LRuthC: Did I go too fast? Or should I whether the withdrawal symptoms?

[LRuthC]

Hi!

 

Have read through a few posts across this amazing online community, and Alto's publication in Therapeutic Advances in Psychopharmacology.

 

I've completed a signature so won't go through the basics, but really hoping to get off the escitalopram at some point, I have been taking it for a year and its the first time ever on ADs. I went on them after a relatively traumatic 2 years. But now that my life is on track, I want my motivation/zest back! And I also would like to shift the 10kg I've accumulated in the last 6 months. I'm just ready to be me again.

 

I read through the literature to come up with my tapering plan (had yet to come across this site) and settled on the reduction regime outlined in Horowitz, M. A., & Taylor, D. (2019). Tapering of SSRI treatment to mitigate withdrawal symptoms. The lancet. Psychiatry, 6(6), 538-546. https://doi.org/10.1016/S2215-0366(19)30032-X.

 

The first step of this regime was to reduce my dosage from 20mg to 15mg. I bought a small medicine weighing machine and got cracking (well, splitting- I split up the tablets and weighed them). What I didn't think of doing though was weighing the whole tablet first, I assumed one whole tablet weighed 20mg (even though splitting it in unequal halves resulted in one half being approx 16mg, and then other being 11mg). So effectively, in the first week of taper I went from taking a 27mg tablet to a 16mg tablet.

 

WS started 3-5 days in. Flu like symptoms, aching body, jaw clenching and general tightness in the throat/tongue/neck region. Similar symptoms to when I first started the escitalopram. These more extreme symptoms lessened over the 2 weeks and so I went down to 14mg, and then after 2 weeks, down to 12mg (did I say I was going to spare the details?).

 

WS are still here- although not like those initial symptoms- however I'm lethargic, I no longer have the strength to do my normal gym routine (which was weights). Now, if I do go to the gym, I do some cardio- it's a slog, I find it rathr sickening but I do try to stick to a routine, and I would like to shift this weight. I need more sleep than I ever did before. I don't have any zest, and I still have this general tightness in the throat/tongue/neck region as well as a feeling of permanent buzzing in the brain (?) I know its WS, I've never had anything like it until I started tapering. Each day is a bit of a struggle.

 

I'm wondering, do I go back up to 14mg? Upon retrospect while I thought I was going from 20mg to 16mg I went from 27mg to 16mg (how does that work meanwhile? Why are the tabs actually 27mg? Is it 20mg of escitalopram with 7mg of filler? Or is my tablet weighing machine just off?) Did I drop too much too quickly and is there any way back? Is it possible to actually avoid WS anyway? Should I just stick it out given it's not horrendous and I can still work/be a parent (albeit, with more struggle)?

 

Any advice would be greatly appreciated (should I be posting this elsewhere? If so, sorry!)

 

Take care everyone, and thanks for making it this far!

 

 

LRC

 

 

 

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  We suggest a very slow taper, much slower than what you have been doing.  

 

It sounds as though you may be confusing tablet weight with the weight of how much drug is in the tablet.  The tablets have fillers, so a 20 mg tablet will weigh more than 20 mg.  Weigh about 7 pills, and then get an average tablet weight.  Take the total weight of 7 tablets and divide this by 7.  That is your average pill weight.  It's confusing, because both are measured in milligrams.  I personally think it would be easier to taper using the liquid - that is what I have been doing.  More on all this later.  

 

Are you on any other drugs/supplements besides Lexapro and doxylamine succinate?  

 

Here is some important information about how these drugs actually work.  This explains why we get symptoms from going off of these medications, and why it's so important to taper slowly and carefully, and be very cautious about changing our doses: 

 

How Psychiatric Drugs Remodel Your Brain

 

 

This helps you understand what withdrawal syndrome is: 

 

Video on Recovery from Psych Drugs

 

Windows and Waves Pattern of Stabilization

 

 

Tapering is best done extremely slowly, and we generally taper by 10% of the current dose no more than once every 4 weeks, so that the reduction becomes exponentially smaller.

 

 Why Taper by 10% of my Dosage  

 

Tips for Tapering Escitalopram/Lexapro

 

Here is a link with checklists of common WD symptoms: 

 

Dr Joseph Glenmullen Withdrawal Symptom Checklists

 

 

Here are some techniques to cope with symptoms: 

 

Non Drug Ways to Cope with Withdrawal Symptoms

 

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

 

Keep It Simple, Slow, and Stable

 

 

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

Magnesium

Omega 3 Fish Oil

 

Finally, going back on a small dose of your drug, or increasing your dose, which we call reinstatement, is best done very carefully.  This is temporary, and after stabilizing you would then taper gradually off of this.  There is some risk involved, but in your case, I think it would be reasonably safe to updose back to 12 mg Lexapro, because you only dropped to 11 mg a few days ago.  Give it at least a week, which is how long it takes for an updose to fully register in your system.  Then, if things are going OK, I would stay on this dose for a while, and allow your system to have a break, and get a chance to fully adjust to the drug changes.  Here is some information about reinstatement.  

 

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

 

You don't want to updose to much, because you probably have a sensitized nervous system from the fast taper, and this could cause you to get worse instead of better.  I've given you a lot of information, so let us know if you have any questions.  Please let us know how you are doing. 

[getofflex]

This post explains the issue of tablet weight versus weight of active ingredient in the tablet:  

 

Using a Scale to Weight and Measure Doses

[getofflex]

In your signature you said "2022 April Also trying to cut out alcohol (which escalated during 2021-2022)".  

 

Drinking, and any other mind altering substances can significantly impact withdrawal for the worse.  You will have a much easier time if you completely abstain from these things.  

[LRuthC]

Apologies, I didn’t realise that the uploading of my post must be delayed and waiting for approval when I couldn’t find it I had assumed I had done it incorrectly! I didn’t realise I had all these wonderfully helpful responses here!! You guys are gems. What a wonderful community. 

 

I’m going to haveto remember how to update my byline because things have changed significantly since my first post. My symptoms resolved, I didn’t end up reuptaking but I did end up sitting on 15mg for about 2 months and then tapering verrrry slowly and holding for 4 weeks. I sat on 5 mg for about 2 months as I tried to find a compound pharmacy that could sort me out with the liquid. Last week I arrived at 1mg 🥳 And 2 days ago I decided I was truly sick of it all and stopped the 1mg. I know, too quick- but I’m sooooo over it 😭

 

I have mild withdrawal symptoms. Lethargy, slight headache but it’s only day 2 and I know the full effect probably won’t hit me for another day or 2. I am considering this morning to just take my 1mg and then work out how to split it from there- half a drop?!? Seems tricky. I guess I’m looking for someone on here to say- don’t try to be a hero and quit now! Just split that 1mg!! 😅😅 Or just tell me that it’ll be okay… that I’ll probably get through it without going back to 1mg.  

 

Also, getofflex thank you for your comment re alcohol. You’re right, it was really messing me up. It was a slippery descent not long after I started Lex but I’ve since quit and haven’t had a drink for 7 weeks 🥳 I think the reduction of Lexapro has really helped me stop drinking… But I also took Revia (US brand name? Med name Naltrexone) for the first 3 weeks to deal with cravings. It’s been a lifesaver. So glad alcohol is out of my life. 

 

BTW, one nice side effect of stopping the 1mg altogether is not feeling like I need doxylamine to sleep- the lethargy that comes with quitting has meant I haven’t taken it in the last 2 nights. 
 

So, again, I’m on here for some support/opinion about this. Do I just suck up any effects associated with going from 1mg to 0? Has anyone else done this? And if I should go back to 1mg and taper from there, how do I reduce it further?

 

Thanks everyone!!

[ChessieCat]

3 minutes ago, LRuthC said:

I’m going to haveto remember how to update my byline because things have changed significantly since my first post.

 

Account Settings – Create or Edit a signature

 

Remember to click Save.

[LRuthC]

Thanks ChessieCat, signature updated 😊

[LRuthC]

So I’ve gone back to 1mg (had 2 nights on 0 as per my signature) and finding I still have side effects. I’m now thinking it’s from the 2 to 1mg drop more than anything. Would others agree? Or have other thoughts? It’s just an overall difficulty with motivation and general malaise, and loss of appetite. Its the same familiar feeling as my earlier (though greater) reductions. It’s crazy how sensitive our brains are to these meds!!
 

Anyway, hoping for some advice/support? How long should I hold on with the 1mg given others experience? I’ve read around and the last couple of grams do seem to be the trickiest. How do people start reducing beyond the 1 drop (1mg?). Is there any anecdotal evidence that if I hold the 1mg for a long time (I.e. 2 months) that going 1mg to 0mg would be easier (avoiding the <1mg dosing?)
 

Thank you!

[ChessieCat]

Q:  What in the mg you state in your drug signature, is it the dose of the drug or the weight of the tablet/powder you are measuring?

 

Escitalopram is a very strong drug.

 

SA's taper rate is no more than 10% of the current dose with a hold of at least 4 weeks to allow the brain to adapt to not getting as much of the drug.  Also, the generally suggested jump of dose is about 0.025mg for most antidepressants, but because of the high strength of escitalopram it might be a good idea to go lower than that before stopping.

 

I suggest that you go back and read the links that were provided earlier in your topic.

 

When to end the taper and jump to zero?

 

 

 

 

[LRuthC]

Thanks Chessiecat,

 

I tried to put more info in the signature so that it would be clear re weight which would have answered your question. When I was on tablets I was weighing it- although the scale wasn’t as accurate as some reported in on of the links. I’m in Australia, a little less wider range of scales perhaps?

 

so for example the May, June dosages were all by weight.

Once (mild) symptoms cleared I would reduce again. But now I realise that it was still too fast. I guess because my partner seemed to be able to get off them so rapidly I’ve felt silly taking it as slow as I have- in comparison- and feel like a hypochondriac when I show withdrawal side effects. My partner just now said to me, “I think you need to snap out of it, get off the couch and stop reading this stuff on the internet”

 

The last week I’ve gone down hill though, my withdrawal symptoms are undeniable and I can honestly say I can barely process the information provided in the links- and can’t collate and summarise it enough in my mind to work out what the smartest next step should be. I have a PhD, my brain usually works pretty well, it absolutely is not functioning at the moment. 
 

I have read through the links, but I still don’t know what decision to make. Last night I took 2mg (2 x drops containing 1mg). So have reinstated further up thinking I should not have rapidly dropped from 3mg and that 2mg might be a safe midway point reinstatement. And then.. I’ll just stay on that dosage until my mind hopefully clears (4 weeks or more) and I can figure out/sift through and process the information on here better. To anyone that bothers reading this- work out a plan, a strategy, the numbers in an excel sheet and how you’ll get it done (I.e. compounded) and don’t wait until you have withdrawal symptoms and your brain is so cooked you can’t even figure out how to rectify things. 
 

Please, if you think reinstating my 1mg to 2mg (in the drop liquid form) is unwise- please let me know.

 

Many thanks! 

[ChessieCat]

I think increasing to 2mg (but going to 1.5mg might have been a better option) is possibly a good idea because you have been reducing too fast.

 

When you are more stable and think more clearly you will need to try and work out how to get smaller doses.

[LRuthC]

1 minute ago, ChessieCat said:

I think increasing to 2mg (but going to 1.5mg might have been a better option) is possibly a good idea because you have been reducing too fast.

 

When you are more stable and think more clearly you will need to try and work out how to get smaller doses.

thankyou Chessiecat for your responses and insights. That’s what I’ll do! 
 

Fingers crossed these symptoms pass soon!

 

thanks for taking the time to help me out. 🙂

 

L

 

 

[ChessieCat]

You are welcome.

 

I think it would be a good idea to hold at 2mg for at least 3 months.  Now is the time to not be stressing of what to do, but to relax as best as you can and let your brain make the adaptations that it needs to make.

 

Non Drug Ways to Cope with Withdrawal Symptoms

[LRuthC]

Just now, ChessieCat said:

You are welcome.

 

I think it would be a good idea to hold at 2mg for at least 3 months.  Now is the time to not be stressing of what to do, but to relax as best as you can and let your brain make the adaptations that it needs to make.

 

Non Drug Ways to Cope with Withdrawal Symptoms

Okay, 3 months it is. And I’ll just focus on pushing through/recovering.

 

I’ve quit the booze completely so hopefully that will assist.

Not take benzo’s which I can take from time to time when I’m feeling particularly rotten.. I’ll stop.

I’ll start taking omega 3 

I do take vitamin D already
magnesium… maybe (I have IBS so it does a number on my stomach and I find the skin spray irritating!!) 

reduce my exercise to a lower tempo. I love a good workout but I think, from what I’ve learned here, that will need to be reduced to.. a walk? Should there be a heart rate I shouldn’t go over for example?

I heard someone on the “let’s talk about withdrawal” podcast yesterday mention Rescue Remedy as helpful. Perhaps I should try that too.
Maybe I need to rethink coffee although I love it. 

But I’m desperate and frightened of not being able to function at work- I’ve worked so hard over the years to get to where I’m at in my life and career! Would be terrible for it all to fall apart now 😭

[ChessieCat]

the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable

[LRuthC]

Perfect, thanks Chessiecat. I’ll follow this advice 🙏

[ChessieCat]

There are many existing topics on SA.  It's also a good idea to search on SA to see what other members have experienced.