Bp1961: Lexapro and Vyvanse withdrawal

[Bp1961]

What should I do next? I need a medication plan.

 

08/06/22

13:30 Feeling a little depressed and anxious. Tinnitus is there. Had some muscle sensation in the back of my head between the ears as I was eating. Took fish oil and reacted magnesium.

14:00 Went out with my wife. I noticed that at times when I get up or sit down fast or step up or down on a chair I get dizzy. Also, with any minor physical task I sweat a lot, a escitalopram side effect.

 

18:00 Had dinner with family and started feeling better although Tinnitus was there.

 

10:30 Took a "mindful" hot shower, it is so relaxing and therapeutic for me with the hot water hitting the head and I focus on all the sensations as the water makes contact with the body, I love it. Tinnitus started to go down...almost quiet.

 

11:00 fell asleep woke up at 1am bathroom run and fell asleep till 4.

 

08/07/2022

6:00 - 10:30 went back to sleep.

 

10:30 the tinnitus is there at lower level and I'm feeling better. 

 

 

I don't know what this all means, probably had a wave early yesterday and now another window.

 

When I went down to 15mg. I felt good for almost 3 days and then 1.5 days of a wave. 

 

What should I do next? I need a medication plan. Should I stay on 15mg? How long? Should I go down to 10mg or is it too late to go to 10mg? since I already took the 20mg for 2 weeks and now on 15mg for a week? 

[manymoretodays]

Hi Bp1961,

And thank you so much for the trial at NOTES/daily symptom and drug logs

What is missing are your drugs, as you'll notice when you take a look at the underlined link above.

And that's okay, you hadn't been asked specifically for those yet, or directed to the "how to" of doing those.

Putting those in will be crucial, time, drug by name and dose.  What we want to see are how your current WD or side effects/adverse responses are related to your present drugs.....we need to to see symptoms before and after you dose your drugs.  So, if you don't mind.......just do a redo of what you've done above, with all you had, and add in times for when you take your drugs, again.....on the left, then drug by name and dose on the right along with everything else you had already recorded.

You did fine.....just did not add in your drugs.

Also, please don't direct us to any google sheets or excel or anything to look at your NOTES when done with a few days......that gets time consuming, and I know Alto's time is limited when they get a chance to oversee and guide us all further with tapering input and information.  I know you didn't do that either.......I'm just being clear, as to what helps us all here.
Also, please scroll on up after you view that one post link about NOTES, and read from the beginning......Good stuff about before you begin tapering, what you need to know information.

2 hours ago, Bp1961 said:

I need a medication plan.

And okay, we aren't really here to help you with a medication plan per se, were a site for tapering off, or to the lowest dose possible of drugs.  Which is different from a medication plan that you might get and have been getting from a couple of psychiatrists and/or maybe a GP too.  We want to empower you and hope to teach you, and then help you manage the waves and windows.  And then become as drug independent as possible.  So if that is your goal, please stick around.

 

2 hours ago, Bp1961 said:

What should I do next? I need a medication plan. Should I stay on 15mg? How long? Should I go down to 10mg or is it too late to go to 10mg? since I already took the 20mg for 2 weeks and now on 15mg for a week? 

 

You went to Lexapro 15 mg on August 1st I see and read.  Today then marks day 6, as it's August 7th.  And yes, it might be possible to lower your dose further.  We need more information from you though.  And you are doing good trying to provide it.  Patience required.

Any improvement in the symptoms you were having, since the reduction?  Any worsening?  You can just summarize on that question.

 

You didn't really reinstate(not in any way that we would promote), rather you just completely remedicated  with full doses of both your drugs, so it's kind of hard to tell what is what.  Granted you had the Finasteride experience too, and effects from that.  I'm glad you are off it.  And ooh, that darn Covid too.  Lot's of factors at play now.

Anyway.....not to worry as ........I take it you are interested in learning more, and then perhaps tapering off completely someday.  

You've been treated with some pretty activating stuff for a long time now, and it'll take us a little time to get to know you too.......so just be patient with us please, and we'll do our best too meet your long term tapering needs.

 

Honestly......I think it's going to be a long haul, in any case, and so.......fasten your seat belt, and get ready.  Hone up on non-drug coping skills too.  I don't know what to point you to exactly right now, so I'll just direct you to the Symptoms and Self Care Forum 

Stick to some of the top pinned topics for now:  non-drug coping for emotional symptoms and neuroemotions are good ones that might shed some light on how you are feeling about now.  I'm guessing you want this all over and just fixed and back to life as it once was.  Unfortunately, like I said.......it may be a long haul.......but I think we can help you limit further psychotropic drug harm.

 

I had been reading, while signed out and found this, which may very much apply to your case so am sharing it here:

https://pharmaceutical-journal.com/article/ld/tobacco-smoking-and-its-potential-drug-interactions 11 January 2019, The Pharmaceutical Journal(the official journal of the Royal Pharmaceutical Society)

Scroll down to the psychotropics, then antidepressants after a read through of the basics.

* and unfortunately that's ^ not going to share in it's entirety.   I don't want to break any copyright laws.....I did share the pertinent excerpt below.  It has to do with the CYP450 isoenzyme metabolism system in the liver.  You might be able to get the whole article by just googling the topic yourself.  Tobacco smoking and potential drug interactions.

I was always able to maintain on just Lexapro 5 mg, as a smoker.  I'm like you though, now an ex-smoker- fairly recent BUT, take note of this passage from that article:

 A recent review of therapeutic drug monitoring data demonstrated a reduction in concentration/dose of amitriptyline, escitalopram and mirtazapine in smokers, even when age and sex variables were accounted for^[25]. Although the clinical significance of this remains unclear, it is possible that sudden smoking cessation may increase serum drug concentrations and increase negative side effects (rather than cause toxicity).

So....it is possible you are not going to need anywhere near the escitalopram/Lexapro you needed before.  Again......the clinical significance of this is still a little murky, and so.....non or ex- smokers don't get routinely dosed lower at this point in time.  It's only a "may increase drug concentrations" not a solid "will increase" in regards to your Lexapro/escitalopram.

I always wondered, and even though I'm all done with tapering and WD per se........I like this area of exploration.  Tapering, WD, and all of it really.  And geeze, the grass always sounds greener in the UK, where this journal originates.   I'm sure it isn't and it is often very hard for those undertaking tapering and WD to find in person support......just like here in the good old USA.

 

Congratulations on kicking the cigarette habit.......that is huge, as I well know!!!!  Are you using a patch or did you go cold turkey?  I'm still mini-patch dependent myself .  A step at a time.

 

And okay......welcome and good luck.  I'll look in from afar and see if and when I might be able to direct you to more information for your eventual empowerment and further tapering.

 

I'd say just HOLD for right now.  Get some complete NOTES done.  Answer my bolded question too.  Thank you.

 

Best, Love, peace, healing, and growth,

manymoretodays(mmt)

 

 

Edited August 7, 2022 by manymoretodays
checking my links, fixed typo to non ex smoker, and answer to members question

[manymoretodays]

Hi again Bp1961,

I wanted to give you the tips for tapering topics too, that we have available for Lexapro/escitalopram, and Vyvanse/lisdexamfetamine dymesylate.

I think that after you get comfortable enough with a dose of Lexapro/escitalopram- hopefully lower, then you could look at further tapers and begin to make a preliminary taper plan.  I'm guessing that's what you meant by a "medication plan".

 

From: Important topics in the Tapering forum and FAQ's

 

Tips for tapering Lexapro/escitalopram

Tips for tapering off Vyvanse(lisdexamfetamine dymesylate

 

Both ^ can be very helpful in figuring out how to get the non-standard doses needed to eventually do a harm reduction taper.

 

Also see:

Why taper by 10% of each previous dose

Taking multiple psych drugs? Which drug to taper first?

 

Read This First

I don't know how many do read it first, but it will help you to get an idea about our site here, survivingantidepressants.org.  And I always say all other psychotropics/psychoactives, as we deal with many, not just those classed as AD's(antidepressants) using the same principles.

 

And finally.....The rule of 3KI's: Simple. Slow. Stable.

 

I should have put those last 2 first.

Okay, plenty for you to look at, and I'm sure you are looking around the site some now on your own too.  Just ask, right here......as at this point we have all kinds of topics that we can direct you too.

 

Your immediate questions regarding your case too.......always go right here in your Introduction replies too.  

Welcome again.  I do so hope you'll take the journey to reduce your drugs/medications.  It's up to you really.

 

Love, peace, healing, and growth,

mmt

 

Edited August 7, 2022 by manymoretodays

[Bp1961]

@manymoretodays 🙏, I appreciate your time and thorough response. Going forward I will keep my notes as you requested (Short & to the point).

 

I quit smoking March 5th cold turkey. I also quit coffee cold turkey about 2 weeks ago. I think I read somewhere that caffeine can reduce escitalopram effect by 28% https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4715838/ so I may actually be able to further reduce my dose.

 

As for my meds, I take them at 7:30 am religiously every day. 

My drug signature is accurate. Other than I take fish oil and reacted magnesium as well.

escitalopram - 15mg (per Alto suggestion).

Vyvanse - 50mg 

 

Since I went down to 15mg (August 1st), I felt the positive effect almost immediately and things gradually progressed getting better. I had a wave that started Friday, August 5 at noon and lasted till Saturday, August 6 at 5pm. Today I'm feeling good, even very good and the Tinnitus is at 1-2 out of 10.

 

I would just like to minimize my dependency on these poisonous drugs as much as possible without suffering if it's at all possible. Meaning that If I go to Zero and I start feeling like I felt the last 4 month and it lasts long I rather take a 0.05 to 1.00mg and live happy.

 

So if I can go to 10mg now for 1 month and then to 5mg, that would be great. Since I tapered 2 years ago from 20mg to 10mg and a year later from 10mg to 5mg and had NO side effects and 5mg was the last dose I was on before stopping CT.

 

Once again, thank you @manymoretodays for reaching out to help me. You guys are all just incredible human beings for doing what you're doing to alleviate the pain caused by the pharma criminals and their MD drug pushers psychiatrists and clueless GPs.

 

 

 

 

[Altostrata]

Happy belated birthday, @Bp1961

 

Thanks for the daily notes. To see what the escitalopram dose is doing, we need to see how you feel before and after a drug dose. Please include the time o'clock of your drug doses in your daily notes. Your sleep pattern is also helpful.

 

It takes about 4 days for an escitalopram dosage change to take full effect. Your plasma level of the drug has descended to the 15mg level. You may be feeling some slight withdrawal effects from the dosage change. This should go away in a few days. Please continue your daily notes, then we'll figure out next steps.

[Bp1961]

Daily log: August 7-8, 2022

 

15:30 I was feeling good. So I did DIY work on the house that I was putting off for some time (cleaning gutters 30ft high in the heat).

17:00 I think I over did it. Lost a lot of liquid. Ate watermelon. Tinnitus spiked to 4-5/10 (sugar and overexertion). 

17:30 Took a shower.

17:45 meditation (20 min.) Dog barking triggered a spike in tinnitus 😒 

18:15 Ate a snack tinnitus calming down.

19:30 dog barking again trigger spike in tinnitus. A little headache.

20:00 dinner 

20:30 took probiotics, and reacted magnesium.

22:00 going to sleep on the couch in the living room. head buzzing/hissing. Clearing of throat ticks... annoying but I will A-A-F.

00:00 woke up Tinnitus loud and tingling sensation in the top left part of the head.

03:00 woke up tinnitus loud...and fell back asleep.

05:00 woke up tinnitus loud...stayed partially awake & light sleep.

06:05 woke up. According to my Fitbit I slept 7 hr. 5 min. (Deep sleep-1hr. 3min; REM-1hr. 14min; light sleep: 4hrs. 48min; awake-1hr. 7miin). Doesn't feel liked it. Tinnitus is high at 5-7/10.

07:30 Day 8 of 15mg escitalopram. Plus 50mg Vyvanse. Overall feeling ok under the circumstances. No anxiety or depression.

08:30 feeling a little jittery might be anxiety in disguise, tingling sensation in the brain in the same spot as usual (too left side of the head straight line above the left ear). Hissing sound in the ears.

08:45 breakfast plus fish oil & reacted magnesium.

09:15 Shower (my favorite activity lol). Hissing ears seem one notch down...but loudness varies between ears.

10:00 Appointment with clinical psychologist. Tinnitus around 4-5/10

[Bp1961]

Is it too late for me to go down to 10mg Escitalopram? Have been on 15mg for 8 days now.

 

Feeling jittery, worsened mood and a headache this afternoon. My tinnitus level is high at 6-7/10.

 

 

Thank you!🙏

 

 

[Altostrata]

You're taking 50mg Vyvanse at the same time you take 15mg escitalopram, 7:30 a.m.?

 

Have you read up on the adverse effects of Vyvanse?

 

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

 

 

[Bp1961]

Yes @Altostrata I've been doing it for the last 10 years and never had a problem that I could tell. Was never told not to take them together (which doesn't surprise me with these clown doctors).

 

Link to Drug interactions

[Altostrata]

You can see the major interaction. Going through withdrawal can make you more sensitive to this adverse effect.

 

Why did you reinstate Vyvanse? After you quit in April, did you have withdrawal symptoms from it? Why was it prescribed?

[Bp1961]

@Altostrata It was >10 years ago, supposedly ADD. If I can remember I told the doctor then that Lexapro makes me sleepy so he thought that Vyvanse would work well together. I had no clue what I was getting myself into. 

 

I reinstated Vyvanse because I was suffering from the withdrawal and thought that the best way to reverse it was go back to what I was on before I CT'ed and do a reset.  I had no one to consult with. I Got a physical in May and 2 GPs that knew my drug history had no clue that I was going through withdrawal. Actually one prescribed me with 5HTP and 30mg duloxetine hcl (I took it 1 day and stopped).

[Altostrata]

After you quit in April, did you have withdrawal symptoms from it? 

[Bp1961]

@Altostrata It all happened at once and so fast. In other words I can't tell what triggered the withdrawal symptoms. Or which specific symptom was triggered by which event. 

 

1 Post Finasteride Syndrome (PFS).

2. Quitting smoking after 30+ years.

3. CT'ed escitalopram and Vyvanse after 10 years.

4. Getting COVID in June (I was triple vaccinated).

 

I went to 2 GPs and neither one could tell me what's going on. I had to figure it on my own. I think my situation snowballed as I would research and try to figure things out. It was all very confusing and overwhelming. Not to mention I felt frustrated and helpless that the doctors are clueless.

 

My wife tells me that I started showing signs of anxiety in Early April. At that point I already quit smoking, figured out that I have PFS and quit Lexapro. I quit Vyvanse towards the end of April.

[Altostrata]

What effect does Lexapro or Vyvanse have on your sleep? I would like to see you move one or the other drug later in the day, by several hours.

[Bp1961]

@Altostrata I did as you requested. I was afraid to change the time for the Lexapro so I changed the Vyvanse and here is how it went:

 

August 8-9, 2022 (Continued from post 08/08/22 at 11:34 AM):

 

11:00 Feeling jittery, somewhat anxious and a headache

12:00 Went to the office, mood was low and tinnitus high (6-7/10)

16:00 Tinnitus Still high

17:45 Meditation 30 minutes

19:45 Ate dinner tinnitus started to calm down.

20:45 Took probiotics and reacted magnesium. Tinnitus lower at 2-3/10 feeling ok.

21:00 Took a shower.

22:30 Went to sleep

23:45 Woke up -> bathroom -> fell back asleep

03:00 Woke up -> bathroom -> fell back asleep

06:58 Woke up. Total sleep 7hrs & 29min (Deep sleep: 1hr & 3min; REM: 1hr & 51min; Light sleep: 4hrs & 35min; Awake: 51min). Tinnitus at 2-4/10

07:30 Took 15mg escitalopram.

08:08 Feeling tired. brain tingling sensation at the usual spot (Top left side of the head straight line above the left ear)

08:15 Went back to sleep 

09:50 Woke up feeling a little tired. Tinnitus a little higher at 3-5/10 (Tough to say if the noise is coming from the head, ears or both). A little jittery but definitely much less than when taking both drugs together).

10:00 Took a shower. 

10:45 Ate breakfast (Oat meal with banana, strawberries, blueberries, nuts and honey). 

10:50 Took the 50 mg Vyvanse.

11:30 Went to the office, mood down.

12:58 Slight headache and tinnitus at 4-5/10.

13:00 Took reacted magnesium and fish oil

14:00 Started to feel better al of a sudden. Focused, able to concentrate and even banter with my team. Tinnitus at 3-4/10

14:53 I'm Feeling GOOD! Tinnitus still there 3-4/10

 

It appears that taking the drugs at different times may be a good approach (Another great call by our master Alto). I'm wondering if I should have taken the Vyvanse first and the escitalopram later. Maybe even take the escitalopram at 7:30 PM since it definitely make me sleepy. Maybe if I go down to 10mg escitalopram my tinnitus will go down.

 

I have an appointment with psychiatrist #1 on August 11. Hopefully we can have a next 30 days plan.....

 

 

🙏🙏🙏

 

 

 

[Altostrata]

If the escitalopram makes you sleepy, it would make sense to take it later and Vyvanse earlier, Vyvanse being more likely to interfere with your sleep.

 

How did the pattern of your tinnitus change when you moved the Vyvanse later?

[Bp1961]

The tinnitus appears to be a bit lower, not much. It might be a function of the dosage!?

 

I will switch them tomorrow the Vyvanse at 7:30 and Lexapro 10:30. I hope it works because it will be 22 hours between the doses for the Vyvanse and 26 hours for the Lexapro. Then I will start pushing the Lexapro 1hr later every week. And see if I can get an optimal time separation between the two.

 

🙏

[Altostrata]

That sounds like a good plan.

[Bp1961]

August 9-10, 2022 (Continued from post 08/09/22:

 

19:00 Meditation (30 minutes) tinnitus low at 2/10

20:00 Dinner + Reacted Magnesium and Probiotics 

21:00 Shower 

23:00 Went to sleep 

02:00 Woke up -> bathroom 

03:00 went back to sleep

05:00 Woke up Total sleep 5hrs & 17min (Deep sleep: 47min; REM: 1hr & 2min; Light sleep: 3hrs & 28min; Awake: 46min). Tinnitus low at 2/10

07:30 Took 50mg Vyvanse. Was feeling good and no impact after taking the drug. tinnitus 2-3/10

08:30 Had breakfast, tinnitus remained calm at 2-3/10

11:00 Took 15mg escitalopram.

12:00 Went to the office, tinnitus started spiking significantly.

13:30 Headache and tinnitus spike to 6-7/10

15:44 Tinnitus still high at 5-7/10

 

@Altostrata It appears that taking the Vyvanse later does affect my sleeping. I'm hoping that I can take the Vyvanse down to 40mg soon. It also seems that the escitalopram is the main culprit to my headache and tinnitus. 

 

 

 

 

 

[Altostrata]

4 minutes ago, Bp1961 said:

It also seems that the escitalopram is the main culprit to my headache and tinnitus. 

 

This is possible, though your symptom pattern today may be from the schedule change. Please settle on this schedule for a few days, keep posting daily notes so we can see what's going on.

 

It's also utterly stupid to prescribe a stimulant with an antidepressant due to probable drug conflicts. I believe I see other signs of this.

[Bp1961]

59 minutes ago, Altostrata said:

It's also utterly stupid to prescribe a stimulant with an antidepressant due to probable drug conflicts. I believe I see other signs of this.

 

May I ask you why don't you think that in my case it may be appropriate to reduce the escitalopram to 10mg? I'm just trying to educate myself.

 

I'm sure I'm not the only one being prescribed this combo. It did work well for me for 10years until I CT'ed @Altostrata with your vast experience, I'm sure you've seen that done many times, no?  

 

🙏

[Altostrata]

7 hours ago, Bp1961 said:

May I ask you why don't you think that in my case it may be appropriate to reduce the escitalopram to 10mg?

 

Reducing escitalopram is probably a good idea, but do you want to cope with possible withdrawal symptoms on top of tinnitus from your drug-drug interaction, or would you rather diminish this adverse effect before creating other complications?

[Bp1961]

@Altostrata my thinking is that the Tinnitus maybe caused by the 15mg escitalopram and maybe reducing it may eliminate the Tinnitus.

[Altostrata]

Yes, it's possible your tinnitus is caused by Lexapro, but we need to see more daily notes to confirm this.

[Bp1961]

August 10-11, 2022 (Continued from post 08/10/22):

 

17:55 Not feeling good. Headache and head/ears hissing at 7/10. Difficult concentrating (I think it's referred to as brain fog).

18:22 Headache/brain fog and tinnitus are easing up a bit.

19:00 Meditation (30 minutes).

20:15 Ate dinner. Tinnitus hissing high at 7/10.

21:45 Tingling sensation in the head usual spot.

22:00 Shower -> took Ashwagandha 1000mg & Reacted Magnesium.

23:00 Went to sleep.

00:22 Woke up -> Bathroom -> went back to sleep

02:55 Woke up -> Bathroom -> went back to sleep

05:43 Woke up -> Bathroom -> went back to sleep

07:00 Woke up (Slept total of 8 hour - it was a good night sleep) Tinnitus was hardly noticeable at 1/10).

07:30 Took Vyvanse 50mg

09:00 Had breakfast + Reacted Magnesium + Fish Oil. Tinnitus still low.

11:00 Feeling good no strange sound in the head for once.

11:05 Took 15mg escitalopram.

11:10 Started feeling minor fogginess/headache and twilight sounds -> tinnitus at 1/10

11:30 Ear pressure and tinnitus at 3/10 with slight headache.

11:35 Tinnitus subsiding.

11:50 Twilight Sounds, tinnitus at 1-2/10.

12:20 Quiet

13:15 Low twilight noise in the head on and off until now at 17:00

 

@Altostrata I think it's getting better...will keep my fingers crossed.

 

 

🙏🙏🙏

 

 

 

[Bp1961]

August 11-12, 2022 (Continued from post 08/11/22):

 

19:30 Ate dinner. Hissing noise in the ears at 4/10

20:00 Meditation 30 minutes

21:00 Shower

23:30 Went to Sleep

01:45 Woke up -> Bathroom -> went back to sleep

05:25 Wake up. Feeling tired but congested and low hissing sound in the ears kept me up. Total Sleep time ~6 hours (Deep Sleep: 32 minutes; REM: 58 minutes; Light Sleep: 4hrs & 31 min; Awake: 53 minutes)

07:30 Took Vyvanse 50mg.

09:00 Tinnitus is up a bit to 3-4/10

10:00 Breakfast + Reacted magnesium. Tinnitus/hissing sound right ear (RE: 4/10), left ear (LE: 1-2/10)

11:30 Took fish oil and went to the office. Tinnitus/hissing sound right ear (RE: 4-6/10), left ear (LE: 1-3/10). Feeling down with some anxiety (probably caused by the relentless hissing in the ears).

12:00 Took escitalopram 15mg.

16:45 Hissing sound continues until now at 5-7/10 I get the special stereo treatment (i.e. in both ears).

 

I don't know, maybe I'm in a wave since yesterday late afternoon. We'll just have to move forward and hope for the best!!!

 

 

[Bp1961]

I just read that sinus congestion is a Lexapro side effect. That explains why all of a sudden I feel congested (mostly at night). @Altostrata I was on 5mg escitalopram for almost a year before I CT'ed. Prior to that I was on 10mg for a year. When I tapered from 20mg -> 10mg -> 5mg, I didn't experience any withdrawal. Is it possible that if I go down to 10mg I won't experience withdrawal. After all, I'm still suffering from the Tinnitus and maybe, just maybe the 10mg will help stabilize me. Since due to my stupidity for jumping to 20mg didn't help stabilize. If it wasn't for you, I'd probably still be on 20mg or dead from serotonin syndrome.

 

🙏🙏🙏

 

 

[Bp1961]

I'm really confused between withdrawal and reinstatement symptoms. They seem similar in how they make us feel. 

My understanding is that reinstatement after CT, depending on the length of time and how it was reinstated may have varying results. The question is at what point do you conclude that what you're doing is not working and something else needs to be done?

Before I abruptly discontinued my meds I was on 5mg escitalopram and 50mg Vyvanse. My understanding was that to reinstate properly you have to return to the dose you were on before discontinuation. Unfortunately, I found SA later in the process. Initially I did reinstate escitalopram at 5mg, but my withdrawal symptoms were unbearable. So after a few days I increased the dose to 10mg. I didn't realize that I just needed to give it more time. When the 10mg didn't work after another few days I saw a psychiatrist, who really wasn't experienced in withdrawal and reinstatement. When I suggested that maybe I should go back to 20mg he agreed. I started feeling really bad, with severe side effects. It was a mistake!!!
That's when I found SA and Alto immediately realized that my dose of escitalopram was too high and suggested I reduce to 15mg which made me feel much better. I'm just wondering at what point can I go down to 10mg (which is probably still going to be high, since I was on 5mg before I CT'ed)? Also, is it possible to split escitalopram and take 10mg at 12pm and 5mg at 10pm?
 

[Bp1961]

 

August 11-12, 2022 (Continued from post 08/11/22):

 

20:00 Had a small dinner (bowl of beans & rice). 

21:00 Took reacted magnesium. Tinnitus on the high side 6-7/10 with ear pressure congestion.

22:00 Took a shower (I also use sinus rinse with saline to help with my congestion).

23:30 Went to sleep (Using sound machine).

12:30 Woke up -> Bathroom -> went back to sleep

02:35 Woke up -> Bathroom -> went back to sleep

04:00 Woke up -> Bathroom -> went back to sleep

06:40 Woke up -> Bathroom -> went back to sleep (Tinnitus was low at 1-3/10. Hearing more of twilight forest sounds rather than the high pitch/high frequency tone).

07:45 Woke up. Total sleep 7 hrs. and 25 min. (Deep Sleep: 50 minutes; REM: 1 hr. 28 minutes; Light Sleep: 5hrs & 7 min; Awake: 58 minutes).

07:55 Took Vyvanse 50mg (Always feeling anxious before putting these psychiatric pills in my mouth).

08:45 Was starting to feel a little anxious as tinnitus volume started to spike.

09:00 Meditation (30 minutes. couldn't get into it as thought were racing). Tinnitus at 5-6/10 with tingling sensation in the brain (The usual spot - Top left side of the head, straight line above the left ear).

09:30 Sinus and ear congestion easing and feeling less anxious, tinnitus volume at 3-4/10.

10:00 Meditation (2nd try 30 minutes, this time it was better). Tinnitus at 3-5/10.

10:40 Took Reacted Magnesium.

11:20 Breakfast. Tinnitus up to 5-6/10. Feeling a little anxious again. Apprehensive about doing any type of outdoor activity out of fear of getting anxiety and tinnitus spike.

12:10 escitalopram 15mg + fish oil.

12:50 Feeling more at ease.

13:30 Was feeling better so I decided to do some yard work for 1:30 hours in the heat. Got tired fast and out of breath. I felt the brain was on overdrive with multi-channels of neurotransmitters firing at once. Overdid it again. I really don't know if and what kind of physical activity I can/should do. I need to exercise, it's healthy, no!?

15:00 Tinnitus spike to 5-6/10

16:00 Took a shower. Feeling better, tinnitus at 5-6/10

 

I'm confused, don't know what's going on, what to expect, what's the plan for getting better.

 

 

 

 

[Bp1961]

August 13-14, 2022 (Previous note should have been August 12-13,2022)😞

 

17:00 had light dinner (rice and beans again).
19:00 Tinnitus high at 6-7/10 both ears with slight headache .

22:00 Took reacted magnesium. Spent the evening on SA and tried to find and information on CT reinstatement and what to do if I you reinstate like I did. Can I lower the dose or is it too late. Couldn't find anything.

23:50 Went to sleep. Tinnitus at 3-5/10 and headache.

04:18 Woke up tinnitus 6/10. Total sleep 4 hours & 10 minutes (Deep sleep: 25 min.; REM: 1 hour and 1 min.; Light sleep: 2 hours & 44 min.; Awake: 18 min.).

Woke up with light cold sweat and shortness of breath. Pacing around the house for an hour tapping on the back of the head and trying to fill my lungs with air. Eventually settled on the couch on the phone and trying to get some rest.

08:15 Took Vyvanse 50mg. Tinnitus at 6/10.

08:30 Went back to sleep.

10:29 Woke up.

12:00 Took 15mg escitalopram. I was so tempted to take only 10mg but I couldn't do it without  @Altostrata agreeing that it would be the next best course of action. 

Tinnitus at 6-7/10.

13:30 Lunch +reacted magnesium and fish oil. Tingling sensation in the usual spot in the brain. Tinnitus at 4-6/10.

 

I'm feeling depressed. I think I might be spending too much time on SA waiting for an acknowledgement to my questions, some support and advise. When I get non it makes me more anxious. Feeling lonely in this fight. I understand that there are so many of us here desperate for answers and every one here is doing their best to support each other and survive.

 

I'm not motivated to do anything. I can't even watch TV and I used to love watching TV. I have difficulties having a conversation and I'm afraid to exercise because I'm afraid all these activities will agitate my nervous system and make my Tinnitus and headache worst. I need to stop feeling sorry for myself, be strong, snap out of it, darn it.

 

 

P.S. I quit smoking and coffee.

 

@Altostrata @manymoretodays

 

 

 

 

 

 

[manymoretodays]

Hi BP1961,

Hold steady now with your doses.  

You've got the Vyvanse 50 mg at 7:30 to 8 a.m.

Lexapro 15 mg at the noon hour. 

Stay put with those times for right now, okay?  You've had just a couple days now with the Lexapro at noon.  And yah.....I know, it's tough to wait when you want to find a change that makes you feel all better, even for a partial window time.......but if any real pattern is going show up.......while there is no change in drug dose, or time........it's going to take that good old 4-7 days I expect, so hang tight.

For all I know, tomorrow may be a good day, after good sleep.

 

Can you post the whole day from morning to night all at once, rather than the overlap of days?  I've got some visual difficulties, but it is also harder to follow with the overlap.

 

I don't see an advantage to you splitting your Lexapro 15 mg dose into 10 mg at noon, and then 5 mg later in the day.  At this point, you should getting a nice steady state of your Lexapro, as it's fairly long acting and not usually split.  So I don't see any advantage to splitting your dose now.  And then furthermore, we'd have to wait out that change before making another.  Are your night wakings increased now?  Taking your Lexapro too much later in the day might interfere further with your sleep is my thinking right now.  You aren't reporting that it's making you tired anymore.

 

On 8/13/2022 at 10:20 AM, Bp1961 said:

I'm really confused between withdrawal and reinstatement symptoms. They seem similar in how they make us feel. 

 

Maybe the better question is, is it WD or adverse effects from one, or the other, or the combination of your drugs.

I'm guessing a little bit of both, and I too, would like to see how it goes eventually with a lowered dose of one or the other of your drugs.  

Let's give it the time though........doses same, time taken the same..........4-7 days........and until Alto peeks in again.  

Do the daily note posting with the full day too, as I mentioned above.  It'll help with interpretation of your Notes.

 

What are you working with at present?

Meaning:

What form and strength do you have of each of your drugs?

Look at the topics for tapering and get a feel for how you might, sometime soon........make changes that might be less than 5 mg or 10 mg.  Just take a look for now, at both tapering topics. (hint: the links are in one of my last posts to you), with an eye for how you might make any reductions that might be less than 5 mg or 10 mg.  Good to get familiar before you begin.

 

I think you are doing just great BP1961........this is definitely not a strength competition or anything and is really tough.  Sorry to hear that you've shifted into a bit of the downs today, and t.v. is tough too.......it can be such a nice soother sometimes.  Just know a day is not a pattern at this point, and I think your patience with us and self will pay off BP1961.

I know I'm being elusive and just want to encourage a couple more days.......same dose and time of your meds/drugs.

 

And keep reporting those NOTES.  You've been a champ with that.

 

L, P, H, and G,

mmt

 

 

[Bp1961]

Hi @manymoretodays,

 

You don't know how much I appreciate your response, advise and support. I feel fortunate, you're GREAT!!! Thank you!!!

• I will start keeping my logs on a daily basis, I can see how it can be hard to follow.
• I will also keep steady with the medications until you tell me otherwise. Like I said before and I'll say it again, there aren't too many people on this planet who know this subject better than the SA Team.
• I don't think the Lexapro/Escitalopram adversely effect my sleep, unless it's the culprit to my tinnitus, which is a major trigger for my anxiety and my anxiety spikes my tinnitus (A vicious cycle). Last night, even though I slept only 4+ hours, I think it was the first time in a while that I slept 4 hours straight without waking up. I did manage to put a couple of hours more a little later.
• For example right now my Tinnitus went down to Left ear: 1-2/10 & Right ear: 2-4/10. So all of a sudden I'm feeling happier. But I'm afraid to move...because I don't want it to spike...LOL.
• As for the tapering instructions, I read them. They seem complicated or it's just my brain on WD from AD. The conversion, weighing, diluting seems confusing and I'm afraid to screw up the dosage. I need to study it carefully and maybe do some dry runs to see how it goes. I think the Lexapro in liquid form will be easier to manage. The Vyvanse, I'm a little afraid.

Thank you again for your reassurance and support, you're a treasure!

BP

 

 

[Altostrata]

As explained before, we have to see the result of every drug change over some days.

 

Please take Vyvanse and escitalopram on the same schedule every day. When you are in the midst of a drug change, even an hour or 2 off-schedule can make a difference in symptom pattern.

 

It seems likely your tinnitus is due to an interaction between escitalopram and Vyvanse. Suggest you reduce escitalopram to 12.5mg. We will need to continue to see your daily notes.

[Bp1961]

August 15, 2022-Monday:

03:20 Woke up. Tinnitus RE 3-4/10 LE 2/10

05:30 Woke up. Tight chest, shortness of breath. Tinnitus LE 1/10 RE 2-3/10

07:58 Woke up. Total sleep: 7 hrs. & 42 min (Deep sleep: 52min; REM: 1hr & 32min; light sleep: 4hrs & 16min; awake: 1hr & 2min).

08:00 Took 50mg Vyvanse. tinnitus is low, LE 1-2 RE 3-10

09:00 reacted magnesium

09:15 Tinnitus LE 0-1/10 RE 1-2/10

10:00 meet with psychologist

11:30 Go to the office.

12:00 took 12.5mg escitalopram

15:45 Tinnitus is at LE: 2/10 RE 5-6/10. Overall I don't feel any significant change from yesterday.

17:45 Started to get some shortness of breath followed by some anxiety or worry about why am I having shortness of breath? Is it anxiety? Is it COVID? Did I develop COPD 6 monts after quitting smoking? Feeling a little congested..

Tinnitus higher LE 3-4/10 RE 6-7/10

18:00 Went home. 

19:00 Relaxed a bit tried some breathing exercises. Breathing a bit better, probably anxiety.

20:00 Ate dinner+ reacted magnesium.

20:00 shower, tinnitus LE 2-3/10 RE 2-3/10

23:00 Going to bed... good night.

 

[Bp1961]

August 16, 2022-Tuesday:

 

01:20 Woke up -> bathroom -> back to sleep. It was the first night in a few months since I slept in my bed. Tinnitus volume is high. 5-6/10

03:45 Woke up -> bathroom -> back to sleep. Tinnitus volume 4-5/10

05:56 Woke up in sweat -> bathroom. Twilight noises in the head. Feeling worried. Shortness of breath but able to eventually catch my breath, congested. Left hand wrist is hurting 🤔

Total sleep: 6 hrs & 9 min (Deep sleep: 22 min; REM: 49 min; light sleep: 4 hrs & 58 min; awake: 48 min).

Tinnitus LE 1-2/10 RE 3-4/10. It appears that it's at its lowest at this time of the day.

08:00 Took Vyvanse 50mg.

Tinnitus LE 1-2/10 RE 3-4/10. It appears that it's at its lowest at this time of the day.

09:00 took reacted magnesium + fish oil

09:45 Meeting with psychiatrist #2 got prescription for escitalopram liquid form.

Tinnitus 1-2/10 both ears.

10:45 Went to the office. Feeling better Tinnitus at 1-2/10

11:30 Feeling better Tinnitus at 1-2/10

12:00 Take escitalopram 12.5mg.

15:00 Feeling better tinnitus at 2-4/10

19:00 Went to group meditation but had a difficult time the first 15 min I was out of breath, almost wanted to get up and leave, but I really didn't want to ruin it for the rest of the group so I forced myself to do breathing exercise 4-7-8 and got it under control.

08:15 Was feeling pretty good throughout the day, had good mood. The Tinnitus appears to starting to go down it's still there but feels different, lower volume but higher tone. The tingling sensation that I usually have in the brain is very mild and hardly noticable most of the time.
08:30 dinner 

22:00 shower. tinnitus low 1-3/10

22:30 Reacted magnesium. Feeling the tingling sensation in the brain (top left side of the head). Tinnitus. On the high side 4-5/10.

23:00 Going to bed... good night ✌️

[manymoretodays]

Hi there BP1961,

With your liquid escitalopram, for now you could take 10 mg of solid medication and then add 2.5 mg of the liquid medication to get your current total dose of 12.5 mg.

Don't do a complete switch from solid to liquid quite yet, but you could certainly do the 2.5 mg portion of your present dose with liquid.

 

Good Lord, are you still meeting with 2 psychiatrists?  Maybe a some point you'll be able to tell them firmly what your experience with rapid WD and full reinstatement was like.  

And you felt better after your appointment yesterday......so maybe they are supportive to you too.  You'll be at a place to let them know your experiences pretty soon and can help us all too, right?

 

We recommend a cross over to liquid and I'll give you the link for that.

https://www.survivingantidepressants.org/topic/25691-cross-over-changing-form-eg-tablet-to-liquid-of-drug-or-changing-brand-of-same-drug/

 

Okay.

Yeah, 12.5 mg escitalopram!  May it go well.

 

L, P, H, and G,

mmt