Altostrata

Tips for tapering off Lexapro (escitalopram)

94 posts in this topic

I too have been tapering off Lexapro and have found that i really have to do a very slow taper.

originally i did a too fast taper (didnt know any of the possible dangers) and stayed off for several months - i got very very sick as the months wore on and had to go on disability for 3 months.

it has been a long road but now that i am following the advice here i have been taking a compounded version that i get from a pharmacy near me and doing 10% tapers and holding for at least a month.

my most recent taper from 0.55 mg to 0.5 mg was tolerable for about 3 weeks but then the w/d symptoms hit. they have evened out now but i will stay at 0.5 mg for at least another month and my next taper will be 5%.  What i feel i am dealing with is balancing withdrawal symptoms with side effects. it seems that since i waited several months to reinstate i am now very sensitive to the medication.

I am and will be forever grateful for the advice i find here!

 

Pokeshaw in Bklyn

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Don't feel bad  Pokeshaw , I am very sensitive as well. I only have 4 mg to go to get to my target of 10 mg, and after a 4 month hold will START with no more than a 5 % cut and likely more like 3 % to feel things out. 

 

Even if it takes me 6 months or more, if I can do it without having to tolerate the symptoms after each cut for too long a period ( MAYBE 1.5 weeks at MOST) accompanied then by a month hold after stabilizing from each taper, will be happy with that.

 

That may even put me beyond 6 months but at this point I really would rather go slowly and feel decent than hurry up and suffer. I guess it's about quality of life. I just don't want to waste the time I've been given on this earth anymore than I already have by being numbed by these damn drugs.. and of course by life's circumstances.

 

It seems that many of us here had sucky childhoods…. I'd like to think I CAN get it back by starting a second one ( childhood) … just in a different form I guess.

 

RU :)

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that's such a nice thought dear RU! yes, we all should treat ourselves to a nice second childhood and take good care of ourselves now when we have become our own primary care givers.

 

no more excuses for bad care ;) being slow with the taper is one example of a good care...

 

big hug,

 

bubble

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Thank you again for this article and all comments.

Please to consider this question.

 

How about tapering off Escitalopram by switching to Citalopram - oldest racemic form of the drug, rather than to e.g. Prosac? As suggested in both wikipedia articles.

(C.f. wikipedia article, stereochemistry:" Citalopram is ... consisting of 50% ®-(−)-citalopram and 50% (S)-(+)-citalopram. Only the (S)-(+) enantiomer has the desired antidepressant effect.". C.f. also the article on

http://en.m.wikipedia.org/wiki/SSRI_discontinuation_syndrome - prevention and treatement!)

 

- As Citalopram contains precisely the same molecule as Escitalopram (with lower potency, higher half-life which is suitable property when tappering)!

 

- Citalopram has already widely available generics (economical point)!

 

How we are supposed to do that the "right way":

- is it trully required to really double the initial escitalopram dose e.g. when switching from 10mg Escitalopram to Citalopram taking firstly 20mg than gradually tapering?

(I am afraid doing so as I have serious doubts regarding the effect of the 50% ®-(−)-citalopram (told to has not the "desired antidepressant effect", it has someways some effect on my brain).

 

- What is the most probable effect of the 50% ®-(−)-citalopram (the "not desired antidepressant effect")?

 

Please to help with advice!

 

my case: I was really stable before trying to taper off Escitalopram, but when doing so by 50% tapering - simply cutting the pill or taking one pill every 2 (few) days, untollerable w.d. symptoms appeared. Escitalopram prescription for teatement of a kind of Seasonal Sleep Desorder (once again) and ordinary life management issues rather than a trully depressif episode.

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Please see with my previous post/question:

 

http://en.m.wikipedia.org/wiki/SSRI_discontinuation_syndrome

 

Prevention and treatement:

 

" ...When discontinuing an SSRI with a short half-life, switching to a drug with a longer half-life (e.g. fluoxetine or citalopram) and then discontinuing from that can decrease the likelihood and severity of withdrawal syndrome.[18]"

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Switching to another drug, such as Prozac or citalopram, to taper incurs an additional risk -- sometimes the switch does not work and you end up with worse withdrawal symptoms. You can have withdrawal symptoms from one drug even though you're taking another.

 

Because of the additional risk, we recommend attempting a gradual direct taper from the drug before trying a switch. Lexapro comes in a liquid so you can taper very, very gradually if you need to.

 

Citalopram is a close relative of Lexapro  (escilatopram). Celexa has a half-life of about 35 hours. Lexapro's half-life is about the same, so no advantage there.

 

Also see this topic The Prozac switch or "bridging" with Prozac

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Altosrata,

could you please advice about the specific case when switching to another SSRI or drug in order to taper off Escitalopram become considerable options.

 

(E.g. long staying in a country where my social security/insurance provide no more support, difficult access to health centres and escitalopram etc.)

 

As in this article (wikipedia, note [18]) both Citalopram and Fluoxetine are suggested when tappering off other SSRI:

could you please advise on the advantages/disadvantages of both options in the specific case of Escitalopram.

 

Is the longer half-life of Fluoxetin is the specific propertie that "guaranties" more-tolerable w.d. symptoms if any?

 

Or, it will be interesting to keep providing one only SSRI molecule to the brain in order to avoid one more indesirable new tolerance/side effect due to the new med. - in case when Escitalopram would be switched to Citalopram?

Even if it will take longer than Escitalopram to Fluoxetine switch?

 

(I couldn't have any issue trying to mesure and tapper of my doses or preparing my one liquid of escitalopram if I can find any, but it's still not the case.)

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The risks and benefits of "bridging" are listed here  The Prozac switch or "bridging" with Prozac

 

They apply to a switch to citalopram or escilatopram as well as fluoxetine.

 

If a switch to Prozac or fluoxetine is successful -- that is, does not cause withdrawal symptoms from the original drug -- a careful taper off fluoxetine usually, but not always, has less risk of withdrawal symptoms. However, one might still develop withdrawal symptoms going off fluoxetine. None of these bridging strategies is risk-free.

 

A direct taper from the drug to which your nervous system is accustomed ("the devil you know") carries less risk than a switch to a new drug ("the devil you don't know"). The risk of a switch is justified if you find tapering from the original drug is simply too difficult. Many people with failed tapers from venlafaxine (Effexor), desvenlafaxine (Pristiq), paroxetine (Paxil), and duloxetine (Cymbalta) find they need to bridge in order to go off the drug.

 

If you're thinking of switching as a matter of convenience, you need to weigh the risk of jumping out of the frying pan into the fire against the amount of convenience you would gain.

 

qtnPls, please start a topic for yourself in the Introductions forum to discuss your particular situation.

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Hi Lilu,

 

I had exact experience as you did! only that passing 2mg is the fatal turning point.

 

I iwll add you as my friend see if we can share more with each other.

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After reading all of this, I will admit I feel very discouraged.  I'm currently at 2.5 mg, and just picked up a new prescription for 10 mg pills last week.  I talked to a compounding pharmacy - they would need a new prescription to make me a solution, and warned me that insurance likely would not cover it.  It would be another month before I could get a prescription in any case, and I'm not even sure if my ins would cover the liquid form.

 

I've read all the instructions on making your own liquid, and it just boggles my mind.  I am having some pretty strong brain fog and it looks like making your own w/Lexapro just isn't that easy in any case.

 

I guess I am stuck at 2.5 for another month at least.

 

Thanks for letting me vent!

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It's not that difficult. For example, you can find something that will measure 50mL of water, in which you can dissolve a 10mg tablet.

 

Then you need an oral syringe that will enable you to take out 25% (2.5mg), or 12.5mL of liquid.

 

Lexapro comes in a liquid, you cannot get a prescription for that? Any doctor can write the prescription, it doesn't have to be a psychiatrist.

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Well, I can possibly get one from my GP but not for another month, because I just got this one filled.  I will have to see if my plan covers the liquid.  

Thank you!

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You may wish to stay at 2.5mg for the month or make your own liquid to taper.

 

Technically, if your doctor writes another prescription with different dosing instructions, your insurance company should cover it. For example, if your prior prescription says "take a 10mg tablet each day" and your new prescription says "take 2.5mg liquid each day," the new one should be covered.

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Oh that's good info to hear!  I did not know that.

And you may be right on the dosing - sometimes I just get stuck in that 'want to feel better right now' mindset.

I am learning that this is not realistic and it's not reality.  This is my life right now; I have to learn to live in it, wherever I am.

I just don't always do it that well.

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Join the club!

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Well, I can possibly get one from my GP but not for another month, because I just got this one filled.  I will have to see if my plan covers the liquid.  

Thank you!

Even medicaid, which is like the worst insurance you can have, filled a prescription for liquid generic Lexapro immediately after I filled one for 5 mg tablets.  These prescriptions do not conflict each other, because if the doctor decides that you need liquid then they have to fill it. Even if you filled one for tablets the day before.

 

Really no need to make your own. The liquid is a little sweet and I have my pharmacist add some red food coloring in it, so that it's easier to see in the bottle.

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It seems that Lundbeck has indefinitely suspended manufacturing an oral solution for lexapro, also known as Cipralex. This is unfortunate as I have only one 15 ml bottle of 10 mg/ ml solution and its expiration date is August 2014. 

 

I suspect that it will suffice for the rest of my taper but I would feel better if I could get more. That bottle was only $40. 

 

I purchase my lexapro from a Canadian pharmacy… they get it from a Lundbeck plant in Turkey. 

 

The reason I purchase from Canada is that it is much cheaper ..even WITH insurance. I cannot tolerate the generic. 

 

From what I can gather none of the Canadian pharmacies can get their hands on it. 

 

Does anyone know of another manufacturer of the BRAND lexapro? 

 

Also… I do wonder why they have stopped making it….

 

RU

 

 

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Oh no!  I just started the oral, this morning at 2 mg!

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MissTrish… you likely got about a 250 oz bottle or something? In the US. I  believe it IS possible to get it in that amount in the US. I just don't want to go that route.

 

Don't fret. I'm still researching...

 

RU :)

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Lexapro is manufactured by Forest Labs.

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After reading these posts about tapering, is it possible then, to taper off of Lexapro without experiencing withdrawal symptoms? And also, I'm wondering that if you get to the end and you have been having no withdrawals, but then you start experiencing withdrawals after you completely stop taking the med, then do you go back on, or just wait it out to see if the symptoms will subside? When do you know you are finally able to completely stop, because there are no more withdrawal symptoms?

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It is possible to taper off Lexapro with minimal withdrawal difficulty. It's best to go slow rather than count on reinstating after you're off to quell withdrawal symptoms. Reinstatement sometimes does not work very well.

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Hi alto, I tried to understand the 2-4 times potency of lex from reading the linked in your initial post on this topic. I failed find the information from there. Could you please point me to it? Many thanks!

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It looks like the Wikipedia article https://en.wikipedia.org/wiki/Escitalopram has been revised.

Escitalopram increases intrasynaptic levels of the neurotransmitter serotonin by blocking the reuptake of the neurotransmitter into the presynaptic neuron. Of the SSRIs currently on the market, escitalopram has the highest affinity for the human serotonin transporter (SERT). The enantiomer of escitalopram (®-citalopram) counteracts to a certain degree the serotonin-enhancing action of escitalopram. As a result, escitalopram has been claimed to be a more potent antidepressant than citalopram, which is a racemic mixture of the two enantiomers. In order to explain this phenomenon, researchers from Lundbeck proposed that escitalopram enhances its own binding via an additional interaction with another allosteric site on the transporter.[45] Further research by the same group showed that ®-citalopram also enhances binding of escitalopram,[46] and therefore the allosteric interaction cannot explain the observed counteracting effect. In the most recent paper, however, the same authors again reversed their findings and reported that ®-citalopram decreases binding of escitalopram to the transporter.[47] Although allosteric binding of escitalopram to the serotonin transporter is of unquestionable research interest, its clinical relevance is unclear since the binding of escitalopram to the allosteric site is at least 1000 times weaker than to the primary binding site.

 


It was originally claimed that the molecular tweak to citalopram to create escilatopram made escilatopram stronger. Now, it is not clear what makes escilatopram stronger than the original citalopram.

 

My own personal experience is that escilatopram is indeed much, much stronger than paroxetine.

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Thank you Altostrata. So I guess I know I'm successful if after the last dose, there are no more withdrawal symptoms? Or if there are, just wait it out to see if they stop? I guess I'm wondering when to know I've been successful?

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Thank you alto for spending time helping out! Due to the severe reaction I am having to lexapro (severe dosing pain everyday last for most of the day and chronic pain all over), I'm considering the possibility of switching to another ssri(Prozac?). If this plan eventually makes sense with more research and consultation, I need to know the equivalent dose between the two. It seems the comparison was mainly between the lex and it's original form.

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I have been having more success mixing the liquid lexapro in water and drinking it rather than taking the liquid directly. Just an FYI in case someone is having trouble with the liquid.

 

It made quite a difference for me.

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Hi, I read about taking escitalopram as a liquid or making your own liquid when you're trying wean off it in very small increments. However, can I just crush the escitalopram and swallow it as a powder if I don't want to do the additional step of putting it in liquid?

 

Thanks for any input!

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Hi, Vivie. Have you ever tried swallowing a dry, bad-tasting powder?

 

This is probably not a good idea. Not only might it taste very bad, it might burn your mouth or throat.

 

Please put the powder in a capsule or a liquid.

 

Also, please start a topic for yourself in the Introductions forum. Thank you.

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The other thing with the powder is that it's pretty tricky to control exactly how much you're getting, unless you use an expensive lab quality scale. Most of us don't have that kind of budget.

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I was hesitant about making a liquid, but found it pretty easy.

I got one of those small brown bottles plus a 10 ml syringe with a curvy plastics tube on the end.

Say for making a 2mg dose I do the following.

Put 2 10 mg tablets in followed by 30 ml water (3 full syringes)

Then I take 3 ml out each day.

The tablets don't fully dissolve, but an emulsion.

I keep it it the fridge.

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I am puzzled.

I have a liquid form of escitalopram. It is cipralex 20mg oral drops solution, made by Lundbeck.

It is said in the leaflet than 1 drop = 1mg...

How accurate are drops?

 

If I was using a 1ml syringe how much do I need to take for 5mg?

I tried to get 5drops out, and then pumped it to the syringe, but in the the syringe it was around 2.5mg. Is this correct?

 

This is so confusing...

 

I am now at 2.5mg...want to get %5 tapper...

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One might always ask a pharmacist questions of this nature, then post here and share the information with the community.

 

Many oral syringes also have markings for drops. They are an old form of liquid measurement.

According to this online converter Drops to Milliliters Conversion Calculator , one drop equals 0.05mL.

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Google is a good way to get factual information about measurements.

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This thread is unbelievably helpful to me. I had no idea Lexapro was more potent than other SSRI's. My experience is starting to make more sense now ???? Thank you, Altostrata.

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I am here to thank Altostrata.  Thanks to the advice at the beginning of this thread I was able to totally come off lexpro without experiencing ANY side effects -- other than actually experiencing my emotions, which is all good.  I used the advice to decrease by 10%and kept to that until I got to 2.5 mg.  Then I went down by .5 mg every three weeks until I was at .5 mg.   Then I went to 1 mg daily, then every other day, then every two days, then three.  It did take me about a year to get to this point.  I also used the dietary and supplement advice in the Mood Cure.   I had a rough winter, but I am hoping that next year will be better.  Thanks again, Altostrata!

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