Full Panic Lexapro Living
This blog entry is a rehash of some forum posts I made on the SurvivingAntidepressants forum in 2015-2016 while I was trialling a treatment with the Lexapro antidepressant as recommended by two of my doctors. I was in a very dark place that I have been able to climb my way out of about 80-90%. My substantial posts are reproduced below. To get the full conversation context, check out the full thread on SurvivingAntidepressants (I’m Icebat).
Posted November 14, 2015:
Hi All,
I’ve been reading this forum for a while and the topics here have been indispensable, especially regarding dealing with withdrawal symptoms as I prepare myself for a slow taper off of my remaining dose.
Pre-backstory
I’m in my early 20s and I just graduated college in late 2014 with a high GPA and a degree in Computer Science. I’ve got a strong resume with projects under my belt. I should be starting my career right now but can’t due to antidepressant withdrawal, but I keep telling myself that I will get better and it will happen, I just need some more time to heal mentally and spiritually.
Backstory
On January 1st of this year (2015) I suffered the first panic attack of my life. I’ve always had weird heart flutters and missed beats, so I thought I was having a heart attack and dying. The day that I had this awful panic attack, I didn’t get much sleep the night before and I didn’t eat much that day (triggers, I know). I also smoked pot regularly (I am clean now) which in retrospect I figure could be messing with my seratonin. I had bad depersonalization that day, basically forgot who I was for a few hours, and over the next month or so I was bedridden feeling shaky every day, suffering a chain of panic attacks in bed. I was immediately prescribed ativan (lorazepam) to help dull the panic attacks, and shortly thereafter, desperate for something to stop the chain of panic attacks, I was prescribed Lexapro. I took the Lexapro 5mg for the first week and 10mg for the second week, and basically over the next few months my panic attacks got generally better but my mental health got generally worse. My doctor upped me to 20mg Lexapro and I got so disoriented and out-of-it that my mom had to start walking me up to the door of my therapy appointments, because I didn’t feel like I could do it alone.
I decided to taper down off the Lexapro because my panic attacks had basically vanished, the Lexapro was causing some bad side effects (at higher doses making me confused and disoriented all the time, at the lower doses mostly just preventing me from getting decent sleep, so I was feeling tired all the time). I felt like the panic attacks would probably not come back, since I was on a good new pattern of diet, exercise, supplements (fish oil, magnesium, probiotic and multivitamin), and I also stopped smoking weed completely, which I think may have been a big contributor to the initial panic attack.
Anyways, I had miraculous success taking the dosage down from 20mg to 10mg, from 10mg to 5mg, and from 5mg to 2.5mg, with almost no withdrawal effects. The side effects improved steadily with each dosage decrease, and I’m very grateful that I had so little trouble getting down this far.
The big trouble started happening about a month ago. I had thought that I had tapered down successfully from 2.5mg because I felt pretty great for 3 weeks on 1.25mg (¼ of a 5mg pill) with no discernible withdrawal symptoms (Sept 9 2015 to Sept 29 2015). On my psychiatrist’s suggestion, I dropped the lexapro completely (0mg) on Sept 30 and I felt worse and worse for about 4 days. On the 4th day I almost had a panic attack, and I felt so depressed and shaky that I took a small fragment of my pill to try to stave off the symptoms. Literally 15 minutes after taking the pill fragment I went from feeling terrible to feeling great, browsing the internet on my phone. So I stabilized again on 1.25mg after about 5 days, or so I thought.
1.25mg (¼ of a tiny 5mg pill) is terribly difficult to measure - there was one time I wasn’t sure if I even took my pill fragment or if it fell on the floor, since it was so small I couldn’t feel it on my tongue. So I started pushing it against the roof of my mouth so I could be sure it was actually in my mouth. But that made it start to disintegrate before it hit my stomach, so… basically I think that my true dosage was getting really uneven. I felt really tired some days and needed naps, and other days I felt mostly fine. So I figured I could get a more consistent dose if I switched to the liquid, which my psychiatrist prescribed for me.
Latest Chapter
So on 10/28/2015 I switched to the liquid. I figured that the liquid form would be much more readily absorbed by my body than the pill fragments and I was right. I started out with 1.2mg of the liquid and it felt like way too much (cloudy head, sleepy all day), so over the course of 2 days I lowered it to 0.9mg, which felt pretty fine for 5 days. I felt like I was getting better and that I could even start driving and running errands around town with my mom again if I just waited a few more days.
On 11/4 I made a really, really stupid headstrong decision. I felt like I could reduce my symptoms even more if I just reduced the dose by a tiny bit further. So that day I cut from 0.9mg to 0.8mg (which in hindsight was a HUGE cut especially considering how recently I had changed the dose before that). The depression came back in such full force that I immediately had to put the dose back up to 0.9mg 2 days later, but reupping the dose didn’t help at that point. I continued to get worse and worse (more depression/anxiety) until my mom pointed out that I was only eating like 800 calories every day - I knew that my appetite was shot, but I had no idea I was eating so little.
On 11/11 I started counting calories and now I’m getting at least 2000 per day, with an ultimate goal of 2500. I upped the lexapro from 9mg to 9.5mg daily and the crippling depression is partway gone now. Anyways now it’s 11/14 and I think I’m seeing some progress, but I can never be sure, and these symptoms are very difficult to work through every day.
Today
Over the last few days, every morning I wake up nauseous and depressed, and every night I get anxious and need to take a 0.5mg lorazepam to calm down. Progress is slow for me and I’m impatient, but I keep trying to remind (convince?) myself that my body is working very hard to right itself chemically, and that if I just hold this dose and don’t do anything else stupid with it, I will feel a little better by next week, and yet a little better by the week after. I could really use some reassurance though :/
My First Question
I’m taking 0.95mg in 2 doses daily (0.475mg at 11am and 0.475mg at 1:30pm). On 0.95mg I feel like my seratonin levels are very unbalanced (depressed/hopeless in the morning, decent around noon, anxious by afternoon/evening). When I accidentally took my second lexapro dose at about 4pm one day instead of 1:30pm, that night I went into a drug-trip kind of sleep (almost like an alternate reality) which was a little scary but most of all exhausting and made me feel disoriented and confused and anxious the next day. As of the last few days, I wake up after vivid dreams exhausted, not at all rested, depressed, and with a burst of adrenaline. Will my body actually be able to get used to such a low 0.95mg dose taken mostly towards the beginning of the day like this? If I just stick it out for another week or two, my mood will start to level out again so that I’m not getting these big daily mood swings, right? If not, where do I go from here?
Thank you everyone for your support.
Posted November 15, 2015:
Since about 2 weeks ago I’ve been taking the Ativan more and more to get through the anxiety. Basically I get anxious when I feel bad every day and I’m not seeing improvement on a day to day basis. So when I’m anxious, I feel worse, then I worry about how bad I’m going to feel the next day, and so on. I want to say that dosage change in the Lexapro (I think both up or down?) and the accompanying withdrawal depression (or reinstatement energy) is generally the seed for the anxiety spike/cycle.
After I tapered down from 5mg, but before 2 weeks ago (i.e. for the past 5 months or so), I’ve needed the ativan literally less than once a month. I was originally prescribed it for panic attacks (took it copiously every day in January this year for instance), but for the last few days I’ve been taking it every day (0.5mg) afternoon/evening to stave back the health anxiety again.
I would be a little bit surprised, but not hugely, if the ativan rebound is what’s causing me to wake up early and not be able to get back to sleep, just because that’s a symptom I don’t remember having before, though I haven’t had anxiety problems like this in months. I have a feeling that it’s more the lexapro, but it may be a combination of the two (ativan and lex). The morning depression I would hazard to guess is the lexapro.
Thank you again for the help. I’m having a better day today (I was even able to play some mellow video games, which was distracting in the best way!) so my hope is that I can coast on this positive mood and continue to ride out the anxiety over the next few days as my body continues to get used to this dosage pattern. I have a feeling that as I start to feel better in general, the anxiety will begin to recede as it has in the past.
And I’ll start introducing a teeny tiny bit of lex late at night, gotta be conservative so that I don’t end up with more sleepless nights from “drug trip” dreams, but if I can balance it properly then that might help with the morning withdrawals. Thank you again Altostrata for the idea - and thank you so much for contributing to all of the incredibly helpful resources on this forum.
Also, thank you so much Petunia for the advice, and JanCarol for the support!
Posted November 19, 2015:
Hi Everyone,
I haven’t been improving as fast as I expected over the last few days. I’m still getting very interrupted sleep with vivid and sometimes unpleasant dreams, and feeling anxious and depressed in the morning and at night, despite taking 0.5mg ativan at 4pm daily (which maybe helps 50% for a few hours, during my worst time of the day). I’m tired all the time and my appetite is shot - every day my stomach feels bad after I eat anything. It’s been difficult to get enough food in me every day, but I’ve been counting calories and trying to eat all day to get up to at least 2000. I’ve been making sure to drink enough water, and I am walking at least 2 miles every day (sometimes 3 or 4). Often when the evening comes I barely have the mental composure to watch videos on the internet - if I’m lucky I’ll be able to play some mellow video games sometime in the late morning or late evening. I’m getting mood swings between feeling mostly normal and feeling panicky along with terrible gnawing anxiety and depression.
I haven’t changed my dosage times yet for fear that I could make it worse, but since it’s been 8 days and I’m still feeling miserable mostly every day, maybe I should start trying to change my dosage times slowly? I have a suspicion that maybe the 27hr half-life of the Lexapro is working against me, and that my blood levels are fluctuating too much for my body to properly adapt to. I was in the middle of adjusting my dosage times in mid October when I started feeling bad, and I never changed the dosage times since then, so for the last week I’ve been taking daily 0.475mg at 11am and 0.475mg at 1:30pm.
I am considering doing what Altostrata recommended - moving a small amount of the dose to the evening. This would carry the risk of making my dreams more vivid and interrupting my sleep more, but it might end up doing more good than harm. First though I wanted to know if anybody knows of anyone who had or is having trouble stabilizing on a very low dose, and if they have had any experience with dosage times. I remember seeing the dose-response curve for SSRIs elsewhere on this forum, so that’s what’s making me think that there’s a chance that spreading out dosage times could be more important at such low doses of Lexapro.
Thank you again for all the help.
Posted December 30, 2015:
Update!
The transition from the pills to the liquid lexapro was difficult (this leads me to believe that it is absorbed differently) but I feel like I’m slowly starting to improve. I am benzo-free again (the withdrawal was unpleasant but only lasted a couple of days, and was a piece of cake compared to Lexapro). I’m able to play video games with friends again some nights depending on how I feel, and during my on-days I’ve been able to spend a couple hours out of the house (during my off-days it sometimes even feels difficult to get out for a 15 minute walk). I am able to generally eat normal food now, though I stay away from anything greasy or spicy. For reference, I went from a ~1.25mg fragment of a 5mg pill daily to 0.95mg liquid formulation.
So my entire daily formulation has been as follows: 0.95mg Lexapro at 11:30am, multivitamin probiotic and fish oil at night. During the day I have been walking 1 mile around the neighborhood, though just today I was able to bump that up to 2mi again (hopefully I will be able to keep that up!), and eventually I may be able to do a daily 4mi again.
3 weeks ago I visited an expensive and experienced psychiatrist who specializes in difficult cases of medication discontinuation. Firstly he advised me to move my 0.475mg at 11:30am and 1:30pm all to 0.95mg in the morning, because “Lexapro is generally activating, so taking your whole dose in the morning will reduce sleep disruption”. He advised me to continue taking my taper very slowly, and prescribed Doxepin 0.1-0.9mg nightly “as an antihistamine, to improve my sleep and daytime anxiety”. I am to take 1 drop of the 10mg/ml solution nightly, then if I don’t see any effect after a few nights I am to take 2 drops, etc. until I see some effect, then I can gauge whether it’s positive and if I should continue. I was afraid to take any for the last 3 weeks, then yesterday my mom convinced me to try it because it has the potential to help with my bad sleep / nightmares.
The biggest thing I’m struggling with now is sleep. Sleep has always been a precarious thing for me even before starting the Lexapro about a year ago. Sometimes I have relatively benign dreams and sometimes I have bad dreams, but one thing for certain is that I always have LOTS of dreams, and I wake up a little bit disoriented every morning. Here’s my experience from the last week - I got a nasty cold about 5 or 6 days ago, and just yesterday and today it’s starting to go away. But 2 and 3 nights ago I had terrible nightmares (and sleep paralysis, false awakenings and panic awakenings) that left me disoriented and anxious most of the next day. So last night I tried 1 drop of the Doxepin at bedtime. Tumultuous dreams like usual, but no nightmares, paralysis, false or panic awakenings. Then I woke up and felt actually relatively good this morning. Coincidence? Not sure at this point, it might just be that I’m continuing to get better from my cold. But I’m thinking of doing 1 drop of Doxepin for a few more nights and then considering 2.
I’ve read a couple things online about preventing excessive dreaming and the general idea that I got was that you dream more when you’re not in the deepest stages of sleep (REM rather than NREM), so the idea is to do things that are conducive to deep sleep, such as not eating right before bed, developing a regular sleep pattern, and I’ve even read that sleeping on your back leads to more lucid dreams than sleeping on your side.
Also of note is that something went seriously awry with my left leg last month, to the point where it was in constant shooting pain every day, I couldn’t keep still, and I was walking with a limp. I started to go to the chiropractor regularly again, and it cleared up about 95% after a couple weeks, though my left arm and leg still feel a slight tingle every few days for a couple minutes.
In any case, I have a few questions - first of all, has anyone had success using an antihistamine (like Doxepin microdose) while coming off of Lexapro or another SSRI? Secondly, does anyone have any tips / threads to share about squashing (dealing with? coping with?) excessive dreams and/or nightmares? And finally, is it really wise to take my entire dose in the morning rather than split up in some fashion? Thanks!
Posted January 17, 2016:
Hey all, on January 5th I went from 0.95mg to 0.9mg, and then on Jan 8th to 0.85mg, and I’ve been on 0.85mg since then. Sleep is still an issue, and I’m still having vivid dreams that make it so I wake up many times during the night, and don’t feel rested when I wake up.
Yesterday I had what I call a “depression attack”, where everything seemed bleak and negative for a short while. When that happens, I lay down in a dark quiet room and become aware of the neuro-emotions and remember that they aren’t genuine, they are just a product of the Lexapro/withdrawal. Then it goes away after about an hour at most and I usually feel pretty fine the rest of the evening, I guess after my brain has a chance to re-stabilize its chemistry.
It seems like I’m already on such an incredibly low dose though, and my drop was only roughly 10% and was more than a week ago. Is Lexapro really this fickle to dosage changes, or is it possible that there is some sort of limbo spot at very low doses where the Lexapro is no longer regulating my chemistry, but my body is not quite able to take back the reins? Do I just need to continue this hold at 0.85? It just feels like it will take a long time to get off of the Lexapro at this pace… Maybe there is something wrong with my sleep outside of the whole Lexapro thing?
I’m seeing a sleep specialist in a few days to see if there is anything mechanically wrong with my sleep, because my sleep has never been great, but it’s also never been this bad.
P.S. I took the Doxepin for 2 nights a few weeks ago and it didn’t seem to be doing any good, so I decided to stop it.
Posted January 21, 2016:
I saw the sleep specialist yesterday, and they scheduled a sleep study, but the appointment isn’t for 3 weeks, so the results won’t be back for about 6 weeks from now. In the meantime I am getting 8 hours of sleep a night and waking up super tired and feeling like I got maybe 1hr. Often I feel just trashed, tired and edgy and high energy in a bad way, and I am starting to take naps again daily.
I am on only 0.8mg Lexapro right now (taken at 11:30am) and I’m not really struggling with depression symptoms anymore, but the sleep ones have been really difficult. Because I’m not getting good sleep my nervous system has been really sensitive. My best time of day is after I’ve gone to bed at 10pm and have just laid down in the dark for 2 hours, then I get up at about midnight to see if anyone else is still up and to get a snack. I feel pretty much normal at that point, with almost no symptoms. I literally feel more rested after lying in bed trying to get to sleep for 2 hours than I do after I sleep for 8 hours.
So I was thinking, what if I just try to stop the Lexapro altogether now? I would probably get more restful sleep, and I have Klonopin and/or Ativan on hand to help me with possible depressive/panic rebound and in case my nervous system is still sensitive. I am not prone to depression, only as a withdrawal symptom of the Lexapro (which was prescribed for panic attacks). I just feel like if I can get the Lexapro to stop messing with my sleep, then I (and my sensitized nervous system) might really be able to start to recover.
Are there any resources I could read to try to gauge whether it would be beneficial or detrimental to just stop the Lexapro at this 0.8mg dose in light of the sleep issues? Has anybody else had symptoms like this at such low doses? I am starting to think that the detriment of staying on this low dose might outweigh the potential bad effects of jumping off entirely very soon, especially since I would have to wait 6 weeks anyway to see if there’s anything wrong with my sleep. So that’s why I am considering jumping off for good. Thoughts?
Those represent most of my posts on the SAD forums. I ended up hitting zero on the Lexapro dose in April 2016. It would be over a year and a half before I posted to that thread again. When I did, it would be a much more positive post! Read it in my next blog post here:
Learning How To Take Care of Myself - Icebat’s Gut Blog