BrotherZoot: Two years of Cipralex and Remeron

[BrotherZoot]

I did read the "read this first" post about the distinction between relapse and withdrawal, but I've read conflicting ideas about time frames, distinguishing symptoms, etc., so I welcome any insights.

 

I tapered off Cipralex (Escitalopram) after taking it for two years, in January of this year. That seemed to go smoothly with little withdrawal to speak of.

 

I tapered off Remeron (Mirtazapine), which I took at 15 mg for two years. I tapered first to 7.5 mg for a month, then 3.75 mg for a month and then discontinued entirely on April 3. I had more symptoms, primarily headaches, loss of appetite, upset stomach, and anxiety/nervousness, to varying degrees over the tapering and discontinuation period. These have continued, and at each point I've worried I might be relapsing, because stomach issues were a bit symptom for me, as well as anxiety and loss of appetite, prior to starting medication. These symptoms often last a day or two and then I feel better. In fact, at times I feel better than I did while on these meds. I have more energy and motivation.

 

But I am no 7 weeks out and thought that dicontinuation symptoms would likely be done. But the last few days (Monday, Tuesday, Wednesday, and now today, Thursday) have been bad and the symptoms only seem to be getting worse. My head is fuzzy, I feel sick to my stomach, anxious, with mood swings, and familiar "depressed" feelings, as well as self-criticism, negative thoughts, and racing thoughts.

 

I did drink too much Sunday night (it was a long weekend) and have been getting back into the habit of overindulging with beer on weekends.

 

I guess what I'm asking is at what point I should consider re-starting one of my medications, or trying something new? I know most (or all) of you are not medical doctors and in no position to offer medical advice. I would just welcome your thoughts, based on your own experiences. This is my first time taking antidepressant medication and my first time coming off it.

 

Thanks!

Edited May 29, 2017 by scallywag
tags; previous edit moved from "Withdrawal or relapse?" topic in Symptoms forum

[Madeleine]

Sounds like you tapered too fast.  Your first cut was 50% as was your second cut -- and then you went down zero.   It's been only just under 2 months since you quit -- so not a long time at all when it comes to healing. Sounds like your brain and nervous system are still weak and adjusting to the changes.  Some people ride out withdrawal symptoms, and some feel better if they reinstate a small amount and then once they stabilize, taper slowly.  Read through the thread on this forum about "reinstatement" to see if it's something that you think might work for you.  

Drinking too much is not a good thing for us at anytime, but particularly when our nervous system is weak....

[BrotherZoot]

Thanks for the reply, Madeleine! That's exactly the kind of insight I was hoping for. Really, if someone could definitively tell me that this is withdrawal, I would simply ride it out. I can handle the symptoms, though they're unpleasant. My fear is that it's a relapse and I'm going to make things worse if I leave it too long.

 

But your indication that the time frame is still prime time for withdrawal symptoms is, in some ways, good to hear.

 

Interesting also to hear that I tapered quickly. My GP thought I should be able to easily just discontinue 15 mg immediately. I did try that and felt terrible after 5 days. So I thought my taper was reasonably gradual!

[BrotherZoot]

And I agree about the drinking--I should know better by now.

[TikkiTikki]

I have yet to meet a doctor who has any knowledge of a gradual taper - I have tapered like you did in the past and thought I was going slow (and then "relapsed" months down the track.)

 

This site recommends a taper of 10% of current dose per month: so 15mg -> 13.5mg -> 12.1mg -> 11mg -> 9.8mg -> 8.9mg and so on until you're low enough to 'jump off'. If you're symptom free after the first few drops, you might consider dropping every 3 and then 2 weeks.

 

Incredibly slow! Tapering can take years. But there are good reasons to use the conservative approach ( see The Slowness of Slow Tapers thread).

 

And for many people, the symptoms of withdrawal pop up months and months after the last dose, sometimes after a fairly quick taper that was seemingly symptom-free. It's happened to me, and I thought I had relapsed (as did every doctor) as so got back on the pills. 

 

So I agree with Madeleine that this is definitely still withdrawal territory, and you might consider reinstating a smaller dose.

 

Good luck ... there is loads of info on handling symptoms and good support here - glad you found us.

[BrotherZoot]

Hi all,

 

I've struggled with depression and anxiety since I was an adolescent. I sought counseling for it, which was helpful (CBT), while I was an undergraduate student at university. I was given a prescription for Prozac at that time as well but never filled it. I struggled, to varying degrees after that point, but had several very good years starting when I was 30. I married and had my first child. That child, my daughter, was diagnosed with acute myeloid leukemia when she was two and was hospitalized for 4 months until she died. Realistically, I had my first major depressive episode at that time, but didn't view it that way because it was overwhelming grief, as experienced by everyone who loses a child. I struggled on, and had two more children with my wife. I believed as I was doing better as my performance at work had improved somewhat, but I didn't realize the full extent that I was struggling. It negatively affected my relationship with my wife and my ability to be a good dad (I especially regret my irritability and lack of patience, which led to often yelling at my boys). I developed severe health anxiety, convinced myself I had bowel cancer, and suffered acute anxiety including panic attacks, in addition to my depression.

 

Anyway, I started Cipralex (Escitalopram) in April or May of 2015. It made my insomnia 10x worse but did seem to make my depression better. Once I got up to 15 mg, my anxiety improved as well. We tried Trazadone but it didn't prevent me from waking up constantly in the night. In July or August of 2015 I started Remeron (Mirtazapine) at 15 mg to help with sleep. Over the next couple of years, I increased my Cipralex to 20 mg, which didn't seem to help my symptoms much (I was having difficult mornings, having a very hard time getting going and being incredibly drowsy) and made my side-effects worse. Back down to 15 mg. Summer of 2016 I added 150 mg of Wellbutrin, which gave me motivation that I hadn't seen in some time and actual enjoyment of life. The Wellbutrin was added mainly to try to counteract the sexual side-effects of the other meds.

 

I continued to do well on that combination, and reduced my Cipralex to 10 mg. That went well. Then reduced it to 5 mg and discontinued it entirely in January 2017. I am a bit fuzzy on the timeline from there, but I attempted a couple of times in the ensuing months to just stop taking Remeron. My doctor had said I could simply stop taking it at 15 mg and was under the impression that any withdrawal effects would clear in a week. Both times I tried I felt good for 5 or 6 days and then felt like I had a bad flu. I reinstated it immediately.

 

Then, starting in March, I think, I cut my 15 mg in half and started taking 7.5 mg for a month. That went okay, so I cut it in half again to 3.75 for a month. The small soluble pills were difficult to cut beyond that so I discontinued entirely on April 3. I have experienced stomach issues, headaches, acute anxiety, sporadically since then. I have also recently been experiencing symptoms of depression. It's hard to describe what the mood of depression feels like to me--kind of a mix of anxiety, guilt, suffocation, and self-recrimination--but I've been feeling that way. I have been waking early in the morning and not getting back to sleep. My appetite is poor and I often feel sick to my stomach, particularly after eating. Generally this lasts a day or two and then I have a good day or two, but I have been feeling this way consistently for the past five days now. So I am quite concerned that I am suffering a relapse of depression and anxiety.

 

So that's my story. At this point I am trying to figure out what my next move should be. Whether to just stick with taking only Wellbutrin (which I never discontinued), or to reinstate Cipralex of Remeron, or try something else entirely (e.g., increase my Wellbutrin does or try a different SSRI with it).

 

This is my first experience taking and discontinuing antidepressants.

[mammaP]

Hi, BrotherZoot, welcome to SA.  I am so sorry to hear of the loss of your daughter, that must have been a horrendous time for you both. I don't know if it was this way for you but generally, when a child dies it is the mother who gets the most support and fathers keep their feelings bottled up. Grief is a natural response to a devastating loss and if it is not worked through depression is a result. It is not the chemical imbalance that was dreamed up by the pharmaceutical industry to sell their drugs. The right support is crucial.  How is your health anxiety now? I am so very sorry that you have had to go through all this. How has your wife coped? 

 

As you stopped Cipralex in January we wouldn't recommend reinstating it but as Remeron was stopped in April you could try the 3.5 again, it might help the withdrawal. I wouldn't try another antidepressant, once you are in withdrawal there can be adverse reactions to new drugs. Doctors do not have a clue about how to taper the drugs they prescribe, they are taught by the drug companies and they don't want to admit that stopping them without tapering causes withdrawal. They will say that it is a return of the illness when withdrawal hits. 

 

Here is our topic on reinstating to stabilise. 

 

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

 

You might find that fish oil and magnesium help with symptoms

 

http://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/?view=findpost&p=100596&hl=magnesium

 

http://survivingantidepressants.org/index.php?/topic/1300-magnesium-natures-calcium-channel-blocker/

 

If you have any questions, just ask, or you can search the site by typing your query in google, followed by survivingantidepressants . org

 

for example, reinstatingsurvivingantidepressants.org and it will bring up all the posts on that subject