Reducing lexapro from 20mg to 10mg (Why is it important?)

In this blog, we are going to talk about the dose reduction of lexapro from 20 mg to 10 mg. We will cover all the reasons associated with lowering down the dose and will discuss the proper use of lexapro in order to ensure maximum safety and therapeutic response. 

What circumstances lead to the reduction of lexapro from 20 mg to 10 mg? 

Your healthcare provider might reduce your lexapro dose from 20 mg to 10 mg if you can not tolerate the higher dose well. In common practices, the treatment with lexapro or any other antidepressant is started with the lowest effective dose. 

This is because when a person is new to antidepressants, there is no way to predict how his or her body will react to these meds. Antidepressants increase the amount of excitatory neurotransmitters to counteract the symptoms of depression. 

Now this excessive neuronal activity makes people respond in different ways. If your doctor notices that you’re presented with more side effects at a higher dose, he or she tones it down to give your body more time to adjust to this med at a lower dose. 

This effect is also seen when the dose is increased from 10 mg to 20 mg, after a week or two of the treatment. Some people develop unusual and new side effects when their dose is increased for the first time. 

This results in shifting back to the 10 mg dose, to help provide some relief from the side effects. The biggest reason behind dose reduction is lexapro withdrawal. When it’s time to stop using this antidepressant, your doctor slowly starts to taper down your dose every 2 to 3 weeks. 

This time duration depends on a lot of factors including the duration of your treatment with lexapro, the dose from which you’re starting to taper off and the fact that how well you can do with decreased dose of lexapro. 

You probably already know that the treatment with antidepressants can range from a few months to several years. It totally depends on the mental health condition of the one taking it. 

For people who have spent years taking lexapro, it could take up to a few years to successfully taper it off. It is not recommended to stop using Lexapro abruptly. 

What happens when you stop using Lexapro altogether? 

Abrupt withdrawal of lexapro leads to withdrawal or discontinuation syndrome. When you start taking antidepressant, it increases the amount of serotonin in your body. 

Over time, your body gets used to this increased amount of serotonin. When you suddenly stop using it, it creates an unannounced serotonin deficiency, to which your body reacts in a negative way. You may suffer from the following symptoms:

• Muscle cramps
• Gastrointestinal side effects 
• Headaches
• Emotional stress or constant crying
• Inability to concentrate or think clearly 
• Forgetfulness 
• Awkward behaviour 
• Dizziness and lightheadedness
• Chills
• Feeling suffocated with excessive sweating 
• Insomnia or somnolence 

Why dose tapering is considered crucial to ensure safe withdrawal of lexapro? 

Dose tapering is an important technique for the withdrawal of antidepressants, in a safe and effective manner. Antidepressants are known to produce dependence. 

As we know, SSRIs increase the availability of serotonin. So, if you abruptly stop taking it, your receptors which are dependent on it will start to have a major impact of serotonin deficiency. 

They literally start craving it and as you have stopped taking the medication, they remain deficient in excess serotonin. This leads to withdrawal symptoms. 

This is why dose tapering is important. It is a safe and effective method to withdraw SSRIs. Your healthcare provider simply just reduces the dose of your antidepressant. 

It enables you to start taking medicine in lesser quantities without completely depriving your receptors of serotonin. Half of the dose keeps decreasing gradually over the period of 7 to 8 days. 

After spending a week or two, the med is on its lowest possible dose and now it is considered safe for you to stop using it.

When the reason behind stopping your lexapro is to switch to another antidepressant, make sure you properly follow the instructions of your healthcare professional. 

In some practices, the dose of the first drug is lowered down while the new drug is started, also from the lowest effective dose. At this time period, you’re supposed to take two antidepressants, as you’re tapering one down and starting another. 

Experts believe that this time period could be a bit confusing for some people and they sometimes take more than they should. Make sure to stay on the lowest doses while you’re taking two antidepressants, because high doses can increase the risk of serotonin syndrome. 

It is a condition associated with too much serotonin in your system, which binds excessively to all of its receptors present throughout the body. The increased serotonergic activity causes a number of symptoms which include:

• Excessive sweating 
• Restlessness and fatigue
• Headache, which often feels like your head is pounding
• Changes in blood pressure and/or temperature
• Nausea
• Vomiting
• Diarrhoea
• Bradycardia
• Tremors
• Muscle twitching and muscle pain
• Shivering and goosebumps

Make sure you carefully take the prescribed dose and protect yourself from getting unwanted side effects. 

How long do these withdrawal symptoms last?

Different factors affect the duration of your withdrawal symptoms. One of these factors include the half-life of the drug. Drugs with longer half lives produce withdrawal symptoms for a longer period of time. Half life of Lexapro is 27-33 hours. 

Most people experience the first symptoms of withdrawal within one to three days after their last dose. Even if you taper off, you may still experience some symptoms. 

During days four to five, the symptoms may become more intense, depending on the dose you were on and the duration of your therapy. Some people experience dizziness, nausea, shakiness and fever. 

Your symptoms will gradually start to fade away in a week or two. It, too, depends on how your body reacts to this withdrawal. 

It is extremely important to follow your taper schedule vigilantly. It may take longer than you think it should, but it’s important to go slowly, so your brain has enough time to adjust the lowered doses. 

Within a few weeks, it will be safe to stop using your lexapro. Don’t mess up your taper schedule, if you wish to prevent discontinuation syndrome. 

Ensure the proper use of lexapro 

In order to achieve the maximum therapeutic response from a drug, it is extremely important to use it right. Read the following points for the proper use of lexapro:

• Make sure lexapro is the right choice of antidepressant for you. Stick to your doctor’s recommended dose. Do not take more or less than that. 
• Ask your doctor before taking lexapro if you’re pregnant, trying to conceive or if you’re a breastfeeding mother. 
• If you fail to understand how to use the drug properly or have any other question, ask your doctor or pharmacist.
• Do not stop the use of lexapro abruptly. When it’s time for you to stop using your antidepressant, your doctor will recommend a taper schedule to ensure safe withdrawal. 
• In case of overdose, immediately reach out to the hospital. Make sure you properly guide them about how much drug you have taken and when. 
• If you have missed a dose, take it as soon as you remember, but if a lot of time has passed and your next dose is near, do not take it. It’s better to skip the missed dose and take the next one.
• Report any problems with bleeding or bruising to your doctor. If you see any unexplained blisters or rashes on your body, or experience any problems with urination, or if you feel changes in your vision, immediately report to your healthcare provider. 
• Keep the bottle away from children and pets. In case of overdose, immediately take them to the hospital. 

Conclusion 

In this blog, we have discussed what circumstances lead to the reduction of lexapro dose from 20 mg to 10 mg. One of the reasons behind dose reduction is the occurrence of side effects on high doses. This results in reduction of dose. 

Most people are subjected to unusual effects when their dose is increased after 2 to 3 weeks of treatment. This could also result in reducing lexapro back to the lower doses to give your body more time to adjust to the medicine before trying to increase your dose again. 

The biggest reason behind dose reduction is lexapro withdrawal. When it’s time to stop using this antidepressant, your doctor slowly starts to taper down your dose every 2 to 3 weeks. 

This practice is crucial to avoid withdrawal or discontinuation syndrome, which is associated with many disturbing symptoms of its own. Make sure you properly follow your doctor’s taper schedule in order to ensure safe withdrawal of lexapro. 

FAQs:  reducing lexapro from 20mg to 10mg

How can I reduce my Lexapro from 20 to 10?

If there’s a need to reduce your dose, your healthcare professional will guide you through dose tapering. It is not recommended to go from high to low dose directly. You need to taper your lexapro in order to avoid withdrawal symptoms. 

How long does it take to taper off 20mg Lexapro?

It depends on how your body responds to the tapered doses. If you start reacting negatively, your doctor will recommend you to stick on one dose longer than usual and wait till your body is completely adjusted to it. Then your dose is tapered down and the same process is repeated. You can not lower the dose of lexapro any further if you’re not stable on your current dose. 

What are side effects of decreasing Lexapro?

You may suffer from the following symptoms: Muscle cramps, gastrointestinal side effects, headaches, emotional stress or constant crying, inability to concentrate or think clearly, forgetfulness, awkward behaviour, dizziness and lightheadedness, chills, feeling suffocated with excessive sweating, and insomnia or somnolence. 

Is 20 mg too much Lexapro?

20 mg is the highest dose for the treatment of depression and anxiety. Although much higher doses are also used in clinical practices, it is not recommended to take more than 20 mg of Lexapro per day. 

Can you cut 20 mg Lexapro in half?

Yes, you can cut 20 mg lexapro in half, but you don’t necessarily have to as lexapro is also available in 10 mg tablets. If you aim to achieve cost reduction by splitting your tablets in half, make sure you’re splitting it in such a way that dose is uniformly divided in two 10 mg halves. You can try tablet splitter or ask your healthcare provider for a proper splitting technique. 

Can Lexapro be taken every other day?

Lexapro is supposed to be taken every other day for several months to help relieve the symptoms of your mental health condition. Make sure you stick to your doctor’s recommended dose and take lexapro only once every day. 

References 

• P Haddad 1 – The SSRI discontinuation syndrome https://pubmed.ncbi.nlm.nih.gov/10958258/
• Norio Yasui-Furukori et al. Clin Neuropharmacol. (2016) – Characteristics of Escitalopram Discontinuation Syndrome: A Preliminary Study https://pubmed.ncbi.nlm.nih.gov/27171568/
• Escitalopram (Oral Route) https://www.mayoclinic.org/drugs-supplements/escitalopram-oral-route/side-effects/drg-20063707
• James M. Ferguson, M.D. – SSRI Antidepressant Medications: Adverse Effects and Tolerability https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181155/
• Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review https://www.karger.com/Article/FullText/370338
• Matthew Gabriel and Verinder Sharma – Antidepressant discontinuation syndrome https://www.cmaj.ca/content/189/21/E747