PattyCatty: Tapering off 10mg Citalopram

[PattyCatty]

Tapering off 10mg Citalopram

Edited February 1, 2024 by Emonda
Name to title

[Emonda]

Welcome @PattyCatty,

 

To confirm, you are now only on 10mg of Citalopram and have been taking that daily since June/July 2023?

 

Do you feel stable now? Do you have any specific questions?

 

Have you had a read around the site? Here are a few links that will help you on your journey.

 

Why taper by 10% of my dosage?

 

If you taper faster than recommended, you are likely to experience unpleasant WD symptoms: Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

Tapering and healing have their ups and downs:

 

Windows and waves pattern of stabilization

 

Emotional Spirals

 

Non-drug coping strategies

 

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 fatty acids (fish oil)

 

Avoid alcohol. 

 

This is your own Introduction topic.  Each member has only ONE Introduction topic.  Your own Introduction topic is the best place to ask questions and the place to journal your progress.  This keeps your history in one place and means you do not have to repeat your story. 

 

Once again, welcome to S.A.

 

Emonda

 

[PattyCatty]

Dear @Emonda

 

Thanks for your message.

 

Yes you are correct.

 

I would say stable (for last few months) in that I don't get more emotional around my period anymore which was the main reason I was recommended Citalopram. I couldn't stop crying and so couldn't sleep which made chronic fatigue worse.

 

Lifestyle is very limited currently due to chronic fatigue which I think is compounded by the Citalopram side effects which is why I want to gradually lower dose and if appropriate come off it. 

 

I'm looking to start by switching from 10mg tablet form to 8mg liquid form. In the UK the liquid form is more bioavailable and so this would be the conversation I'm told. 

 

The liquid is 10mg in 5ml so I would start with 4ml and I will use 1ml syringes.

 

Once switched to liquid I will hold for at least one month to get used to it because I think there are some slight differences chemically in the two. 

 

There is no way to make a gradual switch to liquid as the tablets here are film coated and designed not to be cut as it changes how they work.

 

Quite nervous about the first month as I'm expecting the first few days of switch to be rocky....

 

I've spoken to GP and pharmacist so they know what I'll be doing and they are on side.

 

Not taking any supplements at the moment apart from occasional vitamin c as I don't want to irritate my gut or make the side effects of the ssri any worse. Occasionally will have camomile tea.

 

Since CFS started few years ago, I'm not drinking alcohol or caffeine (rarely (sometimes decaf tea)).

[Emonda]

19 hours ago, PattyCatty said:

I'm looking to start by switching from 10mg tablet form to 8mg liquid form.

 

Have a read of the 4th post down by Gridley: Transitioning from pills to liquid

 

19 hours ago, PattyCatty said:

I'm looking to start by switching from 10mg tablet form to 8mg liquid form.

 

I can't comment on the comparison between tablets and liquid strengths of this AD, but I do know you want to get it right. This may be helpful:

 

 

A particular quote from the article that seems relevant and important: 

 

Note that the UK liquid formulation of citalopram has different bioavailability so 1mg of the liquid solution is equivalent to 1.25mg of the tablets, very important to remember when switching to liquid or when reinstating in liquid. Also use syringes to measure rather than drops which can be inaccurate.

 

19 hours ago, PattyCatty said:

Quite nervous about the first month as I'm expecting the first few days of switch to be rocky....

 

Very understandable

 

I hope this helps

[PattyCatty]

Thanks @Emonda really helpful. I have looked through these threads before and I'll raise it with my GP again but they don't recommend cutting / doing anything to the 10mg Citalopram tablets available here because they're film coated and apparently this ensures the tablet survives various parts of the gut before it is metabolised for maximum effect.

 

I have read a lot about people dissolving and cutting tablets here successfully. Would you know if that's possible because the tablets aren't film coated?

 

This is the main reason I'm nervous about the switchover because I don't think there's a way to taper the switchover in the UK.

 

Thanks again for your kind references to and extracts from very relevant posts.

[PattyCatty]

I have found this online :

 

https://www.sps.nhs.uk/articles/ssri-suggestions-for-adults-with-swallowing-difficulties/

---

Citalopram, escitalopram, paroxetine or sertraline tablets

Can be crushed and/or dispersed in water, or crushed and given with soft food. The tablets are film-coated and contents may taste bitter or unpleasant. Crushed sertraline and paroxetine tablets may have a local anaesthetic effect on the tongue.

---

 

I will definitely bee sharing this with my gp

[PattyCatty]

"

Sustained- and extended-release tablets can be split with the understanding that splitting will compromise their slow-release properties; therefore they should be treated as immediate-release formulations."

 

https://pharmaceutical-journal.com/article/ld/case-based-learning-safe-withdrawal-and-tapering-of-antidepressants

 

I don't know much about this when it comes to the film coating so I have emailed NHS sps - see if they get back to me.

[PattyCatty]

Hi there

 

I'm looking to taper off 10mg film coated Citalopram tablets and to do that I need to switch to liquid.

 

I was under the impression that the film coating was there to allow the ingredient to survive the stomach and make its way to the intestine and / or for slow release purposes.

 

Should I be concerned about this if cutting etc the pill in order to move to liquid (25/75, 50/50, 75/25)?

 

Is this the right thread to post the question on?

 

Thanks

 

[Mamgu]

Hi PattyCatty

 

I thought I'd jump in with my experience of Citalopram hope you don't mind :-).  I swopped over from tablet to liquid suspension some time ago.  I drop a 10mg tablet in 50ml water, mix thoroughly and extract my required dose.  The rest goes in the fridge, I use an amber glass bottle for storage of the solution. I used to make up a weeks supply and store a daily dose in separate bottles in the fridge but now I'm at lower doses I'm wondering if it's better to store in the one bottle.  I've no idea and may be overthinking things but I was worried about dose variations caused by remnants of solution stuck to the insides of the bottles, even though I'd swill out with water and drink that.  I've bought two different sizes of pipettes so I can extract accurately as low as 0.01ml of suspension.

 

I hadn't considered the impact of film coating and am not sure if there is a slow-release property to my tablets.  I'd be very interested to see what response you get from the NHS. I'm given different brands of the drug nearly every time I pick my 'script.  I do notice that sometimes there's more 'stuff' floating about the solution and I put this down to un-dissolvable filler and haven't noticed any effects when I have these tablets compared to others.

 

I can only echo the frequently advised approach (on this forum at least) of taking things slow and listen to how you are feeling before making the next drop, rather than trying to stick to a pre-prepared schedule (mine's been revised so many times and I've still no idea how much longer I'll be at this 😂).

 

Wishing you well in your reduction process.  The good news appears to be we can get off this drug so long as we take care 🙂

x

[PattyCatty]

Dear @Mamgu

 

Thanks for dropping by. Wishing you well on your tapering fellow traveller.

 

I am going to follow up with my pharmacist to ask the manufacturer the question re switching from tablet to liquid (made up by the manufacturer). I think this will be the hardest bit initially because once I've changed format that will be constant. But initially this might change bioavailability and / or slow versus fast release?

 

I had never considered dissolving the tablets. I will ask the pharmacist about this too. 

 

On 2/4/2024 at 10:19 AM, Mamgu said:

I'm given different brands of the drug nearly every time I pick my 'script. 

 

Same- it's bizarre.

 

I think if the approach you've been taking is consistent then you're fine! I'm trying to get as much information as possible before I start so that I'm able to be consistent.

 

It's amazing how little information there is available on the tapering avenues (not including this forum).

 

Sending you very best wishes

[Mamgu]

On 2/5/2024 at 3:02 PM, PattyCatty said:

It's amazing how little information there is available on the tapering avenues (not including this forum).

 

I agree and if I'm being honest, the majority of professionals are not aware or don't care to listen to the experiences of folks like us who struggle to come off anti depressants.  I think many people here have had the same experience as myself by having to educate our doctors. I don't think my GP (who I've never met, I might add, it's all done over the phone these days!) doesn't understand but accepts that I'm having to take things very slowly and will prescribe me Citalopram.  

 

On 2/5/2024 at 3:02 PM, PattyCatty said:

I am going to follow up with my pharmacist to ask the manufacturer the question re switching from tablet to liquid (made up by the manufacturer). I think this will be the hardest bit initially because once I've changed format that will be constant. But initially this might change bioavailability and / or slow versus fast release?

 

I can't comment on the crossover to the prescribed liquid as I've no personal experience but it seems many people on this forum have successfully made that switch.  Once you've got your sums all sorted out it's just a case of faffing about for a few weeks as you wean from dry tablet onto the liquid.  My maths skills stop at my specific ratio of 1ml liquid = 0.2mg drug so I'll leave you in the hands of those who know better 😆.

 

Onwards and upwards (or should that be downwards!)

 

 

[PattyCatty]

Thank you for your kind response @Mamgu

 

I hope you're going (downwards) well?

[PattyCatty]

I have purchased the Gemini scales but under the same pill measured a number of times gives slightly different values eg 68 +/- 5 can be a 10% error. I wonder how people have navigate this? 

 

I have purchased empty capsules to put the crushed pill into - so that's a tick

[PattyCatty]

I've recalibrated the scales again and this seems to have fixed the issue of weight moving up and down.

 

The pill weighed 0.063g 

 

I'm going start by crushing the pill and transferring the whole thing into a capsule. I will start by taking 100% of the pill this way as I'm sure crushing it will change bioavailability. I will take the pill this way for a week and confirm it feels no different / let my body settle. 

 

Then I will take 75% of the pill this way plus 25% liquid to start the transfer over to liquid. 

 

I did a test run of the crushing and filling capsule. I followed the brass monkey way of using two spoons to crush and using a post it note on the scales.

 

The pill weighed 0.002g less after crushing so a bit of loss which can't be helped. 

 

I aim to start taking the crushed pill in a week. Just setting the ground work.

[PattyCatty]

Day 1 I've started by breaking my tablet up (not crushing it) putting into a capsule and swallowing. 

 

I hear bioavailability can change depending on how crushed a tablet is so I'm starting off with just breaking the capsule up. I will take pills like this for a week see how it goes and then crush the tablet up more and more until I get to powered tablet. 

 

Hopefully with this approach I will minimise impacts of changes.

 

Heartfelt thanks for this space. 

 

I'm looking to reduce dosing of Citalopram because it feels too high and to strong and I'm like a zombie for the most of the day with certain other side effects that aren't great.

 

I'm doing physio to build up strength and that feels good. I help my sister with her son a few days a week. I'm trying to build and keep a routine going in parallel. 

[PattyCatty]

Just breaking the tablet made a huge difference. The tightening in the head and neck and numbness didn't come on, I felt more energised and motivated. I felt I could feel more eg when swallowing I could feel the texture of the food hitting the back of my throat. 

 

It was unnerving having the numbness not come on and I was on edge waiting for things to get worse as the day went on as it did the time I simultaneously tried to switch to liquid and reduce my dose by 30%.

 

Things didn't get worse they got better as day went on but what made things worse was the anxiety expectation that things would. 

 

It felt strange to feel things more and sense things more eg more aware of my thoughts instead of them being numbed out in a fog. 

 

I found it all a bit disconcerting and I was waiting for things to get worse I was worried there's something wrong with me because I wasn't expecting just cracking the pill and crushing slightly would be so impactful I thought any changes would be imperceptible.

 

I also felt I don't want a few more days of white knuckling through the initial changes (I expect I would acclimatise in a few days) so I've gone back to uncracked uncrushed pill until I am feeling more up to it. So for the time being continuing to live with the horrible side effects.

 

I'm glad I dipped my toe in though but also super nervous about cracking / crushing pill again.

[PattyCatty]

Dear @Emonda

 

Is the experience of coming off SSRIs similar to what I have experienced above? 

 

Appreciate any input. I imagine it is but just looking for some resources or information that basically says, yes this stuff happens and it's normal, there's nothing wrong with me. That was I don't add the second suffering of resisting or being scared of what's happening. 

 

Thank you

[Emonda]

1 hour ago, PattyCatty said:

Is the experience of coming off SSRIs similar to what I have experienced above? 

 

I think the best experience is described here: Windows and waves pattern of stabilization

 

You'll have good days/weeks, and not-so-good days/weeks.

 

Time, consistency, accuracy and much patience are required on this journey.

 

1 hour ago, PattyCatty said:

just looking for some resources or information that basically says, yes this stuff happens and it's normal, there's nothing wrong with me.

 

Pop over to the success stories. That'll give you a boost from reading the experience of others how have been where you are and succeeded.

 

 

[PattyCatty]

Thanks @Emonda! I will have a read of these areas.

 

Best wishes

 

 

[PattyCatty]

So I'm starting again. 

 

On Wednesday I crushed about 20% of my tablet and took the whole 10mg amount in a gelatin capsule. 

 

I've taken it like this for 5 days and I feel no different. 

 

Taking it very slow and easy 👍

[PattyCatty]

Update; Over the last few days, I have put the pill into a gelatin capsule and with a needle broken up the tablet to about 70%-80% powder. 

 

Then I've closed the capsule and taken the whole 10mg of citalopram.

 

Don't think I feel any different other than I think I've caught a cold or something. I will hold like this for a couple of days. 

 

Grateful for all the wisdom in this website.

 

Taking this very slowly 👍

[Mamgu]

Good luck PattyCatty, sounds like you've a good process going there, slowly and carefully making the changes.  

[PattyCatty]

Thanks @Mamgu! Lovely to hear from you and appreciate the encouragement  ❤️

 

[PattyCatty]

Dear @Emonda

 

I hope your own taper is going well.

 

I hope you don't mind me reaching out and thank you for your presence. 

 

My plan is to hold taking my tablet as 100% crushed powder for ONE MONTH once I get to that stage.

 

My options after that: 

 

*A- convert to using prescription liquid citalopram by 25%, 50%, 75%, 100% over months until I'm taking 10mg of drug as liquid - fully stabilise and then start the taper using liquid

 

*B- convert to using homemade liquid from my pills per above

 

*C- start tapering the crushed pill by weighing the powder (don't cross to liquid) 

 

Are there any resources on this website that set out which method might be easier from wanting minimal withdrawal issues perspective? 

 

I read somewhere that altostrata preferred people using liquid prescription where possible... ? I can't see where altostrata says that though and why that's her preference. I'm not looking forward to withdrawal effects when switching to liquid though... But if that's the best way forward overall to minimise withdrawal later then I will do it.

 

Anything you can refer me to is gratefully received. 

 

Thanks!

[Emonda]

Hi PattyCatty,

I think the answer to your question is whatever you can be most accurate and consistent with.

 

My AD does not come in liquid, so I chose option B in your options above. I have it down to a fine art now, and I will be able to go all the way to the end of my taper without further changes. According to the Maudsley guide, you can turn your pills into a liquid.

 

I know some people find moving to a commercial liquid of the same AD destabilising, so I'm glad I didn't have to make that decision/change.

 

As to option c, at some stage, you'd be back to a choice between options A & B, as the dose gets very small.

 

I hope this helps.

 

 

[PattyCatty]

Thank you so much @Emonda for your feedback. What you have said makes sense and I use that rationale. 

 

---------

 

 

Today I have crushed my tablet 100% between two tablespoons onto a post it note and then poured the powered tablet into a capsule. I could tell the difference slightly - very slightly. I think my headache (that builds up with the SSRI) is slightly less.

 

I will hold like this for a few days. 

 

I have requested prescription for liquid citalopram 8mg in 4ml. When this arrives, I will take 20% liquid - 0.8ml liquid and 80% powdered tablet (using Gemini scales). If this goes well I will hold for a bit and then go 40% liquid. 

 

If this doesn't go well, I will go back to 100% powder and try to make a liquid out of my pill.

 

Glad to be hear and a part of this lovely community. Thanks for so the collective wisdom here.

[DianaDoodle]

Hi there, hope you don't mind me chipping in- I have been on a similar journey with Citalopram since January.  Good to hear that things are going well so far- hope it continues.

The switch to liquid is quite confusing-as you say the bioavailabilty means 4mg tab is not the same as 4mg solution. I am currently taking 4mg, which is 2 drops.

 

Prior to that had been crushing tabs. When I switched from tabs to solution the pharmacist couldn't say whether a home-made solution/suspension had the bioavailabity of the original tab, or a proper solution, and that the dose from a crushed tab may be unreliable-(I guess it just hasn't been designed to be used that way, so probably just being cautious).  So we decided to ignore that complication and move to the same dose in mg, which didn't seem to cause any issues.

All the liquid preparations available in the UK are very concentrated- presumably produced by the drug companies for people who can't swallow pills, rather than for dose reduction!. The solution is 40mg per ml, and there are 20 DROPS per ml, so 1 DROP =2mg.

Good luck!

[PattyCatty]

Hey @DianaDoodle

 

Thanks for stopping by! Really appreciate it. 

 

My GP has prescribed me solution which is 10mg in 5ml. 8mg ie 4ml of this is supposed to have the same bioavailable as 10mg tablet. 

 

I will get this prescription next week and then hopefully will be able to start the switch. 

 

Initially the GP recommended the 1 drop = 2mg (40mg/ml) solution but I said there was no way I could do an accurate taper with. I worked with my pharmacist to find out what was available in the market and then I went back to my GP with the information which he then agreed to prescribe. 

 

On 8/8/2024 at 1:00 PM, DianaDoodle said:

So we decided to ignore that complication and move to the same dose in mg, which didn't seem to cause any issues.

If you don't mind me asking, did you make the switch to liquid 100% in one go?   I'm so pleased to hear that you had no glitches.

 

On 8/8/2024 at 1:00 PM, DianaDoodle said:

am currently taking 4mg, which is 2 drops.

 

Oh well done for getting down to this dose when you get to lower levels you could ask your pharmacist/ go about the 10mg in 5ml solution ? It's definitely available just not well advertised and it took a lot of research to just find out about it

 

 

[PattyCatty]

I have finally received my prescription for liquid citalopram 10mg in 5,ml. Hurray 🎉 

 

I have a flu cold thing, but, once I'm over it I'll start the transition from powered tablet to liquid.

 

Very nervous about this. 

 

I will start by taking 25% (1ml) in liquid and 75% (whatever weight that is) as powdered tablet and holding for ? I'm not sure how long.

 

Can't wait to start to get off this numbing stuff.

[PattyCatty]

Problem:

My scales are not very accurate. So I can't be sure my dose isn't getting messed about if I discard some powder and replace with prescription liquid because I can't be sure how much I'm discarding.

 

Solution: 

I'll switch to liquid citalopram by mixing part of the powder (in increasing doses) to water. Once on 100% water dissolved citalopram, I will switch over to liquid prescription because I can do this more accurately. 

 

Today: 

I have taken approx 30% of my citalopram in dissolved form. Hope it goes well 

 

I am doing this very slowly but I have a sensitive system so I'm okay with this.

[PattyCatty]

Approximately 50% dissolved citalopram yday 50% powder form. 

 

So far so good.

[DianaDoodle]

Hi Patty, didn't mean to ignore you earlier question- I don't visit the site very often, and swither between wanting to read all the posts, then wanting to avoid!

 

It's very interesting that you managed to get a far less concentrated preparation ( and you are in the UK?).  I will speak to my pharmacist about this- I have found one now who seems sympathtic and helpful ( though often very harrassed!).  I agree, it is virtually impossible get an exquisitely precise dose from the 40mg/ml prep.  I transferred straight from tabs to liquid, and it's hard to say if that caused any problems- I have felt quite up and down since Jan, though the general trend is up. 

 

One problem I did find though was with travelling.  We went to abroad for several weeks in the summer. I kept an opened bottle with me at all time, and that seemed to be fine.  However I took a spare bottle ( well, two in fact), and I can't be sure but I think one went into hold luggage for one leg of the journey.  It was unopened.  When I started using it later it was definitely NOT right.  I took maybe three doses and felt dreadful.  The pharmacist said it should have been fine in normal hotel environment, but may have got very cold in hold luggage, or perhaps left in very hot sun somewhere. 

 

So, I'm holding on 4mg for now- felt great last weekend, but a bit of a dip this week- just mild down, but enough to make me want to stay here for a bit longer. Also, the 'tinnitus' has been really loud for the last couple of days-which I don't understand.  Not sure if it's the same thing other people describe as tinnitus, this is more of a white noise in the head rather sounds in the ear. All very strange.

 

I am managing to do a bit more exercise now, which is a positive.

 

Hope things continue well for you.

[PattyCatty]

 

I'm on hundred percent dissolved tablet since yesterday and reduced dose by 10% yesterday. Didn't feel any adverse effects yesterday. 

 

Today I've woken up feeling fine but when I stand up and get out of bed i am swaying and feeling really dizzy.

 

I've looked up the withdrawal checklist and this could be a withdrawal symptom or it could be that I've picked up a head cold or flu - I've been catching lots of things recently. I'm not concerned but it's interesting to note.

 

Either way, per protocol, I'll be holding at this level for 1 month minimum. 

 

 

Dear @DianaDoodle

Thanks for your reply ❤️ if okay with you I will respond in the next few days.

 

 

 

[PattyCatty]

Quoting this screenshot from this website

[PattyCatty]

Current method is mixing crushed tablet into 10ml water. I leave it overnight on my table to help with dissolving. 

 

Next morning, I syringe 1ml out.

 

I have to keep stirring whilst I syringe out as tablet sediment (of which there is plenty) quickly settles down to the bottom of the glass. 

 

If anyone knows of any ways to improve the process, information is gratefully received.

[Mamgu]

Yeah, the dizzieness and swaying is a classic WD symptom for me.  The good news is it doesn't last long and eventually the waves subside and I can function fine.

 

Good luck with the move to 100% solution......I explained my process over on my thread 🙂

 

x