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It's Been A Couple Of Weeks Since We Last Talked.
Question: It's been a couple of weeks since we last talked. During that time, Dr Cho, my prescribing psychiatrist, has recommended that I now start tapering down on my Lexapro, reducing it by 2 mg every 2 or 3 weeks. I'm currently at 8 mg a day. Likewise, she recommends that I continue tapering down Trazodone. I'm currently at around 25 mg Trazodone at bedtime, down from a XXXXXXX of 125 mg.
The Trazodone never seemed to be bother me much, either during the time I was taking as much as 125 mg then or 25 mg now. However, with Lexapro, after careful observations and not taking anything else at all (but Trazodone), it still does seem like I get the worst symptoms of "stupor" about 2 hours after I've taken the entire daily dosage at once. I am now in the habit of taking the entire dose by late morning or lunchtime, and then I have to take it very easy for the rest of the afternoon. By late afternoon or evening, I'm kind of back to normal.
As far as i can tell, I'm not experiencing anxiety like I once did. But I strongly feel that I am in fact suffering from the side effects of Lexapro, or the withdrawal from it. I can't think of anything else that would explain it. And it's my understanding that it could take me a long time even after complete discontinuation for me to regain normal daily functioning. I'm going to have to babysit my brain for who knows how many more months, in order to achieve the "balance" it once had, which is what produces true calm. You know what they say about older people... they can do anything a young person can do, it just takes longer.
Do you have any advice for me in this regard? Do you disagree with Dr Cho's recommendation that I now start weaning off both medications?
The Trazodone never seemed to be bother me much, either during the time I was taking as much as 125 mg then or 25 mg now. However, with Lexapro, after careful observations and not taking anything else at all (but Trazodone), it still does seem like I get the worst symptoms of "stupor" about 2 hours after I've taken the entire daily dosage at once. I am now in the habit of taking the entire dose by late morning or lunchtime, and then I have to take it very easy for the rest of the afternoon. By late afternoon or evening, I'm kind of back to normal.
As far as i can tell, I'm not experiencing anxiety like I once did. But I strongly feel that I am in fact suffering from the side effects of Lexapro, or the withdrawal from it. I can't think of anything else that would explain it. And it's my understanding that it could take me a long time even after complete discontinuation for me to regain normal daily functioning. I'm going to have to babysit my brain for who knows how many more months, in order to achieve the "balance" it once had, which is what produces true calm. You know what they say about older people... they can do anything a young person can do, it just takes longer.
Do you have any advice for me in this regard? Do you disagree with Dr Cho's recommendation that I now start weaning off both medications?
Brief Answer:
Consultation
Detailed Answer:
Hello, and thanks for your question.
Typically people should be treated with Lexapro for 6-12 months after remission of anxiety symptoms. In my opinion it is likely too soon to begin tapering. I also believe many of the symptoms you describe are not related to Lexapro at all, but rather to anxiety itself. However, Dr. Cho is on the ground as the prescribing psychiatrist and knows the situation best. I would follow her recommendations exactly as prescribed and report back how it goes.
Dr. Sheppe
Consultation
Detailed Answer:
Hello, and thanks for your question.
Typically people should be treated with Lexapro for 6-12 months after remission of anxiety symptoms. In my opinion it is likely too soon to begin tapering. I also believe many of the symptoms you describe are not related to Lexapro at all, but rather to anxiety itself. However, Dr. Cho is on the ground as the prescribing psychiatrist and knows the situation best. I would follow her recommendations exactly as prescribed and report back how it goes.
Dr. Sheppe
Above answer was peer-reviewed by :
Dr. Yogesh D
Brief Answer:
Followup
Detailed Answer:
If you are tapering as slowly as 2mg at a time, the likelihood of withdrawal symptoms is essentially zero. Return of or worsening of anxiety is the most likely symptom.
Dr. Sheppe
Followup
Detailed Answer:
If you are tapering as slowly as 2mg at a time, the likelihood of withdrawal symptoms is essentially zero. Return of or worsening of anxiety is the most likely symptom.
Dr. Sheppe
Above answer was peer-reviewed by :
Dr. Prasad
I'm at 8 mg currently, per recommendations of Dr Cho, and I expect to take about 3 months to wean off completely. Most of the literature suggests that doctors frequently recommend just 2 to 4 weeks to get off.
I'm going with the theory that optimal brain health depends on a balance of neurotransmitters, involving a complex interplay of many agents, instead of regulating a single one. Any medication that affects any of the agents necessarily impacts this balance. Sometimes that can be necessary, but a long as such medication is being taken, as with just about anything else that influences the brain, such as alcohol, knocks it off from optimum balance. So, the ideal is to be off all of them eventually, and allow the brain find its own natural balance.
I do not believe that "the level of serontonin" alone determines how the mind is working or how it affects the mood, such as, "low serotonin = anxiety, higher serontonin = less anxiety", in simple monotonic fashion. Either too much or too little serotonin can have unpredictable consequences. And, just as what happens when people get off just about anything else that impacts the balance in the brain, it takes a while for the brain to re-adjust, which means it's not necessarily so stable during that period. It took me months to sort of adjust to taking Lexapro daily, and it's going to take me months to adjust not taking it, and I can expect to suffer from a variety of symptoms doing that, as I did in the beginning.
I'm finding that the best source of information about how it is like to wean off Lexapro are from the actual users of Lexapro, full of personal stories about that. Then I can hear how our stories can be so similiar.
How is it determined when's the best time to start tapering down from Lexapro? Other than the timing of this taper, is there any disagreement?
I'm going with the theory that optimal brain health depends on a balance of neurotransmitters, involving a complex interplay of many agents, instead of regulating a single one. Any medication that affects any of the agents necessarily impacts this balance. Sometimes that can be necessary, but a long as such medication is being taken, as with just about anything else that influences the brain, such as alcohol, knocks it off from optimum balance. So, the ideal is to be off all of them eventually, and allow the brain find its own natural balance.
I do not believe that "the level of serontonin" alone determines how the mind is working or how it affects the mood, such as, "low serotonin = anxiety, higher serontonin = less anxiety", in simple monotonic fashion. Either too much or too little serotonin can have unpredictable consequences. And, just as what happens when people get off just about anything else that impacts the balance in the brain, it takes a while for the brain to re-adjust, which means it's not necessarily so stable during that period. It took me months to sort of adjust to taking Lexapro daily, and it's going to take me months to adjust not taking it, and I can expect to suffer from a variety of symptoms doing that, as I did in the beginning.
I'm finding that the best source of information about how it is like to wean off Lexapro are from the actual users of Lexapro, full of personal stories about that. Then I can hear how our stories can be so similiar.
How is it determined when's the best time to start tapering down from Lexapro? Other than the timing of this taper, is there any disagreement?
Brief Answer:
Followup
Detailed Answer:
I would disagree that talking to people who post in the Internet about Lexapro is the best source of information. You do not know those people's psychiatric history, diagnosis, or treatment history. There is also selection bias that people who are it anxious and do not experience adverse effects rarely post on the internet. I would rely on the professional opinions of doctors who do this for a living and have done so for years or decades. Your theory about a balance of neurotransmitters is incorrect. What we know from the science is people with clinical anxiety should be treated with the maximum tolerable dose of Lexapro for 6-12 months, at which point medication can be tapered over the course of a few weeks. This is how I would proceed if it were me.
Dr Sheppe
Followup
Detailed Answer:
I would disagree that talking to people who post in the Internet about Lexapro is the best source of information. You do not know those people's psychiatric history, diagnosis, or treatment history. There is also selection bias that people who are it anxious and do not experience adverse effects rarely post on the internet. I would rely on the professional opinions of doctors who do this for a living and have done so for years or decades. Your theory about a balance of neurotransmitters is incorrect. What we know from the science is people with clinical anxiety should be treated with the maximum tolerable dose of Lexapro for 6-12 months, at which point medication can be tapered over the course of a few weeks. This is how I would proceed if it were me.
Dr Sheppe
Above answer was peer-reviewed by :
Dr. Remy Koshy
When you speak of "maximum tolerable dose", that implies that there is some dosage that could produce intolerable effects. What would be some of those intolerable effects?
Brief Answer:
Followup
Detailed Answer:
The maximum recommended dosage of Lexapro is 20mg daily. Above that dose there is no evidence of increased efficacy. That is what I mean.
Dr. Sheppe
Followup
Detailed Answer:
The maximum recommended dosage of Lexapro is 20mg daily. Above that dose there is no evidence of increased efficacy. That is what I mean.
Dr. Sheppe
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
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