Med Changes - Scared

[Bob K]

I have been on antidepressants for many years.  Was on citalopram for about 7 years until last fall.  It seemed to"poop out".  So I went to a psychiatrist and he started me on generic Zoloft.  We tried this for 3-4 weeks, and it was not helping.  Then we switched to escitalopram.  Been on this for about 12 weeks.  I was still having side effects (sweats, low libido, sleep issues) and the doc recommended another change.  Through the time since last fall, my anxiety has not been helped very much.

We talked about the latest change yesterday.  He was ready to switch to Prozac.  I wanted to ask about clonazepam, based on recommendations from AZ folks.  He said OK to the clon, taper off the escitalopram over 4 days, and not have any antidepressant. 

I'm afraid of two things - fast taper from escitalopram and not replacing it with anything.  Looking for some voices of experience to help me.  (Ian - I know I've burdened you with this story enough !).  Thanks


Bob

[stevo1111]

Hello there Bob,

Not sure if you've tried in the past, but I personally find TCAs to be much more tolerable and effective than SSRIs. I have tried SSRIs 4 times and each time got the same result, nasty start up sides that had me crawling out of my skin for up to 2 months and almost no relief for generalized anxiety.

I have found Anafranil and Elavil to be effective for treatment of GAD and panic, with Elavil having a less harsh side effect profile for me. The best part is that the start-up side effects are far less pronounced than with an SSRI. I'm sure Insights (Ian) has suggested this to you though, as he is the most knowledgeable on here.

As for a standalone of a benzo, I'm not particularly keen on it only due to the possibility (or necessary) of discontinuation due to a possible change of doctors in the future. The benzo should make discontinuation of the AD more tolerable. Most discontinuation symptoms are likely anxiety generated, with the help of a proper dosing of clonazepam you can keep these at bay.

[insights]

taper off the escitalopram over 4 days, and not have any antidepressant.

Possibly too fast as 12 weeks could be long enough for dependence to develop to some degree. If you get severe withdrawal effects I suggest you don't reduce the dose by more than 5mg every 7-10 days.

Ian

[yrawzrdhry]

I'm not exactly an expert on this type of thing or the medicines you mentioned, BUT... I have been taking ativan for over a year now and I'm pretty dependent on it.  I was told 2 different ways to taper off of it and both made my blood pressure go really high.  So neither of them helped me to get off the medicine.  I had to get back on it and to this day they still won't tell me how to taper off of it.  It's like they don't want me to get off of it.  With these types of meds... the longer u take to taper off of it the better.  So I'm told.  I just hope that I can get off of ativan without killing my liver or whatever else could happen.  It's very scary.  I wish you the best and you find the right medicines for you.  Take care and God bless!

[insights]

I was told 2 different ways to taper off of it and both made my blood pressure go really high.  So neither of them helped me to get off the medicine.

It is very difficult to wean off Ativan because of its short half-life and the small tablet size. The easiest way is to switch to an equivalent dose of diazepam (Valium) which has a very long half-life - up to 200 hours, stabilize on it for a 2-3 weeks and then slowly taper off by no more than 10% every 4-5 weeks.

You need to be aware that withdrawal symptoms are driven as much by psychology as chemistry. Believe you will have severe withdrawal and your mind will produce it for you. There have been a number of studies showing that merely telling patients their benzodiazepine dose has been reduced can cause many to experience withdrawal symptoms even though there was no reduction in dose.

Also, is Ativan your only treatment? If so, you first need to have a way of controlling the return of anxiety, therapy or antidepressants, before tapering off it. Anxiety disorders are chronic conditions.

I just hope that I can get off of ativan without killing my liver or whatever else could happen.  It's very scary.

It won't kill your liver, or anything else. Lorazepam is a natural component of most foods, albeit in small amounts (Wildmann J, et al., 1988; Wildman J, Ranalder U. 1988). Your body is well versed in dealing with it.

Ian