jmixu: Escitalopram withdrawal

[jmixu]

Hi guys!

 

I'm new here and I'm really glad to have found this group. I've been on escitalopram 10mg for three years and was recently tapered off of it by a new Pdoc because she believes I belong somewhere in the bipolar spectrum, maybe bipolar II but not bipolar type I. I've never experienced mania. My main problem has always been depression, anxiety, and ADHD (inattentive type). I also have General Anxiety Disorder, Social Anxiety Disorder, and OCD. Which is why my first Pdoc prescribed me escitalopram. 

 

Escitalopram worked wonders during the first year especially with my anxiety. I felt "normal" and could accomplish tasks that required leaving the house by myself and talking to people without ruminating before and after. It also worked well for my depression. However, during the second year mark I felt like it stopped working. I was getting depressed again although the episodes weren't as long and I was anxious again. My social anxiety was paralyzing and I had to rely heavily on my husband to take care of chores that required leaving the house and socializing with people. I also felt emotionally blunted but only when it came to positive emotions. I felt like I could feel negative emotions twice as much as much but the positive ones left me feeling indifferent. I know I should have seen my Pdoc at this time but my doctor had a very long waiting list. I should have looked for another one right away but I honestly did not have the energy for it. So I waited and endured and self medicated with alcohol while still taking my meds everyday.

 

I've had three major depressive episodes since January of this year and in early June started getting panic attacks (at worst 3 in a day). So I finally decided to go see another doctor.  

 

So anyway, my new pdoc tapered me off the escitalopram in a three week period which now, in retrospect, I think was too quick. During the first week, she instructed me to take 10mg and 5 mg alternately, during the second week I was to take 5mg daily, and during the third week 5mg every other day, on the fourth week I was to discontinue completely. I followed her instructions despite my inhibitions (from having read tapering guidelines online) and now I have severe withdrawal. 

 

It started with flu-like symptoms ( muscle aches, feverish but no temperature) ; crying spells that come out of nowhere, low frustration tolerance, headaches, nausea, suicidal thoughts especially at night, depression at night. I don't know why the depression is worse at night. Maybe because I'm inactive at night. Has anyone else experienced having the worst of their depressive symptoms at night?

 

I'm functional in the morning but do get episodes where I'd start crying out of nowhere. I don't know if it's because the mood stabilizers are somehow helping reduce the withdrawal. I read the post on "The Rule of 3KIS". I did ask my doctor even before reading that post if it might be safer to wait until the antidepressants are out of my system before starting the mood stabilizers but she said it was okay to take the new meds while tapering off. 

 

If any of you have a similar experience to mine, I would love to hear from you. 

[scallywag]

jmixu -- Welcome to Surviving Antidepressants (SA)

 

You've definitely identified the source of your symptoms, an overly rapid taper off escitalopram and an underinformed physician/pDoc. Escitalopram is a one of the most potent SSRI medications and many people have moderate to severe symptoms after doctor-advised discontinuation plans. The  Your symptoms are frequently reported. Please read

What is withdrawal syndrome.

Glenmullen’s withdrawal symptom list.  - "doc" and "xls" files of the list can be downloaded from links in the first post.

 

Thank you for posting a medication and withdrawal history as your signature. On what date did you take your last escitalopram?  Please add that date or your best guess to your signature.

 

Even when a drug stops producing the intended therapeutic result (e.g. anti-depressant), it is still having an effect on many other aspects of the CNS (central nervous system).  When we started taking the drug, our CNS started adapting to the drug's presence. When we discontinue too rapidly the CNS has to "scramble" to undo the adaptations it made earlier; this "undoing" work is the source of symptoms.  For other descriptions of this, please look at

How your brain responds to psychiatric drugs - aka "Brain remodeling"

Youtube video, 4 minutes: Healing from antidepressants

 

Your CNS is now dealing with the rapid decrease of escitalopram and the introduction of the combination of Depakote + Lamictal + clonazepam.  It will take some time for your symptoms to settle down and for you to notice the effect of your current medication combination.  This topic may give you a sense of how patient you'll need  to be:

How long to stabilize after reinstating or updosing.

 

You can help us help you by keeping track of your symptoms. This information is also helpful for a knowledgeable and supportive doctor; I hope your doctor is both knowledgeable and supportive.  Please keep notes on paper of your symptoms and the times of your dose(s). This post has a useful format for a daily log:

Take notes of doses and symptoms.

 

Please read the topics I've linked. If you have questions, please post them here in your introduction topic so that all your information is one place. 

 

You can find others who are tapering escitalopram or dealing with symptoms while/after tapering by clicking on the tag just below the title, jmixu: Escitalopram Withdrawal.

 

I hope you'll find the information in the SA forums helpful for your situation. I'm sorry that you are in the position that you need the information, but am glad that you found us.

 

[jmixu]

Hi, Scallywag! Thank you so much for taking the time to respond in great detail, attaching very useful resources for my current situation. The last dose I took of escitalopram was on July 1, 2017 and immediately felt effects the next two days. It's also likely that some of the side effects are from the new meds I've just started, although I'm pretty certain the emotional sensitivity is because of the escitalopram withdrawal since my new meds are supposed to stabilize my moods not worsen them. Also, while I was taking depakote on the first week of the tapering process and still getting about 75% of my escitalopram dose, the depakote worked great. I don't know how long it's supposed to take for valproate to stabilize moods for bipolar disorder but my doctor did say it quite fast acting in that regard. 

 

I've been tacking dosing +symptoms even before this but have decided to follow your more detailed format at least for as long as I'm feeling some adverse effects from either withdrawal or starting my new meds because it would give my doctor better insight on what I'm dealing with and hopefully, inform her about the ill effects of tapering people off too fast.

 

Again, thank you very much for providing me with such great resources. I'm glad there are groups like this that offer peer support. It's hard enough having mental issues, even harder when you have to switch meds and your "original" state of mind is aggravated to a degree where you often feel like dying is a better option that constantly battling with your own brain.

 

 

 

[jmixu]

Just an update on my current withdrawal situation. My symptoms have been manageable although there are days when I am severely depressed and have crying spells. Today was especially bad. It feels like there's a tug of war going on in my head with the depression and the anxiety. The lamictal doesn't seem to be working even after being titrated up to 50mg. My new pDoc discontinued the depakote after 5 weeks of taking 500mg. I was tapered off it by switching from depakote 500mg extended release to epival 250 mg for 5 days before discontinuing completley (I guess this is the instant release version). Does anyone have any experience with taking depakote for a short period of time and having withdrawal from it? I honestly don't know what's going on in my head anymore. My new pDoc wants to add abilify to replace the depakote after checking my valproate levels. I don't want to add another psychotropic  to the mix. I'm contemplating tapering off lamictal and just leaving ritalin for my ADHD. Ritalin has been helpful not only in keeping me focused but also in stabilizing my moods at least for as long as its effects last which isn't very long (4 hours for me).

 

I've only been taking lamictal for 4 weeks so if I were to seriously consider dropping it, now would probably be the best time before my brain becomes dependent on it. For those who have experience with lamictal prescribed for depression, how long does it usually take to see the benefits? 

 

Thanks in advance to anyone who would respond to this post!

[scallywag]

jmixu -- Your pDoc(s) are trying to use medication to solve a problem for which medications rarely effective.  More switching off and on medications and dose adjustments are likely to make things worse.  The only path out of this using medication is major doses and/or cocktails of multiple meds that SQUASH symptoms but risk SQUASHING you.

 

If you prefer to avoid the pharma merry-go-round, hold your doses and medications steady as they are.  Track your symptoms and develop non-drug coping skills:

Please keep notes on paper of your symptoms and the times of your dose(s). This post has a useful format for a daily log:

Take notes of doses and symptoms.

Non-drug techniques to cope with emotional symptoms.

Non-drug techniques for dealing with physical pain.

Change the channel - dealing with cognitive symptoms.

[jmixu]

Scallywag, again, thank you for taking the time to respond to my post with helpful tips. This site has immensely helped me with my recovery, just by reading the different personal accounts of people on various medications. I'm currently reading "Anatomy of an Epidemic" after finding altrostrata's post on patientslikeme and while I do believe a dialectical approach to the whole meds thing is necessary, I'm now convinced that I don't need such heavy drugs to get my life back on track. Especially since I have reason to believe that I have been misdiagnosed as bipolar and while I'm not completely eliminating the possibility that I can be on the spectrum, I believe my symptoms do not justify starting an antipsychotic like abilify. I never started it even after my pDOC added it to the mix. 

 

The reason why I didn't question the prescriptions in the first place was because I was eager to get myself back to "normal". The problem was not giving myself enough time to deliberate whether starting a new cocktail of meds while knowing so little about them was the right thing to do and just started without reflecting on the severity of my symptoms first. 

 

I'm weanining myself off lamictal, a slightly slower taper than what these pdocs  would recommend but since I've only been taking it for 5 weeks, I think a 50% reduction every two weeks wouldn't do much harm. At least I hope so. But I don't want to be on this drug any longer than I have to. I'm carefully tracking my symptoms. Currently, I'm back to lamictal 25mg, 10mg ritalin 3x day, and 0.5mg to 1mg clonzepam as needed. 

 

As I am still dealing with severe withdrawal from escitalopram use, I do not want to put myself on this same road again in the future especially with heavier drugs and I certainly do not want to be on them for the rest of my life. While I do believe some of these drugs are helpful to some people, I don't think they're what will work for me especially since thinking of taking them alone is increasing my anxiety instead of helping it. The problem with the pDocs I've seen so far is that they see me as nothing but a set of symptoms on their DSM and they hardly listen to their patients even though they supposedly advocate "psycheducation". I've yet to find a pDoc who will actually listen to what I have to say regarding these drugs. 

 

More power to you guys!