OmniaVincitAmor: quitting clomipramine caused me very bad depression

December 8, 2022

If you've recently suffered any kind of drug withdrawal symptoms, we recommend you stabilize thoroughly before starting to taper again.

December 29, 2022

Hi @Onmyway and the entire SA Team!

I hope your Holidays went well and you are all relaxed now! Thanks for this year and all the help me and so many others have received.

I’m about to start my new taper journey with citalopram. I’m going to use the slide method and start with a max of 4%. Starting dose is 30mg. Unfortunately my scale isn’t accurate enough for such small tapers (the scale’s accuracy is 0,000g). In my country citalopram comes only in 10, 20 and 30mg doses. liquid form is unavailable so I’m going to crush the pills etc.

I have the 10mg tablets which I take 3x10mg=30mg. I now I can always buy even more accurate scale but such a scale is very very expensive. Is there any other alternative that you could come up with?

December 29, 2022

1 hour ago, OmniaVincitAmor said:

Hi @Onmyway and the entire SA Team!

I hope your Holidays went well and you are all relaxed now! Thanks for this year and all the help me and so many others have received.

I’m about to start my new taper journey with citalopram. I’m going to use the slide method and start with a max of 4%. Starting dose is 30mg. Unfortunately my scale isn’t accurate enough for such small tapers (the scale’s accuracy is 0,000g). In my country citalopram comes only in 10, 20 and 30mg doses. liquid form is unavailable so I’m going to crush the pills etc.

I have the 10mg tablets which I take 3x10mg=30mg. I now I can always buy even more accurate scale but such a scale is very very expensive. Is there any other alternative that you could come up with?

Hi @OmniaVincitAmor

The pills themselves will actually be weighing much more than 30mg because they have fillers. So your scale might still be ok. An alternative is to make your own liquid from the pills. The tapering forum has a thread on tapering citalopram. That has more details on how to get the right dosages.

let me know if I can help with more info,

OMW

December 30, 2022

Making a liquid from citalopram tablet and tapering with an oral syringe is much less prone to error than crushing tablets and weighing the powder. See Tips for tapering off citalopram (Celexa)

January 13, 2023

Hi @Onmyway, Alto and others! Thank you once again for your advice! I don’t know what I would do without you.

I’m about to start tapering using the slide method with 4%. I’m having a lot of doubts and fears though. It is recommended to hold on for 2 weeks after the complete reduction. Can the two weeks really be enough? It sounds such a short time.. I know I can always hold on for longer but then the whole tapering project would take forever.

can this really work? I’m afraid I’m going to hit the wall again..

January 13, 2023

@OmniaVincitAmor a tiny reduction is a trial to see how it well it works, with minimal risk of withdrawal symptoms. You'll gain confidence as you find a good reduction schedule for yourself.

Are you still taking a benzo twice a day? Which benzo? Please update your signature.

January 14, 2023

Hi @Altostrata!

thanks for responding! Updated my signature. Will update it more once I’m done the first ”slide”. I’m terrified but fingers crossed.

the bentso I’m taking twice a day is Clonazepam. I’ve been taking the same dose (2 x 0,5mg) for many years.

February 2, 2023

Dear SA Team!

I’m currently dilluting my meds in water. Has anyone used syrup etc. in order to get the tablet dissolved better? Or does anyone have better ideas? I keep stirring the water when taking my does with a syringe but I find it a bit difficult.

Another question: are there many here who has tapered too quickly and when updosing, the med doesn’t work properly anymore? Is that called a kindling reaction? This has happened to me at least and was just wondering what is the reason for this.

February 2, 2023

For what purpose are you taking a benzo? What times o'clock do you take each of your drugs, with their dosages?

See

How to make a liquid from tablets or capsules

Pharmacy liquids to make suspensions

Questions and answers about liquid medications

@brassmonkey can answer your questions about the slide method.

February 3, 2023

Hi @Altostrata! Thanks for responding!

the bentso I have is clonazepam (2x 0,5mg). I’ve been taking it for ten or more years now and it was prescribed for easening an extremely severe neck pain. It relaxes the neck muscles and has therefore been very helpful.

I took clonazepam many years together with clomipramine (also prescribed for pain). Once I quit the clomipramine too fast due to doctors advice my problems started. I can’t be sure but I don’t think that my anhedonia etc. problems are due to clonazepam. Like I mentioned, I never had these kind of problems before once I quit the clomipramine.

I,ve heard people complaining that once they have restartes a drug or updosed, the drug doesn’t work properly anymore and was just wondering what the root cause for this could be.

anyways, I have now started to taper down from 30mg of citalopram with a max of 6% using the slide method. will update my signature once I’m dine with the first slide. This time I’ll be super careful!

@Altostrata, if and when everything goes well with my superslow and carefull citalopram tapering should I at some point take a break and taper the bentso instead? Or should I just take it one drug at a time?

thank you!

February 3, 2023

The baseline Brassmonkey Slide (2.5% a week for 4 weeks and a 2-week hold) is a starting point that works well for most people. It is always acceptable to use smaller reductions and/or longer holds. We have found through experience that the 2 week hold is quite adequate for most people. There is a little experimentation involved while one is tapering to find the best combination for each individual. So, if a longer hold is necessary, by all means do it.

The scales you have will work very well. Because of the fillers used each tablet weighs quite a lot more than the specified strength. Before using the scales, it is a good idea to calculate the average weight of one tablet. This number is quite important in calculating the weight of each new dose.

It sounds like you are going to be making your own liquid from the tablets you have. As you are finding out water is not a good media to do this with. Here is part of an article I wrote talking about different media that will work better. It was written for people tapering benzos, but the techniques are the same for ADs.

Suspension Media

Because it is so thin, water is not always the best media for making a suspension. Even though it is quite fine in texture the powder made by crushing the tablets is still heavier than water and can settle out quite quickly. A better way is to use a thicker base material.

There are several commercially made “Suspension Medias” available online or through your pharmacist. Ora-plus and Ora-sweet are two of the most common, but a quick online search will bring up other alternatives. There are some ways to make your own which can work quite well also.

Believe or of not there are some people who have trouble drinking water because it is too “wet”. There is a product available at many drug stores or chemists referred to as “thick water”. It is thick enough to hold the powder in suspension quite well.

Making a homemade suspension media can work well too. A common one is to use maple syrup; you could also use corn syrup or other cooking syrups. There are quite a few recipes available online using a variety of materials. All these media would be used in the same manner as water following the directions given in other parts of this article.

Using fruit juice is also popular as a suspension media. Some juices are much thicker than water and suspend the powder quite will. They also taste much better. Because they contain fruit pulp it is hard to see if the powder is well mixed in. As warned above DO NOT USE GRAPEFRUIT JUICE, it reacts badly with many Benzos and can create a liquid that is dangerous to drink.

It can seem that making a liquid from benzodiazepine tablets borders on getting a degree on chemistry. But by following the process step by step it is pretty straight forward, and these techniques are being used by many people to facilitate their tapers.

February 4, 2023

16 hours ago, OmniaVincitAmor said:

@Altostrata, if and when everything goes well with my superslow and carefull citalopram tapering should I at some point take a break and taper the bentso instead? Or should I just take it one drug at a time?

You should taper one drug at a time, then assess.

In the meantime, you might seek non-drug treatment for what sounds like physical pain issues, such as physical therapy, acupuncture, etc., to see if you can reduce your need for benzos.

Yes, long-term benzos can cause a feeling of blankness or emotional anesthesia.

February 9, 2023

Hi @Altostrata and @brassmonkey!

many thanks for your replies! I really appreciate it 😊

@brassmonkey I’ll try to find that pharmacy liquid you suggested. I think I’ve survived from my first taper which was 6%. Now 3 weeks hold and then maybe trying 7% if I have the courage.

I’m super worried that I accidently make a mistake with the tapering. I’m constantly counting that I’ve measured the amounts correctly. Hopefully I’ll gain confidence in the long run.

thank you both!

February 14, 2023

Hi @brassmonkey!

In my previous post I wrote that I might have survived from my first slide reduction but now it seems I suffer from mild wd symptoms after all. I've started to feel low mood and anxiety. Maybe a loss of appetite as well.

I wonder what I did wrong and how should I proceed my tapering? I tapered 6% from 30mg with the slide method (i.e made four weekly reductions of 0,45mg). My current dose is now 28.20 mg. Whenever I get wd symptoms they usually start on a fourth day of the reduction (citalopram half life is approximately 35 hours). I have a couple of questions below:

1. I obviously should taper less than 6%.. what shall I try next time? 4%?

2. Should I take longer holds between the weeklyreductions? perhaps one week after each reduction isn't enough. Maybe the half life of 35 hours is too long for this kind of pace?

3. Any other ways to taper more carefully?

I obviously don't taper before the wd symptoms are gone. This just kinda makes me sad. I made such a small and careful reduction and yet I got symptoms. The symptoms are not easy to deal with as I'm already not feeling really good. I've suffered from depression, anhedonia etc. for more than two years now ever since I accidently quit my clomipramine ct from 10mg to 0mg. Soon after I was prescribed citalopram but I only got a partial help for my symptoms. I feel really drug resistant. My only hope is that tapering would help to heal my nervous system.

Are there many here who feel drug resistant and tapering has helped?

February 14, 2023

I don't think you've done anything wrong, but a little fine tuning may be called for.

First off, no taper is going to be symptom free. Managing the symptoms to make them as tolerable as possible is the object of the taper. The Brassmonkey Slide has shown that for most people it will reduce their symptoms to a very tolerable level, but it doesn't eliminate them.

Given the longer half-life of the citalopram adding some time to the weekly hold might be helpful. You mentioned that the symptoms usually hit after four days. I would start by lengthening the hold by that amount. By the end of each weekly hold the symptoms should be greatly reduced, but not gone. That is the [purpose of the additional two week hold. To allow the symptoms to settle out to a low level and stabilize. The taper is a balancing act between feeling bad and feeling tolerable as the body rocks back and forth between the two.

This was your first reduction, so there is going to be a little time spent for your body to get use to the idea that the medication will be changing. It can take several reductions before this happens. Changing the amount that is being reduced by will only add to the confusion that your body is feeling. Going lower in dose may help, but I would work with the hold times first. We do have members who are reducing by much smaller amounts. I believe that there are several who are doing Slides with a total of 1% per reduction cycle. It has to be remembered that the longer the hold times and the smaller the reductions the longer the taper is going to take. If you change from a 6% to a 3% taper, then you will double the length of time you are tapering. And we are talking years not months.

Another thing that needs to be taken into account is your CT two years ago. CTs take a very long time to resolve. Again, we are looking at a multi-year time frame. For the CT you are just about in the middle of the recovery process, so you will be getting WD symptoms from that. The Citalopram should help act a bridge to minimize your symptoms, but we have found that bridging only works in less than half the cases. Meaning the some of the symptoms you are getting are from the CT, and as you taper they are not being covered up as well.

Your body is healing all the time while tapering, even if it doesn't feel like it.

February 16, 2023

@brassmonkey, Many thanks for your fast reply! I can’t even explain how much your answer gave me motivation, hope and optimism!

You explained everyhting so well! I understand things so much better now! I am truly believing that everything works out fine for me as well.

thank you for taking the time and effort to help me! Wishing you a lot of sunny days wherever you are!

February 16, 2023

On 2/14/2023 at 2:18 AM, OmniaVincitAmor said:

I've started to feel low mood and anxiety. Maybe a loss of appetite as well.

Please explain more about the anxiety. You may have mild symptoms for a few days after a reduction, which could be your normal pattern of withdrawal.

February 17, 2023

Hi @Altostrata!

thank you for asking! I feel better already but the anxiety I had felt like it came out of nowhere. Four days after the last reduction of my first slide I started having these symptoms. My anhedonia suddenly also worsened. I was able to sleep well etc. But I felt really sad, really unsafe and anxious.

Now I feel like that’s all gone now so maybe that was a WD.

I never thought such a small reduction from such a big dose cause something. I tapered a total of 6% from 30mg with the slide method.

wishing you a nice weekend!

February 17, 2023

@brassmonkey how would you view tolerable? Like having some points of the day where you feel well enough to enjoy things to some extent?

February 17, 2023

That's a hard one because it is so variable. In general, if it can be worked around or ignored it is tolerable. If not bedridden, but can get up and take care of one's self. The ability to put the symptoms aside and do what needs to be done.

February 17, 2023

@brassmonkey yeah I get that. Being functional is the biggest factor. I imagine it varied a lot during your taper but were there periods that you could enjoy stuff at all? Or was it just survival mode the whole time?

February 18, 2023

On 2/17/2023 at 2:59 AM, OmniaVincitAmor said:

the anxiety I had felt like it came out of nowhere. Four days after the last reduction of my first slide I started having these symptoms. My anhedonia suddenly also worsened.

Yes, this would be a typical pattern of withdrawal symptoms. If they resolved after a few days and you find them tolerable now that you know what they are, you could taper at your current rate, expecting this pattern of withdrawal. If you do not find them tolerable, you might reduce by a smaller amount.

February 18, 2023

The first several years were mainly getting through however I could. I still liked doing many of the things I was doing, but not outright joy. But for the most part it was pretty dark. I was the sole provider for the family so that was a big reason to keep going. Also, from the very start I had an inner understanding that this was just a temporary thing and would eventually sort itself out. Temporary is a relative term, the longer you live the longer a temporary thing can last. I figured it would take several years for things to straighten out. Once I really got going on the taper, I was able to get a feel for just how long it would take.

Once I got past poopout my baseline noticeably started to improve. That's when I came up with the term WDnormal. Because the way I normally felt now was an improvement over how I normally felt six months ago. WDnormal is actually a measure of change, not a designation of how one currently feels.

Once I pasted out of poopout, I started having short windows, I was able to start enjoying things around me and experiences. It was very subtle at first, but accelerated the lower I got in my taper. Yes, there were symptoms all the way to "0" and past, but they became progressively less and less of a struggle. It also followed the window and wave pattern. There were some pretty miserable times when the waves would hit, but they were always followed by marked improvement.

One thing I really tried to do was put myself in situations or have experiences that I knew I enjoyed, even if I didn't feel it at the time. I love dramatic cloud formations, so I would try to take moments throughout the day just to watch the clouds. I love flowers, so, I would try to stop and smell the roses whenever the chance came up. I love wildlife, so I made a point of watching the hawks, rabbits and squirrels around the yard. Even if I didn't feel it at the time, I know those things bring me joy, so I didn't give them up just because I felt terrible. Even in the bad times they would provide small flashes of good feelings, a sign of better times to come.

March 4, 2023

Hi!

I found this post regarding the 1mL oral syringes saying that the little nozzles on the end contains approximately 0,5ml…

I started my tapering from 30mg using the brassmonkey’s slide. My first reduction was 6% divided by four ( i.e. 1.5% every week). As I was done with the first slide reduction I was at 28.20mg… or at least I thought I was. Is it possible I have reduced much more? I got quite serious wd symptoms after all.

I take 20mg as a tablet and dillute 10mg pill to 10mL of water. Then I measure the reduction by using 1mL syringe with the little nozzle and toss that into a sink. I drink the remaining water… Have I done it right or not? How do I know what is my current dose inncase I’ve tapered more than I was intended to?

Thank you everybody for helping me and others to get through the tapering process! Wishing everyone lots of sunny days!

March 4, 2023

1 hour ago, OmniaVincitAmor said:

I take 20mg as a tablet and dillute 10mg pill to 10mL of water. Then I measure the reduction by using 1mL syringe with the little nozzle and toss that into a sink. I drink the remaining water… Have I done it right or not? How do I know what is my current dose inncase I’ve tapered more than I was intended to?

If this is your method, just be sure to do it like this every time. That keeps the dosing consistent.

Don't worry about calculations on the bit of liquid in the nozzle. Just do your calculations on your dose.

March 5, 2023

Many thanks @Altostrata for your insights! I really appreciate it.

However, once I continued my taper after a two and a half weeks hold and made the first slide reduction after the hold I got serious wd symptoms again just after 1.5 % drop! I immediately stopped and have stayed in a same dose for a couple of weeks now. I’m letting my nervous system to calm down before continuing again.

if I get such bad wd symptoms so easily I’d like to know how much I’ve actually tapered. If the nozzle contains approx. 0.5 mL it means that I have tapered 4 x 0.5mL per slide more than I thought which is about 2mL ( i.e. 2mg) more than I was supposed to taper…

@brassmonkey what are your thoughts on this?

March 6, 2023

Any taper is going to cause symptoms of some sort. It is just a fact of the process that we try to control and live with. It is very rare for a reduction to be symptom free.

The Brassmonkey Slide is designed to try and keep those symptoms to a minimum while tapering as quickly as possible. By spreading out the symptoms over four smaller reductions it makes them more tolerable. But they will always be there with each reduction. Learning how to live around them and in spite of them is something we all have to practice. There are several good threads about coping strategies and the like throughout the site.

March 7, 2023

What are the symptoms?

March 8, 2023

Hi!

@brassmonkey, thank you for sharing your thoughts! I really appreciate it.

@Altostrata, thank you for asking! My symptoms were exactly the same as last time: dizzines at first followed by anhedonia, anxiety and low mood. Only this time the symptoms hit right after the first part of the slide! So maybe something cumulative happened there. I stopped and have been holding for two weeks now. I feel like the wd symtops are now gone but I want to hold for one week more just in case.

March 9, 2023

How long did the dizziness last? What do you mean by anxiety, how has that changed over the last few weeks?

March 9, 2023

@AltostrataDizzines lastet for a couple of days. The anxiety came out of nowhere. I just felt really anxious without any specific reason. After the anxiety came low mood. I cried one dy for a whole day and nothing bad had happened to me. Then suddenly all of this went away.

March 10, 2023

16 hours ago, OmniaVincitAmor said:

@AltostrataDizzines lastet for a couple of days. The anxiety came out of nowhere. I just felt really anxious without any specific reason. After the anxiety came low mood. I cried one dy for a whole day and nothing bad had happened to me. Then suddenly all of this went away.

This sounds like very temporary withdrawal symptoms, maybe for 4 days?

March 10, 2023

Hi @Altostrata! Yes, I also think it was WD symptoms. And yes, it lasted for approximately four days.

I’m just wondering why I got wd symptoms again just after one tiny drop of 1.5% even though I had the two weeks hold between. This is the reason why I asked about the nozzle with the 1mL syringe.

I’m going to do as brassmonkey suggested and keep a longer hold in between the drops once I’m able to continue my taper. It’s been two weeks now and I’m thinking holding for another week maybe.

March 10, 2023

You might do better with longer periods between reductions. As you know, we advise waiting a month.

Withdrawal symptoms that last for only a few days are acceptable as long as you allow enough time for your system to recover from the prior decrease.

April 3, 2023

Hi Everyone!

I have a question. after my accidental trisyclic CT for almost three years ago I got my very first and severe depression amongst other symptoms. I was forced to start Celexa. I’m feeling drug resistant because Celexa helped only partially.

I started tapering because I thought my nervous system could not recover from the CT unless I’m still on meds.

My question is can the nervous system fully recover if I didn’t start tapering and would have decided to stay on meds forever? This is something I often think about.

April 3, 2023

9 hours ago, OmniaVincitAmor said:

My question is can the nervous system fully recover if I didn’t start tapering and would have decided to stay on meds forever?

What do you mean? You got withdrawal syndrome from quitting clomipramine. You went on citalopram instead. It's possible that if you hadn't started changing the citalopram dose prematurely, eventually you might have stabilized on that. This might take many months. Your nervous system would then be dependent on citalopram. Would you call that healed?

You may still be feeling withdrawal syndrome from going off clomipramine even though you're taking citalopram, that's why it only "partially worked". By tapering too fast, too soon, you might have brought on more withdrawal symptoms.

On 3/9/2023 at 10:08 PM, OmniaVincitAmor said:

I’m going to do as brassmonkey suggested and keep a longer hold in between the drops once I’m able to continue my taper. It’s been two weeks now and I’m thinking holding for another week maybe.

If you get withdrawal symptoms from a reduction, a few weeks may be too short a time. You may need to hold for months to stabilize.

OmniaVincitAmor: quitting clomipramine caused me very bad depression

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