SilverLinings: 22 Year Journey with Citalopram

[SilverLinings]

Like so many others, I am grateful to have found this site, but wish I had found it much sooner. I have spent a lot of time reading through the information here and I wanted to add my story. I don't have any specific questions right now, but I suspect I might when it comes time to continue my taper. Before my story, a few thoughts:

 

• I am currently going through perimenopause as I also deal with WD symptoms from my too-fast taper. I worry that I could be conflating the symptoms of the two, or that they could be amplifying each other (especially the insomnia, brain fog, and irritability). Despite that, I am hoping to avoid HRT if possible, as I just don't want to introduce anything new into my system.
• I am abstaining from alcohol and caffeine. I have been taking a small dose of prescription cannabis once every 1-2 weeks when my insomnia becomes unbearable. I plan to try and discontinue this going forward. 
• I believe I was becoming a problem a drinker when I was on higher doses of Citalopram. I'm not sure I would have been able to quit drinking back then. My alcohol cravings have drastically decreased as I've lowered my dose, and I'm very proud of myself for getting it under control!
• I participate in 60-minute high-intensity exercise sessions at the gym 4-5 times per week. I know this is potentially too much intense exercise for my sensitive CNS, but this is one thing that I really don't want to have to cut back, as it is one of the few activities that I currently enjoy and it provides a much-needed social outlet throughout the week. 
• Because my long journey with psychiatry began when I was still an adolescent, I am terrified that I missed my opportunity to discovery my "real" self and that I will never know if I have "recovered," since I don't know who I am without medication. I sometimes find myself questioning my decision to try and taper.
• I struggle with acceptance. While I know that there isn't anything I can do to change the past, I am still filled with anger when I think about all of the lost time and unnecessary suffering I have had to endure. 

 

In 1999, I was 19 years old and had started my sophomore year in college. I was taking a huge load of credits for fall semester, maintaining straight As, participating in a number of extracurriculars, and trying to have an active social life. Right before Fall break, the pressure got to be too much and I had a meltdown with lots of tears and panic. My roommate was concerned about me and took me to campus health services. They called my parents and recommended that I see a doctor over the break.

 

I went to a general practitioner who talked to me for a few minutes and diagnosed me with depression. She told me that my depression was caused by my my brain not producing enough serotonin, and that there was an amazing drug that I could take to correct the imbalance. It was called Zoloft. I asked her if there were any risks associated with it, and she laughed. "They should be putting this stuff in the water," she said. That was all it took to convince me. I have a recollection of my dosage being 100mg, which I started taking as prescribed and I don't recall having any adverse reactions. 

 

My doctor also recommended therapy, so I started seeing a counsellor at my college every week. It felt really good to just be able to talk to someone. I started feeling better almost immediately. I wish I remember exactly how long I was on the Zoloft; I'm estimating that it was about 6 months. When I asked my doctor about stopping, she questioned why I would want to since I was doing so well, but she agreed to help me stop. She told me there aren't any withdrawal symptoms with Zoloft, but she recommended a "taper" in case my original symptoms returned. That "taper" involved taking half of my dose for two weeks, and then going every-other-day for two weeks. I followed this schedule, and I don't remember having any immediate issues. I do wonder if some of what happened next could have been post-acute withdrawal, however.

 

When I started my junior year, I was back to my old habits. I stopped going to counseling. I was taking on even more credits and activities, my friends were turning 21 and there were lots of parties and drinking, and I started a serious relationship. I was sacrificing sleep and meals in order to study. At the start of January term, I came down with Mono and was as physically sick as I have ever been. I saw a doctor who put me on prednisone for my throat and suggested that I take the spring semester off so I could rest and recover. I gladly took the steroids but ignored the advice and instead doubled down on my activities. A few months later, I started taking birth control for the first time and opted for the depo provera shot.

 

By the time finals rolled around, I was a mess, with frequent tears and a few panic attacks. When I got to my last exam, I just couldn't do it. I stared at the Blue Book for 10 minutes and couldn't even pick up my pencil. I finally just walked out of the building without taking the test. As I was leaving, I ran into a friend who asked me what was wrong. I completely melted down, and through the tears, I think I said something about hurting myself. My friend took me straight to campus health services, who sent me to the hospital and called my parents. The hospital didn't have any beds available, so they released me to my parents and told them they needed to take me to a psychiatrist as soon as possible.

 

I remember the psychiatrist's office having a lot of signage and brochures about something called "Effexor XR." I filled out a bunch of paperwork and then talked to the psychiatrist for about 30 minutes. He diagnosed me with GAD and major depression. He told me that I was suffering from a chemical imbalance in my brain. It was no different than someone with diabetes. Like a diabetic, there were medications I could take to correct the imbalance in my brain. He said that since I had anxiety and depression I needed a medication that would work for both, so he introduced me to Effexor XR. I tried to tell him that Zoloft worked well the last time, but he said Zoloft wouldn't address both of my conditions. I left his office with some free samples of the Effexor XR, a prescription for 75mg, along with a couple of Effexor pens and brochures.

 

I only made it about 3 weeks on the Effexor. It turned me into a completely different person. I was yelling and throwing things, and I even kicked a hole in the wall of my bedroom. One day, when my mom was trying to make me take my medication, I threw the glass across the room and screamed that I was never going to take it again. That was how I ended up quitting CT, and the week that followed was what introduced me to the concept of "brain zaps." I was also dizzy and sick to my stomach, but grateful to be done with that medication.

 

I was taken to a different psychiatrist who gave me the same diagnosis and prescribed 60mg of Citalopram. That's right - 60mg, for a 120-pound adolescent. I had no idea if that was a high dose; I assumed it wasn't high, since it was a smaller number than the Zoloft and the Effexor. I tolerated the new medication well, and before long, I was back to college to start my senior year.

 

No one ever talked about an exit strategy. No one ever talked about dose reduction. No one ever talked about side effects. The internet wasn't a big thing yet in 2001, and I never tried to do any of my own research. I believed and trusted the doctors. My prescription was sent to my general practitioner who continued to prescribe the medication year after year, no questions asked. After a couple of years, I started experiencing anhedonia and sexual disfunction, but I didn't talk to anyone about it. I figured that was the price I was going to have to pay for my "chemical imbalance," and I figured it was better than going back to my original symptoms. These side effects have had a profound impact on my life for many years.

 

In 2012, I went to my doctor for my annual checkup, and he told me I needed to have an EKG. Apparently, the FDA had issued a warning about Citalopram causing heart problems for people taking "more than the recommended maximum dose." More than the recommended maximum?!? I was SHOCKED when I heard that. I had no idea that I was taking a high dose. I asked my doctor if I could reduce it. He said there was no reason to do so, because my EKG came back normal and it was "such a harmless medication." That was the last time I saw that doctor, and the first time I started questioning my need for the medication at all.

 

My new doctor agreed to let me drop down to 40mg and said there wouldn't be any WD effects. In fact, she said I could continue to taper down as much as I wanted by cutting my dose in half every two weeks and that I shouldn't have any issues. I knew that wasn't true because I had missed doses in the past and felt side effects, but I didn't say anything, as it didn't seem right for me to question a doctor. Sure enough, when I dropped the dose to 40mg I started having "brain shivers" and dizziness for several weeks, along with some emotional distress. Little did I know that going from 60>40 would be my easiest dose reduction.

 

At that point, I knew I was going to be on my own with tapering. I invented my own schedule, going from 40>30>20>15>10>5 over the course of the next 10 years. I waited for times in my life where I wasn't anticipating anything important or stressful, and did my cuts then. Still thinking that I had a "chemical imbalance," I took up running and intense exercise to try and boost my serotonin levels. I thought I was being so responsible and careful with my tapering and exercise strategy. However, each cut has been more and more difficult, and the last one from 10>5 has been downright horrific. I had to quit my former job when I went from 15>10, and I feel like I'm now barely hanging on to my current one. My friendships and marriage are suffering. I used to be a world champion sleeper, and now I'm lucky if I get 3-4 hours. My "anxiety" (or whatever it is) is off the charts. I suffer from brain fog, intrusive thoughts, and irritability. As I mentioned above, I sometimes find myself questioning why I'm doing this and if I would be better off staying on the meds forever.

 

The only things keeping me going with the taper right now are my stubbornness, this website, and the few windows that have peaked through the waves recently. The windows give me hope. My current plan is to see if I can stabilize where I am at 5mg. If and when I do, I will switch to a liquid equivalent for at least a couple of months to make sure I tolerate that change, and then will start a S-L-O-W taper. 

 

Whew - that was a long story, but it felt good to write it out. Thank you for this community. I'm glad to be here.

[Altostrata]

Welcome. @SilverLinings

 

Yours is a saga that is unfortunately classic! You might write it up as an article, with all the conversations with doctors, for MadinAmerica.com

 

What are your most prominent withdrawal symptoms? How has your symptom pattern changed in the last 6 months?

 

 

 

 

[SilverLinings]

Hearing that my story is common is both comforting and heartbreaking. I’m gutted to know that so many of us have had to go through this. 

 

My most recent drop in dosage (from 10mg to 5mg) was in mid-May 2022. In retrospect, I’m not convinced that I was fully stable yet from my previous dosage change. 

 

Within 48 hours, I was feeling the weird brain sensations, dizziness, and general malaise. I actually fainted once when standing up from the couch too quickly; fortunately, I fell back on the couch and wasn’t injured. These symptoms gradually improved over the course of the next month and a half. 

 

I didn’t have many other symptoms until late August, and then… BAM. Everything seemed to hit all at once. My most excruciating symptom is the “anxiety.” I’m putting that word in quotes because I don’t have a better word to describe it. It’s like anxiety, except it feels somehow artificial. As if someone is tricking me into drinking pot after pot of coffee and there’s nothing I can do to stop the cortisol that’s coursing through my body. This, of course, leads right into insomnia. When I lie down in bed at night, it’s like my brain is actively fighting against my body to prevent me from falling asleep. I can almost feel the anxiety (or whatever) just washing over me in waves. If I do fall asleep, it’s only to be woken at 3:30am with a fresh surge of cortisol and racing thoughts. 

 

Probably as a result of the insomnia, I am also dealing with some brain fog and irritability. I get irrationally annoyed at the most mundane things. Someone might walk too slowly in front of me at the grocery store and I get this urge to just fly off the handle. (I haven’t given in to that urge, but the fact that it’s there is distressing.)

 

I’m trying to use the techniques I have learned in therapy through the years, but many days they are no match for what I’m going through. Fortunately, I have had some windows peak through in the last couple of months. I’m back in a pretty bad wave right now, though. It’s so frustrating to still be here after 9 months. 

 

My silver linings right now are twofold. As I mentioned previously, my alcohol cravings have all but disappeared on this lower dose, which is HUGE for me. Secondly, my suicidal ideation - my constant, daily companion for the last two decades - has miraculously stared to quiet down. This gives me much hope. 

 

Thanks again for everything you do here. I don’t know where I would be without this community.  

[Altostrata]

You're welcome.

 

In early August, did anything happen that might upset your nervous system? Treatment with antibiotics, adding or dropping a drug, covid, drinking alcohol?

[Carmie]

@SilverLinings

 

Just wanted to say hi. It was good to read that you’ve been getting some windows. Yes, those windows can certainly give us hope. 
 

Good on you for holding until you stabilise, that’s an excellent plan indeed. When you eventually change over to liquid please do a crossover and don’t just change to liquid all at once. Without a crossover the symptoms can be a lot worse. You may have read about crossovers on this site already, but if you haven’t feel free to ask for more information.

 

For now though, all the best for staying at where you are until you stabilise and reach some kind of baseline. 
 

Sending hugs 🤗

[SilverLinings]

7 hours ago, Altostrata said:

You're welcome.

 

In early August, did anything happen that might upset your nervous system? Treatment with antibiotics, adding or dropping a drug, covid, drinking alcohol?

I went on a weeklong vacation in early August, and I did drink some alcohol. Unfortunately, I was still drinking on occasion before I found this site in early December. (When I read the warnings about alcohol here, it was such a DUH! moment for me.) I do have a nagging worry in the back of my mind that the fact it took three months for my severe symptoms to start means they aren't withdrawal-related. 

 

7 hours ago, Carmie said:

Good on you for holding until you stabilise, that’s an excellent plan indeed. When you eventually change over to liquid please do a crossover and don’t just change to liquid all at once. Without a crossover the symptoms can be a lot worse. You may have read about crossovers on this site already, but if you haven’t feel free to ask for more information.

 

For now though, all the best for staying at where you are until you stabilise and reach some kind of baseline. 
 

Sending hugs 🤗

Thank you so much for the advice and hugs! I did read about crossovers and definitely plan on following the information provided here when the time comes. 

 

I know I said I didn't have any questions, but I guess I do have one when it comes to stabilizing at my current dose. Perhaps this is rhetorical, but if anyone has any experience or advice, I will gladly take it. Given that I've been on the drug for so long, how will I know when I have stabilized? How do I know what "stable" means for me? I've been thinking a lot about my late father and the fact that he suffered with insomnia and early morning waking off and on throughout his adult life, and he never touched a psychiatric drug. I'm willing to accept that I may suffer from a certain amount of the same, but how will know when I've reached my baseline? 

[Altostrata]

If you were drinking off and on, could be that finally in August you exceeded your nervous system's ability to bounce back immediately.

 

18 hours ago, SilverLinings said:

My silver linings right now are twofold. As I mentioned previously, my alcohol cravings have all but disappeared on this lower dose, which is HUGE for me. Secondly, my suicidal ideation - my constant, daily companion for the last two decades - has miraculously stared to quiet down.

 

What other changes in your symptom pattern have occurred in the last 6 months?

 

[SilverLinings]

Thank you for your kindness and patience! I would say that the decrease in alcohol cravings and decrease in suicidal ideation are currently the only two positive changes. With regard to the WD symptoms, the symptoms themselves seemed to all come on at once and are all still present. The severity of the symptoms goes up and down, and I'm trying to do a better job of writing things down every day so I can figure out if there are any patterns. My main conclusion so far is that my symptoms get worse leading up to my periods, which are very irregular these days as I deal with perimenopause.  

[Altostrata]

2 hours ago, SilverLinings said:

The severity of the symptoms goes up and down, and I'm trying to do a better job of writing things down every day so I can figure out if there are any patterns. My main conclusion so far is that my symptoms get worse leading up to my periods, which are very irregular these days as I deal with perimenopause.  

 

Waves and windows are typical of withdrawal syndrome. If the intensity of waves is becoming lower, that would be an improvement.

 

 

The Windows and Waves Pattern of Stabilization

 

We have seen women report that symptoms become more severe at times in their menstrual cycle.

 

 

[SilverLinings]

Wanted to share a couple of updates and observations from the past month.

 

Now that I'm 9 months out from my last dosage cut, a few months out from my last alcoholic drink, and have stopped using cannabis, I thought it would be good to start keeping closer track of my symptoms and to look for patterns. 

 

Shortly after my last post in this thread, my insomnia and anxiety really ramped up to almost unbearable levels. I was also having what I would typically associate with PMS (bloating / weight gain, lower back pain, and irritability). Sure enough, about a week later, I got my period. Within 36 hours, all of the symptoms nearly went away. I got several great nights of sleep, I took a nap (which is something I haven't been able to do in quite some time), and the anxiety dampened down to levels I haven't experienced in months. So... it seems that signs are pointing to PMDD. After a few a good days, the anxiety and 3:30am wakeups have come back somewhat, but I would say they are at tolerable levels for now.

 

It's absolutely crushing to think that I'm going to be betrayed by my own body right when I'm starting to see the finish line with my AD journey after all these years. I worry about where this could be headed and if it could get worse. I also worry about what this means for my plan to continue tapering the citalopram. Given that my periods have become so irregular, I don't even have the ability to plan or anticipate when I can expect these setbacks, so I don't think I can plan my tapering schedule around them.

 

Coincidentally timing-wise, I had my annual physical exam this week. I told my doctor about the premenstrual symptoms, and she confirmed that it sounds like it could be borderline PMDD. She gave me the following options:

 

1. Focus on diet and exercise. Eliminate sugar / alcohol / caffeine. Drink plenty of water and try to get plenty of sleep. 
2. Birth control pills.
3. Buspirone (BuSpar). My doctor gave quite a sales pitch for the Buspirone and made it sound really great. Honestly, if I wasn't armed with the knowledge I've gained from this community, I think I might have jumped on the Buspirone idea. Heck, even WITH the knowledge, I was tempted. But, I'm going to continue focusing on option #1. 

 

Now, some positive news. My doctor and I talked about my continued taper off of the citalopram. She said that she trusts me and will support me in whatever I want to do. She didn't bat an eye when I inquired about a prescription for the liquid formulation. In fact, she walked me through the conversions and showed me how to measure it out with an oral syringe. We decided that I will stay on the tablets until I'm ready to switch. The only concern is if my insurance is going to approve the change when the time comes. Fingers crossed.

 

My plan is to continue with 5mg in tablet form for the time being. I want to get though another menstrual cycle or two before I make any changes. I would also like to see if I will have some more improvement with the day-to-day anxiety and sleep. 

[Mamgu]

Hi SilverLinings,

 

I'm just jumping in with what I hope is a little insight to ease your concerns.  I started a botched withdrawal from Citalopram when I was perimenopausal but really hadn't appreciated the impacts of either; I just thought I was losing my mind. I say botched because it was before I found this site and I took my doctor's advice of halving the dose every couple of weeks. I went on the minipill for birth control purposes before withdrawing from the AD but it totally stopped my periods so I genuinely couldn't tell when menopause-proper started for me.  When I stopped taking the minipill I didn't notice any discernible difference to my withdrawal symptoms at all. Of course, this is my personal experience and I'm not advocating anyone follows the same path but I honestly don't think the minipill impacted withdrawal from Citalopram at all.

 

When you're ready to recommence your taper I hope you are able to obtain the liquid form, it would certainly make life easier. However, all is not lost if you can't, I make my own from my prescribed tablets; it's a bit of a faff but it's been working for me 🙂

 

Good luck with your tapering, you'll get there. It might take some time but you will xx

 

 

[Altostrata]

I used to take ibuprofen in advance of my menstrual period. Eliminated the cramps and my usual pre-menses insomnia. Ibuprofen temporarily blocks prostaglandin production (look it up).

[SilverLinings]

21 hours ago, Mamgu said:

I'm just jumping in with what I hope is a little insight to ease your concerns.  I started a botched withdrawal from Citalopram when I was perimenopausal but really hadn't appreciated the impacts of either; I just thought I was losing my mind. I say botched because it was before I found this site and I took my doctor's advice of halving the dose every couple of weeks. I went on the minipill for birth control purposes before withdrawing from the AD but it totally stopped my periods so I genuinely couldn't tell when menopause-proper started for me.  When I stopped taking the minipill I didn't notice any discernible difference to my withdrawal symptoms at all. Of course, this is my personal experience and I'm not advocating anyone follows the same path but I honestly don't think the minipill impacted withdrawal from Citalopram at all.

I hadn't even considered progestin-only birth control. I'm going to keep that idea in my back pocket as I see how things progress. As much as I don't want to add in another prescription, I feel like I might not have a choice if my symptoms become too debilitating. Why do our bodies insist on doing these things to us?? Thank you very much for the reply and for sharing your experience.

 

18 hours ago, Altostrata said:

I used to take ibuprofen in advance of my menstrual period. Eliminated the cramps and my usual pre-menses insomnia. Ibuprofen temporarily blocks prostaglandin production (look it up).

Wow, you sent me down quite a rabbit hole! Fascinating stuff. I've always heard of ibuprofen helping with PMS, but I assumed it only addressed the physical pain symptoms. I will definitely give it a try the next time around. Thank you, as always. 

[SilverLinings]

Well, the pharmacy messed up my latest refill and gave me a bottle of the liquid Citalopram instead of the tablets (and insurance paid!). I was able to go back and get another 90 day supply of tablets as well. 

 

Part of me wants to take this as a sign that it's time for me to start my crossover to the liquid. I've been working on a spreadsheet to try and figure out a plan for timing and dosages. I think I'm going to need to first switch to a homemade liquid version of my tablets, because I don't think I'm going to be able to accurately cut them into eighths, which I would need to do to follow the crossover guidelines from this community. So, I would cut a 10mg tablet into quarters, and then take a quarter tablet plus 2.5mg of my homemade liquid in order to do that crossover. Then, I would stay on the homemade liquid for a bit until I confirm that I don't have any serious symptoms from that change, and then gradually cross over from the homemade liquid to the prescription liquid. What a pain. 😔

 

I'm not convinced that I'm ready yet, however. There's another part of me that keeps begging myself to stay where I am. I'm so scared of having to deal with the bad WD symptoms all over again. I can't afford to let this affect my job, and I fear that it could. Even if it isn't that severe, the prospect of facing down those symptoms is scary and a bit overwhelming.

 

I'm still determined to ultimately get off of this stuff for good. I'm leaning toward at least doing the crossover to the liquid at the same dosage, so when I am ready to start tapering, I'll be in a good place to do so. 

[SilverLinings]

I messed up.

 

I'm not writing this update in search of empathy, because I know this is all my fault. I wanted to post this update as a reminder to my future self (and anyone else who might be reading). The key theme is: there's no such thing as a shortcut.

 

After staring at that bottle of liquid Citalopram for a week, I decided to start my crossover. I was excited at the prospect of moving forward and being done with pills. I'd been feeling pretty stable, and let my hubris take over and dictate my crossover strategy. Instead of following the guidelines from this site, I decided to skip the 75% old / 25% new part of the crossover and go straight to 50/50. I didn't feel like dealing with dissolving pills to get the accurate amounts. So, I started cutting my 10mg tablet into quarters, and taking a quarter tablet plus 2.5mg (1.25mL) liquid.

 

Usually, the first sign of trouble for me comes in the form of a specific brain sensation ("shivers") within 48-72 hours after a change in the drug. I kept waiting for that to start happening, but it never did. I felt no increased WD symptoms at all for two weeks. I even made it through a surprise menstrual cycle with a milder version of my usual premenstrual symptoms. Since things were going so well, I was planning to switch to all liquid after 14 days, but I ended up deciding to stay on the 50/50 for another week.

 

Then, two days ago, on day 16, everything hit all at once. I woke up with horrible ringing in my ears. I've had tinnitus for quite some time, but it's never bothered me too much. This new tinnitus was on a whole other level. I also felt a weird, constant sensation in my head. I don't have the exact words to describe it other than to say it kind of felt like buzzing, like my head was full of bees. My mind started racing and trying to convince me that I was suffering from all manner of horrible neurological diseases, even though I knew deep down this was most likely from the change in drugs. Google was not my friend that day. I got a rotten night's sleep. The next day, the buzzing and ringing had died down a bit, but I was extremely dizzy. It took me 2-3 tries every time I needed to stand up, for fear of fainting. I'm feeling moderately better today; I still have all of these symptoms, but they seem to have lessened. 

 

I can't think of anything that would have happened to destabilize my CNS other than the too-fast crossover.

 

What a miserable way to spend the weekend. Since the symptoms are lessening, I think I'm going to stay with 50/50 for now, but if things start to get worse, I'm going to have to go back and start over. I won't be able to work if I go back to the state I was in this weekend (and work today has been a hard slog). 

 

There is no such thing as a shortcut.

[SilverLinings]

I'm now going into day 25 of 50/50 tablet and liquid citalopram. I'm starting to feel some relief from the head buzzing and dizziness during the day. The dizziness ramps up in the evenings, and the familiar "brain shivers" have also made an appearance in the evenings. I take the citalopram before I go to bed. I'm not sure if the evening symptoms mean it's starting to wear off faster? (Is that even a thing?)

 

Sleep has been so-so. It's definitely not as bad as it was when I was in the throes of my last cut from 10mg to 5mg, but it's not as good as it was before I started the liquid. 

 

My plan is stay on the 50/50 for now until I feel more stable, and then go to 25/75 (no more shortcuts!). 

 

With regard to that stability, I have a question. It might be a tough one, but if anyone has some resources / books, experience, or words of wisdom, I will gladly and humbly accept. I'm struggling to understand how I'm supposed to come up with my personal definition of "stable." As a human being, I know I'm going to experience anxiety and stress. I know that I'm going to have trouble sleeping sometimes. My goal isn't to "stabilize" to the point of not ever feeling these human experiences. In fact, it's quite the opposite. After 22 years of this drug turning me into a zombie, I want to feel things again. But, I also know that the miserable around-the-clock withdrawal anxiety and insomnia are not something that I can accept or deal with long-term. I feel like if I could just define my baseline, then it would be easier for me to identify and separate out the withdrawal and hormonal-related symptoms. I don't want to hold up my taper because I'm waiting to achieve a level of stability that isn't realistic. I also know that I shouldn't try to define stable as what I felt like back when I was taking 60mg of citalopram. That's just not my reality anymore, and that should be a good thing.

 

I think one of the big reasons this process is so difficult is that it's utterly existential. I've been numb for over two decades and I don't know what I'm supposed to feel like anymore, which makes it all the more challenging to decipher and separate out the very real withdrawal effects from my experiences as a human being.

[Altostrata]

What times o'clock do you take your drugs, with their dosages? What is your method for taking half in tablet and half in liquid form?

[SilverLinings]

3 minutes ago, Altostrata said:

What times o'clock do you take your drugs, with their dosages? What is your method for taking half in tablet and half in liquid form?

11:00 - 11:30PM, right before I go to bed. I am currently using a pill cutter to cut a 10mg tablet into quarters, and an oral syringe to measure out 1.25mL of the liquid (the liquid is 10mg / 5mL). I just swallow the liquid drug, take a drink of water, and then swallow the quarter tablet with another drink of water. 

[Altostrata]

3 hours ago, SilverLinings said:

I'm now going into day 25 of 50/50 tablet and liquid citalopram. I'm starting to feel some relief from the head buzzing and dizziness during the day. The dizziness ramps up in the evenings, and the familiar "brain shivers" have also made an appearance in the evenings....

 

 

These symptoms appear before you take citalopram in the evening? How do you feel after taking citalopram?

[SilverLinings]

Just now, Altostrata said:

These symptoms appear before you take citalopram in the evening? How do you feel after taking citalopram?

Yes, as the evening wears on the symptoms get worse. I go straight to bed after I take it, and I usually spend an hour or more rolling around trying to fall asleep and continuing to feel dizzy. I feel much less dizzy when I get up in the morning.

 

As I'm saying this out loud now, I'm feeling like the obvious answer might be to take the drugs earlier - maybe after dinner?

[Altostrata]

Did citalopram previously make you sleepy? The liquid is absorbed faster than the solid tablet. You might gradually move the liquid 2.5mg earlier by an hour each day until you're taking it with dinner.

[SilverLinings]

1 minute ago, Altostrata said:

Did citalopram previously make you sleepy? The liquid is absorbed faster than the solid tablet. You might gradually move the liquid 2.5mg earlier by an hour each day until you're taking it with dinner.

Yes, it used to make me very sleepy, especially when I was on higher doses. That's why I started taking it at night many years ago. 

 

Are you suggesting that I just move the liquid earlier, and keep taking the tablet right before bed? When I finally move to all liquid and stop taking the tablets, would I start taking the full 5mg of liquid at the dinner time, or would do you think I could / should split the liquid amount in half and take it at different times?

[Altostrata]

On 5/8/2023 at 10:47 PM, SilverLinings said:

Are you suggesting that I just move the liquid earlier

 

Correct. Let's see how this works before discussing next steps.

[SilverLinings]

Thanks so much! I'll plan to take the liquid an hour earlier tonight and keep moving it forward gradually. 

[SilverLinings]

Grateful for the advice on splitting up the liquid and tablet. I'm now taking 2.5mg liquid at 7:00pm and 2.5mg tablet at 11:00pm. The evening dizziness is starting to get better. 

 

1. Does this mean I should continue to split up my dose for the remainder of my taper, or will I gradually merge it back into one nighttime dose after I stabilize and finish crossing over to all liquid?

 

2. If I should continue splitting up the timing of my dose, do you think it would work for me to work my way toward 1/2 in the morning and 1/2 in the evening, about 12 hours apart? Last Saturday evening, I had to attend a dinner event, so I brought my bottle of citalopram in my purse and ended up taking it while sitting in a bathroom stall. Certainly not ideal. It's an inconvenience that I will deal with if I have to, but it would be much easier if I could just do a single dose at night, or do morning and night instead of dinner and night. 

 

Huge thanks! 

[Altostrata]

Suggest you taper from the liquid part. Eventually you will use this up and be taking only one dose per day. Then you will want to take part of that in liquid to taper. And so on.

 

It's possible that at a lower dose, you won't feel the difference between liquid and solid dose.

[SilverLinings]

I'm so sorry, I don't think I completely understand. My brain isn't firing on all cylinders today.

 

My thought was that I would move from 50/50 liquid/tablet to 75/25. Am I correct in assuming I would want to continue to use 7:00pm / 11:00pm schedule for that?

 

From there, I would move to 100% liquid. When I get to 100% liquid, would I keep splitting between 7:00pm and 11:00pm (take half the liquid at 7 and half at 11)? Or, would my goal be to move to taking 100% of liquid dose at 11:00pm?

 

THANK YOU.

[Altostrata]

You don't have to convert all of your dose into liquid now. You could taper from the liquid part and do the rest of the conversion later.

 

This might be better for you since it seems you absorb the liquid dose quickly and this causes some problems for you.

[SilverLinings]

Oh, I see. So, keep taking the 2.5mg tablet and start tapering down the liquid. Do I still need to take the liquid at dinnertime and the tablet at bedtime?

 

Also, since this is a hyperbolic taper, this strategy is going to add some time to the overall process, right? I'm looking at 17 months to get from 2.5mg to about 0.4mg, and then another 17 months to do the other 2.5mg to 0.4mg reduction, for a total of 34 months (assuming I can safely jump off at 0.4mg). If I just started at 5mg altogether and reduced from there, it would "only" take about 24 months to get to 0.4mg (I think?).

[Altostrata]

On 5/18/2023 at 9:55 PM, SilverLinings said:

Do I still need to take the liquid at dinnertime and the tablet at bedtime?

 

Split dosing seems to have helped you tolerate the liquid. 

 

Tapering from the liquid does not extend the hyperbolic taper. You'll make your first reduction from the liquid calculated on your entire daily dose. The first reduction would be 0.5mg, from the liquid.

[SilverLinings]

Just a small update. I haven't changed anything yet; I'm still taking 2.5mg liquid after dinner and 2.5mg tablet before bed. I've been feeling relatively stable, which has been a huge relief. My evening dizziness has mostly subsided. The tinnitus is still there, but it's tolerable. 

 

I'm really nervous about tapering my dose, but I know I need to start. When I look at my spreadsheet, I see that I still have a very long road before I'm done. I was thinking I would get past one more menstrual period before I start to taper, but it's been 6.5 weeks since the last one, and I have no idea how much longer it will be until the next. I'm just too irregular these days to try and time anything around it, unfortunately. So, I think I'm going to take the plunge this week. As per the above advice, I will go down to 1.13mL on the liquid and hold at 2.5mg on the tablet. 

[Altostrata]

Good to hear you're up to making a reduction. Please let us know how you're doing.

[Carmie]

All the best with your continued tapering @SilverLinings💛

[SilverLinings]

Thank you for the advice and kind words.

 

I reduced to 4.5mg on June 5. I realize I miscalculated in my last post. I'm now taking 1mL (2mg) of the liquid and 2.5mg of the tablet. I had some telltale weird brain sensations for a couple of days shortly after the reduction, but was otherwise feeling fairly stable until June 19. I'm now experiencing that constant artificial anxiety and irritability, and I've had two very crummy nights of sleep. I'm so tired. 😔 My symptoms aren't as bad as they were at my worst after some of the bigger cuts, but they're still pretty unpleasant nonetheless. I'm trying to keep reminding myself that this is just the drug and to remember that it will get better. But, looking at the long road ahead, it's a challenge to stay positive with the prospect of this being my "new normal" for the next couple of years. 

 

I think my plan is to ride out this wave and see how long and how bad it gets, and to not make the next reduction if I'm still feeling bad on July 5 (unless anyone has other advice). 

[Altostrata]

How many days have you felt these withdrawal symptoms? Are they getting better?

[SilverLinings]

1 hour ago, Altostrata said:

How many days have you felt these withdrawal symptoms? Are they getting better?

Three days - I just had my third night of bad sleep. No changes since they started.