrawal
I changed from powder in capsule Escitalopram to solid (crossover), ChessieCat told me this while I asked on tips of tapering escitalopram. I've bounced from powder to capsule actually for these couple of days, because I did not know this until know, will stick with capsule. So there is no doubt where I am where I am now.

I have made up with my fiancée, as I want to be more stable while getting off the medicine and trying to resolve things between us.

I also up dose to 4.5 and stick with powder in capsule. Will stick with this until I get stabilization.

Stabilization for me was at 3.5 - 4 grade (10 worse, 0 good), it was reasonable and managed to stabilize about after a couple of days / weeks from last fast taper. Maybe now it's not the case, maybe it is, we will see. Can feel a mild improvement in symptoms in these couple of days.

On 10/23/2021 at 10:54 PM, getofflex said:

If it were me, I would not do this. You are already taking another benzodiazepine - clonazepam. Give your updose of Lexapro a chance to work, hopefully in a few days you will feel an improvement. If things get really desperate, I'd rather see you updose on the clonazepam, rather than this new drug, which could further confuse your system. What time do you take your clonazepam?

I take it at 22:00. You have all the info in my signature - daily symptoms. Should I move 0.15 mg in the afternoon when I take the Escitalopram and leave 0.15 mg at 22:00 ? I am not sure if this split of a dose would help, as I got pretty much in tolerance with the Clonazepam ~ 2 months ago.

Now the actually the big issue comes. I have been taking some blood analysis in the last weeks, because my transaminase (liver) are high and the gastroenterologist, after a few brain storming over the last blood analysis, said that the psychiatric medicine is coursing this.

I did not have these high levels in transaminase before I took this medicine, I had it just a bit high (as I have genetic predisposition to it), but now there are increasing.

I asked him, if I remain ~1 more year on this to slowly taper it off what would it mean, he said it's not a good idea, maybe things will complicate in the liver side...

What can be done in this situation ? I know I must slow taper, to let the brain heal, prevent serious withdrawal symptoms, I don't want to CT (that is for sure), but either fast taper as I know the outcome reading from CD & Fast Taper. But don't want big liver problems in the future either.

Is there any middle way of doing this ? I don't know, stabilize for now, than try a 10% reduction at 2 weeks, instead of 4. I have no ideea as I am a newbie here, still learning to listen to my symptoms and so on. Your help is much appreciated.

November 5, 2021

Update : Starting to stabilize, slowly, but getting there.

It is possible to get an answer to the above topic ? I would really appreciate it. I thought you forgot about me

Update 2 : I have been to the urologist, second time, if you remember I had bladder problems, well the conclusion is I don't have any prostate problems, nor colds or anything, it is strictly related to withdrawal , that is why I urinate a lot during the night (4-7 times). I have read on benzo buddies that many of them had this withdrawal symptom. And this happened to me right after fast tapering on the Clonazepam. Is there any possibility in tapering the benzo first, in this particular case, as I may get a better sleep afterwards of not urinating so much at night?

I've given much info on these last 2 replies, take your time >:D<

November 5, 2021

@lex1989

Hi Lex, I am finally getting back to you. You know we all here on SA can relate to the many frustrations, fears, panic, mood swings, depression, anxiety, spiraling thought, and not to mention all the physical symptoms we can get from these drugs.

Have you look up any symptoms from the Symptoms & Self Care forum?

Sounds like you have read my thread so you know that I am a big supporter of meditation. @Mia1 has a great handle on acceptance, meditation, mindfulness. Really learning about your thoughts and how to view them is has been so helpful in combating the thought spirals

Here are some quotes you can use to say to yourself

Everything is just an experience. An experience is neutral, we put the labels of good or bad.

You are always in control Ego (thought) loves a victim

It is my reaction to my symptoms and not my symptoms that were causing my suffering.

The mind will never be able to cure the anxiety because it is causing it. You must shift your focus (attention) outside the mind.

Your brain has convinced you that you must think about it. But it’s your brain that created the problem so it will never fix it.

On 10/27/2021 at 9:31 AM, lex1989 said:

I have been taking some blood analysis in the last weeks, because my transaminase (liver) are high and the gastroenterologist, after a few brain storming over the last blood analysis, said that the psychiatric medicine is coursing this.

At least your doc is acknowledging it that the drugs could be causing the issue. Many do not, they are totally in the dark when it comes to how these meds affect our WHOLE BODY. As you can see how your bladder is responding to the drugs also.

I see you are taking B6, and D3 both of these can be activating. Do you like the L theanine? I am slowly tapering off, it makes me nervous be on it because it works on the Gaba as well as the benzos. It crosses the blood brain barrier. Someone else talked about it being a amino acid and increased his anxiety. Some times it seemed to help me and other times not. I take Magnesium glycinate in capsule form and split it up throughout the day. I usually can tell when I take it.

On 10/22/2021 at 4:39 PM, lex1989 said:

I know that treating symptoms created by psychiatric medication with another psychiatric medication is not a good idea, but I need some relief as at some point I seem to cannot take it anymore. Or should I bare with this hell couple of days until it's getting better ?

Please do not take another benzo or physic drug, I really know how desperate we get and the panic starts to rule, all we can think about is stopping the pain which then this re- enforces the panic. I did that and nothing helped, my system was so out of control and the more I switch, added, well all I can say is what a mess. YES you can by one minute, one hour, one day at a time. As uncomfortable as it is, this will not hurt you.

The biggest thing you can do is to educate yourself on coping skills, meditation, mindfulness, acceptance, etc. all these can be done at many levels, find out what each one means to you and how to go about achieving it. Read and reach out here for advice and encouragement. Talk to the ones that have succeeded and read their stories.

I know that it is easy to get overwhelmed with trying to learn this , or do that. A big one is accepting were you are today and know that you are going to get through it. Then add in some skills to help you get through this journey. There is nothing you can do about tomorrow except worry about what if's and wishful thinking , things we have no control over. Today is all you can really do anything about. So live for today. Then do this everyday.

Hang in there and know that you are not alone😊

November 5, 2021

@lex1989

I hate to tell you but there are other that are experiencing bladder and other personal issues from the WD from ssri's and anti-psychotics. This is a universal WD symptom. @Cheeky is going through something right now and I have have read some others too.😥

You can google.

http://survivingantidepressants.org urinary system

http://survivingantidepressants.org bladder

November 6, 2021

On 10/27/2021 at 9:31 AM, lex1989 said:

I also up dose to 4.5 and stick with powder in capsule. Will stick with this until I get stabilization.

Stabilization for me was at 3.5 - 4 grade (10 worse, 0 good), it was reasonable and managed to stabilize about after a couple of days / weeks from last fast taper. Maybe now it's not the case, maybe it is, we will see. Can feel a mild improvement in symptoms in these couple of days.

I'm glad that you updosed to 4.5 mg, and see some improvement. You may see more improvement as this settles in your system. Since you've been hit with a lot of destabilizing factors, I would stay on this dose for several months, and give you system a chance to heal and recover, and find stability.

On 10/27/2021 at 9:31 AM, lex1989 said:

I take it at 22:00. You have all the info in my signature - daily symptoms. Should I move 0.15 mg in the afternoon when I take the Escitalopram and leave 0.15 mg at 22:00 ? I am not sure if this split of a dose would help, as I got pretty much in tolerance with the Clonazepam ~ 2 months ago.

Why do you want to split your dose of the benzo? Unless there is a very good reason, please try not to keep making drug changes. This will tend to upset and disrupt your nervous system, and worsen your withdrawal symptoms. What you need is stability. Please read Stop Jumping Around with your Drugs

On 10/27/2021 at 9:31 AM, lex1989 said:

Now the actually the big issue comes. I have been taking some blood analysis in the last weeks, because my transaminase (liver) are high and the gastroenterologist, after a few brain storming over the last blood analysis, said that the psychiatric medicine is coursing this.

I did not have these high levels in transaminase before I took this medicine, I had it just a bit high (as I have genetic predisposition to it), but now there are increasing.

I asked him, if I remain ~1 more year on this to slowly taper it off what would it mean, he said it's not a good idea, maybe things will complicate in the liver side...

I will confer with the other staff, and one of us will get back to you on this question.

November 6, 2021

21 hours ago, Greatful said:

@lex1989

Hi Lex, I am finally getting back to you. You know we all here on SA can relate to the many frustrations, fears, panic, mood swings, depression, anxiety, spiraling thought, and not to mention all the physical symptoms we can get from these drugs.

Hello @Greatful, nice to see you here in my topic, I've been looking on the forum, seeing some of your posts :).

21 hours ago, Greatful said:

Have you look up any symptoms from the Symptoms & Self Care forum?

Sounds like you have read my thread so you know that I am a big supporter of meditation. @Mia1 has a great handle on acceptance, meditation, mindfulness. Really learning about your thoughts and how to view them is has been so helpful in combating the thought spirals

Here are some quotes you can use to say to yourself

Everything is just an experience. An experience is neutral, we put the labels of good or bad.

You are always in control Ego (thought) loves a victim

It is my reaction to my symptoms and not my symptoms that were causing my suffering.

The mind will never be able to cure the anxiety because it is causing it. You must shift your focus (attention) outside the mind.

Your brain has convinced you that you must think about it. But it’s your brain that created the problem so it will never fix it.

I agree with you, but easier said than done. For me , acceptance works best, as a coping skill, I know this is at least ~95 chemical, so I try to remind myself that this suffering is not mine or not my fault either (see Claire Weeks). I am not doing so well with meditating, maybe I am doing it wrong or it's not for me :(.

21 hours ago, Greatful said:

At least your doc is acknowledging it that the drugs could be causing the issue. Many do not, they are totally in the dark when it comes to how these meds affect our WHOLE BODY. As you can see how your bladder is responding to the drugs also.

The gastroenterologist doctor acknowledge this, not the psychiatrist (they are simply clueless or they don't care)... And I really thank him that he pointed out the liver damage due to this pills. I really need to think this through, I hope someone from forum can help me with a more "speedy" withdrawal (although I know it's not the best choice), but the liver is critical as well..

21 hours ago, Greatful said:

I see you are taking B6, and D3 both of these can be activating. Do you like the L theanine? I am slowly tapering off, it makes me nervous be on it because it works on the Gaba as well as the benzos. It crosses the blood brain barrier. Someone else talked about it being a amino acid and increased his anxiety. Some times it seemed to help me and other times not. I take Magnesium glycinate in capsule form and split it up throughout the day. I usually can tell when I take it.

I actually saw this topic yesterday, the irony :D. Will stop taking any more B or D vitamins.

About the L-Theanine, I am 100% sure it helped me on some occasions, I felt it. But exactly as you mentioned, sometimes is helping and sometimes is not, this is very strange (I take 200-300 mg in the morning, but occasionally). Do you think it's relevant to taper it ? It's just a amino acid, supplement, not a drug.

From what I understood, it indeed passes the blood brain barrier, but acts directly to block the Glutamate (excitatory neurotransmitter), not acting directly on GABA, although Gaba is related to Glutamate.

I've seen a lot of people that had mentioned it really works for them, some, as you mentioned, had bad reactions like heightening their anxiety. The fact that for us works sometimes and sometimes it doesn't it makes me wonder it's related to the fact that we are in withdrawal, having our CNS very sensitized. Maybe after we are off the drugs and pass the acute period we can use it successfully, but this is just my assumption.

How L-Theanine works

21 hours ago, Greatful said:

Please do not take another benzo or physic drug, I really know how desperate we get and the panic starts to rule, all we can think about is stopping the pain which then this re- enforces the panic. I did that and nothing helped, my system was so out of control and the more I switch, added, well all I can say is what a mess. YES you can by one minute, one hour, one day at a time. As uncomfortable as it is, this will not hurt you.

I won't :). It was very hard ~ 2 weeks ago when I did 3 mistakes at the same time, won't do them again.

21 hours ago, Greatful said:

I know that it is easy to get overwhelmed with trying to learn this , or do that. A big one is accepting were you are today and know that you are going to get through it. Then add in some skills to help you get through this journey. There is nothing you can do about tomorrow except worry about what if's and wishful thinking , things we have no control over. Today is all you can really do anything about. So live for today. Then do this everyday.

Hang in there and know that you are not alone😊

I really need to learn to "live and survive day by day" / live in the moment and not think about the past and the future, specially in this period.

I really appreciate your reply and I hope to hear from you soon 🤗

November 6, 2021

14 hours ago, getofflex said:

Why do you want to split your dose of the benzo? Unless there is a very good reason, please try not to keep making drug changes. This will tend to upset and disrupt your nervous system, and worsen your withdrawal symptoms. What you need is stability. Please read Stop Jumping Around with your Drugs

I won't. Will stay put.

14 hours ago, getofflex said:

I will confer with the other staff, and one of us will get back to you on this question.

Please give me a feedback here, I am more concerned about liver problems than the withdrawal itself this days.. I really hope a middle way it's possible in this situation.

Thank you for getting back to me.

November 6, 2021

@lex1989 you had been taking clonazepam and 5mg escitalopram since last April? When did abnormal liver enzymes appear?

Did you have a history of alcohol use or other drug use?

Please put ALL your drugs in this Interactions Checker and post the report or a link to it in this topic.

What times o'clock do you currently take your drugs, with their dosages?

November 6, 2021

4 minutes ago, Altostrata said:

@lex1989 you had been taking clonazepam and 5mg escitalopram since last April? When did abnormal liver enzymes appear?

Did you have a history of alcohol use or other drug use?

Please put ALL your drugs in this Interactions Checker and post the report or a link to it in this topic.

What times o'clock do you currently take your drugs, with their dosages?

Hello Alto,

Here is the link : https://www.drugs.com/interactions-check.php?drug_list=703-0,1013-0.

I don't have a history of alcohol, I actually drink alcohol rarely.

This was actually a cliché after many years of going to the gastroenterologist doctor to check why I have high liver enzymes / transaminases all the time, as I drink rarely and do not smoke (passive smoker for years still), but after all the possible blood checks and MRI the conclusion was that is a genetical predisposition.

That being said, after taking any kind of pills my liver is sensitives and the enzymes go up, I did not abuse pills, just like a "normal person" does, for cold, stomach pains, etc. But as I took day by day the psychiatric medication, things have gotten bit of bad.

After doing some investigations last weeks it increased even more due to the psychiatric medication, that I took starting from 27 April for the first time. 6 months from now.

13:00 4.5 mg Escitalopram, 22:00 0.3 mg Clonazepam

Daily symptoms

November 8, 2021

The interactions report indicates the 2 drugs may be interacting in your liver.

On 9/18/2021 at 10:34 AM, lex1989 said:

After already 2 months I hit tolerance / dependence with Clonazepam and from that point, for the little I knew, I should have give up on it, but my psychiatrist pushed it even more from 3/4 to 1 (0.5 Clonazepam).

You were prescribed clonazepam and escitalopram together, correct? Why were they prescribed at the same time?

What were the symptoms you had of tolerance / dependence from Clonazepam?

Why have you been going up and down on your clonazepam dosing? Please stop changing your clonazepam dose. It's more likely the escitalopram is causing the elevated liver enzymes.

November 8, 2021

5 hours ago, Altostrata said:

The interactions report indicates the 2 drugs may be interacting in your liver.

Yes. This is what the gastroenterologist doctor also said, although he mentioned both can do liver damage. ( as I am genetic predisposed)

5 hours ago, Altostrata said:

You were prescribed clonazepam and escitalopram together, correct? Why were they prescribed at the same time?

To help / mask the adverse affect of Escitalopram while the body got used to it (this is what I have been told). Few days it was horror and I started just with 2.5 mg of Escitalopram, anxiety got through the roof until ~ 2 weeks.

But I think Escitalopram did not helped at all, basically the adverse effects where masked the whole time by the benzo, while hitting tolerance, then things where clear, even the psychiatrist admitted (ofc she tried to put me on different medication afterwards, but I refused). Then I knew I need to get off this awful poisons as this is much more bad than before taking it in the first place.

5 hours ago, Altostrata said:

What were the symptoms you had of tolerance / dependence from Clonazepam?

Anxiety, but different, more prolonged and sometimes more severe than the anxiety I have been prescribed in the first place.

That is why is hard to stabilize in withdrawal, as I already started this taper process with withdrawal from tolerance / dependency, never been "stable" in the first place to begin with.

5 hours ago, Altostrata said:

Why have you been going up and down on your clonazepam dosing? Please stop changing your clonazepam dose.

I am not. I stood almost 2 months on same dose. I did do a fast taper to it until 0.3 mg, but after I joined benzo buddies and surviving antidepressants I left it as it is.

6 hours ago, Altostrata said:

It's more likely the escitalopram is causing the elevated liver enzymes.

What shall be done in this case ? I don't want a liver injury.

Thank you for your support.

November 9, 2021

On 9/18/2021 at 10:34 AM, lex1989 said:

After already 2 months I hit tolerance / dependence with Clonazepam

14 hours ago, lex1989 said:

Anxiety, but different, more prolonged and sometimes more severe than the anxiety I have been prescribed in the first place.

Your signature indicates that from April 27 to June 14, you were escalating the escitalopram dosage, to 10mg.

It seems to me it's likely you had an initial severe adverse reaction to escitalopram, masked by the clonazepam prescribed at the same time (with escalations in dosage of that as well). After you had been taking 10mg escitalopram for some time (maybe even a few days), you became overcome by activation from escitalopram, not tolerance or dependence from clonazepam.

It's possible that your initial bad reaction to escitalopram was due to your liver not metabolizing it efficiently. Eventually, the backup in your liver resulted in elevated enzymes, indicating potential injury.

If I were you, I'd taper escitalopram, not clonazepam. Since you'll want to go off steadily, you might keep the higher dose of clonazepam on hand to help you with any symptoms you get from tapering escitalopram.

A liquid preparation is the easiest way to taper escitalopram. See Tips for tapering off escitalopram (Lexapro) I would try a 10% reduction first, to see how it affects you.

Please let us know how you're doing.

PS You might consider filing a complaint against the doctor who prescribed escitalopram and clonazepam together and failed to consider the adverse reaction from escitalopram.

November 9, 2021

12 hours ago, Altostrata said:

Your signature indicates that from April 27 to June 14, you were escalating the escitalopram dosage, to 10mg.

It seems to me it's likely you had an initial severe adverse reaction to escitalopram, masked by the clonazepam prescribed at the same time (with escalations in dosage of that as well). After you had been taking 10mg escitalopram for some time (maybe even a few days), you became overcome by activation from escitalopram, not tolerance or dependence from clonazepam.

Yes. That is true. I was first prescribed this medication by a different psychiatrist, that wanted to escalate to 10 mg in the second month.

Also the psychiatrist said that the benzo will give dependency and we need to reduce it, so the Clonazepam was reduced while the Escitalopram was increased, first from 7.5 mg (2 weeks) and than to 10 mg (~10 days).

After that It became horrible, since than I started to feel bad, until this days (never recovered from that point in time).

That being said, I changed the psychiatrist, but the second one said I should stay on the same medicine, just modified the dosages, 5 mg Escitalopram and increased the Clonazepam to 0.5 mg. But things where "better" for a couple of weeks, until it got worse again.

Little I knew back than, but anyway here I am :).

Indeed, the Clonazepam has been masking the reactions (not just liver problems, but also hyphened anxiety, insomnia, etc.) from Escitalopram, this is my understand as well and also "half" admitted by the second psychiatrist as well.

12 hours ago, Altostrata said:

If I were you, I'd taper escitalopram, not clonazepam. Since you'll want to go off steadily, you might keep the higher dose of clonazepam on hand to help you with any symptoms you get from tapering escitalopram.

A liquid preparation is the easiest way to taper escitalopram. See Tips for tapering off escitalopram (Lexapro) I would try a 10% reduction first, to see how it affects you.

Liquid form is not available in my country. I am tapering whit powder (crushed tablets) in veggie capsules. Weighting the capsule first (as they are bit different in weight), with 2 jewelry scales to be more precise, then adding the Escitalopram powder, then scale it again. Is it ok ?

Yes, I've been talkin with @getofflex and also you about what to tapper first, if you remember, I am tapering Escitalopram. I am at 4.5 mg atm, holding to stabilize.

But @getofflex to stay a couple of months to stabilize here, than going again. That means couple of months + probably 1 year of doing the normal 10% tapper from the previous dose => more than 1 year. Not mentioning that would assume more than 2 times the period I took the medicine in the first place, but that would be way to much doing liver injury forward. I said to my gastroenterologist this approximate tapper time and he said : "this is out of the question, to long ". What can I do ?

I feel I can stabilize faster and going again a 10% decrease. Shall I do this ? And see than and let you know.

12 hours ago, Altostrata said:

PS You might consider filing a complaint against the doctor who prescribed escitalopram and clonazepam together and failed to consider the adverse reaction from escitalopram.

I did consider this, you are right, but in my country things are more corrupted than anywhere else, but I might try this as this would prevent any further harm to other people prescribed psychiatric medicine in this way.

November 9, 2021

3 hours ago, lex1989 said:

Yes, I've been talkin with @getofflex and also you about what to tapper first, if you remember, I am tapering Escitalopram. I am at 4.5 mg atm, holding to stabilize.

But @getofflex to stay a couple of months to stabilize here, than going again. That means couple of months + probably 1 year of doing the normal 10% tapper from the previous dose => more than 1 year. Not mentioning that would assume more than 2 times the period I took the medicine in the first place, but that would be way to much doing liver injury forward. I said to my gastroenterologist this approximate tapper time and he said : "this is out of the question, to long ". What can I do ?

I believe I said that, until otherwise advised in here, to hold for several months, and this was before your post informing us you were having liver issues. Now that we have new information, it may be more appropriate to go ahead and start tapering now. We at SA use a harm reduction approach. We need to choose the lesser of 2 evils. How are your withdrawal symptoms at this time? If it were me, I would go ahead and doing a 10% taper of Lexapro now.

Edited November 9, 2021 by getofflex

November 9, 2021

4 hours ago, lex1989 said:

Liquid form is not available in my country. I am tapering whit powder (crushed tablets) in veggie capsules. Weighting the capsule first (as they are bit different in weight), with 2 jewelry scales to be more precise, then adding the Escitalopram powder, then scale it again. Is it ok ?

This is OK as long as the scales are accurate, and able to measure low weights. Another alternative is you can make you own liquid using the crushed tablets. This may be easier and more accurate. Please see Tips for tapering off escitalopram (Lexapro) for instructions on how to do this.

November 9, 2021

1 hour ago, getofflex said:

I believe I said that, until otherwise advised in here, to hold for several months, and this was before your post informing us you were having liver issues. Now that we have new information, it may be more appropriate to go ahead and start tapering now. We at SA use a harm reduction approach. We need to choose the lesser of 2 evils. How are your withdrawal symptoms at this time? If it were me, I would go ahead and doing a 10% taper of Lexapro now.

Yes, I appreciated every advise you gave along the way (even when I did not listen and did not known better) and I believe 100% what you are saying as very accurate, specially based also on your personal knowledge of this medicine.

Very well said, the lesser of the 2 evils, good one :D.

At this very moment, I am almost stable, almost. For me "stable", like said on this forum WDnormal is like 3.5-4 out of 10 (10 being very bad). I am at average 4.5-5 these 3 weeks after the last cut.

See Daily symptoms.

I want to keep 1-2 weeks more to stabilize even further. What do you think ? Then going to 4 mg and see how I am.

To be perfectly honest I have a feeling, that when I lower this Escitalopram that was harming me in many ways, I will be actually better, let's hope my gut is right.

1 hour ago, getofflex said:

This is OK as long as the scales are accurate, and able to measure low weights. Another alternative is you can make you own liquid using the crushed tablets. This may be easier and more accurate. Please see Tips for tapering off escitalopram (Lexapro) for instructions on how to do this.

I think I will stick with powder at the moment, maybe change to my own liquid using powder at much lower dosages if it's the case.

November 9, 2021

I’ll let you decide what to do. It’s your choice. Listen to your body and do what you think is best. I was advising you to do the 10% cut now based on the idea that this is damaging your liver. But if you feel it would be in your better interest to wait a couple weeks then that is fine.

November 14, 2021

@lex1989 How are you doing Mr lex?

November 15, 2021

20 hours ago, Greatful said:

@lex1989 How are you doing Mr lex?

Hello Greatful, nice to see you stopping by.

I am doin ok, I "stabilized" this week. Still having mild anxiety (pretty much my only symptom)through the day with windows after 7-8 PM, when the cortisol is down :D.

I will go 4mg this week, as I need a little faster approach due to my liver issue, will try 0.5 reduction each 3-4 weeks, will see how it goes and will listen to my body.

How are you ?

Fingers crossed !

November 15, 2021

@lex1989 I am doing okay. Like you ups and downs. I stopped the L theanine about a week ago. I also did a 10% drop yesterday to 4.20mg of Lex.

I am nervous to see how I do. I really took a big look at myself and decided that this was going to be all about me. I am doing this for myself and no one else (family, children, etc) has to agree. I want to take all pressure off myself, that means no expectations put on myself that turn in to feeling bad about myself not being able to do( ie visit family or participate in any event that I don't think I can do that day). This is happening to me, this is not me, so no more taking it as a failure on my part.

Hang in there and know that you can do this..........It may get tough at times, but remind yourself that each day that passes is another day of healing.

Remember to be kind to yourself, that mean be really aware off how you talk to yourself. No NEGATIVE self talk about yourself☺️

November 17, 2021

@Greatful Nice to see you cut down in dosage and hanging in there, definitely I am doing this myself and everyday I tell myself another day, another step forward to being healed, although some days are harder, that does not matter.

This week I am cutting myself to 4mg.

I am taking 200 mg L-Theanine once every 3rd day and after all the testing, it seems it's working somehow like this ,I don't know why :).

I have a question for the fellows taking Escitalopram, maybe @getofflex knows this as well :

Been reading about the Escitalopram absorption in body and that is rapidly absorbed and reaches maximum plasma concentrations in approximately 3-4 hours after either single- or multiple-dose administration (been taking it with capsule in powder and maybe even faster for me).

This is a bit odd, as I seem always to struggle the most during the day after a few hours after taking my dose (1 PM), the most anxiety wise hours being in the afternoon (mild or moderate), lasting even a good couple of hours. In the evening, after ~ 8 PM usually things are starting to get better (windows). I have also windows in the morning, usually until taking my dosage.

Is this related to the fact that Lexapro is and was causing adverse effects (anxiety, etc) from the begging ? Until the Clonazepam has stopped masking the side effects. As now I take just 0.3 mg Clonazepam at 22 PM and already got physical dependency to it, pretty impossible to mask anything anymore from the Lexapro.

Or is this related with the circadian rhythm's cortisol idea during the day ? usually in the morning if I get a spike of dread, it falls of fast and I am quite okish until I take the Escitalopram, usually after that, the afternoon anxiety comes. 🙃

November 17, 2021

@lex1989

28 minutes ago, lex1989 said:

Been reading about the Escitalopram absorption in body and that is rapidly absorbed and reaches maximum plasma concentrations in approximately 3-4 hours after either single- or multiple-dose administration (been taking it with capsule in powder and maybe even faster for me).

Let the guessing games begin😁 I had a gene site test done and I am a rapid metabolizer of Lex and increase risk of adverse affects from certain ssris. I have always wondered if the Lex was causing the increase in my anxiety and the brain dysfunction. ( brain buzzing, numbing, vice grip, crushing in feeling, disconnected thinking, sore spots moving around my brain just to name a few) I have had this the whole time I've been on the Lex. I started Lex on a Sat. and by Sunday night my brain was a mess, I felt dizzy, increase in anxiety, I couldn't think right, almost high, head felt floppy on my neck. I just thought I had to give it a chance.

Now with the deceases I feel like things are getting clearer and the brain crazy sensations are getting less intense. Maybe wishful thinking, time will tell.

Do you crush you tablets? Hubby found that if he puts a quarter and the tray (that came with the scale) on the scale and the zeros it out he has a much more accurate weight from dose to dose. By doing this he found the middle of the scale range instead of the low range which is makes for a more accurate/constant weight.

I think you could be feeling the effects of the Lex as it absorbs into your system. Does it affect your sleep. It is a stimulant. Are you tapering by a %?

November 17, 2021

2 hours ago, Greatful said:

@lex1989

Let the guessing games begin😁 I had a gene site test done and I am a rapid metabolizer of Lex and increase risk of adverse affects from certain ssris. I have always wondered if the Lex was causing the increase in my anxiety and the brain dysfunction. ( brain buzzing, numbing, vice grip, crushing in feeling, disconnected thinking, sore spots moving around my brain just to name a few) I have had this the whole time I've been on the Lex. I started Lex on a Sat. and by Sunday night my brain was a mess, I felt dizzy, increase in anxiety, I couldn't think right, almost high, head felt floppy on my neck. I just thought I had to give it a chance.

Now with the deceases I feel like things are getting clearer and the brain crazy sensations are getting less intense. Maybe wishful thinking, time will tell.

Do you crush you tablets? Hubby found that if he puts a quarter and the tray (that came with the scale) on the scale and the zeros it out he has a much more accurate weight from dose to dose. By doing this he found the middle of the scale range instead of the low range which is makes for a more accurate/constant weight.

I think you could be feeling the effects of the Lex as it absorbs into your system. Does it affect your sleep. It is a stimulant. Are you tapering by a %?

I've seen your post on your introduction as well, this is interesting, how is this gene site test working ? Can I do it myself ?

The only thing that I can say to you is that I always had symptoms very fast after any dosage change in Lex, in every case a bad one, so that means I could be a faster metabolizer myself.

The adverse effects you mention, I pretty much have / had them myself, not adding the liver issue as well... So I was wondering myself being so long on this medicine, if it's not making me more sick, instead of slowly stabilizing instead. To be honest I was not "stable" when I started the taper, that being said, how can I be stable now :D.

For example today, I had mild anxiety most of the day, with strange feelings of being dizzy, lost, agitated, disconnected thinking, numbing. Things that I never had before this medicine...

I crush them very well and scale the veggie caps and the powder with 2 different jewelry scales (to be certain) and move them a bit at the middle to be even more precise. I thing my scaling should be pretty precise, not 100%, but close.

Yes I taper by %.

My sleep is meh, I wake up many times at night to urinate, this happened after I started the taper, but I manage to sum up some goods hour of sleep still. My sleep hasn't been good after I increased 4.5 months ago the Lexapro to 10mg (as the doctor said..), then going straight to 5 mg, but my sleep never recovered until that period.

I was wondering to move the Clonazepam as well at 1 PM with the Lexapro, instead of taking it at 10 PM, maybe I'll confuse my CNS even more, I don't know.

November 17, 2021

@lex1989

8 minutes ago, lex1989 said:

how is this gene site test working ? Can I do it myself ?

The doctor has to order one done. I think there a several companies that do it. If you google 'genesight' it is a genic test, you can look to see what it is all about.

My doctor ordered it and the test came in the mail, you swab the inside of your mouth and send it back. It does cast money, I sent it through my insurance and never saw a bill for it.

9 minutes ago, lex1989 said:

The adverse effects you mention, I pretty much have / had them myself, not adding the liver issue as well... So I was wondering myself being so long on this medicine, if it's not making me more sick, instead of slowly stabilizing instead. To be honest I was not "stable" when I started the taper,

This sounds so much like me. I waited from April to Sept. to stabilize and had very little progress. I am really hoping that things will improve as I go down. How often are you planning on cutting.

11 minutes ago, lex1989 said:

I was wondering to move the Clonazepam as well at 1 PM with the Lexapro

I don't think that is a good idea. Altrostrata had Frogie separate my Xanax from other meds. Alto wanted it at least a hour apart. Something to do with drug interaction. Do you just take it a in the evening? Who knows it might be helping you sleep. Is there some reason you want to move it? You can tag frogie if you think you should move it. She is the benzo go to person.

November 17, 2021

15 minutes ago, Greatful said:

@lex1989

The doctor has to order one done. I think there a several companies that do it. If you google 'genesight' it is a genic test, you can look to see what it is all about.

My doctor ordered it and the test came in the mail, you swab the inside of your mouth and send it back. It does cast money, I sent it through my insurance and never saw a bill for it.

The psychiatrist doctor did ?

I found something similar here in my country, genomind test is called and is for the effectiveness of pharmacogenetic testing in influencing the outcome of mental illness medication. Will try it, definitely. Thank you !

37 minutes ago, Greatful said:

This sounds so much like me. I waited from April to Sept. to stabilize and had very little progress. I am really hoping that things will improve as I go down. How often are you planning on cutting.

Exactly, I simply cannot see how can I "stabilize" more than how I am in the present, as I was bad before tapering in the first place...

Being bad because of the Lexapro or being bad both of Lexapro and tolerance from Clonazepam (withdrawal already) does not really matter.

39 minutes ago, Greatful said:

I don't think that is a good idea. Altrostrata had Frogie separate my Xanax from other meds. Alto wanted it at least a hour apart. Something to do with drug interaction. Do you just take it a in the evening? Who knows it might be helping you sleep. Is there some reason you want to move it? You can tag frogie if you think you should move it. She is the benzo go to person.

It was just an idea, I won't move it, I thought maybe would help with the afternoon anxiety due to Lexapro or the cortizol from the circadian rhythm or whatever it is...

Hello @Frogiem could you help with an input here ? :D. In the above 2 topics you have the details. Thank you !

November 17, 2021

Hi:

You don't want to take at the same time as Lexapro.

if you really don't think it's helping you sleep, you could move it up an hour everyday until you get it in the afternoon. But I really think the Clonazepam is not the problem. Insomnia bis very common when tapering.

November 17, 2021

On 11/15/2021 at 10:02 AM, lex1989 said:

I will go 4mg this week, as I need a little faster approach due to my liver issue, will try 0.5 reduction each 3-4 weeks, will see how it goes and will listen to my body.

It's fine to drop from 4.5 mg Lexapro to 4.0 mg for now, even though it's a bit over 10%, because it is affecting your liver. However, after this, I do not suggest doing a 0.5 mg reduction every 3-4 weeks. We at SA suggest an exponential taper. The general suggestion is to taper 10% of your current dose every 4-6 weeks, This means that you taper by smaller and smaller amounts as you get lower and lower in your dose. So for example, if you are at 5.0 mg, a 10% taper is 5.0 minus 0.5, or 4.5 mg. If your current dose is 1.0, a 10% taper means dropping to 0.9, because that is a 10% reduction of 1.0 mg. This is because even at very low levels, these drugs have major effects on our nervous system. Read this link to see why:

SERT Transporter Occupancy Studies Show Importance of Exponential Taper

On 11/15/2021 at 10:02 AM, lex1989 said:

will see how it goes and will listen to my body.

This is a very good plan. That is how I determine when to do my reductions.

6 hours ago, lex1989 said:

This is a bit odd, as I seem always to struggle the most during the day after a few hours after taking my dose (1 PM), the most anxiety wise hours being in the afternoon (mild or moderate), lasting even a good couple of hours.

This may be as the result of the adverse reaction of the Lexapro. As you get lower and lower in dose, this should gradually become less and less.

6 hours ago, lex1989 said:

Is this related to the fact that Lexapro is and was causing adverse effects (anxiety, etc) from the begging ?

Probably so.

6 hours ago, lex1989 said:

Or is this related with the circadian rhythm's cortisol idea during the day ?

I doubt that. The cortisol spike tends to be correlated to early morning, usually at around 4 or 5 AM. Most people, myself included, tend to have our worst anxiety starting at this time, and continuing through the morning, and then things settle down into the afternoon and evening. Thankfully, I don't have the anxiety in the mornings that I used to get, except occasionally.

2 hours ago, lex1989 said:

I was wondering to move the Clonazepam as well at 1 PM with the Lexapro, instead of taking it at 10 PM, maybe I'll confuse my CNS even more, I don't know.

If it were me, I would not do this. The Clonazepam should help you sleep, and sleep is important. And yes, it may confuse your nervous system to keep making drug changes. Please go back to my earlier posts, and see the links about stability, and not making so many drug changes. I agree with what @Frogiesaid above.

November 18, 2021

11 hours ago, getofflex said:

It's fine to drop from 4.5 mg Lexapro to 4.0 mg for now, even though it's a bit over 10%, because it is affecting your liver. However, after this, I do not suggest doing a 0.5 mg reduction every 3-4 weeks. We at SA suggest an exponential taper. The general suggestion is to taper 10% of your current dose every 4-6 weeks, This means that you taper by smaller and smaller amounts as you get lower and lower in your dose. So for example, if you are at 5.0 mg, a 10% taper is 5.0 minus 0.5, or 4.5 mg. If your current dose is 1.0, a 10% taper means dropping to 0.9, because that is a 10% reduction of 1.0 mg. This is because even at very low levels, these drugs have major effects on our nervous system. Read this link to see why:

SERT Transporter Occupancy Studies Show Importance of Exponential Taper

I completely agree with it and you. I know the importance of the exponential taper, I've read it. It is very important and true.

But there are 2 things here, particularly to my case :

1. I've taken this medicine 6.5 months and would need to taper 3-4 years (following the 10% reduction from previous dose, simple math), on the other hand other people took this medicine 20+ years, being much more reliable to taper 3-4 years, isn't it ? A bit of irony here.

Being couple of years more on a medicine that harms myself, would it not be a bad idea ?

2. And most important. I've got a clear statement from my gastroenterologist doctor, there is out of the question to stay another year on this medicine, harming my liver. How can I taper in this particularly case ? That is why I said the idea of going 0.5 mg every 3-4 weeks listening to my body. It was just my idea, don't taking for granted. If you have any other more better tapering please advise ☺️

11 hours ago, getofflex said:

Probably so.

I doubt that. The cortisol spike tends to be correlated to early morning, usually at around 4 or 5 AM. Most people, myself included, tend to have our worst anxiety starting at this time, and continuing through the morning, and then things settle down into the afternoon and evening. Thankfully, I don't have the anxiety in the mornings that I used to get, except occasionally.

Another good example is this morning, I had some dread / anxiety when I wake up (I have this time to time), but then when I start moving around everything dissipates.

And now I am really good, feel normal, until it get's 1 PM and need to get the Lexapro dose and anxiety starts to build up after that until evening. It seems to be clear Lexapro is causing the various side effects (anxiety, strange feelings of being dizzy, lost, agitated, disconnected thinking, numbing) after I take it.

November 18, 2021

13 hours ago, lex1989 said:

But there are 2 things here, particularly to my case :

1. I've taken this medicine 6.5 months and would need to taper 3-4 years (following the 10% reduction from previous dose, simple math), on the other hand other people took this medicine 20+ years, being much more reliable to taper 3-4 years, isn't it ? A bit of irony here.

Being couple of years more on a medicine that harms myself, would it not be a bad idea ?

I know it doesn't seem right that it would take you a longer time to taper, than how long you were on the medication. The problem is, even after 6.5 months, your brain is dependent upon this drug. So in essence, you are caught between a rock and a hard place, because you are dependent on a drug that is causing you an adverse reaction, unfortunately. Because of your adverse reaction, we do recommend an accelerated taper, so it should be faster than reducing by 10% of the current dose every 4-6 weeks. It will be a balancing act.

I suggest taking this one step at a time, and being careful in your taper. We want to make the taper faster, but I wouldn't do it by just reducing 0.5 mg for each taper. I would suggest reducing by 10% of the current dose, but making a reduction more often, instead of every 4 weeks. You may need to increase the clonazepam to deal with withdrawal syndrome. Then, once you are off the escitalopram and stable, you can then taper of the clonazepam.

Can you please link the spreadsheet with your symptoms, so I can get a feel for how you have handled escitalopram reductions in the past? Thank you.

Edited November 18, 2021 by getofflex

November 19, 2021

@lex1989 How are you doing today? Did you do a cut? I am having a little harder time today. I can't do much, I will get to overstimulated. Then the brain goes crazy. Calm Calm Calm

November 19, 2021

@lex1989 you are in a difficult position. There's no good solution, you need to go off the drug fairly quickly and risk withdrawal syndrome. The clonazepam may be of help for some withdrawal symptoms.

You may be able to tolerate small reductions made more frequently (micro-taper), such as 0.10mg decreases every 4 days until you get to 1.0mg escitalopram, then 0.05mg decreases every 4 days.

The adverse effect on your liver should diminish as the dosage goes down.

I hope this goes well for you.

November 22, 2021

@lex1989 How are you doing Mr Lex? Did you cut?

lex1989: escitalopram / Cipralex and clonazepam / Rivotril / Klonopin

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