Journey from Escitalopram to Buspirone

Hi. I said on the Escitalopram forum that I'd write up my experiences of this medication change. So here it is. I will edit this post or reply-to-myself to continue diary.

NOTE: I have tried to be frank, and detailed, so be warned and get your reading glasses out.

Background
I concluded in October that I had suffered from GAD for a long time. Originally it slowly intruded, and in recent years had impacted me more and more. It always had the greatest effect at home - slow decison making and poor effort. Work had always been very different. In April-June 08 I added depression to the mix for fairly reasonable causes, but it was certainly no help. In June I went to my GP. He treated me primarily for depression/stress. Anxiety doesn't seem to mean much to GPs. Thats when I started Escitalopram. Later he also requested some counselling (for me!). I got an assessment in October 08 and as I needed a fast improvement, I managed to start Group CBT (stress/depression/anxiety management course) the Next Day. You only get about 5 real hours though.

Escitalopram
I've been taking Escitalopram (Cipralex, Lexapro) since June 08. Originally 10mg per day and later 20mg per day (the official maximum). Unusually my GP had me take the larger dose in two parts morning & night. All the documentation says to have a single dose but it seemed to work. This worked very well on the depression I had in June 08
but only really took the worst of the background anxiety away.

Esc' did not touch the peak anxiety or remove the general level. Using the NHS GAD-7 assessment (on patient.co.uk) I & my wife reckon that in June 08 I was 20/21 = very severe. Now April 09 she reckoned 17/21 = severe, the lowest I could give myself was 14-15/21 = the moderate/severe boundary.

The anti-depressant effect was strong enough that I felt no major emotional lows when my Father died in November. Although maybe I was too weird already, or just to busy. He was 89 and had not been well, so on one level it was not a shock which may have altered the experience.

I did not have too many side effects, or those I did get were no worse than the mental/physical situation I had already. (In the following ML = medication leaflet - the packet insert or better online versions).

The only ongoing side-effects for me (if any) include:

1. Interaction with blood sugar or GA tolerance (ML: confirms), I had some of this before starting the meds so might be me, the meds, or part of my physical anxiety-stress.
2. A tendancy to headache/migraine (ML: confirms headache). I generally found that the meds stopped me getting migraine and removed my chocolate sensitivity. When I felt I had a lot of the medication in me (eg. in March) it seemed to push me toward migraine pain. This was controllable by missing a dose occasionally.
   
3. A slight mental heaviness. Not a sedative effect or emotionally but like a mental burden. I can't really say if this had any effect. I became most aware of it as it reduced while I have been reducing the dosage. I think its a symptom of the high seratonin load.
4. The physical sexual response can be weakened especially orgasm. (ML: mentions this - male & female.) Again this was partly sensitive to recent dosage. I think you have so much seratonin kicking about that the body cannot experience its natural reactions properly as they may respond to the level or rate of change.
5. A tendancy to clamp my back teeth together (ML: says grinding, but for me it was clamping).
6. Any others are indistinguishable from the general anxiety-stress-depression symptoms you have when you start taking them.

October 08
The CBT course happened. It was quite good and I found the group context quite supportive. Its primary focuses felt like stress and depression though. It gave me a boost and I made a good friend too; they had similar
symptoms and phobias. I did lots of reading - websites and books - and then things fell apart as Dad went from ill to dead in a short time.

April 09
I went to the GP as I felt I was not gaining enough from the Esc' as my anxiety still dominated. My high GAD-7 score seems to confirm this. I hoped he might offer something better/stronger. In fact the most significant thing that came to light was that the PCT wanted him to stop prescribing Esc' as they claim citalopram is the same. Many posters here might deny that - its merely similar. He gave me a couple of days to think about what I wanted. There is a post in the Esc' forum about this.

I reminded my GP about GAD - and gave him a copy of the NHS fact sheet from patient.co.uk. All seemed very new to him. He read the epidemiology bit and said in effect "blimey - this sounds like you". That was what I'd told him in late october, sigh. Anyway we agreed that I could give Buspirone (Buspar) a try. He had prescribed it before to someone, its generic and its specifically listed for GAD on the NHS fact sheet. So if the PCT complain we can hit them with that! Oddly its name seems to rarely come up which is odd as writeups compare it to the 'Azepams without the addiction.

Buspirone (Buspar)I took a copy of the medicine leaflet with me so we concured that the starting dose was 10-15mg per day in 5mg doses and that the lowest theraputic dose was 15mg per day. He gave me an initial prescription of 30 tablets, so we could review before going further.

I'd have hoped for a few more Escitalopram as I only had a few left - but he thought there were enough. I said I'd revisit if withdrawal was a problem. My eventual plan was to halve the dose and then halve it again. I am less concerned than I might be as Buspirone is a seratonin agonist so it should (eventually) fake the seratonin that the reduction in Esc' loses. me.

Transition Plan
My plan was to start making the switch Friday night, so I got to include Friday's medication in the transition giving me an extra day or two:
Day Esc' Buspirone
Was 10 + 10; none
Fri 10 + 0; 0 + 0 + 5 (morning and bedtime)
Sat 10 + 0; 5 + 0 + 5
Sun 10 + 0; 5 + 0 + 5
Mon 10 + 0; 5 + 0 + 5
Tue 5 + 0; 5 + 5 + 5 (At 8 hours if possible)
Wed 5 + 0; 5 + 5 + 5
Thu 5 + 0; as above
Fri 5 + 0; as above
Sat 0 + 0; as above
This has turned out quite a long post so I will record my progress in a separate reply.

My diary continued. See the Opening Post for background details.

Friday 3/4/09: Esc 10 + 0; Bus 0 + 0 + 5
Got the new pills in early evening. Made a plan for the transition after counting Escitalopram pills. At bedtime I left out the second half of my Escitalpram and took a first dose of the Buspirone. The Busp' tastes worse on the tongue - have to swallow it sooner. Slept broadly ok. No worse than on preceeding nights and better than some.

It wasn't too unusual for me to miss a pill. On busy days the morning one could be forgotten sometimes (as I always took it slightly after breakfast). I would also miss a tablet on a low anxiety day IF the pre-headache pressure had increased.

Saturday 4/4/09: Esc 10 + 0; Bus 5 + 0 + 5

NB: Off to my Mum's as she needs a minder - she's 87 - giving my sister a break. I generally find that environment easier as her needs are simple and obvious and I am almost unknown there, so no other demands/responsibilities.

Lighter headed (really less heavy minded) during the day than I recall being of late. This is mainly due to the missed Esc' and the lighter seratonin load I would think. Had a very busy (for me) morning, potentially quite stressful although it was not too bad in practice. Some frustration with trains. Had an anxiety peak around 1pm after pressure was over. Night was the worst:

• Slept poorly. Felt the need for sleep but was very mentally energised and a bit figgity. Nearly got to sleep at 1.30am but prevented by external events. Even more tired/energised after than. Did not sleep properly until 4.30am. Even for me that is very late. Slept but it was patchy and disturbed.
• Had a very sweaty phase - especially legs - but with a tendancy to cold feet as an alternative. That might have been environment as was at my Mum's house.
  
• Had a lot of dreams and these were complex, serious and partly lucid with strong recall. These have often been a symptom of either Esc' or my anxiety.

Sunday 5/4/09: Esc 10 + 0; Bus 5 + 0 + 5
Again less heavy minded during the day than I recall being of late. I was especially tired in the afternoon, due to the poor night before, but it was difficult to fall asleep. I often find it easier to fall asleep in the day than in the night (though still hard) so this may well be related to the meds change. Night was the worst but better than Saturday:

• Slept better. Still woke up a few times but that's been normal for months. Did not have the strange energised feeling of Saturday night. Last patch of sleep seemed longer and better than usual.
• Still prone to being overly warm but not as sweaty as Saturday. That might have been environment as was at my Mum's house.
  
• Did not recall dreaming as much or as much detail.
• When struggling to fall asleep still had a lot of anxious/planning thoughts but these took the form of positive rehearsal far more than recently. Thoughts still wandered a lot though.

Monday 6/4/09: Esc 10 + 0; Bus 5 + 0 + 5
Continued to be less heavy minded during the day. Also felt more active a managed to get some tasks done, this might be a symptom of my location though. I was tired after lunch might have fallen asleep in a quieter environment. Another big burst of anxiety while writing these posts - took the form of poor manual coordination while handling stuff. And so to bed. I think I slept better. Certainly the last batch of sleep was much longer and felt more refreshing. I had a lot of "eye tiredness" on waking though.

Tuesday 7/4/09: Esc 5 + 0; Bus 5 + 5 + 5
This is the first day on a 1/4 of my dose of Escitalopram and the full starting dose of Buspirone. Still feel pretty stable. A few brief moments of anxiety but nothing deep or lasting. Emotions are probably more active than before the meds change; nothing you can put a finger on though. So the change remains quite positive. Some tiredness in the afternoon. Went to bed earlier than usual and progressed to sleep a bit easier than usual. This might be due to the falling levels of Escitalopram and/or Seratonin. The night went OK and although I think I roused a few times I did return to sleep. Still prone to sweating in the night.

Wednesday 8/4/09: Esc 5 + 0; Bus 5 + 5 + 5

NB: Back home during today. I generally find this environment harder to cope with as there are family demands, responsibilities, decisions to be made.

Had to be up early for me (07:30) to put the rubbish out. Bit sort of nausious at that point - the sort where you produce a lot of saliva rather than feeling that bad in the stomach. Could have been my bedtime snack or the medication(s). This normalised after a while and a slow cup of tea. OK during the morning. Tired after my journey home and a mild bowel upset. Travelling, Anxiety or the Meds who knows. Felt able to do some of my free paper deliveries and physically coped well with it. Just realised I suffered a lot less of the rambling dominant worried thoughts that usually occur when my brain is less distracted (and paper delivery leaves the brain pretty unoccupied I can tell you). THIS IS GOOD and CLEARLY DIFFERENT. Physically quite tired after them and felt lowish blood sugar. Quite a normal reaction for me especially after duty-at-mums as that involves very little physical activity. Had a snack, eventually had a lie down, fell asleep fairly easily (unusual and again no worrying or rehearsal), slept for perhaps an hour, woke and talked briefly with wife, fell asleep again (fairly unusual and again no worrying or rehearsal). Awoke after about another hour. Did not feel great and thought I'd suffered a bit of a sugar crash after my earlier snack. Recovered from that faster than recently (had cup of tea) and went and did more of the paperround. The odd short bout of anxiety/fear during the late evening, probably triggered by family responsibilities, interaction, etc. I think these were less possessing than they have been. Felt quite sad a couple of times today and although the situations had the potential to create sadness I think I was more sad than you'd expect. Probably a readjustment to the loss of the antidepressant effect (if we accept that SSRIs, anxiolytics, depression and anxiety have differences as well as similarities). Still found myself jaw-clamping a few times which is normally blamed on Esc'.

Went to bed quite late as I was online a lot. Had a snack and my night time Buspirone. On the Esc' I used to be quite hungry for the snack probably due to its interference with glusose processing. That has been reducing. I've been keeping the snack to boost the bioavailabilty of the Busp' as the online medical info says that eating may do so, and I need it to replace the Esc' asap. Again progressed to sleep a bit easier than a week ago. The night included a lot of recalled dreaming most of which was complex and nearly lucid. I roused a few times and mostly returned to sleep ok. Woke at 5am feeling unwell and anxious/insecure. This went off after a bit. Still prone to overheating in the night, but less sweat - maybe just that our house & bed is cooler. I think I dozed a bit between 5am and 8am.

In theory the loss of the Esc' should be hitting quite hard, and its officially early for the Busp' to be doing much good. I assume that either I'm weird or the Buspirone is feeding into the other end of the Seratonin cycle and maintaining some kind of reasonable balance.

Remember SSRIs work by stopping your body reprocessing Seratonin boosting the levels (eventually) whereas Buspirone pretends to be seratonin (its an imperfect fake though). Busp' also plays around with some dopamine receptors (and possibly other neurotransmitters) which could be very powerful or irrelevant! Interestingly the imperfect-fake thing means that you get a boost if you don't have enough and a reduction if you do! Kind of like parking small buses in large bus parking spaces.

Thursday 9/4/09: Esc 5 + 0; Bus 5 + 5 + 5

See the end of Wednesday - woke early and badly. Struggled to doze on at all. Bit sort of nausious first thing. Fairly insecure about getting up and getting breakfast. This is not new but first time I've felt it so much this week; may just be the back at home thing. As I couldn't sleep or rest I had breakfast and got on with my day earlier and a little easier than usual. So a bit of a mixed start. Managed quite a lot of the paper deliveries in batches throughout the day. Early on had a kind of stiff-neck headache. Late afternoon and early evening had a forehead headache with tight hot brow. In common with my historical migraines my hands were very cool compared to my forehead and neck. Unlike my migraines the crown of my head was not as hot as the forehead, usually in migraine its very hot relative to my hands. I felt that my blood sugar & energy was not keeping pace with my activity today. The delivery walks left me physically tired and I slept after each of them. Its hard to say if this is med related or the change of pace from mum's. I woke with a feeling of crashed blood sugar each time although this cleared faster than historically, but the headaches were present each time and took longer to go.
I again suffered a lot less of the rambling dominant worried thoughts that usually occur when my brain is less distracted. This does imply an anxiolytic effect already! Had some bouts of anxiety/insecurity during the day. Still found myself jaw-clamping a few times (which is normally blamed on Esc'). I forgot to mention that I few a few short spells (minutes, not hours) where I felt that my coordination was a bit wrong. This was both in legs and hands; I can best compare it to when you are very tired or just awake although it was not accompanied by any specific tiredness. I noticed an odd effect on my typing - it feels faster (can't prove that) and I'm touch typing more BUT my accuracy is a bit poor. I've also sometimes typed the wrong word not just a natural typo. All a bit odd.

Stayed up far to late online. Could not find the decision making to detach and go to bed. I've often done this in the past but less so in recent weeks. It was less of a conscious decision to stay up though - more a sense of being locked on. Need to watch this. Got to sleep fairly easily (for me atleast).

I know this is long but I hope this helps someone else too eventually.

Forgot something and I cannot save the edit for some reason. Had that before with Bullet Points. So this is now Original Side Effect #3.5:

3.5 Complex nearly Lucid Dreaming. I find that I recall dreaming a lot at night. The dreams tend to be complex and often almost lucid. Its broadly possible to partly wake up and return to (apparently) the same dream scape. Fairly convinced this is a symptom of the Esc' or the seratonin load. Not convinced it makes more dreams - it might just increase the recall! How would we know without monitoring REM or EEG?

This is a continuation of the diary started in my second post in this thread.
To keep things more wieldy I thought a separate post for each week would e good.

Friday 10/4/09: Esc 5 + 0; Bus 5 + 5 + 5

Note: As things stand this was my final dose of Escitalopram. Having been on 20mg per day (split dose - unusual or wrong by GP) I reduced to 10mg for 4 days and 5mg for 4 days. This is pretty quick and only marginally OK according to the Manufacturer's SPC.

The previous night wasn't too bad although it did start rather late after my inability to decide to go to bed. It did leave me starting the day quite late, eating late, taking the pills late, etc.

Did not feel too great for the first hour or two I was up. I'd say it was a mixture of the headaches and generaly feeling a bit off. Hard to pin down at the time and harder to recall well now (midnight). Physically I was OK to do the final part of my paper deliveries. Afterwards I was a bit tired. I went to sleep for a bit I think - oddly my recall is quite bad. Late afternoon I was feeling some of the concentration-is-hard-work symptom but had to drive for about an hour. I managed this OK but it was hard work concentrating. I had another sleep about an hour after the drive. This was fairly long and again I did not feel great after it. It wasn't the same tiredness I feel now but it was debilitating. Not sure if it was just the late night or a continuation of brain symptoms. Do find recall of the day is a bit poor at the moment. So off to bed.

The night was mad as I had a small snack and a drink (tea!). I usually take the tablet with the end of the drink. I managed to forget! I remember feeling awful a few times during the night (worse than any during this process), very hot and stressed but passive. I thought I'd forgotten it BUT I could not find the motivation to sit up, count the pills and see. ((aside: its easy to check as I have enough till tuesday middle dose)). Eventually about 5am I woke yet again feeling really weird and forced myself to check. I think I was helped as I had to get up to go to the wee anyway...! So... counting... had forgotten it, took one. Only about 5 hours late - ho hum. I put it down to the tiredness or confusion I mentioned before. Not sure if its sleep patterns, withdrawal or the new pills. We shall see. Had a lot of recallable dreams which all seemed to involve having lots of responsibilty during a crisis.

Saturday 11/4/09: Esc 0 + 0; Bus 5 + 5 + 5

After the mess with the pills overnight I slept in. I got some breakfast and ate it in bed. Yes its lazy and a bit avoidant but it helps me cope usually. Had the headache originating from the back of the neck again. Vision with my glasses seemed poor (distance or reading) and during the late morning I ended up using the computer without any glasses on. It seemed half physical in the eyes are half in the brain, but I'm not sure. I have had this occasionally in the past and my glasses are a bit rubbish so it might have nothing directly to do with the meds.

Later on this was better and I was OK to drive. I did find that I had to concentrate more than usual to both drive well and notice things. This was true both early afternoon and late evening. Again find myself staying up typing here and other places when I feel tired enough to go to bed.

Sunday 12/4/09: Esc 0 + 0; Bus 5 + 5 + 5

A family member came to join us for lunch and the afternoon. Lunch was pleasant and I felt reasonably involved and relaxed. This isn't normally a big problem area for me but I can feel uninvolved and unwanted. That comes from my anxiety-insecurity rather more than being a social phobia I think.

Felt quite poorly after lunch, headache string from the back of my neck and to a lesser extent in my forehead. No there wasn't alcohol involved. Ended up going to bed/sleep and crashing out quite hard. In late afternoon I attempted to rejoin the others but felt very unwanted in the conversation. I'm not saying this was an accurate feeling but clearly my meds were doing little for confidence or comfort at this point.

Dreamed a lot overnight again. They continue to be complex, responsibility orientated and fairly lucid. After waking recall of the dreams is high but this mostly fades within 10 to 15 minutes, rather than the seconds we might normally expect. A few key details from a dream can sometimes be remembered a few days later. I still assume this normal for high serotonin at night, the lower it goes the better the sleep but the worse the anxiety if you wake up. I mean to find some references for this.
Monday 13/4/09: Esc 0 + 0; Bus 5 + 5 + 5

Helped my teenage son to cook our lunch (chilli & rice). Actually we did OK and it was probably good for us, especially doing it together. It took us ages though and we'd started fairly late as some shopping had to be done first. More visitors mid-afternoon. Quite comfortable with it for a while. Later I felt a bit light headed - its most like feeling dizzy on standing suddenly, but without the swirly part of the dizzyness. Hard to describe. Parts of this and other feelings could best be described as "patches of disorientation". It would briefly prove hard to think clearly or to continue with something. Slight pre-migraine symptoms also occured, though not at the same time.

Ended up resting for 2-3 hours again in the late afternoon.

Woke about 5am feeling insecure. Not worry type anxiety, just plain insecurity. Got back to sleep after some time. Continuous bad/serious dreams through out the night and both sides of the anxiety.

Tuesday 14/4/09: Esc 0 + 0; Bus X + 5 + 5

Saw GP, this was planned last week. He'd given me 10 days worth to try them out and by phasing them in I'd ended up getting past the bank holiday with 2 to spare. Got some sensible support from him BUT I am not convinced he even acknowledges that anyone - let alone me - might get side effects on withdrawal from Escitalopram. Which is a bit crazy since EVERY write up including those by the manufacturer confirms this and says take at least one to two weeks to taper off them. Anyway I got another 2 weeks worth to see how it progresses. I especially reported the new side effects: the undizzy-dizzyness, neck & forehead headaches, some mental confusion, some poor coordination. I mentioned that I was still near-lucid dreaming and these were not helping my rest. I confirmed the improvements: less worrying when my brain was not distracted, a rough sense that the anxiety was lower. No major progress on getting things done or in overcoming my phobias. I'd hoped that less active anxiety would improve my ability to fight the other aspects.

Somehow forgot the morning tablet. Meant to take that and pocket the next one for afternoon and somehow just pocketed both. Another hint at the memory/confusion symptom.

A very busy day on top of all that. Doctor's, Chemist's, did quick shopping trip for my mother at two supermarkets, went to mother-in-law's, loaded a lot of stuff we were bringing back - carrying, tieing, etc, went to my mother's, dropped off shopping, chatted a bit, back home. The journey's involved quite a lot of driving. Pretty tired mentally once home. Ended up crashing out again.

Wednesday 15/4/09: Esc 0 + 0; Bus 5 + 5 + 5

Had be up and about early for food shopping in the morning so wife could do other stuff in the afternoon. We had a lot to get as they only did a small shop last week when I was away.

I do quite a big free newspaper round. The money is rubbish but its some exercise, some having to get on and get out, and one day I might lose a pound. The paper's arrived fairly early and it was a very nice day. So I got out and in stages through the afternoon and early evening got a lot of them done.

Also did a lot of internet price hunting for some family members as they may have to go on a trip at fairly short notice. Still pretty good at that so the mental impact of the medication seems to affect that sort of function less. I still find - even while typing this - that my typing speed has gone up but the accuracy is weak at times. I am prone to typing letters in the wrong order or even more weirdly typing the wrong word or sometimes just the wrong letter (not keyboard position related). So its like there is a high error rate: between my mind and the language centre of brain AND between the language centre and the memory/fingers. Is this Esc' out or Busp' in or what.

Thursday 16/4/09: Esc 0 + 0; Bus 5 + X + 5

Had the paperround to get on with. For various reasons its better to get it done asap this week. Started a bit late dispite not sleeping in (for me). Did do more internet research for family members though.

Then managed the papers for an hour or so without feeling too fatigued. That's better than the last two weeks where fatigue was pretty bad after each chunk of activity. Again I can confirm that there was very much less negative thinking, worrying and so on during the deliveries. A few weeks ago that could dominate as your brain is barely used to do the round. Eventually that can encroach on your ability to negotiate tricky door steps and paths, your brain is so distracted by its anxieties that eventually you can stumble or even fall over. Did the papers in batches between the rain showers. Despite all the activity I got through the day without any additional rest. Not sure if this is a fluke or improvement at this stage.

Forgot the afternoon pill due to distractions. There is definately a problem with remembering minor things, both before and after the event. Need to keep a watch on this over time.

I did get distracted and stumbled a couple of times late on Thurday but there were additional triggers involved: bit of an argument, some physical fatigue.

Hi , have you any update on how you are getting on with the busperine as I have been on it for 2 weeks now with not a lot of improvement so far but it might take more time to work so I have been told .