Hopepersists: searching for best way to get off Celexa

[Hopepersists]

Hi!  I am a new member and found this group as I was searching the best way to taper from celexa.  
 

I have been on Celexa since 2017 for anxiety related to insomnia.   I successfully tapered from 20 mg to 10 mg after I was on the drug for one year. As my anxiety reduced with getting better sleep, I found that 20 mg made me too groggy in the mornings.  I successfully transitioned from 20 to 10 over four weeks with minimal side effects.

 

I stayed on 10 mg for two years before increasing to 15 mg in June 2020 when my daughter was diagnosed with epilepsy.   After three months, I felt calmer so I titrated back to 10 I alternating 1510 doses for two weeks with no side effects. I do want to mention that I was on ashwaghanda at that point which I had been on for years.  
 

in January 2021 I was feeling really stressed again so I went back up to 15 mg with no side effects.   After three weeks my stress was noticeably less and I was trying to lose weight so I decided to go back to 10 mg.  I did this cold turkey (as I had done a 5mg change in 2018) and suffered severe dizziness and heart palpitations for a month.  I had forgotten how short of time I had been on the new dose and in hindsight I recognize that was much too quickly to change.  
 

I saw my doctor after four weeks of being on 10 mg and still experiencing moderate dizziness.  He told me to reinstate to 15 mg which I did and again experienced severe dizziness even having my legs go out from underneath me once when I went to get up.  The dizziness subsided after two weeks but I was still left feeling groggy in the mornings from the 15 mg dose as well as in the evenings.  
 

in late March my doctor told me that after being on 15 mg for four weeks I could again try tapering down using a 15 mg/ 10 mg alternating days schedule.  I did this for five days before I felt very strong with drawl symptoms including jitteriness, difficulty finding words, twitching nerve under my eye, increased insomnia(waking up in the middle of the night, etc). 
I was not on ashwaghanda going into  any of the 2021 titrations.  I did use the pills a few times during my most recent titration as it seemed to help the symptoms at first but then I became concerned about mixing in this supplement but I was already having strong withdrawal effects.

 

As of 4/1/21, I am now back on 50 mg and intend to stay here for a few months to allow my body to stabilize before trying to taper again.  I’m planning to wait 2 months until 6/1 to try to taper again.  
 

My doctor suggested removing one 5 mg pill per week every three weeks when I try again.  (Eg 10 mg on Monday, 15 mg every other day. Keep this pattern for three weeks.  Then have Mondays and Thursdays at 10 mg for the next 3 weeks).  

 

i’ve read about the benefit of limiting tapering to 10% and support that idea. This program from my doctor would take me down no more than 10% per month when you average out the doses, but I wonder if it’s better to do a graduated taper like Brass Monkey outlined.  Anyone have any thoughts?

 

if I do the brass monkey method, do I literally crush up my Celexa pills into a powder and then weigh them or do I just cut off bits to try to get to the weight?  Not sure how to physically execute this. I have 10 mg pills that I can easily cut in half, possibly into quarters.  Would I need to get medicine from a compound pharmacy?

 

I think I could go from 15 mg to 12.5 mg doses by cutting my pills. Appreciate any advice.  

 

 

 

 

[getofflex]

Hello, and welcome to SA.  We are a peer owned and run forum of people who have been or are getting off of psychiatric drugs.  I believe you are wise to stay on your current dose for a few months to stabilize.  By the way, the strong withdrawal you mentioned above could partially be from alternating doses between 15 to 10 mg every other day, because the levels in your blood go up and down, and this could throw off your nervous system. Another factor could be that when you dropped from 15 mg to 10 mg, that is a 33% reduction, and we suggest a 10% reduction at most.  

 

First of all, can you please give us specific information about your drug history?  Please read the link below for instructions.  This will allow us to give you the best guidance.  Please give specific drugs, dates, and dosages: 

 

How to List Drug History in Signature

 

This helps you understand what withdrawal syndrome is: 

 

What is Withdrawal Syndrome?

 

Here is some information about how these drugs actually work.  

 

How Psychiatric Drugs Remodel Your Brain

 

I'm glad your doctors tapering plan is no more than 10% per month.  Tapering is best done extremely slowly, and we taper by 10% of the current dose, so that the taper becomes exponentially smaller.

 

 Why Taper by 10% of my Dosage  

 

The brass monkey slide method is another good alternative:  

 

Brass Monkey Slide Method of Micro Tapering

 

Also, as we are tapering, we suggest keeping things slow, simple, and stable. 

 

Keep it Simple, Slow, and Stable

 

We do not suggest skipping or varying doses.  

 

Never Skip Doses to Taper

 

Celexa comes in a liquid solution, and I would suggest getting that for precise and gradual tapering.  You would measure it and take it using a syringe.  Here is information about tapering Celexa: 

 

Tips for Tapering off Celexa

 

When we recover, there are times of feeling OK mixed in with times of feeling bad.  This is called windows and waves.

 

Windows and Waves Pattern of Stabilization

 

Here are some techniques to cope with symptoms: 

 

Non Drug Ways to Cope with Withdrawal Symptoms

 

 

We don't suggest many supplements, but 2 that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. It is suggested to add one at a time, and start with a low dose to

see how it affects you. 

 

Magnesium

Omega 3 Fish Oil

 

I've given you quite a bit of information here.  Please read through it, and mull it over, and we will take it from there. In the meantime, take care of yourself, and take heart.  We in this forum have been through this, and we understand first hand the pain and discomfort you are going through.  Please know that the brain is amazing in it's healing abilities.  It takes time, but healing can and will happen. 

[Hopepersists]

Thank you for the warm welcome and advice!  I cannot thank the moderators and contributors enough for the gracious outpouring of advice to help other people going through a difficult time. 

 

I updated my signature to include the supplements I am currently taking.  I added in Fish Oil, which I have previously taken, per this site's advice.  After a few weeks, I will look to add a small amount of magnesium.  

 

Just wanted to congratulate you on your progress on both Lexapro and Xanax.  I have the same pattern with taking Xanax for sleep and have decided not to use it anymore and instead battle my fear of insomnia.  Chronic insomnia was my reason for going on Celexa - I didn't want to take Xanax daily.  If I can address this fear, it should help with the mental part of tapering off of Celexa.  I'm also doing daily meditation and yoga multiple times/week.  I used to do more "intense" exercise, but I am mindful that yoga, walking and perhaps casual cycling will be better for my nervous system.  

 

I'm going to get the liquid Celexa to help me taper down more slowly in conjunction with my 10 mg pill.  I'm going to meet with my therapist next week to share my approach with her and perhaps try to taper this Summer. 

 

 

[getofflex]

Ah, fear of insomnia.  I had that too, big time.  I have had insomnia off and on most of my life.  It is the reason I used to use Xanax and Trazodone 2 or 3 times per week, which I quit as of late December 2019.  

 

My husband is a medical professional.  He says insomnia won't kill you, even if it makes you miserable.  Now I must say, I am retired and am home and have lots of free time, so I have the luxury of being able to rest or nap in the day, although most of the time I'm too wired to do that.  If I could come up with a slogan to describe my own WD, it would be "tired but wired".  Anyway, he is right, insomnia has not killed me.  As time goes on, my sleep has gradually improved.  I'm now able to sleep 7 or even 8 hours on many nights.  On my bad nights, I may only get 4 or 5, but those bad nights are gradually becoming less frequent.  When I can't sleep, I listen to relaxing music on Spotify, or pray.  Both things calm me down and sometimes will help me go back to sleep.  Sometimes I take a small amount of melatonin and some magnesium.  Sometimes it helps too.  

 

I walk every day.  I believe walking helps my nervous system.  It helps me to work off that nervous energy, you know - the wired feeling.  

 

Here is a helpful link: 

 

Tips to Help Sleep

 

[Gridley]

@Hopepersists

 

We generally don't recommend multivitamins in withdrawal.  One reason is that B vitamins present in multivitamins are very often too stimulatin (especially when insomnia is an issue).  If you take calcium or your multivitamin contains calcium, you should be sure any calcium intake is two hours separate from your magnesium when you start it.  Calcium impedes the absorption of magnesium.  Many on the site have reported good results with taking small doses of magnesium throughout the day for its calming properties.

 

Good luck with your Celexa taper.  

[Hopepersists]

Gridley - Thank you for the tip re: multivitamins.  I will go ahead and remove them from my supplements for now as I don't need them for any specific reason.    I'm glad to see that you're on a probiotic as well.  I know that the majority of our serotonin is made in the gut, so I'm a big supporter of gut health.

 

getofflex - thank you for the comments regarding insomnia.  Love what your husband said!  I'm trying to take things one step at a time to manage my anxiety.  First - heal from the destabilization of my nervous system from the Jan-Mar dose changes.  2nd - do a slow, steady taper from 15 mg of Celexa down to 10 mg with a combination of pills and liquid.  Side note:  The 10% max. makes sense.  Has anyone had success with a taper where you just go down 1 mg/month rather than calculating 10% and having odd numbers?  If I do that from 15 to 10, each month by default would be less than a 10% change.  I thought that this might be easier to keep track of during my first slow taper attempt.  My idea is to do 0.5 mg drops every 2 weeks, pending w/d effects, and stabilizing every once in awhile.   

Appreciate any thoughts.  It's hard to balance logically thinking things through without getting caught up in it, per the anxiety.  :)

[Gridley]

On 4/8/2021 at 10:17 PM, Hopepersists said:

a taper where you just go down 1 mg/month rather than calculating 10% and having odd numbers? 

This isn't recommended, especially when you are down where you are at the low doses.  Decreasing by a straight 1mg accelerates the amount that you would be decreasing each time making it rougher and rougher with each drop. Decreasing by a percentage, however, decelerates the amount of each drop and makes things gentler on your system.

 

[Hopepersists]

@getofflex I am currently taking one and a half pills of 10 mg celexa to get to my 15 mg dose. My plan is to titrate down using one 10 mg pill and then the corresponding amount of liquid.   (I will start with my current dose of 5 mg liquid, which I’ve read is 2.5 ml).  Would appreciate any advice re: how to smoothly transition to the liquid pill combo.  
 

I’m still planning to give my body a break for the next few weeks, but would be open to doing the transition to the new medication format mid-May.  In the meantime, I have successfully incorporated 2,000 mg fish oil/day and plan to try the Mg Glycinate next week (isolating the effects to make sure it agrees with me before changing the celexa).  I read that this is best practice and it makes sense.  I’ve also been doing daily yoga and meditation for several weeks.  Used to meditate all the time, but got out of practice.  It’s been nice strengthening my mind again.  😌

 

Will check out the video link you sent.  If you do yoga, I highly recommend Yoga with Adrienne’s 30 day “Breath” series on YouTube.  Thanks again for all of the help.  
 

Gridley - thanks for the thoughts re: doing 1 mg/month down to 10 mg vs. doing 10% increments.  You raise a good point that even though a 1mg decrease per month would be less than 10%, each month would get progressively larger in % change which is not the direction I would want to go.  
 

I’m feeling much more optimistic about my future taper due to both your and getofflex’s advice.  I realize that I did several things wrong with regard to amount of change, speed of taper and overall timing (got my first round of Covid vaccine five days into the first taper and then again about a week before the second taper).  I know that not everything will be smooth sailing but I feel like it should hopefully be more manageable.   
 

 

[Hopepersists]

Tried 100 mg magnesium Glycinate but it ended up being a bit too strong for me.   Led to me feeling extra tired and a little dizzy as if I were tipsy.   I remember that this happened to me a few years ago and I tried taking magnesium.  Going to use Epsom salts as needed instead.  
 

On day 20 of reinstatement to 15 mg Celexa.  Feel a little lightheaded in the mornings and lower energy than normal. Fatigue after minor exercise like walking but I still take my dog for walks twice a day to keep moving.  The heartburn/ gas that surfaced after reinstating seems to be getting better.   I’ve taken Gas-X a few times which seems to have helped.  Not drinking any caffeine or alcohol and has severely cut back on sugar & dairy.

 

Trying to stay positive and know that the waves will diminish.   Looking forward to hopefully starting the taper process this summer but know that my body needs time to heal before then.   It’s a bit hard not being able to do the physical activities that I used to enjoy like riding my bicycle. Trying to do more fun self-care like reading and going for a massage next week since I’m vaccinated   

[Hopepersists]

Just learned that my hormone levels put me officially in perimenopause and close to menopause levels.   I’m 43.  
 

Still holding at 15 mg. Heartburn is now gone.  Still sometimes belchy, easily fatigued and experience very slight numbness on left arm & sometimes side of face toward evening.  Is usually alleviated after I take my magnesium.  

[getofflex]

I'm glad to hear you are holding on the 15 mg of Celexa.  If it were me, I would listen to my body, and wait until I felt stable before reducing the dose again.  I know how frustrating it is to have to taper at a snails pace, but it was definitely worth it for me.  One of the best things I ever did for my WD was holding on my dose for several months last spring and summer.  I felt so much better after that, and my subsequent reductions were easier. 

 

On 4/19/2021 at 9:37 AM, Hopepersists said:

Trying to stay positive and know that the waves will diminish.   Looking forward to hopefully starting the taper process this summer but know that my body needs time to heal before then.   It’s a bit hard not being able to do the physical activities that I used to enjoy like riding my bicycle. Trying to do more fun self-care like reading and going for a massage next week since I’m vaccinated   

It sounds like you have a healthy attitude, and doing a very good job of taking care of yourself.  You are right, the waves do gradually diminish in intensity.  Also, the good times get longer.  Keep up the good work. Someday all this will be in the past, and you will be drug free.  

[Hopepersists]

Thank you for the supportive words @getofflex.  I historically have not been much of a patient person so this is definitely a new exercise in surrendering to the process.  
 

I appreciate the advice that sometimes waiting for the stabilization in the short term actually can make for a better withdrawal process both in terms of side effects and maybe in terms of total length. 
 

My husband and I have a trip to Maine scheduled for August so right now I am just trying to focus on stabilizing myself so that I can hopefully feel good for that trip.  Would love to at least walk around and do casual things.  

[Hopepersists]

Met with new psychiatrist today.  She’s a fan of the fish oil and magnesium and seemed to go along with the guidelines I’ve read on this forum.  

 

She thinks that I am experiencing both Celexa side effects as well as withdrawal symptoms simultaneously right now, so she suggested switching my dosage pattern from taking all 15 mg at night to a split dose.  Since I have been on the 15 for over a month and my symptoms are stable/predictable, I am up for trying this to see if it will help.  
 

if this goes well, the next step is to convert my current dosage from all pills to a combination of pills and liquid.   
 

i’m going to see how I feel on the split dose to determine how long I want to keep only that change before switching my current dose to the liquid pill combo.   

[getofflex]

I'm glad to hear that your new psychiatrist is helpful and supportive.  It's good that your symptoms are predictable.  It sounds like you have a sensible and cautious plan in place.  

[Hopepersists]

If the splitting to two doses per day goes well and my symptoms either remain the same or improve, when do you think I could start the transition to my current dosage but as a liquid pill combo?

 

since I’m now doing 7.5 mg of cut up pills twice a day, the plan is to go to 5 mg pill plus 2.5 mg of liquid twice per day.  My thought is that I would first replace the evening 2.5 mg pill with liquid and then replace both the morning and evening after a period of time.  

When I read other posts about making changes within your current dose it seems like people can sometimes make those changes weekly as opposed to monthly.   Does that seem right to you?

[getofflex]

19 hours ago, Hopepersists said:

If the splitting to two doses per day goes well and my symptoms either remain the same or improve, when do you think I could start the transition to my current dosage but as a liquid pill combo?

 

My suggestion would be to wait at least 4 weeks - the reason being that it can take several weeks for you to feel the effects of a drug change.  

 

 

19 hours ago, Hopepersists said:

since I’m now doing 7.5 mg of cut up pills twice a day, the plan is to go to 5 mg pill plus 2.5 mg of liquid twice per day.  My thought is that I would first replace the evening 2.5 mg pill with liquid and then replace both the morning and evening after a period of time.  

Sounds good.  I would give it a week after you make your morning dose part liquid before you also make your evening dose part liquid, assuming that you don't feel ill effects.  

 

19 hours ago, Hopepersists said:

When I read other posts about making changes within your current dose it seems like people can sometimes make those changes weekly as opposed to monthly.   Does that seem right to you?

Some people can get away with this, but I would suggest you err on the side of caution, rather than risk going into withdrawal symptoms and further sensitizing your system. With the various drugs and drug changes you've made in the past, the likelihood goes up that this may cause problems for you that could take a while to resolve.  

 

This is a quote from one of our senior moderators: 

 

"But a dose change is not just changing the amount of drug being taken.  It can also be changing manufacturers, changing from brand name to generic, changing from tablet to liquid or liquid to tablet.  It can also involve changing the time of day the dose is taken or splitting the dose during the day.  Every one of these Dose Change Events requires time to take effect and more time to stabilize."

 

I'm not sure if I've given you this link yet, so I'll post it here.  I talks about all the various issues and factors that affect drug withdrawal, and the above quote is in #2.  

 

Issues that Affect Withdrawal

Edited May 2, 2021 by getofflex

[Hopepersists]

Thank you for the timing suggestions and for the link to Issues that Affect Withdrawal.  It was a great read.  I can’t tell you enough how much I appreciate your help @getofflex please know that your time and effort are seen and I’m sending a virtual hug of thanks.  
 

I’m 4 days into the split dose schedule and I saw a decrease in fatigue and I’m having milder WD symptoms before each dose.  It’s like it’s been spread out. 🙂

 

Added in Vit D today as a blood test showed I’m borderline deficient.  Would have normally waited but decided to do it now since I have a proven deficiency.  
 

Working with my doctor and insurance to get branded Celexa liquid in preparation for the pill-liquid transition.  I don’t want to get generic and have another transition. 

[getofflex]

14 hours ago, Hopepersists said:

please know that your time and effort are seen and I’m sending a virtual hug of thanks.  

It's my pleasure.  I'm glad I was of help to you.  🙂

 

14 hours ago, Hopepersists said:

I’m 4 days into the split dose schedule and I saw a decrease in fatigue and I’m having milder WD symptoms before each dose

That's great news!  I'm happy to hear this. 

 

14 hours ago, Hopepersists said:

Working with my doctor and insurance to get branded Celexa liquid in preparation for the pill-liquid transition.  I don’t want to get generic and have another transition. 

Sounds like a prudent idea.  I think you are going great.  Keep up the good work!

[Hopepersists]

I’m now about 2 weeks into my split dose regimen (7:30 am and 7:30 pm).   My energy continues to be better than before I change the split those. It went from 2 l/10 before to about 5 now.  As I get more tired, I sometimes feel numbness in my left arm or left side of my face.  When I sit and rest, it improves.  
 

I wake up with a withdrawal feeling, which goes away about 1.5 hours after my a.m. dose and appears again around 4 or 5 p.m.  I take my 100 mg of Mg Glycinate around 5.   Usually I feel more normal again around 8:30.  
 

I added vitamin D last week due to blood test results.  Haven’t noticed any change from this, which I take as a win.  

I’m considering making a change to my Magnesium dosing to help with withdrawal throughout the day.  
 

1.  Would it be ok to try this now?
2.  Thinking of adding a small amount in the morning and potentially mid day.  Could see if I can find a tablet to cut up.  Would hope to do 25 or 50 mg. 
 

FWIW, Mg seems to impact me pretty quickly.  I saw a positive change the first morning after I took it where I saw it help me to wake up in the morning vs. being groggy.  

[getofflex]

11 hours ago, Hopepersists said:

It went from 2 l/10 before to about 5 now.

I'm not sure what this means.  Can you please explain? 

 

11 hours ago, Hopepersists said:

I’m considering making a change to my Magnesium dosing to help with withdrawal throughout the day.  
 

1.  Would it be ok to try this now?
2.  Thinking of adding a small amount in the morning and potentially mid day.  Could see if I can find a tablet to cut up.  Would hope to do 25 or 50 mg. 

1. Yes, I think that would be fine.  Read the link on magnesium near the end of my first post.  

 

It sounds like you are doing pretty well.  It's good that you are being cautious and taking things slowly.  Keep up the good work! 🙂

[Hopepersists]

Hi!  That was a typo.  2 out of 10 and now at a 5 out of 10 for energy.  
 

Thanks for the continued advice.  I’m going to be adding in some CBT work this week as well, such as writing down my fears and refuting them.  I struggled a bit yesterday with my withdrawal feelings and wondering when I’ll be physically ready to try tapering again.  
 

The psychiatrist suggested doing a cross taper to fluoxetine but I’m nervous about trying that.   I think I want to try holding on this current change until at least the month is up and then perhaps trying to cut my pills down to try 14.5 mg (like Brass Monkey’s first step).   Unfortunately the liquid is generic only and I had issues with it when I first came into Celexa.  

[getofflex]

1 hour ago, Hopepersists said:

 I struggled a bit yesterday with my withdrawal feelings and wondering when I’ll be physically ready to try tapering again.  

We suggest waiting until you are stable.  This post talks about stability: 

 

Stability

 

1 hour ago, Hopepersists said:

The psychiatrist suggested doing a cross taper to fluoxetine but I’m nervous about trying that.   I think I want to try holding on this current change until at least the month is up and then perhaps trying to cut my pills down to try 14.5 mg (like Brass Monkey’s first step).

If it aint broke, don't fix it. You are doing so well on your current plan, if it were me I would not do this. (cross taper to fluoxetine) To be honest, I've seen so many people get really messed up by what psychiatrists told them to do with their meds.  It's unfortunate, but in my opinion psychiatrists do much more harm than good.  This posts explains what happens when people switch from one thing to another: 

 

Considerations about Stability Stop Jumping Around

Edited May 13, 2021 by getofflex

[Hopepersists]

I have now completed a full month on the split dose of 15mg.  I would say that I am generally functioning at 75% of normal with fatigue still being my biggest symptom.  I’ve noticed that if I overdo physical activity during the day I tend to get hit with a wave of exhaustion at dinner time. I view it as my body‘s way to tell me to lighten up a bit.  
 

For anyone else reading my story, here’s what has been helping me.  I switched the timing of my magnesium pill to two hours after my evening Celexa dose.  I had previously taken them within an hour of each other with the magnesium first and I would feel zonked out. Now that I have separated them, the evening energy is more consistent.   
 

I continue to avoid caffeine and have only a single glass of wine once every few weeks (May features my anniversary and my birthday).  
 

I started acupuncture a few weeks ago.  The first week I didn’t see a difference but the second week I actually felt my WD symptoms disappear during the session and didn’t have them for a day and a half.  I go back again next week and will continue to go weekly.  My doctor is also a huge fan of acupuncture and has seen it help many of her patients with their withdrawal.  
 

Lastly, I am fortunate to have a supportive psychiatrist who told me to go as slow as I need to during this process and helped me to get a custom prescription done at a compound pharmacy to turn my Celexa pills into a branded version of the liquid (only generic is available at mass pharmacies).   

Lastly, I do meditation every day using the headspace app.   The anxiety module is fantastic and I have done it numerous times. Recently, I have also done the patience module as well as one on fearing the future.   I also try to do a progressive body relaxation exercise a few times per week.  

 

I am going to start transitioning some of the pills to liquid tomorrow morning.  I will replace 2.5mg of the 7.5 mg a.m. dose.  If all goes well, I will do the same in the p.m a week later.  I’m a little nervous about it but I’m trying to stay positive and assume that this change will go smoothly.  
 

 

[getofflex]

I'm glad to hear that you have found some things that work, and that you are doing OK!  

 

1 hour ago, Hopepersists said:

Lastly, I am fortunate to have a supportive psychiatrist who told me to go as slow as I need to during this process

This is wonderful.  That is a blessing.

 

1 hour ago, Hopepersists said:

I am going to start transitioning some of the pills to liquid tomorrow morning.  I will replace 2.5mg of the 7.5 mg a.m. dose.  If all goes well, I will do the same in the p.m a week later.  I’m a little nervous about it but I’m trying to stay positive and assume that this change will go smoothly.  

This sounds like a good and prudent plan.  Keep up the good work!  It sounds like you have a lot of good coping techniques under your belt.  

[Hopepersists]

Would love some advice regarding how to figure out what my titration plan should be.  Here's the latest.

 

5/28 - started liquid titration.  a.m. dose 5 mg pill + 2.5 mg liquid.  Felt moderate increase of jitteriness 1 hour after dose.  Headache at day 3.  No big deal.  Still easily fatigued during dinner.  Very mild interdose withdrawal.  (WD normal symptoms)

 

6/4 - switched a.m. dose to 2.4 mg liquid as I realized that's likely more accurate with the pill cutting.  Totally fine.

 

6/5 - started evening liquid as well.  Total dose 14.8 mg - both doses 5 mg + 2.4 mg liq.  Headache on day 3 again.  Jitteriness felt the same (no change from prior week).  Had done 4 days of the liquid titration, so decided to start a dose reduction (saw on SA that you can do 3-7 days on liquid only change)

 

6/9 - total dose 14.4 mg (5 mg + 2.2 mg/dose).  For dosing, I took 10% off 15.0 mg (1.5 mg) and basically divided it into 3 for the remaining weeks of the month since I first changed off of 15.

• Felt better energy during the day.   
• After p.m. dose, experienced slight facial numbness on left side of face w/ moderate panic attack.  
• Panic subsided after evening Mg dose and meditation. 
• Fell asleep quickly but woke up in the middle of the night.  Took .125 mg of Xanax to fall back asleep after trying to meditate/read for 30 minutes.   All of these symptoms are not routine for me.  Insomnia presents as difficulty falling asleep for me, not waking up.    

 

I emailed my dr. this a.m. and she suggested going up to 14.6 mg and staying there for 1-2 weeks and then making the smallest possible change at those same intervals.  I took 7.3 mg this a.m. and feel OK so far. 

 

Assuming the 14.6 mg level is good for me, when I'm ready to make the next dose change, how should I proceed?  I would normally think to do 0.2 mg each period (1-2 weeks) but I know that SA doesn't recommend being linear in changes for too long as the % increase becomes larger over time.   Should I do the linear for a month, calculate what that % is of the original dose and then use that percentage going forward?  If I did 0.2 mg/week this month, that's 5.3%.  Should I just titrate at 5 rather than 10%?

 

Lastly, do people ever change titration percentages over time?  For example, starting at 5% per month at the beginning but as their neuroplasticity hopefully improves eventually change to 10%?  That's more a curiosity question as I will accept whatever my body is telling me, even if it needs to be 2.5% all the way.  

 

 

[Altostrata]

Hello, @Hopepersists

 

When was the last time you made a dosage change? How did your symptom pattern change after that?

 

Yes, people change titration percentages according to how they feel after the last dosage change.

 

On 6/10/2021 at 9:25 AM, Hopepersists said:

I emailed my dr. this a.m. and she suggested going up to 14.6 mg and staying there for 1-2 weeks and then making the smallest possible change at those same intervals.  I took 7.3 mg this a.m. and feel OK so far.

 

If I understand correctly, you are now taking 14.6mg. (I gather your doctor is learning about titration.)

 

Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. Post 24 hours of notes at a time in this topic, in a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right. This can help track the effect of a drug change.

 

 

[Hopepersists]

Hi @Altostratait is an honor to virtually meet you.  Thank you for all of the work you do with the site and the many people your team has helped.  

Recent Dose History

I have been on 15.0 mg for the last two months stabilizing my symptoms.  In the last month I did some drug transitions such as splitting my dose for a month and then spent almost 2 weeks titrating part of my 15 mg to a liquid.  (5 mg pill + 2.5 mg liquid twice a day).  
 

The dose reductions this week represented my first dosage decrease in over two months.  I went from 15.0 to 14.6 in a week which is 2.7%.  I had stair-stepped it from 15 to 14.8 and then to 14.6.   I would not normally make two changes in a week. It was originally because I thought that 15 wasn’t the right total dose with liquid given that I usually see powder left from cutting my tablets into quarters so I had adjusted it to 14.8 after one week of liquid titration.  
 

I’ve now been on the 14.6 mg for four days and it seems to be working well.  I noticed the withdrawal symptoms decreasing/improving each day they are now pretty mild.  
 

Yes, I do feel like my doctor is learning about how to work with someone who has very heightened chemical sensitivity.  
 

24 Hour Symptoms Journal

 

wake up 7:00 - mild jittery WD sensation.  Take 7.3 mg Celexa, fish oil, Vit D, probiotics and Zyrtec.  Eat breakfast.  Decaf tea. 

 

8:00 - jitteriness is nearly gone

 

9:00-10:00 take kids to school, walk dog, mild housework.  Feel a bit tired. 6/10 of normal pre- WD energy.    
 

10:00 meditate, relax a bit, perhaps have a small snack 

 

12:00 eat lunch - energy at its best.  Maybe do a bit more housework (never ends with 2 kids in elementary school!)

 

1:00 - 30 minutes yoga

 

3:30 - afternoon snack (I have very mild hypoglycemic tendencies, hence the consistent attempt at maintaining blood sugar levels)

 

6:00 Take 7.3 mg Celexa.  Feel with no or super mild jittery WD from 5:00-6:00.

 

8:00 take 100 mg Magnesium Glycinate

 

9:00 mild to moderate wave of jitteriness.  I first thought this was a panic attack on day one of titration.  Now realize that it was likely the jitteriness wave being strong and then my anxiety came on as this was unexpected.   Now that I know this happens every evening I tend to do some deep breathing.  Goes away within half an hour. The wave gets smaller each day that goes by.

 

9:45 go to bed and read.  Asleep between 10:30 and 11:00.  No mid-night wake ups since the first day of dose change.  

 

I know from past experience with my health that I have had this heightened chemical sensitivity before when my gut health was really off five years ago due to post-viral gastroparesis.  As I healed my gut, the chemical sensitivity significantly diminished.  Knowing that the gut produces our serotonin makes me think that this WD process could benefit from some improvements to my gut health as well, so I’m working on that with dietary changes. 

Future Dosing

For now, my plan is to stick with this 14.6 mg dose for minimum of a week until I no longer observe the symptoms of this dose change.  At that point, do you think I should do 0.2 mg as my next reduction or could I try 0.4 mg as that’s affectively what I did within a one week period (which would be consistent with brass monkey‘s 10% taper approach)?
 

Since I do two doses a day, ideally I’m trying to stick with even numbers for the dose reduction.  I realize that later on the numbers will become more wonky as my dose gets smaller, but I’m trying to take advantage of being on a relatively larger dose to keep things simple.  

Thanks for the help.  
A

[Altostrata]

It looks to me like that second dose of citalopram in the evening is too much for you, causing jitteriness. How long have you been taking 7.3mg in the evening?

[Hopepersists]

I had been taking 7.5 mg in pill form since the beginning of May in the evening.  
 

I have taken a combination of pill (5mg) and liquid in the evening for eight days.  

 

I went from 2.4mg liquid in the evening to 2.3 mg in the evening on Wednesday (4 days ago).  I had none of the jitteriness at 2.4 mg but now have it at 2.3 mg.  
 

I had felt some jitteriness about an hour after taking my dose during the first four or five days of my conversion to liquid in the morning.   I think it’s because the Celexa was getting into my system faster and I was actually getting side effects from the Celexa more strongly.  

 

I have noticed that my symptoms get worse with fatigue so I wonder if that’s why I tend to feel it more at night.  I’m not like the other folks on SA where the evenings are their best time.  I tend to feel a bit better in the mornings. 

[Altostrata]

The liquid is absorbed faster. I would slightly reduce the evening liquid portion, to 2.2mg.

 

Please let us know how you're doing.

[Hopepersists]

Thanks, @Altostrata I will drop the p.m. dose to 2.2 mg beginning tonight (total of 14.5 mg day)

 

I’m on day 7 of the 14.6 mg dose.  I have been having great sleep, sleeping in until 8 a.m. now that my kids are off school.  The morning WD feeling is very small.  
 

I do notice that I get The jitteriness feeling about an hour after my a.m. dose as well.  It’s now much more mild jitteriness after the evening dose, which is good.
 

Both my doctor and I agree with you that I am on too high of a Celexa dose. I was on 10 mg for 2 1/2 years.  I’m only on this higher dose because I made the mistake of going up to 15 mg in January after the assault on the U.S. Capitol and and then trying to reduce my dose back down three weeks later.  C’est la vie.  
 

I’ve actually done quite a bit of self talk to get to the point where I no longer harbor regret over that decision. You can’t change the past. You can only change what you do in the present.  

[Altostrata]

You may wish to reduce both daily doses very slightly.

[Hopepersists]

I just saw the note about reducing both doses.  
 

I reduced the p.m dose as of last night to 7.2 mg.   I think I’m going to let my brain do some healing over the next week and then reduce the a.m. dose next Tuesday.  My 11-year-old leaves for camp on Monday and I don’t want to do any further reductions until after she leaves.   I’m currently at 7.3 mg in the a.m.

 

My hope is that by waiting a week, I can further reduce by .2 mg (0.1 mg each dose).  I had my weekly acupuncture appointment today and it seemed to help calm things down a bit. 
 

[Hopepersists]

It’s now been several days since I dropped 0.1 mg to 14.5.  I really didn’t feel much so I’m definitely going to do a decrease of 0.2 mg this Tuesday and go from there. 

[composter]

Hi @Hopepersists, sounds like you are on the right track and I am glad you have a supportive psychiatrist—that can be hard to find. 
 

Looks like you are doing some variation of the Brassmonkey slide. Just be sure your pace is not faster than 10% per month overall. We need to give our brains time to adjust and adapt and that is best when we approach this slowly. 

[Hopepersists]

Hi @composter I ended up dropping 0.1 mg this Sunday to 14.4 mg (total decrease of 4%) and I ended up feeling very wired last night where it made it hard to fall asleep.  I had to take Xanax to sleep last night, which I hadn’t used in weeks.  
 

I went back up to 14.5 mg the this am and will stay here for at least a week.