Hello from RB398 - Introduction

[RB398]

Hi All, I hope everyone is doing OK.

Here's my introduction.

I'm a 56 year old female living in the UK. I've been on antidepressants for over 20 years. 40mg Citalopram.  I've had some of my worst times with my mental health while taking antidepressants though for many years I just stayed on them because I thought they were doing me good. After all, I had no idea of what life would be like without them.

During the time I've been on them, I've had very little drive or impetus to do anything at all with my life. I have had massive problems with sleep - in that I have always been tired. I can sleep for 12 hours and still feel tired.  I don’t know why this is, whether it's a side effect of the ADs or just depression. I have felt the most depressed I've ever felt while taking antidepressants.

About 4 years ago my sister came off Antidepressants as directed by her Dr. This proved to be far too fast and, as we now know after finding this website, she has been through what is described as protracted withdrawal.  I'm glad to say that now my sister is doing so much better and though she does have bad days - (don't we all) - on the whole she is in a far better place for coming off the Antidepressants, in spite of the protracted withdrawal.

Having learned so much through my sister’s journey, and being sick of being so lethargic and numb to everything, I would really like to see what life is like without taking antidepressants. I realise now this is not something I can just try - for a while to see how it goes. I understand that I must taper slowly and carefully to even begin to see what life might be like without the drugs.

In May ‘23 I reduced from 40mg citalopram to 30 mg.

I have found that one of the GPs at my practice has been very understanding. While she doesn't seem to know much about potential problems of coming off antidepressants, she seems very happy for me to decide how I want to come off them and has even prescribed the liquid form of citalopram so I can taper however I want to.

At the beginning of this month (Sept ’23) I swapped from tablet form of citalopram to liquid form but kept on the same - equivalent dose. I am taking things very carefully.

I have also done the initial assessment for the Bath University - Antidepressant Withdrawal and Maintenance Study, but didn’t fit their criteria because I have had a recent episode of depression. I would be happy to take part in any research that might help find out more about the effects of antidepressants.

 

[Emonda]

Welcome to S.A. @RB398

 

So the moderators can best help you, please complete your drug signature by following these instructions. Adding a signature ensures your drug history appears at the bottom of every post, making it more efficient for those trying to assist.

 

That's good that you can recognise that your sister tapered too fast. The recommendation in this community is to reduce by a maximum of 10% per month of the most recent dose. The amount of the reduction gets smaller and smaller every month. I'd suggest you start by reading Why taper by 10% of my dosage?

 

Your initial reduction of 40mg to 30mg (25% reduction) is greater than we would recommend. At larger doses, some of us can get away with this. But, as the dose gets smaller, it may hit you hard if you maintain this level of tapering, and it take you a long time to stabilise. I’d definitely slow down for the next reduction. Did you notice any side effects of the reduction?

 

Did you notice any side effects switching from tablets to liquid?

 

Throughout your taper, some days you’ll feel good and others not so. Sometimes, the rough patches can last weeks, if not months. We refer to this as the  Windows and waves pattern of stabilization. Have a read of these non-drug coping strategies to help you on your journey.

 

You may find it reassuring to read the WD symptom checklist. That way, when you experience something following a reduction in your AD, you may be able to reassure yourself that it is ‘normal’ and part of the process.

 

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

Magnesium

Omega 3 Fish Oil

 

Please post any updates here in your thread. It is helpful to keep everything related to your journey in one spot. You are very welcome to jump onto someone else's page and interact with them. The encouragement members give each other on this site is wonderful to see.

 

Once again, welcome to S.A.

 

Emonda.

[Kostas]

Please take care when your citalopram dose ,is over 30 mg ...

 

I think there are new instructions, not to go above this limit, since that it  interferes with the cardiac function..

 

It's better to consult with your doctor about it...

 

 

 

 

 

 

[RB398]

Thanks Emonda & Kostas.

So good to hear from you & I'll check out all the v good advice.

One of the reasons I decided to come off ADs was because one of the GPs at my practice said they were wanting to take people off SSRIs if they didn't need them. 

I have felt the worst I've ever felt while taking 40mg of citalopram so I haven't been convinced they're doing me any good for a very long time now.

Also one Dr did say that they didn't like people to be on 40mg. When I spoke to another GP (whichever was available for an appointment) about this they contradicted first one. So no idea what was going on.

I've been 'with' ( as in on the other end of the phone)  my sister through her protracted and v. diff. 4 year withdrawal so I've seen a lot of what can happen over the years. 

I know this site was a massive help to her.

I understand my first reduction was quite big but having looked at Mark Horowitz work I figured it might be ok.

So far it has been. In fact I felt like I had quite a lot more energy & actually didn't feel like I wanted to sleep every hour of every day, which was so lovely after being like that for so many years. 

I have purposely stayed on the 30mg dose for a good few months just in case. 

I was also hoping to be part of the Bath University Antidepressant withdrawal study but sadly didn't fit the criteria because I'd had a couple of days of feeling really bad in the previous week to the initial interview. It's a shame but have to let it go. They are only taking people who no longer have any depression at all, which given the research that shows that the longer one is on ADs the more likely you are to have increased and prolonged depression seems a bit counter intuitive to me. Apparently it's the ethics committee that have stipulated that criteria, not the people doing the actual study. 

Hey ho.

On the whole I've been fine since the initial 25% reduction & the subsequent swap to liquid. The usual ups and downs but nothing major or out of the ordinary really.

Just need to find some time to translate Mark Horowitz work into an actual tapering plan. 

I'd be really interested to see if anyone else has already done this and if so how it's gone.

You can be sure I'm not going to do anything fast at all though. 

Thanks so much for the pointers 

And Kostas, afraid my GP, though supportive to a certain extent - i.e. prescribing liquid and saying I was ok to taper as slowly as I liked, she didn't want to take up the offer of a free (as in, me paying) academic consultation with Mark Horowitz in order to learn a bit more about coming off ADs. 

Again, it is what it is and I just have to let it go.

Horses to water and all that. 

Anyway, I'll keep in touch and let you know how I get on with my subsequent reductions

All the best to you both with your journeys. 

The up side of helping my sister through her difficult times is that I do know this can be done. 

Xx

[Emonda]

Hi @RB398,

16 hours ago, RB398 said:

I've been 'with' ( as in on the other end of the phone)  my sister through her protracted and v. diff. 4 year withdrawal so I've seen a lot of what can happen over the years. 

 

That's great that you could support her. You've just got to make sure you don't end up in a protracted, very difficult withdrawal....you've seen what can happen, so it sounds like you have your eyes wide open.

 

16 hours ago, RB398 said:

I understand my first reduction was quite big but having looked at Mark Horowitz work I figured it might be ok.

So far it has been.

 

Be very cautious. I dropped from 15mg to 7.5mg of a different AD (before finding this website). That was okay-ish. When I subsequently dropped from 7.5mg to ~5mg, it got a bit ugly and took some time to recover.

 

16 hours ago, RB398 said:

Just need to find some time to translate Mark Horowitz work into an actual tapering plan. 

 

Dr. Horowitz recommends the same approach used here, a hyperbolic taper. The reductions get smaller and smaller. I've dropped a screenshot of a tapering plan from the rcpsych.ac.uk website on stopping antidepressants. The website credits Dr Horowitz, and others, for preparing the tapering advice. It shows the steps involved in dropping from 40mg of a different AD to 0mg. In the example, they use a combination of pills and liquid....you're already 100% liquid, so that makes the logistics easier.

 

16 hours ago, RB398 said:

I'd be really interested to see if anyone else has already done this and if so how it's gone

 

Since following this approach, I'm down 81% from my starting dose. There's nothing special about me...I'm just like most other members here. We follow the maximum 10% monthly taper, many of us do less than 10% per month. The key is to go slow. Time and patience. There is no shortcut to tapering sadly. 

 

Wishing you well with your taper.

 

Emonda.

 

 

 

[RB398]

Hey @Emonda

Thank you so much for all the help and advice. 

I've not even started to reduce from the 30mg dose yet. Had a few not so good thing happen and not feeling so up at the moemnt so thought it best to hold fire for a bit.  Having said that, I made a spreadsheet the other day of how long it will take me to come off the andtidepressants and it's a little bit sad to see that it's gong to take about 4 years. Hey Ho. there's nothing I can do about that though.

For now I just have to try to lok after myself I guess.

Just a quick thing I noticed with the link you sent to the tapering schedule. It doesn't seem to take into account that the liquid dose and the tablet dose are not equivalent. The patient leaflet in the liquid form shows a table with equivalent doses for the tablets and the liquid. They are not the same - i.e. it says 40mg in tablet form is the equivalent to 32mg in liquid form.  It doesn't seem to make this clear with the schedule that you sent.

I have been a bit down since I swapped to the liquid. I'm not sure it's because of that or the circumstantial stuff I mentioned above but I'm not going to reduce at all until I feel like I'm in a better head-space.

Anyway, thanks again for your help

All the best

R

 

[Emonda]

Hi @RB398

3 hours ago, RB398 said:

Had a few not so good thing happen and not feeling so up at the moemnt so thought it best to hold fire for a bit.

 

I'm sorry to hear about the 'not so good things'. I am glad to hear you will 'hold fire for a bit'. It's prudent to listen to your body.

 

I've found I am more sensitive to life stressors as a result of tapering. Perhaps you are experiencing that, too. 

 

3 hours ago, RB398 said:

I made a spreadsheet the other day of how long it will take me to come off the andtidepressants and it's a little bit sad to see that it's gong to take about 4 years

 

That sounds about right. I made a spreadsheet, too and was originally quite shocked when I saw how long it would take. There is no shortcut. Time and patience is the key to success. From what I've read of others on this site...and past personal experience...if you rush it, it just sets your recovery back.

 

3 hours ago, RB398 said:

Just a quick thing I noticed with the link you sent to the tapering schedule.

 

Yep, I was just trying to emphasise the number of steps involved in following the 10% plan and the fact that each reduction gets smaller and smaller. You'll need to do as you have, create your own spreadsheet and follow that. Sounds like you are heading in the right direction 👍

 

3 hours ago, RB398 said:

I have been a bit down since I swapped to the liquid. I'm not sure it's because of that or the circumstantial stuff I mentioned above

 

It could be the transition to the liquid, it could be the circumstantial...but probably a combination of both.

 

I'd keep the WD symptom checklist on hand and refer to that when you're a bit down or experience something else...I find it reassuring to refer to from time to time.

 

Sign out with any questions.

 

Emonda

[RB398]

Hey Emonda

Thanks again for the encouraging and wise words. 

I'm sure you re right when you say the not feeling so good is probably and combination of the drugs & the 'stuff' that has happened. As always - the answer is in the grey area.

I'll have a hunt around for the WD symptom check list. I'm not finding it that easy to navigate ths site but hopefully I'll learn.

Thanks again & all the best

R

[Emonda]

Here is a screenshot of the symptom checklist link I posted above from Dr Glenmullen:

 

[RB398]

Hi Emonda

 

Thanks again. I'll keep those to hand and be sure to check when I'm feeling anything out of the ordinary.

 

It's so good to have such support. 

 

I see from your signature that you appear to be doing what I think is called a micro taper. Is that the case?  & How are you finding it?

 

All the best

R

[Emonda]

9 hours ago, RB398 said:

I see from your signature that you appear to be doing what I think is called a micro taper. Is that the case?  & How are you finding it?

 

Hi @RB398,

Yes, I'm following the Brassmonkey micro-taper. Details below. I find the weekly drop of ~2.5% much more tolerable than the monthly 10% drop. I still notice each drop, and I find that the 4th week is more noticeable than the 1st week. You've just got to find what works for you 👍 

 

 

[RB398]

Hi Emonda

Thanks again. I'll have a look at that.  As I'm super cautious, I'll probably try the 10% I think. Not sure how I'd be able to tell if I was over the drop with just a week. Do you find you feel better at the end of the week after your drop? 

Seems strange that every 4th drop of the same amount should feel different, or have I miss-understood?  

Thanks again for your help and so pleased for you heading onwards with this journey.

R

 

[brassmonkey]

There is a small cumulative effect from each of the reductions. The one week between reductions is enough for most of the symptoms to stabilize, but there is a little carry over. That is one of the reasons for the additional two week hold.

[Emonda]

Hi @RB398

Thanks for chiming in brassmonkey 😃

 

9 hours ago, RB398 said:

Do you find you feel better at the end of the week after your drop? 

 

I do. Maybe on days 2-3-4 I notice very mild WD symptoms. But by day 7, the next day to drop another 2.5%, I find those WD symptoms have abated.

 

But as brassmonkey said, it's the cumulative effect of the 4 weekly drops at the end of the month I notice. Then, midway way into the subsequent two-week hold, I feel settled and ready to go again.

 

[RB398]

Hi there brassmonkey & Emonda,

Thanks for clarifying. I hadn't realsied that you held for 2 weeks after every 4. That makes sense now.

I'm still holding still for now. Had a chat with my sister tonight and she recommended I wait until I've had at least one full week of feeling OK. Which really makes sense.

Thanks again. Your help is really appreciated.

All the best

[Heath]

@RB398

I agree with you , Edmonda and brass. 
 

everyone is different I started with 10% a month drop. My nerves didn’t like it maybe too much at once. The slide kinda eases and tricks nervous system. 

when I am tapering with the bm slide - I notice symptoms after a few days then they were gone mostly by the end of the week. And by the end of the month symptoms were a little more noticeable and ready for a good 2 week hold. 

 

remember 10% is max recommended. 
listen to body and go slow. And don’t forget when you are listening for those symptoms they may not show up for a week or two. So slower is better. 
 

Great plan for sure wait till you feel better before another drop👍

[RB398]

Hi Heather

Thanks so much. I'll be sure to take it slowly.

It's a little difficult looking forward though and realising that 4 years will take me into my 60s. 

For so long I thought I'd be so much worse if I stopped taking Antidepressants. And maybe I will be, but it's coing to take me 4 years -minimum to find out.

That's a massively long term experiment.

Think I saw something about dealing with the loss. Think I need to head over there & get reading.

Hey Ho

Thanks again for all the help.