289 replies to this topic

[juli]

I would hang in there and give it some time.  I did have anxiety when I started Lexapro but it did get better after the first couple weeks.  I think that it is just part of the start up.  Your system is just really wacked out right now and this whole process is causing you anxiety.  Maybe try another Benzo to get you through the startup phase if the Ativan is not working anymore. 

[EBB]

Thanks all.  Fishinghat, on the Ativan, do you think she needs to increase or change the Ativan for another benzo?  I can see her capacity for handling the anxiety is dwindling fast.  I'm wondering if you can think of anything that can help her get through the startup anxiety.  She's tried clonidine and propranolol and didn't take well to those.

[fishinghat]

A change to something like oxazepam or diazepam may help for a while. Also you might talk to her dr about hydroxyzine. If she doesn't get that she can always lean some on diphenhydramine. This is an antihistamnine like Hydroxyzine and is found in many allergy meds (like Benadryl) and over the counter sleep aides. 50 mg doses, less if it makes her drowsy. This can be used for a few days and then off a few days as you can build tolerance to it.

You might also look through the thread "Summary of Cymbalta Withdrawal" under the Section "Medical Support". It is an overview of what others have tried and what works and what doesn't. It might get some ideas out of that.

[EBB]

Thanks Fishinghat.  Yes, she takes Hydroxyzine throughout the day now.  We're supposed to talk to her doc today, so we can ask about the other benzos you mentioned.  And I'll take another look at the Summary... page too.

[EBB]

Chris here.  So the doc thought we should stick with the current Ativan regimen but try upping the Hydroxyzine.  Has had little to no effect.  She went up to 4mg of Lexapro 10 days ago and is not stable yet, although very slow and slight improvement in the startup anxiety.  Any thoughts on how long we should wait before abandoning the Lexapro?  Should we switch her to say Zoloft or Prozac?  She has taken Zoloft twice before, so we have concern that she will take less well to it since it would be the third time.

[fishinghat]

The minimum therapeutic dose for Lexapro is 10 mg so she may have to increase the dose some before it makes a real difference. Given the start up anxiety she has I am concerned about keep going up. Third time on Zoloft? I think the Prozac idea is better. You mentioned the start up anxiety seemed less this time when she went up on Lexapro. That is a good sign. You are already on the Lexapro and you would have to stop it to go on Prozac. That complicates the withdrawal for most. I guess if it were me I would try to stick with the Lexapro. There is just isn't a clear cut answer. I am sorry.

[EBB]

I was under the impression that 5mg was the minimum dose for Lexapro.  We are using liquid right now while she is tapering up, but we can get 5mg pills apparently.  So when you say you have to stop Lexapro to go on Prozac, do you mean she would have to taper off first before tapering up on Prozac?  In the past, she has switched from equivalent doses between SSRIs from one day to the next.  What was your experience like (I believe you mentioned you tried 6 different ones)?  The other question is on the brain zaps.  These have just started happening for her in the last week or two.  Why?  I would think that is from the Cymbalta withdrawal, but why has she not felt this symptom before now?  She's been steady at 10 beads for several months now, and has had other symptoms typical with Cymbalta withdrawal throughout those months.  Any idea why the brain zaps are happening now?  Is it related to the Lexapro ramp-up?

[fishinghat]

They do male 5 mg Lexapro but the minimum therapeutic dose is 10 mg. They make the 5 mg to help with weaning and stepping up when going on it.

There are two thoughts on cross tapering.

1) Some drs prefer to slowly taper off one AD while going on a new AD over a period of a month. This minimizes the effects of any withdrawal but there is a greater risk of serotonin syndrome.

2) Other drs prefer to go directly from one AD to another to eliminate the risk of serotonin syndrome but the withdrawal from the original AD is usually worse before the new AD kicks in.

I came off Cymbalta with a 3 month wean. No effects from the withdrawal until the last 3 beads. I spent 9 months curled up on a stack of blankets and pillows in my closet screaming in fear. It was like waking up the second before a bus is about to hit you. They tried 6 different drugs including 4 ADs which had no effect at all until I went on Zoloft. As it kicked in my symptoms slowly reduced. My experience and those of many members on this site and others indicate that while someone may switch ADs with little to no problems when stable but when already suffering from withdrawal it is a hit and miss situation. This is just my educated guess but I would say about 50% have to try at least two ADs before having success. There is some research on this and it mostly says that the more ADs you have been on the harder it is to switch and the more unlikely the new AD will be effective.

Symptoms from Cymbalta withdrawal is an ever changing process. Most feel little issues until they drop below 30 mg and then the farther down you go the greater the symptoms. Brain zaps a re an almost universal Cymbalta withdrawal symptom. Luckily they are also one of the first symptoms to fade. Other symptoms like severe anxiety, fear, depression, crying spells, etc may take their place. It is unlikely to be related to the Lexapro start up. There is no reference to them as a start up symptom for Lexapro on the FDA website.

If you look at the "Summary of Cymbalta Withdrawal" thread and do a search for zaps you will find several fairly successful methods people have used to treat these zaps. I remember Omega 3 was one (it worked well for me as well) and also Meclizine if I remember right. Don't trust my memory though. lol You better look at the thread.

[EBB]

So did you cross-taper for a month every time you tried a different AD?

[fishinghat]

Yes, except the first one they tried, Prozac, I was already off the Cymbalta so they didn't have to worry about serotonin syndrome. In years past I was switched 4 or 5 times. Nearly all the drs took a few weeks to wean me off the first one and wean me onto the second one.

[EBB]

FH I have been looking through the Summary document and noticed Meclizine has a moderate interaction with Cymbalta.  Do you think it's okay for her to try meclizine for the brain zaps since she's still on 10 beads of Cymbalta?  I'm thinking it should be fine, since 10 beads is almost nothing, but you never know with this stuff!

[fishinghat]

This combination simply can cause drowsiness lack of focus. I don't think it would cause an issue, as you said, given the dose of the Cymbalta.

"Using meclizine together with DULoxetine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination."

 

Drugs.com

[juli]

10 mg is the theraputic dose for Lexapro.  I needed to go up to 15mg but was planning to go up to 20mg if needed.

[gail]

Hi Juli,

I always thought that it was 20mg. Let's see what our brain master has to say about this!

[fishinghat]

10 mg is correct. A gold star to Ju;i!!!

[EBB]

Chris here.  EBB went to have her hormone levels checked and of course she's off.  We got the results and her estrogen is high and progesterone and testosterone are low.  The doctor wrote a prescription for progesterone and testosterone.  We've been trying to find answers on whether these are okay to start with her other meds and withdrawal, but it's so specific.  What are your thoughts on whether/when she should start these meds?

 

In other news, we tried the Meclizine and she felt really weird on it.  Wired her up and wasn't able to sleep well, so she's not taking it.  She's up to 5mg on the Lexapro, so she can take a pill now (yay).  She's had some rough days before she went up, but I think it's getting better.  She's had a lot of headaches, and still some intermittent insomnia.  Anxiety is still high too.

 

And thank you all for all the thinking and knowledge.  It's scary to think where we'd be without you!

[fishinghat]

Hi Chris

 

Well it seems like she is making some progress. The hormone levels being off during withdrawal is more common than people think. I had a total failure of testosterone during withdrawal. This is part of what is called Post SSRI Sexual Dysfunction )PSSD) and the hormones normally return within three months  after fully coming off the antidepressant as long as you don't go on another one. I would dare say that in your wife's case she should probably begin treatment immediately. These do contribute to anxiety and even depression. Do be aware that once therapy begins it is a life long thing as your body will start to shit down its natural production. Often during withdrawal the shift in hormone levels are linked to minor changes in thyroid levels and I would suggest getting them checked out as well.

 

Getting her hormone levels back to normal will not cure every thing but it will help some. Hang in there. A bumpy ride but you can get through this.

[gail]

Hi Chris,

Same though here, start the p and the T now.

I'm almost sure that she will feel better when these homones are balance. This can create havoc in a woman s life for sure. I know from experience. Good luck with this and do update us on this subject.

[juli]

Yay for 5mg!  That is wonderful news   She is almost to therapeutic levels.

 

Gosh, hormonal imbalance yikes.  I was like a crazy woman when I was pre-menopausal and progesterone made a world of difference.  Hopefully, that will be a very helpful piece to the puzzle. 

[EBB]

Hi Everyone!! OMG! Progesterone is where it's at! It's been only one day but the sleep I got last night was miraculous and I am feeling amazingly better. Hopefully it's not just "a good day." Question for you: Now that I'm sleeping better, what do I do if I sleep through my 4am Ativan? Will I go into withdrawal? Should I just take it when I wake up. I take the Ativan very regularly at 4am, 10am, 4pm and 10pm. Thoughts?

[fishinghat]

Fantastic Ebb. I am so happy for you.

I would probably do a 8AM, noon, 5PM and 10PM. Something along those lines.

[juli]

woohoo! wonderful news.  i agree that progesterone is where it's at 

[gail]

Yeah! Wonderful news! Progesterone will do that for you.

There's nothing like unbalanced hormones, depression and anxiety follows for many.

Ebb, keep on trucking, the best is just in front of you. So many women go on antidepressants around peri menopause, I hope for you that it's just a question of balancing those hormones.

I'm so happy for you!

[EBB]

So as I feared, it was just a good day. Today sucks. Last week I had 4 good days in a row and then 4 bad days. What's with the back and forth? Am I ever going to stabilize? Every time I have a good day I think it's ending. Then I have another crappy day. Is this ever going to end? Am I just not on enough Lexapro? I'm having to go slow because I feel bad with every bump and I don't want to crash my system. Thanks everyone for you support, this sucks.

[fishinghat]

Oh so sorry EBB. I though you had found something there which was going to help you turn the corner. That feeling that it will never end followed by being sure it is all over is a common one. The good thing is that is usually a sign you are on the mend. From now on the good days should come more often and the bad days less often. On those good days try to take it easy and stay as calm as possible. I found that helps to stretch them out a little longer. Don't over do it.

 

More Lexapro might help. It is hard to look forward to another hit when you up the dose. No clear cut answer, it is just up to you.

[juli]

Sorry EBB.  Yes, it will end.  Days like today make you feel like it won't but I promise it will.  You are on the right track - just keep plugging along with what you are doing and one day you will realize that you are feeling completely normal.

 

Good thing you are going nice and slow on the Lexapro.  You will get to your therapeutic dose soon.  Take good care of yourself honey.

[EBB]

Chris here.  EBB has been on Lexapro at 7.5mg for 8 days now, up from 6mg.  She has not yet stabilized at this dose, and has had only about 4 hours of peace in this whole 8 days.  Her anxiety is high, she's sleeping poorly, getting occasional brain zaps, is really weak and can't do much walking.  It seemed like she was getting better from each step up on the Lexapro before this.  Could it just be a longer adjustment period because it was a bigger step up?  She is miserable and we need ideas for our next steps.  I know she had a not so positive experience before with the propranolol, but is that worth trying again, now that we are later in the process?  Should she play with the hydroxyzine amounts she is taking?  When do we consider trying a different antidepressant?  She is highly resistant to the idea of trying Seroquel.  And she is going to start neurofeedback (with someone who sounds like a REAL practitioner of it) on Friday.  Any thoughts you have are hugely appreciated.

[fishinghat]

1) Lexapro is not famous for having side effects when increasing in dose. This makes me think that this drug may not be for her. Consider different antidepressant.

2)Propranolol is a beta blocker and can help some with the anxiety. Atenolol is the more common beta blocker used for anxiety. Remember that beta blockers do NOT cross the blood brain barrier so there control of adrenaline is limited to the body. As such they only have effects on physical symptoms of stress (heart pounding, fast pulse, chest pain, skip beats, etc). I would strongly recommend clonidine which signals the brain to reduce adrenaline production. It can be very effective on anxiety.

3)What dosage of hydroxyzine is she currently taking?

4)Seroquel is not famous for helping withdrawal related anxiety but has helped some. It does have a moderate withdrawal. I would consider that a low priority at this point.

[juli]

Hi Chris,

Neurofeedback helped me tremendously when I was going through this.  It really helped my anxiety and my sleep.  Also,  I wonder if xanax would be in order for the anxiety.

Juli

[fishinghat]

Hi Juli

How have you been doing?