Suggest Treatment For Problems While On Lexapro

Posted on Mon, 29 Sep 2014

Question: Back in April I went on Lexapro for mild depression related to menopause. I started on 2.5 mg went up to 5 mg and 7.5 and then 10 mg. every time I went up on the dose I got worse, hallucinations panic attacks deeper depression. A horrible experience. One day I forgot to take the dose in the next day I felt better. I called my doctor and I said I think it's the drug I need to get off this. He had me titrate down over a period of about eight days until I was off it. During that time he introduced Remeron 7.5 mg and then moved me up to 15mg as I was at the end of the titration of the Lexapro. I was fine for about five weeks. And then one day it all fell apart again. I had friends in town over a week and probably had three or four glasses of wine over the period of four or five days. I thought that might have something to do with the Remeron. It just stopped working. It made me feel worse than before I was on any of these medications. Again my doctor brought me up to 30 mg. terrible totally hyper overstimulated suicidal thoughts out of my mind. Went to a new doctor. I explain the situation to her and she told me that I could go off the Remeron. She wanted to try something else, but at this point I'm just too scared. She told me I could go off it cold turkey. I've been on it a total of three months. The first month in May I was on 7.5 mg, then I went up to 15 mg for almost 2 months. I tried the 30 for about three or four days and because it was so unbearable went back down to the 15mg. I don't want to go cold turkey. I'm a little too scared. But I want to get off as fast as possible. Over the last two days I stayed on 15 mg and then I went down to a 11.25mg for one day and last night 7.5 mg. I plan to stay in 7.5 mg for at least for five days. Does this seem like a reasonable step down off the medication?

Answered by Dr. Sunil Gupta (48 minutes later)

Brief Answer:
Yes, you are right on track.

Detailed Answer:
Hi,

I went through your query and can understand what you must be going through. I am sorry to note that you had side effects with lexapro (escitalopram) and remeron (mirtazapine) stopped showing any benefit after a period of time.

I can also understand your concern regarding stopping remeron cold turkey. Generally i would advise my patients to taper and stop any anti-depressant for that matter including remeron. So, i guess you did right in deciding to taper the dose of remeron before completely stopping it. In general, I would recommend my patient to decrease the dose by 7.5 mg every 4-5 days. You were on 15 mg and have reduced it to 7.5 mg. You can in another 4-5 days completely stop taking remeron. So, I guess you are definitely on track. You won't need to further decrease the dose any more.

I sincerely hope that the next anti-depressant that your doctor decides works well for you and that too without any side effects. Any of the anti-depressants like venlafaxine, sertraline, etc. could be tried and gradual increase in dose. I know you are quite apprehensive about starting any new drug, but trust me when I say that its not necessary that if the previous anti-depressants were not suited for you, the new one won't be too. The next one might work wonders for you actually.

I do hope I was able to answer your query. Please let me know if I can be of any further help.

Best wishes,

Dr. Sunil Gupta

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sunil Gupta (9 minutes later)

Thank you for your very thoughtful answer. As I come down on the drug, I have also started to see an Ayurvedic doctor. He is giving me some herbs to help me come off the medication and possibly help me stay off of it. I am also going to perimenopause, which I think may have a complicated the issues with the antidepressants. I was on Lexapro earlier in my life and had no problems. My doctor also gave me some Ativan to take as I come off the Remeron to help with any anxiety. I hate to have to take it, but I feel like it is helping. Do you think there's any problem with that? Also as I stated before I've been on Remeron for three months 7.5 mg for one month 15 mg for almost 2 months and then a few days on 30 mg, and then titrating down. How long do you think it will clear out of my system? Thank you for your help and guidance, you have been very kind.

Answered by Dr. Sunil Gupta (40 minutes later)

Brief Answer:
Please see details below.

Detailed Answer:
Hi,

Thanks for following up. I am glad to note that you found my answer helpful.

I don't know much about ayurved, but I do hope that you find that helpful. But just remember that if it isn't, don't hesitate in restarting anti-depressants as I feel that it would, on any given day, be better to be without any symptom of depression rather than struggling with it.

Regarding Ativan (lorazepam), it is a benzodiazepine which we often use for short periods to take care of anxiety. It is effective anti-anxiety medication but should not be used for more than a few weeks as there is a chance that one will become dependent on it and it will be difficult to stop it when you want. So, I do hope that you stop it in some time. If you have anxiety persisting after that, its better to try one of the ant-depressants rather than any benzodiazepine alone.

It is difficult to comment on how much your perimenopause is interfering with your medications. It might be possible but then we need to find some medicine which is able to help you without any side effects in any case.

Regarding remeron, its half life ranges between 20-40 hours. So, even considering that upper limit of the half life, it will take maximum one week to clear of your body. It doesn't matter how much dose you were on. It will take the same amount of time in any case.

I do hope I was able to help you with your doubts. Please feel free to ask any further question that you may have. I will be glad to help. In case you have no further queries, please do close the discussion and rate the answer.

Best wishes,

Dr. Sunil Gupta

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar