Sonia009: Citalopram discontinuation/reinstatement

[ChessieCat]

 

It looks like citalopram liquid IS available in the UK:

 

https://www.medicines.org.uk/emc/product/3349/smpc

 

 

On 4/10/2012 at 5:07 AM, Altostrata said:

 

Use Celexa liquid concentrate to taper
In the US, the liquid oral solution comes in 10 mg/5 mL (2 mg/mL), peppermint flavor. The bottle contains 240 mL. Pharmacy identifier is NDC 0456-4130-08

Use an oral syringe to precisely measure out doses as small as .01mg.

Making a Celexa solution yourself
See  how-to-make-a-liquid-from-tablets-or-capsules

 

 

Edited August 12, 2020 by ChessieCat

[Sonia009]

Hi ChessieCat,

Thanks for repying. I just phoned my pharmacy and they said they can order it in, the only problem is, that too has different brands. I explained I have had four different brands of tablet over recent months and they said it's because of the drug shortage worldwide. There's no telling what brand they'll have. All the more reason to come off. Regards.

 

[ChessieCat]

When you collect it check with them on how long it will keep once opened.  Generally you have x amount of time after opening.

[ChessieCat]

Even though it's better to be able to keep to one brand, changing brands is preferable to going without altogether.

 

The other option is DIY liquid.

[Altostrata]

DIY liquid would still be from different brands. If I were you, Sonia, I'd switch over to liquid citalopram for tapering. You'll have to check, but it may last 3 months.

 

To switch from tablets, take part of your daily dose in tablet and part in liquid for a week, then take all your daily dose in liquid.

[Sonia009]

13 hours ago, ChessieCat said:

Even though it's better to be able to keep to one brand, changing brands is preferable to going without altogether.

 

The other option is DIY liquid.

Thanks ChessieCat,

I am going to contact my GP tomorrow re switching.

[Sonia009]

3 hours ago, Altostrata said:

DIY liquid would still be from different brands. If I were you, Sonia, I'd switch over to liquid citalopram for tapering. You'll have to check, but it may last 3 months.

 

To switch from tablets, take part of your daily dose in tablet and part in liquid for a week, then take all your daily dose in liquid.

Thanks Altostrata

I am going to try that, so long as my GP will prescribe it for me. Will find out tomorrow.

[Sonia009]

Hi everyone,

I got nowhere with my doctor (not my regular one) with my request for liquid citalopram, I felt like I was hitting my head against a brick wall. I must have been on the phone at least 15mins with him if not longer. He obviously didn't want to prescribe it for me and quite honestly he was clueless about withdrawal. He suggested I shouldn't be having withdrawal symptoms on such a low dose (5mg). Everything I said to him just got a negative response. I tried to explain about weighing my dose and how liquid drops would be more accurate but he said I would need an insulin syringe to measure out the drops. I told him I thought they came in drops so he suggested I ring my pharmacy to check which I did and the person I spoke to didn't know but said I would probably need a syringe. He said to get back to him if they come in drops. He asked why I wanted to come off and how I intended to come off so I said after stabilising on my current dose 10% of my current dose until I stabilize on the next dose. He suggested 1mg every month or two weeks. He seemed to think that withdrawal took weeks rather than years. I was so annoyed I told him lower doses were harder to come off. It also came up in conversation that it was much more expensive than tablets. I feel so deflated and was relieved to get off the phone. I am not going to ring again, I'll continue to weigh my dose. 

Best wishes all.

 

[Sonia009]

Hi all,

Feeling pretty low today and yesterday, my mind is continually thinking crazy mixed up thoughts, sometimes feels like I'm losing my mind. Headaches more often lately, I call them dizzy headaches. I do what needs to be done in the home but then all I want to do is lay down. I know I should try to get out but I don't feel up to it with my headaches and dizzy feelings. I even avoid sitting in the garden. I wasn't as bad as this before I started weighing my dose in May. I know if I increase I will feel worse, tried it before. I was wondering about switching meds to get a more accurate dose. Tried sertraline once and I got on ok with it but stopped when I was getting reddish urine. It's been close on a year since I reduced my citalopram dose from 10mg to 5mg. I don't know if it's withdrawal or If the citalopram itself is causing these symptoms. Has anyone else reached this point and switched?I

Thankyou

[sunnysideup69]

Hey @Sonia001,

Sorry your GP was unhelpful and ignorant of WD.... unfortunately a common theme.

I'm wondering if he could write you a private prescription for the liquid Citalopram, for which you'd have to pay a bit more...Don't even know if UK gps can/will do that. Might be worth a go if it means that you can get the liquid.

 

OR just wait and speak to regular GP. I want to switch from Venlafaxine generic to Effexor (brand name Venlafaxine) and am anticipating maybe the same annoying conversation with gp. Argh!

[Sonia009]

Hi Sunnysideup,

Thanks for that suggestion. I might ring my regular doctor towards the end of the working week this time rather than the beginning of the week. I could have argued with the other one till I was blue in the face and still not got anywhere, hopefully you will have better luck. Hope you're doing ok.

Regards

[ChessieCat]

It might be helpful to think about what you want to say and how you will say it, jot down bullet points to remind you and and rehearse what you want to say.  Try to be assertive and remember that you are the customer.

 

how-to-talk-to-a-doctor-about-tapering-and-withdrawal-what-to-expect

 

You can make your own liquid from citalopram tablets:

 

Tips for tapering off citalopram (Celexa)

[Sonia009]

Thanks for the tips ChessieCat. Because of covid19, doctors in my village are still only doing telephone consultations, I couldn't speak to my regular doctor when I rang last time.  I've had a better couple of days not great but headaches have passed.  I'm wondering if it was tension from the disappointing telephone conversation I had with the doctor. Still getting the occasional weird dropping sensation but learning to accept and ignore it. Been out a couple of times too since headaches abated which has helped. Hope you're doing ok too,

Regards

[Sonia009]

Hi everyone,

So, I'm still getting what I'm assuming are withdrawal symptoms but I do question whether there is something else going on. I've been a year on 5mg reduced from 10mg which I was on for 10 years. I started weighing my dose for more accuracy in May hoping my symptoms would subside. I'm still getting dizziness, headaches, neck and shoulder pain, sinus issues, tinnitus, anxiety, crying (feeling sorry for myself and for not feeling well), digestive issues, constipation, aches and pains all over. I also felt like I was coming down with a cold a couple of days ago but that seemed to have passed. I get the occasional good day too like a few days ago when my husband had shortness of breath and I had to drive him to the hospital. Luckily he's ok, it was a bad reaction to a diabetic med. I was ok the whole day because I knew I had to leave him there and pick him up later. The following day I felt rotten again. One of my cats has been ill for several weeks, back and fore the vet, which has added to my stress. The other has a heart condition and he's not well either. My only respite is knowing that my blood works were all within normal range a month ago. I do have neck arthritis too. I take aspirin and paracetamol (with caffeine), more often because of my headaches. I also take a diuretic for border line blood pressure but that is under control. Could this possibly still be withdrawal? Could it be stress? I have been getting the odd palpitations too. Maybe I do need anxiety medication? I'm so tired of trying to work things out but not making any progress. I can put up with most things but the dizziness is the worse for me. What hasn't help either is I keep getting different brands of Citalopram(4 brands in total) every month and my diuretic med and I know from past experience that this has always affected me. Sorry for sounding off but typing this actually helps.

Best wishes everyone.

[ChessieCat]

5 hours ago, Sonia001 said:

What hasn't help either is I keep getting different brands of Citalopram(4 brands in total) every month and my diuretic med and I know from past experience that this has always affected me.

 

My suggestion would be to speak to the pharmacist about this and see if they are able to provide you with the same brand each time.

 

I'm not sure if I've asked this before, but are you going through menopause.  That can definitely complicate things.  If you are younger, do you notice any difference in your symptoms at different times of the month?

 

The other thing to consider is that you have been on citalopram for 10 years and it might have pooped out on you, ie reached tolerance.  This happened to me with citalopram but it wasn't until I found SA that I realised that is what had happened.  I was doing okay on it and then I had several stressful life events occuring in a short period of time and ended up having a massive meltdown.  Because I felt horrible on the drug I thought I might as well stop taking it and CTed it, not knowing any better.  I ended up on Pristiq several months later.

 

Tachyphylaxis, Reaching Tolerance or as It's Lovingly Known “Poop-Out”

 

tolerance-or-poop-out-or-tachyphylaxis

 

You could try a small test reduction (perhaps try a 0.5% or 1% reduction) and see what happens when you do that.  If things don't get worse, or even improve a bit (which, if I recall correctly, this can be a confirmation of poop out), then you will know that it is okay to recommence tapering.

[ChessieCat]

BrassMonkey just posted this in another member's topic:

 

22 minutes ago, brassmonkey said:

 

The biggest difference between normal WD and poopout is how the symptoms start up. Poopout symptoms sneak up on you very slowly over many weeks or months where as normal WD symptoms will start up quite quickly. That's one reason for using a wave as an example, because the symptoms crash over you. It is pretty normal to be feeling very good for several weeks and then wake up one morning feeling like you're back to square one. They can come out of nowhere for no reason. It's probably not something you did or didn't do, there is no way of telling. If there is a good thing about waves it's that they will eventually fade and many people actually feel better once it's over than before it started.

 

[Sonia009]

4 hours ago, ChessieCat said:

 

My suggestion would be to speak to the pharmacist about this and see if they are able to provide you with the same brand each time.

I

Thank you for responding ChessieCat. I have spoken to my pharmacist 're the change in brands. Pre covid19 it would have been possible to request a specific brand but I was told that they don't know which brands they will be sent these days as there is a WW drug shortage, they take what they can get. 

4 hours ago, ChessieCat said:

 

I'm not sure if I've asked this before, but are you going through menopause.  That can definitely complicate things.  If you are younger, do you notice any difference in your symptoms at different times of the month?

I am 58, menopause was never a problem for me, started quite early in late 40's.

4 hours ago, ChessieCat said:

The other thing to consider is that you have been on citalopram for 10 years and it might have pooped out on you, ie reached tolerance.I

 

This is a possibility.

 

  This happened to me with citalopram but it wasn't until I found SA that I realised that is what had happened.  I was doing okay on it and then I had several stressful life events occuring in a short period of time and ended up having a massive meltdown.  Because I felt horrible on the drug I thought I might as well stop taking it and CTed it, not knowing any better.  I ended up on Pristiq several months later.

 

Tachyphylaxis, Reaching Tolerance or as It's Lovingly Known “Poop-Out”

 

tolerance-or-poop-out-or-tachyphylaxis

 

You could try a small test reduction (perhaps try a 0.5% or 1% reduction) and see what happens when you do that.  If things don't get worse, or even improve a bit (which, if I recall correctly, this can be a confirmation of poop out), then you will know that it is okay to recommence tapering.

I take my Citalopram at 5.30 pm, I felt light headed before taking it but worse after I took it. I think I will try a slight reduction as you suggest. I have noticed when weighing, if I go slightly over I notice a negative response ie, noticeable withdrawal symptoms or start up symptoms. If I go slightly under it is not noticeable.

[Sonia009]

2 hours ago, ChessieCat said:

BrassMonkey just posted this in another member's topic:

 

I don't get weeks of windows though, I get the occasional part of a day, not even a full day. I seem to have symptoms every day, at any time of day. I could be feeling great and start doing something like cooking and 10 minutes later feel symptoms again. The day I drove my husband to hospital, I felt ok in so much as no symptoms apart from anxious thoughts of whether I could do it but I had to do it. By the evening and next day I felt horrible again. I can go to the supermarket feeling horrible but once in there I am ok although I tend to make it quick. It's the same when I go anywhere, feel horrible going but once there ok. I can't remember a day when I woke up feeling symptom free. Strangely I have been worse since weighing my dose but then there's been the change in brands too.

No point explaining this to doctor, I've tried, they just don't get it. I don't want to go through tests again they cause more anxiety for me. I've had echocardiographs, 24 hours heart monitor, been to ENT, seen a rhuematologist, had a CT scan for thyroid, it has all taken its toll on me, waiting for the dreaded hospital letter coming through my mail box.

A slight reduction is a good suggestion ChessieCat, I did think of that too. I will try starting today.

many thanks for your support and sending best wishes to you.

[Sonia009]

I just want to add some other symptoms I am experiencing so that I can hopefully, one day, tick them off one by one. 

Weird dropping sensations in head.

Occasional brain zaps.

Occasional unsteadiness in balance especially in stressful situations like funerals.

Poor sleep.

Weird dreams.

Intrusive thoughts.

Vision problems, focussing.

Cloudy memory.

Lack of interest in things I used to enjoy.

Lack of concentration .

Moodiness.

Less tolerable of others.

Feeling weird and off balance in long face to face conversations with people/fami!y/friends.

Inability to sit in living room for long.

Intolerance to watching television.

 

Just some things I experience although not all at once and not all of the time. I seem to be at ease when I am doing my housework or knitting for several hours, alone.

[Sonia009]

Hi everyone,

Hope you're all coping ok. I'm thinking of speaking to my doctor about changing citalopram to escitalopram at the equivalent dose, although it will mean weighing again. I tried reducing my dose very slightly but I'm getting migraine type headaches after taking it. They last until the next day up until about 3pm but come back after I've taken citalopram at 5.30pm, within 1/2 your of taking it. I think the problem is the change of brands all the time, four changes in recent months. Also, added stress of my husband not being well and both my cats too and  of course the dreaded covid thing hovering in my mind, as it is for everyone else I'm sure. I minimise painkillers but I have to take them for some relief but they don't mix well with citalopram because of the aspirin content. I'm limited to what painkillers to take because they make me feel ill. I've also been tempted to stop taking citalopram all together and to find other ways of boosting serotonin, I almost didn't take it this evening. How could such a low dose, 5mg, have such a devastating effect? I've been on this dose for about a year after reducing from 10mg too fast. I was on 10mg for about 10 years though. The dose has probably been inconsistent because of cutting and weighing, and by adding various brands to the mix. I just feel they are not right for me anymore.

[Altostrata]

No, you will not want to substitute escitalopram for citalopram, escitalopram is a much stronger drug, and you'll have the same problems measuring it.

 

On 5/12/2020 at 5:43 AM, Sonia001 said:

A year ago I decided on a slower approach and reduced down to 7.5 mgs. Two months later I reduced to 5mg, probably too soon in retrospect and here I am 10 months later still getting withdrawal symptoms.

 

You have had withdrawal symptoms since July 2019. Have you ever tried increasing the dose a bit, to 5.25mg?

 

The liquid is the best way to do this. Yes, the liquid comes with a dropper, but an oral syringe is easier to manage. It is likely you can get one of those from the pharmacist, too. Read Tips for tapering off citalopram (Celexa)

 

Your pharmacist knows how to order the liquid. Show this to your doctor

 

and firmly request that he order the liquid.

[Sonia009]

On 10/2/2020 at 1:11 AM, Altostrata said:

No, you will not want to substitute escitalopram for citalopram, escitalopram is a much stronger drug, and you'll have the same problems measuring it.

 

Thank you for replying Altostrata. I haven't changed my med, just been feeling so desperate to get well again that I'm willing to try anything. Your comment is duly noted and appreciated.

 

You have had withdrawal symptoms since July 2019. Have you ever tried increasing the dose a bit, to 5.25mg?

I tried increasing before and I felt worse for it, however..

My withdrawal symptoms have been worse since weighing my dose and also I've been using 4 different brands in recent months. I've spoken to my pharmacy re this but there is nothing they can do about it. I've always had problems with a brand change in the past.

I took your advice and increased slightly yesterday. I felt the dizziness slightly worse later on but bearable realising it was the med doing it and this morning I have had a slight surge in anxiety. Just feeling jittery and nervous. Headache also but I've taken a painkiller. Should I give this slightly higher dose several days to settle or do you think this could be an adverse effect to the med? 

The other thing I've noticed is I am very sensitive to noises, I can quite literally hear a pin drop.

Quote

The liquid is the best way to do this. Yes, the liquid comes with a dropper, but an oral syringe is easier to manage. It is likely you can get one of those from the pharmacist, too. Read Tips for tapering off citalopram (Celexa)

 

Your pharmacist knows how to order the liquid. Show this to your doctor

 

I cannot show anything to my doctor at the moment,  the practice are only seeing emergency patients, have done for months, all other consultations are via phone.

I could speak to another doctor via phone and try getting the liquid form but I've read that this could take some getting used to also? Just afraid of making things worse. 

Thank you so much for your advice and the attachments, sending best wishes to you.

 

and firmly request that he order the liquid.

 

[Sonia009]

Hi Altostrata,

This is my second day of slightly increasing my med and I am feeling optimistic. The increase makes me feel like I have a slight hangover, muzzy head feeling, not dizzy, and overall I am feeling better in myself and am now cautiously hopeful that this was the right course for me. It's early days I know but today, even after a shaky morning I have felt generally more relaxed and my mind is more at ease. I have been weighing my dose, each 10 mg tablet weighs .064 grams and I was taking .031 grams. I have increased to .034 grams which is roughly the extra .25mg. It doesn't sound much but I definitely notice the difference. Thanks for your advice.

[sunnysideup69]

Got my fingers crossed for you, Sonia xxx

[Altostrata]

Good to hear. The liquid will make these adjustments much easier.

[sunnysideup69]

How's the increase going @Sonia001? Hope it's treating you well.....thinking of you.

[Sonia009]

Hi Sunnysideup,

Thanks for thinking about me. The increase has made a huge difference to me (thank you Altostrata), although I am afraid to be too optimistic just yet. It is only a small adjustment as mentioned in a previous post but I can honestly say my dizziness has gone so too have the weird sensations and I am feeling generally much better. I'm sleeping better and am not getting so many aches and pains. I've been out and about and visiting family but what has surprised me most is, my husband has been unwell with pancreatitis and I have been able to cope without feeling stressed out. I plan to continue on this new dose until after Christmas and then reduce very gradually for as long as it takes.

I hope you are still making good progress x

[Sonia009]

Hi everyone,I

Well, it was nice while it lasted.

Has anyone used loperamide (imodium) for upset stomach with citalopram and had side effects? I felt a cold/chill coming on yesterday and my stomach was upset so I took one imodium because I was out and nowhere near a loo. Today my head feels weird, headachey and fuzzy and I'm wondering if the imodium had anything to do with it. I don't know if I am coming down with a cold or whether it's withdrawal. Nose a bit stuffy also. I've been taking a different citalopram brand for two days also. Of course, all of this is playing havoc with my health anxiety.

[Sonia009]

Seems I was coming down with a gum infection or abscess even. My cheek has swollen, sinuses stuffy, earache and I've been in awful pain. On 500mg amoxicillin 3xday and painkillers which is a setback as far as withdrawal is concerned, from past experience. Sticking with the small increase in Citalopram and hopeful that once I get back on track I will level out. Best wishes all.

[sunnysideup69]

Hey @Sonia001,

Hope the antibiotics and painkillers havent wobbled you too much? Sending good vibes xx

[Sonia009]

8 hours ago, sunnysideup69 said:

Hey @Sonia001,

Hope the antibiotics and painkillers havent wobbled you too much? Sending good vibes xx

Hi Sunny

Thanks for thinking about me, good vibes very welcome.😀 Yes, they did wobble me a bit, I've had anxiety in the mornings and awful headaches. The infection hasn't completely cleared yet but swelling has gone down, using paroxyl mouthwash which seems to be working. Today has been a relatively good day until I took my diuretic at 3pm that is, then I started to feel a bit off again. I'm wondering whether to reduce it slightly to see if that makes a difference. Still on 5.25mg citalopram which I take at 5pm. Getting used to weighing the dose now. Hope you're doing ok. Regards xx

[Sonia009]

Hey everyone,

I've been feeling light headed for two days and the obvious thing I have done differently, apart from another citalopram brand change, is rubbing in magnesium oil at night. Any thoughts? Many thanks.

 

[Sonia009]

Hi,

Can you develop an adverse reaction to Citalopram if you have stopped and started it over the years a few times, (currently withdrawing from it for a year.) My brand changes each month and my head is all over the place. Headaches, muzziness, light headed, ears ringing etc. This noticeable since I started taking the sovereign brand.Thanks.

[Sonia009]

Hey everyone,

I requested a potassium check with my doctor today (a different doctor) because it was 3.5 just 6 months ago. 2 years prior to that it was 4.0. Because I'm on a diuretic also I'm wondering if it's getting too low and contributing to my dizziness, nausea, etc etc. I may have to switch from a diuretic to another BP med depending on the result.

He won't prescribe liquid citalopram so I asked about an alternative. He prescribed me sertraline 50mg to take instead of the 5.25mg citalopram I am taking. I think it's equivalent to 10 mg citalopram. He said to stop Citalopram because the dose is so low it's not doing anything and start taking sertraline. Now we all know that's not quite true but who am I to argue. I don't know whether to switch to 25mg sertraline to begin with or continue wih citalopram on my current dose and try potassium supplements. The problem is I'm weighing citalopram and my brands keep changing causing me too many problems. I do feel I need a change. Any thoughts anyone? This giddiness and weird head feeling is getting me down. Any moderators advice very welome. Thankyou.

[Gridley]

@Sonia001

 

50 mg sertraline is equivalent in potency to 10mg Citalopram.  So your doctor is almost doubling your dose.  "The dose is so low it's not doing anything," as you know, isn't true at all.

 

Switching drug is always risky.   You have no idea how the sertraline will affect you and you run the risk of withdrawal from citalopram if you switch.  You might be able to do a cold switch with no problem or you might not.  If you do switch, 25mg Sertraline is clearly better than doubling your dose with 50mg.

Zoloft is not one of the easier drugs to stop in terms of withdrawal.

 

I understand you want to switch because of the side effects from the Citalopram.  I can't tell you what to but wanted to let you know some of the drawbacks of switching.

 

 

 

 

 

 

[Altostrata]

4 hours ago, Sonia001 said:

He won't prescribe liquid citalopram so I asked about an alternative.

 

Why won't he prescribe liquid citalopram? It's available in UK and covered by NHS. You might show him this from RCPsychiatry https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/stopping-antidepressants

 

It's absurd to substitute sertraline. If necessary, you can make a liquid yourself from the citalopram tablets.

 

You should definitely address potential low potassium, that can cause the symptoms you've reported.