Rodie: Severe anxiety, advice about reinstatement please

[Rodie]

Hi,

I tapered probably too quickly and had some manageable symptoms initially mostly brain zaps and irritability. I started crying in work 4 weeks ago and had to take time off. In the last week the anxiety has become unbearable, the doctor prescribed xanax 2.5mg which hasn't helped. Yesterday I got Diazepam 5mg, it eased the anxiety slightly but doesn't last. I took it at 5.30am but couldn't get back to sleep. I am terrified because all I can think about is suicide to make the pain stop. My husband is the only thing keeping me here, but it is so painful. The doctor doesn't believe its withdrawal because its too long since I stopped taking it. I can barely eat and I feel paralyzed with fear. I have been reading topics on the site for a while and I know it is getting past the window to reinstate, but I have become so scared of doing the wrong thing that I can't think straight anymore.

[Shep]

Hi, Rodie.

 

Welcome to Surviving Antidepressants.

 

2 hours ago, Rodie said:

In the last week the anxiety has become unbearable, the doctor prescribed xanax 2.5mg which hasn't helped. Yesterday I got Diazepam 5mg, it eased the anxiety slightly but doesn't last.

 

How much Xanax have you taken? Please list the day(s) that you used it as best as you can remember. 

 

I would stop taking Xanax and Diazepam. It usually takes about 2 - 4 weeks to become dependent on a benzodiazepine such as Xanax and Diazepam and they are definitely not the answer to antidepressant withdrawal. 

 

You would be better off doing a reinstatement of Lexapro. Here is the information:

 

About reinstating and stabilizing to reduce withdrawal symptoms

 

As written about in the first post in that link, you'll want to start out with a very small dose. The first post in this thread will show how you to get a small dose:

Tips for tapering off escitalopram (Lexapro)

 

I'm going to ask other staff who are more familiar with Lexapro what would be a good reinstatement dose for you. In the meantime, please read over the links I posted and also add the Xanax and Valium information to your signature (days you took it and the dose). 

 

Please continue to use this thread to document your taper and to ask questions. 

 

[Rodie]

Thank you Shep for your response. I had hoped the anxiety was neuroemotions and that I could wait it out, but this is way too severe. 

I had thought of trying a 1mg reinstatement of Lexapro. Also my doctor wants to put me on Brintellix as he is convinced it is a new episode of depression. 

I am concerned that taking diazepam will ultimately make things worse or prolong the withdrawal. But I'm also desperate for any relief.

 

[Frogie]

@Rodie

 

I would start out with 0.5 mg Lexapro, as it is a very strong antidepressant. But don't add Brintellix to the mix please.

 

You could try that and wait 4-7 days for your body to regulate and then we can always updose a little if necessary.

 

@Shep

 

I thought I would weigh in for you😊

[Rodie]

@Frogie

Thank you, I have started reinstatement today.

15 Mar - Diazepam 5 mg at 3pm & 9.30pm - Anxiety 10/10

16 Mar - Diazepam 5mg at 5.30am and 2 pm - Anxiety 10/10 all day, slight improvement in evening, 8/10

17 Mar - Diazepam 5mg 3.30am - Anxiety 10/10, didn't sleep much. 8am took 0.5mg Lexapro.

 

I'm not eating very much and can't see a way out of feeling like this yet.

I did tell my Dr I didn't want to take another antidepressant as I believed it was withdrawal. He prescribed 5mg of lexapro even though it is apparently a sub- therapeutic dose. I don't think I will be able to get a liquid prescription but I have dissolved the tablet.

Please god this works!

[Frogie]

@Rodie

 

I hope you find some relief soon also.

 

It will take about a week for the body to register this. We can always updose a little at a time if needed.

 

Hang in there.

[Shep]

13 hours ago, Frogie said:

 

@Shep

 

I thought I would weigh in for you😊

 

Thank you, Frogie. Very good advice. 

 

2 hours ago, Rodie said:

15 Mar - Diazepam 5 mg at 3pm & 9.30pm - Anxiety 10/10

16 Mar - Diazepam 5mg at 5.30am and 2 pm - Anxiety 10/10 all day, slight improvement in evening, 8/10

17 Mar - Diazepam 5mg 3.30am - Anxiety 10/10, didn't sleep much. 8am took 0.5mg Lexapro.

 

Thanks for letting us know your diazepam use. If these are the only doses you took, you'll be fine simply stopping. Diazepam has a very long half-life (up to 200 hours, which is about 8 days), so you may feel the effects for a few more days. 

 

2 hours ago, Rodie said:

I'm not eating very much and can't see a way out of feeling like this yet.

 

Try to get some protein in you. This is very important. You may be getting symptoms that are related to hunger and low blood sugar, which can mimic withdrawal and make it much worse. Avoiding sugar, caffeine, and alcohol are important. Also, staying hydrated is important, as even mild dehydration can cause us to be anxious and fatigued. 

[Rodie]

I am working on the food and staying hydrated. I'm lucky to have people helping me with this.

I've quit coffee, and am limiting tea. Not a big drinker so no problem quitting alcohol, and at least until my appetite comes back sugar won't be a problem.

 

@Shep @Frogie

Thank you both so much for your help, it gives me hope.

[Frogie]

@Rodie

 

You are very welcome.

 

Hopefully this will work for you.

 

Please keep us posted.

[mstimc]

Rodie, I can't add to Shep's and Frogie's great advice about tapering, but I can certainly relate to your fears.  When I was in the depths of WD, I didn't see a way out, either.  I realized part of my problem was that I was so full of fear I couldn't move one way or the other.  I was afraid if I reinstated I'd be on an SSRI forever, but I was afraid if I didn't, I would never recover.  Once your CNS stabilizes a bit, I strongly encourage you to start looking into CBT or other behavioral tools to help you cope with the intrusive thoughts.  Changing your thought patterns has proven to be far more effective than any medication in the long-term.  I also want to reassure you that you can get your life back.  I was where you are and I, and many others, were able to climb out of this nightmare.  You will too!

[Rodie]

That is exactly what happens to me, I freeze with fear am afraid that anything I do will make it worse. I stop eating, talking, moving - everything is a massive effort and all I want is to not wake up anymore. 

Mornings are the worst, I was less anxious yesterday afternoon/evening. This morning is bad. 

I have been through mental health services in the past and did do CBT and WRAP. When this eases I will look into them again. 

As soon as the intense suicidal anxiety passes all the other stresses flood in. It is exhausting 😔

Thanks for the opportunity to share, I am trying to hold onto the hope that I will get out of this.

[Shep]

15 hours ago, mstimc said:

Changing your thought patterns has proven to be far more effective than any medication in the long-term. 

 

This is very true, Mstimc. And very wise. 

 

@RodieHere are a couple of threads that speak to this:

 

"Change the channel" -- dealing with cognitive symptoms

 

Dealing With Emotional Spirals

 

2 hours ago, Rodie said:

Mornings are the worst, I was less anxious yesterday afternoon/evening. This morning is bad. 

 

Yes, this is a common pattern for withdrawal due to cortisol. Please see:

 

Early-morning waking - managing the morning cortisol spike

 

 

[Rodie]

I tried some guided meditations yesterday and felt they helped. Particularly an autogenic one where I repeated phrases out loud.

 

Today I am struggling. Could it be the after effects of the Diazepam? When I was put on the Lexapro in 2014 I was also prescribed Seroquel which was upped to 25mg 4 times a day and then as needed. I have used it very rarely for sleep when I was very anxious (no more than 4-5 times last year and usually half or quarter of a pill as it leaves me groggy the next day). The temptation to take it is very strong, just to be unconscious for a while. I guess I already know the advice is to put the pills down and back away!

 

When things get a little better I will update my signature. I was on lexapro before 2014 and came off at 5mg as advised by the Dr. I suspect my breakdown in 2014 was really withdrawal. I am very foggy on the details that far back. I found a box of Mirtazapine in a drawer yesterday that I have no recollection of being prescribed! And which I never took thankfully.

 

And on the positive side - I am eating and drinking more despite feeling sick all the time, so that is good. And I have spent a lot of time in the sun which I am sure can only help.

 

 

[Rodie]

Symptoms worse today. Still taking 0.5mg lexapro around 8am. This was 5th day reinstating.

Symptoms:

Nausea making it very hard to eat.

Dizziness

Exhaustion (maybe due to poor sleep over the last few weeks)

Anxiety still severe.

 

@Frogie Could worsening symptoms be due to diazepam leaving my system?

And is it too soon to consider updosing?

Thanks

[Frogie]

@Rodie

 

It sounds more like Lexapro wd symptoms than anything. You could updose to 1mg total and see how you feel.

[Rodie]

Thanks @Frogie, I updosed to 1mg this morning after a really rough 24hours.

Was at the Doctor today and he prescribed Stemetil for nausea. After a quick search I think it sounds like a bad idea. It's starting to seem like they use anti-psychotics to treat everything! 

Would OTC meds like motillium be okay to take for nausea?

I've got Ensure drinks to keep my nutrition up a bit anyway.

 

I really appreciate the help and support, only wish I had found SA years ago.

 

[Frogie]

@Rodie

 

That's great you updosed, hopefully that will help. They will prescribe antipsychotics for everything, you are right. I would stay away from the Stemetil if you can. 

 

You could try the motillium, just don't take it for too long as it is a domperidone, like Benadryl. You could try Tums or Pepto Bismol, that might help also. 

 

Ensure shakes are great for protein. Also try peanut butter and crackers, chicken, even soup might settle your stomach.

 

I'm glad you found us too. Please keep us updated😊

[Rodie]

I had a complete breakdown after this. Wasn't able to talk, just hysterical. My husband and parents stepped in and I am now back on lexapro at 7.5mg. I feel anxious all the time, like I am shaking inside. I can't sleep more than a few hours at night, have been given seroquel and zorclone, neither work. 

I am seeing a psychiatrist on Wednesday who said he would switch me over to citalopram which I was on many years ago.

I know I have done everything wrong, but I spend all day thinking of how to end this, and I never felt that way before.

[Shep]

@RodieYour insomnia may be because you were on 1 mg Lexapro on March 22 and now you've updosed to 7.5 mg. Your nervous system is likely hyper-reacting to that dose. Per the Tips for Tapering Off Lexapro thread:

 

On 5/26/2011 at 10:16 PM, Altostrata said:

Special considerations
A significant characteristic of Lexapro is that milligram for milligram, it is much stronger than other SSRIs. Chemically, Lexapro is a variation of Celexa; the molecule was re-engineered to be patentable as Celexa's patent was about to expire. The streamlined molecule is a more potent SSRI, 2 to 4 times stronger than others. (Wikipedia has a good explanation of this at https://secure.wikimedia.org/wikipedia/en/wiki/Escitalopram.)

 

So this is a very potent drug, especially for someone with a traumatized nervous system. 

 

Also, adding in benzos, z-drugs, and antipsychotics like Seroquel can cause paradoxical and rebound anxiety and upset your traumatized nervous system. 

 

1 hour ago, Rodie said:

I am seeing a psychiatrist on Wednesday who said he would switch me over to citalopram which I was on many years ago.

 

I would reduce the Lexapro back down to 1 mg and stop adding in helper drugs. However, if you decide to continue on with other drugs, please work with your doctor. We're not medical professionals here so all we can do is help guide tapers. We can't help with people going on new or adding in older drugs. 

[Rodie]

Thanks for the advice Shep.

It is hard to deal with doctors who don't acknowledge withdrawal and family who love me but don't know how to help.

I just reached a point where I couldn't think or cope. 

I was considering switching to a low dose of citalopram as it is chemically similar to escitalopram and might be easier to taper off for good.

 

[Shep]

12 minutes ago, Rodie said:

It is hard to deal with doctors who don't acknowledge withdrawal and family who love me but don't know how to help.

 

This thread may help give you a way of messaging to your family:

 

Helping family understand

 

13 minutes ago, Rodie said:

I was considering switching to a low dose of citalopram as it is chemically similar to escitalopram and might be easier to taper off for good.

 

Thanks for clarifying why you wish to switch drugs. I'm not familiar with this so I'm going to report your post and see if any of our citalopram / escitalopram mods are available to weigh in. 

 

[Frogie]

@Rodie

 

Escitalpram is the sister drug to Citalopram, and Escitalpram is stronger than Citalopram.

 

If you want to try and reinstate on Citalopram, I would still try 0.5 mg and hold for a good 10 days or so. You can always updose a little if needed.

 

It might be a little easier to taper off of that Escitalpram, but all antidepressants are difficult and take a nice long taper to do it correctly.