ikam: tapering escitalopram

[mammaP]

You might find this interesting.......http://survivingantidepressants.org/index.php?/topic/2533-that-acid-reflux-pill-may-be-causing-your-health-problems/

[ikam]

I have stomach problems as well.  Get terrible pain and burning in my stomach and through to my back, and it affects my swallowing sometimes and gives sore throat.  Was on panteloc for years but don't take it anymore because I am afraid of nutrient defficiencies with no stomach acid to digest food.  I am also diabetic so I take meds for that and low dose aspirin which are both hard on my stomach.  It is horrid and I am sorry you deal with this.  I also have burning and tingling and pain in my arms and legs and feet, so I am sure the tingling in your hands is withdrawal related.  Sending positive vibes your way.

Thank you. And vibes back to you

I have some acid reflux that has gotten worse at present. I wake up each night with severe nausea. I want to stop one day antiacid meds...I have had long-term esophagus infection. GP said that I need to deal with stomach acid that irritates esophagus...

 

I bought slippery elm today...hopefully I can lower the dose of antiacid meds...

 

Yes, I am beginning to accept that this tinggling is related to withdrawal, apparently due to serotonin excess...

I wonder why it gets worse at night?

[ikam]

Day 7- I have felt almost normal today drove my car after 10days of not driving...got a trsin, underground and another train...went to my favourite part of london, had some meal, walked alongside the river, did some shopping and back home:)

No excesive sweating at all, no dizziness, a bit weak, what is to be expected after spending almost one week home...

I am winning!

 

As I said before, my father was a doctor, psychiatrist, I trusted him, I had no other choice as a child than to take all these antibiotics and meds. I used to be ill so often, five times in hospital in my childhood...

 

I think it is only now when I started questioning doctors/my father...

[ikam]

You might find this interesting.......http://survivingantidepressants.org/index.php?/topic/2533-that-acid-reflux-pill-may-be-causing-your-health-problems/

Thanks. My PPI has been recently changed and added ranitidine...

I have been still waking up with severe nausea at night, which is only relieved by extra ranitidine...

My esophagus is badly infected...

 

I bought something called slippery elm today. I want to stop PPI and stay on ranitidine for some time...

[Ever]

Day 7- I have felt almost normal today drove my car after 10days of not driving...got a trsin, underground and another train...went to my favourite part of london, had some meal, walked alongside the river, did some shopping and back home:)

No excesive sweating at all, no dizziness, a bit weak, what is to be expected after spending almost one week home...

I am winning!

EXCELLENT EXCELLENT EXCELLENT IKAM!

 

Now to work on the reflux and nausea. I remember having this - still have a tiny tiny bit now I think about it - can't remember what I did to fix it. I'll have a think and get back to you. Or maybe you could search the site for it.

 

But very glad you are feeling better

[ikam]

 

Day 7- I have felt almost normal today drove my car after 10days of not driving...got a trsin, underground and another train...went to my favourite part of london, had some meal, walked alongside the river, did some shopping and back home:)No excesive sweating at all, no dizziness, a bit weak, what is to be expected after spending almost one week home...I am winning!

EXCELLENT EXCELLENT EXCELLENT IKAM! :)Now to work on the reflux and nausea. I remember having this - still have a tiny tiny bit now I think about it - can't remember what I did to fix it. I'll have a think and get back to you. Or maybe you could search the site for it.But very glad you are feeling better

Thank you ...it is good to have people around!

 

I bought something called slippery elm today...i have been so long on antiacidic meds...

 

I think I am ready for my next reduction, as I have to get rid from escitaploram, then get balanced on doxepine and at some point consider stopping doxepine as well...

[Frustrated]

 

 

Day 7- I have felt almost normal today drove my car after 10days of not driving...got a trsin, underground and another train...went to my favourite part of london, had some meal, walked alongside the river, did some shopping and back home:)No excesive sweating at all, no dizziness, a bit weak, what is to be expected after spending almost one week home...I am winning!

EXCELLENT EXCELLENT EXCELLENT IKAM! :)Now to work on the reflux and nausea. I remember having this - still have a tiny tiny bit now I think about it - can't remember what I did to fix it. I'll have a think and get back to you. Or maybe you could search the site for it.But very glad you are feeling better

Thank you ...it is good to have people around!

I bought something called slippery elm today...i have been so long on antiacidic meds...

I think I am ready for my next reduction, as I have to get rid from escitaploram, then get balanced on doxepine and at some point consider stopping doxepine as well...

It's definitely a process. I am confident you will get there. Keep plugging away.

[Songbird]

I bought slippery elm today...hopefully I can lower the dose of antiacid meds...

 

I have heard that apple cider vinegar is also supposed to be good for this.

[ikam]

Hmm...last night I had my "normal" anxiety, which I feel in the middle of my chest. No parasthesia! No night sweating!

 

But, headache in the morining and worrying about my future..."what ifs"...and feeling trapped...i want to get back to london, but if I dont get job...etc. etc.

 

Feeling rather low today...

[ikam]

 

I bought slippery elm today...hopefully I can lower the dose of antiacid meds...

 

 

I have heard that apple cider vinegar is also supposed to be good for this.

I heard about apple cider vinegar as well. Need to look on net for this...dont want to throw too many things at one time...

Felt nauseous as usually in the morning, had stomach ache and took eventually omeprasole...

I dont like this, as it seems I only increase antiacidic meds with no result...

 

Some time ago I heard that actually low acidity can create similar symptoms...

[ikam]

Feeling exhausted today...

[ikam]

I am thinking about a further reduction tomorrow. Bit worried, but I can always reintroduce my dose if my withdrawal will become unmanageable, yes?

 

I have also taken the decision that I will not deal with any other drugs at present, such as ppi, as I need to do one step at a time.

 

I will not add any supplements at present.

 

I want to keep it all simple...

 

Big step tomorrow...as I have been so short on escitaploram, I am going to try to get it to 2.5mg tomorrow...i will use a liquid preparation for this, I have my syringes ready...

[dalsaan]

Ikam

 

I think you are right to hold off making any changes at the moment. Your system seems destabilised to me. I wouldn't make any cuts to anything or introduce anything new for a month or more to see if you can stabalise your symptoms. I know you think that you can easily chop and change your medication because you haven't been on it for long (in the context of your long term use of drugs)

 

But, you've been on it long enough for it to matter.

 

The reality us you have made a lot of changes in the last 3 months. Since 24/10 it appears you have dropped diazepam and Zolpidem (where you taking these regularly-it's not clear) started a new AD, increased it and decreased it.

 

Your brain is not made of rubber. You can't jump around like this and expect it to bounce back. Give it a holiday!

 

At any rate, your proposal to halve your dose is a much greater drop than we would ever recommend. Please read through this thread http://survivingantidepressants.org/index.php?/topic/6632-the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable/

 

I think you are still looking for a pill to fix your problem (starting one, taking more, taking less). This site us about getting off medication, safely and finding other ways to address our issues.

 

Dalsaan

[ikam]

Ikam

I think you are right to hold off making any changes at the moment. Your system seems destabilised to me. I wouldn't make any cuts to anything or introduce anything new for a month or more to see if you can stabalise your symptoms. I know you think that you can easily chop and change your medication because you haven't been on it for long (in the context of your long term use of drugs)

But, you've been on it long enough for it to matter.

The reality us you have made a lot of changes in the last 3 months. Since 24/10 it appears you have dropped diazepam and Zolpidem (where you taking these regularly-it's not clear) started a new AD, increased it and decreased it.

Your brain is not made of rubber. You can't jump around like this and expect it to bounce back. Give it a holiday!

At any rate, your proposal to halve your dose is a much greater drop than we would ever recommend. Please read through this thread http://survivingantidepressants.org/index.php?/topic/6632-the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable/

I think you are still looking for a pill to fix your problem (starting one, taking more, taking less). This site us about getting off medication, safely and finding other ways to address our issues.

Dalsaan

Dalsaan, you are right. The only explanation for making it quicker relates to the adverse response I get using ssri and tryciclic antidepressant at the same time.

The question is what is safer, to have an adverse response or to have a withdrawal? Not easy question to answer. I will definitely be mindful of any extra load I put on myself and reinstate the dose if needed...

My problem with escitaploram has started from having an adverse response, apparently metabolism of doxepin was affected givingb me an extra bust of serotonin...

[Songbird]

The question is what is safer, to have an adverse response or to have a withdrawal? Not easy question to answer. I will definitely be mindful of any extra load I put on myself and reinstate the dose if needed...

 

I agree, it is hard to tell what is withdrawal and what is adverse reaction.  Since you felt better on 5mg than 10mg it seems more like adverse reaction.  Normally a very slow taper is recommended, but personally I think this may not apply in your particular case.  You could try the 2.5mg and if bad w/d kicks in, then go back up to 5mg for a good while.  But if you are okay on the 2.5mg you could stay there a couple of weeks then stop.  Bear in mind it is likely you will have some symptoms for a while whatever you do, but hopefully they will be relatively mild and tolerable.  You should avoid the naratriptan as it messes with serotonin.   Also I recommend making no changes to your other regular medication.  You might want to think about tapering the PPI in future, but try to leave it stable for now.

[dalsaan]

Ah yes I missed the doxepin interaction. Sorry I read your signature as you finishing that in 2012. That would warrant tapering down faster.

[ikam]

Ah yes I missed the doxepin interaction. Sorry I read your signature as you finishing that in 2012. That would warrant tapering down faster.

No problem. I value your input. It is great that there are others who respond suggesting the best protocols. And I value this more than doctors perceptions that are not based on experience, but dictated by big pharma.

 

Anyway, I got scared in the morning and took 5mg...

I have been feeling moreless settled last three days and didn't feel like upsetting my balance by further cut.

I am trying to be mindful of harm caused by staying on it, but also harm if I decrese too quickly.

 

There is another problem, if I manage (i hope) to get a job I will not have free time for a long time, so no time for withdrawal...it could take me for year or so to stay on it...

 

Difficult choices...

 

I will think it through today...but I still think I need to make a further reduction, I am only scared of it. But I was also scared when I cut down to 5mg and after one week I felt much better...

[ikam]

 

The question is what is safer, to have an adverse response or to have a withdrawal? Not easy question to answer. I will definitely be mindful of any extra load I put on myself and reinstate the dose if needed...

 

 

I agree, it is hard to tell what is withdrawal and what is adverse reaction.  Since you felt better on 5mg than 10mg it seems more like adverse reaction.  Normally a very slow taper is recommended, but personally I think this may not apply in your particular case.  You could try the 2.5mg and if bad w/d kicks in, then go back up to 5mg for a good while.  But if you are okay on the 2.5mg you could stay there a couple of weeks then stop.  Bear in mind it is likely you will have some symptoms for a while whatever you do, but hopefully they will be relatively mild and tolerable.  You should avoid the naratriptan as it messes with serotonin.   Also I recommend making no changes to your other regular medication.  You might want to think about tapering the PPI in future, but try to leave it stable for now.

I am almost back to normal at present. Don't get paresthesia at night anymore, just my normal cortisol mornings, meaning feeling anxious, but maneagable...My thinking is much more clear, my concentration better and I don't sweat as much. I went to town, drove my car. I am getting bored in times, which is also good sign...

 

Unfortunately, got scared in the morning and did not reduce it...

 

I think I definitely had an adverse response. Almost next day after decrese I started feeling better...I had some withdrawal symptoms, but it seems I am almost back to normal after one week...

I remember it lasted much longer when I was in a slow effexor tappering. Sometimes had to stay for longer on a certain dose, especially towards the end of tappering. And afterwars I dealt with ppi and atenolol. I was meds free for over one year...i restarted when phisical pain kicked in, had many unexplained pains, and chronic, everyday pelvic pain...

So I need to know how to deal with any phisical pain or illness as they seem to be trigger points for me...

 

I realised about naratriptan and destroyed it...

Still don't know how to deal with a migraine in a different way. I think magnesium helps?

 

So, summarising, I have to get brave again and make a further cut...If I will have any extra and unmanageable symptoms I will get back to 5mg...

[ikam]

I wonder if and how people prepare for a possible relapse?

 

I am really surprised that I did not notice any obvious signs. I was really proud of myself when I eventually managed to tapper effexor and other meds. I was using few supplements and had a very balanced diet...

 

Then the phisical pain kicked in. Also I had type of ibs symptoms, and I was diagnosed by a doctor with...pancreatic failure. I was put on pancreatic enzymes and had many health investigations. Put on more meds. I found some naturopath, she helped me to stop pancreatic enzymes and deal with leaky gut symptoms. She was unable to deal with my pelvic pain/i was unable to seat, but had to in my work. So I started codeine and doxepin. Then atenolol was added as prevention for my migraines...

And so on, so on...

 

I minimised my problem...

Until now, when I am hit by my present awarness...kind of shocked...

This time I have found myself with more meds interacting with one another...hence dealing with a difficult decision, as I cannot do just a "simple" tapper...

 

How to prevent it?

[ikam]

I am finding this next step a bit difficult. My hopes are based on my recent decrease, that it has had more positive than negative effect. Today, on my 9th day I feel back to normal...

It is difficult to predict what will happen next...

I feel as if I want to stay at the present, as it seems less disturbed level for life.

But I am aware that the combination of meds I am on, their interaction increases serotonin to the toxic level...So I need to make a logical choice...

I don't know what to expect? I only assume that I will not get worse than in my previous decrease. I am actually much better today...

[ikam]

Hello again...i am worried I may get some symptoms I don't know how to deal with...when I was on effexor the worst was vertigo, but it only happened when I did not know any tappering protocol...i never had it when in slow tapper...

 

What are brain zaps? How do you feel them? What do you do when you have them?

What are electric shocks?

 

When to decide that it is too much and get back to a previous dose?

[cymbaltawithdrawal5600]

Ikam,

 

I moved your post above to your topic and am copying Alto's post in response to another topic like this that was started:

 

 

Posted 10 March 2014 - 08:33 PM

See our discussions about brain zaps http://survivinganti...288-brain-zaps/

 

Often, if you use Search in the Symptoms forum, you'll find existing topics you can add to.

 

Hope this helps. Often, in doing a search, you will find so much more that answers your question than if you start a new topic.

[cymbaltawithdrawal5600]

In reading in your topic about the interaction between escitalopram and doxepin causing 'serotonin syndrome', I set off to find out more about it, specifically the "time frame' of it starting and when it is likely to happen. You have been on the 2 drugs for some time, SS usually manifests within about 6 hours (according to this one article I am reading). But the addition of just one item, an over the counter cough suppressant, dextromethorphan, reacts with escitalopram and can cause SS.

 

Just something to keep in mind. I looked up the cautions for dex and your drug is not specifically listed, others are. It must not be a very common reaction and maybe it is a case of erring on the side of caution.

[mammaP]

Ikam I am really glad that you are feeling much better and personally think that while you are feeling so good 

you might be better to hold there for a while longer, maybe the reaction isn't as great at this lower dose as 

side effects are dose related in most cases.  It might be better to make very small cuts more often to avoid a

large drop at once which will no doubt cause some destabilising. It is a hard call and I feel for you! 

[ikam]

I need to get my calculations right. I have 10mg tablets, so 10mg =100% =10ml. When I get 5ml out, I get 50% = 5mg.

If I would like to do another 50% cut I need to add more water, so 5mg will equal 100% = 10ml...and make cut from 10ml? Right?

[ikam]

Ikam I am really glad that you are feeling much better and personally think that while you are feeling so good 

you might be better to hold there for a while longer, maybe the reaction isn't as great at this lower dose as 

side effects are dose related in most cases.  It might be better to make very small cuts more often to avoid a

large drop at once which will no doubt cause some destabilising. It is a hard call and I feel for you!

 

I have not decided yet, it is not easy decision. You said to make very small cuts, how often?

As I said I want to get this medication out of my system asap. I don't think I will get the serotonin syndrome, but I have had many signs of serotonine overload, which is related to slower metabolism of doxepin...

 

So complex..

[ikam]

In reading in your topic about the interaction between escitalopram and doxepin causing 'serotonin syndrome', I set off to find out more about it, specifically the "time frame' of it starting and when it is likely to happen. You have been on the 2 drugs for some time, SS usually manifests within about 6 hours (according to this one article I am reading). But the addition of just one item, an over the counter cough suppressant, dextromethorphan, reacts with escitalopram and can cause SS.

 

Just something to keep in mind. I looked up the cautions for dex and your drug is not specifically listed, others are. It must not be a very common reaction and maybe it is a case of erring on the side of caution.

I did not have serotonin syndrome and there is no danger of it as long as I am mindful of any medication...

 

Somebody explained to me what happened:

My problem that began with the higher dose of Escitalopram happened because the person prescribing has little knowledge of drug to drug reactions. Doxepin requires CYP2D6 to properly assimilate. Escitalopram moderately inhibits the CYP2D6 enzyme which allows a build-up of Doxepin. At first, the lower dose still allowed me to manage. But the increase was enough for the problem to show. The sensation i was feeling was from too large of a build-up of serotonin from not being able to process the Doxepin quickly enough.

 

So the reason for faster decrease is to get doxepin to be processed quickly enough...

[cymbaltawithdrawal5600]

That makes sense and that is the piece of information that is not elucidated in the drugs interaction checker, the enzyme problem. The way I read it was that escit potentiates (makes stronger) the dox but it did not say why. So then the use of SS is a kind if misleading shorthand for what may happen.

 

You won't be getting true serotonin syndrome, then? What were you feeling? The mild or moderate ones?

 

You don't really have to answer, it is not that important. I was just curious is all.

[ikam]

That makes sense and that is the piece of information that is not elucidated in the drugs interaction checker, the enzyme problem. The way I read it was that escit potentiates (makes stronger) the dox but it did not say why. So then the use of SS is a kind if misleading shorthand for what may happen.

 

You won't be getting true serotonin syndrome, then? What were you feeling? The mild or moderate ones?

 

You don't really have to answer, it is not that important. I was just curious is all.

I guess I was heading there, this was the reason for fast tapper, but also the reason why I want to stop escitalopram quciker...

 

I was definitely agitated and anxious. Had diarrhea. Strange problems with urinating, difficulty to start...splitting headache, dizziness. Blood pressure getting higher but pulse slowing down...paresthesia in both hands and getting worse...i had some problems with vision,as if my eye sight got worse...

Then, of course, anxiety increased my symptoms.

I went to A&E and got another prescription, which was another potent medication that would interact with escitaploram...

I think my symptoms were not completely clear, as I used other meds that week, such as naratriptan or buscopan...

 

At the moment, after nine days of decreasing to 5mg, I am much better...

[cymbaltawithdrawal5600]

Oh, jeeze, those were bad symptoms! I am glad the decrease has you feeling better. (The naratriptan had a bad warning too.)

[ikam]

It was not easy and I am completely on my own, so when I came back home from A&E, still with symptoms and lack of understanding, also unable to judge what was happening and what might happen, I was terrified to fall asleep, as I thought I would never wake up...

I think this was the time I found this group and contacted somebody who helped me before...everything started to make sense...i cut the dose by half and progressively have started feeling better...

I started reading about all meds I was put on...

I started reading files and topics stored here...

At last I was able to talk to people who know what I talk about...

 

Until now, I did not know how badly I relapsed letting doctors to play on my fear, seeing them as the only answer to my problems...

[mammaP]

It is ridiculous how they don't know about interactions! You would think that in this day and age they would 

have software that flags up interactions when drugs are prescribed! Big pharma MUST be behind the lack of 

correct information, it should be standard and I always assumed that they would have this on the computers.

 

I am so glad that you found us, and I am really pleased you are feeling much better, and I would hold a bit

while you are feeling good and enjoy it, but that is just me. ! 

 

How long are you planning to hold between cuts? If you were planning to hold for say 4 weeks I would cut by 

10%  per week instead of 50% all at once. That way you can hold if you start to feel worse as it takes 4 days

for a change to register usually.  

[Ever]

Very glad you're here Ikam

[ikam]

It was not easy and I am completely on my own, so when I came back home from A&E, still with symptoms and lack of understanding, also unable to judge what was happening and what might happen, I was terrified to fall asleep, as I thought I would never wake up...

I think this was the time I found this group and contacted somebody who helped me before...everything started to make sense...i cut the dose by half and progressively have started feeling better..

 

Yes, I checked this, I joined this group after my emergency visit. I took the decision to decrease in half next day, after that slepless night.

I also contacted the person who helped me in the past...

 

When I told psychiatrist about adverse effects, which that time were not so prominent, she told me to continue with the dose...i was getting progressively worse, she said it would pass away...then I stopped talking to her...i will just get a prescription, if I still need it...

[ikam]

It is ridiculous how they don't know about interactions! You would think that in this day and age they would 

have software that flags up interactions when drugs are prescribed! Big pharma MUST be behind the lack of 

correct information, it should be standard and I always assumed that they would have this on the computers.

 

I am so glad that you found us, and I am really pleased you are feeling much better, and I would hold a bit

while you are feeling good and enjoy it, but that is just me. ! 

 

How long are you planning to hold between cuts? If you were planning to hold for say 4 weeks I would cut by 

10%  per week instead of 50% all at once. That way you can hold if you start to feel worse as it takes 4 days

for a change to register usually.

 

I would like to hold a bit, but at the same time I see the reason to get a bit faster...

Also I am off work at present, so have more space to deal with symptoms...

 

When I was in my slow tapper from effexor I made another cut only after my symptoms got better, which could be something like two weeks, or two months...

[ikam]

Very glad you're here Ikam

Thank you Ever. It is so important for me...