PinkPrincess: Hi everyone - coming off Citalopram after 17 years

[PinkPrincess]

Hi everyone. I have been on Citalopram for 17 years and my doctor advised me that I would probably need to stay on it long term. Almost 2 years ago I moved to a new town with my husband and my new doctors surgery has a very different view - they are very much of the opinion that you should not be on antidepressants long term. Cue 18 months off hell.  My mental health has been stable for years while I've been on 20mg Citalopram.

 

Shortly after registering with the new surgery I was asked to go in for a medication review and basically told that I had been on it for too long and needed to come off it. I was told to reduce my dose from 20mg to 10mg for 6 months then stop completely. After reducing to 10mg within a couple of months my depressive symptoms were back. I felt low, irritable, tearful, had no interest in anything. I went back to the doctor and was told to increase my dose back to 20mg. I did this and within a few months I was back to my old self. 6 months after increasing my dose I then had to go back for another review and was advised again I needed to try coming off the medication so again I was told to reduce to 10mg then stop completely after 6 months. Again, my depressive symptoms returned within a couple of months but worse than last time, I felt suicidal. Back I went to the doctor and again I was told to increase my dose back up to 20mg and it would be reviewed in 6 months. After this last appointment I realised that this pattern of increasing and decreasing my dose every 6 months was just going to continue indefinitely unless I bit the bullet and tried to get off it completely. So i actually decided to keep going with tapering after my last appointment and i have currently been on 5mg for the past 3 weeks. I do feel quite low and tearful a lot of the time and I feel like I've lost the person I used to be. I'm terrified this is just how I am without medication and this will be me for the rest of my life. 

 

How can you tell the difference between withdrawal symptoms and a return of depression? If I knew this was just withdrawal and would go eventually I could see it through but what if this is just how I'm going to feel without medication?

[Shep]

Hi, PinkPrincess.

 

Welcome to Surviving Antidepressants. 

 

The 50% reductions are way too fast, so it looks like instead of "needing" a drug, you were dealing with antidepressant withdrawal symptoms. Please note the drugs do nothing to fix our emotions. The chemical imbalance myth has been debunked.

 

Again, chemical imbalance is a myth. Stop the lies, please.

 

These drugs do have a powerful placebo effect, though: 

 

Treating Depression: Is there a placebo effect? video (14 minutes)

 

The fact that your symptoms resolved upon updosing when you tried to taper early on speaks to withdrawal, not any form of so-called "clinical depression." 

 

And it also looks like you're dealing with kindling. Kindling is trauma to the nervous system that occurs with repeated abrupt changes in dose that weakens the nervous system. This can make each subsequent withdrawal symptoms worse. 

 

To avoid this, we advocate a very slow taper of no faster than 10% per month, based on the previous month's dose (not the original prescribed dose). Please see:

 

Why taper by 10% of my dosage?

 

Tips for tapering off citalopram (Celexa)

 

The Windows and Waves Pattern of Stabilization

 

Please note the below, which advocates a slow taper, from CEPUK, 9/24/2020:

 

Major milestone: Royal College releases new guidance on stopping antidepressants

 

And here is the leaflet from Royal College of Psychiatry's website: 

 

Stopping antidepressants

 

You may want to show your doctor the above paper on stopping antidepressants. 

 

You may benefit from a small updose, but please don't make any changes just yet. I'm going to ask the other moderators more familiar with citalopram what would be the best dose to recommend. 

 

Question - what was the last dose you were on that you felt stable and what was the date you were on that dose? This information will help us guide you in the best updose amount to recommend. 

 

[PinkPrincess]

8 minutes ago, Shep said:

 

 

Question - what was the last dose you were on that you felt stable and what was the date you were on that dose? This information will help us guide you in the best updose amount to recommend. 

I have only ever felt like I had no symptoms on 20mg, the last time I was on that was in August this year. 

[manymoretodays]

Hi PinkPrincess,

And welcome. 

 

And okay, so 3 weeks ago you went to 5 mg of Citalopram?  Can you just add the day, to your signature?  Go to AccountSettings/signature

 

And yes, you've been really perceptive in noticing how much you've been basically rocking and rolling your poor nervous system around with what you've been told to do.

 

When we take medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made.  The CNS likes stability. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.

 

And I think that with some of those large percentage drops from the previous dose, it has thrown you off, and probably IS responsible for most of your symptoms now.

 

Are you experiencing any other WD(withdrawal) symptoms?

Dr. Joseph Glenmullen's withdrawal symptom list

 

What may help now is to updose, just a bit, from your 5 mg present dosage of Citalopram.

 

What are you working with now?  Is it a 10 mg tablet of Citalopram?

And then how do you presently get your 5 mg dose?

 

If you look at the Citalopram tapering topic, you'll see more information on the different forms of Citalopram, and then how to get doses outside of how they currently are produced.

 

And you haven't lost the person that you used to be.  She's in there.  Fortunate, or unfortunate........but sometimes we do, have to work really hard after some of these drug mis- haps, with a lot of non-drug coping, meditation, soul searching, and other practices to get on back to our best selves.  Time can do wonders too.  Patience required sometimes for healing.

 

I think I would feel okay, or if it was me........to updose from the 5 mg dose, on up to 7.5 mg now.  And then carefully observe, how you are doing with it.  Or I might give that a try.  It may not bring you all the back to how you felt you were doing in August, but might reduce some of the intensity of symptoms now. 

 

You could liquify some Citalopram to do so, say doing the 5 mg with a solid tablet, and then adding the 2.5 to it with liquid, either prescription or by making your own.

 

When do you take your citalopram now each day?

 

Then, it usually takes 4-7 days for a new steady state of the drug, to be achieved after an updose, or change in dose too.  And sometimes improvements, in symptoms may take even a bit longer to sense.  I think as long as you don't develop any real worsening in symptoms, it could help.   If you felt like symptoms worsened at all, then you would just stop the updose.

 

About reinstating and stabilizing

most of this ^ applies to updosing as well

 

After reinstating or updosing, how long to stabilize?

 

I'll stop there.  Other than to say, that if you do an updose, it is nice to have you keep updates going daily.  And then to use a simple format, noting times on the left, and then on the right, note your medication(s) by name and dose, and then symptoms as they occur throughout the day.  Keep going with times on the left, and note on the right any other drugs taken, supplements, activities, sleep patterns(after the fact), etc.

 

And best.

L, P, H, and G,

mmt