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Reducing Escitalopram Advice


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hi all,

so a few of you know my story as posted within the bipolar thread i created. if not, i recently completed a lamotrigine titration with the daily amount taken now 100mg. anyhow, my doctor and i both want to reduce the ssri i'm taking, lexapro, although i've never done this before without failing and falling quite unstable.

so, she instructed me to reduce by 2.5mg, which i did five days ago and surprisingly, like extremely surprisingly, i feel rather fine. there were a few days of headaches and that's it. i realize that i could feel terrible in a week, but as of now it's looking promising. she did not tell me when to reduce the following 2.5mg, however, and will be unavailable for several weeks as she's on vacation. other on-call physicians will be available, but they don't know anything about my case.

there is a ton of variability when it comes to tapering antidepressants safely with some able to tolerate much larger and/or more frequent decreases than others. from what i've read, waiting at least two weeks is advisable before lowering further.  would those of you who have been through this before suggest that two weeks, should i continue to feel okay, would be sufficient before lowering by another 2.5mg?

thanks!

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12 hours ago, basuraeuropea said:

there is a ton of variability when it comes to tapering antidepressants safely with some able to tolerate much larger and/or more frequent decreases than others. from what i've read, waiting at least two weeks is advisable before lowering further.  would those of you who have been through this before suggest that two weeks, should i continue to feel okay, would be sufficient before lowering by another 2.5mg?

thanks!

I can tell you my personal experience when I tapered Lexapro.....My doctor wanted me off Lexapro because I was also taking Trntellix, another SSRI.....He didn't want to risk serotonin syndrome, although I had been on both for several years with no ill efffects.

I meet with my pdoc about once per month....I was on 20mg Lexapro, so he decided to taper by 5mg each month.....So I went down by 5mg each month, and when I got down to 5mg, he had me cut the 5mg pill in half, so for the last month I was on it, I took 2.5mg....So this was my tapering schedule when I tapered Lexapro:

......15mg for 1 month, then 10mg for 1 month, then 5mg for one month, then 2.5 mg for one month, and jumped off totally from the 2.5mg......So took me about 4 months before I was totallly off.......I know that sounds like a long taper, but I personally think a longer taper was the right way to go for me, because I had very few withdrawal symptoms.

Tapering by 2.5 mg every 2 weeks sounds reasonable, if you continue to do well at that rate....There is a lot of variability on how pdocs decide to taper.antidepressants......Did your pdoc advise you how fast to taper at all?

Edited by CrazyRedhead
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1 hour ago, CrazyRedhead said:

I can tell you my personal experience when I tapered Lexapro.....My doctor wanted me off Lexapro because I was also taking Trntellix, another SSRI.....He didn't want to risk serotonin syndrome, although I had been on both for several years with no ill efffects.

I meet with my pdoc about once per month....I was on 20mg Lexapro, so he decided to taper by 5mg each month.....So I went down by 5mg each month, and when I got down to 5mg, he had me cut the 5mg pill in half, so for the last month I was on it, I took 2.5mg....So this was my tapering schedule when I tapered Lexapro:

......15mg for 1 month, then 10mg for 1 month, then 5mg for one month, then 2.5 mg for one month, and jumped off totally from the 2.5mg......So took me about 4 months before I was totallly off.......I know that sounds like a long taper, but I personally think a longer taper was the right way to go for me, because I had very few withdrawal symptoms.

Tapering by 2.5 mg every 2 weeks sounds reasonable, if you continue to do well at that rate....There is a lot of variability on how pdocs decide to taper.antidepressants......Did your pdoc advise you how fast to taper at all?

she didn't advise at all, but this is handy to know, so thank you for sharing! i am doing fine with  minimal withdrawal effects as of now, so i feel like it's reasonable to drop by another 2.5mg after two weeks assuming that i'm still feeling fine. it's all a bit scary because i've never been able to reduce an ssri without falling quite unstable but there really hasn't been much of a difference in just about all parameters after making the small reduction that i have.

i definitely wouldn't be able to handle a 5mg drop, but i may have been if i were taking another serotonergic antidepressant as you were.

you're absolutely right in that there is a lot variability by both physicians and patients on what is tolerable. i don't think the goal for me, though, is to eliminate lexapro completely, but rather to reduce it until the sides are more tolerable while still controlling the anxiety disorders.

we'll see!

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i heard back from my  psychiatrist via email surprisingly while she was on vacation. lovely of her to advise while away from work. anyhow, she said to wait two weeks and then call and advise how i was doing. if doing well, i can continue down by another 2.5mg or, alternatively, by 1.25mg depending on both what i feel comfortable with and what she thinks will minimize the distressful impact to avoid me freaking the hell out.

i was also diagnosed not with bipolar disorder, but with a 'mood disorder, unspecified with depressive features' per my chart. welp, that's that.

i'm hoping to reduce at least to 15mg/day as this may have a significant positive impact upon overall well-being.

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  • 2 weeks later...

okay, folks, i reduced to from 17.5mg/day of lexapro to 15mg/day on the 9th of the month and the sides are somewhat lessening. i am doing, much to my surprise, rather well. there have been some migraines, some elevated anxiety, and some night sweats, but all have dissipated as time has passed.  my prescribing physician told me that i need to wait a full month before lessening further.

because i'm feeling rather fine, is there a logical reason to wait an entire month prior to lowering by another 2.5mg/day? what is the rationale? the psychiatrist stated that it was to err on the side of caution, but because i'm not feeling ill, is it necessary? are there typically withdrawal symptoms that occur and then dissipate and then reoccur after a period of time? similarly, is the return of the presentation of the illness' symptoms latent? i don't understand the reasoning behind the wait.

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14 hours ago, basuraeuropea said:

okay, folks, i reduced to from 17.5mg/day of lexapro to 15mg/day on the 9th of the month and the sides are somewhat lessening. i am doing, much to my surprise, rather well. there have been some migraines, some elevated anxiety, and some night sweats, but all have dissipated as time has passed.  my prescribing physician told me that i need to wait a full month before lessening further.

because i'm feeling rather fine, is there a logical reason to wait an entire month prior to lowering by another 2.5mg/day? what is the rationale? the psychiatrist stated that it was to err on the side of caution, but because i'm not feeling ill, is it necessary? are there typically withdrawal symptoms that occur and then dissipate and then reoccur after a period of time? similarly, is the return of the presentation of the illness' symptoms latent? i don't understand the reasoning behind the wait.

The signaling cascade that occurs downstream of SERT inhibition does have significant up-front effects at the 2-week mark. However, there are subtle changes in receptor sensitivity and downstream signaling mechanisms up to 6-8 weeks from a dose change, which is why they always encourage waiting that long for "full effect". However, it is similar when titrating downwards.

I guess her thinking is that waiting at least 4 weeks gives the entire downstream signaling cascade time to not only change but also normalize a bit before another change is made. This helps keep the subjective perception of the change as low as possible (i.e. the more subtle the change, the less you'll notice it day-to-day).

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thanks for the info. i went over to survivingantidepressants where of course they were like, you need to taper at a rate of .0001mg every five months.

also, another curiosity that has popped up is that my need for sleep as i've decreased escitalopram from 20mg to 17.5mg and now to 15mg/day has increased. or rather, i'm much more somnolent. i don't really know what to make of this, other than the antidepressant was agitating at higher dosages or it was causing to a dysphoric mixed state? i don't know if that would explain the increase in sleep. important to note that my depression levels haven't changed, so i'm not sleeping the day away because i'm depressed.

perhaps i'll wait three weeks or so before considering the next reduction. i feel as though i'm on a limited timescale due to the move within the next month and the start of the academic program in late september and i have to be stable.

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on survivingantidepressants when asking for the same advice i solicited here regarding reducing escitalopram, i came across a rather nasty super moderator who is antipsychiatry and, of course, thinks everything is in my head. well, yeah, it is in my head and that's the problem. i was asked to provide details on which drugs i was taking which are the same as those in the signature below and this is what i received.

in my sensitive state in which i perpetually find myself in, of course the first thing that comes to mind is humiliation and anger directed at myself. i realize that these are views held by a number of people, but they are painful to read when aimed directly at me. i go to bed tonight defeated but not broken.

Screen Shot 2022-07-17 at 8.26.33 PM.png

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9 minutes ago, basuraeuropea said:

on survivingantidepressants when asking for the same advice i solicited here regarding reducing escitalopram, i came across a rather nasty super moderator who is antipsychiatry and, of course, thinks everything is in my head. well, yeah, it is in my head and that's the problem. i was asked to provide details on which drugs i was taking which are the same as those in the signature below and this is what i received.

in my sensitive state in which i perpetually find myself in, of course the first thing that comes to mind is humiliation and anger directed at myself. i realize that these are views held by a number of people, but they are painful to read when aimed directly at me. i go to bed tonight defeated but not broken.

Screen Shot 2022-07-17 at 8.26.33 PM.png

That may sound silly but- maybe you should just never visit the site again 

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