Evenflow- citalopram/Wellbutrin too fast taper, long term use, exercise and the nervous system

[evenflow]

Brief: 33 y/o female tapered too quickly off Citalopram and Wellbutrin XR (~1 month from 20mg/150mg to 0mg/0mg) after being on that for ~5 years and other drugs for ~15 years. ~6 months since last doses. Functional in daily life but struggling. No more physical symptoms, now experiencing emotional dysregulation in waves. How can I best help my brain/CNS heal? Is "good" stress still good when going though this, or is gentleness and reduced stimulation the way?

 

More context:
I apologize in advance for how much drug history I am missing and how vague it is. I have been on psychiatric medication continuously since I was 13 and it felt both normalized and out of my control, I did not keep records and did not think about it much. I took the pills doctors told me to. When they asked me if I felt "better" or "worse" I tried to come up with an answer to be polite, but the truth is I never felt much better or much worse, even when on unusually high doses of these medications (for my age/weight). I was inpatient twice, once at 14 and once at 20. When I tapered off my most recent meds (Citalopram and Wellbutrin) I did not keep a record of dosages or symptoms and the timeline is an estimate. Until this year I have not felt empowered to treat this part of my life with the seriousness and careful attention that it deserves. To be honest I doubt these pills did anything for me, I have been miserable, depressed, and anxious for as long as I can remember and that has been my "normal". As an adult, I have learned that my mood is improved or made worse by the usual non-pharmaceutical factors-- exercise, sunlight, socializing, healthy diet, sense of meaning, achievement in career and hobbies, etc. After reading some material on this website and experiencing my recent taper, I suspect that a lot of my difficulties over the last 20 years have been the result of these medications, their side effects, and how frequently they were changed up with short tapers. I don't think there was ever anything "wrong" with me that justified medical intervention. Nevertheless, my brain chemistry is now what it is because of these meds, and I am going to deal with it.

 

I can remember being prescribed at one point or another all of these, sometimes in cocktails: Zoloft, Lexapro, Effexor, Cymbalta, Abilify, Klonopin, Xanax, Lorazepam, Nortriptyline. For the last ~5 years I have been on Citalopram and Wellbutrin XR. Over a period of years I did reduce that from 40mg to 20mg and 300mg to 150mg respectively, and did not notice any changes. 

 

Approximately 6 months ago I decided to taper myself off of both medications with what I had remaining in the bottle-- over about a month's time I halved both doses, then halved again until the pills became too small to cut, then did alternating days--- I did not know that tapering should be done at a much slower rate with much smaller increments, that you should not alternate days, that cutting a Wellbutrin XR destroys the slow release coating, or that you should do one medication at a time.... I did everything you are not supposed to do, and I am surprised that my withdrawal has not been worse.

 

For the first month I experienced extreme irritability, digestive issues, shakes, and visual phenomena similar to ocular migraine aura. That has all passed, I am now experiencing strong waves of emotion and combinations of emotion that are sometimes unrelated to my actual situation, and sometimes just disproportionate to a situation. These are usually combo-packs of negative emotion (shame/fear, anger/sadness/guilt, etc.) but I have also wept many times out of a sense of awe and transcendence. The description on this site of "neuro-emotions" makes me think this is what these are. I have found that using skills from CBT is somewhat (maybe 30%) effective at reducing the intensity of them, so that's what I do, it's better than nothing. I also have a high level of anxiety/activation when driving or being out in public, which I manage through exposure and some CBT tricks. I am experiencing some derealization as well. But other than the "neuro-emotions", these are things I experienced while on the drugs as well.

 

If these emotional waves are indeed an issue of nervous system dysregulation after chemical dependence, and my brain is finding a new equilibrium, I want to make that process as easy as possible for my brain. To that end--

 

I practice an "extreme sport", rock climbing, which often puts me in a very activated, sometimes fearful, state. I also lift heavy weights. These activities are what keep me from going off the deep end, but they are very taxing on the nervous system. I have scaled back the lifting to try and give my CNS a break, but I know from experience I won't be able to reduce the climbing much without entering a deep depression. After reading the material here I wonder whether I took up these hobbies because they stressed my over-medicated brain in the "right" ways, and I wonder whether withdrawal and the healing process is going to be helped or hindered by them. Am I doing my CNS a disservice by subjecting it to "good" stress? Is it time to switch to yoga? 

 

I feel like, at this exact moment, these symptoms are tolerable for me, but barely. If they get any worse I am not sure I can tolerate them and also function in my job. I am willing to reinstate the meds to get some relief, but from what I've read here that could be a bad idea 6 months out.

 

Today, with the information I have found here, I am feeling optimistic that even if recovery is measured in years, it will get gradually easier and the hardest part is over. However, the part I am in right now is really, really hard. Does anyone have experiences to share or insight about the CNS aspect of recovery, particularly if you regularly abuse your CNS with heavy weights or some other strenuous activity?

 

Thank you for your time and especially for the wealth of information contained in this website, it has given me hope that I can get my life back.

[Altostrata]

Welcome, @evenflow

 

It appears you have protracted withdrawal syndrome. How has your symptom pattern changed in the last month? How has your sleep pattern changed?

 

Please add the last dates you took citalopram and Wellbutrin to your signature.

 

If you find exertion makes you feel worse, strongly suggest you reduce the exertion.

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  Congratulations for getting off the drugs!  You are correct, your current symptoms are probably due to tapering off the citalopram and Wellbutrin too quickly.  It's quite possible that your nervous system was also somewhat destabilized from your previous drugs and coming off those as well.  I do want to commend you because it sounds like you have done some thorough research on our site already, and have learned a lot about these drugs, what they do to us, and how to taper off properly.  I see that you already have a lot of very good non drug coping skills in place.  Just in case you missed anything, I'll go ahead and give you the links to look over.  Then, I'll give some suggestions for you at the end.   Are you currently on any psychiatric or other meds, or any supplements?  If so, please specify. 

 

I realize you don't remember too many specifics, but can you possibly try to estimate some dates and dosages for your drug history over the past 18-24 months?  It would be especially helpful to have the details of your drugs in a concise vertical list (no symptoms), only specific dates, include the day (as best you can say for example early March if you don't recall the day), drug names, and dosages of each medication decrease or increase. Here is an example: 

 

March 12, ’22: Lexapro 5 mg, Xanax 0.5 mg, Trazodone 50 mg

March 29, ’22: Lexapro 4 mg, Xanax 0.5 mg, Trazodone 50 mg

April 17, ’22:  Lexapro 3.8 mg, Xanax 0.5 mg, Trazodone 50 mg

May 19, ’22:  Lexapro 3.8 mg, Xanax 0.5 mg, Trazodone 25 mg

 

 

Please read the link below for instructions.  This will allow us to give you the best guidance.  

 

How to List Your Drug History in Your Signature

 

Here is some important information about how these drugs actually work.  This explains why we get symptoms from going off of these medications, and why it's so important to taper slowly and carefully, and be very cautious about changing our doses: 

 

How Psychiatric Drugs Remodel Your Brain

 

 

This helps you understand what withdrawal syndrome is: 

 

Video on Recovery from Psych Drugs

 

Windows and Waves Pattern of Stabilization

 

 

Here is a link with checklists of common WD symptoms: 

 

Dr Joseph Glenmullen Withdrawal Symptom Checklists

 

 

Here are some techniques to cope with symptoms: 

 

Non Drug Ways to Cope with Withdrawal Symptoms

 

Stability is really important when we are tapering off psych meds.  Please read the link about stability:

 

Keep It Simple, Slow, and Stable

 

 

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

Magnesium

Omega 3 Fish Oil

 

 

On 6/20/2023 at 5:07 PM, evenflow said:

If these emotional waves are indeed an issue of nervous system dysregulation after chemical dependence, and my brain is finding a new equilibrium

I do believe there is a very high likelihood that this is true.  I'm still experiencing the very same thing myself.  This should eventually become more mild, and go away, with ups and downs.  

 

I personally have found it best to avoid stimulating my nervous system.  In withdrawal, our nervous systems tend to be overly activated, and it is important to learn ways to calm our nervous systems down.  I wonder if you could find an alternative activity that would be fulfilling, but less stimulating.  For me, being creative and artistic is one such activity.  

 

Do please keep us posted, and let us know how you are doing.  

[getofflex]

On 6/20/2023 at 5:07 PM, evenflow said:

Does anyone have experiences to share or insight about the CNS aspect of recovery, particularly if you regularly abuse your CNS with heavy weights or some other strenuous activity?

 

These links will help you understand how our CNS recovers, and why it takes so long, and happens in waves.  

 

What is Happening in Your Brain? (Explains why recovery takes so long)

 

How Long is Withdrawal Going to Take, Factors Affecting Withdrawal

[evenflow]

On 6/25/2023 at 12:05 PM, Altostrata said:

How has your symptom pattern changed in the last month? How has your sleep pattern changed?

...

If you find exertion makes you feel worse, strongly suggest you reduce the exertion.

 

 

Thanks! Signature updated; I looked into the dates more and have a better estimate now-- for one thing, I was wrong about the Buproprion dosage, I was still prescribed 300 mg when I started tapering. I'm pretty sure I took my last dose of both medications around Dec 15 2022. 

 

I am now tracking my exercise and symptoms with the Glenmullen spreadsheet, so I will do that for a few weeks and see whether I notice a pattern. I usually feel better immediately after strong exertion, but it's possible I'm tanking the following day. I definitely am not physically recovering from heavy workouts as quickly as I used to. 

 

In the last month, I've noticed a number of changes; I should mention that I had a stressful event in May (I was laid off from what I thought was a very secure position, random and unrelated to performance, I have a new role lined up starting in July that I am feeling very positively about but it was a rough couple of weeks) that has surely influenced this so I can't say how much of the change is due to that. Most notably I have moved from being primarily irritable and mope-y to primarily anxious and activated. Generally I am less angry and more afraid. I feel more energetic and also more optimistic about and trusting of other people, rather than projecting my negative feelings onto them. It has been easier to get to sleep and I find it more restful; although I am waking up with intense anxiety and feelings of doom, I am not exhausted in the morning. In general the morning seems like the worst time for the anxiety, and it's bad before I have coffee.

 

This is about more than the last month but I want to share it because it's mind blowing to me (although probably not to people on this forum...): I think I have had the symptoms of clinical depression for so long that I forgot what it was like to not have them. Since coming off these medications, although I am having other issues, I am no longer depressed. My baseline state for years and years was a constant, exhausted pessimism and a distrust of people and the world that was so deeply ingrained it constituted my very identity. I could hardly move the needle on that cynicism and exhaustion no matter what I did, and I did all the things that are supposed to help-- exercise, journaling, meditation, community work, thought-checking, etc.

 

Now, it's like the waves of dysregulation come and go, but they are moving on top of an energized, healthy, realistic clarity. Suddenly I actually believe all the things I was trying to convince myself of in decades of therapy-- that people are unique and have their struggles but they are more or less good, that I am a capable and kind person who contributes to my community and can make positive changes in my life if I choose to, that the world is neutral if not benevolent and I am not singled out for cosmic punishment. I actually feel the feelings of reward when I connect with someone or help them, instead of just knowing that I "should" do those things. Decision-making is no longer about following some script I have internalized about what human beings 'ought' to do because I didn't get the affective feedback to know what to do intuitively. Now I get the feedback, so I actually know what I want and don't want. I went from 'faking it till you make it' to actually having made it-- but I don't think having made it is just because I faked it for long enough. I faked it for 20 years. I think I just needed these medications to leave my body. I don't really know what to do with that information, because if it is true for me it is also true for others, and so many people take these drugs. How many of us are sleepwalking through life like this, sexless and miserable and unmotivated by the basic goods of human life? Is the over-prescription of these meds in part responsible for the decline in marriage and birth rates and the loss of interest in community, since a large part of the population is not being drawn to these activities that an unmedicated person sees as their own reward? I've seen people blame the breakdown of American social life on everything from the work culture to the technology we've adopted to the decline of religious observance to poor quality diets-- what if a significant factor is these drugs? 

 

Feeling this deep undercurrent of energy and vitality in myself, and knowing that is simply what it is like to not be depressed, has recontextualized every moment of my life until now. I never understood why the keeping up with the basic tasks of life-- job, friends, family, housework-- was so difficult and draining for me, when others made it look easy. I always thought I was doing something wrong, that there was some secret I was missing. The secret is just that the people who make it look easy aren't physically exhausted and cynical 100% of the time. They have a wellspring of energy and realistic optimism that replenishes itself with sleep, sunlight, and socialization. They have some amount of gas in the tank most of the time, whereas I was just running on fumes, and that's why I perceived the world as grim and intolerable. It's like a veil has been lifted, or I've crawled out of a hole.

 

On 6/25/2023 at 12:09 PM, getofflex said:

Congratulations for getting off the drugs! 

...

Are you currently on any psychiatric or other meds, or any supplements?  If so, please specify. 

...

I do believe there is a very high likelihood that this is true.  I'm still experiencing the very same thing myself.  This should eventually become more mild, and go away, with ups and downs.  

 

I personally have found it best to avoid stimulating my nervous system.  In withdrawal, our nervous systems tend to be overly activated, and it is important to learn ways to calm our nervous systems down.  I wonder if you could find an alternative activity that would be fulfilling, but less stimulating.  For me, being creative and artistic is one such activity.  

 

Do please keep us posted, and let us know how you are doing.  

Thank you for the resources, and for offering me congratulations! It meant a lot to me to be congratulated, this feels so sucky right now it's easy to forget that it's supposed to be something positive I am doing for myself. And congrats to you as well, since it looks like you are completely off! How long once you went off did you notice a significant reduction in the volatility? Or was it so gradual you didn't notice?

 

The explanation of how these drugs change the brain makes intuitive sense to me. I wish there were a way to confirm that this is what is happening, but I am not optimistic that such research will ever be prioritized, even if it were possible. From what I've read it seems like even the companies that produce these drugs are relying on a model of how they work in the brain, not actually observing how they work. As an engineer, that sketched me out. Such a thing would not be permissible in my industry!

 

I am not on any other medications. I do take an iron supplement (26mg, also contains B12 30mcg, folate 680 mcg, VitC 15 mg) as I have persistently low iron. 

 

I am keeping track of exercise and symptoms now, so I'll see whether I can find a correlation. I'm so used to intense exercise helping me that it's hard to imagine scaling it back, it's like a security blanket for me and (if I'm brutally honest) I attach a lot of my identity and sense of value and meaning in life to it. But there is a season for everything in life, and maybe now is not the season for intensity.

[getofflex]

Thank you for your optimistic and insightful post!  It certainly sounds like you have had a significant breakthrough to be rid of your depression!  It sounds as though you have truly been set free from the chemical straitjacket of psych drugs.  I believe that is what they are.  I'm really happy I'm free of them.  I have to say that the symptoms have abated very very gradually for me, and I'm still recovering.  I've been told by the senior staff that I'm still early in my recovery, having only been off almost a year.  But then, I was on them almost 20 years by the time I completed my taper, and was on 3 drugs (Lexapro, Xanax, Trazodone).  I'm still dealing with some sleep issues, but sleep is better than it used to be, so I try to focus on that.  WE often suggest people reduce the intensity of their exercise, because it can cause an increase in adrenaline, which will activate the flight or fight mode in us, and usually in WD that is the last thing we need. We need to calm our nervous systems instead.  Walking outside works well for me. 

Edited June 27, 2023 by getofflex

[Altostrata]

Many people find these to be helpful:

Magnesium, nature's calcium channel blocker 

Omega-3 fatty acids (fish oil) 

 

You might try a low dose of one at a time to see what it does for you.