poohstix: Lexapro, possible kindling and attempt at taper

[getofflex]

If it were me I would take the antibiotic.   Your ear infection could get worse and it’s not likely the ampicillin will affect your nervous system.  

[poohstix]

I finished my antibiotic course, and nothing bad seems to have happened (knock on wood!) I had a bad neuroemotion day today but it may be part of the normal stabilization process on lexapro 4.5. I no longer have bouts of feeling fluish or elevations in temperature above 99F.

 

My body temp goes up from 98.8 pre lexapro to 99.0-99.1 a couple hours post lexapro, to answer an earlier question from @Altostrata. I do also get warm skin followed by sweats and at times sad neuroemotion and upset stomach a few hours after lexapro as well. I still can’t seem to sleep without waking at some point during that 4-6 am window. I can start posting daily notes again from tomorrow if it helps.

[poohstix]

I do have a question. Looking over this website, I count my blessings that my withdrawal has not been as severe as some people’s, going so far from 10 to 5. Part of me even feels bad to be taking up the forum’s time.

 

I also read Dr. Horowitz’s article (https://markhorowitz.org/wp-content/uploads/2021/04/18TLP1004_Horowitz-1-11.pdf) and he advocates decreasing doses based on 10% increments in SERT receptor occupancy. For citalopram this would be 19 mg (80% occupancy) to 9.1 mg (70% occupancy) to 5.4 mg (60% occupancy) etc. In lexapro terms, which is twice as potent as citalopram, this would be, approximately 9.5mg to 4.5mg to 2.7mg etc. however, SA recommends decreasing by 10% decrements in dose, so 5mg to 4.5mg to 4.0mg, etc. Is this just coming from a place of being particularly cautious? 
 

I am in a place where I feel like at least some of what I deal with are side effects, though we are still trying to figure it out via the daily notes. Lack of sleep set in when I most recently restarted lexapro (but was initially mistaken for a primary issue), and never completely resolved, suggesting that this is probably a side effect. 
 

I wonder if between a shorter most recent trial of lexapro, withdrawal being relatively less severe, I might be a candidate for what Dr. Horowitz recommends.

[poohstix]

3/18

9:30am: wake. Tight throat, hands and feet, neuroemotion of anxiety, mild PGAD. In and out of sleep until 10:30. Feel awake on starting day  

11 am: acupuncture. Feel a little better 

12:30 pm: neuroemotion (anxious variety) returns. Lexapro 4.5

1pm: mostly better. Still sad 

2:30 pm: post meditation: sad neuroemotion, warm skin. Temp 99.0

2:40 pm: mild anxiety, tightness in feet, PGAD, dry mouth 

3:15 pm: warm just in legs and behind ears. Mood better

3:30 pm: BM: soft but not loose. Mild knot in stomach and tightness under ribs. Gut does not want to accept food, some nausea

3:45 pm: warm skin more general. Edging toward anxious and “off”. Tight front of mouth and feet, very mild neuroemotion of wanting to cry behind the eyes. Feel weirdly desperate like I need to do something on and off

4:15 pm: slightly worse pgad

4:30 pm: mild discomfort in hands, upper back, tight throat 

5 pm: sweat, hands feel a bit tender

5:30 pm: neuroemotion like wanting to cry: feel in face and upper chest 

6pm: sweats, feel a bit of skin sensitivity (creeping sensation) in upper arms and shoulders

6:40pm: not feeling warm, feel fine, temp 99.1

11:30 am: bed. 8 valerian drops

4:30am: wake up, then fall back asleep 

5:30 am: wake again. Muscle tightness in hands, mild PGAD, mild anxious neuroemotion. Go back to sleep 

7:30 am: wake briefly. Until 10:30, in and out of sleep, feel mild PGAD, neuroemotion of anxiety, mid chest pain and muscle tightness in backs of hands, some sweating. Mostly gone by 11 am

[poohstix]

Hello all,

I am wondering how I might adjust my mindset as I go through this process. I am currently struggling with the fact that I am in a long haul for tapering. What has worked for others? I feel like I’m going through a grief process and having a hard time with acceptance. 
 

I am either in for this for a year or more of relatively milder withdrawal effects and ongoing side effects or can go off quickly and risk severe and protracted withdrawal for as long or longer. Reading this site, it seems like my symptoms are not as bad as some people’s, but still definitely there and are difficult not so much in what they are on face, but what they represent: that I will not be “normal” for a while yet, that the symptoms could get worse or mutate into something else, and that in that case I might become disabled. I then start regretting even reinstating this med, and not considering that I could have been having a bad reaction to it until it was too late (past that 4 week window that puts you at risk for withdrawal). Ironically, my doctor was reluctant to have me resume the med, asking “do you really think you need it?” and I should have listened to him.

 

Not sure if this is the right place to post this. Please let me know if this needs to go under a different category or topic.

[Altostrata]

20 hours ago, poohstix said:

I do also get warm skin followed by sweats and at times sad neuroemotion and upset stomach a few hours after lexapro as well.

 

I don't believe the temperature change is important but the sweats and upset stomach sound like adverse drug effects from too much Lexapro.

 

You have been taking 5mg for too long to make sudden changes. The adverse effects should diminish as you gradually taper it.

[poohstix]

1 hour ago, Altostrata said:

 

I don't believe the temperature change is important but the sweats and upset stomach sound like adverse drug effects from too much Lexapro.

 

You have been taking 5mg for too long to make sudden changes. The adverse effects should diminish as you gradually taper it.

I will wait. I’m currently on lexapro 4.5 for two weeks.

 

I am struggling a lot with the prospect of how long this is going to take. It’s like a grief process, that I will be stuck with these symptoms, be they withdrawal or adverse effects, for so long. My symptoms on face could be worse (for example I’ve not had panic attacks or akathisia), but it is so hard not to be a wreck over the fact that they are here to stay possible long term, and I don’t know how they will evolve. I guess I’m struggling with the acceptance piece. I’ve been torn up about this for days. I can’t seem to change the channel. I can’t even watch a tv show.

[getofflex]

On 3/18/2023 at 9:10 PM, poohstix said:

I also read Dr. Horowitz’s article (https://markhorowitz.org/wp-content/uploads/2021/04/18TLP1004_Horowitz-1-11.pdf) and he advocates decreasing doses based on 10% increments in SERT receptor occupancy. For citalopram this would be 19 mg (80% occupancy) to 9.1 mg (70% occupancy) to 5.4 mg (60% occupancy) etc. In lexapro terms, which is twice as potent as citalopram, this would be, approximately 9.5mg to 4.5mg to 2.7mg etc. however, SA recommends decreasing by 10% decrements in dose, so 5mg to 4.5mg to 4.0mg, etc. Is this just coming from a place of being particularly cautious? 

I'm not familiar with Mark Horowitz, but I will say that we at SA practice a harm reduction approach, which is the 10% every 4-6 weeks hyperbolic taper.   Here is what you can do:  do a 10% reduction.  If you have no symptoms after this reduction, wait 4 weeks, and do another 10% reduction.  If you have no symptoms within 4 weeks again, then, you can do your next 10% reduction, and wait 3 weeks instead of four for the subsequent reduction.  If you have no symptoms after the 3 week reduction, do another 10% reduction, and again wait 3 weeks.  If you have no symptoms again, you could then do a reduction in 2 weeks.  

 

reduce 10%, wait 4 weeks

reduce 10%, wait 4 weeks

reduce 10%, wait 3 weeks

reduce 10%, wait 3 weeks

reduce 10%, wait 2 weeks

 

The reason we advocate this, is if you reduce too fast, and you destabilize your nervous system, it can take many months to years to recover.  Often people rush a taper, and in the long run, it actually takes longer to get off the drug, because the person has to reinstate, and wait a while to recover, then start the taper over again.  Does this make sense?  

 

 

[getofflex]

I also want to add that you've done a lot of abrupt changes with your Lexapro in the recent past, and if you slow down on your tapering and drug changes, your system should gradually stabilize, with windows and waves, and the future tapering process with probably get easier.  So even though it will take a long time, you will feel better, and more functional.  You probably won't feel great, but at least it will be better than how you feel now. 

[poohstix]

1 hour ago, getofflex said:

I also want to add that you've done a lot of abrupt changes with your Lexapro in the recent past, and if you slow down on your tapering and drug changes, your system should gradually stabilize, with windows and waves, and the future tapering process with probably get easier.  So even though it will take a long time, you will feel better, and more functional.  You probably won't feel great, but at least it will be better than how you feel now. 

Thank you for the explanation. To clarify, if at end of 4 weeks there are still withdrawal symptoms, do I hold, or is it ok to reduce the dose of the symptoms seem to be stable?

 

Unfortunately I do still have some withdrawal symptoms, though they may also be side effects or unrelated to the meds. I feel like I still don’t understand my symptoms very well, particularly the early morning ones: they seem to be high cortisol related (at various times have been palpitations, muscle tension, chest pain, and muscle soreness or fluishness) but magically stop long before I take my lexapro. Should I keep posting daily notes?

[Sleepan]

Hello Poostyx.  I'm into the same situation as you and I often wonder the same questions as you do.  I'm just a member here not a mentor.  I think the best is go forward with was is less hard on the brain.  I did a cold turkey for 2 months with out of this world symptoms, reinstated and stabilized good enough but waited 1.5 year to start tapering.  It went good enough, but last Fall, I did not wait to stabilize, tapering every 4 weeks.  Symptoms became intolerable.  I was told to take a break and updosed a little 0.3mg end of January, and I'm now having waves but it is going the right way, slowly.  Next time, I'll taper, I'll wait 6 weeks at least before tapering again another 10% from remaining. Of course, I would have loved also to end it all sooner than later.  It will take me probably 2-3 years.  I'm an elder.  I still think it's worth it.  Staying on that pill such a long time was a burden on my health.  Who knows?  Maybe elders do get better sometimes, yes?  Right now, my symptoms mimicked illnesses. There's saving grace there for us as it is a road to health, I'm sure it is the right path.  Patience is virtuous, Poostyx.  From that virtue, other virtues can establish themselves more easily. 

[Altostrata]

What are the symptoms that you relate to withdrawal? What are the other symptoms?

[poohstix]

1 hour ago, Altostrata said:

What are the symptoms that you relate to withdrawal? What are the other symptoms?

Withdrawal: PGAD, muscle tension (in strange places such as backs of hands and feet), tension in back of throat and tongue, neuroemotion of sadness or anxiety with prickling behind the eyes and tightness in chest/throat

On rare occasions restlessness (feel like I need to be doing something besides what I’m currently doing)

Other symptoms (withdrawal, side effects or other):

insomnia where I always wake up at some point between 4-6 am

fluishness (better post antibiotics so maybe I had actual infectious illness)

sore throat with phlegm (did not go away with antibiotics and doctor says my throat looks normal)
warm skin and sweats (still present despite antibiotics)

upset stomach/poor appetite

chest discomfort — I sometimes get it in the morning and it  goes away by 11 am which is before I take lexapro. I also sometimes get it in the afternoon a few hours after taking lexapro, but to a lesser extent. 

General feeling of something being “off”
 

Overall, all the symptoms are relatively tolerable, except the fluishness was a serious drag when it was here. The neuroemotion has come up in the last 3-4 days, about 10 days into my time on lexapro 4.5.

[Altostrata]

Please post daily notes. The physical symptoms give us more information than emotional ups and downs. Thanks.

[poohstix]

3/19-morning of 3/20

7:30 am: wake briefly. Until 10:30, in and out of sleep, feel mild PGAD, neuroemotion of anxiety, mid chest pain and muscle tightness in backs of hands, some sweating. Mostly gone by 11 am

12noon: lexapro 4.5 

1:15pm: desire to wring hands, mild wave of sad neuroemotion 

1:45: feel off and chilled for a second. Pain mid back

2pm: sad neuroemotion, tight in upper chest and back of mouth

3pm: warm skin. Ongoing upper chest and back of mouth tightness with sad neuroemotion

3:40pm: at this point, most likely just actually feel sad and tired, there is a reason for the sadness 

4pm: mild pulling feeling on backs of hands and tightness in front of face, mild PGAD. No neuroemotions

4:30pm: sweat

6:30pm: mild stomach upset but able to eat. Tight throat and hands and mild sad neuroemotion with tension behind eyes

7:30pm: still feeling crummy and a bit tired. Mild tight throat and hands

8:15pn: minimal chest discomfort 

8:30pm: tight mouth and back of chest 

11:30: bedtime. Valerian 6drops. Toss and turn with some sleep until 12:30, then fall asleep for good 

5:30 am brief wake

7:30am: wake

8-10am: slept 

10-11am: Tight hands and feet, chest discomfort, occasional anxious neuroemotion

[poohstix]

3/20:

19-11am: tight hands and feet, chest discomfort, occasional anxious neuroemotion

11am: feel better

12noon: lexapro 4.5

1:30pm: shiver down arms, stomach a bit upset, small chest tightness. Eating 

1:40pm: stool, not loose

3pm: still small chest tightness 

3:30: warm behind ears, warm backs of hands, slightly warm overall

5pm: mild sore throat

6:40: a bit dizzy after mild exercise. Warm backs of feet and hands. Slight tightness in face. Mild stomach upset. 

7pm: palpable heartbeat, small mood drop, tight backs of hands. Eating. Mildly upset stomach 

8pm: feeling fine, sore throat 

9pm: mild warm skin 

9:30: loose stool

12:30am: bedtime, warmth/tingliness over cheeks. Not tired. Valerian 5 drops

12-4am: in and out of sleep, not anxious or frustrated but just not able to sleep. Maybe feeling not tired enough. Some PGAD, muscle tension and sweats during this time. 

4 am: took 5 more valerian drops and fell asleep until 10:30am

[poohstix]

3/21

10:30am: wake. Some tightness in mouth, PGAD and chest tightness but not as bad as prior days 

12noon: lexapro 4.5

1:30pm: tightness in arms and throat

2pm: some tingling in arms. Having food 

3pm: mild despondency, tingling in arms

3:15: body feels “off” in a way like some internal muscle tightness. Stomach does not want to accept food. Mild chest tightness. Bowel movement, not loose. Took l-Theanine 1/4 pill (50mg)

3:40: tight in front of mouth, chest tightness radiating to back, upper back tightness, mild sadness. Tight backs of hands. 

3:50: Mild PGAD, but feels different: like a genital pain. Mild upset stomach. Palpable heartbeat 

4pm: tingling in arms. More l-theanine 1/4 pill (50mg)

4:30: More tired and calm. Then PGAD and tingling down arms again

5pm: tired

5:10: warm behind ears, prickling up hands, mild sore throat, also dry feeling in throat 

5:30: bowel movement, loose. But otherwise feel ok

5:45: PGAD 2-3/10

6pm: mild discomfort across upper chest, back of mouth tight 

6:30: phlegm in throat

7:30: mostly good, just a brief moment of feeling generally off and front of mouth tightness  

8pm: showering. Feel tight mostly in hands and arms. 2/10 PGAD: mostly just a swelling sensation 

8:30: made magnesium oil and put on arms and hands 

8:45: dinner. Mild lower chest discomfort 

9pm: feel ok, no symptoms 

10pm: bedtime. Valerian 5 drops 

12midnight: wake briefly, warm and sweaty 

2am: wake briefly, warm and sweaty 

3am-4am: wake, feel sweaty, palpitations, upset stomach, 2/10 PGAD, muscle tension in hands and arms, tight throat and tightness behind the eyes like going to cry 

4am: 3more drops valerian

9am: wake. Still feel tired and tight in throat and behind eyes like going to cry 

[poohstix]

I also found the list of synonyms I made when all of this was starting up in January and I was just starting lexapro up again. This may help work out what’s a side effect and what’s withdrawal.

 

-sleeplessness, hard to sleep more than a couple hours in a row 

-anxiety that doesn't make sense (no situational trigger)

-restlessness

-"fatigue and alertness that chase each other"

-pins and needles / itchiness  

-sweating

-mild fever (99.7) (come and go)

-one day of feeling warm without objective fever 

-anger and irritability, mood fluctuations, despair

-pounding heart, at times high pulse 

-inappropriate sexual arousal (PGAD)

-more stools per day (some looser)

-poor appetite / queasiness

 

eventually a lot of the above calmed down except for upset stomach, itch and intermittent insomnia, but now I’m tapering it feels like some things are coming back. But before January I never had any of those issues so I can only attribute them to medication.

[Altostrata]

It appears after you take 4.5mg Lexapro, you feel worse overall?

[poohstix]

2 hours ago, Altostrata said:

It appears after you take 4.5mg Lexapro, you feel worse overall?

I do feel not good for the first few hours after I take it. Then by late afternoon or evening I feel better. This has been the case ever since I started taking lexapro in January. But then I also have issues in the middle of the night and earlier morning at times.

[Onmyway]

On 3/19/2023 at 2:10 AM, poohstix said:

I do have a question. Looking over this website, I count my blessings that my withdrawal has not been as severe as some people’s, going so far from 10 to 5. Part of me even feels bad to be taking up the forum’s time.

 

I also read Dr. Horowitz’s article (https://markhorowitz.org/wp-content/uploads/2021/04/18TLP1004_Horowitz-1-11.pdf) and he advocates decreasing doses based on 10% increments in SERT receptor occupancy. For citalopram this would be 19 mg (80% occupancy) to 9.1 mg (70% occupancy) to 5.4 mg (60% occupancy) etc. In lexapro terms, which is twice as potent as citalopram, this would be, approximately 9.5mg to 4.5mg to 2.7mg etc. however, SA recommends decreasing by 10% decrements in dose, so 5mg to 4.5mg to 4.0mg, etc. Is this just coming from a place of being particularly cautious? 
 

I am in a place where I feel like at least some of what I deal with are side effects, though we are still trying to figure it out via the daily notes. Lack of sleep set in when I most recently restarted lexapro (but was initially mistaken for a primary issue), and never completely resolved, suggesting that this is probably a side effect. 
 

I wonder if between a shorter most recent trial of lexapro, withdrawal being relatively less severe, I might be a candidate for what Dr. Horowitz recommends.

 

@poohstix

two things: 

 

1) The Horowitz article relies on SERT occupancy which we can't measure easily - you need a tracer etc to do it for research. The SERT occupancy curve they report from a previous paper is based on a unique study and will vary between people so your curve will be slightly different from someone else's curve. They use what is called the "Michaelis-Menten equation of best fit" which is derived in the following way: 

various doses of the pill are given to a some people (20?) people and then the SERT occupancy is measured in the brain - i.e. one dot for 5mg person X, one dot for 10mg person Y. Then they plot the dots and they try to find a curve that fits the dots best and then they derive the equation for that curve in this case it happens to be a hyperbolic equation. If you look at the graph at 20mg you will notice that for some people at 20mg occupancy is 85% and for another it is closer to 65%. So it is an imperfect composite - think of it as a few puzzle pieces put together that you can deduce that it is a person but you couldn't recognize the person's name from it. Also, if it were based on multiple measures of the same person the curve would be likely diff for different people but close to hyperbolic.  It will be diff not only in absolute value - i.e. parallel shift of the curve for different people but may differ also in the shape of the curve. 

 

The value in what Horowitz et. al have done is that they have provided a theoretical basis for why you should use hyperbolic tapering (faster rate of reduction in the beginning and slower rate at the end) rather than linear. But whether hyperbolic or exponential etc. is the exact one no one knows. What SA has is observational data - 10s of thousands of people whereas Horowitz et. al have looked into the science and some experimental data to derive the theory or rather apply an already existing theory of drug absorption to withdrawal. Their paper is extremely important because it provides what we are doing here with a scientific basis and helps spread the message among doctors rather than just among suffering patients. But I would trust our experience over their theoretical model. 

 

The other limitation of that paper is that they focus only on SERT occupancy. It is important and measurable but there are lots of changes in the brain besides SERT occupancy that take place during withdrawal. Many other neurotransmitters and hormones need to adapt, genes need to switch on and off etc. The brain is waaaaay more complex than psychiatrists give it credit. 

 

2) The SA model is based on a similar principle except the idea is that a consistent 10% cut ends up being much smaller SERT occupancy. The 10% SERT occupancy cut every month assumes that our brains can recover rapidly. It may work for some people. The Dutch tapering strips also have higher cuts than SA. Again, this is better than what most doctors do but for some people it is way too fast. For me personally even the SA schedule is too fast - I am holding now after doing 5-6% a month for a while which caught up with me after a few months. From my experience here slow is fast.

 

I would consider the option that @getofflex has suggested - observe yourself with 10% cuts for a few months, if everything goes well, then shorten the time period to 3 weeks. Do this for a few months. But remember that symptoms tend to be cumulative - you may not see much for a while and all of a sudden have a complete breakdown that will take months to recover. 

 

The benefit of what @getofflex has suggested is that you can go back quickly if things go wrong as you have made a smaller cut each time so the updosing will be less confusing and painful for the brain. 

 

The only time a longer tapering schedule may be worse than a shorter one (with the risk of withdrawal) is if there are known side effects. But even then it is not always clear -  small side effects can be preferable to large withdrawal effects.

 

The decision is yours in the end. You will bear the consequences and responsibility of bigger cuts and we can't (nobody can) fix things if they go wrong. And we have seen them go wrong here. 

 

Also, in your calculation above it seemed that you think the SA recommendation is to cut 10% of starting dose - 5, 4.5, 4 - that is incorrect. We recommend 10% of previous dose. 5, 4.5, 4.05 etc. This becomes really important at the lower doses which are hard to get through. 

 

Hope this helps, 
OMW

 

[poohstix]

1 hour ago, Onmyway said:

 

@poohstix

two things: 

 

1) The Horowitz article relies on SERT occupancy which we can't measure easily - you need a tracer etc to do it for research. The SERT occupancy curve they report from a previous paper is based on a unique study and will vary between people so your curve will be slightly different from someone else's curve. They use what is called the "Michaelis-Menten equation of best fit" which is derived in the following way: 

various doses of the pill are given to a some people (20?) people and then the SERT occupancy is measured in the brain - i.e. one dot for 5mg person X, one dot for 10mg person Y. Then they plot the dots and they try to find a curve that fits the dots best and then they derive the equation for that curve in this case it happens to be a hyperbolic equation. If you look at the graph at 20mg you will notice that for some people at 20mg occupancy is 85% and for another it is closer to 65%. So it is an imperfect composite - think of it as a few puzzle pieces put together that you can deduce that it is a person but you couldn't recognize the person's name from it. Also, if it were based on multiple measures of the same person the curve would be likely diff for different people but close to hyperbolic.  It will be diff not only in absolute value - i.e. parallel shift of the curve for different people but may differ also in the shape of the curve. 

 

The value in what Horowitz et. al have done is that they have provided a theoretical basis for why you should use hyperbolic tapering (faster rate of reduction in the beginning and slower rate at the end) rather than linear. But whether hyperbolic or exponential etc. is the exact one no one knows. What SA has is observational data - 10s of thousands of people whereas Horowitz et. al have looked into the science and some experimental data to derive the theory or rather apply an already existing theory of drug absorption to withdrawal. Their paper is extremely important because it provides what we are doing here with a scientific basis and helps spread the message among doctors rather than just among suffering patients. But I would trust our experience over their theoretical model. 

 

The other limitation of that paper is that they focus only on SERT occupancy. It is important and measurable but there are lots of changes in the brain besides SERT occupancy that take place during withdrawal. Many other neurotransmitters and hormones need to adapt, genes need to switch on and off etc. The brain is waaaaay more complex than psychiatrists give it credit. 

 

2) The SA model is based on a similar principle except the idea is that a consistent 10% cut ends up being much smaller SERT occupancy. The 10% SERT occupancy cut every month assumes that our brains can recover rapidly. It may work for some people. The Dutch tapering strips also have higher cuts than SA. Again, this is better than what most doctors do but for some people it is way too fast. For me personally even the SA schedule is too fast - I am holding now after doing 5-6% a month for a while which caught up with me after a few months. From my experience here slow is fast.

 

I would consider the option that @getofflex has suggested - observe yourself with 10% cuts for a few months, if everything goes well, then shorten the time period to 3 weeks. Do this for a few months. But remember that symptoms tend to be cumulative - you may not see much for a while and all of a sudden have a complete breakdown that will take months to recover. 

 

The benefit of what @getofflex has suggested is that you can go back quickly if things go wrong as you have made a smaller cut each time so the updosing will be less confusing and painful for the brain. 

 

The only time a longer tapering schedule may be worse than a shorter one (with the risk of withdrawal) is if there are known side effects. But even then it is not always clear -  small side effects can be preferable to large withdrawal effects.

 

The decision is yours in the end. You will bear the consequences and responsibility of bigger cuts and we can't (nobody can) fix things if they go wrong. And we have seen them go wrong here. 

 

Also, in your calculation above it seemed that you think the SA recommendation is to cut 10% of starting dose - 5, 4.5, 4 - that is incorrect. We recommend 10% of previous dose. 5, 4.5, 4.05 etc. This becomes really important at the lower doses which are hard to get through. 

 

Hope this helps, 
OMW

 

Thank you, this is really helpful.

 

I wonder if you could speak to a semi related question of side effects vs withdrawals. 
 

I’ve had certain symptoms including insomnia and PGAD both with getting on and tapering off the med. Is this a thing that has been known to happen? It seems rather illogical to me.  it also makes it hard and confusing to determine what represents being stabilized.

[poohstix]

3/22:

10am: 2/10 PGAD, mild upper chest pain, back of throat tightness, feeling like going to cry 

11:30: better except for PGAD and mild

Itch across arms and chest 

12noon: lexapro 4.5

1:30: eating. Lower chest /upper stomach discomfort 

2:30pm: mild sadness and pulling sensation in arms with urge to rub them. Tightness in front of mouth and face. Still have PGAD 1/10: not a desire to orchid but more like swelling. Mild sore throat. Mild upset stomach. Desire to do something besides what I’m already doing. Put magnesium water in arms

3pm: arms feel better, now similar internal tightness in legs 

3:15: tight lower chest, PGAD increase to 3/10

3:40: better except for PGAD

6pm: PGAD mostly gone, a small amount continues 

7pm: massage, then magnesium oil on skin 

9:30pm: mild tightness in hands and PGAD in form of mild genital pain, mild itch, tightness in tip of tongue  

10pm: bedtime. Valerian 125mg and magnesium spray on skin 

11am: brief awakening. Feel a bit warm and palpitations

1am: brief awakening

2am: brief awakening

3am: brief awakening 

9:15am: wake for the day. Palpitations. Tired. Tight in upper chest. Sad emotion, not sure if neuroemotion or actual sadness 
 

 

I am worried about my sleep. I don’t want to become dependent on valerian or any other sleep aid, but when I got back on Lexapro in Jan 2023, I got really bad insomnia, but at the time I didn’t realize it was a side effect of lexapro. In the last week, I’ve been having more interrupted sleep, probably in context if other likely withdrawal effects getting worse: bodily anxiety, neuroemotion, PGAD.

[poohstix]

@Onmyway

Tagging you since it's requested in your signature. 

 

What makes my situation hard and confusing is that I have not been well since I resumed lexapro in Jan 2023, after prior fairly innocuous trials of it. It seems this new trial of lexapro did not sit well with my body and I've had a merry go round of various symptoms ever since. Since Jan, I’ve had certain symptoms including insomnia, PGAD, upset stomach/diarrhea and fluishness (or just an unusually easy susceptibility to viral illnesses) both with getting on and tapering off the med. Is this a thing that has been known to happen? It seems frustratingly illogical to me. it also makes it hard and confusing to determine what represents being stabilized. I don't know if I will ever get to a point of having no symptoms that could be interpreted as withdrawal as long as I am on this med. 

 

I've read on this forum that one way to know the difference between withdrawal and side effects is the timing - if it happens a few hours after your dose, it's more likely to be a side effect. However, early on when I was just getting on the med, some side effects followed this pattern and some did not. Also, I believe side effects either get better within a couple of months of starting the med or just persist indefinitely, whereas withdrawal comes and goes in waves and appears at some point after a stepdown.

 

 

[Altostrata]

22 hours ago, poohstix said:

I do feel not good for the first few hours after I take it. Then by late afternoon or evening I feel better. This has been the case ever since I started taking lexapro in January. But then I also have issues in the middle of the night and earlier morning at times.

 

As explained before, it appears you're still taking too much Lexapro, and you have adverse effects from it. On a 10% taper schedule, your next reduction would be 0.45mg, in early April.

[poohstix]

1 hour ago, Altostrata said:

 

As explained before, it appears you're still taking too much Lexapro, and you have adverse effects from it. On a 10% taper schedule, your next reduction would be 0.45mg, in early April.

I’m curious, has it been seen before that meds cause overactivation symptoms as adverse effects and as withdrawal effects? I had PGAD, poor appetite and insomnia big time when I first began lexapro, and with each step down those things get worse or re-emerge, at least temporarily.

[Altostrata]

In the last 3 months, you've made 11 drug changes. This sort of thing can make a person hypersensitive and cause odd reactions to drugs that never caused problems before, or make tapering more difficult.

 

Sticking to a dose of Lexapro that's been causing adverse effects for 3 months exacerbates the problem.

 

If you think the adverse effects are less of a problem than the withdrawal effects, you can stay at 4.5mg if you wish. 

[poohstix]

I definitely want off this med as soon as safe. I’ll probably start a Brass Monkey slide of 2.5% increments when it’s time for my next decrease.
 

I compared how my typical day progressed a few weeks ago to now. My afternoons which is when I start to feel worse post lexapro look different now: it went from having signs of physical anxiety, while now I have more sad neuroemotion. Interestingly sad neuroemotion is accompanied by a rapid heartbeat on my watch. I wonder, is it possible for your adverse effects to change like this? Or could withdrawal affect how you react to the med?
 

 

Several weeks ago:

3/2:

8:30: woke up. Feel more rested than expected. Loose stool.

12 noon: Tight sensation in upper left chest, upper back, neck and radiating to head

1 pm: lexapro 5, small breakfast 

1:30-2:30: acupuncture, relaxing

2:45: loose stool

3 pm: tight throat, upper chest and back tightness. Began before eating. When I ate, throat was tight and food seemed reluctant to go down

4pm: exercise by biking 

5pm: psychotherapy

6pm: symptoms that began around 3 pm almost gone. Eating ok but breathing somewhat uneven, heaviness in bottom of chest. Loose stool. Cold hands and feet.

6:30: more exercise by cycling, 30 mins

7:30: mini cortisol spike with PGAD moment, tongue tightness, feeling of internal tremor 

8:30: dinner. Breathing somewhat uneven, tongue tightness. Pinprick sensation under ribs

9:30: continuing to eat, warm behind ears and sore throat. Gut gladly accepting food

11pm: massage, deep breathing

12:30am: slept 

5:30: brief awakening 

8:30: woke for the day, dozed until 9 am 

 

 

now: 

 

3/25

9am: wake up. Neuroemotion: sad, tight and cold in limbs. 

11:30am: lexapro 4.4, food

1:00pm: mild jolt in chest, internal tingling. <1/10 PGAD pain only, a bit sweaty and tired 

2pm: mild sad neuroemotion in a store. Mild tightness in hands and front of mouth

3pm: tingling in hands, stomach, a bit of feet. A bit uneasy 

3:30: sad neuroemotion, or maybe just real emotion during hiking

4:20pm: 1/10 PGAD, mild pain only. Having food. A bit sleepy, midforehead headache 

5:30pm: still tired, still headache, mild brief sore throat 

7pm: feel mostly better, a bit of tightness in hands

8pm: good appetite for dinner 

7-9pm: feel fine, actually less tired than during day 

10pm: bedtime 

[Altostrata]

Overall, do you feel better or worse taking 4.5mg vs 5mg?

[poohstix]

9 hours ago, Altostrata said:

Overall, do you feel better or worse taking 4.5mg vs 5mg?

Some things are better and some worse; there are windows and waves. My spouse says I appear to be functioning better now on the 4.5. Mostly it’s just different. I don’t have anything that approaches a panic attack anymore (ie dread, desire to shut down, shortness of breath). I have neuroemotion of sadness, mostly in the afternoon. If my sympathetic nervous system acts up it is muscle tension, tingling, warmth/sweats, a bit of genital sensation. I’d rather have that than panic. After Stepping down from 5 to 4.5, I went through that bout of fluishness for a while, then I had a bout of worse PGAD, but now both things are better. Maybe it just makes sense to hold at 4.5 for a while.

[getofflex]

Just a heads up, it looks like you do a lot of physical exercise which is great!  However, unfortunately, intense exercise can cause nervous system activation to a nervous system that is destabilized by WD or adverse reaction.  This is because intense exercise can cause your body to produce cortisol and adrenaline.  I know for myself, if I do a strenuous hike, it puts me into a wave for at least a few days, usually by the next day.  For me, that is about a 1.5 to 2 hour hilly hike on rough terrain.  (I'm 61 BTW).  I also saw in your notes, one day you went bicycling twice.  Could this be part of what is causing your symptoms?  

Edited March 26, 2023 by getofflex

[Altostrata]

3 hours ago, poohstix said:

Maybe it just makes sense to hold at 4.5 for a while.

 

It sounds like the adverse reaction (such as panic attacks) diminished after you decreased to 4.5mg.

 

It's up to you if you want to continue to hold at 4.5mg through the remaining adverse effects, which will continue as long as you're taking 4.5mg.

 

If you want to reduce the current adverse effects, you would decrease by 0.45mg, to 4.05mg.

[poohstix]

5 minutes ago, getofflex said:

Just a heads up, it looks like you do a lot of physical exercise which is great!  However, unfortunately, intense exercise can cause nervous system activation to a nervous system that is destabilized by WD or adverse reaction.  This is because intense exercise can cause your body to produce cortisol and adrenaline.  I know for myself, if I do a strenuous hike, it puts me into a wave for at least a few days.  For me, that is about a 1.5 to 2 hour hilly hike on rough terrain.  (I'm 61 BTW).  I also saw in your notes, one day you went bicycling twice.  Could this be part of what is causing your symptoms?  

I’ve thought about that, and that’s why when I exercise these days I don’t go nearly as hard as my usual: I only turn the resistance on the bike a fraction of what I usually do, and less time: 20-30 mins vs my usual 60 or more. I don’t do enough to wear myself out or anything that pushes my limits. The day I biked twice I think I only did 15 minutes each time. I exercise intentionally because of I did not I’d be really sedentary, so probably just need to keep exercise really low key.
 

I'm conflicted about how exercise affects my symptoms. At one point I was mall walking several times a week, but it was earlier in my withdrawal. Later I biked several days in a row and then my bout of fluishness began, so I took a break for a while. This weekend I hiked both days and I think it helped my mood, appetite and maybe sleep, but we will have to see how the next few days develop. 

[poohstix]

5 minutes ago, Altostrata said:

 

It sounds like the adverse reaction (such as panic attacks) diminished after you decreased to 4.5mg.

 

It's up to you if you want to continue to hold at 4.5mg through the remaining adverse effects, which will continue as long as you're taking 4.5mg.

 

If you want to reduce the current adverse effects, you would decrease by 0.45mg, to 4.05mg.

I guess I’m confused because my adverse effects for the several hours every afternoon after I take my dose are qualitatively different on 4.5 than they were on 5.0. So I wonder if they are actually adverse effects or just withdrawal symptoms that happen during that particular time of day. My afternoons used to be more prone to physical anxiety but now I’m more prone to sad neuroemotion during that time. And I’m still almost completely fine in the evenings.

[Patient2022]

I’d say just pick up from where you are at the moment, accepting the decision with kindness. We’re all just trying to do the best we can for ourselves. 
 

When starting out it is easy to dream of your ideal self and imagine how amazing life will be without the meds. However it’s a process rather than something we’ll notice with a day to day difference. i just carry on taking daily not thinking about it much until  I think oh let me check my notes to see how long I’ve been on this dose and then change accordingly. it’s been over a year since doing a slow taper and it’s passed quite quickly. The other time I’m forced to think about it is when I get a wave, usually a week before my period starts and I panic that I may be heading back in to depression..but it passes and I see it as a pattern so I reassure myself. 
 

im sure everyone forms their own strategy to get through it. The main thing is get to get started, listen to your body, go slow and be kind to yourself

[Altostrata]

1 hour ago, poohstix said:

I guess I’m confused because my adverse effects for the several hours every afternoon after I take my dose are qualitatively different on 4.5 than they were on 5.0.

 

As explained to you before, the reason you reduced your dose was to reduce the intensity of the adverse effects. Yes, they are qualitatively different now, that's how this works.

 

Anyway, if you want to put up with them, it's your choice. Please do not tag me unless you want to taper.