Hojo70 - Bad advice

[hojo70]

I've been on 10mg Lexapro for about 9 years. My doctor and I agreed to try and get me off SSRI to see how I do. He recommended tapering to 5mg for 1 week before going off. I followed this regiment and am now on day 6 of withdrawal. It's been a crescendo thus far as I feel pretty terrible today. My symptoms are the usual suspects: feverish, dizziness, foggy, brain zaps, slight nausea, and lack of focus. I've been reading some articles recently that suggest multiple tapers over much longer periods of time. I think my GP may have rushed me considering I've been on the drug for so very long! I am considering now re-starting a small dose of the drug and allowing myself time to re-adjust, and then re-starting a gradual taper over a period of weeks perhaps.

 

I am looking for some solid advice:

 

1) how many milligram I should re-introduce?

2) how many additional taper periods?

3) how much should I reduce per taper period?

 

Thx,

John

[dalsaan]

Hi Hojo,

 

Welcome to SA.   We need a little more information on how you tapered, when did you start, how much did you drop by each time, how often and what symptoms did you feel along the way.  Have your symptoms gotten worse over time.   

 

It would be great if you could put this in your signature - that's a little info line that provides a brief history of your drug history with every post you make.  It is a ready reckoner for us to see what has/is happening for you.   Instructions on how to do that are here - http://survivingantidepressants.org/index.php?/topic/893-please-put-your-withdrawal-history-in-your-signature/

 

I have also gathered together our key posts on withdrawal, tapering and reinstatement.   Please read them and then we can discuss a possible way forward. Generally speaking we recommend that you reinstate a very low dose and move up if necessary.   we also recommend that you taper at a rate of 10% every month or so.  Some people can go quicker, some have to go slower than that.

 

What is withdrawal - http://survivingantidepressants.org/index.php?/topic/603-what-is-withdrawal-syndrome/

 

Why taper at 10% - http://survivingantidepressants.org/index.php?/topic/1024-why-taper-by-10-of-my-dosage/

 

Reinstatement - http://survivingantidepressants.org/index.php?/topic/7562-about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/

 

Tips for tapering lexapro - http://survivingantidepressants.org/index.php?/topic/406-tips-for-tapering-off-lexapro-escitalopram/

 

Once again, welcome

 

Dalsaan

[Fresh]

Hi hojo , welcome to the site. I agree that your doctor rushed you off , and now you're starting to experience

the fall-out.

 

Dalsaan has kindly supplied all the relevant links you should read before reinstating. As it's only been 6 days this should work for you , and then once you're stable you can start to taper in a safe way , so that you don't get debilitating withdrawal symptoms.

 

Good to have you on board , Fresh

 

.

[hojo70]

Dalsaan,

Per my post, I dropped to 5mg for 1 week end then went off.

[bubble]

Hello Hojo,

 

If I understand what you wrote well, 13 days ago you were on 10 mg Lexapro. What your doctor advised you can't be called tapering. It's pretty much cold turkey. 9 years is a long time and Lexapro is a powerful drug.

 

Given that it has been a short period of time since you stopped taking the drug, I would reinstate 5 mg (Lexapro comes in 5 mg pills but for future taper you will have to use its liquid form). 

 

It's important for you to understand that after your brain has been remodelled for 9 years it will take a significantly more time than weeks for it to reverse those changes and be able to live without the drug that has become its founding block. 

 

After you reinstate it will take you some time to stabilise that is for your symptoms to withdraw. It's hard to say how much because we are all different but again it's not a matter of days but rather weeks. I wouldn't touch the drug for at least a month but preferably longer.

 

If you read the links that Dalsaan provided for you, you will see that we recommend a much more gradual taper than you could probably imagine: 10 % of your current dose every 30 days.

 

So I would start with 5 mg asap. It takes 4 days for the drug to register but don't be surprised if it takes you a few weeks or even a few months to start feeling the way you did before this experience. Maybe you will need to readjust the dose but only do so if you get a severe reaction. Now it's most important that you provide your brain with stability. Please read this as well: http://survivingantidepressants.org/index.php?/topic/6632-the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable/

 

Be patient and treat yourself gently. Avoid the temptation to get a quick fix by throwing additional drugs or supplements at your brain but rather respect the time it takes to recover. Please also fill in your signature according to the link Dalsaan provided. It will help us a lot to give you further advice. Just give the dates of your drug changes. In that way you will also be able to keep track of your situation.

 

This text by our member Rhi explains why it takes so much time and what has actually happened with our brains while on drugs.

 

Best,

Bubble

 

A lot of people, including healthcare practitioners; in fact, I guess, most people-- are operating from entirely the wrong paradigm, or way of thinking, about these meds. They're thinking of them like aspirin--as something that has an effect when it's in your system, and then when it gets out of your system the effect goes away.

That's not what happens with medications that alter neurotransmitter function, we are learning.

What happens when you change the chemistry of the brain is, the brain adjusts its chemistry and structure to try to return to homeostasis, or biochemical and functional balance. It tries to restabilize the chemistry. 

For example: SSRI antidepressants work as "serotonin reuptake inhibitors." That is, they cause serotonin to remain in the space between neurons, rather than being taken back up into the cells to be re-used, like it would be in a normal healthy nondrugged brain.

So the brain, which wants to re-establish normal signaling and function, adapts to the higher level of serotonin between neurons (in the "synapse", the space between neurons where signals get passed along). It does this by removing serotonin receptors, so that the signal is reduced and changed to something closer to normal. It also decreases the amount of serotonin it produces overall. 

To do that, genes have to be turned on and off; new proteins have to be made; whole cascades of chemical reactions have to be changed, which means turning on and off OTHER genes; cells are destroyed, new cells are made; in other words, a complex physiologic remodeling takes place. This takes place over time. The brain does not grow and change rapidly. 

This is a vast oversimplification of the amount of adaptation that takes place in the brain when we change its normal chemistry, but that's the principle.

When we stop taking the drug, we have a brain that has designed itself so that it works in the presence of the drug; now it can't work properly without the drug because it's designed itself so that the drug is part of its chemistry and structure. It's like a plant that has grown on a trellis; you can't just yank out the trellis and expect the plant to be okay.

When the drug is removed, the remodeling process has to take place in reverse.

SO--it's not a matter of just getting the drug out of your system and moving on. If it were that simple, none of us would be here. 

It's a matter of, as I describe it, having to grow a new brain. 

I believe this growing-a-new-brain happens throughout the taper process if the taper is slow enough. (If it's too fast, then there's not a lot of time for actually rebalancing things, and basically the brain is just pedaling fast trying to keep us alive.) It also continues to happen, probably for longer than the symptoms actually last, throughout the time of recovery after we are completely off the drug, which is why recovery takes so long. 

With multiple drugs and a history of drug changes and cold turkeys, all of this becomes even more complicated. And if a person is started on these kinds of drugs at an early age before the brain has ever completely established normal mature functioning--well, it can't be good. (All of which is why I recommend an extremely slow taper particularly to anyone with a multiple drug history, a history of many years on meds, a history of past cold turkeys or frequent med changes, and a history of being put on drugs at a young age.)

This isn't intended to scare people, but hopefully to give you some idea of what's happening, and to help you respect and understand the process so you can work with it; ALSO, because you are likely to encounter many, many people who still believe these drugs work kind of like aspirin, or a glass of wine, and all you need to do is stop and get it out of your system. 

Now you can explain to them that no, getting it out of your system is not the issue; the issue is, you need to regrow or at least remodel your brain. This is a long, slow, very poorly understood process, and it needs to be respected. 

[oskcajga]

I've been on 10mg Lexapro for about 9 years. My doctor and I agreed to try and get me off SSRI to see how I do. He recommended tapering to 5mg for 1 week before going off. I followed this regiment and am now on day 6 of withdrawal. It's been a crescendo thus far as I feel pretty terrible today. My symptoms are the usual suspects: feverish, dizziness, foggy, brain zaps, slight nausea, and lack of focus. I've been reading some articles recently that suggest multiple tapers over much longer periods of time. I think my GP may have rushed me considering I've been on the drug for so very long! I am considering now re-starting a small dose of the drug and allowing myself time to re-adjust, and then re-starting a gradual taper over a period of weeks perhaps.

 

I am looking for some solid advice:

 

1) how many milligram I should re-introduce?

2) how many additional taper periods?

3) how much should I reduce per taper period?

 

Thx,

John

 

If you're going to reinstate, you better do it within the next week or two before your brain reverses some of the adaptations and gets hypersensitive to medication.  I'd probably reinstate SLOWLY, don't start at 10mg again.  5mg is a bit of a jump too, but it's better than 10mg.  I'd personally start at 2.5mg, and increase every 5-7 days or so until you're back at 10mg, then taper 10% every month or so. 

 

If you have any sorts of weird reactions when you reinstate, you might want to just lower the dose (e.g., if you start to have weird nervous system feelings, numbness tingling, etc when you get to 7.5mg) I'd not go any higher and drop back down to the previous dose that you were on for the previous week.  Adverse reactions upon reintroduction happen, and they should be taken very seriously.

 

I'd avoid ALL illegal and legal drugs for the next several months, no alcohol pot, prescription medication etc.  Your nervous system is in shock and needs to be treated very cautiously.

 

Good luck.

[hojo70]

I see a lot of recommendations for 10% reductions on this site, but cannot find any professional literature that supports that. Harvard Health recommends 5mg reductions (for Lexapro) with two to six weeks between dose reductions. Nonetheless, I get the point that slow and steady is easier on your brain than cold turkey, and helps to mitigate chances of relapse. I believe that 1 week was far too aggressive though, which is why I termed the subject "bad advice" - I don't think my GP understands antidepressants very well.

 

I think will reinstitute 2.5mg daily for now for at least several weeks or until I feel stable and then try some gradual reductions. I'll need to contact my GP about liquid Lexapro as measuring reductions with any sort of accuracy is impossible with tablets.

[oskcajga]

I see a lot of recommendations for 10% reductions on this site, but cannot find any professional literature that supports that. Harvard Health recommends 5mg reductions (for Lexapro) with two to six weeks between dose reductions. Nonetheless, I get the point that slow and steady is easier on your brain than cold turkey, and helps to mitigate chances of relapse. I believe that 1 week was far too aggressive though, which is why I termed the subject "bad advice" - I don't think my GP understands antidepressants very well.

 

I think will reinstitute 2.5mg daily for now for at least several weeks or until I feel stable and then try some gradual reductions. I'll need to contact my GP about liquid Lexapro as measuring reductions with any sort of accuracy is impossible with tablets.

 

Slow is the point, 10% is just a super ultra conservative method.  Unfortunately, you also won't find horrible withdrawal symptoms and other real issues in the literature.  It should be noted that much of the literature and websites are sponsored and written by individuals working for the pharmaceutical industry.  You seem to be scientifically minded, so you might find the book "anatomy of an epidemic" by Robert Whitaker of interest, considering that you're experiencing difficulty with psycotrophic medication.

 

Let us know how you do with the new dose.

[Altostrata]

Welcome, John.

 

Reinstating 2.5mg Lexapro is a reasonable approach.

 

Please read Why taper by 10% of my dosage? and Tips for tapering off Lexapro (escitalopram) -- two of the links Dalsaan gave you.

 

The reason this site exists is because doctors are unaware of the greater safety of gradual dosage reduction.

[hojo70]

Hi everyone. A short background update: I had been on Lexapro 10mg for 8 years. Tapered slowly to 10, 5, then 2.5 to nothing over the course of several months. I know some of you may think this was too fast but I wanted a more aggressive approach, no regrets there. I suffered, but it was worth it. I've been off the drug now for about 6 weeks and feeling generally well now. The brain zaps grow lighter and less frequent with every week. Actually by week 4 I noticed major improvement in that area.

 

Coincidentally, I'd started taking a statin (Lipitor) starting about 4 weeks ago due to high cholesterol. I did not give any thought previously to the statins potentially interacting with SSRI withdrawal, but I feel like the days that I take my statin I experience much wilder mood swings; I don't seem to be as emotionally stable. Am I imagining this, or have any of you ever experienced exacerbated mood swings during withdrawal while taking statins?

 

The statins didn't seem to affect my mood initially, but I believe I've now entered a new phase of "healing" involving mood swings, and the statins just seem to make everything much worse, as I take it every other day. Anyway, I think I'm going to eliminate the statin for at least 3 months and then perhaps try again. I was just curious if anyone else had run into statins complicating their recovery efforts.

 

Thanks

John

[bubble]

Welcome back Hojo. I have merged the thread you posted in the symptoms section with your introductory thread because I feel a lot of what you are going through now might be related to your drug situation.

 

I found something about statins on our board here and it seems they can affect the CNS: http://survivingantidepressants.org/index.php?/topic/9487-statins-lipitor-and-others/

 

I see you don't have your drug history in your signature. It would be very helpful if you fill it an as described earlier. Did you reinstate Lexapro and now come off it again?

[hojo70]

Welcome back Hojo. I have merged the thread you posted in the symptoms section with your introductory thread because I feel a lot of what you are going through now might be related to your drug situation.

 

I found something about statins on our board here and it seems they can affect the CNS: http://survivingantidepressants.org/index.php?/topic/9487-statins-lipitor-and-others/

 

I see you don't have your drug history in your signature. It would be very helpful if you fill it an as described earlier. Did you reinstate Lexapro and now come off it again?

 

 

Yeah I reinstated 2.5mg after my last post (June 2015) and stabilized rather quickly. The timing was just not right; I had a lot of crucial deadlines for work. November 7th or so I went ahead and went cold turkey from 2.5mg. First 2 weeks were obviously rough, the following 2 weeks were much better and the zaps had largely diminished. I'm around 7 weeks now and feeling pretty darn good as long as I don't take a statin! The stuff literally turns me from Dr Jekyll to Mr Hyde overnight. I become irritable and combative. All of the original acute symptoms that I had early on are gone (diarrhea, nausea, headaches, and body aches). I still have occasional zaps I notice from time to time, they're light and somewhat infrequent and usually occur later in the day when I am fatigued. I think I am recovering pretty well for having been on Lexie for 9 years. However, I am not naïve and I know that my brain still has a lot of healing to do and that process will continue for many more months.

 

Thank you for the article link regarding statins. I want to continue a low dose statin some day to help control my high LDL particle count, despite known risks. I am definitely too weak for that right now, however. My brain is just too fragile at the moment. Science says that the brain needs cholesterol to make serotonin. I think my mood instability issues are directly caused by low serotonin as my brain isn't capable of making adequate amounts yet, and without enough cholesterol...Mr Hyde. I wonder if 5-HTP could help bridge that gap?

 

John

[bubble]

Although statins seem to affect the central nervous system, it is hard not to think that after 9 years of Lexapro and another CT what is happening to you now is not Lexapro withdrawal.

 

It would be helpful to put your drug history in your signature, especially your recent drug changes: 

 

Withdrawal History in Signature OR Complete your Signature from Phone or Tablet

 

5-HTP is not recommened for brains sensitised by withdawal  for reasons explained here: http://survivingantidepressants.org/index.php?/topic/9933-5-htp-5-hydroxytryptophan-and-l-tryptophan/

[hojo70]

There's no doubt that withdrawal makes me more susceptible to mood swings, but the statin exacerbated it to a point where it was not controllable. I stopped taking the statins almost a week ago and felt better the day after and ever since so I am certain it was the antagonist.

[AliG]

I would stay away from 5 HTP, for now .You have enough going on . It can definitely exacerbate things. You seem to be fixated on the Statins, but you are more than likely, in withdrawal .  Not sure though , as you have no drug history. It would be so helpful , if you could fill it in . It just makes it easier for members to answer your questions and concerns , with more accuracy and precision. You withdrew quickly, and are maybe in the " honeymoon " period. It could take months for the severe withdrawal to kick in.

 

Best wishes,

 

Ali.  

[hojo70]

I would stay away from 5 HTP, for now .You have enough going on . It can definitely exacerbate things. You seem to be fixated on the Statins, but you are more than likely, in withdrawal .  Not sure though , as you have no drug history. It would be so helpful , if you could fill it in . It just makes it easier for members to answer your questions and concerns , with more accuracy and precision. You withdrew quickly, and are maybe in the " honeymoon " period. It could take months for the severe withdrawal to kick in.

 

Best wishes,

 

Ali.  

 

Ali, thanks for replying although your response appears quite contentious. I'm not sure what you mean by "fixated on statins". I was able to determine a cause and effect relationship by eliminating the statin. Regarding drug history, it's already in my signature; are you not able to see it?

 

Honestly, I'm going to have to disagree with you on "severe withdrawal" being several months out, that's just not how these drugs work. I withdrew from only 2.5mg so the withdrawal wasn't horrendous. Don't get me wrong, I felt fairly miserable the first week or two, but improved steadily thereafter.

[brassmonkey]

"Honestly, I'm going to have to disagree with you on "severe withdrawal" being several months out, that's just not how these drugs work."

 

Sorry, but it is in fact, exactly how these drugs work.  We see it very frequently here with people CTing from as low as 2mg and sometimes less. They will have a rough few weeks and then feel the best they have in years for about three months.  Then all h*** breaks loose.  Some people are lucky and it doesn't happen, and I really hope you're one of the lucky ones, but I'm not going to take a bet on it.

 

The statins may be a contributing factor in your feeling so bad, as discontinuing them has shown.  But the majority of what you're feeling is due to the fast taper you did earlier this year catching up with you. Not to mention the effects of the reinstatement and subsequent CT.

[bubble]

And 2.5 mg Lexapro is far, far from being a small dose.

 

You can disagree with us but if things start to go south you will know what's going on.

[hojo70]

"They will have a rough few weeks and then feel the best they have in years for about three months.  Then all h*** breaks loose.  "

 

That's not withdrawal then; I'd bet that's being confused with relapse. People tend to like to blame the drugs and not discuss the topic of their chronic underlying mental illness. Withdrawal is pretty easy to identify as it appears upon cessation as flu-like symptoms but disappears within 2-4 weeks. The zaps may take longer as the brain has been changed.

 

Nonetheless, although I may not necessarily agree with you on this particular subject I definitely respect your opinion and your observation of anecdotal evidence from the many folks suffering on this board. I'm grateful to all who have replied to my posts and wish you well in your continued journey. Hopefully 2016 is our breakthrough year for recovery.

[Petunia]

Hey hojo,

 

I had to jump in here because I'm one of those people with my own anecdotal evidence about Lexapro withdrawal.

 

"Honestly, I'm going to have to disagree with you on "severe withdrawal" being several months out, that's just not how these drugs work."

 

Sorry, but it is in fact, exactly how these drugs work.  We see it very frequently here with people CTing from as low as 2mg and sometimes less. They will have a rough few weeks and then feel the best they have in years for about three months.  Then all h*** breaks loose.  ..

 

Yup! That was me. Six years on Lexapro (13 years total on SSRIs), 4 attempts to CT off, finally managing to taper off my 5mg dose at the end of 2010 after a 2 month taper. I jumped from 1.25mg after having taken it for several weeks every 3rd day.

 

I got the usual flu-like symptoms and zaps, just like you mentioned, then it seemed to clear up. I slowly started feeling 'better than I had in a long time' for about 3 months and was relieved to finally be off the drugs and recovered.

 

My original reason for starting SSRIs was mild to moderate anxiety, situational really. I had always been a somewhat anxious person, sensitive more than anxious really, but I was in an abusive marriage without much social support. I was looking for something to get rid of my anxiety, rather than deal with my problems. I doubt I ever had an 'illness' to begin with.

 

The reason I'm telling you my background story is that after my 3 months of feeling better, it happened to me like brassmonkey wrote "Then all h*** breaks loose"

 

But for me it unraveled slowly, one new symptom at a time, over the course of 2011. Lexapro withdrawal didn't occur to me, because I had been well for about 3 months, I was over all that. But the reason I didn't think it was a relapse was because the symptoms I was getting were quite different from my original anxiety. I was out of my abusive marriage by then, in a nicer relationship and had left all the stress and trauma behind, my future was looking bright, but my body started behaving very strangely....sleep problems, sensitivity to sound and light, vision problems, nightmares, feelings of unreality, intense emotions and a growing sense of dread. These were nothing I had ever experienced before.

 

That's not withdrawal then; I'd bet that's being confused with relapse. People tend to like to blame the drugs and not discuss the topic of their chronic underlying mental illness. Withdrawal is pretty easy to identify as it appears upon cessation as flu-like symptoms but disappears within 2-4 weeks. The zaps may take longer as the brain has been changed.

 

 

If my original kind of anxiety had come back, then I would have figured it was a relapse, but this was so much more, and worse, and it just kept getting worse as the months went by. I didn't have a clue what was going on. I ended up with a new diagnosis of ADHD and went on the meds for that. Then even more symptoms started, I was hearing sounds that other people couldn't hear and I started picking at my skin and couldn't stop. It was over 2 years before I found this site and learned about protracted withdrawal.

 

Here is a topic you may find interesting:  Delayed Onset of Withdrawal Symptoms - Symptoms and ...

 

I've been drug free almost 3 years now. But before I found this site I tried reinstating Lexapro and also tried going on Prozac. But it was too late, they both caused intolerable symptoms including suicidal and homicidal urges and I definitely hadn't ever felt like that before.

 

I'm still in protracted withdrawal, but recovering slowly. Unfortunately, I'm not an isolated case, there are a lot of people going through this, it took me a while to believe it and come to terms with this awful reality which is well covered up in mainstream medicine, so I understand your position of disbelief.

 

I sincerely hope you are in the clear and mostly recovered, that the statins were your only problem.  But if not....

 

if things start to go south you will know what's going on.

[Altostrata]

hojo, I hope you do not experience post-acute withdrawal syndrome from your fast exit off Lexapro. But if you do, you will definitely see it is not relapse, any more than the brain zaps were a pre-existing condition.

 

As for your oversized reaction to statins, I would guess your fast taper and cold turkeys have made your nervous system sensitive to ANY drugs with neurological action. I strongly recommend you avoid them for a good while and let your nervous system heal, or the chemical stress could make it worse.

 

For the time being, you might look into lowering your cholesterol with non-drug methods, if you are not high-risk for heart disorders.

[starcontrol2]

I was on lexapro too.

I hope that you never experience the severerity and brutality of withdrawal symptoms like I am and others here.

I would give a hand to get my original 'mental illness' back.

My withdrawal symptoms started fast and hard and like Petunia it was nothing like before meds.

I had a life situation that was getting out of control and i got a severe sports injury on top. I couldn't find a way to deal. Does that make me mentally ill? Maybe our definition of mentally ill differs

I honestly and truly wish you well, the withdrawal hell can be unbearable.