Svetla: need help to find a way out

[Svetla]

Hi there

I’ve been using psychiatric drugs since 2009 for anxious depression and severe insomnia. 
I’m currently taking citalopram 30 mg and mianserine 30 mg since January 2020 after my divorce. The citalopram pooped out in April 2022, I was feeling lethargic, low depressed mood. Psychiatrist wanted to add a low dose antipsychotic, I refused. She increased my dose to citalopram 40 mg - I felt no different, actually more suicidal. Then back to citalopram 30 mg. I started having panic attacks and sleep is bad. She prescribed *flupetixol 0,5 mg for the panic attacks. 
 

I think I want to find a way out of using these drugs but I guess I will have to stabilise first, right? 

 

* Flupentixol, also known as flupenthixol, marketed under brand names such as Depixol and Fluanxol is a typical antipsychotic drug of the thioxanthene class. It was introduced in 1965 by Lundbeck. In addition to single drug preparations, it is also available as flupentixol/melitracen—a combination product containing both melitracen and flupentixol.Wikipedia

 

Edited November 1, 2022 by ChessieCat
added drug information

[Svetla]

Tapering strips

 

Hi guys, just to let you know about the tapering strips I found out about recently: https://www.taperingstrip.com

As far as I know it’s a product based on the Manual of Prof. Heather Ashton. 

Hope that’s helpful. 
warm regards

Svetla 

 

Edited November 1, 2022 by ChessieCat
added Intro topic title before merging with intro topic

[Svetla]

Is this WD? Celexa pooop out

 

Hi guys 

 

I need your experience to figure out if I’m in withdrawal. 

here’s my drug history. 
 

March -June 2009 Zoloft 50mg for anxiety/depression. Felt suicidal and more depressed on it so I stopped cold turkey. 
Had a breakdown in Nov 2009 - couldn’t sleep at all, bit of depression and anxiety. Sleeping pills didn’t work on insomnia. 
January 2010 - May 2013 Lexapro 10 mg with clonazepam 0,5 for sleep. July 2010 clonazepam tapered to 0,25 mg. 
Tapered in April/ May 2013 but insomnia returned in July 2013. Restitution didn’t help sleep, I was advised to up the dose, which made me agitated.  
Started Remeron 45 mg in September 2013 with 10 mg of paroxetine. Tapered to remeron 15 mg in November 2015 and 10 mg paroxetine. 
Tapered to 5 mg paroxetine and 3,75 mg remeron in April 2015. Couldn’t taper further. 
In nov 2019 I had a relapse due to divorce despite being on the drugs. For some reason it was not possible to increase the dose of paroxetine or remeron - both made me very agitated. Was switched to citalopram 30 mg and mianserine 30 mg. 
The citalopram pooped out in April 2022 and I felt depressed, no energy. Psychiatrist increased the dose to 40 mg citalopram in August 2022. After 5 weeks no improvement so we went down to 30 mg. Since then I started having anxiety after I wake up and my sleep is patchy - I wake up at 4 am or 5 am. She added 1 mg flupentixol for the anxiety. 
 

here are my questions and thanks a lot for your answers. 

 

is it possible that the anxiety/sleep disruption is withdrawal? How do I manage it? 
 

as the citalopram has pooped out but I’m not stable at the moment do I wait to stabilise and then withdraw? 
 

the doctor wants to cold turkey switch me to another AD but I’m not inclined to do so considering the many medications I’ve been on. 
 

please help. 

 

Edited November 2, 2022 by ChessieCat
added Intro topic title before merging with intro topic

[Svetla]

WD and being an ultrarapid methaboliser

 

Hi guys 

does anyone know if being an ultrarapid methaboliser of eg citalopram, escitalopram and sertraline has any implications for withdrawal? 
 

thanks for any input. 

 

Edited November 3, 2022 by ChessieCat
added Intro topic title before merging with intro topic

[Altostrata]

Welcome, @Svetla

 

Yes, tapering strips are available in the Netherlands and you might use them when you're tapering.

 

What are the symptoms you think might be poop-out? What drugs are you taking now, at what times o'clock and dosages?

 

If you're looking to switch drugs, you'll need to talk to your prescriber. We do not help people switch drugs for continuing treatment.

[Svetla]

Good morning, dear Alto!

 

I've been on citalopram 30 mg and mianserine 15 mg (the older version of mirtazapine sold in Europe, it's weaker) since January '20. I was well till April '22 when I started feeling low,  having no energy, anhedonia, cognitive difficulties and feeling easily stressed so went on sick leave.

Pdoc increased mianseine to 30 mg. I started therapy, went on 3 vacations but by 4 August '22 I was worse. I've never had a 'depression' like this. My pdoc increased the citalopram to 40 mg. I felt no better after 5 weeks, actually worse with suicidal thoughts. So in September she told me to go back to 30 mg of citalopram and that's when I started not being able to sleep. I'd wake up with a panic attack. Now I don't get the panic attacks but still can't sleep, just lie in bed. She advised to increase the mianserine to 45 mg and perhaps taper the citalopram a bit. 

 

8 am - 30 mg citalopram 

 

10 am - 0,25 mg flupenthixol for anxiety (I have to taper it to 0mg)

 

2 pm - 0,25 mg flupenthixol (I have to taper that to 0mg)

 

10 pm - new doe of 45 mg mianserine (It made me agitated yesterday)

 

I'm looking for a long term solution, because I've had medication 4 times now over 13 years, it's not working (I've been on all SSRIs except prozac), nobody told me I'm not going to be able to stop it. I'm currently on disability. 

 

I started Zoloft 50 mg in 2009 for work stress. When I Ct-ed it because it made me severely depressed, I had a crash 6 months later (severe insomnia with a bit of anxiety and depression). Then when I tapered escitalopram in 2013 I had severe insomnia again. 

 

I've only fully understood what happened to me after reading through your website. 

 

Thanks a lot of all the work on it!

 

Warm regards

Svetla 

 

 

 

[Altostrata]

It looks to me like those drug increases made you feel worse. Many people find the SSRIs cause insomnia, and they may also worsen feelings of depression. They have lots of adverse effects, especially when high dosages are combined with drugs like mianserin.

https://go.drugbank.com/drugs/DB06148:

Quote

 

The risk or severity of adverse effects can be increased when Mianserin is combined with Citalopram.

 

 

Please put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php

and copy and paste the results or a link to them in this topic.

 

On 11/5/2022 at 11:54 PM, Svetla said:

I started Zoloft 50 mg in 2009 for work stress. When I Ct-ed it because it made me severely depressed, I had a crash 6 months later (severe insomnia with a bit of anxiety and depression). Then when I tapered escitalopram in 2013 I had severe insomnia again. 

 

 

Clearly, you had an adverse reaction, depression, to an SSRI, Zoloft. After you quit Zoloft, it sounds like you had classic antidepressant withdrawal syndrome. You got withdrawal effects again when you tapered escitalopram.

 

If you just increased mianserin and got a bad reaction, if I were you, I'd go back to the earlier ineffective and also excessive dose.

 

We offer peer support for going off drugs. How may we help you?

[Svetla]

Dear Alto, 

 

thanks for the swift reply. Please find below the interaction checker. I’ve done it for mirtazapine because mianserin isn’t listed - it’s not sold in the USA, although I have to say mianserine is a way weaker drug. It’s a sedating drug supposed to help with sleep. 
https://www.drugs.com/interactions-check.php?drug_list=679-0,1640-0

I didn’t find flupenthixol 0,5 mg but it gives me tremors and cramps. 

 

I’d like to find a way to stabilise and then taper citalopram if it works no more. I wake up with panic attacks every day, feel anxious, sleep is bad. I used an emergency clonazepam 1 mg yesterday night to calm down. My doctor is very understanding, we tried to taper the citalopram down to 25 mg but that made me depressed and more anxious. 
 

I think the problem is I have no downer in the current drugs, my nervous system feels on fire. Part of the reason is that she had this idea to use CBD oil for anxiety. It made things worse. 

 

I’m starting CBT therapy on 6 Dec. I’m not sure that’s going to help with the withdrawal, time only. 
 

[Svetla]

I don’t know if a drug change will help to stabilise. I never had this with the low dose of paroxetine I was taking, it was easier to taper down. 

[Svetla]

One of the problems is tapering citalopram, escitalopram, sertraline is  that I'm an ultrarapid metaboliser. With citalopram it didn't help to sleep in 2020 when I got treatment, that's why the mianserin was added. I have no idea why it pooped out, may be same reason. 

[Altostrata]

The benzodiazepine is the "downer" among your current drugs.

 

What times o'clock do you take each of your drugs, with their dosages? 

[Svetla]

Dear Alto, 

I watched the live stream with Brook Siem on Friday, great perspective on withdrawal. 

8 am I take 30 mg citalopram. I have anxiety till lunch time 

Then I try to go out, buy groceries etc 
Evening 22 pm I take 30 mg mianserine and I’m not sleeping. Because of that I have started to experience memory problems and cognitive difficulties but I had those in the summer too after citalopram pooped out. 

 

I think both meds aren’t working sadly… if I taper them, I’d get worse. 
 

I tried tapering citalopram last year and it was very hard. I only attempted with 1/8 of a pill, which 2,5 mg and I could feel it. 
 

I don’t know why but I’ve not had difficulties tapering paxil for example, may be because I was on such a low dose and I took mirtazapine with it. 
 

Wishing you a lovely night, 

svetla 

[Altostrata]

11 hours ago, Svetla said:

8 am I take 30 mg citalopram. I have anxiety till lunch time 

 

How do you feel before you take citalopram? When does the anxiety start? What is your sleep pattern?

[Svetla]

Dear Alto,
Anxiety is worse in the morning, I read on the SA website about the morning cortisol spikes. 
It takes the whole morning to feel better. Sleep is all over the place with 3 am or 5 am awakenings and I’m apprehensive of taking benzos. One addiction is enough 🙂 

 

I do take Omega 3 and magnesium. 

 

warm regards

svetla 

[Svetla]

My doctor is very understanding, she encouraged me to start tapering citalopram last year. I’ve never had a problem tapering, withdrawal previously would manifest itself with insomnia a few weeks after I have stopped taking medication. 
Needless to say, I’m devastated. I was prescribed Zoloft for 5 panick attacks and work stress. I read in Giovanni Fava’s book the use of antidepressants for anxiety has to stop because it sensitises people to depression. 
Couldn’t agree more with that …

[Altostrata]

On 11/12/2022 at 10:39 AM, Svetla said:

8 am I take 30 mg citalopram. I have anxiety till lunch time 

 

How do you feel after taking citalopram, compared to how you feel before taking it in the morning?

[Svetla]

a little bit better, but it only last a few hours. I have akathisia too. To be honest I'm starting to loose it, with the insomnia. I'm going to a private clinic abroad to get help. It's an ordeal. 

[Svetla]

In the private clinic they said they help people recover from Benzo withdrawal, hope they can help me too. 

[Altostrata]

What clinic is this?

 

I would need more detail about your symptom pattern. 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.

[Svetla]

It's the clinic of Dr. Vorobjev in Belgrade, Serbia. Jordan Peterson went there. It's my third day here.

I don't sleep at all.  

Then the whole morning is one big anxiety attack. I have cognitive problems. I tried to buy Phenobarbital over the internet because I'm suicidal but I wasn't successful. just gave away 300 bucks to a fraudster. 

They will change my medication to try to stabilise me.  

[Altostrata]

Since you're under the active care of this clinic, please discuss your situation with them. We cannot work at cross purposes if you are an inpatient.

 

Good luck.

[Svetla]

I understand , dear Alto. Thanks a lot for all the support. 

[Svetla]

Dear Alto, 

 

I'm writing to ask you for advice. I'm currently in a clinic, I couldn't sleep at all when I arrived and I'm suicidal if there was a painless way to die, I'd choose it. They switched me to sertraline 50 mg and trazodone 150 mg but I still don't sleep more than a few hours. Anxiety is 10/10 in the early morning hours before I take my meds. My cognitive abilities are quickly deteriorating due to the sleep deprivation, I feel confused and unable to complete even a simple task such as putting on clothes. I don't have appetite. Seems the medical profession can't help me.

I'm working with a therapist here but it doesn't help much. I try to think of people surviving wars etc to no avail. 

 

What does one do in a situation such as this. 

Warm regards 

Svetla 

 

[Svetla]

I'd like to find a way out of this situation which started in Sept this year with the citalopram withdrawal. It's a true ordeal ...

[Altostrata]

On 11/16/2022 at 5:58 PM, Svetla said:

a little bit better, but it only last a few hours. I have akathisia too. To be honest I'm starting to loose it, with the insomnia. I'm going to a private clinic abroad to get help. It's an ordeal. 

 

@Svetla I understand you're in a difficult position, your initial problem may have been withdrawal, and all that you could think of was to become an inpatient in this clinic. However, they have changed your drugs. We are not responsible for whatever happens when you are in the clinic and they have control of your drugs.

 

As we're just an Internet peer support group, our general advice is not to seek another drug solution, which we've seen usually causes nothing but problems, but you chose to do this. 

 

If you don't like what they're doing, you need to tell them. We cannot fix whatever is going on in the clinic.

[Svetla]

Dear Alto,

My question was what happens to me if no medication works. I have no more treatment options. CT from any psychiatric medication isn't an option as far as I've read here. I've been on SSRIs (citalopram now Zoloft) for close to 3 years. When I was switched from citalopram I had muscle pains, whole body tension, panic attacks that lasted 4-5 hours, couldn't sleep at all. Now on Zoloft I have aggression and severe agitation. But if I CT it then I will have the severe withdrawal and my own depression to deal with. 

 

[Svetla]

@Altostrata 

Dear Alto,

After 2 hospital intakes, I'm at home and stable but at what price. 

I'd like to reduce the Zoloft because I was put on a high dose against my objections. My brother and mom took me to the second hospital because I became unstable. 

I read lots of info on this site and it's best to first taper Zoloft, then the rest.  

How long should I wait until I start a taper?

 

Warm regards, Svetla 

[FireflyFyte]

55 minutes ago, Svetla said:

After 2 hospital intakes, I'm at home and stable but at what price. 

 

Hello Svetla - I also had two hospitalizations last year which resulted in my being stable but poly-drugged. Not ideal but I accept that it is my current situation.

 

56 minutes ago, Svetla said:

How long should I wait until I start a taper?

 

From the feedback I got here, the idea is to be stable for a month or two before starting to taper. You want to give your CNS some time to relax, without any changes, before decreasing a medication. I have been stable since early November and will start my first taper next week.

 

57 minutes ago, Svetla said:

I read lots of info on this site and it's best to first taper Zoloft, then the rest.  

 

Generally, the thought is to taper the activating medication first which for you sounds like it would be the Zoloft.

[Svetla]

@FireflyFyteThanks for stopping by, really appreciated!

I was a rehab type pf place and a hospital to be precise. 

I'm really worried about taking an antipsychotic. I read one can get hypersensitivity psychosis and dyskinesia (as if the rest of WD symptoms aren't enough). It's used as sleep aid. My main Wd symptom was severe insomnia - 3 times already when I tried to 'jump' off doses such as 2,5 mg of Lexapro or 3,75 mg Remeron.  

Also worried about the wooping big dose of Zoloft I'm om. Trazodone is a very weak antidepressant so least likely to cause long term problems even at this dose. 

Otherwise I think I will do the Brassmonkey slide method in 2 months. 

A question here. Do you make your own liquid? I was wondering how one makes it homogenous. 

warm regards, Svetla 

 

[FireflyFyte]

5 minutes ago, Svetla said:

A question here. Do you make your own liquid? I was wondering how one makes it homogenous. 

 

Yes, I make my own liquid. What I do is use a 2oz amber jar with a lid and add 25ml of water using a 60ml syringe. I add my 2.5mg pill to the water, close the lid, and put the jar in the fridge for around an hour. I remove the jar, unscrew the lid, and using a wooden coffee stirrer - stir the water until the pieces of the pill are spread evenly. When I am ready to start tapering next week, I will remove 5% of the liquid (1.25ml) using a 2ml syringe and drink the remainder. 

 

I am in the process of transitioning from a pill to a liquid and, so far, haven't had any issues but have been following the tips on Cross Over: Changing form (eg table to liquid) of drug OR changing brand of same drug

[Altostrata]

Hello, @Svetla How long have you been taking each of the drugs in your current cocktail? What do you mean by "stable"?

[Svetla]

Dear Alto,

 

Hope you're well! Thanks for the swift reply!

 

I've been taking the cocktail for a month and a half after the Celexa poop out and the up and downs in dose. I've also had a tolerance to Remeron after 6,5 years of use (reinstatement of higher dose felt like I was taking nothing).

 

Stable means I've got no early morning anxiety (used to last 4-5 hrs) and I'm sleeping on most days, I can do my chores around the house, I can concentrate to read and watch TV (before I had weird perception - movies seemed scary), my memory is back. Suicidal thoughts have diminished.

I'd like to try the Brassmonkey slide method but perhaps I should wait 2-3 months. 

 

warm regards, 

Svetla

[Svetla]

@Altostrata

I'm really concerned about the tolerance issue btw. 

[Altostrata]

After so much work, including 2 hospitalizations, why do you want to change your cocktail?

[Svetla]

@Altostrata

Dear Alto, 

The problem is I already had tolerance to mirtazapine (in 6,5 yrs) and citalopram (just 2 years). On citalopram I worsened over a period of 6 months. There's no guarantee I won't get tolerance to Zoloft too. I found out through my experience with citalopram that despite tolerance one gets withdrawal. How does one recover from something like this? 

Warm regards

Svetla 

[Svetla]

Second reason is side effects - I feel wired, anxious on waking up - perhaps side effect of trazodone/mCPP.

I think the Chlorprothixene was prescribed to counter the stimulation by Trazodone. I think if I taper Trazodone ('normal' dose for sleep is 25-150 mg) I will feel less wired.