MirandaN: Severe Escitalopram withdrawal after too fast tapering, is reinstatement an option?

[Altostrata]

Were these improvements underway before you introduced 0.25mg escitalopram 2 days ago?

[MirandaN]

19 hours ago, Altostrata said:

Were these improvements underway before you introduced 0.25mg escitalopram 2 days ago?

Sorry, I did not see your reply until now (problem with my browser). I really appreciate your help! 

 

No, I am quite sure these improvements came after introducing 0.25 mg, not before. I have made a list of things that have changed since I reinstated 0.25 mg escitalopram. So today is the fourth day that I have taken 0.25 mg.  

 

What is better:

- Much less stiff in my muscles, more flexible in my muscles, less pain in muscles (my range of motion has increased considerably in just a few days - I first noticed it when I did my daily qigong practise, but also anytime I do anything at all, I feel much "lighter" and my body hurts less)

- Slightly less paresthesia in feet and hands (still numbness etc. but slightly less)

- Somewhat less tingling in my head

- Nose is much less stuffed, I can smell more again

- Slightly less brain fog (still really bad, but there I notice a small difference)

- Less feeling of "chills" going through my body (still happens though)

- Slightly less sensitive to lights (before we had to turn off many of the lights at night in our home, because I got migraine from ordinary kitchen lights, now it is still bad but I can handle it better)

- Somewhat less fatigued

 

What is worse

- Got back the "chemical anxiety" I had when I previously took escitalopram 

- Feel "unnaturally awake" (as if I had too many cups of coffee)

- Difficulty falling asleep

- Feel more "drugged" again and more "outside of my body" 

- Got diarrhea (not too bad though)

- Got back tremor in hands (not too bad though, but still noticeable)

- Slightly more muscle twitching before sleep 

 

Unchanged

- Dizziness, paresthesia/numbness in my face and scalp, pressure over head as well as all the other symptoms I have previously described. 

 

[Altostrata]

You may wish to reduce to 0.10mg escitalopram or substitute 0.25mg citalopram, its milder sibling.

[MirandaN]

33 minutes ago, Altostrata said:

You may wish to reduce to 0.10mg escitalopram or substitute 0.25mg citalopram, its milder sibling.

@AltostrataIt may take a long time for me to get hold of citalopram, since I will first need to convince my doctor that WDS do exist and that this method is a good idea. I guess I should not wait too long with reducing to 0.10 mg escitalopram? Should I taper down from 0.25 mg to 0.10 mg or just reduce directly? Do I understand you correctly that you think a reduced dose may still earn me some of the benefits listed above but hopefully decrease the bad side effects? If the reduced dose proves to be too low, can I go up again if needed? 

[Altostrata]

Yes, a lower dose might have lower adverse effects but still help. You might want to try 0.10mg escitalopram first, since you have it.

 

You don't have to convince your doctor that withdrawal exists. Simply say you'd like to try citalopram instead and would like to gradually titrate up with a liquid (if available in your country). They're usually thrilled when a patient asks for another antidepressant.

[MirandaN]

OK, so I can try to directly reduce to 0.10 mg from 0.25 mg? 

 

I just realized tonight while doing my qigong and some meditation that all my recent injuries/pain in knees, upper back, neck area, shoulders etc. are related to extremely stiff muscles from withdrawal. Now that the muscles feel "lighter" again it is such a huge difference. It does not hurt as much to just make normal movements. And I can actually sit down and meditate again, which I have not been able to do for a while. I really hope this positive effect stays if I lower the dose. My qigong and meditation practise help a lot with distracting me from the overall symptoms of withdrawal, so I would say it is an important piece. 

[MirandaN]

@getofflex 

@Altostrata

My anxiety spiked again this morning. I have not felt this anxious and hopeless for many months (not since I stopped the drug). So I have now, as you recommended, reduced to 0.10 mg escitalopram for today's dose. 

 

I have all reasons to feel more relieved because of the slight improvement in symptoms, but instead my anxiety spiked badly this morning. It is certainly "chemically induced", I see no other reasonable explanation. I cried and cried, although I can now move my body with much less pain. This strange "chemical anxiety" overwhelms me. 

 

So now I wait again and see with the reduced dose. Will the improvements stay and the anxiety go down with the lower dose? 

 

I keep thinking that with the limited knowledge we humans have of our brains and nervous system, we really should not attempt to calibrate these systems by artificial means (such as through medication). It is just a "trial and error", where "error" can be disastrous for the person who is tried on. And doctors have no idea why these medicines sometimes work and sometimes are disastrous, because the brain and the nervous system are too complex. It is like a lottery what works and what does not work. Especially since antidepressants are prescribed for seemingly lots of different conditions such as anxiety, depression, tinnitus, insomnia, pain, dizziness, fatigue, endometriosis, stress etc. And these conditions are in themselves not well understood at all. Medical care should never be based on a lottery. Controlled calibration of the human brain and nervous system would require extremely delicate techniques that we do not have. With the current medications we are trying to knit with wood logs. 

[getofflex]

3 hours ago, MirandaN said:

It is certainly "chemically induced", I see no other reasonable explanation

There is a good chance your anxiety is caused by withdrawal from the escitalopram.  In July, you jumped from 5 mg to 0 mg.  That is a very drastic change, and harsh on the nervous system.  Anxiety is a classic hallmark symptom of withdrawal from antidepressants and psych meds.  

 

3 hours ago, MirandaN said:

I have all reasons to feel more relieved because of the slight improvement in symptoms, but instead my anxiety spiked badly this morning.

Are you saying that there is improvement in your other symptoms, but anxiety is worse?  It is very typical for symptoms to morph and change as we go through withdrawal.  Please see the video on withdrawal in my first response to your initial post.  

 

3 hours ago, MirandaN said:

o now I wait again and see with the reduced dose. Will the improvements stay and the anxiety go down with the lower dose?

Only time will tell.  Please give this new dose a chance.  It takes a minimum of a week for a reinstatement to get into your system, and can take longer to really settle and your stabilize with it.  Unless advised otherwise by Altostrata or other staff, I would not suggest that every time you get a new symptom, or worse anxiety, you change your dose.  That will only lead to more and more destabilization.  Please read this link very carefully, and consider what it is saying:  

 

Considerations About Stability

 

 

Edited October 11, 2021 by getofflex

[MirandaN]

51 minutes ago, getofflex said:

Only time will tell.  Please give this new dose a chance.  It takes a minimum of a week for a reinstatement to get into your system, and can take longer to really settle and your stabilize with it.  Unless advised otherwise by Altostrata or other staff, I would not suggest that every time you get a new symptom, or worse anxiety, you change your dose.  That will only lead to more and more destabilization.  Please read this link very carefully, and consider what it is saying:  

 

Thank you. I read the link. I completely agree. However, reducing to 0.10 mg was not a whim from my side (please see previous threads above). That is what I understood Altostrata recommended me to do. Are you now suggesting I should have staid on 0.25 mg? 

 

Sadly, I think 0.10 mg is too low a dose. During the afternoon/evening I have felt my back and neck muscles as well as shins tighten up again and the bad muscle pain is back. Also more cramps and tingling in my head muscles again. And the numbness in my feet and hands are worse again. Since I have daily exercises and qigong exercises that I do on a daily basis I can really tell the difference when I experience more or less range of motion as well as more pain and stiffness. My interpretation is that 0.10 mg is too low to alleviate the muscle and pain problems, which is why they have returned. While 0.25 mg did help with these symptoms, I instead got more anxiety and this feeling of have drunk "lots and lots of coffee". 

 

Now that I have changed to 0.10 mg I suppose you suggest staying on this dose for a while even if this dose, as compared to 0.25 mg, is not helping with my withdrawal symptoms? Please confirm. 

[Altostrata]

I would try 0.15mg.

 

Yes, it's trial and error, and the patient pays the price of the error.

[getofflex]

2 hours ago, MirandaN said:

Are you now suggesting I should have staid on 0.25 mg? 

No, I wasn't trying to say that.  I've seen other members change their dose frequently on their own, without input from the staff, and get more messed up.  

 

Like altostrata says, this is trial and error.  

 

I hope the 0.15 mg helps you with your anxiety, as well as your muscle tightness.  

Edited October 11, 2021 by getofflex

[MirandaN]

Ok, thanks both of you. It sounds reasonable to try 0.15 mg as from tomorrow. 

 

I can add that I have also felt more tired again this afternoon/evening, so the "lots of coffee" effect has actually gone down after changing to 0.10 mg, which is good in a way. Also, I feel less "drugged" again, which is nice. So it makes sense to try something inbetween such as 0.15 mg. This is indeed some delicate calibrating...  

 

I will keep you posted. 

[MirandaN]

@AltostrataSadly, most of the previous muscle pain and hard rubber feeling as well as tingling/numbness have returned. I hurts a lot to just walk and do normal movements - again. And more light sensitive again. At the same time I feel much more tired again and also calmer again (no "chemical anxiety"). So all these things seem to go hand in hand. It would be nice to find a dose where I am not in so much physical pain but still do not get too much "chemical anxiety". 

 

This afternoon I made some calculations on my own (plotted different curves based on how I have felt day by day the previous week as well as different scenarios for steady state with different doses). I have reason to believe that the dose where I will most likely get some alleviated symptoms but not too much anxiety should be somewhere in the following range: 0.175 - 0.22 mg.

 

Based on this I feel inclined to try increasing the dose to 0.175 mg and then hold there for a while. 

[Altostrata]

@MirandaN citalopram is escitalopram's milder sister drug, you may get the benefits without the adverse effects if you substituted that.

[CharlieBrown13]

Dear @MirandaN,

I'm new to the forum and have read your thread with great interest. Taking an increase in the dose of escitalopram (25 mg to 25.5 mg) I have exactly the same "what is worse" symptoms as you, especially the morning anxiety, which I didn't have before.  I wish you very much that you find the right dose for you and that your symptoms will improve, I will follow this up!  
 

Warm greetings from Germany

[MirandaN]

@CharlieBrown13 Thank you for your greetings! I have followed your story too actually. Many similarities, really so sad. We have to find a way to survive this! I am currently trying to find a way for reinstatement that may alleviate some of the withdrawal symptoms without too many bad side effects. My worst symptoms are the physical symptoms, such as severe dizziness, cramps in my head muscles, tinnitus, paresthesia, problems with my eye muscles (and therefore light sensitive and not able to see well in the dark) and extremely stiff muscles all over the body. I have figured out that most of the symptoms are linked to the muscles - muscles in the eyes, the head, the ears, the back, the legs, the arms etc. 

 

Just like you, I also got chronic fatigue syndrome last year (over-worked) as well as lower back problems (bulging disc). Then my insomnia during covid-19 infection was "treated" with antidepressants. And one antidepressant lead to another, because none of them worked for me (do they "work" for anyone, I wonder?). My chest tightness and severe breathing problems during the first 1.5 weeks of the covid-19 infection were also mistaken to be general anxiety syndrome (I was certainly anxious, because I could not breathe and did not sleep). At that time there were difficulties procuring tests for covid-19 in Sweden. 

 

I will follow up on you as well. Please take care. Warm greetings from Sweden!

[MirandaN]

@AltostrataI am still trying to procure the sister drug Citalopram. We will see if I succeed. Considering I needed at least 0.25 mg escitalopram to alleviate some of the worst symptoms, what dose would you suggest I take of Citalopram?

[Altostrata]

Citalopram may be the most prescribed antidepressant in the world. I might start with 0.15mg, see what that does.

[MirandaN]

9 hours ago, Altostrata said:

Citalopram may be the most prescribed antidepressant in the world. I might start with 0.15mg, see what that does.

Thanks for replying! It would help me a lot if I can understand the reasoning behind a certain recommendation. I suppose you recommend starting with 0.15 mg to see if I get any immediate (other) adverse reaction to Citalopram as compared to Escitalopram? And if not, I could then go up in dose. Since Escitalopram is at least 2 times stronger than Citalopram (mg for mg) I would expect to take at least 0.50 mg Citalopram to somewhat alleviate the worst symptoms (since I needed 0.25 mg of Escitalopram for that).

 

My concern is mainly the following: my nervous system may react badly to "lowering the dose" once again, since a dose of 0.15 mg Citalopram is surely a lower dose than the equivalent dose of Escitalopram. Would it not be better to start higher with Citalopram? 

[MirandaN]

I can add that I have meanwhile (while waiting for my doctor to respond regarding my request for Citalopram) tried 0.175 mg for 4 days and then increased to 0.20 mg escitalopram since yesterday (according to my own calculations on what I will probably need in order to get a positive response close to what I experienced during the 4 days on 0.25 mg, please see above). This far I have no feeling of having had "lots of coffee", which is good. Anxiety is not worse. However, I have somewhat more muscle twitching, but I have been able to fall asleep anyway. My muscle pain is a little bit better and slightly less stiff, but still far from how it felt on 0.25 mg escitalopram. And I still have terrible cramps in my head muscles and a stuffed nose (which I did not at all have as badly on 0.25 mg). I sleep around 5-6 hours and wake up largely because of muscle/joint pain and cramps. So I definitely need to find a way to further reduce the muscle/joint pain as well as reduce the cramps. 

 

 

[Altostrata]

12 hours ago, MirandaN said:

I suppose you recommend starting with 0.15 mg to see if I get any immediate (other) adverse reaction to Citalopram as compared to Escitalopram? And if not, I could then go up in dose.

 

This is correct.

 

If you feel a bit better on 0.20mg escitalopram, you may not need to make any further changes. It can take some time to stabilize, but at least you are not feeling the adverse effects.

 

However, it will take several days for the change to fully take effect. You may be feeling the downstream effect of the lesser amount you took a day or 2 ago. This is why we ask people to wait and see after any dosage change.

[MirandaN]

@AltostrataThank you for the clarifications!

 

My doctor replied tonight and has written a prescription for Citalopram (he recommends 5 mg btw). I actually did not expect that... So I will pick it up tomorrow. 

 

However, I wonder if I should wait a few days and see what happens on 0.20 mg escitalopram first before trying another drug. Today is only the second day on 0.20 mg. Anxiety is not worse and still no "lots of coffee" feeling. However, no further improvements regarding cramps in the head, stiffness and pain in muscles/joints etc. Cramps in the head are really bad btw. And my nose and ears are still "stuffed" and my head feels swollen. Now that I know these withdrawal symptoms can be alleviated (with a higher dose) it is even harder to accept the symptoms on a lower dose.  

 

Does it sound reasonable to wait a few days before attempting a switch to Citalopram? And now that I take 0.20 mg escitalopram, would you say 0.20 mg Citalopram makes sense or do you still recommend 0.15 mg?

 

I also have another thing that worries me. Well, a question really. I try to understand why Citalopram should have milder side effects, but did not find anything on this topic. Is this something you have discovered while helping all the people in this forum over the years? Would you say there is a reasonable possibility that I may have milder side effects on Citalopram while still getting alleviated symptoms? 

 

What I DID figure out while digging, which did not really explain why the side effects would be milder, was that Citalopram has a somewhat longer half-life than Escitalopram and also the SERT-curve (SERT on y-axis and dose on x-axis) seems perhaps somewhat less steep in the beginning of the curve, i.e. for the lower doses. Also,the dose required for a certain SERT is at least 2 times more than for Escitalopram. Further, I checked the public medical information for the specific drugs, but could not really see that side effects would be less or milder from that information. So this worrier me a bit, since I expect a switch of drugs to be rather tough (just as everything has been since I first took antidepressants). 

[Altostrata]

1 hour ago, MirandaN said:

Does it sound reasonable to wait a few days before attempting a switch to Citalopram?

 

Yes, that would be the right way to do it. Observe for a week.

 

Please stop making spontaneous drug changes. Your history shows you tend to make changes very often. This may be the cause of some of your problems.

 

Escitalopram is a variation on the citalopram molecule. It binds more strongly to SERT, that is how it is more powerful. Citalopram may substitute without the adverse effects. Please stop overthinking and second-guessing.

[MirandaN]

17 hours ago, Altostrata said:

Please stop making spontaneous drug changes. Your history shows you tend to make changes very often. This may be the cause of some of your problems.

 

Until mid July this year all drug and dose changes including several CT were actually specific recommendations by my doctors (although the last CT on 28 July was my own decision). Now that I know more about these drugs I agree it must have been extremely bad for my nervous system. I will stick to 0.20 mg escitalopram for a week and observe. 

 

Just want to add that the positive effects of reinstatement have actually subsided day by day during the last week. My muscles are growing more stiff again, more pain in muscles/joints, more stuffed in my nose and more swollen in hands/feet, more numbness in hands/feet and face, still cramps in head. 

 

17 hours ago, Altostrata said:

Escitalopram is a variation on the citalopram molecule. It binds more strongly to SERT, that is how it is more powerful. Citalopram may substitute without the adverse effects. Please stop overthinking and second-guessing.

My earlier mistake this year was that I did not learn enough about these drugs from the start and listened to doctors who could not explain what was happening to me (and who did not really care either). I must try to do the opposite now. 

 

[Altostrata]

Learning about the drugs is a good thing to do, but it takes a lot of reading!

 

Well, a little more escitalopram causes other adverse effects, and a little less doesn't seem to address the withdrawal symptoms. Substituting citalopram may work, but success is not guaranteed. What do you want to do?

[MirandaN]

I think I would like to stay another few days on this dose, i.e. 0.20 mg escitalopram, and closely observe any changes. I suppose waiting a few days will not change my other available options. 

 

Also, I want to ask something I have been thinking about regarding the doses (no, not over-thinking, just wondering ). Do you think it is possible that the increase of anxiety and "lots of coffee" feeling I got when I took 0.25 mg may be attributable to "insertion symptoms" (I am not sure this is the correct word in English, but you may know what I mean) and would have passed within a week or two? Something similar happened when I initially started each of these drugs during the last 10 months. 

[MirandaN]

Hi, I have now made daily logs and observed different symptoms. Would very much appreciate help on how to move on with my reinstatement. I am not functioning very well in my current state. Today is the 7th day on this dose, 0.20 mg escitalopram. There ARE some improvements (compared to 0 mg), but not as many as previously on 0.25 mg. Some make sense, while others do not make sense (why am I more congested in nose/ears/sinus on 0.20 compared to 0 mg, while I was less congested on 0.25 mg for example). 

 

What is better on 0.20 mg (compared to 0 mg)

- slightly less brain fog

- slightly less fatigued 

- somewhat less stiff muscles (which has helped improve sleep)

- somewhat less pain in muscles and joints all over the body (which has helped improve sleep)

- less nausea

- slightly less light sensitive

- I still get migraines, but not every day (I suspect this is connected to cramps over head, sinus and ear congestion etc.)

- somewhat less tingling in body and somewhat less "crawling" feeling in scalp 

 

Unchanged or worse symptoms on 0.20 mg (compared to 0 mg)

- Very stuffy nose and swollen inside ears including sinus congestion - this is actually somewhat WORSE than on 0 mg (I need to take corticosteroids, Nasonex, as well as another nasal spray to be able to breathe a little bit through my nose, but mainly I now breathe through my mouth)

- Dizziness (I suspect this is at least in part related to congestion in nose, sinus and ears, since I feel more dizzy when I am more congested)

- Cramps over my head 

- Tinnitus and amplification of "internal sounds" such as swallowing, chewing etc. (I suspect this is related to congestion in nose, sinus and ears)

- Blurry vision, floaters, difficulty focusing, difficulties seeing in the dark 

- paresthesia/numbness in face, hands and feet and shins/calves

- pain and bad circulation in hands and feet and shins

 

Symptoms (possibly side effects) on 0.20 mg (that I did not have while on 0 mg)

- slightly more feeling of "being outside of my body", unrealistic

- more difficulty hearing (have to increase the volume several steps while listening to exactly the same programs as compared to on 0 mg)

- somewhat constipated 

- skin does not feel like my own skin

- burning skin sensation, that comes and goes

- tight jaws

- tight throat muscles

 

What I would like to achieve

- Alleviate some symptoms without further side effects (less congestion in nose, ears and sinus as well as less cramps would really help me survive this). I can add that after I take the daily dose of 0.20 mg escitalopram my nose/ears and sinus feel more swollen within an hour

 

My options

- Continue on 0.20 mg escitalopram and see what happens (although not much more is happening lately)

- Increase dose of escitalopram (what dose?)

- Change to citalopram (what dose?)

 

I would very much appreciate some help and thoughts. Thank you!

 

 

 

 

[ChessieCat]

On 10/20/2021 at 7:36 PM, MirandaN said:

"insertion symptoms"

 

You might mean "start up symptoms".  That is, what you experienced when you first started taking the drug.

[MirandaN]

1 hour ago, ChessieCat said:

You might mean "start up symptoms".  That is, what you experienced when you first started taking the drug.

Yes, that is exactly what I mean. Thanks. 

[Heath]

@MirandaN I put up with the adverse effects dry burning sinuses, dry eyes and dry mouth with dizziness. It’s a pain in allergy season. 
 

 I would suggest to use saline spray and hot steam shower instead of steroids and nasonex or medication. 

[MirandaN]

@HeathThanks Heath, very kind of you! I forgot to mention that I use a neti pot with saline solution (slightly warmer than luke-warm) as well and cleanse once a day. It feels good, but does not really clear the swelling. I will now try some "drain sinus and stuffy nose" acupressure moves to see if it helps. 

[MirandaN]

Yesterday I went to see my rehab neurologist, i.e. a specialist in neurology and rehabilitation of neurological problems. This was the second time I went to see her. First of all, she does not at all believe in ssri withdrawal symptoms lasting more than 1-2 weeks... not ever. HOWEVER, she explained to me that all my symptoms are real and come from an imbalance in my nervous system. So she acknowledged all my symptoms and the difficulties I have in my daily life. She calls it an "illness" that needs to heal over time. She attributes the imbalance in my nervous system mainly to chronic fatigue and my covid-19 infection. The way to heal, according to her, is very similar to what you suggest here on SA - it takes time, suitable rehab exercises, eating properly and sleep. Since antidepressants have not helped me, she did not think I should take any medications (I did not see any reason to discuss my reinstatement with her). We are going to have a follow-up in a few months to see how I am doing. She belives that I am doing more or less the right things - walks in nature, resting, qigong and breathing exercises, healthy diet etc. 

 

Myself, I believe she is in part right. My nervous system was probably upset by chronic fatigue and the covid-19 infection. However, I can clearly see how the on and off of drugs this year have immensely affected my nervous system. Also, the majority of the symptoms I have now, I did not have before taking the drugs. 

 

Still, it is good that she recognizes the imbalances in my nervous system. She claimed it is not uncommon with these kind of imbalances in the nervous system (and with my symptoms), but there is still not very much research in this area. 

[Altostrata]

Good that she's half-right. A lot of these clinicians are 100% clueless.

[Khaldanis]

Alto, can you elaborate a little bit as to why she is half right?

[Altostrata]

On 10/23/2021 at 2:26 PM, MirandaN said:

First of all, she does not at all believe in ssri withdrawal symptoms lasting more than 1-2 weeks... not ever.

 

This is 100% incorrect.

 

With "imbalances", she may be thinking of neurological dysregulation, which would be correct for withdrawal syndrome as well as chronic fatigue and covid.

 

However, even if she came up with the wrong explanation, her recommendations to let your system settle down are good ones.

[MirandaN]

Hi! I would really appreciate some advice if you have time. Sorry for any trouble and thanks a lot to you all!

 

So I have stayed another week on 0.20 mg escitalopram. Some benefits remain: less pain in muscles and joints, somewhat less stiffness, somewhat less brain fog and somewhat less light sensitive.

 

However, side effects have escalated regarding sinus, nose and ear congestion as well as constricted throat muscles (which are known side effects of escitalopram according to the medicial information that comes with the drug). And no - I do not have a cold or the flu!

 

During the last week I have experienced increased difficulty breathing and I have problems with my hearing. Also, much worse headache and increasing pain/stiffness in the face/head/neck due to sinus and ear inflammation. It is always worse in the afternoon and evening. I take my dose at noon, so it basically gets worse after I take the dose. And it always feels a bit better in the morning until noon (before I take the day's dose). I now have so congested sinus and ears that I have received hydrocortisone drops for my ears and my doctor has decided to have me do a computer tomography of my sinus regions. All "natural remedies" have failed, which I told my doctor yesterday and she completely agreed. She also prescribed a double dose of Nasonex (cortisone) for my nose both in the morning and evening due to the breathing problems. Not sure if I have mentioned it before, but I have had these issues since I started SSRI in January 2021 (i.e. sinus, nose and ear congestion), but after the reinstatement it has been much, much worse than before. I will try to see my doctor again tomorrow for further ear inspection. I have not told her about the reinstatement (but I suspect she will not consider it possible that 0.20 mg can affect me in this way, but I do not know). 

 

I am pretty sure my increased sinus, nose, ear and throat problems emerged (again) after the reinstatement to these lower doses. The odd thing is that the congestion actually felt better on 0.25 mg than on the lower doses. I have always had sensitive sinus and ears, but this is something entirely else. While on the drug (before CT) I had sinus, nose, ear and throat problems too as a side effect, but not nearly as severe as now after the reinstatement. 

 

What do you advice in the following regard: If I consider the reinstatement to be too tough (i.e. much more pain and evil than before the reinstatement) - what can I do? Is the only way to slowly taper down? If the sinus inflammation gets much worse the doctor may advice me to discontinue the drug (if I tell her I take it), since the drug has sinus inflammation as a side effect. If the inflammation gets too severe I may have to discontinue somehow. Or should I try to up the dose to 0.25 mg again (since it felt better regarding congestion a few weeks ago)? 

 

Thanks again!