Twilly: Tapering off Lexapro after 2 years while on stimulant

[Twilly]

Hello all,

 

Really nervous about introduction posts. I'm a 31 (almost 32)-year old woman. I have severe ADHD and also struggle with anxiety. My anxiety is not formally diagnosed, but I have been impacted by it for my entire life. I have not been medicated for anything until 3 years ago. I have not been able to hold down a single job at all until I started taking stimulants for my ADHD.

 

I am overall extremely health-conscious. I work out 2 times a week at the gym, do regular long-distance runs, and work a physically active full-time labour job (got tired of sitting at a desk). I have also been on a strict carnivore diet for 5 years now.

 

The pandemic sent me into a shock and my hormones went out of whack, where I started having fully sleepless nights before my periods etc. I experienced this before when I was in school/university due to stress, too, but could not handle the impact of lack of sleep on my physical performance. This is mainly why I decided to get on Lexapro.

 

My basic medication history is in my signature. About a year in, I felt like the Lexapro was no longer really adding anything to my life, while making me feel more lethargic and giving me other physical issues (e.g., uncontrollable hunger and thirst, frequent bathroom trips).

 

I also no longer take stimulants daily as I felt like they would build up and wear me out after using for multiple days in a row. I would usually take them as-needed for work or other tasks. Vyvanse is really effective at treating my anxiety as long as I take regular tolerance breaks from it.

 

While tapering off Lexapro, though, my nervous system has become destabilized and it has been difficult to take even a single day's break and to vary the times I take my stimulant meds. I understand that consistently dosing all other prescription medications is key during AD withdrawals. However, I work an inconsistent schedule (sometimes early 7am shifts, sometimes shifts that go as late as 10pm). My prescription does not last me at the effectiveness I need at work for the whole day from 7am to 10pm.

 

I used to take a higher dose depending on when my shift is, but cannot anymore until my system is stabilized. As a result I am forced to updose for my total stimulant amount used throughout the day (with doctor's approval) if I am to use every day at fixed times. I do not like taking the highest effective daily dose like this regularly; it really feels rough on my sensitive system right now. I also inevitably develop tolerance especially when it comes to using the stimulant to treat my anxiety, feel less rested in the long run, etc.

 

Does anyone have any advice on how I could optimize my stimulant dosage here while tapering, given my circumstances, while giving my system as much of a chance to recover as possible? I need to figure this out before jumping off Lexapro. My last Lexapro dose drop is taking me a really long time to stabilize from, possibly because I switched to a stronger stimulant and then increased my stimulant amount when experimenting with consistent dosing times.

 

I should also mention that I have never had this much trouble taking breaks from my stimulants. Before, I would just be a little bit more tired and anxious on days I did not take my stimulant; I could still get basic things done at home. Now, the brain zaps, body aches, and muscle rigidity make me completely non-functional, even if I just reduce my amount by a bit or shift the time of use slightly. I am pretty sure these changes are delaying my stabilization in terms of Lexapro tapers, too.

 

Just to be clear, I do not intend to be completely med-free. I am hoping to be only on one medication (stimulant) in the end, which is far more manageable for me.

[manymoretodays]

Hi there Twilly and welcome,

Looks like you did it......a fine first post.

 

On 11/26/2022 at 1:54 PM, Twilly said:

I also no longer take stimulants daily as I felt like they would build up and wear me out after using for multiple days in a row. I would usually take them as-needed for work or other tasks. Vyvanse is really effective at treating my anxiety as long as I take regular tolerance breaks from it.

 

While tapering off Lexapro, though, my nervous system has become destabilized and it has been difficult to take even a single day's break and to vary the times I take my stimulant meds. I understand that consistently dosing all other prescription medications is key during AD withdrawals. However, I work an inconsistent schedule (sometimes early 7am shifts, sometimes shifts that go as late as 10pm). My prescription does not last me at the effectiveness I need at work for the whole day from 7am to 10pm.

 

On 11/26/2022 at 1:54 PM, Twilly said:

Does anyone have any advice on how I could optimize my stimulant dosage here while tapering, given my circumstances, while giving my system as much of a chance to recover as possible? I need to figure this out before jumping off Lexapro. My last Lexapro dose drop is taking me a really long time to stabilize from, possibly because I switched to a stronger stimulant and then increased my stimulant amount when experimenting with consistent dosing times.

 

We are not a drug management site per se.  And I would have to wonder if maybe you might consider non-drug management for your "ADD".  Perhaps your ADD arose from another drug?  I don't know.  Or from WD(withdrawal).  I think you could be doing more harm than good going on and off stimulants at this point in time.  They too, I believe, should be tapered if at all possible using the 10% harm reduction way.  And I'll give you a link to that topic shortly.

 

What is 1/12th of Lexapro? 1/18th?  The dose is what I would want to know.

 

And have you ever checked drug interactions with your drugs?  That might be eye opening too.  I would do that.

I like Drugs.com:  https://www.drugs.com/drug_interactions.html

to do that at.  If you would plug in your medications, and then provide a link to the results or copy and paste that would be great.

 

I do see a lot of drug changes through October, and then finally perhaps staying put........which might benefit you more than anything now.  We never advise skipping days while tapering. 

 

NEVER SKIP DOSES TO TAPER

 

With the quotes, this is getting too big, this reply and so.......will post and start another one around our general tapering and WD(withdrawal) information, in hopes you might wish to go drug free some day.

 

Good job with your Introduction.  And many thanks on doing your signature too!

 

Love, peace, healing, and growth,

moderator manymoretodays(mmt)

Edited December 2, 2022 by manymoretodays
additional

[manymoretodays]

Here at Surviving Antidepressants, it is recommended that a person taper by no more than 10% of their current dose with at least a four week hold in-between decreases.  The 10% taper recommendation is a harm reduction approach to going off psychiatric drugs.

Why taper by 10% of my dosage?

 

Tips for tapering off Lexapro

 

I am going to include the topics on tapering for your present stimulant, and also for the shorter acting one Adderall, as well

 

Tips for tapering off Vyvanse(lisdexamfetamine dimesylate)

 

Tips for tapering off Adderall

 

What happens when we take these drugs, and what happens in WD(withdrawal)

Brain Remodelling

What is withdrawal syndrome.

 

Dr.Glenmullen’s withdrawal symptom list.

do see the downloadable PDF, which might explain so many of your symptoms

 

The Windows and Waves Pattern of Stabilization

 

When we take medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made.  The CNS likes stability. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur. And sleep is really important during withdrawal. 

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system.  

 

Magnesium, nature's calcium channel blocker 

Omega-3 fatty acids (fish oil) 

 

This is your introduction/journal page where you have now introduced yourself to the community, you can ask questions here regarding your tapering, give updates, communicate, and keep a record of your journey.

 

Best, L, P, H, and G,

mmt

[Twilly]

1 hour ago, manymoretodays said:

We are not a drug management site per se.  And I would have to wonder if maybe you might consider non-drug management for your "ADD".  Perhaps your ADD arose from another drug?  I don't know.  Or from WD(withdrawal).  I think you could be doing more harm than good going on and off stimulants at this point in time.  They too, I believe, should be tapered if at all possible using the 10% harm reduction way.  And I'll give you a link to that topic shortly.

 

What is 1/12th of Lexapro? 1/18th?  The dose is what I would want to know.

 

And have you ever checked drug interactions with your drugs?  That might be eye opening too.  I would do that.

I like Drugs.com:  https://www.drugs.com/drug_interactions.html

to do that at.  If you would plug in your medications, and then provide a link to the results or copy and paste that would be great.

 

I do see a lot of drug changes through October, and then finally perhaps staying put........which might benefit you more than anything now.  We never advise skipping days while tapering. 

 

NEVER SKIP DOSES TO TAPER

 

With the quotes, this is getting too big, this reply and so.......will post and start another one around our general tapering and WD(withdrawal) information, in hopes you might wish to go drug free some day.

 

Good job with your Introduction.  And many thanks on doing your signature too!

 

Love, peace, healing, and growth,

moderator manymoretodays(mmt)

 

 

Hey,

 

Thank you so much for your approval and response. It was taking a while for my post to come through, so I was wondering if something I said was inappropriate or whatnot. 

 

Here is some more background on me:

 

I have an MA in Behavioural Psychology and did not believe in drugs for 29 years of my life. I got straight As in undergrad AND grad without any medications and very drastic environmental modifications + accommodations for my "learning disability". After I graduated, I used all extra money I had left to work with top coaches, speech pathologists, and behaviour therapists to try to make myself be able to communicate properly and keep up at work.

 

I also did long-distance running almost every day, worked with a personal trainer, kept a regular sleep schedule, got rid of my smartphone, and went on a carnivore diet, which all also helped tremendously. I also did all my work-from-home in public spaces, which kept me focused. I spent half a year doing nothing for my Master's thesis until I invested in a co-working space. The people who worked with me, though, kind of just let me go after a while of making very little progress. At work, after all accommodations were made, I still could not meet expectations and pass my probation. This is when I lapsed into a deep depression, became suicidal, and settled for medication as my last resort.

 

As a behaviourist, I still strongly believe that, for most people, change can be fully attained with behavioural methods only. However, for some, there are real financial and social limits to how much they can change their environment to allow them to thrive. I am now convinced that some people do benefit from minimal amounts of medication to feasibly reach their desired level of functioning.

 

I am open to being medication-free in the future by all means if I can find other ways to solve my problems. I dedicated all of my free time for years to trying to figure out how to be a fully functional human being in the working adult world. This is just me after believing I tried everything and not finding the answer. At this point in my life, though, I am drawing a blank. My main problems at work are that I am very, very slow because my attention is all over the place and my reaction time is terrible, completely disorganized, and cannot think in the moment+respond quickly enough in interactions. My head is also always "in the clouds" and I tend to not have a full understanding of a situation at hand that goes on around me, not to mention of time and priorities.

 

The stimulant medication somehow greatly improved all of these things and just made life much more manageable. I was also really impulsive and lashed out easily in the past, which the stimulant weirdly levelled out like nothing else.

 

1 hour ago, manymoretodays said:

What is 1/12th of Lexapro? 1/18th?  The dose is what I would want to know.

 

 

So 1/12th is about 0.42mg and 1/18th is about 0.3mg. I have had to resort to eyeballing after going lower than 1/6th because my mg scale could not accurately measure such a small amount. Do you think because the dose is so small, my eyeballing could be contributing to the problem of my WD symptoms lingering for longer than I expect them to? I will meet my new doctor on Monday and try to get her to prescribe me a compounded dose. I am thinking of tapering 0.3mg for another month, 0.2mg for a month, 0.1mg for a month, then off. I want to stay with 0.3mg for a bit longer because I recently did end up taking a couple of mini breaks from my stimulants and destabilizing myself a little bit.

 

The main withdrawal symptoms I am struggling with are: feeling like I cannot stand fully on my left foot+slight tremors (usually at work/when active), burning-type sensation at the back of my head, episodes of heart pounding, chest tightness, and sweating coming seemingly out of nowhere, dizziness, sort of a shaky/disconnected/derealized perception, nightmares and waking a lot (stopped once I switched my AD dose to nighttime), and a burning sensation in my hands/feet. These only went away this week after a whole month on that 0.3mg. I am also thinking the symptoms just took longer to resolve because my previous taper was too fast.

 

I actually already went through many of these resources, but will take a look again to see if there is anything I might have missed. I am a bit uncomfortable about this and don't want to be seen the wrong way, but I had an adverse reaction to my Vyvanse once I started tapering (which is why I switched to Concerta). After being sick almost the entire month, I realized I should just stay with something that my body is most used to. I started using meth on and off during the pandemic because I could not focus on working from home enough even with the Vyvanse. My doctor also went on leave at the time and I had no GP for months. I generally used 20mg-30mg orally in the past. I settled with 20mg to reduce issues as much as possible. I tried it after trying Vyvanse and my body responded more favourably to it, so I just stuck with it. My doctor approved as long as I stay at this dose, which I have no issues with.

 

Here is a full list of things I take right now:

- Lexapro 0.3mg

- Meth 15mg in the morning (spaced 3 hours apart), 5mg at 1pm.

- Xanax 0.05mg 3x/day (10:30pm, 9:15am, 4:15pm).

 

I also take daily supplements I have taken for years.

Morning: Circumin, 2000ug Vit D, Magnesium citrate, Potassium citrate

Evening: 2 caplets NAC (don't remember measurement), l-Theanine, GABA, Magnesium citrate

 

I am fine with continuing to take everything above at a regular schedule and in consistent amounts. My only concern overall has always been neurotoxicity and stimulants. Tolerance does develop over time and I understand you cannot avoid changing your brain when you take a medication. That is why I am worried about daily use. I am also wondering whether stimulant use will slow down recovery from the AD and how much it can possibly do so. It makes sense to try to reduce all stimulation to let your body recover, but then it also seems best to just keep using something that your body is habituated to?

 

Also, do you by any chance know if taking regular breaks from a stimulant could cause CNS sensitization the same way AD withdrawal does? I have been thinking about this a lot ever since diving into the sensitization thinking. Not being able to have a drink with friends or to try a new supplement like this is really not a life I want to keep living in the near future.

 

Again, I'm just really not ready to taper off my stimulant at this time, but am willing to go the non-med route if I find a viable solution for my issues.

 

Thanks again for your welcoming response!

[Twilly]

I don't have a computer so have been keeping a paper diary of what has been going on.

 

I also realized I forgot to mention my previous drug history. I took Xanax up to 1mg last year to help me sleep. I quit when I started using meth because meth has always helped me sleep, even the first time I tried it. I know it's weird, but I basically did it with a friend that night, fell asleep right after, and he stayed up all night. When quitting Xanax, I looked up how to taper it at the time and pretty sure I did a month's slow taper. Had only one adverse reaction to meth while doing the taper; otherwise did not notice any symptoms. Replaced Xanax with CBD weed every night, one joint/night. Started using meth irregularly May-August 2021, used heavily (1/5 of a gram - 2/3 a gram) September-December 2021, then quit slowly. Stopped the weed around November; it started making me a bit agitated for some reason. 

 

When quitting meth, I remember on some days having that sensitization reaction to it, too. Stopped it completely for a month in February, but realized it helped me more than my Vyvanse on some days, so started using 30-40mg daily for the first few months. There were a few days I came close to using 100mg, but usually used up to 60mg/day. 

 

Started tapering off Lexapro in March; resumed using small amounts of Xanax at bedtime for mild (at the time) sleep issues.

 

The above might be why I am sensitized... but I do feel I've generally been fairly sensitive to substances in general. I also strongly feel that the only reason I've ever abused a stimulant is because of the SSRI. The serotonin oversaturation must have been what made me so sluggish and I was trying to push through that with the meth. I have no desire to abuse a stimulant anymore and really feel that I never will once I come off the Lexapro.

 

I have no drug use history prior to 2021, aside from the occasional joint and drinking maybe 3 glasses of wine 3x/week for a couple of months. I typically just drank socially for the most part, 1-2 glasses of wine per week. Non-smoker.

 

Starting September, the pain from the doctor-assisted taper got really disabling at work, so I started using Percocet 1/4th a pill every ~4 hours. I did this for a couple of months, quit for about 1.5 weeks (felt no WDs) then switched to Dilaudid 1/6th a pill every ~4 hours because the Percocet was not always strong enough and was expensive. I had to quit the Dilaudid recently because it was contributing to this vision issue; my right visual field felt partially blurred and my eyes felt very dry.

 

I did feel stabilized within the past few weeks until this week because of quitting the Dilaudid. Because I only took it for a brief bit, I tapered quickly over two days and then stopped. I felt three days of typical withdrawals and am almost back to a more normal me now.

 

I understand that I really need to settle and keep everything stable from now on, from the timing changes to dosage changes etc. I do not feel too destabilized compared to some other times in the past, so I am confident I can get back on my feet fairly quickly. I've been sleeping well every night, but going from one day too tired - next day too wired, with today the first day being somewhat okay. There's still a bit of this unending haze hanging over my days.

 

I am also realizing that I've been undermeasuring my amount at closer to 0.2g. I would like to taper VERY slowly and will see a doctor tomorrow to ask for a compounded dose. My plan is:

0.1mg twice a day - 0.2mg total for a month

0.05mg twice.day - 0.1 for 2 weeks.

0.05mg for 2 weeks.

 

I'm really disappointed no doctor offered this as an option before. I also did try a slightly higher dose this morning and oh man did my body react to it. It is not right how such small changes in the endgame amounts are completely dismissed by the doctors as being significant. I went over the SERT data and made screenshots of those pretty charts along with some other relevant research vignettes. I really, really hope this will work and get me what I desperately need here. I need to be able to run and exercise and resolve my muscle/dizziness/headache issues above EVERYTHING.

 

I would love to know how some of you fine folks manage to get your dose under 0.05mg? That seemed to be the limit when I talked to the pharmacy guys...

[manymoretodays]

Hi Twilly,

Thanks for all the comprehensive information given above.

And no, you didn't do anything inappropriate.......we just have been understaffed to meet the needs of incoming members recently any more quickly.  And currently are temporarily closed to new registrations.  This started after you came on.

 

Have you had a chance to really look at the Why taper by 10% (or less) of each previous dose?  And then from there, you'll further understand more by looking at this one too:

Why taper? SERT transporter occupancy studies show importance of gradual change in plasma concentration

Those charts can be very telling/revealing.  And then we often will use the same principle with other drugs too, not just the SSRI class of psychoactives.

On 12/2/2022 at 10:29 AM, Twilly said:

I am open to being medication-free in the future by all means if I can find other ways to solve my problems. I dedicated all of my free time for years to trying to figure out how to be a fully functional human being in the working adult world. This is just me after believing I tried everything and not finding the answer. At this point in my life, though, I am drawing a blank. My main problems at work are that I am very, very slow because my attention is all over the place and my reaction time is terrible, completely disorganized, and cannot think in the moment+respond quickly enough in interactions. My head is also always "in the clouds" and I tend to not have a full understanding of a situation at hand that goes on around me, not to mention of time and priorities.

Okay.  Good to know.  I often wonder in my own case, if maybe I had made the wrong career choices or something?  I don't know.  I however, feel fortunate as I got to do what I set out to do, at least for awhile, and since have had to recoup, get to know myself better, etc.......anyway......sometimes it is just life.......not a defect or deficiency of something......when we don't fit how we used to.

I'm thinking some of your difficulties are most certainly related to your drugs and likely more than you give credit to at this point in time.  Of course I don't know how your journey should go, from here on out.......anyway glad you are open.

 

On 12/2/2022 at 10:29 AM, Twilly said:

So 1/12th is about 0.42mg and 1/18th is about 0.3mg. I have had to resort to eyeballing after going lower than 1/6th because my mg scale could not accurately measure such a small amount. Do you think because the dose is so small, my eyeballing could be contributing to the problem of my WD symptoms lingering for longer than I expect them to? I will meet my new doctor on Monday and try to get her to prescribe me a compounded dose. I am thinking of tapering 0.3mg for another month, 0.2mg for a month, 0.1mg for a month, then off. I want to stay with 0.3mg for a bit longer because I recently did end up taking a couple of mini breaks from my stimulants and destabilizing myself a little bit.

 

See if you can get those fractions replaced by doses in your signature please.  Easy access to your signature:

AccountSettings/signature/updates/edits  be sure to hit SAVE when done.

And then I would like to see just a little more clarity with the other drugs in your signature too.

Here's the link:  How to summarize your drug history in your signature

I'm not seeing the Xanax or methamphetamine, in there, and you may be able to summarize some of the Lexapro(escitalopram) information as well.  Look at the sample note for ideas.  And I'll put a copy of your present signature into a reply following this one, so we have that detail saved.

Try and work it on paper first, and then try to edit.  I honestly think you should put the Percocet and Diluadid in there too, briefly as it's all so recent and definitely related to where you are currently at.....with symptoms, WD, in general.

 

I do, most sincerely, appreciate your honesty in disclosing all of it, your history most recent and going back to when you started with the drugs in 2021.  Again.....your drugs are a huge part of your difficulties I believe......or did I say that later on here.

 

I am all for you staying at 0.3 mg of your Lexapro/escitalopram.  I think that is a great idea while we sort through things a bit more.  What is your doctor like?  This may be helpful:

How to talk to a doctor about tapering and withdrawal? What to expect? (and again, scroll up to the first post in any topic link, to start please, if it doesn't take you there)

 

On 12/2/2022 at 10:29 AM, Twilly said:

Here is a full list of things I take right now:

- Lexapro 0.3mg

- Meth 15mg in the morning (spaced 3 hours apart), 5mg at 1pm.

- Xanax 0.05mg 3x/day (10:30pm, 9:15am, 4:15pm).

 

I also take daily supplements I have taken for years.

Morning: Circumin, 2000ug Vit D, Magnesium citrate, Potassium citrate

Evening: 2 caplets NAC (don't remember measurement), l-Theanine, GABA, Magnesium citrate

 

Thanks for ^.  Very helpful.  Is your doctor actually prescribing methamphetamine? 

And then this list doesn't include when you go on and off off the other stimulants.

 

8 hours ago, Twilly said:

I would love to know how some of you fine folks manage to get your dose under 0.05mg? That seemed to be the limit when I talked to the pharmacy guys...

Remember this ^.  We do have our methods.  I've tried to just get through everything you have written now, and will get back to you again, when time allows.  Other members or mods/staff may as well.  I may need to organize a bit more all your information too, myself......to see if we can or how we can best help.

 

I hope that's okay.  We all learn patience through this process that is for sure.

 

On 12/2/2022 at 10:29 AM, Twilly said:

The main withdrawal symptoms I am struggling with are: feeling like I cannot stand fully on my left foot+slight tremors (usually at work/when active), burning-type sensation at the back of my head, episodes of heart pounding, chest tightness, and sweating coming seemingly out of nowhere, dizziness, sort of a shaky/disconnected/derealized perception, nightmares and waking a lot (stopped once I switched my AD dose to nighttime), and a burning sensation in my hands/feet. These only went away this week after a whole month on that 0.3mg. I am also thinking the symptoms just took longer to resolve because my previous taper was too fast.

 

Yes, WD symptoms ^.  And I did want to pull those out too.  Good reason to stay put on the 0.3 mg dose of Lexapro/escitalopram now I think.  And yes.....definitely another case of too fast tapering.......no judgement, we've all or many of us have done it.

 

Okay.  Best I can do for now.  Are you able to get your work days in now, and take adequate care of yourself?  Any non-drug coping that you've begun?  And I certainly can get to giving you more information on your present symptoms.....where they come from and suggests on non-drug coping too, at a later date.

 

And best.  L, P, H, and G,

mmt

[manymoretodays]

Saving member's present signature here:

Started Lexapro 5mg around May 2020 due to extreme pandemic-related distress and chronic anxiety; Vyvanse 40mg (previously Concerta 36mg) started ~March 2020; previously on Concerta 36mg since October 2019.

June 2020: Went up to 10mg Lexapro. After a year, started noticing side effects more, reduced effectiveness

January 2022: Increased to 15mg to see if effectiveness would come back

March 2022: Reduced back to 10mg, no w/ds.

May 2022: Tapered 10mg - 7.5mg - 5mg. Liquid Lexapro not available in Canada.

June 2022: Tried reducing from 5mg, could not tolerate w/ds, stayed at 5mg until July.

July 2022: Tried alternating 2.5-5mg doses as prescribed by doctor, terrible w/ds again, bumped back to 5mg.

Mid-August 2022: Reduced by 1/6ths every week, withdrawals were tolerable but could no longer tolerate my Vyvanse 40mg. Switched to Concerta 72mg for one month start of September.

October 2022: Went back to Vyvanse 40mg start of October, found SA, held at 1/12th Lexapro for three weeks

November 2022: Symptoms completely stabilized for a week, reduced to 1/18th; holding there.

[Twilly]

Manymoretodays, thanks. Been wanting to update my signature but only got half an hour at a computer lab yesterday since at least Thursday. Will try to make it to the library later tonight.

 

And yeah, taking the slightly increased dose again today and feeling a major physical improvement. I do get by at work but very slow and terrible when I'm physically rusty like that. Just could not take it anymore. Even though my sleep has actually been fine lately.

 

I'm going to use that SERT occupancy data to try to convincw my doctor today. Also hoping to be able to taper my morning/night doses by at least 0.01mg to stick with the 10 percent rule. I'm going to try figuring out that self measurement thing but am still a bit scared to do something like that all by myself.

 

No, I'm not prescribed meth - not available where i am. But my doctor approved my dose and how I'm using it. We are also checking in regularly. I'm seeing a totally new doctor today because my other one went on leave, so we'll see how everything goes.

 

oh and i'd love to get some tips on managing the physical symptoms without medications, especially on my own. Very tight on time and budget at the moment. I already am in therapy and use emotional coping techniques so that's not a huge deal for me.

[Twilly]

Okay, so i definitely was measuring out less than i thought i was before. My updosing is giving me nausea, headache, general brain numbness, and this overall wired feeling. Also a bit of foot tingles. These feelings are unpleasant but mostly transient after taking the dose. Yesterday i was in an amazing mood but still struggled with akathasia. Not noticing any akathasia this morning, though.

 

i did get my compounding prescription. It's for 0.3mg but I'm realizing i should maybe even start at around 0.1mg and updose from there if needed. What i was taking was such a tiny crumb that i suspect was maybe even lower than 0.1mg. I'll try at 0.075mg because of how the measurement is for my prescription and then go from there. As in hold for a couple weeks, then if i settle on the amount, stay on it for at least a month before changing anything else.

 

This endgame taper is sooo delicate and tricky... ugh  I'm really just looking forward to finally properly stabilizing.

[Twilly]

Was just able to make it to the library and update my signature. Today has been a slog. Felt sleepy most of the time except for quick bursts of energy just after noon and right now, evening around 5pm. Had a terrible headache first thing in the morning. Then, felt like my body turned into Jello; the signal from the brain to my legs/arms felt more faint and delayed. Also got some restlessness in my feet/body starting later in the afternoon - I'm guessing because the AD levels are still on a bit of a rollercoaster ever since I slightly upped my dose?

 

Still nauseous on and off since upping. Spent basically the entire morning in the bathroom. Been struggling with constipation for days now since quitting Dilaudid. Also very hungry all day - eating almost non-stop. I'm trying to find some rhyme and reason to what my body is giving me, but can't.

 

Also got my compounded script - yay! Now the challenge will be to find that right amount for where my body is at right now. I'm a bit worried about this with all the ups and downs...

 

@manymoretodays Just want to say how much I appreciate your username. It somehow reads "hope" to me and warms my heart. It's brilliant. I also read your story and see you've been through quite a lot. Just had a long conversation with someone who has worked in the clinical field about the medical/tragedy model. I feel that someone who believes in a socially-based narrative can make change from within, but it is very difficult and many sacrifices might have to be made. Are you still involved in the field? If not for psychiatry, what else have you thought of potentially doing?

[manymoretodays]

Hi Twilly,

Yes, if I was you I would stay put for awhile.  You just quit Dilaudid, and then you are using meth to compensate for stimulant WD.........yikes, I mean that just cannot be the greatest.

 

You may need to examine your drug usage a bit more thoughtfully, at some point.......just thinking maybe there is something that you need to attend to emotionally, spiritually......I don't know.  At least bring it into your awareness.

You might benefit from AA or NA, or dual diagnosis AA(I think there is one)......and maybe you've mentioned or tried that, and just want more on the drugs now.

 

I imagine you would go off meth just like any of the other psychoactives, using the 10% rule and harm reduction.  I don't have a clue around how you dose that and then how you would get doses for tapering purposes.  I mean if you have a previous history of abuse of meth........I really hope you have adequate support now to prevent that.  Something.

 

What kind of physical symptoms are tough right now?

 

And sorry I left you just hanging.  I'm not in daily usually to moderate.  Sometimes.  This time of year I will start to get busy soon....or busier on the ground.  But I get a lot out of moderating, and coming round......so........know I'm usually reading........not always able to respond quickly though.

 

Okay, hope this finds you well enough.

 

L, P, H, and G,

mmt

 

Oh.....other questions.  I only worked in "mental health" settings briefly, while still licensed as a professional.  I no longer am licensed, and sometimes wonder why I retired that liscensure(License) .......  I actually thought it might be free- ing for me, AND help me decide what to do next.  I could never have gone back to what I did as a younger woman......that I know.  I did a lot of pediatrics- ER, ICU, even life-flight, and then more briefly a pediatric specific nurse practitioner. 

Cool stuff and again......I've been one lucky individual I think......in opportunities and experiences.  I'm older now.  And.  It's been so long.  So.  Onward.  So.....well yes and no.....of course I'm always a Nurse, it doesn't just end, but not employing in it, or doing anything outside of the Nurse Practice Act, or illegally. 

I honestly don't know for sure, what comes next.  I'm guessing maybe it already has, or will be more artsy.......creative mind.  I don't know. 

Hey thank you for asking. 

  

On 12/6/2022 at 3:14 PM, Twilly said:

I feel that someone who believes in a socially-based narrative can make change from within, but it is very difficult and many sacrifices might have to be made.

 

Yah, on ^........maybe.  I like that term "socially based narrative" too.  Have you read Johann Hari- Lost Connections ?  Do.  And maybe not, on many sacrifices.  I would, totally like to be part of something peer run, and managed.......and something that perhaps I myself could have totally used and benefited from at some point.  Respite or people who could come over, and I would have allowed them to, to help when I needed that.  I would envision though this really cool respite, oh in a nice natural setting of peace and calm, that folks could get to, when they needed it.  It would have to be word of mouth, and low key.  And have some professional licensed staff on call.  That I don't know that I'll get to be part of here.  Maybe just more minimally... or not......you know.....doing yoga or artistic expression with people........or jamming-playing music.  So many things.  I do know or think I know that I am wanting to be sure, where to focus, and what to focus on.  I guess I'll know.   I am, slowly but surely becoming more focused.

 

Edited December 12, 2022 by manymoretodays
additional at end

[Twilly]

2 hours ago, manymoretodays said:

Hi Twilly,

Yes, if I was you I would stay put for awhile.  You just quit Dilaudid, and then you are using meth to compensate for stimulant WD.........yikes, I mean that just cannot be the greatest.

 

You may need to examine your drug usage a bit more thoughtfully, at some point.......just thinking maybe there is something that you need to attend to emotionally, spiritually......I don't know.  At least bring it into your awareness.

You might benefit from AA or NA, or dual diagnosis AA(I think there is one)......and maybe you've mentioned or tried that, and just want more on the drugs now.

 

I imagine you would go off meth just like any of the other psychoactives, using the 10% rule and harm reduction.  I don't have a clue around how you dose that and then how you would get doses for tapering purposes.  I mean if you have a previous history of abuse of meth........I really hope you have adequate support now to prevent that.  Something.

 

What kind of physical symptoms are tough right now?

 

Hey, no worries for the delayed reply! I figured you were busy. We all have our own lives!

 

I did not go on meth to compensate for anything at all. I simply switched stimulants to allow for better coverage of the day. Vyvanse is good and I recently (almost a month ago?) tried it without an adverse reaction, too. However, it only ever gave me 8-10 hours' coverage for a 16-hour day. I take a strict 25mg/day dose, which is a clinical dose according to the literature, orally (dosed across 4 hours throughout the morning 10mg-5mg-10mg). This seems to be working really well for me - I'm actually not noticing any tolerance developing at all.

 

I've always found amphetamines to be more effective at making me less "nervous" while giving me that nice focused flow throughout the day. I don't smoke it or shoot it, I don't try to increase my dose, - i.e. I don't use it recreationally right now and have no problems not doing so. I don't feel a whole lot when it kicks in, to be honest - there is no "high" at this dose. It just works and seems to be what my body is most adapted to now. I'm not getting sick at all, which I did constantly on Concerta.

 

If I were to taper off it, I would definitely follow the 10% rule and use my mg scale to measure out reduced amounts for my capsules. Just as I am doing now. As mentioned though, I'm not ready to get off that yet, and would need to find a viable behavioural strategy to help me cover the needed bases without it first.

 

I honestly switched to Concerta in the beginning because I experienced serious withdrawals at first, which terrified me. I got scared that I was overstimulating my body by taking strong stimulants. Back then, I did not fully understand what I was doing and was changing my stimulant dose. If I had some proper advice and explanations around this from the get-go, I would have not kept changing everything around and adding drugs like that.

 

I spend time around harm reduction folks almost every day. I've gotten really passionate about this after my addiction episode last year, which ironically stemmed from a crisis I went through then that was initiated by someone with a gambling addiction. I became really interested in the gambling thing and now almost feel like I have a grasp of addictions inside and out. And yes, I feel confident that I am no longer in a place where I will lapse into another addiction ever again.

 

So, the physical stuff. I realized that my poor measurement of trying to do dry cutting for that 0.3mg was causing me not to stabilize. I took a closer look and I was probably actually measuring closer to 0.1mg. This is not the speed I wanted to taper at and explains why I felt completely wrecked after quitting dilaudids. I started on the compounded 0.3mg and it does feel like an updose. I'm not liking how the mental clarity I had earlier is suddenly muted a bit BUT all of my physical symptoms are GONE! I'm starting to feel a bit more lively, well-rested, and back to normal again, too. Now, I am just debating how long I should stay on the updose before I start tapering again. 

 

Honestly, the reason I've been wanting to go faster on the taper was that initial experience I had after a dose drop a few months back. It felt like the fog cleared... I remember sitting on the balcony in the evening after work and realizing how vibrant everything suddenly became. The breeze, the rustling of the trees... It was so intense that I started crying. I felt beautiful. I felt like I wanted to hug and kiss and just endlessly appreciate every emotion coming out of me, thanking them and telling them that I never meant to leave them behind. A friend called me just then and I realized how long it's been since I've truly enjoyed a conversation like that... We talked about nothing and everything and I remember myself feeling every word, every pause, everything flowing into everything else so seamlessly and nonchalantly and freely. 

 

I wanted more of that and it pained me to keep taking something to dull all of this out. Now, I wake up and remind myself every day why I must keep doing with this taper. I just want that person I expect to be after reaching zero, but after this physical symptom scare, my intellectual self knows that I can't just be jumping to there yet. This is such a struggle. I would love to learn how you/others have motivated themselves to keep going?

 

Also, I'm still stuck as to finding non-drug ways to manage pain. It's not easy after dose drops. I won't be doing that for probably at least a couple more weeks, but feel like I need to be prepared.

 

2 hours ago, manymoretodays said:

 

 

Oh.....other questions.  I only worked in "mental health" settings briefly, while still licensed as a professional.  I no longer am licensed, and sometimes wonder why I retired that liscensure(?Liscense) .......  I actually thought it might be free- ing for me, AND help me decide what to do next.  I could never have gone back to what I did as a younger woman......that I know.  I did a lot of pediatrics- ER, ICU, even lifeflight, and then more briefly a pediatric specific nurse practitioner. 

Cool stuff and again......I've been one lucky individual I think......in opportunities and experiences.  I'm older now.  And.  It's been so long.  So.  Onward.  So.....well yes and no.....of course I'm always a Nurse, it doesn't just end, but not employing in it or doing anything outside of the Nurse Practice Act, or illegally. 

I honestly don't know for sure, what comes next.  I'm guessing maybe it already has, or will be more artsy.......creative mind.  I don't know. 

Hey thank you for asking. 

  

 

Yah, on ^........maybe.  I like that term "socially based narrative" too.  Have you read Johann Hari- Lost Connections ?  Do.  And maybe not, on many sacrifices.  I would, totally like to be part of something peer run, and managed.......and something that perhaps I myself could have totally used and benefited from at some point.  Respite or people who could come over, and I would have allowed them to, to help when I needed that.  I would envision though this really cool respite, oh in a nice natural setting of peace and calm, that folks could get to, when they needed it.  It would have to be word of mouth, and low key.  And have some professional licensed staff on call.  That I don't know that I'll get to be part of here.  Maybe just more minimally... or not......you know.....doing yoga or artistic expression with people........or jamming-playing music.  So many things.  I do know or think I know that I am wanting to be sure, where to focus, and what to focus on.  I guess I'll know.   I am, slowly but surely becoming more focused.

 

Sounds like you actually have a doctor background - that's awesome! Sounds like you had positive experiences in the field, too, which I am glad to hear  It warms my heart to hear successes in healthcare. It is such an important field and I want to do my best to support it and have people helped properly. My doctor is actually a nurse practitioner right now - I often find them to be a lot more collaborative and open-minded than regular physicians. If I end up getting into the harm reduction/"addictions" area of practice, I'm thinking of getting a nursing diploma on the side too. I've been fascinated by health topics all my life and really wanted to be a doctor as a kid - lol!

 

I do love the idea of respites if they are run by the right people. Worked in the developmental services field and had some encounters with less-than-optimal respites, too. I think I'm more of a problem-solver, head-on sort of person who wants to change things in society actively, so maybe am just not as drawn to rest/respite/artsy-type things as some. I have not read Lost Connections but will add it to my list! 

[Twilly]

Just posting an update because I am getting really emotionally torn about this lately.

 

Still holding at 0.3mg. I've been experimenting with moving my doses around a little bit, though. I think i got my schedule down now and am planning to stabilize on it for at least another 2 weeks, then see how i feel.

 

Taking the SSRI in the morning, even two hours away from all stimulant dosing, does not work at all. It just makes me into a sluggish zombie for the rest of the day. Right now, i dose 0.15mg at 2pm, half a 0.15mg at 7:30pm, last half 10:30pm. Stimulant 10mg 7am, 5mg 9am, 10mg 12pm. I'm struggling with the timings sometimes as I can be scattered, especially at night, and take the wrong thing at the wrong time. I had a few accidents but managing ok for the most part.

 

Also just had the most awful period ever. Painful diarrhea and cramps, body tightness/soreness/random pains, sleep was awful for a couple of nights. I have significant issues functioning at work if I get bad sleep in any way and have been trying to protect my sleep at all costs. Symptoms resolved by the end of yesterday.

 

Feeling really good today so far, emotionally and physically. Not much soreness other than around that 9am cortisol spike, which was pretty quick and manageable.

 

I am hating how the escitalopram is making me feel each time I take it. No matter how low the dose, it always feels like it fries a part of my brain, gives me nausea, and makes me lazy and hungry. The longer I go without it, the more I feel like my old self, and the less stimulants I actually feel like I need to use. There are mornings now where I just wake up and feel great without taking anything at all. I have not had mornings like this in years before while taking the higher doses of SSRI.

 

I do still get one painful brain zap in the morning when I just dose my stimulants and wait to dose the SSRI later in the day.

 

I'm starting to wonder how healthy it is to keep on with the taper vs just stoppping. I read and understand the reasons for the taper, but my mind keeps arguing that taking it every day also makes your brain adjust to the dose and then re-adjust to it wearing off, so there's some instability that way either.

 

But part of me is just insanely scared that I wil be physically incapacitated and will get this awful neck rigidity back of my head feeling 24/7 for god knows how long if I do.

 

I did find the non-med strategies to manage pain this morning. Took me a while but I'm glad I did and will be exploring them.

[manymoretodays]

Hi Twilly,

I am just worried about the long term use of stimulants and you is all.

I'm referring to your previous post.

I think it often CAN lead to mood instability.  I had short term usage of prescription stimulants, after being medicated with AD's, and it always was good, helpful.......at first........later.......not so much, and no, me neither.......I didn't abuse them.

I just googled long term use of stimulants and a lot came up.

 

Anyway......so, I wondered if/then you might ever wish to taper off them.  And I would think that tapering the stimulant prior to Lexapro would be key.  And yes, I know........finding what you would need for ? occupational therapy, and support.......to do this might be challenging.  Yes, challenging.  And that explains why I was saying I had no idea how methamphetamine is packaged for regular usage.

Oh Twilly, and I have heard the stories........of those in recovery from meth usage.  Granted, abuse of.  But, often I hear of delusions, based on severe paranoia.........and then that is only realized after a few years of recovery or freedom from that drug.

 

No, nothing like a doctor background.  That's more what PA's get I think.  Nursing is cool.  Back when I began.......in the 70's, nearly 80's......it was very holistic, or we were taught a lot about holistic care of a person.  I did get spared from some of the tougher coursework like Organic Chemistry.  Phew.  And the orientation, is just a bit different from doctors learning.  I was more of a Nurse nurse.  I didn't really enjoy what I did as a peds NP as much as when I was in Hospital.  I did love the pediatrician I worked with though, and had no problem adopting his ways of management.

Anyway.  Like I think I said......I was very fortunate. 

 

Back to you.

2 hours ago, Twilly said:

Still holding at 0.3mg. I've been experimenting with moving my doses around a little bit, though. I think i got my schedule down now and am planning to stabilize on it for at least another 2 weeks, then see how i feel.

 

Taking the SSRI in the morning, even two hours away from all stimulant dosing, does not work at all. It just makes me into a sluggish zombie for the rest of the day. Right now, i dose 0.15mg at 2pm, half a 0.15mg at 7:30pm, last half 10:30pm. Stimulant 10mg 7am, 5mg 9am, 10mg 12pm. I'm struggling with the timings sometimes as I can be scattered, especially at night, and take the wrong thing at the wrong time. I had a few accidents but managing ok for the most part.

 

Also just had the most awful period ever. Painful diarrhea and cramps, body tightness/soreness/random pains, sleep was awful for a couple of nights. I have significant issues functioning at work if I get bad sleep in any way and have been trying to protect my sleep at all costs. Symptoms resolved by the end of yesterday.

 

What is your schedule now?  Just note the times on the left and then your meds by name and dose on the right. 

That will make that clear for us.

And oh, when did you start splitting your total daily dose of Lexapro into 2?  Or 3?  Are you taking 0.15 mg of Lexapro at 2 pm, and then 0.075 mg at 7:30 pm and again at 10:30 pm? 

So tell me when you began that split?

And why splitting it in the way you are?

And just put that quoted information into a nice list format for us.

Thanks Twilly.

Doses of meth, and the full name too.....into a list format, with the Lexapro.  Times on the left, and then drug and doses on the right.

 

Oh my gosh, yes.........no wonder you are confused with such a dosing schedule.  Wowser.

 

I am glad additional symptoms resolved after monkeying around with dosing and dosing schedules.

 

2 hours ago, Twilly said:

I am hating how the escitalopram is making me feel each time I take it. No matter how low the dose, it always feels like it fries a part of my brain, gives me nausea, and makes me lazy and hungry. The longer I go without it, the more I feel like my old self, and the less stimulants I actually feel like I need to use. There are mornings now where I just wake up and feel great without taking anything at all. I have not had mornings like this in years before while taking the higher doses of SSRI.

 

How do you know this is the escitalopram and not the effect of the methamphetamine stimulant? And/or long term usage of stimulants?

 

I mean I don't know for sure either Twilly.  And I think I will put you in for conferring with staff now too.  As I am torn.  I might be off base, but I'm wondering if once we get your dosing pattern squared away, if may you might need more or an updose to the SSRI Lexapro.  Just a mini updose.  And then a begin to taper on the stimulant/methamphetamine.  Too soon to tell.

Okay and editing in here:  I know you don't wish to get totally off your stimulant, but to the lowest dose possible.  And it would be nice too, if it was a legal substance, or prescription drug we were dealing with.  Just my thoughts now.

 

I'll bold what I want you to report in a reply next(it will be above).  And then of course, you can in narratives voice your thoughts too.

 

Best of this season for you Twilly.

L, P, H, and G,

mmt

Edited December 18, 2022 by manymoretodays
additional

[Altostrata]

@Twilly you have a very interesting drug history. Someone with a very creative interest in psychotropics has been prescribing for you. Did one doctor prescribe all these drugs?

 

Ordinarily, we are very concerned with helping people minimize adverse drug effects while they taper, but you seem to be a veteran who can deal with their drugs. Your use of amphetamine is beyond the abilities of peer support. We can't stop people from making their own problems. Please do what's best for you.

 

If you want to go off escitalopram, here are Tips for tapering off escitalopram (Lexapro)

 

 

[Twilly]

5 hours ago, Altostrata said:

@Twilly you have a very interesting drug history. Someone with a very creative interest in psychotropics has been prescribing for you. Did one doctor prescribe all these drugs?

 

Ordinarily, we are very concerned with helping people minimize adverse drug effects while they taper, but you seem to be a veteran who can deal with their drugs. Your use of amphetamine is beyond the abilities of peer support. We can't stop people from making their own problems. Please do what's best for you.

 

If you want to go off escitalopram, here are Tips for tapering off escitalopram (Lexapro)

 

 

I am so sorry. I would not recommend or advocate what i am taking to anyone else. I have awfully low self esteem and am always looking for other solutions. I do understand this is not medication management advice forum and did not want to ask this directly, but I made it clear in my initial post. I was unable to do this any other way because i needed full 7am to 10pm stimulant coverage, while taking all my meds at same times of the day. I tried taking two Vyvanse 40mg but there was a one-hour window where the first one wore off that gave me pretty disabling anxiety.

 

What i am currently doing is the only way I am as emotionally stable as possible at work, with smooth effets throughout the day. This is not a doctor prescription, it is something i implemented and ran by the doctor while trying to adapt to this new "no stimulant breaks" routine. I used to take my Vyvanse as prescribed at the start of my work shifts, be it 7am or 3pm. Then i had two 5mg Dexedrines that i would take outside of that when needed. I would feel pretty uncomfortable withdrawals when i took the Vyvanse at an irregular day... and i was not sensitized back then as i often am now throughout the taper. I can't imagine how much doing that would trigger my system now. When i do something out of order and at the wrong time, i get this burning headache at the nack of my head, my neck feels paralyzed, and i just feel disoriented and out of focus. I'm clearly very sensitive to serotonin too, felt it even when i started Vyvanse.

 

I've read the posts on tapering, which one to taper first, etc. I wanted to understand deeper as to how the stimulants might further sensitize my nervous system while I'm trying to withdraw from escitalopram, so i can at least do my best to mitigate any issues. I've been thinking a lot about how i am basically withdrawing from the stimulant each and every day and the implications of that. I am also trying to wrap my mind around how it's not advised to take a stimulant break when so many doctors do say it is a good idea. 

 

I am also trying to understand why I sometimes react badly to my SSRI dose. This happened once when I was on Concerta and took just a few sips of coffee. It then happened a few days after i quit opiates. I'm thinking it has to do with nervous system getting disbalanced, but the gut reaction when something feels bad to the body is to change it? Does this mean my body wants to reject the drug/is getting hurt by it somehow, or do i need to just push through this?

 

I am feeling suicidal again and can't help it. I began feeling suicidal when i was 12 years old and have been on and off. I have put tremendous effort into staying off everything until now. I knew i was going to kill myself right there and then if i did not go on adhd meds.

 

I am trying to get to a better place and get better answers so i don't end up kicking the bucket. I'm really, really trying for everyone i love.

 

I wanted to get OT supports and get off the meds asap right when i got diagnosed. The pandemic happened right after and made it inaccessible for me. I broke down because all my dreams of creating an internet-free, minimalist space where i can thrive went out the window. Then, I lost all my money in that crisis last year. What really hurts is that I still have some issues with time management and organization in the most basic, minimum wage job. I'm living in fear that my meds will stop working and i will lose that. I have put all this effort and thought into trying to even keep that while correcting this huge mistake of going on ADs, as so many of us here have.

 

I am reading so many posts here with people having exact same withdrawal experiences as me and not taking stimulants at all. Not everything is tied to my stimulant use. I've been through all these things in the very beginning of my taper and they pretty much all went away after a few months' hold at 5mg. With (almost) daily stimulant use.

 

I'm really honestly feeling not worthy at all because I've spent my life trying to fit my square, deranged self into round holes and apparently now the only way i found to get through this that works for me is not acceptable. It would have been amazing to be able to share my experiences, to support others too, and to feel part of a community through this rough time. I waned to hide and not disclose, but i see there's an expectation to be honest too so people can get a full picture. I know this is my neuroemotions talking late at 2am when i have a 7am shift. I just feel like I'm a living problem and should have been eradicated anyway. My hopeful self wanted me to work on a publicaton, to actually get somewhere in life for once, yet i am spending hours and hours trying to piece this all together, neglecting everything else....

 

I'm tired of hurting. All my life. I'm sorry again. I hope this at least gets to someone if it doesn't get approved. 

[Altostrata]

13 hours ago, Twilly said:

I am reading so many posts here with people having exact same withdrawal experiences as me and not taking stimulants at all. Not everything is tied to my stimulant use. I've been through all these things in the very beginning of my taper and they pretty much all went away after a few months' hold at 5mg. With (almost) daily stimulant use.

 

Yes, everything is tied to your stimulant use. A combination of drugs affects everything.

 

I am sure that with your long drug history, you have experience drug withdrawal symptoms many times. This could be an example of interdose withdrawal indicating a rather intense physiological dependency on Vyvanse:

13 hours ago, Twilly said:

I tried taking two Vyvanse 40mg but there was a one-hour window where the first one wore off that gave me pretty disabling anxiety.

 

-- or it could be from an interaction with something else you were taking at that time, or it could be too damn much stimulant overall. Or it could be caffeine, such as

 

13 hours ago, Twilly said:

This happened once when I was on Concerta and took just a few sips of coffee.

 

When you're taking a bunch of drugs and changing your drugs frequently, that could cause symptoms you interpret as "sometimes react badly to my SSRI dose". Or you could be reacting badly to your SSRI dose. 

 

About your amphetamine dosing, we understand that you're doing what you feel is best for you. But we cannot distinguish between adverse effects of the amphetamine and escitalopram withdrawal effects, so we cannot assist you in a harm reduction taper. This does not feel safe to us.

 

We can tell you this is the way to taper escitalopram Tips for tapering off escitalopram (Lexapro) You already know about holding on a dosage when the going gets rough.

 

I also advise you to read up on adverse effects of the drugs you're taking, which may be causing the very symptoms that cause you such problems, such as https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7069845/  When considering a change in your cocktail, you also might want to use a Drug Interactions Checker.

 

Since you're under the active care of a doctor, the doctor is responsible for the adverse effects of your prescription drug regimen. Unraveling this is too much to ask of free, unpaid, volunteer peer support.

[Twilly]

Hey Altostrata, thank you for your quick reply!

 

On 12/19/2022 at 4:10 PM, Altostrata said:

Yes, everything is tied to your stimulant use. A combination of drugs affects everything.

 

I am sure that with your long drug history, you have experience drug withdrawal symptoms many times. This could be an example of interdose withdrawal indicating a rather intense physiological dependency on Vyvanse:

I know what you mean - of course the other drugs will change the properties of my SSRI withdrawal symptoms. What I meant is that I know my stimulant baseline. If any changes happen as a result of long-term stimulant use, they would happen slowly over time. When I change my SSRI dose while keeping my stimulant dosage constant and see novel physiological and psychological changes, I know that the main cause of these changes is the SSRI dose change. 

 

The things you mentioned all could be possible. I am also thinking that the interdose withdrawal anxiety is from my anxiety threshold being reduced due to a relative serotonin deficiency in my body from SSRI withdrawal. I believe I did that a couple of weeks after reducing my SSRI dose at the beginning of my taper, around March. Vyvanse never gave me anxiety prior to the taper, even if I did a week of heavier meth use and then took a 40mg Vyvanse on my day off. I would simply feel more tired and groggy that day. Same with caffeine - I used to drink 2-3 cups a day for about two years with no issues. Now, I am amazed at how severely my body reacts to even a few sips.

 

Meth does provide more of a serotonin cushion that reduces anxiety, but obviously comes with the cost of worse withdrawal after. I realize that sleep issues, loss of appetite, muscle tension, etc. caused by SSRI withdrawal are even more exacerbated by any stimulant. That serotonin cushion is unreliable and possibly takes away from my brain learning to generate its own serotonin. So yes, it makes complete sense to reduce my stimulant use as much as possible. I am willing to go very low, just not stop altogether. I started doing 22.5mg today and will do this for the next couple of weeks, will then reduce to 20mg. I will try going lower after that and see how I feel, but 20mg might be optimal for me for now. I can stabilize on 25mg, but noticed lately with the heavy period and other stressors, this dose can still be too much. I might also hold mid-way through my SSRI taper to taper down my stimulant further, because I might end up needing even less then.

 

In the end, it will be a tradeoff between optimizing the mental stimulation I get from it that benefits me while minimizing physical side effects. I know I have a dependency on amphetamines, but it is part of that tradeoff I have accepted for myself. I just need to find the dose that gives me the best pros/cons balance while keeping stress/changes to a minimum.

 

Quote

About your amphetamine dosing, we understand that you're doing what you feel is best for you. But we cannot distinguish between adverse effects of the amphetamine and escitalopram withdrawal effects, so we cannot assist you in a harm reduction taper. This does not feel safe to us.

 

We can tell you this is the way to taper escitalopram Tips for tapering off escitalopram (Lexapro) You already know about holding on a dosage when the going gets rough.

That is completely understandable. You and @manymoretodays helped me address my questions for the most part and provided me with other things to think about, so I really appreciate that. 

 

I was thinking of increasing my SSRI dose a bit as mmt suggested, but seem to be stabilizing okay on the 0.3 for now. I say this because I have been sleeping well for the most part, except for the two days I was on my period. I always recover steadily as long as I consistently get proper sleep. I would rather have to taper off as little as possible.

 

My main concern with tapering slowly is serotonin toxicity. I noticed that whenever I dosed amphetamine even two hours after the SSRI, I would get brief toxicity-like symptoms like ears/hands feeling hot, agitation, sweating, and a bit of that blunted/tired/brain fry kind of feeling. It is concerning because the SSRI lives in my body for the rest of the time even after the dose, while the amphetamine is also long-lasting. These symptoms are not nearly as salient if I take my amphetamine in the morning, at least 8 hours after my last SSRI dose. Basically, dosing amphetamine relatively shortly after any SSRI dose seems to be a big no-no (at least for me).

 

I also notice that the more serotonin oversaturation moments like this I get during the day, the harder it is for me to sleep at night. This also happened when I suddenly bumped up my Escitalopram, despite keeping stimulant use constant. I interpret this as serotonin being depleted/my brain rebounding and not wanting to generate more serotonin to allow me to fall asleep. I'm amazed that this is still happening at such a low Escitalopram dose - just shows how powerful this med is.

 

So while taking my SSRI at night is more sustainable as I do the taper, I still want to go the faster way if and when possible to remove this interaction from my body ASAP to be able to function more optimally. Lowering my stimulant dose meanwhile will definitely play a role, too. I will still do the 10% taper (0.27mg, 0.24mg, 0.22mg, etc.) and start off my first drop with the recommended 3-4 weeks, but was thinking of possibly taking 2 weeks on a step in the future if my body seems to be adjusting okay? I planned it out and the taper will take me at least 6 months with the shortest timelines, so possibly even longer. 

 

Quote

I also advise you to read up on adverse effects of the drugs you're taking, which may be causing the very symptoms that cause you such problems, such as https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7069845/  When considering a change in your cocktail, you also might want to use a Drug Interactions Checker.

 

Since you're under the active care of a doctor, the doctor is responsible for the adverse effects of your prescription drug regimen. Unraveling this is too much to ask of free, unpaid, volunteer peer support.

Thanks for this article link - it is a really interesting case study and sent me down a rabbit hole of other really neat papers. I am not surprised that a drug which constricts your veins and makes you more physically tense can make soreness/muscle pain worse. It is intriguing that a dose that does not cause issues for many other people caused real physical impairments for this boy. I do notice soreness from my stimulant use, which is why I always took 1-2 days off all stimulants every week before. Yeah, I had no issues with that before and never even thought it can cause problems for my body until I started reading things on this site. So I am gathering that there is no way I can do this skipping days anymore when my body is adjusting to the SSRI changes...

 

Again, it does make sense to reduce my dose. It is just a bit hard to deal psychologically with not performing as fast/efficiently at work as I used to, I guess.

 

Unfortunately, doctors are swamped with information in medical school and do not fully understand everything, either. For example, I told my doctor that I tried taking 10mg of meth after a month of Concerta and it made me sleepy. I expected this because my brain spent all this time being serotonin-deficient and now is suddenly given a bigger rush of serotonin than it is used to. My doctor was surprised that a stimulant could make me sleepy. I talked to another doctor, asking along the same lines about sleepiness a few months back when I had to bump back my SSRI dose to 5mg. He said I was sleepy because I did not do enough stimulant (I did a typical amount for me at the time, but did take half of the 5mg dose in the morning). I have an appointment with a psychiatrist to ask my questions shortly, too, but don't expect them to give me the best advice on my serotonin concerns. After all, they do prescribe amphetamines and SSRIs together all the time.

 

I really, really wish I could consult with doctors about everything and always get meaningful advice that truly improves my life, but that is not always the case. I appreciate that there are limits to what you people can do on here, too. I just want to say that you all do amazing work and the information I've gathered from here has been extremely invaluable to me. I am also referring some people I know and are on ADs to this site to give them another perspective. I just ordered Dr. Glenmullen's The Antidepressant Solution, too. I'm hoping to understand a bit more on the ins and outs of what exactly the ADs do to the brain (and how this can interact with other drugs). Drug cocktails seriously scare me now.

 

I will hold on the 0.3mg dose for at least another month before dropping down. When I started this journey, I was desperately looking for reports of experiences from people who got off ADs while on stimulants. I would really like to be able to post here every couple of months with a description of my symptoms, doses, progress, etc. This is not to encourage anyone to take exactly what I am taking, but to learn from the overall pattern, as prescription stimulants have very similar effects on the body. I think it might help someone like me out there. It would also be a little accountability thing for me. I'm hoping this would be okay by you?

[Altostrata]

3 hours ago, Twilly said:

I noticed that whenever I dosed amphetamine even two hours after the SSRI, I would get brief toxicity-like symptoms like ears/hands feeling hot, agitation, sweating, and a bit of that blunted/tired/brain fry kind of feeling.

 

Not a surprise, you're probably maxed out on the amphetamine. Less than a half-milligram of escitalopram probably has negligible involvement.

 

Good luck. 

[Twilly]

Hey @Altostrata, 

 

Good to know that this dose might not be a huge concern. I agree but still do think that the fact that my body is still adapting to the relatively higher dose of the SSRI might have exacerbated the effect of the amphetamine. I had this happen Monday when i took 2.5mg Dexedrine just under two hours after dosing my SSRI, but not yesterday when I tried dosing it 3 hours after (have been doing 20mg meth + 2.5mg Dexedrine, latter is an as needed prescription).

 

Was going to write out a list for past couple days but caught a bug and have been feeling too sick to go out and use a computer.

 

Last quick question if you do not mind answering. Since i just started reducing my stimulant use and got sick, would you suggest keeping the lowered stimulant dose or bumping back up? Curious about this in general for any future change in medication.

 

Thanks again.

[manymoretodays]

Hi Twilly,

On the Lexapro, and working towards tapering off that eventually.

 

I was just looking for some of the information on end doses.

We've got this on site:

Managing the Endgame Taper

 

And although it is a unknown, as far as the end dose for each and every drug we work with,  and it is likely different for some of the different drugs.

2.5% of your starting dosage is one estimate.

 

Which gives me a dose of 0.5 mg of escitalopram(Lexapro) based on a start dose of 20 mg.

 

Given your present dose of Lexapro at 0.3 mg

I was thinking 0.05 mg might be doable for an end dose.

 

This is on the low side.  That is actually 0.025 percent of 20 mg

 

If you can measure out the even smaller dose of 0.05 mg........that might be reasonable , for a jump off point on the Lexapro/escitalopram, after you continue to taper that at no greater than 10% of each previous dose.

 

Of course pay attention to your body and mind.

 

Other thoughts from me today for you.

 

If I were you I might totally consider trying a 12 step group for support now.

Possibly NA(narcotics anonymous) or AA, or if you could find a dual diagnosis type group even.  Mainly for the principles that apply to dependencies.

 

Not so much for tapering though.

 

I have yet to find many who prescribe to tapering in the groups that I attend.  I teach when I can, or try to enlighten.

So for that, tapering, you might find yourself alone, or relying on what you have learned, are learning now.

For support and people dealing with similar issues, and possibly finding even a few who may become your healing tribe of sorts, it might be great.

 

And we have a topic, of course, which you may find helpful:

Twelve Step Recovery and Surviving Antidepressants

 

Okay.  Best in healing.  Always.

 

L, P, H, and G,

mmt

Edited December 23, 2022 by manymoretodays
it's still a bit confusing, forgive.....tired ho ho ho

[Altostrata]

Sorry, @Twilly, we do not offer addiction medicine services here, either. There are plenty of doctors you can consult for your meth situation.

[Twilly]

@Altostrata Sorry if I was not very clear with the nature of my question. It was not about meth specifically, but the scenario prompted an (anxious and obsessive) train of thought for me. I just got violently sick with COVID for the past couple of days, actually, which has just ramped up my overall distress, neurological and otherwise. I have always been terrified of getting sick. So I started frantically looking up answers on here and not finding any. I realized that, what if I get sick like this again after just dropping my Escitalopram dose in the future? I am assuming that a 10% drop is supposed be mild enough that it would not be a detriment to recovering from any illness?

 

I did stay with my lowered stimulant dose as I thought it would just be easier on the body. Stimulant taper is not such a big deal for me and I do not need assistance for that at all.

 

@manymoretodays Thanks for making more sense out of the target end dose. I was reading others' experiences of dropping from 0.05 to 0 (was wondering how they got the 0.05, but now I get it - I read the endgame taper post a while ago). It looks like they still experienced a significant change in symptoms after getting off. I would like to try getting down to 0.01 before dropping off and seeing how it goes. I think I can get the compounding pharmacy to do this - I will try my best.

 

I did not want to share too much specifics about this, but I actually was part of an Anon group in the past. I was a victim of a gambling addict who forced me to surrender thousands of dollars, which is how I lost everything. He knew my address and where I worked (because we were on good terms in the beginning). So, if I stopped communicating with him, he would repeatedly call my work and even come to my home. I became so addicted to meth as a direct result of this. I worked 60 hours a week at the time and used meth to make more time staying up at night to deal with his harrassment. Obviously, the entire situation caused me so much distress that I also used meth as an escape and almost as a self-harm mechanism. Thankfully, the situation has been resolved, and so has my extreme meth use. I see this whole year as having been one long (but less-than-ideal) taper from that, too. The thousands of dollars are still lost, though, and I've been under a lot of pressure to try to recover them (in addition to dealing with other expensive issues this year).

 

Needless to say, the meth was no longer actually helping me therapeutically when I used it in excess, versus how I use it now. This is the main reason I know I will never go back to that pattern of use, along with just the insights I've gained into my body from the withdrawal process, etc.

 

I did find the GamAnon group very helpful. I did feel like an outsider, though, as most people there were family members. My absolutely main and most crucial source of social support/sense of belonging before the pandemic was participating in face-to-face support groups and classes. Of all groups I participated in, the most beneficial thing for me was getting together with other neurodivergent folks, no matter what label. Many of them were not on medications, either, just like I was not. We constantly shared our day-to-day experiences and coping strategies. It is really hard to get by in life when you constantly feel like you do not fit in and cannot ever meet anyone's expectations properly.

 

When in-person support got cut off was when I mentally collapsed. I cannot handle owning a computer or a smartphone because of how distracted I get on these devices. I mismanage my time, procrastinate on chores, then do everything late at night, then mess up my sleep, wake up exhausted the next day, and the cycle repeats. I have been fighting with this issue since high school when I started to recognize it. So virtual groups are a no-go for me. I connected to the GamAnon group over the phone, but it was a virtual group too, and just having the phone input made things even more awkward at times. The pandemic has resolved and so many things have gone back face-to-face, so it makes no sense that key support groups for people with differences are still not available in-person here.

 

I will consider joining another Anon group in the future and will have to look into the local format, pros/cons of that, etc. I wish there could be one for SSRI addiction, too, whatever that term actually means.

 

I do not have a whole lot of time on my hands with publication work, managing WD, constant medical testing/exams, and trying to make enough money to fix severely receded gums from this year's serotonin withdrawals (meth AND SSRI). I am really self-conscious about this and it's grating on me. So I am just stressed through the roof and will need to prioritize, which can be hard for me. Social interaction carries a lot of uncertainty and is, by default, more stressful than doing things on your own, where you can control your own environment fully. Stress tends to make me very asocial.

 

So I think I will first focus on re-establishing my own spiritual practice. Meditation has always helped my issues more than any other non-drug approaches have. I would like to take a break from the Internet for a while and get in tune with myself more. When money allows, I will work with my therapist and see if I actually have room for self-acceptance in me. It has been a challenge when I've been feeling like the society is constantly bending the other way from how I know my brain works and what environments I thrive the most in.

 

Very hard to not get distressed or triggered right now after COVID hit. I'm really scared of losing employment and opportunities to make money; every day off work intensifies that fear. I was doing so well with the 0.3mg dose otherwise. Trying my hardest to hold it together.