Grind80: tapering Lexapro

[Grind80]

Grateful to have found this site. I have a similar story to many in here. I was put on Paxil for anxiety at age 25 in 2005 when I went to a treatment center for alcohol and drugs.
 

I have been sober since then but have had a major battle with ADs - I have tried to come off 5 or 6 times with no success. I am now learning through the information on this site that I was tapering too quickly. 
 

I am only a couple of weeks in but I am really struggling with restless leg syndrome at night. I would love to hear from anyone who has experience with this. I am tapering from 15mg at a rate if 10%.. currently on 13.5mg. Thank you!

[Onmyway]

35 minutes ago, Grind80 said:

Grateful to have found this site. I have a similar story to many in here. I was put on Paxil for anxiety at age 25 in 2005 when I went to a treatment center for alcohol and drugs.
 

I have been sober since then but have had a major battle with ADs - I have tried to come off 5 or 6 times with no success. I am now learning through the information on this site that I was tapering too quickly. 
 

I am only a couple of weeks in but I am really struggling with restless leg syndrome at night. I would love to hear from anyone who has experience with this. I am tapering from 15mg at a rate if 10%.. currently on 13.5mg. Thank you!

Welcome to SA @Grind80

So sorry you've been struggling with Paxil. Given your history of multiple drugs/psychoactive substances dependence it's possible that you are kindled. You may need to go slower than 10% a month. I can only do 3-5% myself. The point is no matter how slow, you will keep making progress. Look up also BrassMonkey's method of microtapering.

 

At this point the best thing is to wait and see how this goes on. What are your symptoms? 

 

One thing that people find helps with restless legs is a weighted blanket. 

[Grind80]

Thank you so much for your quick response. This has been such a struggle.

 

I have changed my meds/doses several times in the last 2 years. I kept my description succinct because I honestly can’t accurately remember the timeline and wanted to post the most recent/pertinent information. Also my apologies if I haven’t followed the site’s format perfectly.

 

My failed attempts at tapering in the past culminated with panic attacks that rendered me unable to work. Going back on meds was the only option presented to me by psychiatrists. When I am on meds I have very little energy/creativity/emotion. 
 

I have actually felt decent after coming down to 13.5mg, however after about a week the restless leg when trying to fall asleep creeps in and prevents me from getting to sleep at a decent hour, which obviously makes me completely exhausted during the day.

 

[Onmyway]

@Grind80, 

if so far the restless leg is your only symptom, I think it is worth waiting it out rather than updosing. Not to minimize how disruptive that is (I had it briefly) and how much it can impact us. I think of it as  a smaller version of akathisia so it is definitely a warning sign to be careful in tapering. In the grand scheme of how much worse it could be, having seen so many experiences on these boards, it seems like you are doing relatively OK, but please watch out and see how this develops. As you start tapering you are learning your body's reactions and patterns. It may be worth tracking symptoms on a scale so you know what happens. As an example, in the first week after lowering a dose I am unusually calm and happy, then the physical symptoms and insomnia start and then the emotional ones (agitation) and week 4-6 I am hit with really bad emotional symptoms. Others have different patterns. I am now doing a very slow micro-taper with long holds when symptoms ramp up - I go by 0.2-0.25% a day for no more than 20 cuts (usually much less) a month but stop often by watching my symptoms (an internal restlessness/familiar nausea/rumination/insomnia/anger&irritability/extreme fatigue - everybody differs here). Mark Horowitz (the doc who publishes on WD) says that micro-tapers are not advised but I am not sure why that is. I suspect it is because it makes it harder to tell things are getting worse before they accumulate. 

 

Having said all that, patterns also change during withdrawal, lower doses are harder, stress happens and we need to adjust. So for the foreseeable future you need to be a you-observer, respecting your body and being attuned to it but not crossing the fine line into being obsessed with the symptoms (though we all go into that occasionally, especially in the beginning so if it happens to you not the end of the world). So body observer but not symptom detective. 

 

I am digressing. What I wanted to say is - you seem to be doing ok and doing the right things educating yourself ahead of time and being careful. We have seen so many people who have tried unsuccessfully to come off of their drug do it with slow tapers with minimal symptoms and come through the other end. 

 

If you haven't read this year, have a look at these threads: 

OMW

PS. No worries about the details of the signature - it is to help us gauge how the drugs worked/didn't work, what side effects they had, how often they changed in terms of type/dosage, how many different kinds of drugs were there etc. and how kindled/disrupted the nervous system could be. The details of each drug are not important.

Edited August 2, 2022 by Onmyway
posted before I could add links

[Grind80]

Wow I am so appreciative for the feedback and support. Thank you!

 

It has been about two weeks on 13.5mg and I think it was too big of a jump down. This morning on the way to work I had the beginnings of a full panic attack.. lunch break now and feeling a bit better but not great.

 

I was actually on 20mg lexapro for a month or so before I had jumped down to 15mg before I started the 10% taper method.

 

I will try 15mg for a month. Does that sound like a reasonable fix?

 

 

[Onmyway]

Hi @Grind80

It may be worth waiting it out instead of changing again. The brain likes stability. If you can bear the current symptoms, I'd suggest that you stay here for a couple of months instead to let your brain catch up.

 

IF things get really bad you can updose to 14 maybe. Remember the brain has already made adjustments.

 

How does that sound?

OMW

[Grind80]

I almost had to turn around and head home this morning due to the panic. Not sure if I can risk trying to wait it out.. I feel I likely underestimated the effect of having been on 20mg even if it was only 6 weeks or so. 
 

This is a bummer

[Onmyway]

Hi @Grind80

I'm not suggesting you tough it out for the sake of toughing it out but because with an increase there is a risk of things getting more dysregulated. Why don't you try just 14mg first. It takes about a week to feel the full effect of reinstatement.

 

But, one thing that you will need to learn during WD is not to be scared of your emotions. (It was the biggest lesson for me!) You can diffuse an anxiety attack by not being afraid of the anxiety itself and not getting anxious about getting anxious.

 

Look up Claire Weekes'methods as well. Because even mild withdrawal will be unpleasant and you will often have to say to yourself: 'this is withdrawal' it will pass. It is a Neuro emotion that doesn't have a deeper meaning than the fact that my brain is doing some healing. 

 

I know it's easier said than done but lots of these skills serve people who come through withdrawal very well afterwards. 

 

[Grind80]

@Onmyway

Thank you so much! I have been on 13.5mg for the last few months and am doing better all time. Got married and started a new job last week.. probably not the best decision but I got through it!

 

I have a question for you. I was a complete idiot and forgot to take my pill yesterday.. didn’t realize until I started getting brain zaps. Took my normal 13.5mg today but still having brain zaps. Do you think I should take another 13.5 today? Or maybe dump some out and take half?

[Onmyway]

Hi @Grind80

the brain zaps should subside after a few hours/day. I wouldn't double up my dose - that's what's usually recommended by doctors. Not quite clear what to do in withdrawal. If things don't get better in a while, you may consider taking another 1/2. 

Let me check with the other moderators as well on what their recommendations are. 

OMW

[Grind80]

Man are you some kind of angel or what?

 

You seriously helped me a couple months ago by suggesting I maintain on the 13.5mg and also looking at Claire Weekes. 
 

How’s your journey going? Looks like you’re down to super low doses. 

[ChessieCat]

Hi Grind,

 

It will probably take a few days for things to settle.  Many members have accidentally missed or doubled their dose.  All you can do is carry on as usual and accepting this as a bit of a hiccup and accept any uptick in symptoms but knowing the cause helps you to be less stressed about it.

 

If it was me I would not be making another reduction for at least 4 weeks.

 

One thing that you might not be aware of is that Lexapro is a very strong drug compared to most other ADs, so missing your dose might have more of an impact than someone who is taking the same dose of a different AD.

[Grind80]

@ChessieCat @Onmyway

I went ahead and took about an extra 1/3 yesterday and took my normal 13.5mg this morning. After continuing to have the brain zaps into the afternoon today, I took another 13.5mg. Tomorrow I’m planning to take my normal 13.5mg around noon instead of my normal 7am. In my past experience in taking Paxil daily, if I missed a dose and started to have brain zaps, taking my dose usually resolved my symptoms very quickly (hours).

 

Since right now I’m still feeling constant brain zaps I’m wondering if there’s an issue with the purity of the escitalopram generic that my compounding pharmacy gave me. These symptoms also started when I started in this new bottle. I’m not 100%positive that I actually missed a dose.

I guess my question is how likely would it be that the compounding pharmacy for their hands on a bad batch of generic escitalopram?

 

I appreciate you both.

[Onmyway]

Hi @Grind80,

I wouldn't take an extra dose from now on. This will resolve itself if you let it rest. I have done the same on a couple of occasions - forget, or take the wrong dose or what have you. 

 

Generics are tricky, they are not exactly the same amount of ingredient as the original drug or the other generics [clarification: they are the same amount of active ingredient but because they have different supplementary ingredients such as fillers, the bioavailability of the active ingredient may not be the same], so it's possible there is variation in their impact. There are ranges in which this variation of bioavailability has to fall (area under the curve (statistics term) has to be within 20% of that of the branded drug so it's not a very wide range but variation is possible. Area under the curve variation is not the same as 20% of weight, it's much less. Normally it shouldn't impact anything but in withdrawal it might because we are sensitized esp given that you have escitalopram which is a hard drug to wean off of. You can ask the pharmacy to stick to the same generic from now on. 

 

For the time being, I'd keep at the current dose for 4 more days. If you keep having brain zaps, I'd do a small updose, maybe 5-10% after 4 days. If the brain zaps are not too bad I might stick it out. I personally am weary of going up and down doses because the brain in withdrawal is extra sensitive but sometimes you do need to updose and that is ok. 

 

I hope this resolves quickly. I wouldn't worry too much about it. I've worried that I've ruined my taper by mistakes like this and it has turned ok every time.

 

Is it possible that the compounding pharmacy got your dose right? Can you check with them? Mistakes happen as well. I doubt they have the equipment to check the amt of chemical in the drug though.

 

 

 

 

 

Edited November 12, 2022 by Onmyway
clarification on generic drugs - more info here https://www.psychiatrist.com/jcp/psychopharmacology/bioequivalence-generic-drugs-simple-explanation-food/

[Grind80]

@Onmyway @ChessieCat

Thanks again for all of your support and insights. Still having the brain zaps but maybe not quite as intense. I’m astonished that missing one dose can have this kind of an effect when I was feeling pretty stable on the same dose for about a month prior.
 

The odd thing is that when I have had these in the past from tapering too quickly, I would get horrible restless leg, insomnia, panic, and sweating, but I haven’t had really any of that during the last week. Hoping if I continue to hold at 13.5mg things will even out eventually. Will probably stay for at least another month at this dose before trying to cut further. What a crazy journey.. I’m amazed that this forum is my only place for good information. I bet in 10 years this will be mainstream science.

[Grind80]

@Onmyway

 

Hope you are well. Just wanted to update you on where I am and see if you had any input. I am about 26 days out of missing my dose of 13.5mg lexapro after feeling pretty stable on that dose for a month or 6 weeks.

 

Brain zaps are still there although drastically improved. The cascade of other side effects have now settled in which include some cold sweats, panic, restless leg when trying to sleep or relax, and I hate to admit but the occasional scary thought of suicide which I have no intent to carry out.

 

When I first went from 15mg to 13.5 this was the exact pattern it followed and I ended up getting through and eventually feeling stable. Credit to you for teaching me identify my pattern of withdrawal symptoms as they arise. It seems like I should continue to stick this out based on past experience.

 

I did call the pharmacy and they assured me they are very careful in their measurements and have many checks in place to make sure dosing is accurate. Still really amazes me that missing a single dose can have these long lasting effects. 
 

I guess I don’t have any questions for you, but just need to get this out since it’s a difficult conversation to have with people who have not been through this. I’m also in AA (sober 16yrs) and we are taught not to keep things in!

 

Anyway I appreciate any feedback you may have. Sorry for the long post!!

 

 

 

[ChessieCat]

Lexapro is a very strong drug.  See below.

 

If the brain zaps only appeared after missing that one dose, then I think it would be a good idea to hold until they have gone.

 

It's a good sign that they are improving.

 

From  dose-equivalents-equivalency-comparison-for-antidepressants

 

fluoxetine 40mg/day was equivalent to

 

paroxetine dosage of 34.0mg/day,

escitalopram 18.0mg/day,

sertraline 98.5mg/day,

venlafaxine 149.4mg/day.

 

I've calculated the approximate equivalent for 13.5mg Lexapro so you can understand that why missing one dose can have such a big effect:

 

Prozac     30mg

Paxil         25.5mg

Lexapro    13.5mg

Zoloft        74mg

Effexor     112mg

[Onmyway]

Hi @Grind80, 

it's a great sign that things are improving and you now have observations over your symptom pattern. Things will settle down for future drops. I would advise that you keep holding for a few more weeks until the symptoms go down more. Would it be ok for you to tell the pharmacy to always use the same generic in the future - i.e. not switch between generics.

 

As you lower your dose you may still have waves and windows and waves will feel bad but hopefully stability will be more common. But it is important to get to that place of stability first. 

 

So  glad that you are feeling better, 
OMW

 

PS. Suicidal thoughts and feelings are distressing but they are just thoughts and feelings - don't give them more importance than they are worth - they are useful gauges as withdrawal symptoms but they don't mean more than that. Let them go just as they come.

Edited November 7, 2022 by Onmyway

[Grind80]

@OnmywayYou are not going to believe this ****. Or maybe you will, but I’m still shocked!

 

So yesterday I picked up another 30 day script for 13.5mg lexapro since I’m about to run out. I noticed that the pill size was back to what it had been originally before last month, which was the only month it was a good bit smaller. Picture attached. 
 

When I got home I called the pharmacist about it and he explained some generics use different fillers and that the dose of the drug should still be the same despite using different generics (which actually started the month before and I was fine). I can say with 100% certainty now that the previous month‘s dose was not 13.5mg. After having brain zaps every single day for the last several weeks (and a slew of other symptoms including invasive suicidal thoughts) they have finally completely dissipated after I took the first of the new batch of pills this morning. 
 

I still have two of the previous months pills and want to see if there’s a way I can prove they gave me the wrong dose through a lab test. I have never been a litigious person but in this case I feel they should be held accountable. 
 

What do you think about this? I suffered through my wedding, starting a new job, sleepless nights and suicidal thoughts all because they made a careless error. I am really just happy that I am already feeling better but feel it’s irresponsible to just let it go.  Thanks again for all your help!

 

  

 

Edited November 12, 2022 by ChessieCat
added picture

[ChessieCat]

I have moved you post to this topic:

 

getting-compound-custom-dosages-at-compounding-pharmacies

 

[Onmyway]

1 hour ago, Grind80 said:

@OnmywayYou are not going to believe this ****. Or maybe you will, but I’m still shocked!

 

So yesterday I picked up another 30 day script for 13.5mg lexapro since I’m about to run out. I noticed that the pill size was back to what it had been originally before last month, which was the only month it was a good bit smaller. Picture attached. 
 

When I got home I called the pharmacist about it and he explained some generics use different fillers and that the dose of the drug should still be the same despite using different generics (which actually started the month before and I was fine). I can say with 100% certainty now that the previous month‘s dose was not 13.5mg. After having brain zaps every single day for the last several weeks (and a slew of other symptoms including invasive suicidal thoughts) they have finally completely dissipated after I took the first of the new batch of pills this morning. 
 

I still have two of the previous months pills and want to see if there’s a way I can prove they gave me the wrong dose through a lab test. I have never been a litigious person but in this case I feel they should be held accountable. 
 

What do you think about this? I suffered through my wedding, starting a new job, sleepless nights and suicidal thoughts all because they made a careless error. I am really just happy that I am already feeling better but feel it’s irresponsible to just let it go.  Thanks again for all your help!
 

 

 

Hi @Grind80, 

I so understand your anger and frustration - it was a whole  month of suffering. And I am so glad that you are back to a normal dosage again. 

What the pharmacy have done, however, is likely not an error but a consequence of how generics are regulated in the US (and other countries). The pharmacist is right - generics differ from each other and it is legal. In general, with most drugs, it is not enough to hurt people. [There are a few exceptions where the dosage has to be extremely accurate and the doctor can write for the pharmacist not to substitute a generic for the brand name drug - this usually happens with some blood thinners and such. There are some other cases where the drug's release mechanism is different - I remember a case of Wellbutrin XL (or XR?) and a generic that gave people interdose withdrawal. With us it is important because our nervous systems are so sensitized in withdrawal that even small changes are making our brains scream. And escitalopram is a very strong drug so small changes are not actually that small in impact. 

 

What I would do if I were you is that I would enjoy the relief of the new batch and then let the pharmacy know in no uncertain terms that you want them to keep to the same generic and fillers to make your compounded drugs every month. You could also make your own solution of escitalopram and measure the liquid but that would involve you getting the same generic again. 

 

By the way, the anger and the desire to sue those who have wronged us was something that was very prominent for me in the beginning of withdrawal. I consider it a distinct withdrawal symptom. If you have read about emotional spirals it might help a bit. I think in some ways it is helpful because ADs do make us too chill (at least they did with me) to stand up for ourselves sometimes. But I think withdrawal pushes us into the other extreme. This is not to say that your anger is not legitimate but I don't think a law suit is worth your time and effort. But I do think that you should write/talk to them firmly about having the same generic for you from now on and request that information in writing for the previous times that they have made pills for you. 

 

I am so glad that you know what the reason was and that you are feeling better now. And so sorry that it messed up such important events for you. You will recover. Keep looking forward and focusing on healing and tapering. 

 

Also, congrats on the wedding ! May it be full of much better moments than this last month! 

 

OMW

 

 

 

 

[Grind80]

@Onmyway

Thank you again for your response and most valuable insights. I want to provide an update here for you to see if you had an opinion on where I am.

 

So it’s been two weeks now since being back on 13.5mg. My sleep is slowly starting to improve.. restless leg at night is mostly gone. I am currently dealing with pretty bad morning fatigue and waking up feeling uninspired for the day (no creativity and very foggy)..Pretty familiar of being on ssri. The other thing I have is inner restlessness that comes in waves throughout the day - I have to keep an eye on this because I remember when I first cut to 13.5 back in July these feelings turned to panic. Is this kindling or akathasia? I believe my system is probably sensitized because last month it felt like my dose was closer to 5mg based on how I was feeling. I am planning to wait until this symptom resolves before cutting to 12.15mg. 
 

Just to catch you up on the compounding pharmacy. They told me that August was the only month where they used a different generic and filler. Last month when they used the smaller capsule, the generic and filler quantities were supposed to have been exactly the same. This was clearly not the case. Even so I’m not going to pursue anything legally with them as I think they have identified what went wrong whether they admit it or not. They know to produce the meds the same way going forward.

 

Thanks again for your help. I hope you are doing welll!

 

[Grind80]

@Onmyway

Just posting here to keep up with my own symptoms and if anyone has any perspective I greatly appreciate it.

 

Since my compounding pharmacy debacle in October, I was on 13.5mg for a month, and for the last month I have been on 12.15mg. I am extremely fatigued during the day and have really bad cognitive and memory problems - not a great mix when trying to navigate a career. It's actually extremely embarrassing to be forgetting things all the time at work. Waking up in the mornings is really difficult and I am basically a zombie throughout the day trying to do the bare minimum. Last weekend I drove 5 hrs to Charleston SC for a short vacation and while walking around I felt way oversensitized by everything around me - the depersonalization I hear about in these forums. Over the course of the 17 years that I have been on ssri/snri treatment, I think I have gotten used to being nearly brain-dead, so it's hard to parse out at this point which of my symptoms are withdrawal related, and which ones are just due to the Lexapro. 

 

On the plus side I am able to fall asleep within about an hr which is relatively quick for me. No restless leg and night anymore and the agitation during the day is dissipating. I am not sure if I should hold for one more month at 12.15mg or go down to 10.9mg - I picked up scripts for both yesterday. I would really like to come down to 10.9mg but am wondering if things might be taking longer to settle at 12.15mg due to what happened in October where my dose was wildly off due to compounding pharmacy error or perhaps the generic they used was seriously impure. 

 

Tagging @Altostratahere as well since I have been watching her on youtube for months and think she is an absolutely incredible person for founding this site!

 

Thank you all!

[Altostrata]

Thank you for those kind words.

 

2 hours ago, Grind80 said:

On the plus side I am able to fall asleep within about an hr which is relatively quick for me. No restless leg and night anymore and the agitation during the day is dissipating.

 

Are there other ways your symptom pattern has changed in the last month?

[Grind80]

  You're welcome!

 

I decided to stay one more month on the 12.15mg lexapro. Even though I feel terrible I can at least somewhat function at my job.. I have been still very exhausted during the day, have memory problems, and trouble forming coherent sentences, and the feeling of restlessness which may be a mild form of akathesia has come back the last couple of days. It seems like the more tired my body and brain feel, the more susceptible I am to this charged feeling. 

 

I know that this process takes time but wow it feels like I'm making very little progress so far.  

 

Another crazy thing is that I only just remembered about a week ago that I was on 20mg of Lexapro for about 18 months before coming down immediately to 15mg. I had basically forgotten how much of the drug I had been taking for 18 months.. That's insane.

[Onmyway]

@Grind80

Can you pls update your signature to reflect the 20mg of Lexapro? 

 

Good on holding.

OMW

[Grind80]

Thanks @Onmyway 

 

I have updated my signature but I guess it takes a few hrs to reflect changes.

 

I have another few weeks of this 30 day script of 12.15mg. Guess I should hold again after that? 

[Onmyway]

Hi @Grind80, the signature should reflect immediately so I wonder if you forgot to save? Could you pls try again. It seems petty right now but in a few months someone will give you advice based on this and it may be the wrong advice. 

 

I personally lower at a rate of much less than 10% a month - close to 5-6% because I have a hard time with tapering so the best thing is to listen to your body. Are you taking 12.15 right now? If you feel like you need to hold longer then you may need to order larger sets of the specific doses at the pharmacy to have buffer.

 

 

[Grind80]

It doesn't seem petty at all! I just so appreciate someone cares enough to have those details. Perhaps I will go down by less next time but think it might be smart to hold one more month..again.

 

Thanks Onmyway!

[Grind80]

@Altostrata Do you know when Outro Health will be available in Georgia, US?

[Altostrata]

No, sorry. It could be late this year.

[Grind80]

So I am still battling this battle. I've been on 10.4mg liquid for about 3 months now... I was starting to stabilize and feel better and then I decided to quit nicotine.  I started dipping again in 2020 and felt it was not helping my taper - I switched to zyn 3mg and did 3 a day for a week and weaned down to one per day for a week before stopping completely three weeks ago.  Just about all of my symptoms returned including insomnia after about 3 hours of sleep each night.

 

My question is can quitting nicotine really have this much of an effect?  I'm extremely restless and while I'm not pacing I imagine this is what akathisia must feel like if turned up a bit.  Thanks for any experience or insight on the topic of quitting nicotine while tapering.

[Altostrata]

37 minutes ago, Grind80 said:

My question is can quitting nicotine really have this much of an effect?  I'm extremely restless and while I'm not pacing

 

Yes, you could look it up. Sorry, we don't know much about going off nicotine, that's a whole other subculture.