Hello,

Note:

this topic is written by a second person on behalf of Dunya. Dunya has reached out for help to get advice on how to taper her antidepressant. Although, I have personally experienced tapering SSRIs and was involved in SA, I am having hard time guiding Dunya what to do due to her complex medication history.
I have translated her message below and appreciate your help giving her tapering advice please especially due to limited resources we have in our mother language Arabic. I will be translating your messages to Dunya and replying back with her translated replies in English.

..

I am 34 year old female from Saudi Arabia. In 2019 my mom passed away and I fell into deep sadness and constant crying. I went to the doctor who immediately diagnosed me with depression and prescribed me antidepressants Enrapro 10mg (I believe it's called escitalopram) without any behavioral therapy.

I continued taking the meds until September 2025, I quit cold turkey and felt horrible withdrawal effects including severe depression, anxiety, fear, dissociation from reality and I couldn’t sleep for 4 days. I went to the doctor again who prescribed me Entapro again starting at quarter of a pill and increased gradually to 2 pills (20mg) within a month and I felt way better. He also prescribed me 2 mg clonazepam Rivotril which I took then stopped taking after 2 months in December. After 3 months in January this year 2026, my doctor switched me from the Entapro to Effexor 150mg and also started me on pregabalin 150 mg Lyrica.

I just saw the doctor past week on September 10th and he reduced my dose of Effexor to 75 mg and planning to switch me back to Entapro. I have been feeling headache and very tense in my body and feeling like I'm in fight or flight mode, intense anxiety and I’m smoking more to ease it. Anxiety is worst in the morning I feel very negative then it eases slowly with time and I have better mood at night. The doctors plan is to taper me off the Effexor reducing dosage every two weeks and then go back on the Entapro. The doctor also plans to admit me in the hospital to taper off the Lyrica.

Appreciate your help and advice please on how to approach this, should I follow the doctor's plan to switching back to Entapro? Your guidance and feedback is much appreciated

Edited September 13Sep 13 by SarahMc

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 withdrawal 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.

 

Please familiarise yourself with the forum rules and the disclaimer located here: Guidelines

 

Please make sure your signature is kept up to date with your drug history. This will allow members to see some basic information about your drug history and situation so that they may help you best. Information on how to do this is located in the FAQs section above, but here is a direct link: Update Signature

Once this is done, future posts made by you will have this signature turned on by default. For this reason please keep it clear but condensed as possible.

Please use the format outline here Preferred signature/drug history format

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

1 hour ago, Dunya said:

Note:

this topic is written by a second person on behalf of Dunya. Dunya has reached out for help to get advice on how to taper her antidepressant. Although, I have personally experienced tapering SSRIs and was involved in SA, I am having hard time guiding Dunya what to do due to her complex medication history.
I have translated her message below and appreciate your help giving her tapering advice please especially due to limited resources we have in our mother language Arabic. I will be translating your messages to Dunya and replying back with her translated replies in English.

Thank you for contacting us on behalf of Dunya, she is lucky to have you. I'll write the rest of my response below as if I'm speaking directly to Dunya.

57 minutes ago, Dunya said:

In 2019 my mom passed away and I fell into deep sadness and constant crying. I went to the doctor who immediately diagnosed me with depression and prescribed me antidepressants Enrapro 10mg (I believe it's called escitalopram) without any behavioral therapy.

I continued taking the meds until September 2025, I quit cold turkey and felt horrible withdrawal effects including severe depression, anxiety, fear, dissociation from reality and I couldn’t sleep for 4 days.

I'm so sorry for the loss of your mom. Unfortunately, often when we go through these situational mental health crises all doctors can offer is drugs. The drugs then cause more problems when we try to come off. As you now know, they should never be cold-turkeyed. All of withdrawal symptoms you list here are commonly experienced when trying to come off these drugs.

1 hour ago, Dunya said:

I went to the doctor again who prescribed me Entapro again starting at quarter of a pill and increased gradually to 2 pills (20mg) within a month and I felt way better. He also prescribed me 2 mg clonazepam Rivotril which I took then stopped taking after 2 months in December.

Unfortunately most doctors know little to nothing about psychotropic drug withdrawal. It would have been better for the doctor to simply reinstate a low dose of the escitalopram, rather than increasing all the way to 20 mg and adding clonazepam.

2 mg daily of clonazepam is a pretty sizeable dose, and I would expect you to become dependent after taking that for 2 months straight. Did you have withdrawal symptoms when you stopped this in December? Have any of those symptoms continued to the present day?

1 hour ago, Dunya said:

After 3 months in January this year 2026, my doctor switched me from the Entapro to Effexor 150mg and also started me on pregabalin 150 mg Lyrica.

Why did your doctor make this switch and add lyrica? Were you doing poorly at this time? Did you experience any new or different symptoms when these drug changes were made in January? I would expect that you're experiencing withdrawal from the escitalopram?

1 hour ago, Dunya said:

I just saw the doctor past week on September 10th and he reduced my dose of Effexor to 75 mg and planning to switch me back to Entapro. I have been feeling headache and very tense in my body and feeling like I'm in fight or flight mode, intense anxiety and I’m smoking more to ease it. Anxiety is worst in the morning I feel very negative then it eases slowly with time and I have better mood at night. The doctors plan is to taper me off the Effexor reducing dosage every two weeks and then go back on the Entapro. The doctor also plans to admit me in the hospital to taper off the Lyrica.

We need more information to understand why your doctor is reducing the effexor, planning to switch you back to the escitalopram and wants to admit you to the hospital to taper off the lyrica Had you been doing badly on the higher dose of effexor with the lyrica? Or are the symptoms you're describing new since your doctor reduced the effexor dose by half? A 50% reduction is much more than is usually recommended - we recommend a slow taper reducing by no more than 10% of your former dose per month: Tapering Information

1 hour ago, Dunya said:

Appreciate your help and advice please on how to approach this, should I follow the doctor's plan to switching back to Entapro? Your guidance and feedback is much appreciated

You have now been on the effexor and lyrica for 9 months. This is absolutely long enough to gain dependence on them. I think it would be a bad idea to switch back to the escitalopram at this time, especially if you are feeling quite unstable already. It would also be risky to go to the hospital to taper off the lyrica, assuming that this means they plan to do a rapid taper.

If the symptoms you're experiencing are new since the effexor was reduced by 50%, it might be a good idea to increase the dose of effexor, stabilize at a higher dose, and then taper much more gradually. But I'd like to hear a lot more about how you were feeling on the higher dose of effexor and lyrica before you do that.

 

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!

 

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

On 9/13/2026 at 8:55 PM, SarahMc said:

Thank you for contacting us on behalf of Dunya, she is lucky to have you. I'll write the rest of my response below as if I'm speaking directly to Dunya.

Hello @SarahMc , thank you for taking the time and effort to reply. It is much appreciated. I have passed your reply to Dunya, however I am finding it hard to get the answers to your questions as my communication with her is through texts and it's difficult to get the details straight, also Dunya has been going through difficult times, going to multiple doctors and getting different instructions causing more confusion. I don't have a written reply from her ,but I will share the information she shared with me through our conversations hoping it will help:

On 9/13/2026 at 8:55 PM, SarahMc said:

Why did your doctor make this switch and add lyrica?

Dunya shifted from Entapro to Effexor because she complained to the doctor that it was keeping her awake and causing insomnia so he suggested Effexor, however it caused her more anxiety and confused thoughts and the insomnia remained so she does not want to take it anymore.

On 9/13/2026 at 8:55 PM, SarahMc said:

We need more information to understand why your doctor is reducing the effexor, planning to switch you back to the escitalopram and wants to admit you to the hospital to taper off the lyrica

She was planning to go back to Escitalopram/Entapro mainly because it is covered under insurance while the Effexor and Lyrica she has to buy it and it's harder to obtain and more expensive (around $400 per monthly visit!). Also the Effexor did not work well for her as mentioned earlier.

Since I made the post on Sep 13th, Dunya was taking 150 mg Effexor Xr as she ran out of the 75 mg capsules. She also skipped dosage for a day and felt brain zaps.

In her last visit to the doctor on October 6th, she expressed her desire to taper and he suggested to switch her to prozac because it has less withdrawal effects. He instructed her to take remaining 9 doses of Effexor 150 mg she has on hand along with Prozac 20 mg, then take 75 mg Effexor along with Prozac 20 mg then quit Effexor and stay on Prozac only. She has been following this plan since Oct 6th.

She is also on Lyrica/Pregabalin 300 mg since October 6th and doctor advised to reduce it to 150 mg next month. She is contemplating the option to go into a rehab clinic to taper her off the Lyrical which would be cheaper and they'd give her meds that would ease her withdrawal symptoms . Dunya wants your advice on which meds could she take to help ease Lyrica withdrawal and how can she quit it?
When she skips it she struggles with intense side effects such as dark thoughts, sweating, low appetite, insomnia.

Dunya also expressed she wants to switch back to Escitalopram because she feels tablets will be easier to taper and weigh instead of the Effexor/prozac capsules. What do you think about this switch?Could you please advise her on how to switch from 150 mg Effexor to Escitalopram? In the mean time I advised her to not take the 20 mg prozac since she wants to switch to Escitalopram.

Thank you and looking forward for your input.

17 hours ago, Dunya said:

Dunya shifted from Entapro to Effexor because she complained to the doctor that it was keeping her awake and causing insomnia so he suggested Effexor, however it caused her more anxiety and confused thoughts and the insomnia remained so she does not want to take it anymore.

Thanks for the response. At this point, given how many changes have been made, it is very difficult to sort out whether any particular drug is causing specific symptoms. I suspect that most of Dunya's symptoms are a result of the cumulative nervous system injury caused by going on and off so many different drugs. Based on the initial timeline you provided, it sounds like Dunya cold-turkeyed a pretty high dose (2 mg) of clonazepam shortly before switching from entapro to effexor, which can certainly cause significant insomnia. Once so many changes have been made it becomes very difficult to untangle unfortunately, and often there is no quick fix.

17 hours ago, Dunya said:

She was planning to go back to Escitalopram/Entapro mainly because it is covered under insurance while the Effexor and Lyrica she has to buy it and it's harder to obtain and more expensive (around $400 per monthly visit!). Also the Effexor did not work well for her as mentioned earlier.

Since I made the post on Sep 13th, Dunya was taking 150 mg Effexor Xr as she ran out of the 75 mg capsules. She also skipped dosage for a day and felt brain zaps.

In her last visit to the doctor on October 6th, she expressed her desire to taper and he suggested to switch her to prozac because it has less withdrawal effects. He instructed her to take remaining 9 doses of Effexor 150 mg she has on hand along with Prozac 20 mg, then take 75 mg Effexor along with Prozac 20 mg then quit Effexor and stay on Prozac only. She has been following this plan since Oct 6th.

Once the nervous system has been sensitized by so many different medication changes, what we generally see is that more changes only make things worse. I think at this point Dunya really needs some stability and time to see if things will settle down. I understand that Dunya does not think the effexor has been working, but she has now been on it for 10 months and will definitely have become dependent on it. I think the best way forward for her is to stay on the same dose of effexor and see if her symptoms will settle down. It sounds like since she's been on the effexor she's been changing the doses around and potentially skipping days -- this is all very destabilizing. She should take the same dose at the same time each day and give herself time and patience to try to gain as much stability as possible before starting a taper off effexor.

After everything she's been through, including the cold turkey off clonazepam and changing effexor and lyrica doses around, it could take a while longer to find some stability. But if she's able to hold everything steady and give herself some time to see if some of her symptoms will calm down, this could give her the best platform for a future taper.

I certainly would not recommend switching to prozac or back to entapro at this time. It's very possible this could make things much worse since Dunya has been taking effexor long enough to build up dependence. Switching will cause further withdrawal and destabilization.

17 hours ago, Dunya said:

She is also on Lyrica/Pregabalin 300 mg since October 6th and doctor advised to reduce it to 150 mg next month. She is contemplating the option to go into a rehab clinic to taper her off the Lyrical which would be cheaper and they'd give her meds that would ease her withdrawal symptoms . Dunya wants your advice on which meds could she take to help ease Lyrica withdrawal and how can she quit it?
When she skips it she struggles with intense side effects such as dark thoughts, sweating, low appetite, insomnia.

Again, I would advise her to hold her lyrica dose steady and not taper at this time. She needs to see if she can find some stability without switching her doses around and skipping days. Take the same dose at the same time each day. It may take a while at this point for her nervous system to calm down so she will need to be patient. She has been through a lot.

I absolutely would not recommend going to a rehab clinic -- though they might give her drugs that will ease acute withdrawal symptoms for a few days, they do not understand nervous system destabilization and protracted withdrawal. Tapering off the lyrica quickly is likely to make things worse for Dunya. She needs to give her nervous system time and patience to find some stability before starting a very slow taper off one drug at a time.

17 hours ago, Dunya said:

Dunya also expressed she wants to switch back to Escitalopram because she feels tablets will be easier to taper and weigh instead of the Effexor/prozac capsules. What do you think about this switch?Could you please advise her on how to switch from 150 mg Effexor to Escitalopram? In the mean time I advised her to not take the 20 mg prozac since she wants to switch to Escitalopram.

As I said above, any additional changes are likely to only cause further destabilization. I would not recommend switching back to entapro at this time. Effexor is pretty notorious for causing bad withdrawal symptoms, so I highly suspect a switch like this would make things even worse for Dunya.