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Isabel

Any advice is appreciated! Do I wait it out to see if I get stable on 3.75mg or decrease by more then 10% to see if it helps at 2.5 mg. Its awful having reinstatement not help or withdrawal symptoms, tolerance, hepersensitivity..... how do I know what is what?? I feel like my brain is shaking. Are these tremors?

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Isabel

I know I ask a lot of questions but still have them with no answers. 3.75 mg x3 weeks. Sleep and appetite better but not great. Still weird hot and cold head feelings and shaky hands. Does this mean I'm at WD normal? Still decrease to 2.5 or try 10%? I've read all the digital scale and percentage calculations but still don't quite grasp it. So scared to try any supplements like magnesium or fish oil cause I think I react to it so it's tough to tough it out without anything.

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Kittygiggles

Hi Isabel,

 

I think I know how you feel. Coming to terms with withdrawal is the hardest thing I've ever done. Making it this far I feel is almost a miracle, relatively speaking. I'll get to the point though:

 

You need to decide for yourself. I know it is hard but no one here can make the decision to drop down to 2.5mg for you. I think the main reasons are:

 

1. SSRI withdrawal is not understood fully by science yet, so all we have are educated guesses. The moderators on this site have read and assisted a lot of people with their situations, making them very experienced. However, they still can't guarantee that their advice will be completely appropriate for any person's situation. 

2. Everyone here has had some bad experience with SSRIs, whether personally or vicariously, and I think we can all agree that SSRI withdrawal is horrible. So I feel confident when I say that no one here wants to push you into making a decision that could make your withdrawal worse!

 

I think the decision to go to 2.5mg is a sound one but there is still a risk of things getting worse. You are not tapering yet, you're trying to get down to a dose your body is used to, which from your history is 1mg because of likely adverse effects from a reinstatement that was too high. If you were tapering, you would need to drop by 5% to 10% every 4 to 6 weeks, or longer. I think the golden rule for proper tapering is to play it as safe as possible, which I interpret as holding at a dose for as long as necessary and dropping by a dose that a person can handle without significant disruption to their life. 

 

So, the moderators suggested that you can probably drop to 1mg eventually over a relatively short period because right now, there is still a good chance that your brain is used to 1mg and not 3.75mg. However, the longer you stick to 3.75mg, the more likely it will be that 3.75mg will have to become your baseline for tapering, whenever you choose to do that. Right now I think your goal is to stabilize and it seems you're more likely to do so comfortably at 1mg. 

 

I am not tapering yet as I am in a stabilization period. This means I am very strict with changing anything in my supplements or medication. If I were in your situation, I would probably drop to 2.5mg but adopt my current policy, which is to give myself 24 hours to see if a change has caused problems, and if I'm not sure, or the suspected problem is not too bad, I'll give it another 24 hours. That's it though: if things haven't improved or have gotten worse within 48 hours, I stick to what I was doing previously and review my daily notes to see what could have gone wrong. In your case that would be go back to 3.75mg after 24 hours if things are awful, or 48 hours if things seemed to be getting worse.

 

I don't know if a 24 or 48 hour period is suitable for me or for you but so far it has kept me out of sticking to some bad decisions. I've been getting better on my stabilization journey so I think it has some merit. This is why keeping daily notes on your symptoms, medication, supplements, and relevant lifestyle decisions is so important. It helps you see whether certain choices are good or bad for you. 

 

In summary then: 1mg seems like the logical dose for you, so dropping to 2.5mg for now is worth a try. However, it is up to you if you want to take that risk but if things go wrong, we are here for you and at least you will have found out that you've reached your new baseline dose. If things go wrong, you can always go back to 3.75mg, or if you are able to divide your doses with such accuracy, you could try 3mg. 

 

Withdrawal is scary but the kinds of decisions you will make with the help from this website are much safer than the ones that brought you here in the first place. I am here because I made dangerous choices with my SSRI: alternate day dosing, fast tapering, stopping cold turkey when I was on a low dose, etc. Many people made choices just like mine and sadly, mine were all following doctors' advice! 

 

I mentioned earlier in your thread to rate which symptoms really freak you out. You can share them here if you've noted them. Maybe we can get to the bottom of them, see if there's a pattern, maybe you can learn that some of your symptoms aren't too scary. I noticed you've had something like paresthesia. I have it mostly in my hands but in my feet too. I saw the doctor and fluoxetine is likely the culprit. It is scary sometimes if I dwell on it but in reality, it hasn't stopped me doing anything yet. 

 

Anyway, I tend to write too much or ramble, so sorry for giving you a wall of text. I've highlighted the important bit anyway. Let us know what you decide to do. 

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Isabel

Thanks for advice. It may have provided some clarity. Because I reinstated I'm still trying to find my baseline? So you think 3 weeks at current dose isn't stable yet? I just can't risk jeapirdizing my current function level if it goes wrong which is why I'm hesitant. How can I know if where I'm at is my WD normal and I now need to taper.

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Isabel

I also don't want to switch to liquid and don't have a scale. Any ideas how to get accurate dosage?

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Kittygiggles

Because I reinstated I'm still trying to find my baseline? So you think 3 weeks at current dose isn't stable yet? 

 

I think you just summarized my entire post much more succinctly! Yes, I think there's a strong chance that your baseline is closer to 1mg than 3.75mg or even 2.5mg. 

 

I reinstated too high at 20mg and I am stuck with that now as my baseline. I guess that's why I am advocating trying 2.5mg if you are willing to take a risk. Your brain gets used to 3.75mg each week you stick to it, which closes the window of opportunity to drop down to 2.5mg.

 

Although I did reinstate too high the symptoms I have now are pretty much the ones I had when I reinstated too high, and it's been a 7 month stabilization journey. Some of the symptoms are slightly worse and I would have been better off at a lower dose but overall, I'd consider my journey to becoming stable a success. 

 

So, if you really are coping well with your current symptoms, you can just stick with 3.75mg but be aware that if you adopt it as your baseline, the short term plan described earlier by mods to drop to 2.5mg will no longer be as safe for you. You'll need to taper slowly then from 3.75mg using the 10% or less method. 

 

Frankly, I'm at a loss to recommend anything but liquid. I racked my brains for all kinds of alternatives to weighing scales, as I find tiny doses hard to measure accurately. I looked at volumetric methods but the powder is hard to manipulate when it is dry and it is hard for me to get the right consistency. Liquid or water titration is really, really easy and makes it possible to divide doses down to the microgram level, which is more than adequate for safe SSRI tapering. 

 

Is there any reason you don't want to switch to liquid? I am going to retry liquid quite soon but I'll go slower this time; it's definitely worth it I think as you are dealing with very small doses already. 

 

You should only taper when you are stable, which means that having daily records of your symptoms, you notice that for a significant period, I'd say at least 2 months, your symptoms are predictable, tolerable, and do not vary at all. For example, you may notice that every evening you might get paresthesia but it's no big deal, or once a week, you'll get a few hours of dizziness and headaches but it's the same each week and you can work around it. The same goes for stressors in your life: for exmaple, if you are working, if doing an extra hour at the end of your day makes some of your symptoms worse, you make allowances for that. It's really about having a record so you can know that when you make a single change, such as tapering, you can see clearly how it will affect you.

 

So being stable means being able to predict your symptoms like clockwork and that they are probably as mild as they can get. The latter part can be determined by just waiting an extra month or two to be sure. Some people's stable means putting up with some nasty side effects, other lucky peeps only have to put up with the occasional inconvenience or very mild irritation. It varies wildly unfortunately but the common factor is that the sufferer knows that things are stable. In my case I think I am getting very close to stable so my decision is to ride it out longer without changing anything and record my findings. In about two months I'll see how I am and then decide based on the data I've collected whether to begin tapering.

 

Have you started recording your symptoms yet? It can be a couple of sentences a day if you find it tedious or stressful. Sorry for going on about it but it is just so important to me so I strongly advise it at all costs! :P

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Isabel

Thats what I'm afraid is happening. I might now have this dose as baseline. I've not specifically recorded symptoms but I can tell from my posts here, I've had some improvements but also varying symptoms. I just read about others who can't get out of bed and have horrible symptoms which I guess since I'm having an ok day I'm afraid to change. Did you stay at 20 too long and it became your baseline. In the past I've gone up and down and didn't notice any symptoms with dosage change which is why I am afraid this time is different and I'm going to have to taper at 10% for a long time. I don't know about tolerance and if I keep taking it what happens.

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Isabel

What is water titration?

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Kittygiggles

What is water titration?

 

I might now have this dose as baseline. I've not specifically recorded symptoms but I can tell from my posts here, I've had some improvements but also varying symptoms. I just read about others who can't get out of bed and have horrible symptoms which I guess since I'm having an ok day I'm afraid to change. Did you stay at 20 too long and it became your baseline. In the past I've gone up and down and didn't notice any symptoms with dosage change which is why I am afraid this time is different and I'm going to have to taper at 10% for a long time. I don't know about tolerance and if I keep taking it what happens.

To avoid rambling I'll address your points in order, with bullets :)

  • Water titration is just another term for turning your SSRI capsule or tablet into a liquid using water. Some SSRIs are fully soluble in water, in my case fluoxetine is. 
  • You can still cut doses using 'dry' methods, such as cutting pills, measuring the mass of powder in capsules. There are guides I think that have been linked to you in this thread. They are very detailed and take you through the process, along with people's accounts of success with doing so. I just found it difficult but that doesn't mean it is intrinsically. 
  • I doubt 3.75mg is your new baseline after 3 weeks but I am just guessing. 
  • You really should record symptoms! :P
  • Lethargy is one symptom that can appear either from withdrawal or as a side effect from taking an SSRI. In my case, fluoxetine has kept me in bed pretty much as long as I've been taking it. I get out of bed whenever I can but it is a struggle. Getting out of bed was no problem without fluoxetine, I was rarely in it!
  • One OK day is not indicative of your stability, you need to record your symptoms over a long period to determine whether you are stable or 'OK'. Hopefully things stay OK for you though, it is very possible that things will be okay at 3.75mg
  • Yes, I'm fairly certain that my new baseline is 20mg, all the data I've collected suggests this. Had I reinstated at a lower dose, there is a good chance that I could have stabilized at a lower dose, as I was on a very low dose before I jumped off to 0mg. Again, all I have are considered guesses based on evidence. However, the number you choose to stabilize at isn't particularly important, it's really subjective. It's more important to focus on what that number or dose does to you: right now you feel okay at 3.75mg, you may also at 2.5mg. Either one is okay to stick to if you are not bothered by the symptoms too much or they do not adversely and seriously affect your health. 
  • It is dangerous to go up and down in dose, which I'm sure you know by now. I think many of us here, myself included, had no adverse effects when I first started going up and down in fluoxetine dose but eventually it is very likely that doing so will disrupt your brain and cause withdrawal syndrome. So you are right, this time is probably different and you have withdrawal syndrome, in which case you are going to have to taper by 10% or less whether you stick to 3.75mg or 1mg. I think the confusion here is that you've been given a special one-off schedule to get back to 1mg (or 1.25mg as it is exactly quarter of your pill and easier to measure) as soon as is safely possible. The schedule suggested by a moderator seems safe but there is a risk, of course. The risk though may just be a temporary worsening of some or all of your symptoms, which would likely resolve as soon as you went back up to 3.75mg.

I hope I was clear and that it clarifies some of the advice given previously. I hope you are doing okay today.

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Isabel

Thanks for so much info. I just got done reading LexAnger story and it sounds similar to mine so it has me so terrified.

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Isabel

Any moderators think 3 weeks at 3.75 is too long to make the reduction to 2.5 now.

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Kittygiggles

Any moderators think 3 weeks at 3.75 is too long to make the reduction to 2.5 now.

 

You're on the right track asking that question. I hope you get an answer soon. Also, if you don't mind me saying, I think you're suffering from anxiety right now. I'm an anxiety sufferer too. Reading other people's stories can make or break you when you're an anxious person or in a stressed state. It's easier said than done but try to distract yourself from withdrawal (including ruminating over stories) as much as you can. I fail at doing so a lot but I am also getting better at it with time, so I still have great days now! :)

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Isabel

Yes I worry about everything. The variability of all this especially. I worry that I'm not getting s consistent dose. I also go back and forth

With living an ok life on meds or suffering nightmare withdrawal for years to get to what?

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Isabel

Kitty giggles- sorry to bore you but I get confused with rebound depression, reinstatement, withdrawal, tolerance, hypersensitivity. Wow, how do I know the difference? I feel like I'm going down the same path 8 years ago that landed me on meds?

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Kittygiggles
Yes I worry about everything. The variability of all this especially. 

 

I suppose in one sense I am lucky in that my withdrawal symptoms are completely different to my symptoms prior to taking any SSRI. Consequently I could identify withdrawal syndrome very quickly and that was confirmed through reinstatement working within hours. I have anxiety, in particular, 3 different yet significantly overlapping anxiety disorders, and a co-morbid depression. The depression is fairly easy to manage if I treat my anxiety properly. I use Cognitive Behavioral Therapy (CBT) to treat my anxiety and it works very well. I presume you've heard of it and may have done some yourself. I did it without a therapist using excellent books, exercises from which I used and still use daily. I can link the books here or in a PM if you want, they are available on Amazon. I would consider myself about 70 to 80% recovered from my anxiety disorders through CBT alone. To put it in perspective, some days I spend no time dealing with anxiety, most days it is only an hour at worst. SSRIs did nothing for me other than mask some symptoms by giving me a lot more to distract me. 

 

Worrying about everything is a symptom of General Anxiety Disorder (GAD), which you may have if you tended to worry in the same way before medication. CBT that targets GAD is likely to help you. A key to CBT is making records of symptoms and our activities and rating symptoms out of 10 for severity. It sounds trivial if you've not done it before but I swear by it as a great way to improve your insight into your symptoms and condition as well as building a foundation for getting better permanently.

 

The variability of all this is worrying. However, the longer you stick to a dose and the more you monitor your symptoms and routine with simple notes that take minutes, the faster the variability will diminish. Of course there is always variability in most things but you can reduce it from withdrawal hugely and very early on.  

 

I worry that I'm not getting s consistent dose. 

 

It is good to be concerned with consistency. Taking the same amount of medication the same time every day (or as close to it as you can get) will help you so much. Once you settle on 3.75mg, 2.5mg, or possibly lower, you'll get some stability and predictability back into your routine and symptoms. We're waiting on mods to let you know if dropping to 2.5mg is still okay, after that you know what the next step is. Things will be more straightforward from there. Until then try to distract yourself and enjoy anything for as long as you can!

 

I also go back and forth with living an ok life on meds or suffering nightmare withdrawal for years to get to what?

 

It's taken me months to accept withdrawal as just a fact of my life. It hasn't been easy but I have accepted it and for most of the day I can ignore it. In windows, which I am in now, I forget about it completely for most of the day. Hopefully I am getting close to stabilizing and frankly withdrawal is just easy during windows, it's nothing to worry about. You could get to long periods of windows relatively quickly. The latter part of your question hints at catastrophizing, which entrenches your belief that your worst fear is valid. It's a symptom of anxiety and depression and you can learn to slowly stop doing it :)

 

Nightmare withdrawal for years isn't the norm from what I've seen but I am new here. My withdrawal is the worst thing I've ever gone through but I am so much better now than before I reinstated. My withdrawal journey started about 8 or 9 months ago. It was a nightmare at the start but it got better slowly and steadily. I've had to work a bit harder with my CBT to treat my anxiety, and I've used elements of CBT to help me accept withdrawal and deal with some of the symptoms. This website has helped immensely with all the links from moderators and their insight. I feel great today, aside from a couple of side effects from taking fluoxetine, withdrawal isn't affecting me at all! :)

 

Kitty giggles- sorry to bore you but I get confused with rebound depression, reinstatement, withdrawal, tolerance, hypersensitivity. Wow, how do I know the difference? 

 

I'm not bored! :P If I'm helping even a little bit, then I'm happy :) In return, I'm sorry for rambling!

 

Rebound depression: this is a possibility but in my humble opinion it could be that your SSRI wasn't doing much for your depression anyway and you were coping with it yourself. In that sense, it wouldn't be a rebound but perhaps an intensifying of your depression that has always been there. In any case, I recommend CBT for depression. From what I can tell from others, depression is really one of the hardest things to treat as it has so many symptoms that have to be tackled with varying techniques and it can feel overwhelming but I've treated aspects of mine successfully with CBT. For example, rumination is a symptom that I had to tackle for my anxiety disorders but using the same techniques I've almost cured my depressive rumination. 

 

As for what you are fighting for, well it's not like everyone here has a choice: we have withdrawal and we now have to deal with it sadly. Most stories I've read here vary but quite a lot of people have lost relationships, resources, finances, time, opportunities, due to withdrawal and SSRIs. I've been brought to my lowest points thanks to withdrawal and fluoxetine but in dealing with withdrawal, I have found an inner strength that amazes me. I don't want to let that part of me down! I've come to appreciate simple things that have changed my life: such as all the animals and insects around me (I live in the countryside), every good hour in a day that I've fought hard for, laughter (it's amazing when it happens). More importantly, seeing real proof of my progress through my diary is inspiring. I see good times that are clearly better than earlier periods, so when I get hit with a wave I realize it isn't as bad as previous waves and I got through them. 

 

Reinstatement is what you are doing now and in my experience with time, you will start to decipher what is what: you need to make records though!

 

I feel like I'm going down the same path 8 years ago that landed me on meds?

 

Possibly but you don't have to take meds this time. I'm not sure what led you to medication; if I were to guess, it would be depression and anxiety, is that true? If so then CBT could help you overcome them. As a layperson it is my opinion that SSRIs do not treat anxiety and depression. Some people get better in time on SSRIs, which could be a change of circumstances, reduction in stress, or that the conditions were self-limiting. Others get better with SSRIs and CBT but I would bet that it is the CBT doing the hard work in those cases. Studies have varying results on the efficacy of SSRIs and I am trying to read through them but so far the best ones that support SSRIs don't have very high success rates over placebo, and usually only in cases of major depressive disorder. Still though, it's just my opinion so far and I always change my opinion when presented with new evidence!

 

Don't dismiss this 8-year journey as one where you learned nothing about yourself or how to get better. The fact that you're still here, willing to fight even a little bit, is an accomplishment. 

 

My summary advice is: hang in there, by your fingernails if necessary, and wait for a mod to get back to you. Treat yourself well if you can by reducing unnecessary stress. Make a record of your symptoms! Distract yourself from withdrawal as much as you can, worrying about it never got me anywhere and I spent so much time doing that! Also, perhaps it isn't said much or very often but forgive yourself for mistakes, or losing time to symptoms and withdrawal, it isn't your fault and it is temporary :)

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Isabel

Thank you so much for taking your time to address all my thoughts. It has helped so much! Yes you can link the CBT here. Is there a way to get a moderator to reply. Been waiting and each day that goes by is another day on this dose.

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Kittygiggles
Thank you for saying thank you :D I am new around here but I think it is okay to message a moderator directly from time to time. I just imagine they are very busy dealing with all the new people that come here and the existing members; it's a lot of work! So in your case, send a message to mammaP with your question, I think it will be okay and she'll more likely get back to you sooner. You can do that by clicking on her profile from her message in this thread. 

 

As for CBT, here are the books I've used, still use, and swear by. I am not sure if there are newer editions in print. I am not affiliated with the publishers or authors in any way. You can probably get them all second-hand as well. The Overcoming series books are used in clinical settings in the UK as part of the health service there. The OCD book I recommend may not be relevant but I thought I'd include it as part of the anxiety spectrum. 

 

To any mods: I am not sure if I am allowed to post links to books or recommendations, so I apologize for not checking that rule before posting this, sorry!

 

For general anxiety and GAD, this book is excellent (Overcoming Worry and Generalised Anxiety Disorder (Overcoming Books) Paperback – May 7, 2015):-

 


 

If you are prone to health anxiety, this book will challenge you to embrace the scary things that really worry us, like death, serious illness, and the uncertainty of health (Overcoming Health Anxiety: A Self-Help Guide Using Cognitive Behavioral Techniques (Overcoming Books) Paperback – November 26, 2009):- 

 


 

If you feel you are more in the realm of suffering from panic, this can be useful (Overcoming Anxiety: A Books on Prescription Title (Overcoming Books) Paperback – October 1, 2012):- 

 


 

I am not sure if I can link websites here but if you ever have a panic crisis, this website and charity have been invaluable to me in the past and I still refer to them for their knowledge on all things anxiety-related:- 

 


 

I think depression is a tough one but despite that, this book really helped me in the beginning, especially putting things into perspective and helping you sort out your symptoms, whether you have just depression or more than that (Overcoming Depression: A Self-Help Guide Using Cognitive Behavioral Techniques Paperback – September 8, 2009 by Paul Gilbert):- 

 


 

Finally, if you have OCD, there is no better book than this as far as I know. It is remarkable (Break Free from OCD: Overcoming Obsessive Compulsive Disorder with CBT Paperback – October 17, 2011):-

 


 

As for advice from this website, there are some good links in the "Non-drug techniques to cope with emotional symptoms" thread and under the self-care section of the forum in general:-

 


 

Happy reading, when your symptoms let you :)

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Isabel

Need advice please! I got a digital scale and found out I've been getting 4mg instead of 3.75mg lexapro x3 weeks. I was supposed to cut to 2.5 after 2 weeks and noting symptoms. I don't know what to do now. Hold or decrease to what dose. I'm having Side effects and withdrawal I think. Inside my head feels"cold" and I'm nauseous when that happens. Pins and needles. Symptoms vary. Other times head feels hot. Face and neck usually red. Any of those more experienced have advice? I reinstated too high per dr. Stopped at 1 mg and dr wanted me back up to 5mg. But I did 4 mg instead. Is it too late to drop quickly from 4 to 2.5mg. Anyone else reinstate too high and feel better decreasing. I know CNS is in such a state cause if ups and downs.

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Isabel

I understand and appreciate your reply. Just having some other thoughts is nice. No I have not heard from a mod and it's getting frustrating waiting to know what they would recommend.

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AliG

Isabel. As it has been quite a few weeks now since the original advice to taper more quickly was given , I would hold for now and stabilize. You have had quite a few changes and to drop too fast now could possibly just create more instability and therefore an increase in symptoms. 

 

Holding is often the best solution as it gives your CNS time to catch up with the many changes it has experienced lately.

 

It would help to keep notes on your symptoms over the next few weeks so as to ascertain whether your symptoms are settling or ramping up. That should hopefully be enough to tell whether they are the result of side effects or withdrawal.

 

The body is always trying to reach homeostasis and by holding for a while you can possibly achieve that. After a period of time you could continue with the 10 % taper method when you are feeling more stable and less symptomatic.

 

http://survivingantidepressants.org/index.php?/topic/3949-stabilizing-after-a-reduction-what-does-that-mean/

 

http://survivingantidepressants.org/index.php?/topic/1008-before-you-begin-tapering-what-you-need-to-know/?p=249388

 

In the meantime there are many alternative measures that can help soften and / or alleviate some symptoms.

 

We recommend fish oil and magnesium.

King of supplements: Omega-3 fatty acids (fish oil)

Magnesium, nature's calcium channel blocker

 

Melatonin can help with readjusting the sleep cycle but start small - 0.25mg . you don't need much . Less is more. 

Melatonin for sleep

 

It would pay you to acquaint yourself with these techniques also as they can ultimately help you become drug free. 

Non-drug techniques to cope with emotional symptoms

 

It can take a little while but if you hold, taper slowly and learn to manage your symptoms along the way then you should be fine.

 

Ali

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Isabel

Thanks for the advice. So the original plan was to dose 3.75 x 2 weeks and observe which they didn't say for how long. Then drop to 2.5. And observe. Now it seems your saying that schedule is too fast? If the thinking is that I'm on too high a dose, why would I want to try to stabilize there? My symptoms have been the same for three weeks. Shakiness/electric feeling in hands, crawling feeling legs, Hot cold sensations in head and like I can feel avctivity, heart palp? This is all CNS unstable or too much lexapro?

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Isabel

I've been waiting for days to hear back from a moderator to know what to do and possibly list a window of opportunity?

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Isabel

I forgot to mention, last night I took 3.5mg instead of 3.75-3.9mg cause I hadn't heard back and didn't know what to do. What dose do you recommend. Does the CNS react to these variances?

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Isabel

Sorry I thought of one more thing- how do I know if I have tolerance to it or "poop out" if that's the same thing. Won't continuing to take it be bad if that's the case?

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Kittygiggles

Hi Isabel,

 

Sorry for my previous post; I assumed you weren't accounting for the gross weight of your capsule, which was a mistake on my part. On top of that though I assumed you somehow managed to extract pure lexapro and were weighing that, so I apologize. I think I managed to confuse myself today with this so I should have thought it through more. If a mod would be willing to delete my previous post I'd be grateful as I can see my post makes little real sense. I'll refrain from posting in a hurry in the future and think things through! 

 

I understand your frustration and confusion as to whether you're experiencing symptoms due to too much lexapro or withdrawal, or a strange combination of both. You can still make the choice to drop to 2.5mg but what AliG is saying is that after about 3 weeks at 3.75mg the risk of an adverse reaction (please see following post regarding this) is now greater. I suggest really making a note of all your symptoms past and present, as best as you can remember, to help you work out what could be the cause of your current symptoms. 

Edited by ChessieCat
added note re following post

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Isabel

I do take note of symptoms but that doesn't really tell me too much. I just don't understand how I can be in withdrawal if I am taking this stuff. Would a small dose reduction to 3.0 or 3.25 mg be bad. I'm pretty sure it's a combo of both. I mostly have headache, weird head hot/cold and pins/needles. These all came about within the last 2-3 weeks and pretty much every day. When I reinstated at 2.5 x 2 weeks I had insomnia, no appetite and intrusive thoughts. Am I correct to assume its dosage related then? I have a hard time understanding tolerance. Is it that I just have to pick a dose and hope it gets stable at some point. What a guessing game this is. Wears a person down trying to figure it out. I know when you reinstated you said you felt better right away. Any mod available on thoughts on dose.

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ChessieCat

Kittygiggles:  "what AliG is saying is that after about 3 weeks at 3.75mg the risk of an adverse reaction is now greater."

 

AliG:  "it has been quite a few weeks now since the original advice to taper more quickly was given , I would hold for now and stabilize. You have had quite a few changes and to drop too fast now could possibly just create more instability and therefore an increase in symptoms. 

 

Holding is often the best solution as it gives your CNS time to catch up with the many changes it has experienced lately."

 

Keep it Simple, Slow and Stable

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mammaP

Hi Isabel, I just caught up with your thread, You didn't cut down to 2.5 yet, and have been taking  4mg instead of what you thought was 3.75? 

 

Today you took 3.5? How are you getting those amounts, is it by cutting? If you are afraid of using the liquid that you have been prescribed you could make a liquid with water. You can find instructions how to do that here.....

 

http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/

 

It is quite simple when you get used to it and much more accurate than cutting. As you have  taken 3.5 today you could stick to that dose for 2 weeks and see how you get along with it but I cannot stress enough the importance of accurate dosing. You may still be able to reduce faster than we normally recommend but with smaller cuts than originally advised because of the time that has passed. 

Often the side effects lessen as the dose lowers but we have to be careful not to go too fast and have withdrawal. 

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Isabel

I have a digital scale to get accurate dosing. No I hadn't reduced to 2.5 cause I had questions but hadn't heard back from mod and then another week passed by.

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Isabel

My best guess is for three weeks I've been getting 3.7-4.0 mg. What dose should I try?

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Altostrata

Can anyone explain the difference between adverse reaction to reinstatement at a high dose or withdrawal? I'm trying to determine if I should cut to 2.5 from 3.75mg to alleviate reaction but will I also be getting withdrawal symptoms? Emotionally ok but feel "shaky" in hands and head has burning and "busy" feeling that's hard to describe. Is this glutamate? I'm not taking my other supplements cause I'm afraid of reaction to those.

 

Hi, Isabel. When you get a bad reaction to an increase in dosage, that is an adverse reaction to the drug. When you get certain symptoms after reduction of a drug, that is withdrawal.

 

Either of these can upset your nervous system, which is a complex, delicately balanced web of interactions between many hormonal and chemical processes. That is what they have in common: Nervous system upset.

 

I know I ask a lot of questions but still have them with no answers. 3.75 mg x3 weeks. Sleep and appetite better but not great. Still weird hot and cold head feelings and shaky hands. Does this mean I'm at WD normal? Still decrease to 2.5 or try 10%? I've read all the digital scale and percentage calculations but still don't quite grasp it. So scared to try any supplements like magnesium or fish oil cause I think I react to it so it's tough to tough it out without anything.

 

It sounds like you're doing better at 3.75mg than at 5mg. Since you reduced, have your symptoms gradually getting better, worse, or are they the same?

 

It's very important that you keep daily notes on paper about your symptoms, when you take your drugs, and their dosages.

 

I understand you are cutting a tablet and weighing it to take 3.75mg Lexapro. It's important to understand that a 10mg Lexapro tablet doesn't weigh 10mg, the 10mg refers to the drug content of the tablet, which also contains fillers, as Kittygiggles explained. So to get to 3.75mg Lexapro, you need to find the weight of the tablet (an average of several of them) and then using a percentage to figure out what weight to take.

 

3.75mg out of a 10mg tablet would be 37.5% of the weight of the tablet, verified by your scale.

 

If you've been a little off in your measurements and have been taking 4mg, that's okay, as long as you are consistent. What's important is how you feel. Your symptom pattern will indicate whether that's too much for you or not. If it's not too much -- if you continue to feel a bit better -- whatever you're taking is fine.

 

(For the sake of your tapering schedule, it would be a good idea to determine how many milligrams of Lexapro you're taking. Weigh a half-dozen of your tablets to determine the average weight of one tablet. What weight of tablet fragments have you been taking? Then we can do the math to determine your current Lexapro dosage.)

 

I agree with both AliG and mammaP, holding would be a good idea right now, to observe how you're doing at your current level.

 

What time of day do you take your drugs? How is your sleep? What is your current sleep pattern?

 

Don't worry about receptor occupancy -- what we go by is how you're feeling. We can't see what's going on with your receptors, there's probably a lot of individual variation in the rate of receptor occupancy.

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Isabel

Thanks for your recommendations. I have decided as per advice of mammaP to stick with the 3.5 x 2 weeks and observe. Do you think this is too big of a reduction if I was taking 3.75-4.0? I have noticed pins/needles but had those before too. I take dose at bedtime. Sleep still varies. I do have cortisol mornings with increased anxiety and difficulty falling back to sleep. Should I try fish oil however I read something which I can't recall about if there is too much of something it causes worsening of symptoms? Any info on this. Right now too afraid to take anything because of paradoxical affect.

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Isabel

Can I take Tylenol or Advil for headache?

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mammaP

Fish oil is very good  and you could try the lowest dose to start and build up. Epsom salts baths are very good too and the magnesium is absorbed through the skin. I use a LOT when I get a bath but just a handful is best to start with when you are not used to it.  Magnesium is in the soil and the food we eat but is deficient with todays farming methods. 

 

It is important that your lexapro doses are consistent so make sure you take the same dose every day and keep notes on your symptoms so that you can see what changes. Don't change the doses so  your brain can adjust to the new dose of 3.5. Hopefully this will ease some of the symptoms with each drop. 

 

If you can get some paediatric tylenol you could try a very small dose to see if you are ok with it. I can't take an adult dose but can take the same dose a 6 months old baby takes and it can help. I can only do that occasionally, some people tolerate it very well. Have you tried  cold compress on the forehead or the back of the neck? That can help a headache as they are often caused by muscle tension. 

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Altostrata

Magnesium can be effective for headache.

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