Annelle: tapering off escitalopram after long term treatment

[annelle]

Hello - I have just come off escitalopram (Cipralex) and am finding it rather difficult - but doing some searching yesterday realized that it is not so uncommon. I was just taken aback by it because it struck me so hard and sudden - the day after I took the last Cipralex - 5 mg - I spent most of the day crying and feeling panicky because it felt like it would never be better - maybe I went about it wrong - I thought I could handle it because I have been through it before, and as I recall it was not that bad at that time - about 6 years ago - but maybe it has something to do with the fact that I have been taking antidepressants - on and off but still fairly consistently - for appr 10 years.

 

I am feeling a little better today - 12 days after I took the last one - but yesterday was terrible. Crying and also felt like throwing things. My reasons for stopping taking antidepressants are firstly I am hoping that it will better my terrible restless legs - and arms and almosst anything else - syndrome which started about 4 years ago - and secondly that I feel I do not need them anymore, and I do not want to be on this medication for the rest of my life - it makes me emotionally flat so to speak. In a way I am glad to learn that there are real withdrawal symptoms from this med because otherwise I would probably think that I was having a relapse of depression and start taking it again.

 

I also took Seroquel for about 3 years - I stopped taking it because my GP said he thought my restless legs syndrome was due to too many medications - and he started me on pramipexole which is helpful - but just another chemical in my body - so I would love to be able to find the real cause of my restless legs, which is why I want to take as little medicine as possible. And I actually think I have a little less restlessness at night since I stopped with Cipralex - but instead I am on an emotional rollercoaster.

 

I would love it if somebody out there could give me an idea as to how long this withdrawal syndrome is likely to last - for someone like me who have taken antidepressants for appr 10 yrs and sometimes in a rather high dosage - I took 20 mg for about 5 yrs, then 10 mg for appr 4 yrs - about 2 months ago I went down to 5 mg a day, then after about a month to 5 mg every other day, the last week I took 5 mg every three days until I finally took the last one on Oct 13, 2012. I should maybe mention that I before cipralex took citalopram for a few years, but my psychiatrist was certain that escitalopram was a better product. So I have been taking antidepressants for a long time. I suppose that my age - 60 - could make it more difficult for my body to adjust to being without the antidepressants compared to when I tried to do so some years ago.

[peggy]

Hi annelle, and welcome!

 

Firstly, you will find lots of support here from lots of people who have gone through and asked exactly the same questions as you. You have probably tapered too quickly. If i were you I would reinstate back to 5mg. You are not long off and you should settle within a week or so. Once you have settled you should stay there for a month and then begin a slow 10% of your dose - so down to 4.5mg.

 

You can find some info for tapering off cipralex here hints for tapering cipralex

 

I know how hard it is to go back on when you have just come off, but withdrawal effects don't go away quickly, they are a sign that your nervous system is in distress.

[dalsaan]

Hi Annelle,

 

Welcome to the site. unfortunately its not possible for us to say how long your symptoms might last. I know personally I was off my meds for 3 months and experienced severe withdrawals that were unrelenting. They didn't ease one bit during that time. I reinstated and am now tapering off very slowly.

 

You have to be gentle on yourself. There are many stories on here of people trying to 'push through'. This rarely works and in my experience makes even slow tapering more difficult that it

otherwise would be because you have really sensitized your system.

 

My advice, reinstate asap. Give your system a chance to adjust to change incrementally.

[Altostrata]

Welcome, Annelle. Thank you for joining us.

 

When one develops withdrawal symptoms after quitting, the usual practice is to reinstate the medication, stabilize, and taper more slowly. Have you mentioned your withdrawal symptoms to your doctor?

 

If I were you, I'd immediately take 2.5mg escitalopram and see if it helps. You may not need to go up to 5mg again.

 

If it helps, stay at the low dosage for at least a month to allow your nervous system to settle down, then use the information in the link peggy gave you to make a liquid to taper.

 

Were you taking an antidepressant before you got restless legs?

[Karma]

Hi Annelle,

 

Welcome to the forum. I agree with Peggy and Dalsaan, if I were in your situation I would reinstate at a small amount (5 mg), get stable and then taper off slowly at 10% for each decrement. See if you can get your escitalopram in a liquid solution which will make tapering at 10% much easier.

 

I see that you tried skipping doses as part of your taper - that is a really bad idea because it doesn't allow a consistent amount of the medication in your system and it upsets your CNS, which can make your system hypersensitive. We are aware that many physicians recommend this as a tapering method; they are misinformed.

 

When you feel up to it, please add your medication withdrawal history in your signature http://survivingantidepressants.org/index.php?/topic/893-please-put-your-withdrawal-history-in-your-signature/ - as you post questions and updates to this thread that will remind us of which meds you've been on and how you are tapering so that we can tailor our suggestions to your situation.

 

Karma

[annelle]

Hello again. Sorry I have not responded before now to the nice advice and comments. I am a little ashamed to say that I have not taken the given advice because I still thought I could just toughen it out. And now I am actually feeling worse than I did 6 months ago. I am very emotional, have crying spells daily. It takes very little too set it off. And it feels as if the emotional lows are getting lower and more intense now. In addition to this as if it was not enough! I have for the last few months had some very strange sensations throughout my body that are very difficult to explain. I have not seen my doctor because I simply do not think that I will be able to explain this to him. It feels as if my sensory nerves have become more sensitive. I have a feeling in the palms of my hands and the soles of my feet and sometimes the inside of my elbows that I can best describe as a mix of an itching and tickling sensation. And sometimes it is in my breasts as well. It is almost unbearable when it is at its worst. In collaboration with a health practitioner (not my doctor) I have been taking various new supplements with herbs etc and for a while I have paused with these because I thought they might be the culprit. But it has not really made any difference. So I am now wondering if this is yet another sign that I have stopped Cipralex too abruptly.

My restless legs syndrome is also as bad as ever. This syndrome started appr 4 to 5 years after I started taking Cipralex and about 3 years after starting taking Seroquel. So I feel that there must be some connection there with one or maybe both medications.

I think it is now time that I started listening to people here who advise me to reinstate Cipralex although I have been off it appr 6 months. But since I am not getting any better, I will try reinstating and then after a month or so start slowly tapering off.

Thank you so much for your response, and sorry I did not take your advice before. I guess I had to learn the hard way!

[Altostrata]

Yes, it sounds like you have prolonged withdrawal syndrome. Those symptoms are very familiar. To get ideas about what to do, see our Symptoms and Self-care forum. Be very, very careful with supplements -- you're right, you may be so sensitive you're reacting badly to them.

[mammaP]

Hi Annelle, it's such a shame you tried to tough it out

and ended up like this . I'm sorry I can't offer any

advice personally but just wanted to say hi.

Someone will be along soon who can advise what to do.

[Rhiannon]

Hello again. Sorry I have not responded before now to the nice advice and comments. I am a little ashamed to say that I have not taken the given advice because I still thought I could just toughen it out. And now I am actually feeling worse than I did 6 months ago. I am very emotional, have crying spells daily. It takes very little too set it off. And it feels as if the emotional lows are getting lower and more intense now. In addition to this as if it was not enough! I have for the last few months had some very strange sensations throughout my body that are very difficult to explain. I have not seen my doctor because I simply do not think that I will be able to explain this to him. It feels as if my sensory nerves have become more sensitive. I have a feeling in the palms of my hands and the soles of my feet and sometimes the inside of my elbows that I can best describe as a mix of an itching and tickling sensation. And sometimes it is in my breasts as well. It is almost unbearable when it is at its worst. In collaboration with a health practitioner (not my doctor) I have been taking various new supplements with herbs etc and for a while I have paused with these because I thought they might be the culprit. But it has not really made any difference. So I am now wondering if this is yet another sign that I have stopped Cipralex too abruptly.

My restless legs syndrome is also as bad as ever. This syndrome started appr 4 to 5 years after I started taking Cipralex and about 3 years after starting taking Seroquel. So I feel that there must be some connection there with one or maybe both medications.

I think it is now time that I started listening to people here who advise me to reinstate Cipralex although I have been off it appr 6 months. But since I am not getting any better, I will try reinstating and then after a month or so start slowly tapering off.

Thank you so much for your response, and sorry I did not take your advice before. I guess I had to learn the hard way!

 

Let us know how the reinstatement goes for you. Unfortunately after this much time it doesn't always help. But sometimes it does and maybe you will do great with it.

 

If you don't feel better immediately, that's normal. Don't expect to suddenly feel much better. Improvement is not always so drastic. Sometimes it's enough to just feel a little better.

 

And don't change meds up and down a lot; make only very few changes, with long time breaks between them, or preferably no changes at all until you're feeling stable and ready to begin a slow careful taper.

[annelle]

Hello again - and thank you so much for your response. I was just today thinking that I actually was afraid that I was getting worse after being on 5 mg Cipralex for three days - last night was terrible with restless legs - actually restless arms and trunk as well - so I started wondering if reinstating was not good idea after 7 months totally off Cipralex. But since I have now started taking the 5 mg Cipralex, I now feel that it will be best to continue, even if - as you mentioned - I may not feel better right away - or for some time. I can only hope that I have not left it too late - It would probably have been better to reinstate after 3 months or so - but I am giving it a chance now, and will continue on the same dosage for at least a month, maybe longer - till I - hopefully - feel stable. In addition to the restlessness I also feel a little hypomanic - overexcited and stressed out. I suppose that can happen when you reinstate after 7 months' time? It is difficult to know whether the 5 mg is the dose - but I figured that after this long off AD it would be better to take 5 mg than 2,5 mg for instance.

I am taking pramipexole for restless legs - do you think that it could interfere with the level og Cipralex and my nervous system in general?

[Altostrata]

It sounds like you are sensitized to Cipralex. It sounds like 5mg is making your symptoms worse. It's too activating.

 

If I were you, I'd take only 2.5mg and see if it helps.

[annelle]

Hello again!

I just wanted to say thank you to you, Altostrata - and everybody else as well - because last night I slept really well, 7 hours almost in one stretch - wonderful! That has not happened for months. And as a whole I am feeling much better, almost feel like myself again.

I went down from 5 mg Cipralex to 2,5 mg, which I have taken for three days now. Maybe it is a little early to tell after such a short time, but I do feel that I am on the right track at the very least. And for every good day - and night - I get a little bit more hope that I can really get better. I feel more emotionally stable and relaxed. And I did not have any restless legs or anything else last night - that does not happen very often either.

Now I hope that I can convince my doctor to prescribe me liquid Cipralex - I think it is available in this country - because it is a little difficult to split a 20 mg Cipralex tablet into to 2,5 mg size.

Now that I am convinced that it is very important to taper off very slowly with regard to AD, I started wondering, if maybe the same goes for some other meds that I have discontinued recently.

I went off tramadol - which I took for severe pain in my lower back and left leg for three years - in Sept 2011. That was very very difficult to do, I had a lot of withdrawal symptoms for about a month, and my restless legs syndrome was very bad then.

I also stopped taking Omeprazol August 2012 after taking it for acid reflux symptoms for appr 7 years. The symptoms are still difficult to handle, but I get by taking antacids of various kinds.

I also stopped taking Seroquel after 3 years and 6 months - stopped after a quick tapering in April 2009 - which I suspect could be contributing to my restless legs syndrome still. And also I think I have some degree of parkinsonism - my movements are very slow and stiff - but I gather that also can be due to withdrawal from Cipralex.

So all in all I have made many changes in the last 4 years or so - maybe to many for my body to handle, although I originally thought that they were good changes, and it was all for the best.

Does anybody have any experience with discontinuing Seroquel, and perhaps Omeprazol as well?

[Altostrata]

I suggest going carefully off omeprazole first, see http://survivingantidepressants.org/index.php?/topic/4361-tips-for-tapering-off-stomach-acid-blockers-esomeprazole-lansoprazole-omeprazole/

 

For Seroquel, see http://survivingantidepressants.org/index.php?/topic/1707-tips-for-tapering-off-seroquel-quetiapine/

[annelle]

Thank you for your advice, Altostrata.

Just to make sure - do you think it would be best to go back on Omeprazole, and then start a slow tapering, even though I have not taken this drug for 10 months now? I read somewhere that the rebound reflux symptoms that you were bound to get, would improve after appr 12 weeks - but I must admit that I still have a lot of acid reflux symptoms both night and day - so much so that I am afraid it may cause permanent harm to my esophagus. Maybe it is my usual way of trying to 'push through' that is repeating itself with all my medications! There seems to be a pattern there!

 

I took the last Seroquel in April 2009 - I forgot to mention the dosage - I never took more than 75 mg a day, and usually 50 mg daily - it was prescribed to me because I did not fall asleep until about 6 a.m. - so my psychiatrist chose this way to help me. In hindsight, there were a lot of better ways to improve sleep, I think. So, after 4 years off Seroquel, I feel it would be unwise to start again? Or is it still my 'push through' thinking talking? Also, I am not sure my doctor will think it will be a good idea to give my a prescription for Seroquel again.

 

I will probably not be a problem to get a prescription for Omeprazole from him.

 

Sorry, if I am a little confused - it still amazes me how potent almost all drugs really are, and how difficult they can be to get off - even if they are not considered 'addictive'!

[flower]

you are in a good place to get help..I also quit tramadol..I'm glad to see someone else had WDs coming off that drug.My Doc made me feel like I was making it all up. It took me about a month to get over that too... Go slow and stay strong..I'm a good one to talk...I get soooo anxious it's hard to be strong.

[annelle]

Thank you Flower for your response - I am also very glad to hear from someone who has had the same experience with tramadol - my doctor did not think it was a very big deal to go off it - but it was really tough - one of the hardest things I ever had to do actually - did you get restlessness in your entire body? That and sweating was my worst symptoms - I hardly slept for a month and had to contact en emergency doctor twice to get some relief and some sleep. Do you think you have any withdrawal symptoms from tramadol still?

I have a hard time telling which symptoms come from which drug withdrawal because I have gone off several during the last 6 or 7 years.

First I stopped taking benzodiazepines - then I stopped taking Seroquel (quetiapine) - then I stopped tramadol - then I stopped taking Omeprazol - and finally I stopped taking Cipralex (escitalopram) - so it is probably a mixture of withdrawal of several drugs - although I now feel that withdrawal from Cipralex is the one giving me the most severe symptoms.

Have you been taking other drugs besides tramadol?

[annelle]

Flower, now I see, of course, in your signature, that you did take other meds. How do you manage the pain for which you were taking tramadol - if you still have pain?

[Altostrata]

No, do not take omeprazole. This will only complicate your healing.

 

Please look in the Symptoms and Self-care forum for suggestions to improve your gut health.

[Jemima]

Annelle,

 

I'm glad to see that the reinstatement of a very low dose of Cipralex is helping. Just in case you can't get the liquid, here are instructions on how to make your own:

 

How To Make A Liquid From Tablets or Capsules

[annelle]

Thank you Altostrata and Jemima.

I think you are right, Altostrata, that adding Omeprazol again would be a mistake. I will look at the other options.

Jemima, I talked to my doctor yesterday, and she did prescribe me oral drops of Cipralex - it did take some convincing - she did not quite understand why I wanted to get the liquid form of Cipralex, and why I wanted to take such a small dose - 2,5 mg. But she did give it to me in the end - now I hope that I can figure out how to use the liquid. I have not been to the pharmacist to get it yet, so I am wondering how it works - if I will need a syringe or there is a measuring cup of some kind.

Since I reinstated, I have been bothered by a lot of cold sweat - which I recognize as a side effect from earlier - I take the medicine in the morning.

Does anybody have any experience as to whether it would be better - with regard to sweating as an adverse effect - to take it in the evening?

[annelle]

Hello again!

I may be too impatient, but I am feeling rather bad, and had hoped to feel somewhat better by now, a week after reinstating Cipralex at a low dose.

 

I have awful feelings in my palm and the soles of my feet and also in my breasts - it is almost unbearable today, which is disappointing, because it does not seem to get better - on the contrary. I guess it is a form of paresthesia or dysesthesia. It is even difficult to sit quietly because of the tingling or tickling feeling.

 

I also feel very blue and scared - it comes in waves throughout the day - hardly sleeping is probably not helping.

 

I just wondered if maybe I should updose to 5 mg Cipralex again - or maybe even more? Since it has not gotten any better in the 7 days I have taken this low dosage of Cipralex - after not taking any for 7 months - I had 4, and today is my 5th day of 2,5 mg Cipralex.

 

What do think - should I updose or stick it out? This is almost unbearable.

[annelle]

Sorry - I meant to say that I had 4 days on 5 mg Cipralex, and today is the 5th day of taking 2,5 mg.

[annelle]

Hello again

 

I am still very much in doubt whether the best dosage for me is 2,5 mg Cipralex - which I have taken now for 6 days, prior to that I took 5 mg for 4 days.

 

I am still feeling awful - these strange and very unpleasant, almost unbearable tinglings and tickling in my hands, finger tips, soles of my feet and my toes, inside my elbows and in my breasts.

 

And as that was not enough, I also had a terrible night with only 1-2 hrs of sleep, because I had some food stuck in my throat or the top of my esophagus - I could not cough/regurgitate it up, and could not swallow - it made it difficult to breathe.

 

I have had this dysphagia from time to time in the past, but last night it was worse than ever before.

 

Is this a typical symptom of withdrawal as well - or is something else going on?

 

Please give some thoughts and comments - and advice on updosing to 5 mg again or staying on 2,5 mg? Altostrata - anybody?

 

I am actually feeling rather desperate at this point!

[basildev]

Hi Annelle,

 

I also feel very blue and scared - it comes in waves throughout the day - hardly sleeping is probably not helping.

What you've described here, and in your other posts, is completely normal and typical of the the non-linear nature of recovery when we reinstate medication. That is to say, you'll have some days where you feel great (almost like your old self). These are called 'windows'. Then, inexplicably you'll fall into a hole again and feel like you're back to square one. These are called 'waves'. But you're not really back to square one, this is just how your CNS heals itself - in fits and starts.

 

Please see this thread for more detail:

 

http://survivingantidepressants.org/index.php?/topic/82-the-windows-and-waves-pattern-of-recovery/

 

As to whether you should go up or down, I'd advise you to stay put for a while. The more dosage changes you make the more you will confuse your CNS. This will further destabilize your situation.

 

I know you're feeling horrible right now and I'm sorry you are suffering. However, I'm afraid there's no way to avoid these 'bad days' as this is part of the recovery process.

 

I hope you feel better soon.

[annelle]

Oh, thank you so much Basildev for answering so kindly and quickly - it helps just to hear some kind words from someone who knows exactly what I am going through.

 

Seeing it described like you did makes it easier to recognize that what I am experiencing is windows and waves. Sometimes it is just difficult to see it when you are right in the middle of it.

 

I will take your advice and stay on 2,5 mg for a good while.

 

I feel that I am getting worse than I was before reinstating, but I am confident that it will be worth it in the end.

[flower]

Try to stay strong Anelle..Keep telling yourself "this is withdrawal" Celexa is difficult to taper too ..The liquid should be easier..Good luck ladybug{I call everybody that}....flower.

[annelle]

Thanks Flower for the kind words - always nice to get a greeting from someone who is going through the same stuff!

[Rhiannon]

you are in a good place to get help..I also quit tramadol..I'm glad to see someone else had WDs coming off that drug.My Doc made me feel like I was making it all up. It took me about a month to get over that too... Go slow and stay strong..I'm a good one to talk...I get soooo anxious it's hard to be strong.

 

I once took tramadol for about three weeks for severe dental pain and when I quit I had a terrible reaction that lasted for a couple of weeks. You're not making it up. Tramadol has serotonin and norepinephrine reuptake inhibitor properties as well as acting on opioid receptors.

[Nikki]

Hi Annelle

 

This site is amazing in that we meet people from all over the world and feel connected.

 

I have taken both Celexa and Lexapro. I am currently on Celexa. My taper from Lexapro was difficult and took two years. There were physical symptoms which I tolerated.

 

It was the emotional aspect which was very difficult for me.

 

When I was down to 11mgs. of Lexapro from 40mgs., I took a tricyclic as my PsychNurse suggested. When I totally finished my taper with Lexapro I had Protracted WD which lasted for a good year. In other words, I still had WD symptoms after finishing the drug and while on another one.

 

It happens. These ssri's have a mind of their own and there are lingering effects after we are off of them.

 

I don't know how to advise someone to reinstate, but alot of the others here do. I am gathering that reinstatement is done by adding a little bit rather then alot.

 

Keep posting and keep reading thru threads, someone always comes along with help.

 

Hugs

[annelle]

Thank you Nikki and Rhi for good comments.

 

I think you are right, Nikki, that the SSRI's have a mind of their own I have noticed lately that it is as if the type of withdrawal symptoms alternate in the way that when the physical symptoms are bad, the emotional problems are a little better - as if the brain can only handle one 'area' at a time.

 

I think for me right now the physical symptoms are worse than the emotional, but right after quitting Cipralex after the quick taper, the emotional symptoms were definitely worse. It was only after about 2 months the physical ones started - nausea, headache, and the weird tingling feelings in hands and feet etc.

 

Yes, it is a very nice thing that we can connect with people all over the world who are going the same thing with these AD's.

 

Interesting information on tramadol, Rhi - I did not know about the neurotransmitter inhibitor properties. Just makes me even more happy that I am off tramadol too.

 

Yes, a very low reinstate dose and very slow tapering seems to be the way to go - it makes sense, but also requires a lot of patience!

[Altostrata]

Did the symptoms change from when you were taking 5mg or are they exactly the same?

[annelle]

Hello Altostrata!

 

It is not a big change, but I do think my symptoms are a little worse now on 2,5 mg - I had a particularly bad day today, probably because I hardly slept last night.

And the tingling in hands feet and breasts is killing me - it seems the physical symptoms are the worst ones right now. But I do have some anxiety as well.

 

Should I stay at 2,5 mg, do you think?

[Altostrata]

I'm not a doctor and I can't tell for sure what's going on, but it sounds to me like you're highly sensitive to Cipralex.

 

If I were you, I'd reduce by 0.5mg and see if that helps at all.

[annelle]

Thank you Altostrata!

 

I will try that - today I am getting the liquid form of Cipralex - I hope that will make it easier to measure doses accurately, which I think is important, especially if one is hypersensitive to the medication.

 

I have noticed in the past few months that I have had some OCD-like (I think) symptoms - they manifest as certain songs or tunes always playing in my mind - also when I am thinking of something else, it seems to always be playing in the background - strange and a little unnerving and unpleasant. I wonder if it is another withdrawal symptom?

 

Also I am rather sensitive to sunlight and daylight - I try to get some daylight every day because I think it is helpful in terms of getting into a healthy sleep pattern, - but sometimes it feels like it is too much for me - too intense.

 

I am also very easily tired - almost exhausted - when I try to exercise - just walking - and it takes very little - maybe just a phone call or discussion with somebody - to make me feel extremely stressed - with heavy sweating and heart palpitations. This seems to have gotten worse since reinstating.

 

Does anybody else recognize these symptoms?

 

I hope everybody is having a good day!

[annelle]

Hello again!

 

I was just thinking about the length and severity of withdrawal - which seems to be shorter and better after a very slow taper. That is one thing you can do to help the situation and the symptoms - also long-term.

 

And then I wondered - is anything known about how age influences the severity and time of withdrawal? I would assume that it would be harder on the body and brain to cope with everything the older you are?

 

I am 60 years old, and afraid that my age will make it all harder. It certainly seemed much harder to taper - quickly - last fall - than it was about 10 years ago. But it could also be due my nervous system being in distress by many changes in medications during the past decade or so - no matter what age, that would do it, would it not?

 

Any thoughts anyone?

[annelle]

Hi again!

 

I think I have been having some trouble finding the right dose of Cipralex upon reinstating. Now I am on 2 mg Cipralex, taken as oral drops.

 

Since it seems that I am very sensitive to change, - first reinstating at 5 mg after 7 months of no Cipralex, then down to 2,5 mg, now down to 2 mg for 2 days, I feel that it would be good for my nervous system to stay on the same dose for a long time, so that it will have a chance to get used to this level.

 

I just wanted to ask you, Altostrata - do you think it will create problems to stay on the 2 mg Cipralex for more than a month? - if I stay at this dose for for instance 2 or 3 months, will that make it more difficult long-term to taper and get off the medication in the end?

 

Thanks!