Posted by bleauberry on May 24, 2010, at 16:20:35
In reply to Milnacipran - anxiety: bleauberry, posted by vic80 on May 24, 2010, at 9:32:31
The quick taper of lexapro is definitely a big player in what you are feeling. Serotonin is an inhibitory neurotransmitter. That inhibition was removed rather rapidly without time for the brain to readjust, which can take up from 4 weeks to 12 weeks to fully happen.
All that inhibition was replaced with an excitatory neurotransmitter NE. There is still some serotonin, but not as much as you were accustomed to. Dopamine is also indirectly increased in one part of the brain as a result of the NE reuptake of milnacipran.
I think it all would have gone smoothly if not rushed. The lex should have come down over a period of a couple months. Miln probably should have stayed at 12.5mg per day, divided into two 6.25mg doses, for at least a week, and then gently nudge it up over several weeks.
Rough guess. We're all different so it is hard to say. I've come off lexapro slow, and fast. So I know what both feel like. Same with zoloft. I've gone on miln and played with various doses. Rough guess as I see it is that about 70% of what you are feeling is lex withdrawal, and 30% is too much NE too fast.
I know I've said it before, but I still think if a low dose of lex and low dose of miln had been allowed more time you might have found the combo to work better than either alone. That's not uncommon with miln in other parts of the world.
I guess if you are completely set on keeping lex out of the mix, then maybe the best bet would be to lower the dose of miln and break it into smaller doses to spread out through the day. I mean, I found 6.25mg three times a day to be ideal. Could I be the only one? I don't think so.
poster:bleauberry
thread:948575
URL: http://www.dr-bob.org/babble/20100524/msgs/948623.html