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Frogie

Frogie: Lexapro - how to get below 10 mg

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I am new here as you can see. I need help!!
I'm hoping someone can help me get off 10 mg Lexapro. Every time I try to drop to even 9mg, I end up sick to my stomach. I go back up to 10mg and am still sick to my stomach. I have no other symptoms.

In my profile is all my information, I don't know how to get it to the bottom of this page. I'm not very good on the computer. Sorry

Edited by ChessieCat
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Frogie -- Welcome to Surviving Antidepressants (SA)
 
I've moved your post to an introduction topic for you so that more people will see your question.

 

I'm glad you found SA at the start of your dose reductions.

You asked about a signature.

  • Summarize your history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-18 months particularly. 
  • Be sure to include all medications you're taking, not just Lexapro.
  • Here are instructions and tips on doing that: Please put your withdrawal history in signature

 

A tip: You'll get notifications when someone posts in your thread if you follow this topic. To do that

  1. Click the gray "Follow this topic" button. Result: A dialog box appears with notify options. 
  2. Select one of the notify options, then
  3. Click follow this topic in the dialog box.

 

This is where you posted your question originally. I'll leave the link here for your reference.
Tips for tapering off Lexapro (escitalopram)
 

Would you write more about when you felt sick after reducing to 9 mg:

  • When did it start and how long did it last?
  • When did you go back up to 10 mg, i.e. how many days/weeks after cutting to 9 mg?

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.

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Thanks,

I think I got it figured out.

I was on 10mg Lexapro and dropped to 9mg. It took it about 6-7 days and it was like I had morning sickness (I'm not pregnant). I went back to 10mg on Sat, and am still sick to my stomach.

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Good job on your signature, thanks for doing that.
 
Nausea and stomach upset have been noticed at all phases of taking an SSRI: starting, a side effect while taking it, and when discontinuing. In all likelihood, your stomach upset is a withdrawal symptom. You may not know that the vast majority of neurotransmitter cells are in your gut, >90% of serotonin receptors if I recall correctly. 
What is withdrawal syndrome
 
 Your signature shows that you tapered off 3 other psych drugs from significant doses in 2015 rather quickly.  That may have sensitized you somewhat. This topic may help you understand what's going on when you change doses up or down and start or stop psychiatric medications.
How your brain responds to psychiatric drugs - aka Brain remodelling
 
 
It may take some weeks for your stomach upset to resolve. It's best not to fiddle with doses to treat these symptoms. Give yourself time to settle back at 10 mg. If after 2-3 months you feel ready to start dose reductions, you could try a smaller cut, going to 9.5 mg. Then give yourself 10-14 days at that dose. It takes 3-4 days for the new dose to reach a steady state and then another week or so for your symptoms to settle a bit. Bouncing doses up and down is hard on your brain and the rest of your CNS (central nervous system).

Lexapro is a very powerful medication. Many people need to reduce dose cautiously. Although this topic discusses dose reductions of 10%, you've may have found that amount is too much for you. The principles are the same, regardless of the percentage:
Why taper by 10% of my dosage?  
 
Would you put your current dose of Lexapro in your signature and your recent attempt at 9 mg? Please include the dates -- approximate as best you can -- rather than relative time frames such as "2 weeks ago." Two weeks from today, "2 weeks ago" refers to a different date. ;)
 
For the time when you're ready to taper:

Tips for tapering off Lexapro (escitalopram)

 

Welcome again. Have a look at the topics linked above and browse & read the forums.

 

If you have questions about your situation, please post them here so that all your information is in one place.

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Good job on your signature, thanks for doing that.

 

Nausea and stomach upset have been noticed at all phases of taking an SSRI: starting, a side effect while taking it, and when discontinuing. In all likelihood, your stomach upset is a withdrawal symptom. You may not know that the vast majority of neurotransmitter cells are in your gut, >90% of serotonin receptors if I recall correctly. What is withdrawal syndrome

 

 Your signature shows that you tapered off 3 other psych drugs from significant doses in 2015 rather quickly.  That may have sensitized you somewhat. This topic may help you understand what's going on when you change doses up or down and start or stop psychiatric medications.How your brain responds to psychiatric drugs - aka Brain remodelling

 

 

It may take some weeks for your stomach upset to resolve. It's best not to fiddle with doses to treat these symptoms. Give yourself time to settle back at 10 mg. If after 2-3 months you feel ready to start dose reductions, you could try a smaller cut, going to 9.5 mg. Then give yourself 10-14 days at that dose. It takes 3-4 days for the new dose to reach a steady state and then another week or so for your symptoms to settle a bit. Bouncing doses up and down is hard on your brain and the rest of your CNS (central nervous system).

Lexapro is a very powerful medication. Many people need to reduce dose cautiously. Although this topic discusses dose reductions of 10%, you've may have found that amount is too much for you. The principles are the same, regardless of the percentage:Why taper by 10% of my dosage?  

 Would you put your current dose of Lexapro in your signature and your recent attempt at 9 mg? Please include the dates -- approximate as best you can -- rather than relative time frames such as "2 weeks ago." Two weeks from today, "2 weeks ago" refers to a different date. ;)

 

For the time when you're ready to taper:

Tips for tapering off Lexapro (escitalopram)

 

Welcome again. Have a look at the topics linked above and browse & read the forums.

 

If you have questions about your situation, please post them here so that all your information is in one place.

 

So I should stay on 10mg for a couple of months?

I have a scale (should be here today). I saw somewhere there was a spreadsheet that you could use with the scale, but I can't find it now.

When I do go down by 10%, how long should I stay on that dosage? I wanted to go down a mg every 2-3 weeks, but guess that is too fast.

 

Thanks for your help!

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As I had to taper quite fast in the beginning, i then stopped tapering for over one year. At the moment I do only 1% at the time...seems to be working...

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Do you do the liquid or tablets. My ins won't pay for the liquid, so my fiancé bought me a scale, it should be here today.

How often do you go down? At 1%, it would take 10 years for me to be done. I was hoping to stay at 10mg for a month and then try again. I tapered from 20 to 10 in 6 weeks and I think that is my problem. The dr. did give me zofran to help with the nausea, but I need to get off of Lexapro as soon as I can without all the symptoms. It's hurting my liver after so many years.

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I'm lucky the only symptoms I've had is horrible nausea like I'm pregnant, which I'm not. I have 2 children and a granddaughter. Like I said the dr gave me zofran for the nausea. Maybe I will try a 10% taper in a couple of weeks and with the zofran I can make it work. Anyone with any ideas I could really use them! Thanks!

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I make a liquid. But you can use other methods. I think the idea is to stick to the same method all the time...

 

I quite like the method Brasmonkey suggested/sliding protocol, so I do 1% at the time up to 4 weeks, then hold for two three weeks. I have only started, after long holding, so I am still unsure, but so far so good, only emotions seem stronger and deaper...

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Is it hard to make the liquid? I was reading about it and the scale I think will work for me. I would like to go down 1mg a month or faster if my body will let me. If all I get is the nausea, with the meds the dr gave me, I should be ok. I guess I will see. Let's keep in touch helping each other :)

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Frogie -- Give yourself time to get steady on 10 mg, at least 2 weeks after the nausea resolves.

 

Zofran is a fairly heavy medication; there are over the counter medications intended for motion sickness nausea such as dimenhydrinate (in Canada there's a brand name "Dramamine"). This and other similar OTC meds should be available in the pharmacy section of any large chain store and in pharmacies/drug stores. If you're unsure about which one, ask a pharmacist or pharmacy assistant, I've found them really helpful. I think some greatly prefer actively helping customers than counting pills and doing the paperwork. ;)

 

 

Tips for tapering off Lexapro (escitalopram)

Making a liquid from a tablet or capsules

 

nz11 has a spreadsheet "The Works" that has calculations set up for the 10% taper and creating a liquid among others. I'll ask him to post here with a link.

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Hi Frogie-- Welcome to SA. I'm sorry to hear that you're having such trouble getting your taper started. When did you do the taper from 20mg to 10mg? That is very important for us to know. It could have a large bearing on how to proceed.

 

No taper is going to be symptom free and the symptoms usually show up several days to a week after the drop. As you have discovered. The trick to a successful taper is to manage the symptoms as best as you can.  That usually means taking small drops with a long hold between.  The idea that the taper will tape years is very daunting, so it's usually best to celebrate how far you've come and not how far you still  have to go.  Once your big drop settles out, and it will, you will have decreased your dose by half.  That's fantastic.

 

As Ikam just mentioned there are ways to decrease the symptoms but still make good progress on your taper. A 10% drop all at once can still be pretty harsh, but if you break it into four successive smaller drops and a hold it really decreases the severity of the symptoms.  By dropping 2.5% a week for four weeks and then holding for two additional weeks the symptoms can be quite controllable. 

 

Dropping 1mg a months sounds like a nice slow taper, and if you were on a much higher dose it would work well.  10mgs is a very tricky dose to start tapering from.  It's right at the top of the most sensitive part of the taper. Something like 85% of the drugs effectiveness happens in the first 10 mg, so making even a small change can have a big effect symptom wise. Decreasing by a straight 1mg also accelerates the amount that you  would be decreasing each time making it rougher and rougher with each drop. Decreasing by a percentage however decelerates the amount of each drop and makes things gentler on your system.

 

There is a huge amount of information here and we'll be bombarding you with links. Before you start to taper again, read as much as you can and ask us a lot of questions.  That way we can help work out a plan that will succeed.

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Hi,

I am taking 40mg Prilosec and 300mg Zantac (20/150 morning and night). I am also WD from Lexapro and having a really hard time going down from 10mg. How did you get off the acid reducers without rebounding. I tried to go on a schedule from the dr and it about killed me. Any help would be great!

Frogie, we recommend tapering one medication at a time.

3KIS: Keep it slow. Keep it simple. Keep it stable.

 

When a someone is taking multiple medications, we ask that that you post an interactions report.  Follow the link below to get your report. Just select the text, copy it and paste it in a post here.

 

Drugs-dot-com Drugs Interactions Checker.

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hi Brassmonkey:

 

Thanks for the info, except I'm so confused I don't know what to do? I did the initial taper in 6 weeks from 20mg to 10mg. I've been stuck at 10mg for about 2 weeks now.

 

Do I do a 10% taper for a month and then another 10% taper for a month, until done?

 

I'm on pills, insurance won't pay for liquid and making my own just doesn't look like something I can do. I'm on disability and can only use 1 hand correctly. The other hand is in a brace all the time.

 

I also take 1mg Xanax 4 times a day. Will that help with the WD of Lexapro?

 

So I shouldn't be taking the zofran? I only take it when it unbearable.

 

I have so many more questions but can't think of them right now. I'm sure I will be bugging you for a while :)

 

Thanks for everyone's help!

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Hi,

I am taking 40mg Prilosec and 300mg Zantac (20/150 morning and night). I am also WD from Lexapro and having a really hard time going down from 10mg. How did you get off the acid reducers without rebounding. I tried to go on a schedule from the dr and it about killed me. Any help would be great!

 

Frogie, we recommend tapering one medication at a time.3KIS: Keep it slow. Keep it simple. Keep it stable.

 

When a someone is taking multiple medications, we ask that that you post an interactions report.  Follow the link below to get your report. Just select the text, copy it and paste it in a post here.Drugs-dot-com Drugs Interactions Checker.

I have done the interactions checker numerous times and everything in fine. I just don't know how to copy and paste on an iPad. Sorry :(

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Hi Frogie--  There's going to be a lot of confusing information flying around for a bit but it will start to make some sense in a while. So ask all the questions hat come to you.

 

" I did the initial taper in 6 weeks from 20mg to 10mg. I've been stuck at 10mg for about 2 weeks now."  This is the important thing right now. It's telling me that you don't want to do anything for several months. You've done a very large and quick taper to get to the 10mgs and it is going to take a while for your brain to sort things out.  During that time any changes in dosage will just add to the confusion.  I need to talk it over with the other mods but it might be a good idea to increase your dose back to about 15mg and stabilize there.  

 

​Yes, that's basically how it works. You take, for example 10mg this month, 9mg next month and 8.1mg the month after that.  Until you get down to about 0.3mg which is a convenient place to jump off.

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I figured the 10% taper and it will take over a year. I don't think my liver can take Lexapro over another year. It's infiltrated because of the Lexapro and I need to get it healthy ASAP. I'm soooo confused!

 

My dr gave me a schedule you stay on each dose 3 weeks:

10, 7.5, 5.0, 2.5, 1.0, 0.5, and .25

 

That's still 5 months. I just need to get off of this. Can I have my dr switch me to something else and then wean off of it?

 

Or do you have another idea? I'm desperately!

 

Thanks...

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Frogie, Do you have a health issue that requires you be off Lexapro quickly?

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Yeah my liver is infiltrated because I have been on antidepressants for so many years.

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Is this something you've been diagnosed with and seen a hepatologist about?

 

What are your symptoms of "infiltrated liver"?
 
Edited to add:
 

If you're looking for a taper faster than the one you doctor has suggested, I have to tell you that you may have come to the wrong place. We've seen too many people suffer uncomfortable and distressing symptoms from fast "tapers."

 

Please read: Why taper by 10% of my dosage?

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I have been diagnosed by 2 drs which want me to get off my meds ASAP so my liver will heal. How many withdrawal symptoms am I going to have with the WD that my dr gave me? I have hemangioms and they can't do anything until I get healed.

 

Thanks...

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Our recommendations are usually to go slower than what your doctor has recommended.

 

Since you've got medical advice that attempts to mitigate the risk of withdrawal symptoms, I'd follow that rather than advice from the internet.

 

No one can predict whether you'll get withdrawal symptoms and if you do, no one can predict which ones, how intense they'll be and how long they'll last. I wish I had better news for you, there just isn't any information about this.

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Hello, Frogie. What tests have you had showing the condition of your liver?

 

Please put ALL the drugs you take in the Drug Interactions Checker http://www.drugs.com/drug_interactions.html
and copy and paste the results in this topic.

 

Drugs taken in combination can cause a traffic jam in your liver. It could be that one of your other drugs is the problem.

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Hey Frogie, I'm sorry this is so difficult for you.

 

The dr. did give me zofran to help with the nausea

 

What?  This is a serotonin based drug!  That's like pouring salt in a wound.

From drugs.com (please - put ALL your drugs in the Drugs.com Drug Intreraction checker, and copy and paste the results here!)

Interactions between your selected drugs

Major ondansetron  escitalopram

Applies to: Zofran (ondansetron), Lexapro (escitalopram)

Using ondansetron together with escitalopram can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should contact your doctor immediately if you experience these symptoms during treatment. In addition, combining these medications can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

You wrote:

I have done the interactions checker numerous times and everything in fine

 

Apparently not - as evidenced by what I just found by putting only 2 of your drugs in the checker.  

 

I understand you have trouble with your hand in a brace - I have been one-handed for about 2 years now, myself.  (see:  http://survivingantidepressants.org/index.php?/topic/5234-%E2%98%BC-jancarol-reboxetine-first-then-lithium/page-11?p=121351#entry121351 for when it was the worst!)  And the iPad is unhelpful on copy and paste - but I don't know all the drugs you are on or I would do it for you.  I will make my best effort after making this post.  

I will say this - I've been doing dry cutting and powder sifting with my supplements (I didn't need to for my taper, I had different doses that I could combine 1/4's and 1/2's for my taper) - and it has made me envious of the liquid people.  They just drop the tablet in liquid, wait for it to dissolve, shake it, and draw out the part they don't need and drink the rest!  It's probably easier than fiddling with powder and scales, funnels and brushes, tares and weighing trays and don't sneeze!

 

* * *

I do not see in your signature when you went from 20 mg Lexapro to 10 mg Lexapro.  Could you please put that in your signature, with the dates and the speed of the taper?  Was it just a 50% drop on one day?

 

I see that BrassMonkey wants to know this, too:

When did you do the taper from 20mg to 10mg? That is very important for us to know. It could have a large bearing on how to proceed.

 

You have had a number of drops in drugs - were you co-tapering the Lamictal, Gabapentin, and Valium - at the same time?  What were the dates (month is fine) of your last doses of each of these?  Please include this in your signature too!

Depending on when the Lexapro drop from 20 to 10 mg was - you could still be having rebound withdrawal from all of those changes.  

 

* * *

 

Scally wrote:
 

nz11 has a spreadsheet "The Works" that has calculations set up for the 10% taper and creating a liquid among others. I'll ask him to post here with a link.

 

http://survivingantidepressants.org/index.php?/topic/7571-%E2%98%BC-nz11-climbs-onboard/page-17?p=219415#entry219415

 

Scallywag also said:
 

there are over the counter medications intended for motion sickness nausea such as dimenhydrinate (in Canada there's a brand name "Dramamine"). This and other similar OTC meds should be available in the pharmacy section of any large chain store and in pharmacies/drug stores.

 

I would suggest that dimenhydrinate or scopolamine may be too strong, as well.  You are already on 2 stomach acid drugs, you may wish to settle for something more natural.  

 

Things I use for nausea that are more gentle for your brain and nervous system:

TUMS or Rolaids - simple antacid.

Tbsp baking soda (sodium bicarbonate) in water, stir and drink

Ginger tea (better to aid digestion)

Mint tea (better for nausea)

Cinnamon tea (better for diarrhea)

DGL - Deglycinated licorice - these are lozenges that I suck on when I'm nauseous and they are highly effective.  Because they are deglycinated, they do not have systemic consequences.

 

These are all inexpensive, "simples" or even folk remedies, but are a good step towards moving away from drugging your symptoms.

 

You wrote:

I also take 1mg Xanax 4 times a day. Will that help with the WD of Lexapro?

 

 UM WOW!  That is a lot of Xanax!  That is the equivalent of 80 mg of Valium per day.  And you've been taking that since 2008 - for 8 years!  YES, it will cushion some of the Lexapro withdrawal, but obviously not all of it.  And it can turn on you, too.  

 

At some point, you may want to hold at a low dose of Lexapro and deal with this high dose of Xanax using our Members Only Benzo Forum

 

Also - study here to learn what your stomach acid drugs are doing.  I will try post your drug interactions and then address your "tapering plan."

 

That Acid Reflux Pill May Be Causing Your Health Problems

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Okay Frogie - here are your interactions.  I don't know whether you drink or not - so I put Alcohol in, as well.  I have NAFLD (Non-Alcoholic Fatty Liver Disease) which is becoming more common - it used to be that nearly all liver disease was caused by cirrhosis, directly caused by drinking alcohol.  Now, our diets and these drugs are enough to cause problems.

 

Do you take acetominophen / Tylenol?

 

Please let us know what your liver diagnosis isthis is important because you are asking to taper at a dangerous rate.  You need to weigh the doctor's advice against your own well being.  It does you no good to "clean your liver" if you end up in suicidal akathisia.  These are the stakes we are talking about here.  I'm sorry to use scary language, but this is not something to be approached casually.  We see people suffering from doctor-guided tapers every day.  The doctors do not know, have not taken the drugs themselves, and have no understanding of the difficulties involved in getting off of them.  They use the information given to them by the drug companies, which minimize the risks involved.

 

OKAY, here goes:

Interactions between your selected drugs

Major ondansetron  escitalopram

Applies to: Zofran (ondansetron), Lexapro (escitalopram)

Using ondansetron together with escitalopram can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should contact your doctor immediately if you experience these symptoms during treatment. In addition, combining these medications can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate alprazolam  omeprazole

Applies to: Xanax (alprazolam), Prilosec (omeprazole)

Omeprazole may increase the blood levels and effects of ALPRAZolam. This can increase the risk of side effects including excessive drowsiness and breathing difficulties. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate alprazolam  ethanol

Applies to: Xanax (alprazolam), ethanol

Using ALPRAZolam together with ethanol can increase nervous system side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with ALPRAZolam. Do not use more than the recommended dose of ALPRAZolam, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medication without first talking to your doctor.

Switch to professional interaction data

Moderate alprazolam  escitalopram

Applies to: Xanax (alprazolam), Lexapro (escitalopram)

Using ALPRAZolam together with escitalopram may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate omeprazole  escitalopram

Applies to: Prilosec (omeprazole), Lexapro (escitalopram)

Talk to your doctor before using escitalopram together with omeprazole. Combining these medications may increase the blood levels and effects of escitalopram. You may have an increased risk of developing side effects, including irregular heart rhythm and a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. You should contact your doctor immediately if you experience these symptoms while taking the medications. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate ethanol  escitalopram

Applies to: ethanol, Lexapro (escitalopram)

Using escitalopram together with ethanol may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with escitalopram. Do not use more than the recommended dose of escitalopram, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Only one major, and 3 moderates, not counting the ethanol.  Yes, this is drug interaction, it is not "all fine."

 

I have to go, for now, but will return with some thoughts about your tapering plan.

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In summary, I am looking for this information:

 

1.  Exact dates you went off Gabapentin, Lamictal, and Valium  (please put in signature)

2.  Exact dates you decreased your Lexapro from 20 to 10 mg. (please put in signature)

3.  Do you drink alcohol?  (please put in signature)

4.  Do you take paracetamol?  How often, how much?

5.  What is your liver diagnosis - based on what tests?  What symptoms led to the doctors wanting to test your liver?

 

Thank you!

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OK, as Alto said, there may be a traffic jam in your liver.  These drugs have a way of skewing the numbers on the labs, too - that yes, you will heal as you get off the drug - but perhaps you will not know how dire it is until you have further reduced your drug load.

 

Your doctor's plan is aggressive.  (most doctor plans are - this is one of the better plans - doctors usually say, "cut it in half then quit" but they are modifying that more and more to a "taper plan" which is still too fast)

 

While you are looking at "total time tapering," we look at "how do I feel while tapering?"  The latter is very important.  If you feel awful, then it does you no good to taper further, and can actually make your time to recovery longer and more tedious!  

 

When you dropped from 10 mg to 9 mg, your nausea started, and it hasn't let up.  That was 3 weeks ago.  So you are not in good condition to taper at all, until the nausea lets up.  Then you wait another month before tapering again.

 

By the time you get to 5 mg, you should be feeling much better.  Keep in mind, that your Xanax is metabolized in the liver, too.

 

Using NZ's "The Works" you could possibly get down to 5 mg in 8 months.  IF you have no symptoms, or your symptoms are bearable.  

 

Keep in mind, the withdrawal can be cumulative:  1st month, just nausea, but if you persist on tapering, the 2nd month might introduce other symptoms (the list is pretty large, see: Dr. Joseph Glenmullen's Most Common symptoms of Withdrawal) .  

 

However, 10% was too much for you before - what makes you believe you can drop to 7.5 mg (33% or 3 times what you tried before) without suffering?

 

We'd like to keep you from suffering, because once you go into total withdrawal - acute or protracted - it is so much harder to manage than if we can start from a position of strength and stability, than if we wait until you 'crash.'

Please see:

 

Before You Begin Taper - What you Should Know

 

Intro to Antidepressant Withdrawal Syndrome

 

 

Why taper by 10% of my dosage?

 

and if you want it in a video (only a few minutes long):

Healing from Antidepressants - Patterns of Recovery (by Toxic Antidepressants)

 

I wish there was something clear and concise that you could show to your doctor - there is a ton of information on the interwebs, but doctors tend to dismiss "Dr. Google" when they weigh it against all the time, investment, and suffering they went through to get their degree.

 

What Should I Expect From My Doctor About Withdrawal Symptoms?

How do you talk to a doctor about tapering and withdrawal?

 

ONE last thing.  If you are planning to remove all of these drugs which have been regulating your emotions and your brain, what do you plan to replace them with?  To not replace them, is to invite hospitalizations and hardships into your life.  We replace them with 

 

Non Drug Techniques for Coping with Emotional Symptoms .

 

Okay, that's entirely too much for you to study.  I'm sorry, I went overboard on the links - but your situation could be serious, and educating yourself is the best way to proceed and decide what is next for you.

 

We cannot tell you what to do - maybe you will decide that following your doctor's advice is the best plan.  You are always welcome to come back and partake of our slower Harm Reduction protocol, when the doctor's taper plan proves to be too difficult.  I only hope you don't wait too long - because Humpty is hard to put together again.  It's better to prevent his fall in the first place.

 

Please let us know what you decide, how you plan to proceed.  And thank you, when you provide the information we are looking for.  We'll be able to comment more, when we have that information.

 

I hope you see the sun today!

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I was sick, throwing up. Went to the er and they did an ultrasound which showed a 8mm hemangioma in the left lobe of my liver. They did a ct to confirm it. And the ct says infiltration. My liver enzyme blood levels are also high. The Drs want me to get off all the meds, said Lexapro, Prilosec, Zantac then Xanax. They gave me zofran for the nausea. I don't drink. If you can get me off in 8 months or less, I would be able to do that. The taper the dr gave me will take approximately 5 months. I have tried tums and that's like eating candy. Ginger makes me throw up. What is paracetamol? I just got a very nice scale, and is very accurate. I want to replace the meds with natural things, and could use help with that. I am in counseling and she is wonderful. She's not a psychiatrist but does know a lot about meds and helping me. I just want to get well.

The ct did show that the hemangioma could be laying on a small part of my stomach which could be causing some of the nausea.

 

I appreciate everyone being so caring and kind. I hope you can do the WD of Lexapro in 8 months or less that would be awesome

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OK, as Alto said, there may be a traffic jam in your liver.  These drugs have a way of skewing the numbers on the labs, too - that yes, you will heal as you get off the drug - but perhaps you will not know how dire it is until you have further reduced your drug load.

 

Your doctor's plan is aggressive.  (most doctor plans are - this is one of the better plans - doctors usually say, "cut it in half then quit" but they are modifying that more and more to a "taper plan" which is still too fast)

 

While you are looking at "total time tapering," we look at "how do I feel while tapering?"  The latter is very important.  If you feel awful, then it does you no good to taper further, and can actually make your time to recovery longer and more tedious!  

 

When you dropped from 10 mg to 9 mg, your nausea started, and it hasn't let up.  That was 3 weeks ago.  So you are not in good condition to taper at all, until the nausea lets up.  Then you wait another month before tapering again.

 

By the time you get to 5 mg, you should be feeling much better.  Keep in mind, that your Xanax is metabolized in the liver, too.

 

Using NZ's "The Works" you could possibly get down to 5 mg in 8 months.  IF you have no symptoms, or your symptoms are bearable.  

 

Keep in mind, the withdrawal can be cumulative:  1st month, just nausea, but if you persist on tapering, the 2nd month might introduce other symptoms (the list is pretty large, see: Dr. Joseph Glenmullen's Most Common symptoms of Withdrawal) .  

 

However, 10% was too much for you before - what makes you believe you can drop to 7.5 mg (33% or 3 times what you tried before) without suffering?

 

We'd like to keep you from suffering, because once you go into total withdrawal - acute or protracted - it is so much harder to manage than if we can start from a position of strength and stability, than if we wait until you 'crash.'

Please see:

 

Before You Begin Taper - What you Should Know

 

Intro to Antidepressant Withdrawal Syndrome

 

 

Why taper by 10% of my dosage?

 

and if you want it in a video (only a few minutes long):

Healing from Antidepressants - Patterns of Recovery (by Toxic Antidepressants)

 

I wish there was something clear and concise that you could show to your doctor - there is a ton of information on the interwebs, but doctors tend to dismiss "Dr. Google" when they weigh it against all the time, investment, and suffering they went through to get their degree.

 

What Should I Expect From My Doctor About Withdrawal Symptoms?

How do you talk to a doctor about tapering and withdrawal?

 

ONE last thing.  If you are planning to remove all of these drugs which have been regulating your emotions and your brain, what do you plan to replace them with?  To not replace them, is to invite hospitalizations and hardships into your life.  We replace them with 

 

Non Drug Techniques for Coping with Emotional Symptoms .

 

Okay, that's entirely too much for you to study.  I'm sorry, I went overboard on the links - but your situation could be serious, and educating yourself is the best way to proceed and decide what is next for you.

 

We cannot tell you what to do - maybe you will decide that following your doctor's advice is the best plan.  You are always welcome to come back and partake of our slower Harm Reduction protocol, when the doctor's taper plan proves to be too difficult.  I only hope you don't wait too long - because Humpty is hard to put together again.  It's better to prevent his fall in the first place.

 

Please let us know what you decide, how you plan to proceed.  And thank you, when you provide the information we are looking for.  We'll be able to comment more, when we have that information.

 

I hope you see the sun today!

I answered all the questions I could... Please help me!

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I'm really having some anxiety today. Maybe it's just the weather, cloudy and looks like rain. But no nausea yesterday or today!

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I was reading some peoples forums and came across blackjacklv (I think). Anyway, they dropped a mg every couple of weeks until they got to 5mg and then went faster. Is that possible or what withdrawals am I looking at? I'm staying at 10 for an couple more weeks.

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Frogie, if I were you, I'd reduce in this order:
 
Prilosec
Zantac
Lexapro
Xanax
 
Going off Prilosec and Zantac are not as difficult as going off Lexapro and Xanax. Lexapro and Xanax require more careful tapering.
 
You can reduce Prilosec by 25% per week. Same with Zantac. Stop reducing if you get rebound reflux.
 
Then start reducing Lexapro. Initial cut can be 25%. Hold for 3 weeks, if no serious withdrawal symptoms, taper by 10% every 3 weeks.

 

Please let us know how you're doing while making any change in your drugs.

 

Seems to me your liver injury might more likely be from Prilosec and Zantac interacting with the other drugs. Lexapro and Xanax are probably relatively minor players. Your doctor has overmedicated you, he or she should have known about the interactions, and is now in panic mode to cover up the error.
 
Please read this about Xanax carefully https://livertox.nlm.nih.gov/Alprazolam.htmThis is a US government-produced site about drug-induced liver injury
 

Hepatotoxicity
 
Alprazolam, like other benzodiazepines, is rarely associated with serum ALT elevations, and clinically apparent liver injury from alprazolam is extremely rare.  There have been a few case reports of acute liver injury from alprazolam and recurrence on reexposure has been reported.  In alprazolam related cases of acute liver injury, the latency has been within a few weeks and the typical pattern of liver enzyme elevations has been cholestatic or mixed (Case 1).  The injury is usually mild-to-moderate in severity and self-limited.  Fever and rash have not been described nor has autoantibody formation.

Likelihood score: D (possible rare cause of clinically apparent liver injury).
 
Mechanism of Injury

Alprazolam is metabolized by the liver via the cytochrome P450 system, predominantly by CYP 3A4.  Concurrent use of CYP 3A4 inhibitors, such as cimetidine or ketaconazole, can cause an increase in alprazolam plasma levels.  The liver injury from the benzodiazepines is probably due to a rarely produced intermediate metabolite.

 
And about Zantac (ranitidine):

https://livertox.nlm.nih.gov/Ranitidine.htm
 

Hepatotoxicity
 

Chronic therapy with ranitidine has been associated with minor elevations in serum aminotransferase levels in 1% to 4% of patients, but similar rates were reported in placebo recipients.  The ALT elevations are usually asymptomatic and transient and may resolve without dose modification.  Rare instances of clinically apparent liver injury have been reported in patients receiving ranitidine, but the time to onset and pattern of injury has varied greatly.  Onset can be as short as a few days to as long as several months, but is usually within 6 weeks.  The pattern of serum enzyme elevation varies from hepatocellular to cholestatic, most cases being “mixed” hepatocellular-cholestatic.  The injury is rarely severe and resolves within 4 to 12 weeks of stopping ranitidine.  Liver biopsy histology often shows prominent centrolobular necrosis.  Immunoallergic features (rash, fever, eosinophilia) are uncommon, as is autoantibody formation.
 
Mechanism of Injury
 
Ranitidine is metabolized by the microsomal P450 drug metabolizing enzymes and inhibits the function of CYP 3A and 2D6, and injury may be the result of its activation to a toxic intermediate.  Rapid recurrence with rechallenge is typical, but features of hypersensitivity are uncommon.

 
And this about escilatopram (Lexapro) and omeprazole (Prilosec)
 

Clin Pharmacokinet. 2007;46(4):281-90.

The clinical pharmacokinetics of escitalopram.
Rao N1.

Abstract http://www.ncbi.nlm.nih.gov/pubmed/17375980

Escitalopram is the (S)-enantiomer of the racemic selective serotonin reuptake inhibitor antidepressant citalopram. Clinical studies have shown that escitalopram is effective and well tolerated in the treatment of depression and anxiety disorders. Following oral administration, escitalopram is rapidly absorbed and reaches maximum plasma concentrations in approximately 3-4 hours after either single- or multiple-dose administration. The absorption of escitalopram is not affected by food. The elimination half-life of escitalopram is about 27-33 hours and is consistent with once-daily administration. Steady-state concentrations are achieved within 7-10 days of administration. Escitalopram has low protein binding (56%) and is not likely to cause interactions with highly protein-bound drugs. It is widely distributed throughout tissues, with an apparent volume of distribution during the terminal phase after oral administration (V(z)/F) of about 1100L. Unmetabolised escitalopram is the major compound in plasma. S-demethylcitalopram (S-DCT), the principal metabolite, is present at approximately one-third the level of escitalopram; however, S-DCT is a weak inhibitor of serotonin reuptake and does not contribute appreciably to the therapeutic activity of escitalopram. The didemethyl metabolite of escitalopram (S-DDCT) is typically present at or below quantifiable concentrations. Escitalopram and S-DCT exhibit linear and dose-proportional pharmacokinetics following single or multiple doses in the 10-30 mg/day dose range. Adolescents, elderly individuals and patients with hepatic impairment do not have clinically relevant differences in pharmacokinetics compared with healthy young adults, implying that adjustment of the dosage is not necessary in these patient groups. Escitalopram is metabolised by the cytochrome P450 (CYP) isoenzymes CYP2C19, CYP2D6 and CYP3A4. However, ritonavir, a potent inhibitor of CYP3A4, does not affect the pharmacokinetics of escitalopram. Coadministration of escitalopram 20mg following steady-state administration of cimetidine or omeprazole led to a 72% and 51% increase, respectively, in escitalopram exposure compared with administration alone. These changes were not considered clinically relevant. In vitro studies have shown that escitalopram has negligible inhibitory effects on CYP isoenzymes and P-glycoprotein, suggesting that escitalopram is unlikely to cause clinically significant drug-drug interactions. The favourable pharmacokinetic profile of escitalopram suggests clinical utility in a broad range of patients.

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Frogie, if I were you, I'd reduce in this order:

 

Prilosec

Zantac

Lexapro

Xanax

 

Going off Prilosec and Zantac are not as difficult as going off Lexapro and Xanax. Lexapro and Xanax require more careful tapering.

 

You can reduce Prilosec by 25% per week. Same with Zantac. Stop reducing if you get rebound reflux.

 

Then start reducing Lexapro. Initial cut can be 25%. Hold for 3 weeks, if no serious withdrawal symptoms, taper by 10% every 3 weeks.

 

Please let us know how you're doing while making any change in your drugs.

 

Seems to me your liver injury might more likely be from Prilosec and Zantac interacting with the other drugs. Lexapro and Xanax are probably relatively minor players. Your doctor has overmedicated you, he or she should have known about the interactions, and is now in panic mode to cover up the error.

 

Please read this about Xanax carefully https://livertox.nlm.nih.gov/Alprazolam.htmThis is a US government-produced site about drug-induced liver injury

 

 

Hepatotoxicity

 

Alprazolam, like other benzodiazepines, is rarely associated with serum ALT elevations, and clinically apparent liver injury from alprazolam is extremely rare.  There have been a few case reports of acute liver injury from alprazolam and recurrence on reexposure has been reported.  In alprazolam related cases of acute liver injury, the latency has been within a few weeks and the typical pattern of liver enzyme elevations has been cholestatic or mixed (Case 1).  The injury is usually mild-to-moderate in severity and self-limited.  Fever and rash have not been described nor has autoantibody formation.

Likelihood score: D (possible rare cause of clinically apparent liver injury).

 Mechanism of Injury

Alprazolam is metabolized by the liver via the cytochrome P450 system, predominantly by CYP 3A4.  Concurrent use of CYP 3A4 inhibitors, such as cimetidine or ketaconazole, can cause an increase in alprazolam plasma levels.  The liver injury from the benzodiazepines is probably due to a rarely produced intermediate metabolite.

 

 

And about Zantac (ranitidine):https://livertox.nlm.nih.gov/Ranitidine.htm

 

Hepatotoxicity

 

Chronic therapy with ranitidine has been associated with minor elevations in serum aminotransferase levels in 1% to 4% of patients, but similar rates were reported in placebo recipients.  The ALT elevations are usually asymptomatic and transient and may resolve without dose modification.  Rare instances of clinically apparent liver injury have been reported in patients receiving ranitidine, but the time to onset and pattern of injury has varied greatly.  Onset can be as short as a few days to as long as several months, but is usually within 6 weeks.  The pattern of serum enzyme elevation varies from hepatocellular to cholestatic, most cases being “mixed” hepatocellular-cholestatic.  The injury is rarely severe and resolves within 4 to 12 weeks of stopping ranitidine.  Liver biopsy histology often shows prominent centrolobular necrosis.  Immunoallergic features (rash, fever, eosinophilia) are uncommon, as is autoantibody formation.

 Mechanism of Injury

 

Ranitidine is metabolized by the microsomal P450 drug metabolizing enzymes and inhibits the function of CYP 3A and 2D6, and injury may be the result of its activation to a toxic intermediate.  Rapid recurrence with rechallenge is typical, but features of hypersensitivity are uncommon.

 

 

And this about escilatopram (Lexapro) and omeprazole (Prilosec)

 

Clin Pharmacokinet. 2007;46(4):281-90.The clinical pharmacokinetics of escitalopram.&cauthor=true&cauthor_uid=17375980]Rao N1.

Abstract http://www.ncbi.nlm.nih.gov/pubmed/17375980

Escitalopram is the (S)-enantiomer of the racemic selective serotonin reuptake inhibitor antidepressant citalopram. Clinical studies have shown that escitalopram is effective and well tolerated in the treatment of depression and anxiety disorders. Following oral administration, escitalopram is rapidly absorbed and reaches maximum plasma concentrations in approximately 3-4 hours after either single- or multiple-dose administration. The absorption of escitalopram is not affected by food. The elimination half-life of escitalopram is about 27-33 hours and is consistent with once-daily administration. Steady-state concentrations are achieved within 7-10 days of administration. Escitalopram has low protein binding (56%) and is not likely to cause interactions with highly protein-bound drugs. It is widely distributed throughout tissues, with an apparent volume of distribution during the terminal phase after oral administration (V(z)/F) of about 1100L. Unmetabolised escitalopram is the major compound in plasma. S-demethylcitalopram (S-DCT), the principal metabolite, is present at approximately one-third the level of escitalopram; however, S-DCT is a weak inhibitor of serotonin reuptake and does not contribute appreciably to the therapeutic activity of escitalopram. The didemethyl metabolite of escitalopram (S-DDCT) is typically present at or below quantifiable concentrations. Escitalopram and S-DCT exhibit linear and dose-proportional pharmacokinetics following single or multiple doses in the 10-30 mg/day dose range. Adolescents, elderly individuals and patients with hepatic impairment do not have clinically relevant differences in pharmacokinetics compared with healthy young adults, implying that adjustment of the dosage is not necessary in these patient groups. Escitalopram is metabolised by the cytochrome P450 (CYP) isoenzymes CYP2C19, CYP2D6 and CYP3A4. However, ritonavir, a potent inhibitor of CYP3A4, does not affect the pharmacokinetics of escitalopram. Coadministration of escitalopram 20mg following steady-state administration of cimetidine or omeprazole led to a 72% and 51% increase, respectively, in escitalopram exposure compared with administration alone. These changes were not considered clinically relevant. In vitro studies have shown that escitalopram has negligible inhibitory effects on CYP isoenzymes and P-glycoprotein, suggesting that escitalopram is unlikely to cause clinically significant drug-drug interactions. The favourable pharmacokinetic profile of escitalopram suggests clinical utility in a broad range of patients.

 

Ok I was holding on 10mg Lexapro for a couple more weeks, so I can go off Prilosec and Zantac. If I get rebound acid what do you suggest to take?

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The suggestions in this post might help.

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The suggestions in this post might help.

Thanks for the info. I can't take turmeric or ginger, I throw up. Maybe I will try that DGL, I've heard good things about it.

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Hey Frogie - thanks for getting back with us, and updating your signature:

 What is paracetamol? I just got a very nice scale, and is very accurate. I want to replace the meds with natural things, and could use help with that. 

 

Sorry.  I moved to Australia, and forgot.  Paracetamol = acetominophen = Tylenol.  (they were developed independently on each continent, and the companies that developed them got "chemical naming rights")

 

Also - check here before you consider the "natural things," because as you come off your psych drugs, the "natural things" tend to be risky in withdrawal; St John's Wort, SAM-e, 5HtP, even Rhodiola and Vitamin B can be overstimulating and cause problems.  

 

I understand about TUMs being like candy.  Your stomach has been so heavily drugged, that it probably thinks TUMS are just a treat, not medicine.  Also remember, 90% of serotonin is in the gut - so this will not be a walk in the park.  (sorry, but I'd rather be honest with you than say "everything will be just peachy!")

 

It is good to know - from Alto's research - that the drugs you are worried about hurrying - are not the likely culprits for "infiltrating" your liver.  But it's more likely the stomach drugs which are changing how your liver enzymes are working.

 

ALSO Alto did not address the Zofran in her list.  Can you just quit using it?   First? How often do you use it?  How well does it work for you?  If you continue it, can you please add it to your signature?

 

Keep in mind that most "anti-emetics" are actually psych drugs with the side effect of "anti-nausea."  They sneak psych drugs in on us, and SA members need to be very careful with anti-emetics. 

 

It is quite clear that your current symptoms are exacerbated by your extremely fast taper of Lexapro from 20 to 10 mg in March, with some rattling around of your previous fast tapers, from the year before.

 

You've come down this far.  You're doing really well.  Nausea is a common side effect of liver hemangioma, as well as withdrawal.  

 

Another more controversial possibility is Medical Marijuana, if you are in a state where that is legal.  It is best used in cases of extreme nausea - you would have to seek out a strain that was low THC (because that will mess with your psych drugs), high CBD.  If it is raw, uncooked, unheated, then it will not be psychoactive at all.  And it won't have the serotonin / liver flow-on effects that all your other drugs are having.

 

It may take you a few months before you are ready to even consider it, but keep it on the back burner as a possibility if you get desperate.  http://survivingantidepressants.org/index.php?/topic/5030-cannabis-thc-or-marijuana-to-ease-withdrawal-symptoms/

 

But try the DGL and mint tea first (I notice you didn't object to mint, and it is better for nausea than ginger, it cools, rather than increases heat), and maybe try some yoga for nausea?

 

Yoga for Nausea - Allannah at YogaYin  

 

You can join our nausea and gut problem discussion here  (yes it's a common enough symptom in withdrawal):

http://survivingantidepressants.org/index.php?/topic/3413-digestive-problems-nausea-diarrhea-bloating-gerd/

 

I hope you see the sun today!

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