Flowers: tapering citalopram

[Flowers]

Hi Joy

 

Thanks for your help and advice.

 

I have pain in my abdomen over the liver area - it is very tender hence the GP checking up. I was just wondering about these enzyme tests and if they were included in liver function. As you say probably not but I will see if any private clinics in Granada offer this service. I am not sure but think it might be more like a DNA test.

 

 

 

I don't know what to do about the Venlafaxine. If I start taking it again I will have 3 drugs to get off. I just seem to be going backwards all the time but my quality of life is important to me. 

 

Flowers xxx

[apace41]

Hi, Flowers.  So sorry this is happening to you.  It sounds like you have a good rapport with the doctor which is good, but I think restarting at 19mg on the Ven is too high as a starting point.  I would be inclined to try to find the lowest amount you need to stop the symptoms so that you have less to get off of once you are ready to do so.  Thus, I would start at 1 or 2mg and titrate up by 1mg every 3-4 days to see if you can find a point where you are stable.  

 

With regard to the alprazolam, don't worry about that at this point.  Hold it where it is and we can worry about tapering off once you are done with the anti-depressant tapers.  The benzo will help to cushion the symptoms coming from the A/Ds.

 

As far as the liver function goes, a general blood panel will have tests for basic liver enzymes but not the genetic enzyme testing needed to determine clearance rates of antidepressants.  Frankly, I would not really worry about that at this point.  I would look to stabilize on the Ven and see if that takes care of the stomach issues.  If it does, I'm not sure that you gain much from the further testing.

 

Those are my thoughts.

 

Feel better!

 

Best,

 

Andy

[Flowers]

Hi Andy

 

Thank you for your guidance and thoughts.

 

In response:

 

Yes, my Dr is a nice man and is always trying to help me with his very limited knowledge of WD! I know he chose 19 mgs of Ven to go back on  because that was the dose I was on when I felt much better for those 2 -3 weeks last month. The only time I have felt good in the last 5 -6 months! I agree it is a lot and I could do without having to do a 5 - 10% taper off that in the future. I will be on the drugs forever! 

 

I suppose my inquisitive mind got working about these genetic tests. I am so desperate to find any info that might help me recover a little. As it is, my Dr has arranged a whole load of blood tests which do include just basic liver enzymes as you quite rightly said. Thank you for putting me straight on this one. I am sure if anything untoward shows up re the liver further investigations will be necessary.

 

At the moment I don't feel as bad as I did when I first switched over to Ven from Cit. I think taking the Cit now is maybe helping things along although I don't know if Ven and Cit  work the same in the brain.  

 

I hate  taking the Alprazolam because it makes me feel very drugged but am terrified of the shaking getting out of control again. Those good weeks I was able to reduce down on it so maybe the same will happen if I can get to a level to stabilise on Ven.

 

As regards the Ven I had to ask the Dr to give me some ordinary tablets rather than the extended release. I understand one shouldn't cut up the XR pills. The XR  capsules with beads are only available in 37.5 mgs (144 beads)( 1mg would be 4 beads) so would make tapering impossible on low dosage. So, when I take the regular non XR Ven I will take half a dose twice a day. This hopefully will replicate the XR effect!

 

Gosh, this is so complicated for my distressed brain!  Please correct me if I have made any errors with calculations.

 

I appreciate you so much for always making things clearer for me and offering sensible solutions.

 

Flowers xxx

[Flowers]

OK I made up a liquid solution last night and am taking my first this morning. 1 mg of  Ven twice a day reinstated. 

 

 I am only taking a small amount from 37.5 mg pill cut in half = 19mg.

 

Does anyone know if I can keep the solution and for how long to save wastage?

[joy2730]

Decision made - always good.

 

Years ago, when tapering antidepressants was only considered a minority event, I remember reading that Prozac could be diluted in water or fruit juice and kept covered in the fridge for a week, but that was a long time ago.  It may have been discovered that the solution would loose some of its efficacy doing that, perhaps a moderator can let us have more information.

 

This small reinstatement may well work.  Yesterday when I accidently dropped 4 drops of citalopram I could feel the difference.

 

It may just take the edge off the withdrawal symptoms.

 

You do not have to answer this, how is your diarrhoea - my constipation would love to be diarrhoea

 

I am very interested to know if your small reinstatement helps, as when I get ill with citalopram I never do small reinstatements, I panic and go back to 20mg straight away.

 

Keep us all informed Flowers, this is rotten for you, but useful for the rest of us to follow.  Joy

[joy2730]

I have been reading your posts more carefully Flowers.

 

When I took venlafaxine I was in hospital and didn't have the XR until I got home.  When I was on unextended venlafaxine, the doses were given to me 4 times a day. 

 

Presumably they did this to keep blood levels stable, and then when I went home they gave me XR as they said 4 times a day was too complicated for long term home use.

 

I wonder if taking your ven 4 times a day instead of 2 might makes things more stable in your blood.

 

Again, can a moderator think this one out?  Joy

[Flowers]

Hi Joy

 

It is amazing that you noticed your mistake so quickly. You must be very sensiive to these drugs like me.

 

Tummy issues are still the same unfortunately. Maybe the Ven will help once back in my system. Andy pointed out this might not be for a few days.

 

I think maybe the mods could give me some guidance re keeping the liquid and daily dosages. 

 

Hopefully Andy will read this and offer some advice.

 

Flowers 

[apace41]

Hopefully Andy will read this and offer some advice. 

 

Hi, Flowers.  I'm not following you on what you want advice on.  How long you can keep the mixture?

 

Please clarify and I'll try to help.

 

Best,

 

Andy

[Flowers]

 

Hopefully Andy will read this and offer some advice. 

 

Hi, Flowers.  I'm not following you on what you want advice on.  How long you can keep the mixture?

 

Please clarify and I'll try to help.

 

Best,

 

Andy

 

Hi Andy

 

Sorry - Joy has been giving me info on dosage/storage but we both need clarification from you please.

 

I am using 37.5 normal tablets to take my 1mg x 2 a day from. The tablets are small so  I am cutting them into halves and using water in a syringe to make the  liquid to draw the 1mg from. I will be wasting a lot of medicine if unable to store it. I wondered if you could offer any advice about how long and where the liquid can be stored.

 

Also, Joy mentioned that she was being given dosages of Ven 4 times a day to keep the amount level in her system. I would prefer to take only 2 times a day and am doing this purely because when I came off Ven I was on extended release tablets.

 

I took my first dose this morning and could have sworn 4 hours later my heart rate went up together with anxiety! Of course I am looking very closely for any reaction which is not a good thing!

 

Have you had a chance to practice any mindfulness yet? I really hope it helps you.

 

Thanks for any advice you can give regarding the above.

 

Flowers xxx

[apace41]

Flowers,

 

Have you read our information on tapering Venlafaxine?  My guess is you did a while ago but probably have not gone back recently.  Here is a link for your convenience:

 

http://survivingantidepressants.org/index.php?/topic/272-tips-for-tapering-off-effexor-and-effexor-xr-venlafaxine/

 

It has a ton of information. 

 

Most people need only dose 2x a day but it is definitely a YMMV (your mileage may vary) kind of thing.  If you find yourself going into a symptomatic state, i.e., interdose withdrawal in the benzo world, you might want to try Joy's approach of adding a dose at lunchtime.  

 

As far as how long it lasts the only thing I could find is that we are not sure of the inherent stability of the medicine once it is made so it would be hard to provide any certainty on that front.  Have you considered seeing if a compounding pharmacy might make up a liquid if it isn't too expensive? Then you know what you are getting without concerns.

 

Sorry not to know more, Flowers.  Venlafaxine is kind of foreign to me.

 

Best,

 

Andy 

[Flowers]

Andy - thank you once again for your prompt response.

 

I have read the thread but couldn't find anything regarding storage plus my brain is so befuddled right now I can't make much sense out of anything I have to read.

 

I will look into compounding pharmacies but not sure if they exist either in Spain or where we live - we are kind of out in the sticks!

 

I will see how the twice daily dose goes and possibly take another if I run into problems.

 

Have a good weekend!

 

Flowers xxx

[joy2730]

Hi Flowers, you could always ask at your local chemist, if they can compound, or if they know anyone who does.  Apparently compound pharmacists are trained over and above dispensing pharmacists, but still need a doctor's prescription to work from.

 

I have just read a little of the above link, and it seems ven has a very short half life of 4 hours, yuk. 

 

It seems that people withdraw from the extended release version bead by bead, reminds me of the drop by drop method I am doing at the moment. 

 

Perhaps you need to go back to the XR version and start counting beads out!

 

Joy

[Flowers]

Hi Joy

 

I was counting beads out but 1mg is only 4 beads and when you have to taper down it will become impossible!  So I took the chance to go over to normal tablets and will try taking them twice a day and if that doesn't agree with me take them more often! What a palaver!!

 

I did ask my friendly local chemist this afternoon about compounding pharmacies. The nearest one is an hours drive away and is very expensive so I will just carry on making up the solution and throwing away what I don't use. I have plenty of tablets but just can't stand wasting anything!

 

My next question will be about the benzo I am taking. Because of the shakes I got on the higher dose of Ven I was prescribed Alprazolam on an as needed basis up to 3 x 1mg per day. I have had to use it daily since Feb so it will be 3 months 18 May.As I reduced Ven I was able to take less and now take one dose of .50mg daily. I know nothing about benzos but apparently I have read that  Alprazolam (Xanax) has a very short half life and you only get the benefit of using it for around 5 hours. If I am taking it just once there is a lot of day left when I am not getting any benefit from it. I was wondering if it was a good idea to split the dose over the day to keep it in my system more evenly.  I am still getting the shakes but don't want to increase the benzo!

 

Andy might be able to help me with this or I might go on to the Benzo forum and ask them there.

 

I think if I can sort out the times of administering all these meds  I might get the most out of them!

 

So much to think about ............

 

Flowers xxx

[apace41]

My next question will be about the benzo I am taking. Because of the shakes I got on the higher dose of Ven I was prescribed Alprazolam on an as needed basis up to 3 x 1mg per day. I have had to use it daily since Feb so it will be 3 months 18 May.As I reduced Ven I was able to take less and now take one dose of .50mg daily. I know nothing about benzos but apparently I have read that  Alprazolam (Xanax) has a very short half life and you only get the benefit of using it for around 5 hours. If I am taking it just once there is a lot of day left when I am not getting any benefit from it. I was wondering if it was a good idea to split the dose over the day to keep it in my system more evenly.  I am still getting the shakes but don't want to increase the benzo!

 

Andy might be able to help me with this or I might go on to the Benzo forum and ask them there.

 

Hi, Flowers.  Fortunately for you (and not for me), I have WAY too much familiarity with benzos having been on (and now off) clonazapam bfor a period of 20 years.  

 

Do you find that the shakes come after the 5 hour period or at some other time after it would be reasonable to believe that the Xanax has left your system?  It is VERY common with Xanax and the other short half-life benzos to have what is known as "interdose withdrawal" which is what it sounds like -- you get symptomatic between doses.  If that is the case it would be wise to try splitting the pill in half and taking it in divided doses.

 

This is essentially the same phenomenon we are talking about with the Venlafaxine, i.e., sometimes you can do better dosing more frequently with smaller doses.

 

Hope that helps.

 

Best,

 

Andy

[Flowers]

Andy - you are so on the ball!!! I had just finished writing a huge topic on the Benzo forum as wasn't sure if this was your domain. I am so pleased it is!  

 

I am sorry that you had to learn all about benzos the hard way but you did well to go off after 20 years.

 

I am finding it hard to sleep so have been taking .50 mg at bedtime but waking at 5 - 6 am with no sleep after that. I have like a shaking/jittery feeling in my stomach on waking and then the anxiety is there in bouts  on and off all day. This feels different to a cortisol type awakening.

 

 

I understand where you are coming from with the interdose withdrawal which would lead one to pop another pill to relieve the symptoms. I have no intention of doing this as I am in  enough trouble already but will try spacing the dose out over the day and see if it makes any difference.

 

I have no idea what to put down to what after all the recent changes but am willing to try anything to make things easier on my system and manage symptoms in a more effective way. 

 

I am at last thinking more clearly and wanting to sort the meds out.  Couldn't do it without you though Andy.

 

Thank you.

 

Flowers xxx

[apace41]

I understand where you are coming from with the interdose withdrawal which would lead one to pop another pill to relieve the symptoms. I have no intention of doing this as I am in  enough trouble already but will try spacing the dose out over the day and see if it makes any difference.

 

I would start off with trying .25 at bedtime and then .25 when you awaken.  That might help to spread out the effectiveness of the medicine.  

 

Let's see how that goes and then we can modify as necessary.

 

Best,

 

Andy

[Flowers]

OK Andy -  will do - just off to take my new regime of meds now.  11.15 pm here.

 

 

Flowers 

 

xxx

[Flowers]

Think I got a very slight improvement yesterday spacing out the Xanax and possibly from the tiny amount of Ven I reintroduced. 

 

I slept a lot better last night which always helps.

[joy2730]

Good I am so interested to see if these small tweaks help.

 

I do think spreading the sedative out will help. The whole of the yearsame I took diazepam I had inter dose withdrawal anxiety but it wasn't recognised then by anyone

[apace41]

Think I got a very slight improvement yesterday spacing out the Xanax and possibly from the tiny amount of Ven I reintroduced. 

 

I slept a lot better last night which always helps.

Awesome to hear, Flowers!

 

Here's hoping for more.

 

Best,

 

Andy

[Flowers]

Awesome to hear, Flowers!

 

Here's hoping for more.

 

Best,

 

Andy

Yes, let's hope this trend continues.

 

I have sent Skeeter a drug log of what has been going on with Xanax  since I started 18.2.

 

You are being a great help and support as always so I hope you don't mind me doing this? Don't want to upset my Knight in Shining Armour!

 

Flowers xxxx

[apace41]

Of course not, Flowers! We are a team and all work together. Skeeter is great.

 

Just curious as to what you are looking to find out?

 

Best,

 

Andy

[Flowers]

Well, I wrote to them about splitting doses before you replied to me with your suggestion of twice daily xanax which I have implemented.

 

Skeeter came back and asked for tons of info which I have put on my thread over there.  I have posted  a log I kept of all the drugs and dosages since going over to Ven on 18 Feb. Not very well I might add as am not a computer person!

 

Skeeter wanted to see the Xanax doses I had been taking and for how long and where I am now. 

 

So I think it is a case of them wanting to find out info

 

 

Flowers xxx

[joy2730]

I think you are coping great, it is tragic though that by trying to come off a drug, all these complications can take place - it shouldn't be like this, but we are where we are.

 

My symptoms are all very very mild, but noticeable, so I am documenting for the sake of a record.

[Flowers]

Thanks Joy. I am trying to do  my best to cope but it is hard with my husband being out of action.

 

It's good to keep a record of how you feel. I am doing a really detailed journal now as every day differs! 

 

There was an article in the Guardian UK yesterday that a friend sent me. I posted it on the media site here. It is about us poor people being stuck on long term AD's.

Very interesting read and good that this is being highlighted in the news again.

 

Maybe one day these drug companies will have to create something to fix us - don't think it will be in my lifetime somehow.

 

Flowers xxx

[joy2730]

Hi Flowers

 

I am having a look around for your article, I don't really understand this site properly, but I am interested in reading that.

 

x

[joy2730]

Hi Flowers

 

Just time for this last update.  How are you, are you any more stable as a result of spreading some dosages more evenly throughout the day?

 

I read the Guardian article with great interest, I think it is very relevant to a lot of us and the general public, it makes me think that I will be one that can't get off as I have used antidepressants all my adult life, but will have to settle with a reduced dose, but I can accept that and just be grateful for any slight reduction.

 

I am finding that the more I read about this situation, the more interested I become.

 

It really shouldn't be such a struggle to get off a legal prescription med, more research is definitely needed, there should be something to help those who are really struggling to the point of disability.  But I am not sure there will be much financial incentive to help patients get off a drug, and help to get off will by definition be short term and the profits not so great, unless it was research that was subsidised by the Government. 

 

Hopefully your citalopram is shoring you up enough to enable you to get off the venlafaxine, are you still struggling to make up a liquid dose of venlafaxine?

Are you sleeping?  I slept 9 hours last night, sleeping is something I can do at present so am making the most of it by going to bed early.

Have the dolphins gone - it is colder in Britain today, the washing isn't drying.

[Flowers]

Hi Joy

 

Glad you were interested in the article - I think it is important to get this into the press as much as possible. Did you see the link to post your own experiences?

 

I slept so well last night and was like a zombie until 11am. A friend rang and woke me and I could just about get out of bed to get some coffee! Felt drugged and spaced out all day but some other symptoms are missing. Not so nauseous and off balance. Feeling a little depression today. Everyday is different!

 

I am doing OK making the Ven into a liquid but it only works out to be a very small amount of liquid to take. I think it should just about be getting into my system now. 

 

Dolphins just went cruising  across the bay to the next bay along the coast so were not in sight for long. I love them!

 

 

Flowers xxx

[joy2730]

You sound to me as though you are starting to get a bit better - your small reinstatement might be working and a much better plan than leaping back to 19 mg ven.

 

I didn't see the link to posting own experiences, I tend to skim read, or something distracts me and I start reading again in a different place. I will read it again and think about posting. 

 

Having said that this addiction business to antidepressants is nothing new, people became dependent on MOAIs and then tricyclists, then diazepam (Valium) and now SSRIs.  I remember being prescribed Ativan years ago and was swapped to diazepam as it was thought easier to get off diazepam than Ativan. I remember 3 weeks of sheer hell swapping those over - they were not a direct swap for each other, just like citalopram is not a direct swap for venlafaxine - a lot of gaps are left when drugs are changed and the gaps produce symptoms. 

 

I could write a book - I wish I could start all over again when I was a young girl, I would do everything differently, but I suppose hindsight is a wonderful thing, and there is no point in wishing for the impossible.  I am just grateful all these new ideas are coming to light now, and new concepts such as tapering are being recognised and used more and more.  The internet has helped this a lot. 

 

We will never meet in the flesh, but your experiences of reinstating a small instead of a large amount of ven is really helping shape my thoughts about my previous citalopram reinstatements.  How powerful is that!

 

Joy

[joy2730]

Hi Flowers

 

How are you today, any better in getting rid of the venlafaxine, or at least managing?  Try not to be too concerned about your situation at the moment, you thought you were doing the right thing, turns out it wasn't, but hindsight is a wonderful thing.

 

You have citalopram back on board, that is the most important thing, and it is rescuing you from the withdrawal symptoms.  Hope your husband is managing, it must be hard on the men in our lives to see us held hostage to these situations and to the anxiety/depression that drove us to take them in the first place.

Joy

[Flowers]

Hi! Just an update following reintroducing Venlafaxine a week ago and spreading out the doses of Xanax.

 

 I am now on normal (not extended release) Ven/Effexor and take 1ml every 12 hours.  I take .25mg Xanax every twelve hours. I take 20mgs Citalopram at night.

 

The good effect was evident in a couple of days. The nausea /diarrhea eased off although I still have it occasionally. Shaking has improved. Sleep has improved. I am still getting depression and not feeling interested in much. Everything is an effort! Anxiety is there but the Xanax is easing that. I refuse to take anymore than I need to.

 

Energy is low but I am able to get out most days for a walk in the afternoons. I do things then rest and then do some more and rest.

 

So, if I could just get my mental state into a better frame I would be really happy.  As the time goes on and the stimulating effects of Ven are going I feel the tranquilising effects of the Xanax more. I am fairly wiped out in the mornings.  I am not sure if this is contributing to my low mood. I would love to start tapering the Xanax but feel I need to give more time to gain stability before doing anything drastic.

 

My thanks go out to mods Andy,  Ali, Shep and Skeeter for their continuing support and advice. Also Joy, Frogie and JC and everyone else here who has supported me and I may have forgotten.

 

Bless you all.

 

Flowers xxx

[joy2730]

You are obviously doing much better Flowers, how great, but clearly are not quite 'there' yet.

 

Just enjoy the progress.  You are in a much better position than a few weeks ago.

 

Venlafaxine is very stimulating for many, but not for others, how strange!

 

Keep up the good work, and remember your mainstay of the citalopram will be getting more and more of a foothold in your system, and the full effects of that are probably not yet felt.

 

Joy

[direstraits]

glad to read you seem to be stabilising...hope things get better and better as time goes on.

 

you've really been through the mill!

 

loved reading about the dolphins ! I love being at the ocean.

 

sending much love and healing thoughts.

 

xxx

[Flowers]

You are obviously doing much better Flowers, how great, but clearly are not quite 'there' yet.

 

Just enjoy the progress.  You are in a much better position than a few weeks ago.

 

Venlafaxine is very stimulating for many, but not for others, how strange!

 

Keep up the good work, and remember your mainstay of the citalopram will be getting more and more of a foothold in your system, and the full effects of that are probably not yet felt.

 

Joy

Thanks Joy.

 

I am just taking each day as it comes. Everyday is different and some are better than others. I am nowhere near well yet but any progress is very welcome!

 

Flowers xxx

[Flowers]

glad to read you seem to be stabilising...hope things get better and better as time goes on.

 

you've really been through the mill!

 

loved reading about the dolphins ! I love being at the ocean.

 

sending much love and healing thoughts.

 

xxx

Thank DS

 

Am  trying to focus on the positives and not the negatives! 

 

Hope things are OK with you.

 

Flowers xxx

[apace41]

Good to hear you are stabilizing, Flowers. 

 

Just stay the course for now and hopefully you will continue to strengthen.

 

Best,

 

Andy