Hi,

First time poster looking for some guideance and support.

Was on escitalopram for 10 years or so. Worked reasonably well for anxiety.

Was on sertraline last year, had bad start up effects and tapered off too quickly in hindsight.

Back on escitalopram in June this year. Straight on 10mg. Had horrific activation that never settled. Stupidly I put up with this for 9 weeks, when I knew it was far too strong. Dr just told me it was my normal anxiety when I knew it wasn't.

Decided to drop to 7.5mg for 4 days, then 5mg 4 weeks ago. I instantly felt some relief in the activation and thought I was on the road to gradual recovery. Then 2 weeks ago I realised I was getting worse every day. The anxiety feels different, presume its withdrawal, maybe with a mixture of residual activation. Very concerned its escalating every day.

At a complete lost at what to do. Do I continue to hold at 5mg, up dose slightly (but concerned about returning to horiffic activation), or lower dose to get off this drug?

In hindsight it felt my body was rejecting escitalopram from day 1. Now I feel trapped on the medication and Dr just tells me its my normal anxiety when I know its not.

Welcome to the forum!

 

This is a volunteer-run, community forum aimed at helping those who are tapering and/or experiencing difficulties with psychiatric medications and withdrawl syndrome. We are not medical professionals and cannot offer medical advice. We simply offer support and opinions which you could use as talking points with a medical provider knowledgeable in withdrawing off psychiatric medications.

 

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I'm so sorry to read about the tough time you've had recently you will find plenty of support here for sure.

 

In the mean time this is what I would do if I were you:

 

-Stay Hydrated 

 

-Eat a good clean whole food diet, avoiding processed foods and sugars.

 

-Stay away from caffeine, alcohol and antihistamines and any other psychoactive substances.

 

Supplements are to be avoided initially, as they often irritate our nervous systems. Try to get your nutrition through food.

 

Down the line, you may wish to introduce Fish Oil and Magnesium. Those who can tolerate them have found them calming to the nervous system. Be careful try one at a time and start low and see how you get on should you choose to try them.

 

A daily walk is very important as much as you can manage, if you can manage it. Gets you your fresh air and Vitamin D does wonders for your mind!

As for what to do next, it can be quite difficult to say as there usually isn't a clear, one size fits all right answer when it comes to the harms that these drugs can do- we are all different and we all react differently.

I would say that you've assessed the choices open to you fairly well, I'll take you through my thoughts on each of them.

1. Continuing to lower the dose

   I wouldn't recommend this, on the basis that you have noticed increasing symptoms from dropping the dose already, and the effects of dose drops can become more severe at lower doses. It's very hard to say what would happen, but unfortunately it is certainly possible to be harmed from a fast taper even after short term usage. You might quickly taper off, experience some withdrawal symptoms and then come out of it, but there are also a number of members here who are in lengthy, protracted withdrawals from doing this after short term use.

   I would also say that despite using escitalopram for a short time, you're likely quite sensitised by tapering sertraline previously as well, sometimes withdrawal symptoms can take time to ramp up.

2. Continuing to hold

   You could do this, and see whether you eventually stabilise on 5mg. It is extremely difficult to predict when this might be, it could be soon, but it might also be a very long time. I think the fact that you're worsening at several weeks after dropping to this dose is a sign that perhaps you've tapered this drug a bit too quickly and you may well be really quite destabilised.

3. A small updose

   I would say that this is probably what I'd do in your situation, however this is just my personal thoughts and I'd be keen to hear some of the thoughts of others here (who I'll tag in this post). You've essentially halved your 10mg dose quite rapidly, and this is a very large cut. You'd think that it would be fine after short term use, and for many it might be, but sadly some of us (which is pretty much everyone who finds themselves on this forum) are sensitive to these drugs and as above, short term use can still cause significant harm and is enough to form a level of dependency that can then induce withdrawal.

   I would caution against going right back up to 10mg, but instead would probably suggest gradually increasing from 5mg and see how you get on. This is a delicate balance against what often gets called "kindling" in prescribed harm communities. It's an invented term, but it essentially describes seriously destabilising yourself by adding in more drugs/higher doses than you can tolerate when your nervous system is already very sensitised.

   Your nervous system likely is already sensitised, and also you found the drug quite activating and not very tolerable already, so it's important not to rush an updose and give your body more than it can handle.

   So, considering all of this, I would try an updose to something like 6mg, and see how this affects you, and then re-evaluate. You may wish to try a bit more, but I would suggest a maximum of 7.5mg and no more to start with. I'd lean much more towards seeing what 6mg does as I think in your situation there is definitely a possibility of there being an amount that's too much.

As I've said, all of the above is just my personal thoughts, and I have to say that I'm one of the less experienced members of the team when it comes to reinstatement, tapering and updosing. So, I'd be keen to hear what @Chippy, @LostinCanada, @SarahMc and potentially any other members think about the above.

What we do here is provide you with information, and our thoughts based on what has and has not worked for other harmed patients that we've seen.

 

You are very welcome here and I hope you find the site supportive.

Welcome to the forum @Steve1 Glad you found us.

We see this alot. Folk stop a drug they have been on a long time and 'switch' to another one which always goes badly.

I think you are reacting to Lexapro and your RI was too high.

I would be tempted to try to taper down further to a lower dose over around the same period of time you have been on the drug. With Lexapro 1mg seems to be a good dose for those RI and all they need, any more often does this from what I've seen.

So this could look like this if you have been back on for 13 weeks, not 100% sure from your footer. Perhaps you could add in the dates for us :)

Stage	Approx. RO	Lexapro dose	Weeks at this stage
Start	80%	10 mg	3.25 weeks
Drop 1	65%	4.22 mg	3.25 weeks
Drop 2	50%	1.78 mg	3.25 weeks
Drop 3	35%	0.75 mg	3.25 weeks
End	20%	1 mg	—
Total		10 → 1 mg	13 weeks

I wouldn't just follow this blindly but I do think if you can manage to reduce the dose further you may feel the benefit. You might land a bit higher than 1mg this is only a suggestion. Eventually you'll need to hold the dose and wait to stablise. Then taper off very carefully from there.

Thanks for the replies....

At the moment I'm at 5mg for 4 weeks. After a horiffic 9 weeks at 10mg. Activation is gradually easing, but withdrawal seems to be ramping up.

Ideally I would like to stabilise at 5mg for weeks/months. My concern is that withdrawal is ramping up daily. Do you think I'm close to peak withdrawal after 29 days?

Thanks

4 minutes ago, Steve1 said:

Thanks for the replies....

Pleasure

4 minutes ago, Steve1 said:

At the moment I'm at 5mg for 4 weeks. After a horiffic 9 weeks at 10mg. Activation is gradually easing, but withdrawal seems to be ramping up.

That's goog to hear, perhaps 5mg is acceptable to your system.

4 minutes ago, Steve1 said:

Ideally I would like to stabilise at 5mg for weeks/months.

Thats reasonable to me.

5 minutes ago, Steve1 said:

My concern is that withdrawal is ramping up daily. Do you think I'm close to peak withdrawal after 29 days?

Unfortunately stablisation can take some time and is very non linear, if you think the activation is lessening and this is WD then holding still and working on coping skills whilst this settles for you is the best route. We have little control over how the body heals and recovers, main thing is to try to ease the suffering by not looking too far ahead and accepting the symptoms as they come. Hard skill to learn but very important. Acceptance is key - Why does acceptance feel impossible?

The best solution (if it’s tolerable) would be to hold where you are and ride it out until you stabilise. It could take many months. Either way you have to pick a dose and commit to it until you do stabilise. Your body knows what to do but it takes a while.

Don’t do what I did and end up having to bring in another medication because I changed the dose. Also don’t start messing with supplements, other than magnesium and possibly fish oil. I spent a fortune on lots of useless supplements because my nervous system cannot tolerate them.

Yes I definitely want to stabilise at 5mg for months if tolerable.

My concern is if symptons continue to escalate on a daily basis, which they are doing currently!

I was hoping by 29 days on 5mg where I currently am that symptons would have peaked?

Thanks again

10 minutes ago, Steve1 said:

Yes I definitely want to stabilise at 5mg for months if tolerable.

My concern is if symptons continue to escalate on a daily basis, which they are doing currently!

I was hoping by 29 days on 5mg where I currently am that symptons would have peaked?

Thanks again

What symptoms are you experiencing?

Im currently experiencing two symptons;

1. Restlessness/wired anxiety - what was main sympton on 10mg. Developed into mild akathasia. This is gradually fading on 5mg.

2. Increased anxiety/weird sensations through body - this is increasing following the drop to 5mg.

49 minutes ago, Steve1 said:

Yes I definitely want to stabilise at 5mg for months if tolerable.

My concern is if symptons continue to escalate on a daily basis, which they are doing currently!

I was hoping by 29 days on 5mg where I currently am that symptons would have peaked?

Thanks again

Hey @Steve1

I understand your concern and that is mine too. If you think the reaction to the dose is easing and this is just WD than holding makes sense. There is no evidence that 29 days is the cut off for stablisation to happen in a hold. The opposite is true, sometimes it can take a very long time for things to settle.

31 minutes ago, Steve1 said:

Increased anxiety/weird sensations through body - this is increasing following the drop to 5mg.

This could be a sign of your still being hypersensitive to the dose. Ads are activating, maybe 5mg is still too much.

Unfortunately there are no absolutes in this. Doctors put us on these drugs, when it all goes wrong we are left to try to work it out on our own.

Hey @Steve1 im sorry to hear about your situation. Warm welcome to the forum. its so good that youve found it as im sure that youll find the help and knowledge you need. Dont hesitate to update us if any changes occur and even when they dont occur. I wish you the best of luck on your journey!

Edited September 7Sep 7 by Some0n3

Thanks all yet again for the warm welcome!

Funnily enough today the "withdrawal" symptons seem to be less and the "activating" symptons seem to be back.

I'm so confused at what to do!

2 minutes ago, Steve1 said:

Funnily enough today the "withdrawal" symptons seem to be less and the "activating" symptons seem to be back.

yeah it's normal, just let your nervous system tune itself for some more time.

Do you think my daily swim and sauna is making things worse or better?

13 minutes ago, Steve1 said:

Funnily enough today the "withdrawal" symptons seem to be less and the "activating" symptons seem to be back.

Fluctuating symptoms is very normal. Standard advice is to hold, this is often the right thing. However if you are reacting to the RI still than this may not be your best option as you found out when you reduced your dose to 5mg.

5 minutes ago, Steve1 said:

Do you think my daily swim and sauna is making things worse or better?

There is a lot of factors there to take into account. Chlorine in the pool maybe an issue, maybe it isn't. Too much heat might not be good for you. I've seen someone doing a cold plunge/water swimming and thrown back into a heavy wave. Best thing is to try not going for a while and see if it helps, then try going and see if you worsen.

Some are exercise intolerant, so if you are swimming hard than that might be an issue, if you are just plodding around in the pool perhaps not so much.

We have to become experts in our own journeys unfortunately.

I'm probably being stupid, but what does "RI" relate to?

Many thanks

2 minutes ago, Steve1 said:

what does "RI" relate to?

Reinstatement

Could holding at 5mg actually help my long term anxiety problem? Or is that now completly unrealistic considering the problems I've had?

Just now, Steve1 said:

Could holding at 5mg actually help my long term anxiety problem? Or is that now completly unrealistic considering the problems I've had?

It's possible if you hold you will stablise. If you are talking about anxiety that you felt before taking these drugs, I would stop thinking about these drugs as the answer to our issues. They harm us. At best they numb us. Once you have been injured by these drugs it's best to concentrate on keeping your nervous system as calm as possible and dont try to work out what is WD and what is 'normal' anxiety, it's impossible to know at this stage. You need to either hold and wait to stablise or reduce the dose some more and hope that helps the activation from the dose, then hold and stablise. From there a careful taper off would be my advice. Sorry you are having to deal with this.

26 minutes ago, Steve1 said:

Do you think my daily swim and sauna is making things worse or better?

thats tough to say but id monitor your symptoms before and after doing those things. like chippy said, maybe try taking a break from them and see if your symptoms improve and then try again to see if they make your symptoms worse. i myself dont really notice any symptom worsening when going to the sauna which im happy about because i enjoy it so much but everyone is different.

Edited September 7Sep 7 by Some0n3

7 minutes ago, Steve1 said:

Could holding at 5mg actually help my long term anxiety problem? Or is that now completly unrealistic considering the problems I've had?

Hello @Steve1, welcome to the group (and the world of weird sensations!), you will get good advice here.

As you've already seen, there is often no clear right answer, but it often boils down to keeping things simple and waiting. And waiting.

It is particularly tricky when there's activation/ possible kindling as well as withdrawal- you don't know whether to go up or down. Holding is often the best option- the one that causes least harm in the long run. Sometimes, if the WD symptoms are very bad, a very small updose can bring relief fairly quickly, but if you've already found the drug to be highly activating that could be risky.

5mg is a low dose in therapeutic terms for most people, and these drugs can stop working after a time, leaving only troublesome symtoms. Don't worry about the long term at the moment; withdrawal thoughts can lead us down all sorts of dark rabbit holes, just focus on staying as well as you can now.

As to swimming and sauna, who knows? I've had a couple of experiences where I just 'knew' that a particular exercise had triggered a wave, but of course it might have happened anyway. The whole business is so unpredictable, but it's understandable that we try to make sense of it and look for cause and effect. This is all part of the torment!

Are you keeping a symtom diary? Some people find that helpful, particularly in the early stages.

4 hours ago, Steve1 said:

Thanks all yet again for the warm welcome!

Funnily enough today the "withdrawal" symptons seem to be less and the "activating" symptons seem to be back.

I'm so confused at what to do!

Sadly we see this a fair bit, it can be very difficult to work out what is what and everyone reacts differently.

There's every chance that what you're experiencing is a bit of both: WD and reacting badly to taking the drug. In situations like this, it's pretty much your best guess as to which is the more prominent one when it comes to what to do about it.

If there is some residual activation (which I suspect there is) will the body eventually adapt to it? Or in some cases does the body just ultimately reject the drug permanantly?

Thanks

1 hour ago, Steve1 said:

If there is some residual activation (which I suspect there is) will the body eventually adapt to it? Or in some cases does the body just ultimately reject the drug permanantly?

Hi @Steve1, welcome to the forum. I'm sorry for what you've been going through. From what I've seen, sometimes when your nervous system is already highly sensitized, your body has a much harder time adapting to the presence of the drug. That doesn't necessarily mean that your activation symptoms won't ever calm down, but it may take quite a while -- and I wouldn't expect to ever feel like you used to feel when you took escitalopram before the switch to sertraline. You'd basically be trying to get to a place where your symptoms are relatively mild and tolerable so that you can start tapering from a place of strength.

Unfortunately, whichever route you choose -- holding here or reducing slowly to a lower dose to hold, as Chippy suggested -- it may take some time to find meaningful relief. So I think the important thing is to pick a path and stick to it, trusting that relief will come with time. Because all the evidence suggests that things will get better!

So its unlikely that escitalopram will ever have a positive impact in the long term? I.e. if I stay on 5mg for months?