Mrs Scottly9999 : 60mg Citalopram and 200mg Tramadol HELP!

[scottly9999]

Hello Friendly people!

 

I just wanted to put this out there and ask for some advice on behalf of my lovely wife.

 

Very quick history of her.

SHe has suffered quite bad depression a lot of her earlier life.

She lost both parents by age of 16, and fell into deep depression.

By age 21 or so, she got herself together, got a job and started in a positive direction.

After her first marriage breakup, she went on 20mg of Citalopram, around year 2000.

I entered her life a little after this.

We moved out to Australia 2004.

I can't quite remember the situation, but she started getting depressed again, and went to a helpful doctor (ironically the same one that put me on Lexapro!!!)

She put her dose upto 40mg.

That seemed to help her.

After the birth of our daughter, she has had chronic back pain.  It's been 9 years now, and has slowly got worse and worse.

After MRI scans showed inconclusive information, but various issues, she was put on 200mg of slow release Tramadol to help manage the pain.

It does help her.

She was also put upto 60mg of Citalopram!  I beleive she was hitting "poop out" at 40mg, and was becoming more and more depressed more often.

 

I understand the maximum dose is 40mg.

She was advised to be tested for liver issues occassionally.

So far, her blood tests have been fine.

She suffers TERRIBLLY with side effects, night sweats, fatigue etc.

 

I also understand that Tramadol also acts as an SSRI!!!

So she is not only over the 40mg of Citalopram, but added 200mg Tramadol!!!

 

I fear that this situation isn't ideal and really needs to be addressed.

 

The GP's she has seen in the meantime give mixed messages about what to do.

 

If she lowers the dose to 100mg of Tramadol, she finds her back pain ALMOST unbearable.

 

She tried to lower her Citalopram to 50mg - by the 5th week she went into a VERY VERY deep depression, and immediately went back to 60mg, suffering with side effects.

She was fine for a good 4 weeks.  But 5th week hit her hard!

 

I fear that her dose is far too high.

Can she titrate to a different SSRI?

Is this something that can be done quite safely?  Can it be titrated to minimize side effects?

 

I'm very upset at the GP that put her on both Tramadol and the high level of Citalopram - she but me on Lexapro - which I'm still struggling to get off.

 

From a personal perspective, she is in a good place emotionally in her life, and recently discovered extra happiness through joining a church.

 

She feels trapped on her current medication, but the dose cannot stay that way.

She says she read something that said she can't swap SSRI's.  SHe is a bit reluctant to delve into this herself.

Even the pharmasist approached her and said that the combination she was taking, and the amount wasn't good for her heart or liver.

 

Any advise?

 

We are in Australia.

 

[Fresh]

I put citalopram and tramadol into the drug interaction checker at www.drugs.com , and they have a serious major interaction. 

 

Some of the symptoms she is having may well be indicative of serotonin syndrome.

 

Decreasing citalopram from 60 to 50mg is almost double what this site recommends as safe.

 

I'm sure others will be along to make suggestions or comment on her best move from here.

 

[mammaP]

Hi Scottly, welcome to your wife, I'm sure she will be reading this along with you. Your wife is in the same situation as I was in, taking both effexor and tramadol which should never be prescribed together.  As your wife needs the tramadol for the pain it would be best to taper the citalopram.  If she tapers slowly and carefully she could start to feel better as the dose lowers, that is what happened for me, side effects are dose related, and depression is a side effect of anti depressants! 

 

We advise tapering no more than 10% of the current dose with 4 weeks between cuts. At 60mg that would be an initial cut of 6mg, if you are splitting pills it will be easier to cut by 5 mg for the first cut.  Citalopram is also  available in a liquid, or you can make a liquid easily from tablets. See tapering citalopram for details.....

 

http://survivingantidepressants.org/index.php?/topic/2023-tips-for-tapering-off-celexa-citalopram/page__pid__19887#entry19887it includes links to making your own solution for tapering.  Your wife may find that her pain reduces as she tapers, pain is a side effect too! 

 

We don't recommend switching drugs, it's better to taper from the one you are taking to avoid further problems. 

[scottly9999]

Thanks for the suggestions so far guys.

I think with my knowledge of what to expect in a taper, I get hit with EXCEPTIONALLY strong waves of fierce depression for 2-3 weeks about 4-5 weeks into my taper... but it passed.

and If I'm there for her, it'll help her to get through that nasty patch.

[mammaP]

If she feels withdrawal it means the cuts are too big, some mild withdrawal for a few days after a cut is normal but any more means they are too big, if that happens then just make the following cuts smaller. A micro taper might be better if there are any symptoms. , it's smaller cuts but more often. I wish I had done this with my taper!  http://survivingantidepressants.org/index.php?/topic/2878-micro-taper-instead-of-10-or-5-decreases/

[scottly9999]

Hi Guys - thanks for the advice.

All good.

 

I was also wondering, how she could maybe transfer to another brand or similar?  

 

I'm worried about the high dose she's on and pooping out again.

I understand (having read an awful lot myself) that it's a bit of pot luck and she might end up on the "med-go-round".  She does say that being on Citalopram has definitely helped her for sure.

[Altostrata]

Sorry, we can't advise on drug switches for the purpose of fine-tuning a cocktail.

[scottly9999]

Hi Altastrata.

 

Sorry - I didn't mean to offend or break any rules.

I guess I'm after other people's experiences of a similar situation.

[Altostrata]

No offense taken. We simply can't advise on that.

 

She is in a pickle, though. It's not good to stay in a state of adverse drug reactions.

 

Please see Tips for tapering off Celexa (citalopram)