DianaDoodle: Citalopram taper

[DianaDoodle]

I started taking citalopram around 2014. In retrospect my problem was really work-related stress, against a background of chronic negative thinking habits.  Citalopram did help though, and I used the 'headspace' to develop better thinking habits. A couple of years later it seemed to be time to stop, but I did this far too quickly- halving the dose  every couple of weeks down to 5mg.  The main symptom then was disabling head zaps.  So went back to 20mg, and stayed there until the start of 2024- being retired then and life seeming to be as stable as it was ever likely to be. Naively I thought I could just come off by repeatedly halving the dose, and riding out any symptoms over a few weeks, or at worst a couple of months.

 

I didn't fully understand what a slow taper was- reducing from 20mg citalopram to 5 in about 6 weeks.  Intially it seemed ok- a couple of days of feeling light-headed and slightly zombied, and only mild problems with head zaps this time. Then I read Mark Horowitz's paper and began to understand hyperbolic tapering, slowed down the reductions.

 

However, gradually I started to experience waves of... despair- it's the only word I can find to descibe it. They are completely unrelated to anything that is happening or thinking about. There is also a persistent 'white noise' in my head, and awful lethargy and 'can-be-botheredness'. Fortunately no physical symptoms such as nausea, and no sleep distrubance ( if anything the vivid dreams I had on the full dose are less prominent).

 

So I've been stuck on 4mg for 5 months. Things are a bit better, but I just don't know what to do next.  I am 63, so the idea that it could take 10 years to get off completely is quite frightening. 

 

Not sure what I am asking here really-just for some support that all this is normal (all the medical professionals I've had contact with say that people don't have a problem with citalopram!)

 

 

 

 

[Jane318]

Greetings @DianaDoodle, and welcome to SA!  We are a community of volunteers providing peer support in the tapering of psychiatric medications and their associated withdrawal syndromes. 

 

Thank you for completing your signature. 

 

It does sound like you have experienced protracted withdrawal from tapering too fast. It is not unusual for the onset of withdrawal symptoms to be delayed for weeks or months.  Even though you slowed down, your body is still trying to catch up from an earlier too-fast taper.   Your and my experiences have many parallels. 

 

I am glad you discovered Dr. Mark Horowitz’s work on hyperbolic tapering and slowed down your reductions.  Hyperbolic tapering is the method we recommend.  You can read SA’s forum on this here:

 

Why taper by 10% of my dosage?

 

Since you understand the hyperbolic nature of these drugs, you know that the lower the dose, the greater the effect.  In practical terms, what this means is that the lower you go, the slower you need to taper in order to keep withdrawal symptoms manageable. 

 

I understand your desire to get off of citalopram as quick as possible – I am approaching 70, have been at this for almost two years, and when I started, I naively expected to be finished by now!  However, I have chosen to let go of my own schedule and do things safely by paying attention to my body.  The time will go by anyway, and I’d rather spend that time in a safe place than completely disabled by going too quickly.  I tell myself, “I took these meds for years and didn’t think about it – now I am still taking it, but less and less all the time.”

 

So where do you go from here?  As I understand it, you’ve been at 4 mg for five months and things are “a bit better.”  Your choices are to continue to hold at 4 mg until you do believe you have stabilized at this dose and then begin to taper again.  If do not feel you are stable and are not improving, you might consider a slight updose before you start to taper again.  You can read more about this here:

 

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

 How long does it take to stabilize after reinstating or updosing?

 Hypersensitivity and kindling

 

If you decide to updose and want input on how to do that, let us know.

 

Once you decide to taper and given that you are at a pretty low dose right now, you might consider choosing to taper even more slowly, with longer holds or smaller cuts.  Read about this here:  The Brassmonkey Slide Method of Microtapering. 

 

It’s important to keep tabs on your symptoms and adjust your taper amount and schedule as needed.  I now track my symptoms every day, rating them on a scale of 1-10 for severity.  This will help you identify your windows and waves and reveal your progress, which is encouragement we need!  You can use the following list of typical withdrawal symptoms as a template for a journal, if you wish:

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

You may choose to also track your foods and activities to identify things that trigger symptoms as well.  We do encourage people who are tapering to avoid caffeine, alcohol, and recreational drugs.  Many prescription and OTC drugs can cause problems too and should be avoided as much as possible. 

 

We recommend only two supplements here at SA, magnesium and omega-3 fatty acids.  So if you decide to try a supplement, even those we recommend here, start with a very low dose.  If you tolerate it well, you can increase the dosage slowly over time.  

 

As you taper, and even in protracted withdrawal, it is very normal to have periods where you feel better, and periods where you feel terrible.  This is what we call the windows and waves pattern of stabilization.  This is actually a good sign of healing!  Read more about windows and waves here:

Windows and waves pattern of stabilization

 

We have many threads on how to cope with symptoms – I encourage you to check out the various forums / links on the SA.org home page.

 

This is your introduction topic.  Each member gets one intro topic- please post updates and questions here, in this thread.

 

Do explore the rest of the forum – there is a lot of great information here.  Be sure to read “About SurvivingAntidepressants.org,” which has good information about how to use / search the site: https://www.survivingantidepressants.org/forums/topic/54-about-survivingantidepressantsorg   

 

Also, feel free to read and comment on the intro threads of other members.  This is how you build a community of people who understand what you are dealing with.   It is so helpful to connect with others who are experiencing the same things.

 

Yes, most health care professionals believe that it is easy and quick to get off these drugs.  It is not, as you and thousands here and elsewhere know.  However, it is possible and our brains will heal, and many here will attest!

 

I look forward to following your journey and helping out as I can.

Edited October 23, 2024 by Jane318

[DianaDoodle]

thank you so much Jane318 for this kind and thoughtful response.  Having read back through my story it doesn't really describe the moments of hell; at times it felt like being attacked by Harry Potter's Dementors, or being lashed by tentacles of demons rising up from hell.  Thankfully things have  improved a bit now compared to a few months ago. 

 

It is tempting to reinstate a small dose- if it would put me back to where I would have been had I not reduced so quickly, so that I could just start again very, very slowly.  However, my symptoms are better now-I am just very impatient to feel better and enjoy life again, and from what I've read here (partic Alto's very informative post), it might be risky given so many months have elapsed.  This is tolerable, and I certainly don't want to make things worse.It's just so hard motivating myself to do the things I know I should do to help- exercise for example, and just tackling the little things in my life that are constant irritants.  It is helpful to know that others have also experienced this ( although I wish they hadn't).

[Jane318]

17 hours ago, DianaDoodle said:

It is tempting to reinstate a small dose- if it would put me back to where I would have been had I not reduced so quickly, so that I could just start again very, very slowly.  However, my symptoms are better now-I am just very impatient to feel better and enjoy life again, and from what I've read here (partic Alto's very informative post), it might be risky given so many months have elapsed.  This is tolerable, and I certainly don't want to make things worse.It's just so hard motivating myself to do the things I know I should do to help- exercise for example, and just tackling the little things in my life that are constant irritants.  It is helpful to know that others have also experienced this ( although I wish they hadn't).

 

I totally believe that life has been hellish for you, it is very hard to describe in writing or even verbally.  But I and many others here have experienced it and understand.  I am so glad to hear you are experiencing some improvement!

 

I think you are wise to sit at current dose to stabilize, given how much time has elapsed, especially since you are seeing improvement.  It could make things worse and further delay your progress.  As long as you are improving, it is better to sit here until you feel stable enough to continue.

 

I relate to your eagerness to get on with life without drugs as well as frustration with the withdrawal symptoms.  I too struggle mightily with motivation and energy to do the things that need doing.  Here are some specific threads that you might find helpful for understanding and dealing with these and other withdrawal symptoms:

Apathy, anhedonia, emotional numbness, emotional anesthesia 

 Derealization or Depersonalization

 Non-drug techniques to cope with emotional symptoms

 Easing your way into meditation for a stressed-out nervous system

Music for self-care: calms hyperalertness, anxiety, aids relaxation and sleep

Ways to cope with daily anxiety

"Change the channel" - dealing with cognitive symptoms

Dealing With Emotional Spirals

Symptoms and self-care

Getting Started With Mindfulness

 

You are not alone.  Please reach out with any questions and keep us posted on how you are doing.

 

Edited October 25, 2024 by Jane318

[feelslikemonday]

Hi Diana

 

I can totally relate to your post! I too am now on 4mg of Citalopram. I have previously tried to taper - way too fast - and suffered the most horrific dizziness & brain zaps + I raged a lot too - which was basically focused towards my DH. I couldn't control my anger towards him and blamed him for everything wrong in my life. As soon as I reinstated it, it was like flipping a switch, and I went back to normal.

 

Any fast forward to today - I have over the past year or so reduced slowly from 20mg to 4mg, and have not had a brain zap yet - but every time  I make a reduction, I have 2 weeks of exhaustion, lake of my tolerance, just basically want to be left alone. (its bearable)

 

I'm going to start the hyperbolic taper recommended by Jane, instead of the linear I am currently doing. But I am very anxious about Brain Zaps - as they are the main reason I reinstated the other 2 times. This time I want to get off 100% - no matter what, I am done with Citalopram. 

 

[DianaDoodle]

Hi, yes, your journey sounds very similar.  Isn't it odd that neither of us have head brain zaps this time?  Last time they happened everytime I took a step.

Yesterday, perhaps encouraged by Jane's response,I actually felt a few moments of hope/ positivity. It was a bit like seeing a glimpse of a blue sky through the clouds.

In general I can function normally, but I am now retired and don't think I could work like this.  Motivation and 'being on top of things' are an issue. It's hard to think starigh, and I've become a bit 'scatty'.

 

I plan to stay on 4mg a bit longer- although it's been since end May, it's been a bit of an up-and-down time with a long trip to visit our son in Australia.

 

Then- and this might be useful for other to note- I had an issue with the medication.  I started a new bottle, which we had taken with us abroad, we tried not to out it in hold luggage- but we had several flights and it is possible we did. I can only think that it was subjected to extreme temperatures, because it did NOT work!  Within a few days I felt very strange-and couldn't work out whether the effective dose had gone down or up (perhaps the previous bottle had become ineffective?). Anyway, the pharmacist said it was possible that extreme cold or heat might do this. So keep the bottle with you!  Back to the 'new normal' after a few days of a newly prescibed bottle.

 

I am hoping with a proper BrassMonkey taper it will be a smoother- but very long- path to Zero meds. 

 

 

[feelslikemonday]

Yes, it's a very long road to 0, and I have to remind myself daily to stick to my plan—no matter how much I want to get off!

 

I took the step to start the hyperbolic taper and am now on 3.9mg. I have not noticed any symptoms AT ALL with this tiny reduction, so I am feeling so hopeful—nearly ectatic. I remind myself to enjoy these moments of happiness while they last, no matter how fleeting.

 

It's so nice to start feeling something again. I even cried a little (happy tears) for the first time in years. I can't remember the last time I cried. 

 

[DianaDoodle]

that's one step closer to the goal! Keep going.  It's so encoraging that you've had no symptoms froma small reduction.  I am hoping for the same- that the awful stuff was because of coming down too fast, and now our brains have healed enough to reduce further.

[Jane318]

@DianaDoodle - Just a note to say I am thinking of you and hope you are doing well - or at least "okay!"  

[DianaDoodle]

Hi Jane318, thanks for thinking of me.  Yes, I'm okay- probably improving, but even though I'm keeping a symptom diary it's hard to judge how today feels compared with last week- every day is different.  Main symptoms are low mood and lack of motivation- but with increasingly frequent brief windows. The awful 'demons' don't come now. I would like to reduce from 4mg- having been on this dose since the end of May, but not sure what is meant by 'stable' before reducing.

[Jane318]

On 11/9/2024 at 11:39 AM, DianaDoodle said:

Yes, I'm okay- probably improving, but even though I'm keeping a symptom diary it's hard to judge how today feels compared with last week- every day is different.  Main symptoms are low mood and lack of motivation- but with increasingly frequent brief windows. The awful 'demons' don't come now. I would like to reduce from 4mg- having been on this dose since the end of May, but not sure what is meant by 'stable' before reducing.

@DianaDoodle - Your and my situations are parallel in so many ways.  I so identify with everything you say about "probably improving," every day is different, and main systems being low mood and lack of motivation.  With me, it is plus fatigue.   As ugly as this feels to me, I am often grateful that so far I have been spared the crippling anxiety, insomnia, akathisia, headaches, and other physical symptoms so many suffer.  

 

As far as when to resume your taper, it will be subjective.  I don't think it necessarily means waiting until you feel "good" like in the old (and future) days.  But resume when your symptoms are somewhat evened out and you feel ready, emotionally and psychologically to handle the challenges that may come.  Remember, you can always adjust your taper amount and schedule.  If you try 10% and it is too much, you can updose slightly and/or hold longer again.  Generally, the lower you go, the slower you will want to go to ensure withdrawal symptoms are manageable.  You might find this post helpful: https://www.survivingantidepressants.org/forums/topic/4954-rhis-start-small-listen-to-your-body-taper-plan/#comment-126298.

 

Best wishes and please keep us posted.  

 

 

[DianaDoodle]

As good as it gets?

I've been on 4mg citalopram (via drops) since May, and in effect that may have been an updose because I'd been taking 4mg via dissolved tabs since Feb, (4mg drops equivalent to 5mg tabs).  I've held for this long because we had a stressful couple of months (for happy reasons!), and then a couple of short, unpleasant waves. There is a fairly constant level of mild depression and lack of motivation but I suspect this is as good as it gets for this stage of the process, so I feel it's time to start a proper slow taper.

I am thinking about the Brass Monkey scale, so will reduce by 2.5%, and see how that is.  This close to Christmas I wonder whether it would be best to hold after 2.5mg drop for a few weeks?  We are only planning a low key Christmas with a few close family, but want to enjoy it as much as possible.

I feel quite anxious about the effects of this reduction- I just don't know how sensitive I will be to small reductions at this point, it feels like a step into the unknown.  However, as well as anxiety, I feel almost excited to get going again; it's been frustrating being a state of persistent low mood and lethargy and not getting any closer to the end goal. Any advice and /or encouragment would be very welcome!

[Jane318]

Greetings @DianaDoodle

4 hours ago, DianaDoodle said:

I've held for this long because we had a stressful couple of months (for happy reasons!), and then a couple of short, unpleasant waves. There is a fairly constant level of mild depression and lack of motivation but I suspect this is as good as it gets for this stage of the process, so I feel it's time to start a proper slow taper.

It does indeed sound like things have stabilized for you sufficiently to begin tapering.  

 

4 hours ago, DianaDoodle said:

I am thinking about the Brass Monkey scale, so will reduce by 2.5%, and see how that is.  This close to Christmas I wonder whether it would be best to hold after 2.5mg drop for a few weeks?

The beauty of the BrassMonkey scale is its flexibility and the tool linked at the website makes it easy to quickly adjust the amount and duration of each decrement.  It's never a bad idea to insert extra holds and makes sense to do that during busy / stressful periods.  It takes about 4 days for a dose change to get to get to full state in the blood and a bit longer for it to register in the brain.  The important thing is to pay attention to your body and be willing to adjust as needed.

 

Let me know if you have any questions about how to use the calculator.  It can be a bit confusing, but just to confirm/clarify, the "baseline" is 10% reduction (of prior dose) every four weeks followed by a two-week holding period.  The 10% reduction is made gradually, one-fourth of that (2.5%) every week for four weeks.  Some people find 10% too much so do 8% or 5% per month and/or hold for longer than two weeks between cuts.  The spreadsheet makes it easy to make these adjustments.

 

5 hours ago, DianaDoodle said:

I feel quite anxious about the effects of this reduction- I just don't know how sensitive I will be to small reductions at this point, it feels like a step into the unknown.  However, as well as anxiety, I feel almost excited to get going again; it's been frustrating being a state of persistent low mood and lethargy and not getting any closer to the end goal. Any advice and /or encouragment would be very welcome!

The encouragement I offer is that I can tell that you have done the work to prepare for this, you are staying on top of your symptoms, and you are willing to be flexible, and you are committed.  You've got this!  And we are here to support / listen as you go.  Please keep us posted.

[DianaDoodle]

thanks Jane318!  I really appreciate your advice and support.  

I am okay with the maths - I have a science background, and know how to calculate reductions and make dilutions, so that bit is the least of my worries!

 

I reduced to 3.9mg today- was a bit ambivalent because I hadn't slept well (nothing to do with WD), so felt tired this am. However if it takes a day or two to show any adverse effects if felt like the right thing to do...

 

I hope things are going well with you.

 

[Jane318]

10 hours ago, DianaDoodle said:

I am okay with the maths - I have a science background, and know how to calculate reductions and make dilutions, so that bit is the least of my worries!

This is huge!  We have a lot of tools / helps, but I do feel for folks who are not as comfortable working through these calculations.

 

10 hours ago, DianaDoodle said:

I reduced to 3.9mg today- was a bit ambivalent because I hadn't slept well (nothing to do with WD), so felt tired this am. However if it takes a day or two to show any adverse effects if felt like the right thing to do...

It can take a few days for the brain to register the change.  I am optimistic you will be able to manage any blip in your symptoms.  Keep us posted.

 

10 hours ago, DianaDoodle said:

I hope things are going well with you.

 I am doing better, thank you for asking.  I am also feeling ready to taper again - You've given me inspiration!  I will wait until after Christmas I think just to make sure I don't ruin my son's Christmas, LOL!

[DianaDoodle]

Felt great yesterday- after dropping 2.5%. Lighter somehow, and the tinnitus was less. More like my old self. I noticed this previously when reducing. Probably just the relief and excitement of moving forewords again-  rather surely it’s too soon for and physiological change?

Just woken up with a fuzzy head and loud tinnitus. Hoping this isn’t an indication of severe symptoms to come? I wasn’t, expecting to notice anything just yet. Perhaps a 2.5% drop was too much? I take it in the morning so will have to decide shortly what to do; stay on 3.9 or a slight updose? 

[Evelyne]

3 hours ago, DianaDoodle said:

Felt great yesterday- after dropping 2.5%. Lighter somehow, and the tinnitus was less. More like my old self. I noticed this previously when reducing. Probably just the relief and excitement of moving forewords again-  rather surely it’s too soon for and physiological change?

 

This sounds very familiar to me! And I feel like it's also probably one of the reasons many tend to rush the tapering/quitting, since we might feel great after taking a smaller dose, and the WD symptoms do not hit everyone until later. 

3 hours ago, DianaDoodle said:

ust woken up with a fuzzy head and loud tinnitus. Hoping this isn’t an indication of severe symptoms to come? I wasn’t, expecting to notice anything just yet. Perhaps a 2.5% drop was too much? I take it in the morning so will have to decide shortly what to do; stay on 3.9 or a slight updose? 

I keep my fingers crossed for you that it doesn't indicate anything worse ❤️

[DianaDoodle]

6 hours ago, Evelyne said:

 

This sounds very familiar to me! And I feel like it's also probably one of the reasons many tend to rush the tapering/quitting, since we might feel great after taking a smaller dose, and the WD symptoms do not hit everyone until later. 

I keep my fingers crossed for you that it doesn't indicate anything worse ❤️

Thanks Evelyne, today was ok in the end- in fact I felt quite good once I got going. I had the tail end of a cold and sore throat, so maybe that had something to do with it.  It looks like you've been having a tough time, but it's lovely that you have such supportive parents.  You ups and downs sound so much like mine.  When you're in a 'down' it is impossible to believe you'll ever feel better- but windows do come.  Eventually the window will be an enormous bifold door- and it'll be open, and we'll flt through it!  One day...

[Evelyne]

10 minutes ago, DianaDoodle said:

Thanks Evelyne, today was ok in the end- in fact I felt quite good once I got going. I had the tail end of a cold and sore throat, so maybe that had something to do with it.  It looks like you've been having a tough time, but it's lovely that you have such supportive parents.  You ups and downs sound so much like mine.  When you're in a 'down' it is impossible to believe you'll ever feel better- but windows do come.  Eventually the window will be an enormous bifold door- and it'll be open, and we'll flt through it!  One day...

 

I'm happy to hear that! Let's be positive and think you'll go this step through just fine.

Yep, I'm really going through the worst wave - though this day was somewhat better, even if I feel as strong as a newborn deer, like I've been through a week and a half long storm. My parents really are amazing - even if they can't of course fully understand what I'm going through, they try their best to be there for me. 

It's always sad and same time so supportive to hear someone knows the ups and downs, because I wouldn't want these experiences to anyone else. But at least we are not alone then, and yes, we'll go through those doors some day! And step by step we get closer to that. 

[Jane318]

@DianaDoodle

On 12/1/2024 at 11:58 PM, DianaDoodle said:

I wasn’t, expecting to notice anything just yet. Perhaps a 2.5% drop was too much? I take it in the morning so will have to decide shortly what to do; stay on 3.9 or a slight updose? 

I would not do an updose so soon.  At lower doses, it seems symptoms can onset earlier after a drop.  Give a full week.  If symptoms are terrible, then hold until you stabilize again, before next drop.

 

 

[Jane318]

Also, to make sure I see your posts, best to "tag" me (where names appear inside a blue bubble).  To do this, type the @ sign, then start to type my handle.  A drop-down list will appear, select my name, and that will make it a tag and send a notification to me.  Even though I follow you and am supposed to be getting emails when you post something, this isn't happening for some reason.  I probably have a setting wrong some where... 

[DianaDoodle]

@Jane318 thanks Jane!  I didn't know how to do that, but will do so in future.

 

Today is Day 6 after a 2.5% reduction, and it's been fine so far. I've had a viral thing- which is probably why I felt so bad on Monday- and panicked a bit!  I've felt increasingly tired (though that could be the virus), and the tinnitis is worse today, but otherwise completely manageable. There is of course a very long was to go yet!

I think I'll stick here until after Christmas, just to see when/if there is a dip. Rather than adding in another reduction as per BrassMonkey plan.

 

Thank you for reaching out Jane, I do appreciate it.

[Jane318]

Hope you are continuing to even out during this hold and that you have fully recovered from the bug.  Merry Christmas!

[DianaDoodle]

@Jane318 thank you Jane.  It is so kind of you to message me.  Yes, I am well, and have managed a further reduction of 2.5% (overall 5% of 4mg), now day 11 since last drop and feel ok.  My mood seems to dip a few days in, although it is hard to be sure there is a causal relationship.  There are so many other thinsg going on in life ( nothing dreadful in my personal life, but the world is enough to depress anyone!). 

 

How are you doing?

Let's hope we can both move into the New Year will hope and resolve to free ourselves of these poisons (eventually).

with best wishes for a Happy Christmas and Peaceful New Year.

C

[Jane318]

On 12/24/2024 at 3:24 AM, DianaDoodle said:

Yes, I am well, and have managed a further reduction of 2.5% (overall 5% of 4mg), now day 11 since last drop and feel ok.  My mood seems to dip a few days in, although it is hard to be sure there is a causal relationship.  There are so many other thinsg going on in life ( nothing dreadful in my personal life, but the world is enough to depress anyone!). 

Thank you for the update!  Rule of thumb is that it takes about 4 days for a dose change to get to get to full state in the blood and a bit longer for it to register in the brain, so it is more normal than not for withdrawal symptoms to lag a dose change by a few days or more.  It also seems that external and internal stressors can exacerbate withdrawal symptoms.  Good let things settle a bit before the next cut.  I find that taking a break from the news occasionally is helpful!

 

On 12/24/2024 at 3:24 AM, DianaDoodle said:

Let's hope we can both move into the New Year will hope and resolve to free ourselves of these poisons (eventually).

with best wishes for a Happy Christmas and Peaceful New Year.

Amen, thank you, and same to you!

[Tania]

Hi Diana, for citalopram, what is the ratio of weight to active ingredient? So that I know what 10% off is. Thank you 

[DianaDoodle]

Hi @Tania, I can see that what I wrote was a bit unclear! Apologies.
The aim was  reduce by 10% of 4mg , as per Brass Monkey taper,  spread over four smaller reductions (2.5% each). I’d been holding on 4mg, so the numbers this time were easy: 10% of 4mg is a cut of  0.4mg, or four reductions if 0.1mg.
I’m using citalopram drops, which are far too concentrated for these small doses (40mg per ml) , so every few days I make up a solution in water by adding 0.5mls to 19.5mls- which means there are 20mg of citalopram in 20mls solution ( 1mg per ml) . Hope this makes sense, and that I’ve understood your question correctly.

best wishes

[Tania]

Hi, sorry I wasn't clear...so if I am on 15mg of Citalopram, pill format, does that mean that a 10% reduction would be a straight forward 1.5mg off?