ikam: tapering escitalopram

[ikam]

I would normally follow 10%at a time protocol, but because I have been on it only two months and because it has adverse effects on me and becuase it interacts with doxepin, I need to do it faster...

I have not been too bad today...i will definetely monitor myself and if needed I will up the dose...

[ikam]

I was searching for answers about interaction of escitaploram and doxepin, they could lead to a serotonin syndrom...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.

 

This is the reason I have to get rid from escitploram quicker...

 

I was so close to die...the night I had problems I was so scared to fall asleep as I was reiffied I would not wake up...

I am alive...i have a new life, new chance...

[Songbird]

In general, ADs should not be combined, due to risk of serotonin syndrome.  Doesn't seem to stop some docs prescribing all sorts of combinations.

[ikam]

Yes, and I did ask her if it was ok to continue doxepin, she said that it was ok...i told her about my symptoms when I increased escitalopram, she said that they would pass...they were getting worse and worse...

Decresing escitaploram to 5mg has already helped...

But I am so worried about my future, cannot attend any job interviews at present...i am in a ver shaky state...anything get me overaroused...

I am aware that my decrease may be too qucik. But I need to manage the adverse response first...so I need to choose between surviving withdrawal and managing serotonin overload...

[bubble]

Hello Ikam,

 

I have read through your thread since I also deal with Escitalopram, although in a different way than you. I can only say that it is a very potent and nasty drug. I'm glad reducing it has reduced your symptoms but I'm even more glad that you have become aware of how responding to symptoms with more drugs, increasing and reducing them is very counterproductive. Keeping things stable or introducing any changes very gradually is our best bet as well as trying to stay calm when feeling worse as you have noticed.

 

The other strategy that it took me very long to adopt is to recognise that whatever I'm feeling at the moment is true for me at the moment but that it doesn't define my future. We all tend to project the negative emotions from presnt into the future and that makes us feel only worse. The key is this: you cannot attend any job interviews at present. In such situations I tell myself that it is OK that I don't attend interviews in the same way it would be OK to cancel a run if I broke my leg. After a while I would slowly and carefully go to a job inteview respecting my state and acknowledging that things overarouse me and doing my best to take care of myself by protecting myslef from things which affect me badly and create conditions which are good for me. If it means lying in the dark room, lie in the dark room. This is what you need now. It doesn't mean that spring will find you lying in the dark. On the contrary, if you give yourself what you need, accepting that it is temporary, it's more likely you will lie in the dark less sooner, or not at all. 

 

Don't worry about decreasing too quick. You've been on the drug for a short time. Even 10 % rule depends on the context. Remember that your brain is the only authority on what is the best pace for you. And it's telling you that what you are doing is OK. What we are looking for are reduced symptoms at first rather than their disappearance. 

 

It would help us a lot if you could put your drug history in your signature as described here: http://survivingantidepressants.org/index.php?/topic/893-please-put-your-withdrawal-history-in-your-signature/

 

Best,

Bubble

[ikam]

Hello Ikam,

 

I have read through your thread since I also deal with Escitalopram, although in a different way than you. I can only say that it is a very potent and nasty drug. I'm glad reducing it has reduced your symptoms but I'm even more glad that you have become aware of how responding to symptoms with more drugs, increasing and reducing them is very counterproductive. Keeping things stable or introducing any changes very gradually is our best bet as well as trying to stay calm when feeling worse as you have noticed.

 

The other strategy that it took me very long to adopt is to recognise that whatever I'm feeling at the moment is true for me at the moment but that it doesn't define my future. We all tend to project the negative emotions from presnt into the future and that makes us feel only worse. The key is this: you cannot attend any job interviews at present. In such situations I tell myself that it is OK that I don't attend interviews in the same way it would be OK to cancel a run if I broke my leg. After a while I would slowly and carefully go to a job inteview respecting my state and acknowledging that things overarouse me and doing my best to take care of myself by protecting myslef from things which affect me badly and create conditions which are good for me. If it means lying in the dark room, lie in the dark room. This is what you need now. It doesn't mean that spring will find you lying in the dark. On the contrary, if you give yourself what you need, accepting that it is temporary, it's more likely you will lie in the dark less sooner, or not at all. 

 

Don't worry about decreasing too quick. You've been on the drug for a short time. Even 10 % rule depends on the context. Remember that your brain is the only authority on what is the best pace for you. And it's telling you that what you are doing is OK. What we are looking for are reduced symptoms at first rather than their disappearance. 

 

It would help us a lot if you could put your drug history in your signature as described here: http://survivingantidepressants.org/index.php?/topic/893-please-put-your-withdrawal-history-in-your-signature/

 

Best,

Bubble

Hi Bubble, thank you for your input. I have not been too well today. It has started from anxiety about my future...

What you say and I know logically, makes sense...

I think the more I look after myself at present the better I will be in the future...

 

I will put my drug signature, but my concentration is not too good at present...also, as it seems this task brings too many emotions...as I do recognise the damage, it is like a sudden awakening...

 

Today, I worry again that I will not manage...

Feeling rather dizzy and shaky...

 

It is my third day of decreasing Escitalopram from 10mg to 5mg...it is difficult to judge what is better, to expose myself to withdrawal or to adverse symptoms?

It seems, when I was in my slow decrease from effexor (over three years, ended in 2010), it was much simpler. I was "only" dealing with wihdrawal, able to track my symptoms...

Now, I am unsure if decresing the dose increses withdrawal or if I increase my dose, will it increase adverse response???

I was better yesterday...

 

The symptoms I have today are: feeling dizzy, lighteaded, headache, bit of pins and needles, anxiety...

But these were also symptoms that I had before decreasing...

[bubble]

It takes 4 days for the change in drug to register. So it's too early to tell. 

 

Take your time with filling in the signature. I know how it feels. Knowing what I know now makes looking at my drug hostory very painful. But this whole experience is an exercise in accepting. And moving on. I often think to myself: if only I had found the forum before. But it might have happened that I had never found it...

 

I don't think you should worry about withdrawal. We have proposed a bigger cut because you have been on Escitalopram for a very short period of time (unlike your time on Effexor). So I wouldn't compare these two experiences. 

 

It's important to monitor the symptoms and especially their intensity because this is what tells us what is the right thing for us to do. 

 

We will all manage. Nobody else will do it in our place

[ikam]

Thank you. I see I am more panicked today...therefore symptoms may feel worse...i have been more shaky and it seems I have more tingling in my hands...i am feeling dizzy and more anxious...

 

I guess, my serotonin and other neurotransmiters are fluctuating...

You said it usually settles after 4 days, so I guess I need to be more patient?

 

I think, I was a bit excited ar first, but now more anxious...

 

My concentration is so bad...i hope I make sense in my emails...

[ikam]

I think I know what has made my symptoms worse today. I did not measure an exact cut, just cut a pill in half with a knife. So most likely today's dose was smaller/hence I got a bigger decrease...

I will start doing water solution tomorrow...

I used to do this with effexor in the past.

I need to do an exact 5mg...

I think that it is possible that yesterday I took 6mg and today 4mg. Hence my symptoms are worse...

[ikam]

I am not feeling well today at all. Dizzy, headache, lightheaded, some numb feeling in my hands, sensitive to noises, difficulty concentrating...

 

Lost my hope today, feeling more anxious that it will never pass...

 

I was much calmer last two days...

I will be more mindful about proper cut tomorrow...

 

Will I manage? Will I ever get better?

[ikam]

How to recognise symptoms that are life-threatening?

[bubble]

Being precise is measuring is extremely important since the key to healing is stability. Great that you already have experience with liquid tapering.

 

However awful and debilitating these symptoms are they are not life threatening. People often end up in ER especially when going through a panic attack because it is so very severe in intensity. But physically we are fine. The suffering is all mental.

 

Which symptoms do you find so severe? Are you taking any magnesium? Try to calm yourself by following your breathing and gentle walks if you can. But most importantly, try not to be scared. Fear generates fear. However bad it feels, this is just temporary and it will get better.

[ikam]

Yes, I have been more anxious today.

I have had a headache, feeling dizzy, lightheaded, kind of numb in my hands and I seem to have problems with vision, as if my eyesight got worse, type of misty.

But it has not been as bad as on Christmas Day when I went to the emergency, acheiving nothing than getting another prescription...

 

I have problems with taking supplements as I usually end upwith diarrhea.i had this problem with magnesium, was taking citrate-malate, I think...

[mammaP]

I found magnesium citrate and magnesium chelate were too strong and would affect my stomach, also had diarrea.

Now I take mag glycinate and it is much gentler on my stomach. Start at a low dose of anything and increase if needed

up to whatever works for you.  Have you tried fish oil capsules? They help many with dizziness and brain fog. 

[ikam]

At the moment I will not add any extra supplements. I only thought to try Passionflower for anxiety. I wonder what people think about this remedy? I think valerian root is too strong, I never liked it...

 

I have been a bit better today. Did not wake up with a severe, migraine type headache. Was very anxious in the morning and when I get anxious, sine escitaploram, I have this strange senation in my both hands.

Got up, meassured cearefuly my escitsploram dose...

 

Today, the most difficult are worries about my future...i should be more proactive...and my anxiety seems stronger..

 

Somebody said in one of the answers to me, that I should not use my present state to predict about my future...if I only could...

 

My coping with anxiety in the past related to taking meds, if I did not have any I would use paracetamol with codeine....

So, my coping skills repertoire is rather limited...

I am also completely on my own...which has also advantages...

[ikam]

I just read information about another drug I was put on when I started escitaploram. It was zolpidem. I am terrified. I was stupid...trusting too much...

 

It is first time when I see I have had problems with at least psychological addiction...it is only me who is guilty for my present state of mind...

Why I did not see it? Why, if I saw this in my father, I went just the same route?

 

I survived...i almost died this Christmas...

[ikam]

I have not felt so well since it all started...

 

I have noticed something else, when I get emotionally better, I feel more in a phisical pain. Such as my old injury with achilless tendon...this is strange...

 

I remember after my stopping effexor, I had many unexplined pains in my body, eventually ended up with a pelvic pain, unable to seat...

All this phisical pains usually lead me to using painkillers...

 

So, I know today, I am addicted to meds...not only problem with antidepressants. For years I deluded myself that I was doing so well...

Until now...i will always remember that I almost died this Christmas. I will alway remember that ChristmaS Eve I got into a panic that they did not have doxepin in my pharmacy, leaving me short one day...

So, on ChristmaS Eve I was more concerned about my meds than traditional Xmas food. I actually hardly eat anything...

 

So my recovery is going to be more complicated...

[ikam]

5th day...my palms feel kind of numb today, which is possibly, hopefully normal and irreversable...it sesm that it is more pronounced in ring and small fingers in both hands...which I guess is something to do with nerves...it is associated with some kond of weakness...

 

I have been worrying more today, maybe this is what increases intensivity of symptoms...

[Ever]

Yep - worrying makes everything worse. But difficult to stop worrying yes?

[ikam]

Yes, my life is in such huge mess. I need to be more proactice in finding a new job...there was time in my life when I seriously thought about relocating to New Zealand

 

You must be already in New year, arent't you? So, I hope new year will be the way you want it to be!

[Ever]

Yes it's New Year's Day here. And a beautiful, warm and sunny summer's day it is.

 

I also need to get myself together and find a new job. I left my job of 19 years four months ago. I've been putting off looking for another - I've been enjoying our spring and my horse. Luckily I have enough money at the moment to be able to do that. First time in my life I've ever had more than a week or so off work! It's an amazing experience for me lol.

 

I hope this year is a better one for you ikam

[Frustrated]

Wow lucky you ever . It is snowing and FREEZING here. I hate it. We are in the negatives with a windchill. Spring sounds lovely.

[ikam]

Cold here, but not so bad...

 

Staying home is nice, but I am beginning to feel a bit bored, maybe good sign...

I moved to a completely new area when I chsnged my job four months ago, I was promoted. I was unable to stand ethical standards there and left eventually.

I dont like this new area, but have decided today that I will look for some places around...i like contact in nature a lot...i have not done any walking for long...i need to restart it...

 

Yes, I hope this year will be better for us:)

[Frustrated]

I wish my legs would stop hurting long enough for me to walk. Not freezing solid when I go outside would help as well lol. Sorry you are not happy where you are.

[ikam]

6th day of decrease...

Last night was worse, I woke up with severe pins and needles in both hands. I did not do anything different, only went to sleep a bit later.

I am stil on 5mg escitalopram in the morning, atenolol 25mg twice a day and doxepin 75 mg in evening...

 

Maybe it is because my serotonin level fluctuate?

[ikam]

Just read that pins and needeles may relate to omeprazole, which I take in evening...

[ikam]

I am not too good at the moment, started to worry that I will never be able to sort my life and get a job, go through the stress of travelling to work and stress related to starting something new.

 

This pins and needles sensation was much stronger last night. It happened at a different that normally time. This sensation last night was usually in both my hands. It always goes through my arms towards ring and small finger.

I felt very anxious in the morning, as I started to worry about this...

 

I normally take doxepin 75mg, atenolol 25mg and omeprasole in evening.

In the morning 5mg of escitaplroram and atenolol 25mg.

Generally I feel a bit better. Just these sensations worry me.

 

But last week I was still on a coctail of meds...also, when psychiatrist started me on escitaploram, she put me on diasepam and zolpidem. I think they masked any adverse effects.

Last week on wednesday and thursday I took my last zolpidem at night. I also took Naratriptan last wednesday.

 

It is so difficult to judge what is a wihdrawal, what an dverse response.

 

I still think escitaploram contributes to serotonin overload as it interacts with doxepin. But I am anxious to go any lower than 5mg. I think I should get rid of this medication asap, but still don't know what to expect...

So far it has not been so bad. I am feeling pretty calm at the moment. As long as I keep any stimulation low I am ok. Any extra stimulus, it could be more vibrant music on tv, gets me overaroused, my heart gets faster, I start sweating and feel a bit panicky. I try to use my logic and I know that nothing dangerous is happening.

But my bodily sensations make me anxious...i dont know if they will ever stop? And how long will they last? Or will they get worse, e.g. spread on my different body parts?

 

I have to add that I suffered from ptsd in the past, so my autonomic nervous system gets more easily into an alert state. Hence, I have been using wrong strategy, medication, to calm it down...

Maybe it is just normal what I feel in my body at present?

 

In the past I had lots different strange symptoms, mostly pains that had nor explanation...all diminished with time and paying less concentration to them.

It is a bit difficult at present, especially at night, not to pay attention to my symptoms...

 

Maybe it needs to get worse to get better?

[ikam]

I wish my legs would stop hurting long enough for me to walk. Not freezing solid when I go outside would help as well lol. Sorry you are not happy where you are.

I am not happy here, as I did not realised how different it will be. I used to live in London, surrounded by parks, close to the river, many places to walk. I moved here to discover that there is still a building site in front of my window and that the flat is very noisy. When I feel low, I am very sensitive to noises.

People in this part of UK seem less inclusive.

I moved here because of new, as I thought exciting job, that turned out to be just opposite. One day I was unable to go there anymore. I was in such a conflict all the time with my ethical standards...I went for sick leave and took the decsion to resign.

So, both work and moving house, turned into pretty negative experience.

I started antidepressant as I was, wrongly, hoping it would help me to switch off and carry on with my duties...it did not...

Everything is just more difficult at present and I feel time pressure, as I need to earn some money asap...

So, I feel really trapped, worried that I need quite a lot of money to pay my bills, etc, etc.

 

But yesterday I started looking for nearby parks, found quite few, I want to find some green places, open spaces, singing birds, etc. I miss it so much...

 

I am not going anywhere today, it is pretty grey day, going to rain...

[Frustrated]

I am so sorry you are going through this.  I understand wanting to have some sort of nature around you.  Peace is what we all need right now.  I hope you are able to find some semblance of happiness for yourself in this new year.  I do not have family or friends to lean on and I feel very alone in my space.  My kids depend on me so they don't count.  I would love to have a friend.  Maybe you will connect to someone where you are and this will lessen your load.  I hope this for you.

[ikam]

I am so sorry you are going through this.  I understand wanting to have some sort of nature around you.  Peace is what we all need right now.  I hope you are able to find some semblance of happiness for yourself in this new year.  I do not have family or friends to lean on and I feel very alone in my space.  My kids depend on me so they don't count.  I would love to have a friend.  Maybe you will connect to someone where you are and this will lessen your load.  I hope this for you.

And I hope this for you

[ikam]

I am unsure when to start further reduction. I see that escitaploram added to dioxepin acts like a type of irritant. So I would like to stop it asap. But at the same time I have problem with recognising right moment to make my next step.

Apart from paresthesia, sensitivity, getting easily emotionally overaroused and sweating I am doing all right.

As I said before, I dont know what belongs to the ithdrawal and what to the dverse response symptoms. So I have difficulty to guide myself...additionally some of the symptoms may belong to the menopause...Moreover, I think, some of the symptoms may relate to benzo withdrawal...

 

 

I remember I was anxious to get down to 5mg, but I have had more positive than negative symptoms...

 

I may try to cut to 4mg and observe myself...as long as I will not get over-anxious...

 

I would apreciate if people have some suggestions, please.

[ikam]

I read a bit more about paresthesia, looks what I have relates to the ulnar nerves, C7 and C8 nerve.

How to heal nerves? Are there any supplements for this? Is magnesium somebody already suggested going to help? And when to start supplements? Shouldnt I wait a bit?

 

I only use at present some homeopatic remedy (aconite 30c) and I took one tablet of Passionflower in the morning...

 

I know that we are quite sensitive even to supplements and vitamins. In the past I was twice diagnosed by homeopths with adrenal fatigue. Each time when they put me on some cortisol related supplementation, I responded with severe anxiety...

[Songbird]

It's best not to mess with the adrenals.  Passionflower should be okay, depending on how you respond to it.  Magnesium could also be worth a try.  With any herbs or supplements, introduce only one thing at a time and start with a small dose to see how your system reacts, as individual responses vary a lot.

 

In a way, you are lucky that the AD didn't help you cope with your job.  Mine got me through 7 years in a job I wasn't happy with, they feel kind of like wasted years now.  I'm also now jobless and worried about money, but I don't regret leaving my old career.

 

Going for walks in parks, etc. will be good therapy.  You could also try relaxation exercises for calming the nervous system, e.g. gentle yoga stretches, progressive muscle relaxation, guided visualisation, meditation - choose anything that you like.

 

Some of your anxiety is coming from your "what if" thinking (i.e. worry).  See if you can just observe these worries and then let them go, as they don't help anything (I know, easier said than done!). 

 

I can't remember if you said why you are on omeprazole?  How long have you been back at 5mg escitalopram now?

[ikam]

It has been one week on 5mg. I am not too bad.

 

Last night I slept 12hours, I needed this...still feeling exhausted...

 

Yes, I tend to use a lot of "what ifs"....

 

Omeprasole- I have some problems with excess of stomach acid which at present affects my throat as well...some infection...

[Ever]

It has been one week on 5mg. I am not too bad.

 

Last night I slept 12hours

Woot woot! Happy dance here

[Frustrated]

I have stomach problems as well.  Get terrible pain and burning in my stomach and through to my back, and it affects my swallowing sometimes and gives sore throat.  Was on panteloc for years but don't take it anymore because I am afraid of nutrient defficiencies with no stomach acid to digest food.  I am also diabetic so I take meds for that and low dose aspirin which are both hard on my stomach.  It is horrid and I am sorry you deal with this.  I also have burning and tingling and pain in my arms and legs and feet, so I am sure the tingling in your hands is withdrawal related.  Sending positive vibes your way.