Stone: Tapering problem - please help - a bit urgent

[stone]

Hi, I wish I had found this site and learned of the 10% rule earlier...though I did taper very slowly I did it all wrong and probably stayed on certain doses too long and moved too fast at other times.

 

I was prescribed 20mg of Citalopram many years ago (about 20 years ago, the drug had only just come out) and started tapering a couple of years ago (I am not sure when I started), I did go slow but I didn;t do the 10% thing because I didn't know about it. 

 

Up until a few weeks ago I was taking 2.5mg every other day, then I just stopped, thinking 2.5mg every other day was basically nothing and I would be fine but I seem to have crashed into a very bad depression. This is not like the withdrawal symptoms I had when tapering over the last couple of years (brain-zaps, feeling weird) it is a feeling of over-whelming depression. I have not felt depressed during the tapering until recently.

 

So, my last 2.5mg was 3 weeks ago. Should I go back on 2.5mg every other day like I was? Or is it better now to just wait and hope this goes away?

[bubble]

Hello Stone and welocme to SA,

 

I have moved your post here from Tapering section to be your introductory post. You can post all your questions here.

 

Alternating doses is a particularly bad way of reducing or better to say messing up with the drug and 2.5 mg is not a small dose. On the contrary, people have most difficulties at low doses.

 

I would go back to 1 mg asap every day at the same time and wait there to stabilise. After 3 weeks your brain has alerady done some adjustments which might make 2.5 mg too much now.

 

 This thread will give you the rationale behind the advice I'm offering together with more detailed explanation:

 

http://survivingantidepressants.org/index.php?/topic/7562-about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms.

 

If you need advice on how to get at 1 mg of Citalopram you will find it here:

http://survivingantidepressants.org/index.php?/topic/2023-tips-for-tapering-off-celexa-citalopram/

 

If you have any questions, please post them here. ​

 

This thread explains the importance of going extra carefully at low doses: ​

http://survivingantidepressants.org/index.php?/topic/6036-why-taper-paper-demonstrates-importance-of-gradual-change-in-plasma-concentration/

 

It would be also helpful to add your drug history in your signature.That way we can see at a glance all the information we need to make suggestions.

 

 Please put your withdrawal history in your signature

 

Let us know how you are doing.

 

Best,

 

Bubble

[stone]

Thanks Bubble, and thanks for the links, I have already been reading quite a lot on the forum this morning and it's very helpful and I wish I had found it a couple of years ago when I started tapering. I think your advice is right.

 

I had already cut a 10mg tablet into 8ths this morning after I posted and I took an 8th, that would be 1.25mg if I had cut it perfectly which I didn't because it's not possible.

 

I will do the liquid suspension thing from now on and take 1mg a day.

 

I will do the signature thing later.

 

It has been a horrendous couple of weeks.

 

Thanks again.

[bubble]

20 years is a lot and your brain has changed around the drug. I'm on a similar, "improved" combination which I also dropped at 2.5 mg so I can imagine how you are feeling at the moment.

 

Reinstating immediately stopped things from getting worse for me and then it took a few months to slowly climb up and out of the whole...

 

Just be very gentle with yourself and arm yourself with a lot of patience.

[DavidStone]

I'm a novice myself add recovery and still trying to educate myself. I can't give sound advice like many others here but...welcome! You've found a good community to be part of during this time. Others will no doubt reply to your post with practical steps to take.

 

You'll be okay.

[stone]

Thanks Bubble, yes this is absolutely horrible. I feel optimistic that this feeling is due to the withdrawal symptoms and I will be ok, that it won't last. It has actually been two weeks since I stopped taking them and not three, like I thought so that is probably a good thing. It's good to know you did something similar and how it went for you, thank you.

 

Thanks for the welcome and re-assurance David.

 

I will let you all know how I get on. 

[oskcajga]

Hi, I wish I had found this site and learned of the 10% rule earlier...though I did taper very slowly I did it all wrong and probably stayed on certain doses too long and moved too fast at other times.

 

I was prescribed 20mg of Citalopram many years ago (about 20 years ago, the drug had only just come out) and started tapering a couple of years ago (I am not sure when I started), I did go slow but I didn;t do the 10% thing because I didn't know about it. 

 

Up until a few weeks ago I was taking 2.5mg every other day, then I just stopped, thinking 2.5mg every other day was basically nothing and I would be fine but I seem to have crashed into a very bad depression. This is not like the withdrawal symptoms I had when tapering over the last couple of years (brain-zaps, feeling weird) it is a feeling of over-whelming depression. I have not felt depressed during the tapering until recently.

 

So, my last 2.5mg was 3 weeks ago. Should I go back on 2.5mg every other day like I was? Or is it better now to just wait and hope this goes away?

 

Thanks Bubble, and thanks for the links, I have already been reading quite a lot on the forum this morning and it's very helpful and I wish I had found it a couple of years ago when I started tapering. I think your advice is right.

 

I had already cut a 10mg tablet into 8ths this morning after I posted and I took an 8th, that would be 1.25mg if I had cut it perfectly which I didn't because it's not possible.

 

I will do the liquid suspension thing from now on and take 1mg a day.

 

I will do the signature thing later.

 

It has been a horrendous couple of weeks.

 

Thanks again.

 

A 1mg a day dose seems like a good idea to try.  It sounds like you've avoided the more catastrophic peripheral and autonomic nerve damage, organ damage, and brain damage that many members on here have experienced, so you should probably consider yourself fortunate.  It's very likely that you WILL experience rebound depression as your brain adapts to the lack of this drug in your system.

 

There's not much other than a small reinstatement that can be done to remedy this situation - but keep in mind that MOST if not ALL depressions last no more than 6-9 months, and correct themselves spontaneously. 

[stone]

Hi Silver star "peripheral and autonomic nerve damage, organ damage, and brain damage that many members on here have experienced" what, really? I didn't know it could be that bad!

 

I am still pretty bad today but I still have an underlying feeling that it will pass and am grateful I realised what was happening.

[bubble]

I don't realyl know in what meaning Oskcajga uses the word damage but I wouldn't worry about that.

 

These drugs cause changes but they are reversible thanks to neuroplasticity.

 

It takes 4 days for the drug to register in the system but when I reinstated I had that feeling as if a cart stopped speeding down a steep slope and remained precariously suspended. Only after a while I began feeling that things are moving up.

 

It's a very good sign that there was no bad reaction, that things seem to have levelled out and that you even have this feeling it will pass.

 

Did you figure out how to make 1 mg precisely? You might have to updose (after 20 years 1 mg might not be enough). But we will see about that.

 

Signature would be very helpful when you can do it: Please put your withdrawal history in your signature

 

Keep us posted.  

[oskcajga]

Hi Silver star "peripheral and autonomic nerve damage, organ damage, and brain damage that many members on here have experienced" what, really? I didn't know it could be that bad!

 

I am still pretty bad today but I still have an underlying feeling that it will pass and am grateful I realised what was happening.

 

It can certainly be that bad, you are very fortunate.  Damage vs. change is just a difference of rhetoric, damage can mean anything that disrupts a normally functioning nervous system - as can change.

 

Based on the symptoms that you are describing, I have no doubt that you'll experience a 100% recovery.

 

Stay in touch and let us know how you do - it's always heartwarming to learn that a life has been spared the immeasurable suffering that some can attain from these medications.

[brassmonkey]

Giving opinions or offering advice is a very tricky business, one that must be handled with great delicacy and consideration before the post button is pushed.  Firstly there is the matter of giving accurate information. If the statement is identified as an opinion the accuracy will be viewed as less important, even though it's not.  If given as advise then the information must be a s accurate as possible, checked and checked again.  Even though none of us are medical practitioners, what we are saying is often taken as medical truth.  This goes for members as well as moderators.

 

Secondly, how we say something is as important if not more so than what we are saying.  There are several factors that need to be kept in mind. 

 

1. The people we are talking to are usually scared out of their minds, which will cause them to latch onto any negative reinforcement they can see.

2. Most of the people here are not in their right minds in the first place.  They are suffering allsorts of cognitive problems, language and comprehension being two major problem places. 

3. For the majority of people here, English is not their primary language.  They will not be familiar with the idioms and nuances of a very difficult language, and many will be using computer based translators which understand even less. 

4. The person we are speaking to is not the only one reading the post.  At any given time there are 4-10 times as many visitors reading these pages as there are members.  So we are speaking to them also when ever we post.

 

Keeping this in mind we have to write our posts in a manner that will convey the correct information in a manner that is not sensationalistic, in as clear and succinct wording as possible.

[stone]

I don't realyl know in what meaning Oskcajga uses the word damage but I wouldn't worry about that.

 

These drugs cause changes but they are reversible thanks to neuroplasticity.

 

It takes 4 days for the drug to register in the system but when I reinstated I had that feeling as if a cart stopped speeding down a steep slope and remained precariously suspended. Only after a while I began feeling that things are moving up.

 

It's a very good sign that there was no bad reaction, that things seem to have levelled out and that you even have this feeling it will pass.

 

Did you figure out how to make 1 mg precisely? You might have to updose (after 20 years 1 mg might not be enough). But we will see about that.

 

Signature would be very helpful when you can do it: Please put your withdrawal history in your signature

 

Keep us posted.  

 

 

For the 1mg I will be using the liquid suspension method, I have 10mg tablets so that should be fairly easy. Mix 10mg tablet with 100ml of water, take 10ml of the suspension = 1mg of Citalopram. I have just been taking the 8th's of the 10mg tablet for the last couple of days. I haven't been able to think or go out and buy an oral syringe or anything yet, felt too depressed/weird to leave the house.

 

I will read up on the liquid suspension process before I do it, I really haven't been able to function or think or properly yet and I think taking the 8ths (1.25mg) though not exactly accurate is good enough for now.

[bubble]

That sounds right.

 

(My math skills are underdeveloped so I go with 1:1, 10 mg in 10 ml.) But with such a small dose as yours, your method sounds better.

 

When we traumatise our CNS by forecefully removing a drug from it (that's what I imagine fast taper feels on the brain), nothing we do will make the symptoms go away instantly. The brain has to repair itself and that takes time. Even if we feel the tiniest of relieves, it's a bonus.

 

take your time. It will get better.

[Petunia]

 

 I haven't been able to think or go out and buy an oral syringe or anything yet, felt too depressed/weird to leave the house.

 

 

If you wanted to, you could order some online, here is a site in the UK that delivers:

 

http://www.expresschemist.co.uk/Oral-Syringes.html

[stone]

Thanks Bubble, I think it is slowly improving. I wasn't expecting it to be like that, it was awful. 

 

Thanks Petunia, I have ordered some off Ebay and have my eye on a 100ml measuring cylinder on Amazon.

[KarenB]

Hello Stone,

 

So glad you've found this site.  I am fairly new here too and wanted to share the image that has been the most helpful to me. 

 

I can't find the origianl post, but I know it was one of the seasoned people here who wrote it - perhaps Rhi or Petunia??  It was about the brain being like a garden and the anti-depressants being like a trellis.  If you decide to take that trellis out of the garden, you have to go slow and careful of each precious plant.  Ease the trellis out bit by bit, and allow the garden to settle as you do so.  Let the plants find their own strength again, and how they function naturally - they will do it!

 

Take care of you,

Karen

PS if anyone does know where that post is, perhaps they can chime in? 

[stone]

Thanks KarenB.

 

I had spent a long time getting down to 2.5mg every other day, I had been very careful really, though I wasn't aware of the 10% thing....but boy did I make a mistake thinking 2.5mg every other day was a low enough amount to just stop from! It really does get harder the closer to the end of weaning you are.

 

Just wanted to update that I am still doing better, still cutting the 10mg tablets into 8ths and will be doing that for at least a month or two before I start the 10% reduction method. Does that sound reasonable, to stay on this dose for two months?

[stone]

Hi everyone, I stayed on 1.25mg for the last month or so but have found the last month and particularly two weeks I have been very depressed (I seemed to recover from the few days I missed and level off and this is more recent).

 

Two days ago I felt so badly depressed I decided I would start taking 20mg of Fluoxetine, I took the same today too. Yesterday I felt weird and today I have a splitting headache, so I am pretty sure I am starting to get side effects already).

 

Now I don't know what to do, I suppose it would make more sense to go back to 2.5mg of Citalopram than do what I did but I was so depressed I suppose I thought I needed to just go back on a "therapeutic dose" and given that I have seen Prozac work for my Mother when Citalopram and Sertraline didn't, I asked for Prozac/Fluoxetine.

 

This is going to sound stupid but despite the side-effects I already feel a bit better (placebo probably) and the thought of going back to how I have felt the last few weeks is a scary one. Despite all my good reasons to not want to be taking anti-depressants I want to believe they will work for me because I feel so awful.

 

I suppose I am asking for input but I don;t exactly know what I am asking or what anyone could say. I am overwhelmed and not feeling very logical so please forgive me.

 

I feel like 20mg of Fluoxetine is too much (side effects already), I could take 10mg instead, see how that goes for 6 months or something, or go back to a higher dose of Citalopram?

[KarenB]

Hello Stone,

 

It looks like you are having adverse reactions to the Fluoxetine.  One of the mods will be able to better advise what to do about that.

 

I'd like to share what I wish somebody told me years ago, which is not to get drawn in to trying to find 'the one that will work.'  Because once we start switching meds and doses we increase our sensitivity to SSRIs, are morely likely to get worse adverse reactions, and therefore need to (eventually) taper even more slowly.  Better to get out with the minimum damage possible. 

 

I realise you are in a really horrible place, and desparate for some relief.  I had to learn the hard way that the surest way to lasting relief is to stop trying new SSRIs, and start gently tapering.  Yes, it involves a very uncomfortable length of time, but in the long run it is a less painful path.  This site exists to help the many people who have discovered that drugs are not the long-term answer, and I hope you are able to find other ways here to relieve or manage your depression. 

 

I've struggled with depression my whole life, and in that time my 5-year-blip on anti-depressants has been the worst by far.  I hope this and others' experiences here will help you see another way through.  You don't deserve to be in this mess.

 

Karen

[stone]

Hi Karen and thanks. 

 

It was a big decision, after spending years weaning from Citalopram with all the side-effects that involved after being on them for 20 years and one I am still not sure about. It's a huge U-turn, I know. I am still not convinced about anti-depressants efficacy etc...but am so desperate I want to believe they work, even though I still have all the same knowledge and beliefs that caused me to start weaning in the first place. I still don't think I should have been left on them for 20 years in the first place. It is quite possible my brain chemistry has been altered in a big way.

 

I am just so desperate that I feel I need "something". I have a physical illness that keeps me mostly housebound so I can't do any of the other things that help depression. I can't go for a walk, can't keep busy etc. I am so overwhelmed I can't meditate or do the stuff that helps me.

 

I have decided to take 10mg and not 20mg in the hopes of lessening the side-effects, stay on that for 6 months and see what to do then. I will probably wean then and do it right this time, 10% a month.

 

I know it all must sound contradictory and it feels contradictory but the thought of carrying on as I have been (with the suicidal thoughts, intrusive thoughts, crying, inability to cope etc) is a worse prospect right now than the thought of taking AD's again.

 

I could have gone back to a higher dose of Citalopram again, and maybe should have done that instead. I suppose I just want to believe that this is worth trying. 

[stone]

Maybe I should go back to 2.5mg Citalopram, is it too late to stop the Fluoxetine?

 

So messed up about trying to decide what is the best thing to do. 

[DaddyCee]

Hi Stone,  When I first came off from Escitalopram I found this organisation to be good to talk to http://www.citawithdrawal.org.uk/

 

You can do it, may be not at this moment, but you will be meds free as you have the desire to be.

 

Namaste.

[stone]

Hi Stone,  When I first came off from Escitalopram I found this organisation to be good to talk to http://www.citawithdrawal.org.uk/

 

You can do it, may be not at this moment, but you will be meds free as you have the desire to be.

 

Namaste.

 

 

Thanks, as you can see I am vacillating something terrible about this right now. One moment I am sure about my decision and the next I am sure about the opposite. The instant, constant headache, from the moment I took my first Fluoxetine is a factor too.

 

Right this moment I am thinking of going back to maybe 2mg Citalopram, 30 minutes ago I was dead set on giving this 10mg Fluoxetine a go. The more I read the more I want off them.

[stone]

If I am going to go back to weaning from the Citalopram I need to decide now, before I mess with my brain chems any more than I already have. 

[DaddyCee]

Whatever you decide is the best course of action know that brains heal.... the human body has a wonderful way of repairing itself when left to its own devices.

[stone]

Sod it, I am going back to Citalopram weaning, I will raise the dose a little because 1.25mg might have been too much reduction. As we know the last bit is the hardest and I seem to have reacted by deciding to jump back in with another anti-depressant instead of doing the sensible thing and rising my weaning dose.

 

Now I need advice about that please.

 

These 3 days of Fluoxetine worry me but 3 days is nothing in the light of 20 years on Citalopram, it was a bit stupid of me but it shouldn't cause anything long lasting?

 

What dose of Citalopram should I go back to? Given that 1.25mg is too little too soon.

 

(thanks for being reassuring 

DaddyCee )

[bubble]

Hello Stone,

 

I'm sorry you are struggling. These symptoms are so horrible and I completely understand how overwhelmed and scared you are. I've read through your thread again. It seems you were doing a bit better after you reinstated. 

 

When did these symptoms start: suicidal thoughts, intrusive thoughts, crying, inability to cope etc)? Was it after you started with fluoxetine? Now when you started Fluoxetine did you stop taking citalopram altogether? 

 

There are no hard and fast rules as you know well but my personal feeling is to stick with the devil we know (for 20 years). Although bridging with Prozac is a somewhat recognised way of tapering we see that such transitions don't always end well: it seems people still experience withdrawal from one drug while struggling to get used to the other. I just feel that different drugs are just different and cant be replaced so seamlessly. In addition to that in your case 20 mg was obviously too much.

 

If it was me I would stick with citalopram. As you say 3 days is very little compared to 20 years. I would try with 1.5 mg citalopram (going from 1.25 to 2.5 might again be too much).

 

Can you describe your symptoms a bit more? It seems that changing to fluoxitene definitely made them worse. Could it be that the depression that you mention (being more specific would be welcome) was a wave? I have experiences of waves and the experience of a downward spiral  when I felt that I wasn't only feeling horrible but that things were just getting worse without just being bad in a stable way. If that makes sense...

 

Sorry I can't be more helpful. Let us know what you decide and how you feel. Unfortunately as you know there are no quick fixes and there's nothing we can do that will instantly make us better. When I destabilised myself it took me months to start feeling better. Things will get better. It might take longer than you would expect but you have come a long way.

[stone]

Thanks bubble, the real bad symptoms started 2 weeks ago I think, so I was on the 1.25mg Citalopram and had been since the 1st of sept when I reinstated after stopping CT for 10 days. So, I seemed to stabilise for a few weeks after reinstating then crash. It could just be a "wave" like you say, I have always fluctuated and had waves anyway. But this was bad, it was like you describe, not a "copable bad" but a feeling of "on the verge of breaking down" type of thing. It panicked me into deciding to basically stop weaning and start taking ADs again (which was a huge decision given I had been weaning for so long, and have got through many symptoms of withdrawal that were horrible, like de-personalisation and feelings of unreality).

 

I have not felt worse with the Prozac (only been 3 days) I have just had a splitting headache since starting them. I took the Prozac because I felt so bad rather than the Prozac making it worse.

 

Yes, I stopped the Citalopram when I took the Prozac.

 

I have situational reasons for fluctuations in depression, as I mentioned I have a physical illness too, one that limits my activities and keeps me mostly housebound and isolated. Given that I have always had a history of depression and now am dealing with a difficult situation I think it is understandable that I have these "episodes" sometimes. 

 

Strangely, the last day or so I have not been quite as bad, I doubt it's the Prozac, (it would be too soon anyway wouldn't it?) and think it might just be that deciding to take action (even though I think it was the wrong action) was enough to help, which sounds weird I know.

 

Right now I am leaning towards reinstating Citalopram weaning and I was thinking of 1.5mg myself actually. 

 

I have spent the last 3 days vacillating, it's been exhausting. I feel like I have to decide tomorrow, I can't stay on the Prozac without committing to it, 3 days is enough for a wrong decision, if that's what it was.

 

Thanks again bubble and everyone else.

[KarenB]

You're getting there Stone - you're processing heaps of information and getting closer to knowing which way to go.  Don't be alone - keep posting here with what's happening and how you're feeling.  And you are spot on - it is totally understandable that you have waves of depression. 

 

For what its worth (and from my very minimal experience) I agree with bubble about tapering citalopram.  Seems less mucky-aroundy. 

 

Hugs,

Karen

[brassmonkey]

Hi Stone--  Thank you for adding in your signature block it really helps to make things clear.  It was mentioned several weeks ago that alternating days is a very bad way to taper.  Right now you're finding out why.  When you alternate it throws you back and forth between reinstating and CTing and really, really screws with your brain.  You followed that by jumping off at 2.5mg which is way to high a point to jump from, even after a long slow taper.  All of this adds up to giving you a good case withdrawal syndrome, which is why you're feeling so rotten.  Throw another short reinstatement, a CT, another reinstatement and a new drug and your brain is as confused as I am trying to follow it all.  Every time there is a dose change either up or down it takes a minimum of four days for the body to recognize it and then several weeks to several months for it to stabilize.

 

The good news is that it can all be sorted out, but it is going to take some time for it to happen.  First off, ditch the Prozac, from your reaction it's not going to do you any good, and could make things a lot worse.  Secondly, stay put on the 1.25mg of Citalopram till after the new year, maybe longer, to give things time to settle down.  Once things are stable we can talk about planning a microtaper to get you of the last little bit safely.

 

In the meantime check into non drug techniques for handling the depression.  It looks like you know about the wave/window pattern that WD can follow, so you know that even the worst waves are followed by windows.  Right now you're in a bad wave but it will break and things will be better.  Hang in there and roll with it as best as you can.

[KLA324]

Hi Stone - we are in similar situations so I thought I would post to your thread. I feel for you and understand how confusing it can be knowing what to go back on, at what amount, and for how long. I am still in the process of trying to stabilize after a change in meds due to WD and each day is a challenge. Just know there are others out there in the same position and we WILL get thru this!

 

Karen

[Altostrata]

Yes, you could be feeling better because of the Prozac. You may be getting a headache because 20mg is too much; I would reduce it to 10mg, stay on it and give it a good try.

 

Please update your signature with the fluoxetine information.

[stone]

Thanks everyone, last night I was quite set on going back on 1.5mg of Citalopram, this morning I don;t know again.

 

Altostrata, I am surprised by your advice (not saying it's bad or you are wrong) it is different from everyone else and seems different from the ethos of getting off antidepressants that this site has.

 

TBH, it has made me start debating with myself again about what to do. Would you mind explaining why you think it's a good idea to give the Fluoxetine a try at 10mg rather than go back to weaning the Citalopram?

[stone]

OK, I have to decide today and I have decided on going back to weaning off Citalopram. Thanks everyone, I will keep updating my situation.

[stone]

I wanted to say thanks for the input to KarenB, "less mucky around" it is. Brassmonkey, thanks and yes I agree that the alternate day thing followed by CT at 2.5mg was all bad and could well be responsible for the very bad recent depression. And KLA234, thanks and yes we will.

[Altostrata]

How are your withdrawal symptoms today?

 

If the Prozac is working to reduce your withdrawal symptoms, I would stay with the Prozac, at the reduced dose of 10mg. Prozac is very commonly prescribed to "bridge" people off antidepressants.

 

Better to stay with something that's working than to switch around again.

 

I suggest 10mg Prozac because you started at 20mg -- in proportion to the 2.5mg citalopram you'd been taking, that's too high, I would have suggested 2.5mg or 5mg -- making 10mg Prozac a compromise to reduce potential side effects from too high a dose of Prozac.

 

(Dropping from 20mg Prozac to 5mg or 2.5mg at this point might be additionally destabilizing.)

 

It takes at least 4 days for a dosage change to fully register in your system. As you had adverse startup effects (headache, etc.), this could indicate that, as it ramps up, 20mg might bring on worse side effects.

 

Read The Prozac switch or "bridging" with Prozac