paresthesia and escitalopram

[ikam]

Hi, I am new to the forum. My question relates to escitalopram side effects. Around two weeks ago I woke up with a strange tingling, burning feeling in my both arms and palms. I got really scared. But read later on about paresthesia and it definitely matches my symptoms. I was on 5mg and it has started when I increased the dose to 10mg. I am also on a low dose of doxepin a night and betablocker.
I wonder if paresthesia goes away?
I feel generally better in my mood during the day,but still respond with anxiety to some events. I have been almost two months on escitalopram, around two weeks on 10mg.
Thank you
Ikam

[SteveW]

It is true that for many people on anti-depressants initial side effects do tend to fade over a few weeks. But this is a long way from 100% and a significant proportion are stuck with their side effects.

Normally in such a situation you would be thinking of changing a drug. Your situation is a bit more complex than the average though. All three drugs you are on are capable of causing paresthesia. You don't specify which beta blocker you are on but the most commonly prescribed Propranolol certainly can give rise to paresthesia and I suspect so can some of the others. Working out which drug is causing the problem could require a little trial and error.

Hopefully you'll be in luck and the paresthesia will just disappear.

[ikam]

I thought it has been related to the combination of drugs I am on. I was thinking about decreasing escitaploram back to 5mg, but I am worried I may have some withdrawal symptoms...
It always happens only in the morning, then goes away when I start moving around.
I am on atenolol.

[SteveW]

I looked up the side effects of atenolol and paresthesia is listed as "rare" but that is the same as propranolol. I would think carefully before dropping the escitalopram to 5 mg. The normal anti-depressant dose is 10 mg to 20 mg and you could lose any anti-depressant effect you have obtained. Withdrawal symptoms are common in the escitalopram group but they are not usually severe.

Personally I would persist for a while and then if the paresthesia doesn't go, return to your GP and start making adjustments.

[ikam]

Thanks. I will persevere...i think my anxiety has a role in this. It seems that the depression has lifted, but I stil have some anxious responses. Especially that my life is far from being stable at present...
My psychiatrist also said that I need to wait...

[ikam]

I was about to decrease my dose today, I have only been two weeks on 10mg, and it seems I felt better on 5mg. Strangely enough, I am feeling more depressed on a higher dose.
The paresthesia occurs only in the morning, it starts when I wake up, still in bed. When I get up it goes away. I worry that I could have some nerve damage. It is weird feeling. Usually, I was waking up with an anxiety. It seems that I feel paresthesia instead of anxiety. Is this possible? Then I get anxious over paresthesia and of course it increases both feelings...
I wanted to see how would I feel back on 5mg, but it seems I may get withdrawal symptoms. Or maybe not? as I said I have been on a higher dose only two weeks...
Thanhs

[SteveW]

Firstly the feeling worse on a higher dose. Very few people remain on exactly the same level of depression over a period. Better then worse periods are pretty standard. I would guess that you have entered a down phase at the same time as you have upped the dose of escitalopram. Just a co-incidence really.

I would bet money that you have not experienced nerve damage. Paresthesia is a very common symptom. It can occur in mercury and heavy metal poisoning and at the other end some women experience it as a symptom of the menopause and there are many other causes in between. Remove the cause and the paresthesia usually goes. It is treatable. I think lidocaine the local painkiller in a cream form is used. But since you only experience it for a relatively short period each day I doubt your doctor would be willing to prescribe.

I suppose swapping one focus of anxiety for another is possible. If you are extremely anxious though it is likely that you might react in this way with any side effect you might experience.

As regards withdrawal symptoms not everyone gets them. A figure often quoted is 20%, so you are more likely not to get them than to get them.For most people they will have disappeared in a month and they are not likely to make you feel that ill.

Altering doses of drugs you have been prescribed on your own initiative is unwise unless you have a pretty good knowledge of drugs. If the paresthesia is really troubling you I think a trip to your GP might be the best thing.

[ikam]

Firstly the feeling worse on a higher dose. Very few people remain on exactly the same level of depression over a period. Better then worse periods are pretty standard. I would guess that you have entered a down phase at the same time as you have upped the dose of escitalopram. Just a co-incidence really.

I think you are right about co-incidence. So much has been happening in the last month, quite negastive experiences. I got the first "paresthesia" symptoms during the same morning when I was supposed to go for a job interview...
Since then I have been going down hill...i upped the dose hoping that it weill make me calmer straight away...

I would bet money that you have not experienced nerve damage. Paresthesia is a very common symptom. It can occur in mercury and heavy metal poisoning and at the other end some women experience it as a symptom of the menopause and there are many other causes in between. Remove the cause and the paresthesia usually goes. It is treatable. I think lidocaine the local painkiller in a cream form is used. But since you only experience it for a relatively short period each day I doubt your doctor would be willing to prescribe.

I am menopausal! So there are so many factors contributing to this symptom...When it happens it makes me so anxious, so I make it even worse, I suppose..

I suppose swapping one focus of anxiety for another is possible. If you are extremely anxious though it is likely that you might react in this way with any side effect you might experience.

Yes, I am prone to anxiety...and anything unusual can make me anxious...

As regards withdrawal symptoms not everyone gets them. A figure often quoted is 20%, so you are more likely not to get them than to get them.For most people they will have disappeared in a month and they are not likely to make you feel that ill.

I was in the past on velnafaxine, my. withdrawal was horrible, it took me over one year to stop it...i am quite sensitive and usually get side effects...

Altering doses of drugs you have been prescribed on your own initiative is unwise unless you have a pretty good knowledge of drugs. If the paresthesia is really troubling you I think a trip to your GP might be the best thing.

I intend to stay on 10mg, only when I get panicky I feel to stopit all. I know it would not be wise...

I guess, I need to watch any drug interactions, as also recently took some migraine relief painkiller, later on read that it interacts with escitalopram, including the risk of serotonin syndrom...

[SteveW]

Taking the one over the counter Triptan was a big mistake. You have already read about the raised risk of serotonin syndrome but what you read might not have stressed how dangerous it can be. There have been a number of cases where serotonin syndrome has proved fatal. Combining escitalopram and a triptan just isn't worth the risk.

That raises the question of pain relief when you get a migraine. There are two over the counter painkillers that you should avoid, aspirin and ibuprofen. Combined with escitalopram there is a raised risk of various bleeding disorders. As with triptans it isn't worth the risk. Paracetamol and Co-Codamol are fine.

I hope you have a good Christmas.

Love

Steve

[ikam]

Steve, thank you so much for your support. I am thinking about stopping escitaploram. Yes, I was sad and negative. But now I am completely demotivated..there are also nights, more and more often when I dont sleep at all. Sleeping used to be one of my coping strategies...my life seems to be more difficult at present.
I only need to think my strategy. I think it will be easier to stop now, I have been only two months on it, and only two weeks on higher dose...
Additionally, I have had severe stomach cramps and severe nausea...also joint pain...
I feel I am less in control of my emotions, anxiety comes out of sudden, e.g. because I have to wait longer, get a train, drive my car, etc. Apart from paresthesia, which I read is quite normal on it, I have had severe sweating, etc. I cannot even think what the interview panel will think of me seeing sweat on my face...
I had stomach ulcers in the past and many other health problems, such as migraines...so it is not worth to get these conditions worse...
I have my doxepin, it should help with withdrawal...

[SteveW]

I guess  if you feel as ill as you describe you don't have a lot of choice about coming off escialopram. But you still have to make the choice as to whether you come off anti-depressants completely or swap to something else. That really requires a conversation with your doctor. I'm sorry I couldn't manage to help you more. Take care of yourself.

Love

Steve

[ikam]

Steve, on a contrary, my discussion with you helped me to recognize that this is not drug for me. My physical problems are under control, but they require taking other meds. And I realized how dangerous it has been. I did not realize that I cannot take tryptans, which help me with migraine. Until I felt spaced out after using them, I also had diarrhea...

I think people know so little about drug interactions. I read about serotonin syndrome, and I guess I may have been quite close to it...
Still, I cannot stop cold turkey, neither escitaploram nor doxepin. I thought to stay on doxepin and start escitaploram reduction.

I was thinking about tricyclic antidepressants in the future.