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View Full Version : Struggling to come off Escitalopram! Help!



hayley123
06-05-09, 14:54
I have been very slowy coming of this tablet for about a year and a half now, from one tablet a day
To half a tablet a day, to quarter of a tablet every day which all went really well. Now I have been taking ¼ of a tablet every other day for about 6 months, so I thought it was time to come off totally, so the day my tablet was due I didn’t take it and by the afternoon I felt so dizzy and sick that I had to take it but it took ages to work and I felt sick and so on edge for about 2 hours.

So im now back to taking my ¼ of the tablet every other day and have been feeling terrible for weeks! Theres not one day that I feel exhausted, dizzy or sick and need to lay down.

Should I just come off them totally or will my panic attacks come back? Please help! xx

alias_kev
06-05-09, 21:40
Hey Hayley, The documentation on Escitalopram does favour a slow reduction, what's usually called tapering off. For Esc' they claim that it only takes 2-4 weeks for most people. I recently switched to Buspirone and my GP only allowed me about 7 days of overlap; although they both play with your serotonin cycle so there is some overlap.

I'm assuming you were taking 10mg Once Daily originally. So a quarter tablet would be 2.5mg which should be below the active dose (for most people at least). So that wouldn't be doing much for your depression/anxiety/etc as its too week. It could be enough to give you side effects and withdrawal symptoms though.

Now from my reading - and I am no expert, just a fellow sufferer - the half life of this medication (like most perhaps all SSRIs) is about 27-32 hours (according to wikepedia). Thats why we take it once a day as the body retains at least half a dose at the point we take our next one. So I am concerned that your "every other day" strategy is actually making the worst symptoms for you. That's because 48 hours (ie. every other day) is about enough time for LOTS of the medication to leave your system. Then the next pill bumps it up again, then down again.... As I say I am not well informed on this bit especially but it does seem to me that taking a daily medication every 48 hours is going to be a bit of a biochemical hell.

This Page (http://www.answers.com/topic/biological-half-life-2#Prescription_medications) claimes that in practical terms it takes about 4.7 HALF LIFES for a medication to stabilise at a new dosage (higher or lower). So for Escitalopram that's about 5.3-6.3 DAYS, assuming a regular fixed daily dose (even of zero). This fits with my concern. On an alternate day dosage your body can never stabilise. The maths looks a little complicated and we do not usually get to see the necessary numbers BUT my informed guesses go like this below....

Sorry if the following seems complicated. I am no expert so I am showing my working so anyone else scientific/mathematical can contradict me if I am wrong.

The calculations are only estimates as the real biochemistry of meds can be quite complex, and react to the actual amounts involved and other complex things.

Using a spreadsheet and pretending that the half life = 24 hours (instead of 27-32 hours) pretending that half life and dose period are the same - and simplifying the maths hugely, the minimum level of the drug in you would be this percentage of a dose at the end each day starting from a level of zero: 50%, 75%, 88%, 94%, 97%, 98%, 99%, etc. The peak daily level could be much higher but that depends a lot on how quickly we absorb the new dose and remember it will also be subject to loss once it is absorbed. Also as the real halflife is longer than daily so the real minima would be a bit higher each day and the final loading would be higher than a single daily dose (ie. 27 vs 24 hours implies around a 127% of a dose as a minimum level but takig slightly longer to get there. 32 hours would be higher and slower)

NOW: Using an alternate daily dose and again pretending as before that the half life is 24 hours the maths says the minimum dose in you does this starting from zero: 50%, 25%, 63%, 31%, 66%, 33% and so on. Starting from any other level you still end up at approx. 66%, 33% alternating. Your body never sees a stable dose so you have 1/3rd of a dose increase and withdrawal every other day plus the normal fluctation when a dose is taken! Even using the 27 hrs vs 24 hours simplistically just makes things worse as your alternate mimima become 81% and 46%. Even trying 32 hours half life suggests to me alternating mimimum doses of 120% and 80%.
So even though your dose is very small your body will probably be seeing it as a rapidly varying dose. And ofcourse as we absorb this medication fairly quickly the peak level might be as high as 180% of a daily dose.

If you were me I would be looking at either taking a 1/4 dose DAILY for about a week, or taking NO dose for about a week and seeing what happens to the symptoms by the end of the week.

Ideally you should discuss this with your GP or pharmacist but since you've been in this situation (mess?) for 6 months and they seem to have left you in it you may need to take your own decision.

Stuck on the tablets or off them would be better - I am convinced that taking a dose every other day can only be putting your biochemistry and brain through hell.

NB: For others reading this later.
On drugs with much higher or much lower half lifes the calculations give very different results. With a slower half life an alternate daily dose can be mathematically useful and perhaps medically so. For a fast half life the missing of a single 4 times a day dose can be unpleasant or worse.

Its all in the maths and biochemistry.

alias_kev
06-05-09, 21:50
Short answer of your direct questions:
1. You are not taking very much as a dose - so it cannot be doing too much to affect your panic attacks, so coming off ought not to make them worse.
2. (as big reply above) The other effects could all be caused by your every other day dosing. You need a stable daily dose (or no dose).
3. BUT your symptoms might also be from depression/anxiety/stress or a number of physical conditions. You need to stabilise the medication (at 0 or whatever) DAILY. If symptoms remain you need a doctor's advice!

reallyfedup
06-05-09, 23:28
I stopped taking seroxat which has a shorter half life. Stopped and went from 40 to 0 mg overnight - this took 2 weeks to be out of by system. Withdrawal symptoms carry on after this time and are not pleasant and this is what you are getting. your dose is so low I'd juststop and get it over with x good luck

hayley123
08-05-09, 16:57
hello all, thank you so much for you replies. I think you are right it must be best to just stop as maybe what im doing is just taking it out of my system and then introducing it again which could cause me to feel so bad. I have a doctors appointment on mon so will have a talk with him xx

Yvonne
08-05-09, 19:23
Hi Hayley

Ask the gp if it comes in liquid form which is by far the safest way to come off the ssris when you are at a low dosage as you are. Kevin's right every other is not good. Having said that, loads of gp's advise it.

Kev - Buspirone isn't an antidepressant though is it. How are you doing on it?

alias_kev
09-05-09, 14:18
Re: Hayley. Her current dosage is so low I don't see it would be doing anything other than making side effects in and out. The alternate day thing is crazy on any short-medium half life tablet based on the maths I did (and included in my post). I begin to think GPs always hear things and then apply them generically when they may only apply to certain situations. To work well on alternate day dosing the medication would have to have a half life LONGER than 48 hours otherwise the level oscillation would occur.

So sadly you cannot really rely on your GP knowing sense about medications. If in doubt after their advice talk to a Pharmacist!

Aside: Its like the whole "baby on back vs baby on front" and cotdeath thing. For decades, perhaps centuries, mothers lay babies on their back. Medics get worried about choking (based on little or no statistics) AND research showed the front lying helped certain premature babies in incubators in hospitals. Rapidly all nurses, etc made mothers put baby on her front. Eventually the advice is cancelled - back to basics literally - and cot death falls by a huge percentage in multiple countries and climates!

Yvonne - Quite. Buspirone in an anti-anxiety medication. I introduced my GP to the concept that treating my GAD with an appropriate medication would be more effective that using SSRIs on some broad NHS theory that "SSRIs help anxiety" on the added basis that when I first went I had some secondary depression.

Its not going too bad. I meant to carry on writing up the change but hardly anyone was reading my posts and no responses so I felt lonely and stopped....!

Now onto 25mg Buspirone daily.

clare101
31-05-09, 09:37
I was on escitalopram for 18 months in total for post natal depression and it helped wonderfully. The only downside was coming off them. I was on 10 mg dose. I cut down to 5 mg within a couple of weeks but getting off the 5mg i found hard. I spent a month on 2.5mg daily then i asked the gp for the drops. I think 1 drop is equivalent to 0.5mg so every day i put 5 drops in 100mls of water then after a couple of weeks i went to 4 then 3 etc. If i didnt do it then i got terrible brain shocks and must have been really sensitive to it.

Having said that ive just started taking it again for reactive depression due to marriage breakup. Not feeling too clever at the moment and i think 5mg dose may just be enough for me to cope. Hope this helps it was a long process to come off think it took me 4 months but i felt fine once i stopped :yesyes:

Trixie
11-06-09, 16:45
I have been on Cipralex for over a year and I was determined not to be on them too long as I am usually a happy go lucky cheerful person (except for a brief period of anxiety last June)

I was on 15mg so what I have been doing is taking the 5mg and then carefully shaving bits of the 10mg with a knife over a space of a few months. I am almost down to the scored bit, touch wood so far I haven't had any side effects.

hayley123
16-06-09, 10:23
Thank you all for your replies, I saw my doctor and he said i should keep on the 1/4 tablet every other day which im sure as aliaskev has said its helping but as i have my last two main accounts exams tomorrow he thought it was best not to make any changes to my medication as i need to be as on form as poss.
I have another appointment after my exams and im defin asking for the liquid form and also for someone to talk to as i have been very panicy this week, maybe due to the stress of my exams!
I am also thinking of having hypnotherpy, has anyone tried this? x

alias_kev
18-06-09, 20:40
Hey hayley123. The only thing is I said that "every other day" was unlikely to be helping. Maybe my answer was too long as I tried to justify the opinion as it was at odds with your prescription.

From looking at the maths these pills don't have a long enough half life to average out nicely over 48 hours and so what you feel might be a combination of starting & stopping side effects. I've heard its not uncommon for GPs to use alternate days to reduce a med - even these meds - BUT I'm not convinced its based on science. ie. Because it works for another med with a much longer half life they assume it will work with lots of others.
Medicine does that a lot.

I agree that you should use the drops to get a reliable daily dose and then reduce it. Each adjustment should stabilise in the body about every 5-7 days. Without the exams I'd have suggested stopping the 1/4 tablet (which is a pretty low dose) with your GPs agreeement and seeing if you felt better after 5-7 days.

Sorry to see you are still struggling with this.

hayley123
20-06-09, 18:07
Thank you for you reply, I agree that it does feel like i have starting and stopping side effects.
I have finished my exams now and i cant wait to stop taking my tablets and try the liquid form x