Brenmos: Citalopram 20mg, withdrawal, Trazodone

[Brenmos]

My journey to hell began November 21st, 2022.

 

After suffering from a relapse in obsessive-compulsive disorder and hypochondria, I spiraled. Then on January 26th, 2023 everything imploded I started to experience insomnia for the first time ever. And insomnia that I didn’t realize existed. When I would attempt to fall asleep I would get what felt like a rush of adrenaline in between wakefulness and the first stage of sleep and I would be wired. On January 29th, 2023 I was at the end of my rope.

 

I felt like antidepressants would be the answer since my psychologist that I’ve been seeing since 2015 had suggested them over the years. I didn’t feel the need for them until I spiraled and everything imploded. I went to a mental health clinic in the Phoenix, Arizona area called Mind 24-7 and was prescribed Paroxetine 20 mg and Trazodone 50mg. My insomnia continued until I went Mayo Clinic on January 31st there they said it was a manic episode and prescribed Trazodone 100mg. I didn’t feel safe so I voluntarily admitted myself to a behavioral hospital for 8 days.

 

There they continued Trazodone 100mg and increased the Paroxetine to 30 mg. I was discharged on February 8th and on February 13th had a follow up with a psychiatrist. Because of the sexual side effects and emotional bluntness of Paroxetine 30mg we cross-tapered Paroxetine with Citalopram. Going from 20mg to 10mg of Paroxetine and 20mg of Citalopram. Along with Trazodone 100mg nightly.
 

I experienced a range of side effects trying to cross taper. On the 6th week I developed severe insomnia. That even Trazodone 200mg wasn’t touching. On March 29th,2023 they told me to stop taking Citalopram 20mg cold turkey.

 

Since then I believe I’ve been going through withdrawals from Citalopram 20mg. But I do suffer from OCD and hypochondria so I’m not sure what’s going on. My symptoms are as follows. Some will wax and wane.

Insomnia; I don't even feel tired or drowsy anymore

loss of appetite

suicidal ideation (April 25th and 26th but around 4:00 PM on April 26th it went away like a light switch)

crying spells

brain fog

head buzzing

hypersensitive to sound when attempting to sleep

sensitive to cold on my forearms

hyperarousal

several or one finger twitch's after gripping something

a panic attack that lasted a day and a half
 

[Brenmos]

My antidepressant nightmare began January 28th, 2023. 

 

I had a relapse in obsessive-compulsive disorder and hypochondria November 21st, 2022 and from there I spiraled. I’ve worked with a psychologist since 2015 doing EMDR and up until this point it was working. On January 26th, 2023 I felt like it all imploded and I came down with severe insomnia that lasted for 5 days. Something I had never experienced. I use to always need (enjoy) 8-10 hours of sleep.

 

When I would attempt to sleep, the period in between wakefulness and the first stage of sleep, I would get a sudden surge of adrenaline that would give me energy. It felt like a dump of adrenaline with physical effects similar to a panic attack. On January 28th, 2023 I felt like I was at the end of my rope and went to a mental health clinic. I thought antidepressants were the answer as my psychologist had been suggesting them for years. I didn’t feel the need to take them up until this point.

 

I was prescribed Paroxetine 20mg and Trazodone 25mg. By January 31st, 2023 I wasn’t getting better and still hadn’t slept so I went to the ER at Mayo Clinic. There they said it was a manic episode as my blood work, urinalysis and EKG showed nothing. They prescribed Trazodone 100mg but I didn’t feel safe and from there voluntarily admitted myself to a behavioral hospital for 8 days. The behavioral hospital increased the Paroxetine to 30mg.

 

After I was discharged I made a follow up appointment with a psychiatrist on February 13th, 2023. I told him that Paroxetine 30 mg was causing me sexual side effects and emotional blunting. He prescribed Citalopram 20mg and lowered Paroxetine to 10mg attempting a cross-taper to get onto Citalopram. I started the cross-taper on February 15th, 2023 and on February 27th I stated to feel what I believe were the start of effects.

 

On the 6th week I started to experience severe insomnia caused by the Citalopram and was advised by my psychiatrist to just stop it cold turkey. My last dose of Citalopram 20mg was March 29th, 2023. From then on out I’ve experienced what I believe to be are withdrawal symptoms. I was sleeping fine with Trazodone 100mg up until April 24th when the insomnia came back.

 

The symptoms I’ve experienced are as follows and most come and go.

 

Insomnia; I don’t even feel tired or drowsy anymore

loss of appetite

diarrhea

suicidal ideation

crying spells

head buzzing

hypersensitive to sound when attempting to sleep

sensitive to cold on my forearms

left index finger twitches after gripping something

a panic attack that lasted a day and a half

 

I’m looking for advice as to what I should do. All my psychiatrist did when I told them all of this was prescribe Quetiapine 100mg for sleep and mood. I hesitate to take any more medication.

 

 

 

 

 

 

 

 

 

 

 

[Altostrata]

Welcome, @Brenmos

 

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

 

On 4/30/2023 at 8:59 AM, Brenmos said:

I had a relapse in obsessive-compulsive disorder and hypochondria November 21st, 2022 and from there I spiraled.

 

Had you previously taken psychiatric drugs?

 

Quote

 

February 15th 2023- cross-tapering Paroxetine 10mg with Citalopram 20mg

March 29th 2023- stopped Citalopram 20mg cold turkey

 

 

At what point did you stop paroxetine in the cross-over process?

 

On 4/28/2023 at 10:15 PM, Brenmos said:

On March 29th,2023 they told me to stop taking Citalopram 20mg cold turkey.

 

Who told you to stop taking citalopram a month ago, and why? Were you still taking paroxetine at the time, or did you reinstate 10mg afterward?

 

On 4/30/2023 at 8:59 AM, Brenmos said:

I was sleeping fine with Trazodone 100mg up until April 24th when the insomnia came back.

 

What drug changes did you make in mid-April?

[Brenmos]

I don’t have a set time I take my drugs as I also travel for a living but usually anywhere between 8:00 AM and 12:00 PM

 

I took methylphenidate and atomoxetine in elementary school. I also took Adderall from January 2011-November 2012.

 

I never stopped taking Paroxetine in the cross over process.

 

My psychiatrist told me to stop taking citalopram because I felt that during the 6th week of taking it I was experiencing severe insomnia. Now I’m not sure if it was that or an increase in my anxiety causing me to not sleep. I was still taking paroxetine.

 

The only drug changes I made in mid-April was taking trazodone 200mg instead of 100mg for two nights. I’m prescribe 100-200mg of trazodone.

[Altostrata]

On 5/1/2023 at 7:21 PM, Brenmos said:

I don’t have a set time I take my drugs as I also travel for a living but usually anywhere between 8:00 AM and 12:00 PM

 

 

You mean you take paroxetine in the earlier part of the day? It's important to be on a consistent schedule, particularly with paroxetine. A variation of 4 hours is too much. Some of your problems may have come from inconsistent dosing,

 

What time o'clock do you take trazodone?

 

What new symptoms arose after you dropped citalopram on March 29?

[Brenmos]

I had considered that I was taking the medication at inconsistent times.
 

I take trazodone between 2:30 AM and 3:30 AM. 

I had what I believe to be brain zaps on the back of the left side of my head. It felt like buzzing. Muscle aches on my forearms. My forearms were sensitive to cold. If I placed any object that was cold and took it off I would still feel the sensation of coldness on my forearms a half hour later.

The first week or two of April I had brain fog.

April 9th I had crying spells and anxiety.

 

April 14th I felt tired.

 

April 17th I had a panic attack at night that didn’t go away until the afternoon of April 18th. The acute phase lasted a few hours. I might’ve forgotten to take paroxetine on April 17th.

 

April 18th I felt fatigued.

 

The week of April 23 was really bad. I lost my appetite on April 23 and it didn’t come back until April 28th.

 

April 24th- April 29th was the start of severe insomnia and diarrhea. 100-200 mg of trazodone wasn’t working. And sometimes I would take trazodone 100mg and doxylamine succinate 25mg and that wouldn’t work either. I didn’t feel tired, only wired and would get 2-3 hours of broken sleep. And I had hyperacusis the night of April 24th as well attempting to sleep.

 

April 25th-April 26th was suicidal ideation and crying spells. I’ve had it before as a passing thought but this was an intrusive urge to do it. On April 26th the suicidal ideation went away at 4:00 PM like a light switch.

 

April 29th I would start to sleep better and it would get better as the days progressed.

 

May 1st I started to feel like my old self. 

 

 

[Altostrata]

18 hours ago, Brenmos said:

I take trazodone between 2:30 AM and 3:30 AM. 

 

 

What is your usual sleep schedule?

 

18 hours ago, Brenmos said:

May 1st I started to feel like my old self. 

 

 

Please explain. You don't feel any odd symptoms? Your sleep is normal?

[Brenmos]

I usually go to sleep around 2:30 AM and 3:30 AM as I am a night owl as well. And I get out of bed between 10:30 AM and 12:00 PM. I’ll usually wake up 3-4 hours after sleeping lately and fall back asleep of and on.

 

Another symptom I have been experiencing is pins and needles. And that has gotten better as the days go on but I still feel that from time to time along with random anxiety. 
 

My sleep is better, but I wouldn’t say normal as it was prior to January 26th, 2023. As what got me into this mess initially was insomnia. 

[Altostrata]

On 4/28/2023 at 10:15 PM, Brenmos said:

Then on January 26th, 2023 everything imploded I started to experience insomnia for the first time ever. And insomnia that I didn’t realize existed. When I would attempt to fall asleep I would get what felt like a rush of adrenaline in between wakefulness and the first stage of sleep and I would be wired. On January 29th, 2023 I was at the end of my rope.

 

This symptom pattern is a good description of withdrawal insomnia. Most likely, it came about because you had been taking paroxetine inconsistently and the addition of trazodone was unnecessary.

 

Keeping a regular sleep schedule ("sleep hygiene") matching the normal human circadian rhythm strengthens sleep. See 

 

 

What is the sleep cycle?

 

Waking with panic or anxiety -- managing the morning cortisol spike

 

Tips to help sleep -- so many of us have that awful withdrawal insomnia

 

Path to Better Sleep FREE online for everyone from the US Veterans Administration

 

Music for self-care: Calms hyperalertness, anxiety, aids relaxation and sleep

 

White noise devices for sleep

 

Melatonin for sleep: Many people find it helpful

 

TV or computer use in evening can disrupt sleep: Bright light signals the brain that it's daytime

 

What do you want to do in terms of going off your drugs?

 

[Brenmos]

The type of insomnia I was experiencing January 26th was before I started antidepressants. The week of April 24th was a different type of insomnia which felt like it was from withdrawing citalopram. 

[Altostrata]

Sorry, I misunderstood. The description does match withdrawal insomnia.

 

On 5/7/2023 at 1:48 PM, Altostrata said:

Keeping a regular sleep schedule ("sleep hygiene") matching the normal human circadian rhythm strengthens sleep. See 

 

What is the sleep cycle?

 

Waking with panic or anxiety -- managing the morning cortisol spike

 

Tips to help sleep -- so many of us have that awful withdrawal insomnia

 

Path to Better Sleep FREE online for everyone from the US Veterans Administration

 

Music for self-care: Calms hyperalertness, anxiety, aids relaxation and sleep

 

White noise devices for sleep

 

Melatonin for sleep: Many people find it helpful

 

TV or computer use in evening can disrupt sleep: Bright light signals the brain that it's daytime

 

This still applies.

 

On 5/7/2023 at 1:48 PM, Altostrata said:

What do you want to do in terms of going off your drugs?

 

 

Please answer this question.

[Brenmos]

I believe I’m in a wave right now with the insomnia.

 

Isn’t it advisable to get through the citalopram withdrawal before tapering off trazodone and paroxetine?

[Altostrata]

On 5/4/2023 at 8:50 PM, Brenmos said:

April 17th I had a panic attack at night that didn’t go away until the afternoon of April 18th. The acute phase lasted a few hours. I might’ve forgotten to take paroxetine on April 17th.

 

If you forgot paroxetine, this could have been a significant setback.

 

Yes, it's best to stabilize before more tapering of anything.

[Brenmos]

Again, I’m not sure if I forgot to take paroxetine that day or if the panic attack was from withdrawing from citalopram.

 

The only symptoms I have right now is insomnia and my fingers will sometimes twitch after I’m done gripping something. 

[Altostrata]

Please explain more about your sleep pattern. Do you feel any effect from the trazodone?

[Brenmos]

I take the trazodone and get about 3-4 hours of uninterrupted sleep. Then I get light fragmented sleep until it’s time to get out of bed. Or I’ll just lay there with my eyes closed resting.

[Brenmos]

I was wondering if it’s advisable to reinstate citalopram? I was told by my psychiatrist that on the 6th week of taking it I had an adverse effect when I had developed severe insomnia. He told me to stop it cold turkey. I had a whole slew of side effects during those 6 weeks of taking it and I actually feel better off of it.

 

The side effects I had when taking citalopram were:

Muscle twitches throughout my entire body

Crying spells

Insomnia

loss of appetite

Pins and needles

Night sweats

My sweat would smell like chemicals such as ammonia

An overactive cremasteric reflex. My scrotum would contract and retract constantly at times

Depression

Panic Attacks

Anxiety

Suicidal ideation

Sensitive to cold objects on my forearms

My heart would skip beats several times in a row periodically

 

I was told to continue to take citalopram as the side effects should go away up until I developed insomnia. Which the psychiatrist said was an adverse effect.

 

 

 

 

 

[Altostrata]

Very possible that those were withdrawal symptoms from going off paroxetine, not an adverse reaction to citalopram.

 

You've been taking 100mg trazodone nightly since January 31?

 

17 hours ago, Brenmos said:

I take the trazodone and get about 3-4 hours of uninterrupted sleep. Then I get light fragmented sleep until it’s time to get out of bed. Or I’ll just lay there with my eyes closed resting.

 

Trazodone wears off in about 5 hours and then its activating metabolite mCPP takes over. Could be that a slightly lower dose of trazodone might produce less mCPP.

[Brenmos]

From going from 30mg to 10mg of paroxetine?

And then withdrawals from stopping 20mg of citalopram cold turkey after 6 weeks?

 

Yeah I’ve been taking 100mg trazodone nightly since January 31st. It’s prescribed to take 100-200mg. There have been times that I’ve taken 200mg. I didn’t realize it’s activating after 5 hours.

 

My psychiatrist had prescribed 10mg propranolol, 1mg lorazepam and 100mg of quetiapine. I have taken none of these.

[Altostrata]

On 5/12/2023 at 9:18 PM, Brenmos said:

I was wondering if it’s advisable to reinstate citalopram? I was told by my psychiatrist that on the 6th week of taking it I had an adverse effect when I had developed severe insomnia.

 

You had reduced paroxetine in that same 6 weeks, correct? Yes, it's likely those symptoms your psychiatrist attributed to citalopram were withdrawal from paroxetine.

 

16 hours ago, Brenmos said:

I didn’t realize it’s activating after 5 hours.

 

It's only a guess that might be causing your waking. Is your trazodone immediate-release or extended-release?

[Brenmos]

I believe the trazadone is immediate-release.

[Brenmos]

Anyone experience losing the ability to feel drowsy and fatigued? Insomnia is my main symptom as well right now.

[Altostrata]

When did the insomnia start? What drug changes have you made in the last month?

[Brenmos]

5 hours ago, Altostrata said:

When did the insomnia start? What drug changes have you made in the last month?

This type of insomnia started on April 24th and I haven’t made any drug changes. 

[Brenmos]

My psychiatrist today acknowledged my withdrawals. He mentioned hydroxyzine might help withdrawal if it’s related to histamine. He suggested adding fluoxetine or raising paroxetine by 10mg if hydroxyzine doesn’t help.

[Altostrata]

On 4/28/2023 at 10:15 PM, Brenmos said:

Because of the sexual side effects and emotional bluntness of Paroxetine 30mg we cross-tapered Paroxetine with Citalopram. Going from 20mg to 10mg of Paroxetine and 20mg of Citalopram. Along with Trazodone 100mg nightly.
 

I experienced a range of side effects trying to cross taper. On the 6th week I developed severe insomnia. That even Trazodone 200mg wasn’t touching. On March 29th,2023 they told me to stop taking Citalopram 20mg cold turkey.

 

Pretty clear that your psychiatrist's treatment plan, which included a switch to citalopram and addition of trazodone, was a disaster. Why would you want to take citalopram at this point?

 

Is it your intention to stay on antidepressant treatment? If so, please discuss this with your doctor. We provide peer support for going off, not adjusting current cocktails for maintenance.

[Brenmos]

6 hours ago, Altostrata said:

 

Pretty clear that your psychiatrist's treatment plan, which included a switch to citalopram and addition of trazodone, was a disaster. Why would you want to take citalopram at this point?

 

Is it your intention to stay on antidepressant treatment? If so, please discuss this with your doctor. We provide peer support for going off, not adjusting current cocktails for maintenance.

The only reason I would consider taking citalopram in a lower dose is to possibly ease the withdrawals. But given the fact I had a lot of side effects during those 6 weeks I’m not sure that’s possible. Do I also run the risk of kindling if I did that?

 

I’d like to eventually stop paroxetine and trazadone but that’s not possible right now. I’m trying to figure out the withdrawals from citalopram and if I should continue to ride this out as is.

 

I also don’t want to add anymore or change antidepressants. My understanding is that hydroxyzine is an antihistamine and it’s fairly low risk?

[Altostrata]

Your psychiatrist does not seem to have a clue about what's going on.

 

As explained earlier, paroxetine is very difficult to go off. If I were you, I would stabilize on it for some months before considering tapering again.

 

Hydroxyzine makes people sleepy because it is an antihistamine.

[Brenmos]

4 hours ago, Altostrata said:

Your psychiatrist does not seem to have a clue about what's going on.

 

As explained earlier, paroxetine is very difficult to go off. If I were you, I would stabilize on it for some months before considering tapering again.

 

Hydroxyzine makes people sleepy because it is an antihistamine.

Yeah I need to stabilize after quitting citalopram 20mg cold turkey. Also that I went from 20mg of paroxetine to 10mg at the start of the failed cross-taper.

 

And even my intuition is telling me that taking citalopram again, raising paroxetine, or adding a different antidepressant will make things worse. 

[Altostrata]

It does not appear your problem is citalopram withdrawal. You probably started having paroxetine withdrawal when cross-tapering.

[Brenmos]

53 minutes ago, Altostrata said:

It does not appear your problem is citalopram withdrawal. You probably started having paroxetine withdrawal when cross-tapering.

Could it be both paroxetine and citalopram withdrawal? 
 

I stated paroxetine January 28th, 2023 at 20mg. During my hospitalization it was raised to 30mg in the beginning of February. And February 15th it was lowered to 10mg and that was the start of the cross-taper with 20mg of citalopram. 

[Altostrata]

What is it you want to do? If you want to replace paroxetine with citalopram again, please go back to your doctor.

[Brenmos]

3 hours ago, Altostrata said:

What is it you want to do? If you want to replace paroxetine with citalopram again, please go back to your doctor.

I’m just going to continue taking paroxetine and trazodone until I stabilize. Then hopefully taper off of them.

[Altostrata]

Please let us know how you're doing.

[LostInCanada]

@Brenmos hi and welcome to SA. How have you been doing? Any improvements? I too have been waiting to stabilize on paxil. It's been just over 6 months for me and I am  seeing positive changes. Hope you are seeing improvement too.

[Brenmos]

10 hours ago, LostInCanada said:

@Brenmos hi and welcome to SA. How have you been doing? Any improvements? I too have been waiting to stabilize on paxil. It's been just over 6 months for me and I am  seeing positive changes. Hope you are seeing improvement too.

Hello and thank you 😊. Today has been a great day. In fact I have more windows than waves. The waves that I do have last mere minutes or hours. Waves that include suicidal ideation, crying spells, morning anxiety and burning forearms.

 

My number one complaint is insomnia since quitting citalopram cold turkey 11 weeks ago.

 

I’ve been taking trazodone since January 28th though.