Prescribed Escitalopram - switching off of St. John's Wort

[mn_guy]

I've had GAD and recurring depressive episodes for over 10 years. I've taken St. John's Wort (Kira/Jarsin brand) at 900mg/day since 2009. It worked quite well at first but in recent years I got high anxiety and depressive episodes even on my regular dose. I'm now seeing a psychiatrist who has a lot of experience working with both prescription antidepressants and supplements and he is transitioning me from SJW to escitalopram over the course of a few weeks. He realizes that serotonin syndrome is a theoretical possibility but by dropping the SJW to 600mg first and only starting at 5mg escitalopram (and reducing SJW further before going up to 10mg), it should minimize the chance.

For background, I've taken amitriptyline and 5-HTP (at separate times) with SJW in the past and not had any ill effects.

Since this is probably a fairly unusual transition, I'm posting my experience here to let everyone know how it goes. I dropped to 600mg SJW 3 days ago and will be taking my first 5mg escitalopram dose tomorrow morning; I'll post more updates as anything of interest occurs.

[mn_guy]

Day 3 Update

I'm now three days into taking 5mg of escitalopram/Lexapro together with 600mg of SJW. Nothing really dramatic has happened either way. I was recovering from food poisoning when I started the Lexapro but that went away by yesterday evening (day 2) and today I've had a normal appetite and no nausea. I've slept somewhat poorly the last two nights, so that may be a side effect. The first night I woke up at midnight and again at 3 and had a hard time getting back to sleep both times. Last night I tried taking some Unisom to help with sleep but still woke up around midnight with my heart racing; got back to sleep after awhile.

Other than that nothing to report. I'm going down to 450mg SJW on Wednesday and increasing the Lexapro dose to 10mg on Friday based on my doctor's schedule. Will post again around that time or if anything interesting happens sooner.

[NervousKel]

Good luck :-)! It sounds like you are doing really well so far.

[mn_guy]

Day 5 Update

Not a whole lot to report. Dry mouth has gotten somewhat worse and the insomnia is still pretty bad. I wake up quite a few times at night and sleep is restless overall. I e-mailed my psychiatrist and he said that if the insomnia isn't tolerable I can cut back to 2.5mg for a week and then re-up to 5mg for another week before going to 10. I'm going to try to stick it out at 5mg for a few more days and see if it settles down, but I'm definitely not going up to 10mg until the side effects subside a bit. He also said to keep reducing the SJW as planned so I'll be going down to 450mg/day on that either tomorrow or Thursday.

As far as positive effects it's probably too soon to expect anything major, but I have felt a bit more positive the last few days. Even when lying awake in bed I felt pretty relaxed last night vs panicky the previous couple of nights, so that's progress.

[mn_guy]

Day 7 Update

I decided to stay on 5mg for the time being as I'm still getting at least 5-6 hours of sleep per night, which is tolerable for a few weeks. The main side effect that is annoying me at the moment is dry mouth. I had been having some intermittent dry mouth for a couple of weeks already that I chalked up to either anxiety or some minor virus, but since starting the Lexapro it's gotten quite a bit worse. I'm seeing a doctor this afternoon to see if anything else is going on, but assuming that it's just a side effect I've been chewing some Trident throughout the day, which seems to help. Other than that I do feel somewhat spacey from time to time throughout the day, but nothing serious.

I'm still not sure if I'm experiencing any positive effects yet. I do feel somewhat more relaxed than I was previously but since it's still early on that might not be due to the medication.

Per my psychiatrist's advice I'll be going down to 450mg of SJW tonight but staying on 5mg of Lexapro for another week to see if the side effects die down.

[mn_guy]

Day 8 Update

I reduced the SJW to 450mg last night and will stay on 5mg of Lexapro for another week before going up to 10mg. I did sleep somewhat better last night but did wake up a few times and couldn't get back to sleep after 4-4:30 or so. Dry mouth seems better today as well. Still not sure whether I'm experiencing positive effects or not. No inklings of serotonin syndrome as of yet; it seems that if I was to get that it would have happened at 600mg of SJW and 5mg of Lexapro. By the time I go up to 10mg of Lexapro I'll be at 300mg or 0mg of SJW.

[mn_guy]

Day 12 Update

I did sleep better again last night; it seems to be getting a bit better each night. Dry mouth is almost gone at this point also. That's basically it for side effects; after all of the horror stories I read online I was prepared for the worst but it's been a pretty mild experience so far. I do feel a bit more relaxed overall still but nothing dramatic in terms of effect yet either (which I would expect given I'm only on 5mg).

I'll be going up to 10mg of Lexapro this Friday (and reducing the SJW to 300mg). I'll post another update this weekend sometime.

[Mumzy]

I have been reading your updates and it’s sounding very positive

[NervousKel]

You're doing really well, Mn Guy!

[mn_guy]

Day 15 Update

I decided to up to 7.5mg instead of 10mg for a couple of days just to see if the side effects get significantly worse; if not I'll up to 10 in 3-4 days (otherwise I'll wait maybe a week). I took my first 7.5mg dose this morning and so far nothing dramatic. I've been a bit more tired and spacey today with a slight dry mouth and headache, although some of that could be due to eating three donuts at a work function this morning (oops). The big test is going to be how I sleep tonight; none of the other side effects besides insomnia have really bothered me. Will post another update later in the weekend.

As far as side effects went on 5mg, last night I slept pretty much normally and had no side effects that I could detect.