ikam: tapering escitalopram

[ikam]

Of course. This is just a copy of flashback protocol I found

I have found similarities between flashbacks and WD, in both we tend to get in as opposed to OUT emotional responding, especially when we go through similar symptoms...always worried that it will be as it was...

[Frogie]

46 minutes ago, ikam said:

Of course. This is just a copy of flashback protocol I found

I have found similarities between flashbacks and WD, in both we tend to get in as opposed to OUT emotional responding, especially when we go through similar symptoms...always worried that it will be as it was...

Thanks:

 

You are right, I seem to panic more if I think the situation is going to be the same.

 

I think it will help.

 

Take care,

Frogie xx

[brassmonkey]

That's a very interesting find Ikam.  Like you said, there seem to be some real possibilities for translating it into something useful for WD.  I would love to hear your ideas on how it can be modified and used.

[ikam]

just some observations:

- they both affect autonomous nervous system...so they both increase responses of fight-flight-freeze

- they both relate to severe affect dysregulation

- WD may be considered as a traumatic response, including fear of dying 

- WD creates states that may be considered as dissociation

- in WD there is a kind of connection/fear of reoccurring symptoms; hence almost expecting the worst scenario

- in WD we may act as if the worst is happening and believe that it is happening (I am not saying it is not happening though)

in both it is helpful to find a strategy OUT of it, instead of IN (flashback)..flashbacks are reinforced by getting IN all over again; whereas the protocol gives a hope that this is controllable

- another similarity: "out of control feeling"....and being out of control...

- the flashback protocol (WD protocol) helps with grounding in here and now, but it requires to acknowledge what I feel and here and now I may be much stronger that there and then... 

 

[ikam]

WD vs/and PTSD

What I am covering below is not diagnostic, I only try to find the similarities, as it helps me (maybe others as well) to deal with this difficult experience of WD 

I will start from the exclusion criterion- hence we cannot call what we experience as PTSD, but in my view there are lots of similarities, so we can treat ourselves as if we have been traumatized (as we are....)

Criterion H: exclusion

Disturbance is not due to medication, substance use, or other illness.

(THIS ONE IS NOT MET)

 

Criterion A: stressor

(Possibly we are not meeting this criterion fully, although I was terrified that I would die; i felt completely out of control, terrified that if i fall asleep i may never wake up....)

The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, as follows: (one required)

1.    Direct exposure.

2.    Witnessing, in person.

3.    Indirectly, by learning that a close relative or close friend was exposed to trauma. If the event involved actual or threatened death, it must have been violent or accidental.

4.    Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties (e.g., first responders, collecting body parts; professionals repeatedly exposed to details of child abuse). This does not include indirect non-professional exposure through electronic media, television, movies, or pictures.

Criterion B: intrusion symptoms

The traumatic event is persistently re-experienced in the following way(s): (one required)

(hmm, only one is required to meet the threshold...)

1.    Recurrent, involuntary, and intrusive memories. Note: Children older than six may express this symptom in repetitive play.

2.    Traumatic nightmares. Note: Children may have frightening dreams without content related to the trauma(s).

3.    Dissociative reactions (e.g., flashbacks) which may occur on a continuum from brief episodes to complete loss of consciousness. Note: Children may reenact the event in play.

4.    Intense or prolonged distress after exposure to traumatic reminders.

5.    Marked physiologic reactivity after exposure to trauma-related stimuli.

Criterion C: avoidance

(I have avoided next tapper for really long; terrified that I would get the same symptoms as at first)

Persistent effortful avoidance of distressing trauma-related stimuli after the event: (one required)

1.    Trauma-related thoughts or feelings.

2.    Trauma-related external reminders (e.g., people, places, conversations, activities, objects, or situations).

Criterion D: negative alterations in cognitions and mood

Negative alterations in cognitions and mood that began or worsened after the traumatic event: (two required)

(I definitely meet at least two)

1.    Inability to recall key features of the traumatic event (usually dissociative amnesia; not due to head injury, alcohol, or drugs).

2.    Persistent (and often distorted) negative beliefs and expectations about oneself or the world (e.g., "I am bad," "The world is completely dangerous").

3.    Persistent distorted blame of self or others for causing the traumatic event or for resulting consequences.

4.    Persistent negative trauma-related emotions (e.g., fear, horror, anger, guilt, or shame).

5.    Markedly diminished interest in (pre-traumatic) significant activities.

6.    Feeling alienated from others (e.g., detachment or estrangement).

7.    Constricted affect: persistent inability to experience positive emotions.

Criterion E: alterations in arousal and reactivity

Trauma-related alterations in arousal and reactivity that began or worsened after the traumatic event: (two required)

(in this one I get all of them + additional symptoms of ANS deregulation)

1.    Irritable or aggressive behavior

2.    Self-destructive or reckless behavior

3.    Hypervigilance

4.    Exaggerated startle response

5.    Problems in concentration

6.    Sleep disturbance

Criterion F: duration

Persistence of symptoms (in Criteria B, C, D, and E) for more than one month.

Yes- fully met

Criterion G: functional significance

Significant symptom-related distress or functional impairment (e.g., social, occupational).

Yes

Specify if: With dissociative symptoms.

In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:

1.    Depersonalization: experience of being an outside observer of or detached from oneself (e.g., feeling as if "this is not happening to me" or one were in a dream).

2.    Derealization: experience of unreality, distance, or distortion (e.g., "things are not real").

(I definitely have times of feeling detached from myself or experience of unreality, distance to the outside world)

Specify if: With delayed expression.

Full diagnosis is not met until at least six months after the trauma(s), although onset of symptoms may occur immediately.

 

Edited October 14, 2017 by ChessieCat
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[ikam]

16 hours ago, Frogie said:

Thanks:

 

You are right, I seem to panic more if I think the situation is going to be the same.

 

I think it will help.

 

Take care,

Frogie xx

me too...I expect exactly the worst scenario, something as severe or worse as in the past...

[ikam]

Preparing (mentally) for a third slide tomorrow (another 1% drop); so far I have had no additional symptoms of recent two slides...

 

If I have (HOPE) no symptoms should I carry on with slides until I feel it, or should I get two weeks "time off sliding", as I had planned?

[brassmonkey]

It's very important to take the two week breaks every four slides.  This allows for the slides to fully stabilize before starting again.  If you don't the little symptoms that you may not be feeling can add up and really cause trouble when they get too big.  It's very tempting to speed things up when they are going well, but t's never a good idea.

 

I'm so glad that your taper is going smoothly.

[ikam]

Thank you, appreciate your input...

I have been doing 1% drops...

I am tempted to try 2% next time... Unsure...

 

This time I will do two weeks after 4 weeks of 1%, all together it will be 4%drop...

[baroquep]

Hi ikam, you are getting closer to the finish line, a time where we should be a little more cautious through each and every taper. I tried speeding things up when I was feeling on top of the world, and ended up destabilizing and it took three months to get back on track.  

5 hours ago, brassmonkey said:

It's very important to take the two week breaks every four slides.  This allows for the slides to fully stabilize before starting again.  If you don't the little symptoms that you may not be feeling can add up and really cause trouble when they get too big.  It's very tempting to speed things up when they are going well, but t's never a good idea.

 

I'm so glad that your taper is going smoothly.

 

[ikam]

yeah, the temptation to speed things up is so strong...I will be mindful and stay with 1% at each slide...

I am to do 4 weeks, 1% each week and then stabilise...

 

I am finding escitalopram really difficult...tiny doses of this drug contain lots of poison...it is really strong drug...

 

[brassmonkey]

Especially at the lower doses.  You're in the area where a small change can have quite a big affect on the receptor loading. So you really need to take it slow and easy ans listen to your body.

[ikam]

2 hours ago, brassmonkey said:

Especially at the lower doses.  You're in the area where a small change can have quite a big affect on the receptor loading. So you really need to take it slow and easy ans listen to your body.

Yes, I will be slow, thank you so much for reminding me, as I had as strong urge to speed it up...

I will do my fourth slide tomorrow, as planned and then wait for two weeks...

 

As I mentioned before I have a bit of a problem in distinguishing my responses to the life events, from WD symptoms...

I have just started a divorce process, but I did not want to wait, as it seems I was constantly moving the start day as something wax happening in my life...

 

[ikam]

2.125mg as from today/third slide of 1%

[ikam]

I have been reading an amazing book: "Mindlessness- the corruption of mindfulness in a culture of narcissism" by T. Joiner. There is one fragment that relates to benefits of times tincture and management of bulimia nervosa...it is particularly important for me in terms of my emotions, urges, as I tend to catastrophize, make them more powerful, etc. 

I know, I am not hit this time by severity of WD...but still it is a good explanation...

 

They "instruct patients, in response to urge to binge or purge, to instead sit at a desk with pencil and paper and simply graph out their minute-to-minute mood, usually for about five minutes. the horizontal axis of this graph represents the passage of time in minutes and is numbered from 1 to 5 and so...the vertical axis of the graph represents overall negative mood, ranging from 1 at the bottom (feeling good) to 10 at the top (feeling very bad)...For virtually everyone who does this exercise and begins say 9, 10....the graph will slope downward....the therapist responds like a following: "your rating went down from 9 to 6, about 33%drop, pretty substantial. Tell me again what you did to produce that substantial drop in negative mood". A typical answer is: "nothing. I just sat there for a few minutes and graphed my mood".

Conclusions:

1. Emotions must not be all that powerful if something so simply can easily change them

2. emotions pass and do so relatively quickly and easily

3. regulating one's emotions need not to be all that hard to do...."

 

I do not want to minimise our suffering and I can only talk from my experience. I know that I tend to "spread emotion over a time", which means, I feel something, then my mind gets "attracted" to this and starts dwelling on it, making my life misery, catastrophe, etc. 

Whereas when I manage to distract myself, the feeling "moves away...", my attention shifts, and emotion lasts shorter...

 

The above mentioned book has many aspects that I consider healing, such as: "sometimes thoughts cascade through the mind like a waterfall. We might take some delight in this image, and visualise ourselves sitting behind the torrent in a little cave or depression in the rock, aware of the ever-changing sounds, astonished by the unending roar, resting in the timelessness of the cascading mind in such an extended moment" (Kabat- Zinn).

 

[ikam]

what happens to the strength of the symptom when we manage to distract? is the symptom as strong as it appeared to be? I mean my morning anxiety, when I get on with a day (distract, focus on something else), the anxiety is replaced with a feeling of calm and a big question: what was it about in the morning?

[ChessieCat]

Anxiety and stress produce cortisol and we can also experience cortisol spikes.  Cortisol uses energy which can create our desire for sugar.  Adrenaline also comes into the mix so by doing something maybe we use the adrenaline and the hormones all start to level out and go back to normal.

[ikam]

This makes sense. Thanks 

 

[ikam]

13 hours ago, ChessieCat said:

Anxiety and stress produce cortisol and we can also experience cortisol spikes.  Cortisol uses energy which can create our desire for sugar.  Adrenaline also comes into the mix so by doing something maybe we use the adrenaline and the hormones all start to level out and go back to normal.

Following this, it seems so important for us to get up, do something instead of staying in it...But knowing myself, there are times when I just simply stay in the misery...this explains why during the weekends I feel the worst...

 

Being busy/distraction relates to my tinnitus as well. When I am occupied I hardly hear this. I have ENT referral, as apparently I have retracted eardrum...

 

Today is a third day of third slide, I am feeling OK...no problems...

 

I have noticed that for sometime I tend to wake up feeling really cold, I put electric blanket on, but have problem with getting warmer, until I get up...

[ikam]

Am I only denying my symptoms? I try not to get involved too much with them, as I have tendency to catastrophizing, but am I minimising? making the problem smaller than it is? 

I have had problems that led me to talking ad; how are they different in WD?

[Martina23]

19 hours ago, ikam said:

Following this, it seems so important for us to get up, do something instead of staying in it...But knowing myself, there are times when I just simply stay in the misery...this explains why during the weekends I feel the worst...

 

Being busy/distraction relates to my tinnitus as well. When I am occupied I hardly hear this. I have ENT referral, as apparently I have retracted eardrum...

 

Today is a third day of third slide, I am feeling OK...no problems...

 

I have noticed that for sometime I tend to wake up feeling really cold, I put electric blanket on, but have problem with getting warmer, until I get up...

That is great that you feel ok. It seems that slow tapering suits you really well.

 

Continue in a good work, you will come there.

[ikam]

so far so good, anxiety on waking up; unsure if this is wd-related or life-related or both...

[Frogie]

52 minutes ago, ikam said:

so far so good, anxiety on waking up; unsure if this is wd-related or life-related or both...

I'm glad you are doing well.

 

I'm sure your anxiety is a combination, look what you are going through. But I'm not a dr.

 

Hang in there.

 

Take care,

Frogie xx

[ikam]

Fourth slide of four today... Down to 2.1mg...four weeks ago it was 2.2mg... 

[Frogie]

4 hours ago, ikam said:

Fourth slide of four today... Down to 2.1mg...four weeks ago it was 2.2mg... 

That's great! I wish you luck on your holding now.

 

Take care,

Frogie xx

[ikam]

2 hours ago, Frogie said:

That's great! I wish you luck on your holding now.

 

Take care,

Frogie xx

yes, I will hold for 2, 3 weeks; I do not want to hold for too long, as then I get to the avoidance state and it is difficult for me to restart...but I will be mindful about my symptoms...additionally how much is reflection my ongoing stressors (divorce) and how much it relates to WD...

ikam

[ikam]

So far so good...I am tired, but it could be associated with work and extra training (I was in intensive training over the weekend). I have some A/L , so I see if I get more rested...I hope...

 

I am HOLDING at present on 2.1mg

[ikam]

For how long should I hold? 

[baroquep]

I would hold until you feel your mind and body are ready to make another reduction.  It looks like you are doing the Brass Monkey Slide method which I'm not completely familiar with but you could probably find more information here:

 

Brass Monkey Slide

[baroquep]

On 2017-10-16 at 2:40 PM, brassmonkey said:

It's very important to take the two week breaks every four slides.  This allows for the slides to fully stabilize before starting again.  If you don't the little symptoms that you may not be feeling can add up and really cause trouble when they get too big.  It's very tempting to speed things up when they are going well, but t's never a good idea.

 

I'm so glad that your taper is going smoothly.

 

[ikam]

Yes, I have followed Brass's protocol... 

I will hold for two weeks... If I feel any additional symptoms I will hold for longer... 

It is difficult for me to judge by my symptoms, as I am never symptom free, too much is happening in my life...divorce and lots of uncertainty related to life (work, finances, lack of emotional support). I work very hard, often take additional jobs, I will need lots of money to finish divorce, etc. 

So, judging by symptoms does not work for me... 

There will be never good time to tapper... My last holding was for over half a year, as I was waiting for a better time.... 

[ikam]

still holding until next Wednesday...I have been sweating more...

[ikam]

Can anybody guide me or let me know how antibiotics affect WD, I have been on erythromycin last few days, really tired, headache and sweating a lot 

[ikam]

Decreased another 1% of 2.2mg 

[ikam]

3rd day of second slide...

I am tired, but life is tiring; we leave in a strange time...brexit in uk, feeling uncertain what future holds...also going through divorce, he has been acting out and I do not know what will happen next...this makes me exhausted...

[Frogie]

14 minutes ago, ikam said:

3rd day of second slide...

I am tired, but life is tiring; we leave in a strange time...brexit in uk, feeling uncertain what future holds...also going through divorce, he has been acting out and I do not know what will happen next...this makes me exhausted...

I hope everything turns out ok with your divorce. I've been through 2, they are very exhausting. That's what made me go on antidepressants was my 2nd divorce, 20 years ago. How do you measure .075? I'm just not grasping that concept.

 

Thanks.

 

Take care,

Frogie xx