BizzyLizzie: citalopram withdrawal cognitive symptoms

[BizzyLizzie]

I have been on Citalopram on and off for several years. I started the last time in 2014 after a bereavement. I decided to wean myself off it as it was giving me tinnitus and I didn't want to take it forever. I tapered the dose slowly, although in hindsight, maybe not slowly enough. It's been around two months since I stopped, and everything went well at the start. I can honestly say I didn't notice any difference. But in the last month there has been a gradual build up of symptoms. I actually wondered at one point if I was getting early onset dementia. I know your brain naturally forgets things for it to function, but I've actually been scared on some occasions. For example, I randomly forgot the word for cabbage. It came back to me eventually but I just couldn't get the name. Also, I deliberately went to pick something up in the supermarket and thought I'd picked it up, then got home with something completely different, without realising. And in a restaurant, our meals came to the table and I'd completely forgotten that I'd changed my order. So I'm at the table saying I hadn't ordered what they had brought me. It took me a few minutes to realise I'd actually changed it.

Reading this back sounds trivial and silly, and I think because I've noticed a memory issue, I'm picking up on every little thing and over analysing everything now (I suffer from health anxiety and OCD).

 

In addition, I feel as though my brain is foggy sometimes and I can't think straight. I feel confused and can't concentrate. However that will clear for a while and I feel ok again. There are odd moments I feel as though my anxiety has returned ten fold, although sometimes I feel ok. I wake up sometimes feeling panicky, but I don't know why. I generally feel I don't want to go out or see anyone. I often can't be bothered to engage in conversation, either that or I won't shut up. I've felt tearful a couple of times, had some brain zaps and felt a bit 'flat' sometimes. I've read that some people have a horrendous time coming off citalopram or SSRIs, but I've mainly read about the more physical symptoms and not the mental ones. I really don't know what to do. I saw my doctor today. She was unbelievably unhelpful. She didn't appear to have any awareness about withdrawal or possible memory problems etc. In fact she did a dementia test with me in her office (I passed). But that just fuelled my anxiety hugely. I'm first to admit I'm completely obsessing over my health now. By the was, I'm 53.

 

Edited August 8, 2019 by ChessieCat
removed links/added space/reduced font

[Sassenach]

Hello BizzyLizzy.

 

Welcome to SA.

 

This site is run by volunteer moderators who either have been or are still experiencing withdrawal.

Like the rest of us you have found out the hard way that doctors know nothing of withdrawal from antidepressant meds.

I will be asking you to complete an introduction and drug  signature in due course.

For the moment I would like the following information.

Is Citalopram the only drug you have taken in the last two years?

Do you take any supplements?

What was your Citalopram dose before the start of the taper?

What percentage did you taper and over what period?

What date did you take your last dose?

What dose did you jump off?

 

 

1 hour ago, BizzyLizzie said:

I've mainly read about the more physical symptoms and not the mental ones

 

All the symptoms you have listed indicate you are in withdrawal.

https://www.survivingantidepressants.org/topic/2390-dr-joseph-glenmullens-withdrawal-symptom-checklist/

 

The only known way to mitigate W/D is to reinstate a small dose of the medication in order to stabilise.

https://www.survivingantidepressants.org/topic/7562-about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/

https://www.survivingantidepressants.org/topic/82-the-windows-and-waves-pattern-of-stabilization/

Please supply the info requested above in order for us to help you.

 

It is far more likely that your symptoms are withdrawal than dementia.

 

Sassenach

[BizzyLizzie]

Thank you for your response.

 

Whilst taking Citalopram   I have been on Mebeverine 135mg (drug used to alleviate some of the symptoms of irritable bowel syndrome) three times a day, Omeprazole 20mg once a day, Seretide 250 inhaler twice a day, Cocodamol 30/500 two pills four times a day. 

 

No supplements taken.

 

On 20mg citalopram before taper. I tapered over around 4 weeks. Wish I'd kept a note of what I did and when.  Roughly speaking,  I halved the dose for a week, taking it every day, then the same dose the following week, but only taking every other day. Same for week 3 and 4, so jumped off at 5mg.

 

Edited August 8, 2019 by ChessieCat
added IBS drug info

[Sassenach]

Afternoon BizzyLizzy.

 

Will you please use the link below to enter all your meds into the interreaction checker, then copy and post the results on here.

 

https://www.drugs.com/drug_interactions.html

 

Do you have any Citalopram at present?

I will be back on the site between 5-7pm this evening.

 

Sassenach

[BizzyLizzie]

I have looked a the Drugs Interactions Tools. There is a major interaction between Citalopram and Omeprazole (mainly heart issues). There is also an interaction between Citalopram and Codeine (citalopram may lessen the analgesic effect). However, I haven't been able to add Mebeverine to the mix, as the tool doesn't recognise it.

I still have Citalopram at home.

[Sassenach]

1. Drug Interactions Checker
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Drug Interaction Report

This report displays the potential drug interactions for the following 6 drugs:

• citalopram
• omeprazole
• Serathide (hydralazine / hydrochlorothiazide / reserpine)
  The interactions information for this drug may not be up-to-date. More...
• codeine
• Paracetamol (acetaminophen)
• Ferrogels Forte (multivitamin with iron) Mebeverine

Edit list (add/remove drugs)

• Consumer
• Professional
• Email this report

Major (1)

Moderate (7)

Minor (0)

Food (2)

Therapeutic Duplication (0)

Interactions between your drugs

Major

omeprazole citalopram

Applies to: omeprazole, citalopram

Talk to your doctor before using citalopram together with omeprazole. Combining these medications may increase the blood levels of citalopram and increase the risk of certain side effects, including an irregular heart rhythm that may be serious or life-threatening. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or fast or pounding heartbeats during treatment with these medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

codeine hydrALAZINE

Applies to: codeine, Serathide (hydralazine / hydrochlorothiazide / reserpine)

HydrALAZINE and codeine may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

codeine hydroCHLOROthiazide

Applies to: codeine, Serathide (hydralazine / hydrochlorothiazide / reserpine)

HydroCHLOROthiazide and codeine may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

hydroCHLOROthiazide omeprazole

Applies to: Serathide (hydralazine / hydrochlorothiazide / reserpine), omeprazole

Chronic use of drugs known as proton pump inhibitors including omeprazole can sometimes cause hypomagnesemia (low blood levels of magnesium), and the risk may be further increased when combined with other medications that also have this effect such as hydroCHLOROthiazide. In severe cases, hypomagnesemia can lead to irregular heart rhythm, palpitations, muscle spasm, tremor, and seizures. In children, abnormal heart rhythm may cause fatigue, upset stomach, dizziness, and lightheadedness. A dose adjustment or more frequent monitoring by the doctor may be required to safely use both medications. If you are using an over-the-counter proton pump inhibitor medication such as Prilosec OTC, Zegerid OTC or Prevacid 24 HR, you should follow the directions on the package carefully. Do not use the medication more frequently or for a longer period than recommended on the label unless otherwise prescribed by your doctor. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

hydroCHLOROthiazide reserpine

Applies to: Serathide (hydralazine / hydrochlorothiazide / reserpine), Serathide (hydralazine / hydrochlorothiazide / reserpine)

Before taking hydroCHLOROthiazide, tell your doctor if you also use reserpine. You may need dose adjustments or special tests in order to safely take both medications together. The blood pressure lowering effects of this combination may be additive. You should take reserpine at bedtime and to notify your doctor if have dizziness or feel faint. It is important that you tell your healthcare provider about all other medications that you are using including vitamins and herbs. Do not stop using your medications without first talking to your doctor first.

Switch to professional interaction data

Moderate

omeprazole multivitamin with iron

Applies to: omeprazole, Ferrogels Forte (multivitamin with iron)

If you are iron-deficient or have anemia, you should talk to your doctor before using multivitamin with iron together with omeprazole. By reducing stomach acid, omeprazole may reduce the absorption of iron and make multivitamin with iron less effective in treating your condition. Your doctor or pharmacist may be able to offer suggestions on safer alternatives if you require treatment for stomach acid or ulcer while you are being treated with multivitamin with iron. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

codeine citalopram

Applies to: codeine, citalopram

Citalopram may reduce the effectiveness of codeine. You may need a dose adjustment if you have been taking codeine and are starting treatment with citalopram. Let your doctor know if your condition changes or you experience reduced or inadequate relief of your symptoms. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

hydroCHLOROthiazide citalopram

Applies to: Serathide (hydralazine / hydrochlorothiazide / reserpine), citalopram

Treatment with citalopram may occasionally cause blood sodium levels to get too low, a condition known as hyponatremia, and using it with hydroCHLOROthiazide can increase that risk. You should seek medical attention if you experience nausea, vomiting, headache, lethargy, irritability, difficulty concentrating, memory impairment, confusion, muscle spasm, weakness or unsteadiness, as these may be symptoms of hyponatremia. More severe cases may lead to hallucination, fainting, seizure, coma, and even death. Citalopram can also affect your blood pressure and heart rate. You may need a dose adjustment or more frequent monitoring of your blood pressure and pulse to safely use both medications. You should avoid rising abruptly from a sitting or lying position while taking these medications, especially at the beginning of treatment or after an increase in dose. Call your doctor if you experience dizziness, lightheadedness, fainting, or a rapid heart beat. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

No other interactions were found between your selected drugs.
Note: this does not necessarily mean no interactions exist. Always consult with your doctor or pharmacist.

Drug and food interactions

Moderate

citalopram food

Applies to: citalopram

Alcohol can increase the nervous system side effects of citalopram such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with citalopram. Do not use more than the recommended dose of citalopram, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

Minor

multivitamin with iron food

Applies to: Ferrogels Forte (multivitamin with iron)

Consumer information for this minor interaction is not currently available. Some minor drug interactions may not be clinically relevant in all patients. Minor drug interactions do not usually cause harm or require a change in therapy. However, your healthcare provider can determine if adjustments to your medications are needed.

For clinical details see professional interaction data.

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

Report options

• Return to the Interactions Checker
• Email this report to a friend/doctor/patient
• Ask questions/find answers

 

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.

Major	Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate	Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor	Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown	No interaction information available.

Edited August 9, 2019 by Sassenach
Drug name

[Sassenach]

Hello BizzyLizzy

 

It is good that you have been finding your way around the site.

I hope you are getting some insight to A/D, W/D.

Your full interaction list pasted above and as you commented shows Citalopram and Omeprazole show a major interaction which will be addressed if you wish to reinstate.

In order to initiate reinstatement we will need you to complete the formal introduction and drug signature here

https://www.survivingantidepressants.org/topic/25-please-start-a-topic-about-yourself-in-this-forum/

I realise you cannot remember exact dates, give as much info as you can remember as accurately as possible.

You have already provided this info on your thread but your formal drug signature will appear below every post and make it easy for senior mods to see at a glance.

It also ensures continuing accuracy provided it is kept up to date.

We will also require a daily med and symptom diary in the following format.

 

Thurs 18 July

Awoke 4am, went back eventually.  Vivid dreams.

7.30am 50mg sertraline 

9am Felt ok

9.30am Exercise bike and yoga session

11am Felt good

2pm Tired

4pm Headache, paracetamol 500mg

6pm Spaced out and empty

8pm 20mg promazine

9pm Felt ok, tired

10.30pm Bed

 

The diary is essential to allow both us and yourself, to track progress and evaluate changing symptoms.

On 8/8/2019 at 4:59 PM, BizzyLizzie said:

And in a restaurant, our meals came to the table and I'd completely forgotten that I'd changed my order. So I'm at the table saying I hadn't ordered what they had brought me. It took me a few minutes to realise I'd actually changed it.

The above is why the diary is important. We have all done something similar.

If you feel it likely you want to try reinstatement it would be good to start a diary now to give your baseline situation.

We do understand that when you are suffering W/D that this can seem onerous but is the only way to monitor your ongoing progress.

As it is now the weekend things slow down a little, which gives us the chance to get everything sorted if required.

I remember the rock and a hard place feeling, which way to go, only you can make that decision, but either way we are here to support you.

I will be around over the weekend if you require any further info.

 

Sassenach

 

P.S. Horrible wind and rain here. Hope it is better with you.

[Dizzy4]

Welcome BizzyLizzy!  You'll get your brain back 😘  I cold turkeyed off 40mg escitalopram, my symptoms are mainly cognitive but getting better. Some days its like this all never happened.

 

I have been to many useless doctors haha, - why I keep going back I don't know! I went to a neurologist recently who said 'you sound like my concussion patients.. but there's nothing wrong with you"

 

My GP did keep prescribing me drugs too - to treat my symptoms (she meant well), as soon as I started saying no I felt better. I had some interactions going on!! 

 

When I doubt myself and begin to feel pessimistic about it all I come back here 🙂 

[BizzyLizzie]

Thank you Dizzy4, I really appreciate your posting. It would be good to find a doctor that firstly could give me some time to discuss my issues, and also someone that I felt semi understood how I feel and give me some reassurance, instead of sending me for tests and offering different meds.

I've now been put on Ramipril for high blood pressure,  and because I've been given new medication,  the pharmacist had a chat with me. I got more from a ten minute chat with him, than all the times I saw my doc. Saying that, he was surprised I was still having withdrawal symptoms after 2 months.

I almost picked up the Citalopram this morning to start taking a small dose as had a bad weekend. I've had one night where I didn't sleep until 5am, then last night I had a really terrible wobble and ended up going to bed at 8pm, just to get away from my head. I'm going to try to persevere. 

[BizzyLizzie]

Sorry, just been looking at your meds history.  So you've been off citalopram for a year?

[Sassenach]

Good morning BizzyLizzy.

 

When did you take your last dose of Citalopram ?

 

Sassenach

[BizzyLizzie]

29th May, this year.

[Sassenach]

Hi BizzyLizzy

 

Dizzy4 states she C/Ted Citalopram/Lexapro which indeed she did.

However if you look at her drug signature you will see she reinstated after almost two months, which is very much like your current situation.

Neither the GP or the pharmacist understand W/D, they believe that once the drug is out of your body all should be well.

They do not understand these drugs change neurotransmitters in our brains and it takes a long time to reach homeostasis.

Reinstatement is the only known way to mitigate withdrawal symptoms.

The option is wait it out until symptoms improve.

 

Please contact us if you need any further help with your decision.

 

Sassenach

 

[Altostrata]

Hello, BL.

 

On 8/8/2019 at 8:59 AM, BizzyLizzie said:

There are odd moments I feel as though my anxiety has returned ten fold, although sometimes I feel ok. I wake up sometimes feeling panicky, but I don't know why. I generally feel I don't want to go out or see anyone. I often can't be bothered to engage in conversation, either that or I won't shut up. I've felt tearful a couple of times, had some brain zaps and felt a bit 'flat' sometimes.

 

Please give more detail. How often do these spells happen? When was the last time you had a brain zap? How often do they occur?

 

On 8/8/2019 at 11:25 AM, BizzyLizzie said:

I have been on Mebeverine 135mg (drug used to alleviate some of the symptoms of irritable bowel syndrome) three times a day, Omeprazole 20mg once a day, Seretide 250 inhaler twice a day, Cocodamol 30/500 two pills four times a day. 

 

Taking Cocodamol may be a reason why you feel flat and have brain fog. Please read up on side effects on drugs.com. How long have you been taking it, and why?

[BizzyLizzie]

The spells just happen randomly, maybe days sometimes between them. Brain zaps generally just happen on waking. I may have two or three of them. I had them this morning. I don't think I've had them other times. I've not noticed.

I've been taking cocodamol for a couple of years to manage back pain. I've been trying to gradually reduce them too.

[Altostrata]

Have you been reducing Cocodamol at the same time you've changed citalopram?

 

Please do not change the dosing or timing of any of your drugs for a while. We need to see a baseline symptom pattern relative to your drug intake. We also need to see how often and when you get these odd symptoms.

 

Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms. You can post 24 hours of notes at a time in this topic, with a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right. We'll need to see these daily notes over at least several days.

[ChessieCat]

Example of what is required:

 

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep