ikam: tapering escitalopram

[ikam]

1st day of 2.5mg

I have decided for a bigger cut. Unfortunatelly, the only way to check it out if it affects me is through doing it. With hope that it will not affect me too badly.

I took my dose ar 7.30am, same as yesterday dose.

 

I have a bit of headache now, but it may be from staying in bed too long. Did not want to face this day, knowing that the builders would be back at work (they building new houses in front of my window); it is very noisy during the day. Makes me feeling a bit powerless as I cannot just switch it off. I have always been very sensitive to noises...

[ikam]

5pm, feeling a bit dizzy and sleepy. Strangely enough, I feel calmer. Similarly as before, I seem to be having problems with vision, as if my eye sight got worse. My concentration is not too good, kind of forgetful.

 

I wonder if doxepin, which I take in the evening, actually makes my decrease easier?

[Rhiannon]

I feel you about the construction--last summer they were doing water main repairs near my house and digging up the road all day, it got on my every last nerve. I was wearing earplugs all the time, they were a little help but not much. 

[ikam]

I feel you about the construction--last summer they were doing water main repairs near my house and digging up the road all day, it got on my every last nerve. I was wearing earplugs all the time, they were a little help but not much.

 

Thanks. You are the first person who has shown some empathy about this issue. Apart from the noise from time to time the house actually shakes...this makes withdrawal even stranger...but I felt this even before...

[ikam]

7pm, so far so good. No more symptoms...just sleepy...

I am aware that first day of decrease is too early to predict anything...but when I decreased to 5mg I had more symptoms...

[Ever]

Did not want to face this day, knowing that the builders would be back at work (they building new houses in front of my window); it is very noisy during the day.

 

LOLOL - Really inappropriate to laugh ikam, but this reminded me of one period when I was in withdrawal (but didn't know it was withdrawal). We had had a big earthquake here in New Zealand and zillions of smaller shakes all day. It went on for many weeks. Well, I thought I could feel the earthquakes long before anyone else could and I was going around at work telling people that an earthquake was occurring, and then one WOULD occur and everyone thought I was super-sensitive to the beginning of earthquakes.

 

Then I discovered on the net that I was just getting vertigo from the withdrawal. BWAHAHAHA!!! I never told anyone..... LOLOLOL

 

Fingers crossed this drop goes really well for you

[mammaP]

It usually takes about 4 days for your brain to register the decrease Ikam, hopefully you will be ok with it. 

 

I understand about the building work too, nothing you can do about it and it drives you insane! There were

builders in the flat above mine when I was in the worst of withdrawal and it was awful.  The only good

thing was that they clocked off at 5pm so I could get some peace. That is when the neighbours in the one

below weren't tearing each other apart   ! Is there a library or quiet corner of a cafe where you can sit and

have some peace during the day?  One day they will finish whatever they are building and I hope they don't

take too long! 

[ikam]

 

Did not want to face this day, knowing that the builders would be back at work (they building new houses in front of my window); it is very noisy during the day.

LOLOL - Really inappropriate to laugh ikam, but this reminded me of one period when I was in withdrawal (but didn't know it was withdrawal). We had had a big earthquake here in New Zealand and zillions of smaller shakes all day. It went on for many weeks. Well, I thought I could feel the earthquakes long before anyone else could and I was going around at work telling people that an earthquake was occurring, and then one WOULD occur and everyone thought I was super-sensitive to the beginning of earthquakes.Then I discovered on the net that I was just getting vertigo from the withdrawal. BWAHAHAHA!!! I never told anyone..... LOLOLOLFingers crossed this drop goes really well for you

I am not surprised, as I think we get into a kind of super-sensitivity, trying to manage our symptoms, predict what may happen, etc. It is a bit like a fight-flight response, so we must be hyper-tuned...and then able to sense people don't...

 

I am doing better than I expect...this is actually strange, but I have not tested myself out yet...

I guess, if I would have symptoms anyway...

So, so far so good...

It seems that nothing is as bad as it was on 26th December, when I went to the emergency...

 

Also having this group, ability to talk and feeling understood and supported, really helps...

 

I told job agency that I will be ready around 20th January...

[ikam]

It usually takes about 4 days for your brain to register the decrease Ikam, hopefully you will be ok with it. 

 

I understand about the building work too, nothing you can do about it and it drives you insane! There were

builders in the flat above mine when I was in the worst of withdrawal and it was awful.  The only good

thing was that they clocked off at 5pm so I could get some peace. That is when the neighbours in the one

below weren't tearing each other apart   ! Is there a library or quiet corner of a cafe where you can sit and

have some peace during the day?  One day they will finish whatever they are building and I hope they don't

take too long!

 

When I moved here in August I did not know that they will be building more houses. I was so excited, starting new job, expecting it would be quieter here than in London...

It has been much more noisy...moreover, it I live at present in a new build block of flats, finding out that it only looks good outside...it seems it is build with the cheapest possible material...

My rent contract expires in July...

 

And I resigned from the job, which was supposed to be promotion for me...i was unable to stand their ethical standards...

 

So I have been mostly indoors...

It was nice over the Xmas break; no builders. But they are back. And I guess for at least half a year!

 

I am very sensitive to noises...and the world has been more noisy...

 

Still prefer to stay at home. When the weather will improve, I will be going out more...

[ikam]

I am on my second day of 2.5mg and I am actually feeling better, somehow calmer and brighter...looks that esctalopram was really toxic for me...

I am still at home...sleeping a lot and doing nothing really. So I have not tested myself out...

But it is much better than I expected.

[Ever]

Ikam that is so good that the drop seems to be making you feel better. And you are sleeping a lot! I think that's a sign that your body is healing - sleep away Ikam!

[ikam]

I hope I will not get anymore symptoms, but I know it is not time to celebrate yet. My main problem at the moment relates to feeling tired. Also, a bit as if having a cold...This is to be expected...

I am trying to rest as much as it is possible...

[ikam]

I read some of my previous posts, I seem to be making some mistakes, sorry...

[ikam]

I have been reading other people's posts about getting protracted wihtdrawal...it is all worrying...but it seems I did not have much choice than to get it faster...

I don't have paresthesia anymore. Doing generally better. But I have to be mindful not to get up too quickly, as I get dizzy...i have been indoors since friday. I need to get out and check how will I manage. Need to start dealing with tax-return, bank and lots of paper work...

I wonder when I can calm down in terms of consequences of my relapse...???

 

Again, the question remains unchanged: why did I not notice this earlier? But, I guess, I could have not noticed this at all...

[ikam]

Day 3/2.5mg

 

Hi again, I have been feeling extremely low today. It is the lowest since I started decresing. I am aware that this is a part of this process, but...Nobody likes to feel low...

 

It seems it has started from my conversation with my mother who was crying on a phone that she does not have money, does not take her meds as she does not have money, feels lonely, she may die in her flat and nobody will find her for long...To cut a long story short, my mother often uses me as a container for her feelings. I thought I did handle this well...but...woke up low...I cannot send her money, cannot go there to visit her...Anyway, when she is like this nothing helps, she needs more and more...I am feeling guilty again...My mother does not know about my problems...I have only one friend who knows and I talk here...

 

I woke up not wanting to be alive anymore. Not really suicidal, but tired...This was one of the reasons I started taking esitalopram. I felt so low and tired...

 

I am tired of my life and don't feel today like doing anything. At the same time I feel like a slave of my flat, but this is me who does not go out. And this is not like me. Since I moved to this town, I have problems with going out. I find outside very unfamiliar. Even people seem different, the way they act, talk...So I am finding to face this new reality this extremely difficult. At the same time keep watching builders outside in their machines and get feeling more trapped. I don't understand why instead of detaching myself I get over-tuned to any noises and very upset about them...This was another reason to take meds- as I wanted to cut off from the noises...

 

I had a bit more paresthesia in the morning and my fingers were painful, but it may have been my response to my yesterday's conversation with my mother. When I was talking with her I felt my hands becoming more tense. I guess this is because emotions affect blood flow and have impact on the nerves.

 

Then I had a bit of pelvic pain, which always gets me scared, as I was in pain day by day fir over one year. This was the time when I stopped controling meds with codeine. So when I feel any pain in this area I find it very distressing. I have started worrying that I will need to use painkillers again. How to live with no painkillers? I always tened to use painkillers, or medication for any health problem.

 

I am feeling low and all on my own...

Maybe my "honey moon" has ended?

[Ever]

Ikam I can relate to much of what you feel. I can only say that I don't feel like that now and haven't for many weeks now. While I was bad, I MADE myself do many of the right things that would help in the end. I called it GOMBFA-ing - Get Off My Big Fat A** and do something. Even walking 20 steps down to the mailbox and back a few times a day. And I practised my breathing exercises. It doesn't feel like it's doing anything, but months down the track it makes a difference.

 

I can appreciate what you say about your mother also - very difficult and depressing to deal with.

 

Hang in there my friend - we're listening...

[ikam]

Thank you. I don't understand why I cannot motivate myself?

[Ever]

Thank you. I don't understand why I cannot motivate myself?

Because you're in withdrawal and feel like sh** Ikam. Which is what we're here for - to help keep you going when you're stuck. So stop making yourself feel bad for feeling bad lol.

 

Now go GOYBFA and go for a short walk. Do 50 steps somewhere and 50 steps back. For me. And report back please!

[ikam]

 

Thank you. I don't understand why I cannot motivate myself?

Because you're in withdrawal and feel like sh** Ikam. Which is what we're here for - to help keep you going when you're stuck. So stop making yourself feel bad for feeling bad lol.Now go GOYBFA and go for a short walk. Do 50 steps somewhere and 50 steps back. For me. And report back please!

Ever, it is almost 10pm here, I will do my steps to bed...

Thanks...i will try to dfo 50steps tomorrow, ok?

[Ever]

ok then Ikam. I'll hold you to that lol.

 

Hope you have a good night

[ikam]

4th day of 2.5mg

 

My pareshesia seems worse, also dizziness and low mood...

 

It is highly difficult for me to establish if this is still an adverse response or withdrawal?

I have been on this faster tapper due to the adverse reaction...

 

How can I recognise if this could be the time to get back to higher dose?

 

When I made my first sharp reduction I had more symptoms...

But this paresthesia seems at its worst at the moment...

I have noticed that this symptom gets worse when I have any emotional situation...it is also always worse in the morning...

 

So difficult to judge...

It was much more simple with effexor, as I was just tappering one medication. I was also preprepared for this. Around half a year before tappering, I got to paleo diet and was taking few supplements...

 

Should I start magnesium now? I bought a powdered one...magnesium glycinate...

[ikam]

ok then Ikam. I'll hold you to that lol.Hope you have a good night

Hi Ever, thank you. I slept well, but did not want to get up. If not paresthesia I would stay in bed...

I spoke to my friend on a phone, got a bit more energised and went to town, did my shopping, went to the bank...

I feel I have acheived something...

 

Unfortunatelly, the paresthesia has been more prominent today. It has not gone away completely. But the way I read other people have similar sensations...

It really bothers me, I don't know how much is too much...difficult to judge...difficult not to get overanxious...

 

Hope you are well...

[ikam]

Hi augustiny,

Its difficult to answer that question because every situation is different.  Reinstatement refers to going back on a drug which has been completely stopped.  Updosing can be an option after a long hold with no improvement of symptoms. 

 

Due to the adverse response to escitalopram I had to decide for faster tappering (it interacted badly with doxepin). So I tappered first from 10mg to 5mg. Had some withdrawal symptoms, but stabilised quite quickly. I did my second decrease after 10 days and I am now at 2.5mg dose (this is my 4th day).

My main symptoms are: paresthesia in both hands, dizziness and low mood. Manageable, but I am still unsure how much is too much? How to judge when it is time for updosing?

I worry that paresthesia may be sign of nerve damage and that it may remain chronic or/and lead to no reversible changes and disability...

As per four days rule I think I am possibly at a moment when my body has only started acknowledging a lower dose.

I wonder how long to wait?

Am I still in the adverse response (i left doxepin unchanged)? Or am I in the wihtdrawal? Or both?!

As I said it is manageable, but I get anxious over this and then get worse...

[ikam]

Just reported my symptoms at RxISK webpage and read more about interaction escitalopram has with doxepin, also read about interaction with triptan. How doctors can do this to their patients?

 

I hope this is ok to share what I read there?

 

Major Drug Interaction — Doxepin

MONITOR CLOSELY: Concomitant use of agents with serotonergic activity including selective serotonin reuptake inhibitors, tricyclic antidepressants, and other antidepressants may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucination, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.

 

MONITOR CLOSELY: Escitalopram can cause dose-dependent prolongation of the QT interval. Theoretically, coadministration with other agents that can prolong the QT interval including tricyclic antidepressants and other antidepressants (e.g., trazodone) may result in additive effects and increased risk of ventricular arrhythmias such as torsade de pointes and sudden death. In a double-blind, placebo-controlled ECG study consisting of 113 healthy subjects, the change from baseline in QTc (Fridericia-corrected) was 4.3 msec for escitalopram 10 mg/day and 10.7 msec for the supratherapeutic dosage of 30 mg/day. Based on the established exposure-response relationship, the predicted QTc change from placebo under the Cmax for 20 mg/day is 6.6 msec. Cases of QT interval prolongation and torsade de pointes have been reported during postmarketing use. In general, the risk of an individual agent or a combination of agents causing ventricular arrhythmia in association with QT prolongation is largely unpredictable but may be increased by certain underlying risk factors such as congenital long QT syndrome, cardiac disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia). Also, the extent of drug-induced QT prolongation is dependent on the particular drug(s) involved and dosage(s) of the drug(s).

 

MANAGEMENT: In general, the concomitant use of multiple serotonergic agents should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Patients should be closely monitored for symptoms of the serotonin syndrome during treatment. Particular caution is advised when increasing the dosages of these agents. If serotonin syndrome develops or is suspected during the course of therapy, all serotonergic agents should be discontinued immediately and supportive care rendered as necessary. Moderately ill patients may also benefit from the administration of a serotonin antagonist (e.g., cyproheptadine, chlorpromazine). Severe cases should be managed under consultation with a toxicologist and may require sedation, neuromuscular paralysis, intubation, and mechanical ventilation in addition to the other measures. Due to the potential for additive effects on the QT interval, ECG monitoring may also be appropriate when escitalopram is used with tricyclic antidepressants or other antidepressants like trazodone. Patients should be advised to seek prompt medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, lightheadedness, fainting, palpitation, irregular heart rhythm, shortness of breath, or syncope.

[Altostrata]

Yes, doctors are often not sufficiently educated in drug-drug interactions.

 

I moved your post from the Tapering topic to here, where it won't get lost. Please keep these kinds of questions in your Intro topic, because your entire history is important in answering them.

 

Hi augustiny,
Its difficult to answer that question because every situation is different.  Reinstatement refers to going back on a drug which has been completely stopped.  Updosing can be an option after a long hold with no improvement of symptoms. 

Due to the adverse response to escitalopram I had to decide for faster tappering (it interacted badly with doxepin). So I tappered first from 10mg to 5mg. Had some withdrawal symptoms, but stabilised quite quickly. I did my second decrease after 10 days and I am now at 2.5mg dose (this is my 4th day).
My main symptoms are: paresthesia in both hands, dizziness and low mood. Manageable, but I am still unsure how much is too much? How to judge when it is time for updosing?
I worry that paresthesia may be sign of nerve damage and that it may remain chronic or/and lead to no reversible changes and disability...
As per four days rule I think I am possibly at a moment when my body has only started acknowledging a lower dose.
I wonder how long to wait?
Am I still in the adverse response (i left doxepin unchanged)? Or am I in the wihtdrawal? Or both?!
As I said it is manageable, but I get anxious over this and then get worse...

 

Parasthesia is a common withdrawal symptom. Given your adverse reaction to drugs, if I were you, I'd stay at 2.5mg for a while and let these symptoms dissipate while your nervous system gets used to the new environment, not worrying about updosing.

[ikam]

Thank you. It seems better today. I often get so anxious over my symptoms, so they increase...

I will stay on 2.5mg for longer...

[ikam]

I wonder how taking other medication may affect symptoms of wihtdrawal. On wednesday I took painkiller paracetamol. On thursday morning I felt that parasthesia was much worse...

Looks I am more sensitive to any medication...

[ikam]

Day 5 of 2.5mg

Seems I am getting back to my "normal", depressed state. Don't want to get up in the morning, have problems with getting out, worry that I will not manage this time, feeling quite negative...

It does not help I don't like my new place, where I live. I wish I was in the area I know well...and the noise on the building site...

But I keep staying home and indulge in my own misery...

I remember my mother was always depressed, I worked hard to lift her spirits but she reminded unhappy...

I remain unhappy, have problems with lifting my spirits...

I have this strange tendency to find the worst and concentrate on this...the negativity...Why on earth I do this to myself???

[ikam]

Day 6 of 2.5mg

No paresthesia anymore, just stiffness and pain in my palms. So it is shifting. As I never had this symptom prior to escitalopram it suggests that taking it caused this problem to appear...

Unfortunately, I am beginning to feel like before escitalopram, very low in the morning with intrusive suicidal thoughts (i am not going to act on them)...

Also intrusive thoughts about mistakes I made and losses in my life...

[Ever]

Ikam I think a lot of your 'depression' is probably still wd.   But, I myself have to watch myself with depression generally.   Over the years, the most powerful things I have learned to guard against it are:-

 

1.  Slow exercise - like walking every day if possible - I get mine in by feeding my horse, making up his feed, picking up poos etc.   About an hour of just slow stuff in the fresh air.  But at least 20 minutes most days.

 

2.  Sudarshan Kriya - this is a technique of breathing I learnt about 5 years ago - it has been extensively studied for many years in regard to depression.   When I do it every day, this would be the most powerful thing EVER that affects my mood.  After about 40 days of doing it every day, I feel on top of the world and as if I can do anything and nothing will knock me down.   I have been doing it since I crashed last time and I attribute much of my feeling good at the moment to this breathing.   It's a very simple course run by a lovely non-profit organisation called the 'Art of Living' organisation.   They do much good around the world.

 

3.  Green juice.  About a year ago, I did a 44 day green juice fast as I had severe Urticaria.   Not only did it fix the Urticaria (and my diarrhoea and many, many other things), but I felt AMAZING - there is no way depression would have gotten hold of me then.   I don't think anyone needs to do the fast bit, but I keep meaning to have a big green juice every day because I know it makes a massive difference in the way I feel.   I do it intermittently at the moment because, well, the juice tastes like ****.   lol.  I have to hold my nose and count my swallows and keep holding my nose till I've finished drinking and have put a piece of chewing gum in my mouth to cover the taste lol.

 

Anyway - those are the things I've found that make the most difference to my keeping the depression at bay.

[ikam]

I had similar experience with escitalopram and doxepin and naratriptan...I think had I srayed longer on Escitalopram I could have had serotonin syndrom...

I think I had some toxicity...

[UnfoldingSky]

I had similar experience with escitalopram and doxepin and naratriptan...I think had I srayed longer on Escitalopram I could have had serotonin syndrom...

I think I had some toxicity...

 

I am sorry to hear that Ikam. How are you now?

 

 

[ikam]

 

I had similar experience with escitalopram and doxepin and naratriptan...I think had I srayed longer on Escitalopram I could have had serotonin syndrom...

I think I had some toxicity...

 

 

I am sorry to hear that Ikam. How are you now?

I am not too good today. I had two better days and it seems I am back with paresthesia today and feeling hopeless...

 

I don't know what I had but my symptoms got worse when I increased escitap,oram dose on 12th december, then I had this strange drunk like feeling when took naratriptan on 23td december. I did not know about drug interactions there and then...Had I continued taking them...

I have been on doxepin and apparently this contributed to serotonin overload...

 

On 27th of december I started my faster escitalopram decrease...

 

I lost hope today, as some of my symptoms are back...Will I ever get better?

[UnfoldingSky]

Hi ikam,

 

Sorry you are having bad days.  Please don't give up hope though, people do recover.

 

I don't know if what I had was serotonin toxicity either but I was diagnosed as having had an adverse reaction to an SSRI and have had many other serious problems with other drugs and I have recovered a lot.  I had parasthesias and they are gone, too.  Haven't had them in years.

[ikam]

I am only on my 14th day of decrease. I was told I had an adverse reaction to escitalopram. Somebody who knows about these drugs explained to me:

 

My problem that began with the higher dose of Escitalopram happened because the person prescribing has little knowledge of drug to drug reactions. Doxepin requires CYP2D6 to properly assimilate. Escitalopram moderately inhibits the CYP2D6 enzyme which allows a build-up of Doxepin. At first, the lower dose still allowed me to manage. But the increase was enough for the problem to show. The sensation i was feeling was from too large of a build-up of serotonin from not being able to process the Doxepin quickly enough.

 

It is difficult to stay hopeful when symptoms are back...

 

How long did your paresthesia last?

[UnfoldingSky]

I am only on my 14th day of decrease. I was told I had an adverse reaction to escitalopram. Somebody who knows about these drugs explained to me:

 

My problem that began with the higher dose of Escitalopram happened because the person prescribing has little knowledge of drug to drug reactions. Doxepin requires CYP2D6 to properly assimilate. Escitalopram moderately inhibits the CYP2D6 enzyme which allows a build-up of Doxepin. At first, the lower dose still allowed me to manage. But the increase was enough for the problem to show. The sensation i was feeling was from too large of a build-up of serotonin from not being able to process the Doxepin quickly enough.

 

It is difficult to stay hopeful when symptoms are back...

 

How long did your paresthesia last?

 

Hi ikam,

 

I hear you about it being hard to maintain hope when symptoms are bothering you.  I was hopeless a lot of the time too.  Nonetheless, I still have recovered so much even with my feeling like it would never end.

 

My parasthesias cleared up a little while after I got off the drugs that were causing them, if I recall properly.