worrierprincess: Dad on Citalopram, want to help him taper

[worrierprincess]

worrierprincess

 

Hi all,

 

I am currently looking after my dad who is taking Citalopram. He is in his 70s. After a cancer diagnosis in January 2020 he began not sleeping, eating less and less, having muscle spasms and kept insisting he was going to die of cancer very soon despite being told no treatment was even needed. By second week of February he was afraid to eat due to acid reflux and had lost 12kg in weight. He was prescribed Citalopram 20mg and Zopiclone 3.75mg for anxiety, depression and insomnia. After much begging and tears we persuaded him to take the prescribed medicines. In the first few days of beginning Citalopram he started having violent spasms that would lift him off his bed and his anxiety was much worse than before. Waves of panic would constantly wash over him. We told the doctor at a&e that my dad was on antidepressants but it didn't sound any alarm bells. Sent us home with a packet of senokot for his constipation. We told the GP the following day, he also told us to continue.

 

Somehow we persevered with Citalopram for 3 more weeks. He became less anxious, was able to eat pureed food, but had become silent and he had developed a hand tremor. The GP said the improvements were too slow so increased the dosage to 40mg. I think at the time I was already researching all I could, but I was flustered from seeing my dad suffering from his illness. If I had been more clear of mind myself at the time I should have insisted on letting 20mg work a bit longer, or to only increase to 30 mg and see how well that worked first. The recommended maximum dosage for someone in their 70s is 20mg after all...

 

With the little knowledge I had I did make some effort to lessen the side effects of the increase by increasing to 30mg first. I think we were fooled into believing the GP that an increase was the correct course of action because after 2 days on 30mg my dad started smiling. Then he had 2 bad days which caused my mum to become impatient and increased to 40mg. My dad did become more anxious and the tremors increased, but on the 4th day of 40mg he laughed. It felt like we were witnessing a miracle... After that he's had some good days with no anxiety episodes, started eating solids again, had very rare moments of clarity when he could hold a normal conversation, could watch tv. At around week 5 he was laughing a lot, but also that's when the crying started too. He started having feelings of helplessness, being a burden and wishing he was dead... We accepted it was because he was becoming more aware, but he was getting better.

 

Then 2 weeks later everything changed. He had to go on a course of antibiotics Nitrofurantoin. The first couple of days he was dizzy and drowsy, common side effects of taking antibiotics. But as each day passed we could see my dad was becoming more anxious and restless, and he was getting brain zaps. The GP suggested we reduce his Citalopram dosage to 30mg, which should help with the dizziness and drowsiness. Another doctor we have access to advised us to reduce to 20mg. We waited until after the antibiotics before making any reduction. Having read up on reducing, we knew we should taper and not just drop to 30mg, and definitely not 20mg. We chose to reduce to 35mg.

 

Unfortunately, things have not gone according to plan. We should have waited for my dad to settle after the antibiotics before making any reduction. Also, I was not aware that my mum had already reduced Zopiclone dosage 5 days prior. My dad became very anxious, strong brain zaps throughout the day, so restless he can't sit in a chair for more than a couple of minutes and crying when we're not within his sight. The crying and looking for us starts at around 4am. One day he woke up thinking everything around him, including us, are hallucinations. Another thing we hadn't noticed before, there's something wrong with his memory. 2 days ago, we finally managed to get him outside the house and into the garden after 2 months of not stepping outside. The following day we asked about it and he said he doesn't remember it at all. This forgetfulness is especially apparent when he looks for us again only moments after we leave the room.

 

So where we're at now is that we've increased dosage to 37.5mg after 5 days on 35mg, hoping it will help with some of these symptoms. Maybe 1/8 reduction was too much for him? Or maybe if we waited a few more days he would've stablised? But his symptoms were becoming unbearable for him. We are day 2 on 37.5mg and the symptoms are still about the same. His anxiety was worse today. I guess it will take a few more days to settle. Curiously, my mum reported that my dad had 30 minutes free of brain zaps last night, and the night before...? Again, wish she would tell me these things before I changed the dosage again.

 

The 2 doctors both said to go back to 40mg, but we don't want to do that. We want to at least taper him down to a lower dosage, closer to the recommended dosage. We will stay at 37.5mg for a few weeks and make sure he is more stable before deciding how much to reduce again.

 

Sorry for rambling on... Not really sure if I have a question in there somewhere, but I guess I would just like some reassurance that we're more or less on the right path. It's difficult to know what to do when you know you can't follow doctor's advice, and the person you are looking after will not/can not communicate with you properly. Hoping a lower dosage will somehow let him speak to us again.

Edited May 14, 2020 by Gridley

[Gridley]

Welcome to SA, worrierprincess.

 

You have made a lot of dosage changes over a short time, and what your father needs now is stability.  I would make no further changes at this point and, as you mentioned, let your father stabilize on 37.5mg and 1.87 Zopiclone.  It's very important that you and your mother communicate with each other and that you not get impatient and increase or decrease dosages with every change in symptoms.  More is not necessarily better, and jumping around in doses is very destabilizing. 

 

He is also probably suffering from withdrawal due to the two large decreases in Zopiclone.

 

What is withdrawal syndrome.

 

We are a site for tapering off psychiatric drugs and dealing with withdrawal.  If, after your father has stabilized, you want to taper him down to 20mg or all the way off, and later off the Zopiclone, we can help you with that.  

 

We recommend tapering no more that 10% of current dose every four weeks. 

 

Why taper by 10% of my dosage?

 

The following link is specifically bout tapering Citalopram, including how to get the nonstandard doses you'll need for your 10% taper.

 

Tips for tapering off Celexa (citalopram)

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium (glycinate is a good form) and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems.

 

This is your Introduction topic, where you can ask questions and connect with other members.  We're glad you found your way here.

 

 

 

 

 

 

 

[worrierprincess]

Thanks for the welcome and reply, Gridley.

 

I have emphasized again the need to stick to the current dosage with my mum. We will stay with the current dosage for both drugs for the next 4 weeks at least.

 

I do have a question about switching to making the liquid form of Citalopram to make each dose more precise. We have been cutting the tablets for the past few days and realised it would be much more consistent if we followed the liquid method advised here. Cutting a 10mg tablet into quarters is very tricky and the sizes of each is different. My question is whether it is ok to introduce that right now? We are on day 4 of 37.5mg. I know we should give him the medicine partially as tablet and partially as liquid to minimize the effect of the change. So 30mg as tablet and 7.5mg as liquid?

[Gridley]

19 minutes ago, worrierprincess said:

I know we should give him the medicine partially as tablet and partially as liquid to minimize the effect of the change

Since your father has had so many changes in dosage, you might want to wait a week or two before beginning  the switch.

 

We recommend a gradual crossover from tablet to liquid:

3/4 dose tablet, 1/4 dose liquid for 3 to 7 days

1/2 dose tablet, 1/2 dose liquid for 3 to 7 days

1/4 dose tablet, 3/4 dose liquid for 3 to 7 days

all liquid thereafter