TightLinesGuy: Citalopram rapid withdrawal to lower dose

[TightLinesGuy]

Hello,

 

I am very grateful to have found this website and the large amount of knowledge which I have been busy reading and learning but I still have many questions.

 

Some background information;

 

I was prescribed citalopram at a dose of 20 mg in 2020 for an adverse reaction to a medication which was misdiagnosed as depression. Soon after I started citalopram I developed what I think was hypomania but this was not linked to the medication and I lived my life spending too much, very impulsive and hyperactive for several years destroying my relationships in the process. I also gained weight and had various physical symptoms e.g. my stomach. Citalopram had no benefit on my mental health and in fact it made me feel worse. It actually seemed that the longer I stayed on citalopram the worse I became. All of these problems were blamed on a mental illness or medical disorder. At one point the dose of citalopram was doubled from 20 mg to 40 mg but after a week or so I became so emotionally disturbed the doctor had to lower it back to 20 mg.

 

In November 2023 I joined the dots, I realised I needed to take action. Long story short I was given a very quick taper over about a week which I could not tolerate. I became acutely paranoid and dangerously agitated and suicidal with strong urges to destroy property and much more. So I saw my psychiatrist as an emergency and he reinstated me on citalopram again for me to taper off. I reinstated to 10 mg which made all of my withdrawal symptoms go away within a matter of hours. Unfortunately at this dose my baseline side effects before withdrawal of feeling hypomanic and extreme compulsive spending came back so I was soon forced to lower the dose to find a happy medium between side effects and withdrawal symptoms. I lowered the dose to where I felt most stable and this dose is 5 mg.

 

In the middle of December I made a bad decision — as I was not fully stable on 5 mg per day (in two divided doses) — and tried reducing my dose to 3.75 mg citalopram but I developed very strong anxiety and after 10 days I was hit by acute severe depression which forced me to increase my dose in small steps to 7.5 mg citalopram around the start of January for 6 weeks to stabilise. I realise with hindsight I was not ready to reduce my dose to 3.75 mg as I still was very irritable, grumpy and had not stabilised.  Unfortunately, I was forced a few weeks ago to reduce back to 5 mg due to hypomanic symptoms of feeling high and spending money uncontrollably on 7.5 mg.

 

I have read on this website that after a big reduction in dose or reinstatement it is best to wait perhaps several months to stabilise as much as possible before reducing. I am thinking of waiting another couple of months (or longer?) and then spend 6 months or even longer (listening to my body) to wean off the final 5 mg of citalopram. I am thinking of taking about a year in total (I started my process of reducing, albeit rapidly, in October 2023) to come off citalopram completely but keeping the option of being flexible based on how I respond to reductions — does this sound sensible? I take it twice a day (2.5 mg morning and 2.5 mg at night) as I found I am more sensitive on the lower doses to the drug wearing off. I do feel I am slowly stabilising as time goes on but still have periods of increased anxiety at least once per day, I am eating and sleeping better although a few days ago my appetite and sleep was not good for a couple of days which makes me worry I am going to experienced delayed withdrawal symptoms, hopefully just a bad couple of days.

 

My new psychiatrist supports my decision to come off antidepressants and is allowing me to reduce very slowly at my own rate. She feels antidepressants are unlikely to benefit me as I do not have evidence of major depressive disorder.

 

If I do get hit with delayed withdrawal that is severe I am wondering if I should do a small up dose like by 1.25 mg (an 1/8th of a 10 mg tablet) or even 0.6125 mg (a 1/16 of a 10 mg tablet)? I am still quite worried of any delayed withdrawal symptoms emerging as my brain chemistry tries to sort itself out. I am also concerned about protracted withdrawal symptoms. I am not an expert and I would warmly welcome any advice or constructive criticism of my ideas from this community of volunteers.

 

In addition to my question in the above paragraph I guess my questions are: given the large dose reduction, how long should I stay at this dose before making very small 0.625 mg reductions? Is there any advice that can be given? I have been on 5 mg or lower since November (apart from the up dose to 7.5 mg through most of January and to the middle of Feb. 2024) and I am finally starting to stabilise after dropping back to 5 mg. Although my anxiety is at times worse I am actually doing much better than when I was on 20 mg in many other ways. I am caught between a rock and a hard place.

 

Another question is the rate of reduction. I was thinking I should wait another 10 weeks before considering any further small reductions and then making less than 1 mg reduction every 4 to 6 weeks?

 

Thank you for considering all of this,

 

Jonathan

[Emonda]

Welcome to S.A. @TightLinesGuy,

 

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. 

 

On 3/12/2024 at 8:36 AM, TightLinesGuy said:

In the middle of December I made a bad decision — as I was not fully stable on 5 mg per day (in two divided doses) — and tried reducing my dose to 3.75 mg citalopram but I developed very strong anxiety and after 10 days I was hit by acute severe depression

 

Here is the recommendation on this site: Why taper by 10% of my dosage?

 

When you go faster than this, WD symptoms are the likely outcome: Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

On 3/12/2024 at 8:36 AM, TightLinesGuy said:

I have read on this website that after a big reduction in dose or reinstatement it is best to wait perhaps several months to stabilise as much as possible before reducing. I am thinking of waiting another couple of months (or longer?) 

 

I'd be waiting months. I waited 5 or 6 months after dropping too fast.

 

On 3/12/2024 at 8:36 AM, TightLinesGuy said:

and then spend 6 months or even longer (listening to my body) to wean off the final 5 mg of citalopram

 

Dropping by 10% per month of the most recent dose will take much longer than you anticipate. Each monthly reduction should get smaller and smaller. The lower you go, the slower you often have to go. Don't rush, or you'll end up back at the start. There is no shortcut.

 

On 3/12/2024 at 8:36 AM, TightLinesGuy said:

If I do get hit with delayed withdrawal that is severe I am wondering if I should do a small up dose like by 1.25 mg

 

I'd apply the same logic in reverse. A maximum cut of 10% per month, and no more for an updose. Many go back to the previous dose they felt stable.

 

A few more helpful links:

 

 

Windows and waves pattern of stabilization

 

Emotional Spirals

 

Non-drug coping strategies

 

Melatonin for sleep

 

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

[TightLinesGuy]

Thank you @Emonda for your very helpful insightful post and warm welcome. I am sorry that you too are suffering and battling a similar beast to me.

 

I have completed my drug signature. No doubt as my withdrawal progresses I will need to condense my signature so that I can expand it.

 

I agree with you the lower the dose gets the slower and smaller the cuts need to be. I learnt this the hard way. I believe this might be to do with the ‘saturation point’ where when most binding sites are occupied at any one time further increases in dose make only a small difference, but below the saturation point small reductions cause bigger changes to drug occupancy of binding site. In fact, I found on the lower doses the once daily dosing did not work well for me and I had to change to twice daily dosing. You are lucky in that vortioxetine has significantly longer half life than citalopram and is less prone to wearing off even on low doses.

 

I am finding the collective experience knowledge of this website and your own knowledge to be very helpful in educating me. I am also factoring in this research to help guide my reductions in the sense of being aware of the need to go much much slower on the lower doses, which seems to mirror the advice you are giving me. https://www.nature.com/articles/s41380-021-01285-w/tables/2

 

Unfortunately misdiagnosed side effects forced me to reduce more quickly than I wanted to but I can go more slowly now now that I am stabilising from side effects and withdrawal effects. I am curious why you reinstated to only 5 mg instead of 15 mg vortioxetine? How much did you stabilise after holding 5 to 6 months? It has been over 4 months since I rapidly reduced to 5 mg (see my sig.) and almost 5 weeks since I reduced back to 5 mg from 8 week or so updose to 7.5 mg (again see my sig.), so I am wondering if by holding I can see further improvements in my withdrawal symptoms such as anxiety? I am frequently wondering how long I have to suffer withdrawal related anxiety. I am dreading it lasting years. Having said that I am reassured that it has reduced from the severe to very severe levels I experienced in previous months but I am still struggling.

 

I read on your introduction topic that you developed persistent tinnitus after a cold turkey from escitalopram. I was wondering if any other drugs were involved such as benzos, zolpidem or alcohol or was it purely an antidepressant withdrawal syndrome?

 

I guess I am worried some of my residual withdrawal symptoms such as motivation and periods of anxiety might be very protracted. I imagine after you are fully weaned off you will make a full recovery of residual symptoms. That is my hope for myself and of course everyone here.
 

I feel like I am stabilising on my current dose 2.5 mg in morning and 2.5 mg at night so thankfully I have not found the need to do a small updose. That said I agree with you that it is too soon to make any further reductions (especially after my severe crash when I reduced too soon in December).

 

I try not to take any unnecessary supplements but I am currently taking vitamin D3 and omega 3 fish oils. I am trying to improve my diet to ensure I am getting enough fruit, vegetables as well as protein to help both my physical and mental health.

 

I am T-total but agree that avoiding alcohol is very important.
 

again, thank you very much for your help.

[Emonda]

On 3/21/2024 at 3:04 AM, TightLinesGuy said:

I am curious why you reinstated to only 5 mg instead of 15 mg vortioxetine? How much did you stabilise after holding 5 to 6 months?

 

I up-dosed to 7.5mg as I recalled feeling 'ok' at that dose. I still had WD symptoms, but life could continue on as 'normal'.

 

How much did I stabilise? Enough so that I experienced what is referred to on this site as 'WD normal'. You don't feel bad, but far from perfect. Just sort of 'blah'.

 

On 3/21/2024 at 3:04 AM, TightLinesGuy said:

so I am wondering if by holding I can see further improvements in my withdrawal symptoms such as anxiety?

 

Any reason to hold a little longer is a good reason. You've made lots of changes. I'd be holding where you are for months. Let your body recover from the recent changes. Symptoms should become less intense.

 

On 3/21/2024 at 3:04 AM, TightLinesGuy said:

I read on your introduction topic that you developed persistent tinnitus after a cold turkey from escitalopram. I was wondering if any other drugs were involved such as benzos, zolpidem or alcohol or was it purely an antidepressant withdrawal syndrome?

 

The tinnitus developed immediately after reinstating Escitalopram. Nothing else was involved. These days, if I increase my taper pace just slightly, my tinnitus flares up. It's always there, just worse at times from WD.

 

On 3/21/2024 at 3:04 AM, TightLinesGuy said:

I guess I am worried some of my residual withdrawal symptoms such as motivation and periods of anxiety might be very protracted.

 

I've noticed improvement in many areas with time and much patience.

 

On 3/21/2024 at 3:04 AM, TightLinesGuy said:

You are lucky in that vortioxetine has significantly longer half life than citalopram and is less prone to wearing off even on low doses.

 

Lucky 😂, after close to three decades on this stuff (Sertraline, Escitalopram and Vortioxetine), I feel every drop, but I do know what you mean...there are drugs I am fortunate to have avoided. 

 

Time and patience are your friends.

 

Emonda

[TightLinesGuy]

Hello again Edmunda,

Many thanks for your reply and answers to my questions.

 

Thank you for your advice that I should hold my dose for months. Do you have any advice as to how many months I should hold for? I realise this is individualistic. Perhaps my question is best framed as: after how many months holding (after a big dose reduction followed by a crash) does it reach a stage where a 10% reduction is no longer a high risk of causing a severe flare up/crash?

 

I have been holding for nearly 3 months now. I am not sure whether I am experiencing withdrawal damage from a very bad crash in the last week of December through to the start of February or withdrawal symptoms. I developed new symptoms during the crash such as a fear of being alone, strong anxiety when out in public, etc. If I am never going to fully stabilise on the drug after the crash then I do not want to hold for like 9 months or a year or 2 years, etc. On the other hand I really cannot afford to make my symptoms significantly worse by tapering too soon as I am at times struggling a lot. I am finding my anxiety levels at times to be very difficult to cope with. Sometimes I have to quickly leave a shop and head for home due to acute anxiety symptoms. Is there any medication that is not an antidepressant that could help me? Or do I just need to wait it out? What is best?

 

My post-withdrawal/crash or post-acute/protracted withdrawal symptoms come in waves — sometimes, perhaps most of the time, I feel not too bad, almost normal and other times I am suffering a lot. Sometimes they (the symptoms) come on for no reason and at other times there is a stressful trigger. Is it a good sign that my symptoms come in waves?

 

Another concern I have is that I have never been mentally well on citalopram, it has made me prone to angry outbursts and impulsivity and addictive shopping/spending as well as attacks of hypomania. Although reducing the dose to 5 mg has taken a big edge off these side effects it has been at the cost of developing new withdrawal symptoms. So I need to strike a balance between getting off citalopram at a speed that reduces my suffering of side effects but does not cause a serious withdrawal crash/acute mental breakdown. I am mindful of the advice that “there are no short-cuts”…. I know I could be tapering for another year or so. Maybe even longer.

 

My ongoing symptoms include broken sleep where I wake up at least once for several hours, sometimes several times so I often find myself sleeping at funny times during the day. Other symptoms include markedly increased anxiety episodes and low mood and feeling suicidal. My dizziness symptom seems to have eased recently. Would holding likely help to correct my sleep difficulties?

 

I tried taking magnesium at a dose of 400 mg per day but it seemed to paradoxically make me worse. I began to feel more anxious and all day long and paced up and down the garden for hours. I am tempted to give magnesium another go though, at a lower dose of say between 50 and 100 mg per day. Have you heard of this reaction to magnesium before? Why am I so sensitive?

 

Haha, glad you knew what I meant. I hope you are progressing well with your taper and your symptoms are decreasing.

 

I am not sure how to quote people’s posts properly on this site, is there a site guide to do this?

 

Many thanks for your time and kindness in this matter.

[Emonda]

4 hours ago, TightLinesGuy said:

after how many months holding (after a big dose reduction followed by a crash) does it reach a stage where a 10% reduction is no longer a high risk of causing a severe flare up/crash?

 

You're right, it's different for everyone. I'd be thinking 6 months and reassess. From memory, I was around 5 months. LostinCanada was 6 months.

 

4 hours ago, TightLinesGuy said:

I really cannot afford to make my symptoms significantly worse by tapering too soon as I am at times struggling a lot.

 

You don't want to start tapering if you still feel fragile. You don't want to start a marathon with a sprained ankle...

 

4 hours ago, TightLinesGuy said:

I am finding my anxiety levels at times to be very difficult to cope with.

 

Breathing exercises on Spotify helped me with anxiety, as did swimming.

 

4 hours ago, TightLinesGuy said:

Is there any medication that is not an antidepressant that could help me? Or do I just need to wait it out?

 

No medication that I am aware of will help with WD symptoms. A doctor would certainly give you something (like a benzo), but that'd just make things worse.

 

Time and much patience are required.

 

4 hours ago, TightLinesGuy said:

My post-withdrawal/crash or post-acute/protracted withdrawal symptoms come in waves — sometimes, perhaps most of the time, I feel not too bad, almost normal and other times I am suffering a lot. Sometimes they (the symptoms) come on for no reason and at other times there is a stressful trigger. Is it a good sign that my symptoms come in waves?

 

Windows and waves are part of the recovery process: Windows and waves pattern of stabilization

 

4 hours ago, TightLinesGuy said:

Although reducing the dose to 5 mg has taken a big edge off these side effects it has been at the cost of developing new withdrawal symptoms.

 

Once stable, slow and steady is the way to go to balance side effects and WD.

 

4 hours ago, TightLinesGuy said:

I am mindful of the advice that “there are no short-cuts”…. I know I could be tapering for another year or so. Maybe even longer.

 

Correct, there are no shortcuts. I've been at this for 2+ years. I've got at least another 2 years to go at the pace I'm tapering. But tapering slowly is minimising WD symptoms to a tolerable level. 

 

It's not a race. Now, I look at how far I've come rather than how far there is to go. Sometimes, you've just got to shift your mindset.

 

4 hours ago, TightLinesGuy said:

My ongoing symptoms include broken sleep where I wake up at least once for several hours,

 

This is a typical WD symptom: Melatonin for sleep

 

4 hours ago, TightLinesGuy said:

My dizziness symptom seems to have eased recently.

 

This is positive.

 

4 hours ago, TightLinesGuy said:

Would holding likely help to correct my sleep difficulties?

 

Pushing on with the taper is certainly not going to improve your sleep.

 

4 hours ago, TightLinesGuy said:

I tried taking magnesium at a dose of 400 mg per day but it seemed to paradoxically make me worse

 

Starting with a very small amount is best. If you respond well, then increase slightly. 

 

4 hours ago, TightLinesGuy said:

Why am I so sensitive?

 

The rapid taper has knocked you around.

 

4 hours ago, TightLinesGuy said:

I am not sure how to quote people’s posts properly on this site, is there a site guide to do this?

 

Select the quote you want to respond to with your mouse, and click "quote selection".

 

4 hours ago, TightLinesGuy said:

Many thanks for your time and kindness in this matter.

 

I've been where you are. You'll bounce back, and will be returning the favour to others in no time at all 👍

 

Emonda