Gumboot: Citalopram from 2006 to 2015

[Gumboot]

Hello. I found this site last night and feel I'd like to know what people here think about my experience. So...

 

For many years I've suffered from agoraphobia and panic disorder. Much of that time I've gone without medication for long periods, but in 2006 I saw a new psychiatrist who prescribed me Citalopram, at 10mg daily to begin with but moving up to 20mg shortly after. For a long time I felt it was helping, but more recently I doubted it. I'd miss a day's dose, or a couple of days', and seemed not to feel any different. So at the start of November, I stopped it. It wasn't an actual decision, I just got out of the habit.

 

Not long afterwards my anxiety and depression began to increase. There were very stressful things going on in my life, family illness and other problems, and to be honest it didn't even occur to me for some time that Citalopram withdrawal could be involved - if I was having real problems, and the stuff didn't seem to be doing anything any more...? But on reflection it seemed possible.

 

So I decided to go back on. On New Year's Eve I took a 20mg dose.

 

Within the next couple of days my anxiety increased enormously again and has stayed high since. I wake up feeling sick with panic and can hardly do anything for much of the day. I can't eat a full meal. I can't listen to music or watch TV or read for more than a page or two at a time. I keep thinking how old I am (age 56) and feeling that death is imminent. A couple of times I've broken down in tears. I feel better at night time, almost normal, but I dread the next morning. Could one dose have been that much of a shock to my system?

 

I saw the GP last week and his advice was to go back on again. Frankly I'm afraid. I suggested waiting a couple of weeks to see if I didn't improve, and he agreed that was a compromise. In the days since I have felt slightly better, but only slightly. I go up and down, and the downs feel as if they'll never end.

 

From what I've read here I think going right back on 20mg was a serious mistake. Right now I am inclined to go back on again at a reduced dose, however. At other times I've thought, well I've been off for two months, maybe I'm nearer the end of withdrawal than the beginning and will come out of it soon...? But I don't KNOW, and have found it so hard to get information. And I can't help thinking I was better off on it than I realised.

 

Anyway, thanks for reading.

 

 

[Gumboot]

I realise I haven't put my ID in the thread title, could someone fix it please?

[Fresh]

Hi Gumboot , welcome to the site. As you're finding , there's information here on all aspects of ssri's

and a bunch of people who've been through similar experiences.

 

You're exactly right in your thinking.

After taking citalopram for 9 years , your brain adapted to it. It seemed to "poop out" or stop working. Stopping it at the start of November set off the withdrawal process which you experienced as increasing anxiety and depression.

Then the 20mg dose on Dec.31 was too much after 7 weeks off , and it threw things into a bit more chaos.

 

In spite the 20mg on Dec. 31 , you're still in withdrawal. You've probably read on here that after stopping abruptly , w/d can last for many months , years even. And the symptoms that develop keep changing and fluctuating in intensity.

 

The way to avoid the w/d process is by reinstating - as you say , a very small amount.

Please read "About Reinstating and Stabilizing to Reduce Withdrawal Symptoms" here http://survivingantidepressants.org/index.php?/topic/7562-about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/

 

Also see Tips for tapering Celexa http://survivingantidepressants.org/index.php?/topic/2023-tips-for-tapering-off-celexa-citalopram/?hl=citalopram

and

How to make Liquid from Tablets or Capsules http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/?view=findpost&p=171976&hl=citalopram

 

Use this thread for all your questions/journalling.

 

So pleased you got here at just the right time.

 

Best wishes , Fresh

 

.

[Gumboot]

Thanks, Fresh. I'll be talking to the GP again tomorrow and will see what he says, but will probably go back on afterwards in any case.

[Fresh]

Goodo. Your doctor may try to tell you that 10mg is the lowest therapeutic dose. We know that's not the case. You might want to consider starting at 1 or 2 mg. The lower the dose you can stabilize on , the better for your health and for tapering off when the time comes.

The idea of starting low is to avoid the type of adverse reaction you had to 20mg.

[Gumboot]

Well, I'm back on... at 10mg. I suggested a lower dose to the GP, but didn't feel equal to arguing with him. However, it's nearly 24 hours since my first reinstated dose and I don't feel as bad as I did after the 20mg.

 

Still tired and weak - which must be largely down to lack of food, as I can hardly eat at all till around midday. When I eat I get more enjoyment out of things I wouldn't usually have, for instance nuts or juice. Things I've always enjoyed seem tasteless, I can hardly swallow them.

 

A striking change, to me, is that I'm hardly getting any spells of depersonalisation or derealisation. For a long time that's been the panic symptom I found hardest to cope with, the feeling of strangeness within my own thoughts. At present I hardly seem to have an interior life, I don't daydream or fantasise, I have no plans for the future. This isn't a benefit since it means my mind can't get away from thinking all the time about anxiety and illness. When the panic comes on it feels inescapable. I sweat, my stomach churns, I retch and all but vomit - which seems to bring the physical symptoms to a climax, after which they recede for a while.

 

Oh well, that's day one.

[bubble]

If this proves too much for you, you can make a liquid suspension to get as small a dose as you want.

 

You don't need your GP for that. Or you can even cut the pill in half for a start.

[Gumboot]

Right now I'm willing to see how it goes, at least. I have got a pill cutter and a couple of boxes of 20mg tabs to practise on...

[Fresh]

Let us know how you're doing Gumboot. You should find a noticeable lessening of symptoms over the next

days and weeks.

[Gumboot]

Hope so Fresh. It's morning here and I'm feeling pretty bad, shivers, stomach turning. I feel like getting back into bed and seeking oblivion.

[Fresh]

Hot tea , or hot water with apple cider vinegar and honey , and a warm bath or shower , and you'll feel a million bucks.

 

Go back to bed and snuggle down if that's what will help you feel better at the moment.  Be gentle.  

And remember to eat a little every few hours , even if you don't feel like it.

[Gumboot]

Just past 4 am. I've got a bad headache and am sweating, but seem to feel less anxious for the moment. 

[Songbird]

I think you've done the right thing by reinstating, as you haven't been off all that long and if you can restabilise you won't have to go through the long-term effects of a cold turkey w/d.  The aim now is to get stable, by keeping a consistent daily dose and allowing time for things to settle down.  Hopefully things will gradually settle down for you over the next few weeks.

 

Relaxation exercises and/or gentle yoga can be helpful for anxiety/panic. Also many people find the books/recordings by Dr. Claire Weekes helpful.  Be very gentle with your nervous system, avoiding stimulants such as caffeine, alcohol, scary movies, etc.

 

Try to eat whatever you can manage, little and often is the best way as Fresh said.  I've had phases of getting by on tinned spaghetti, other times when all I could eat at a meal was one boiled egg.  Try to find things you can face eating and don't worry about having the perfect diet for now.  Many people find ginger quite good for nausea and stomach aches (e.g. ginger tea, ginger ale, crystallised ginger, etc).

 

Hope you get lots of improvement soon!

[Gumboot]

Taken 5 doses now, each at 10 pm. Rough night, no headache unlike the previous couple of nights but kept waking up in a panic, dreading the morning. Managed to shave today for the first time in four or five days, had tea and an oatcake for breakfast. 

[Songbird]

Sounds like a bit of improvement - no headache, shaving and breakfast.  Oatcake sounds good!  Oats are supposed to be calming.  I'd recommend decaffeinated tea while your system is sensitive and you're experiencing anxiety.

[Gumboot]

Thanks Songbird. It's 6:30 am now, again I've been sleeping for a while then waking up anxious. Can't get a long sleep.

[Gumboot]

Breakfasted today on tea and a sausage roll, not great I know! But I do seem to be getting some appetite back. Still agitated on waking up.

[Fresh]

It does sound like you're getting just a little better each day , and that's wonderful.

It's going to be slow , but you're on an upwards trajectory.

The panic and other symptoms will get less intense , and your sleep will improve.

 

Keep eating Gumboot , you need all the nutrients you can manage.

 

[Gumboot]

Didn't get much sleep last night, though that wasn't because of medication but other things disturbing me.

 

I've had breakfast this morning. Yesterday (Thursday) I actually felt more normal than for weeks past, able to get on with a few things. Still not eating a lot, but not weak with hunger as I was. It's been a couple of days since the anxiety made me dry heave.

[Fresh]

That's what we like to hear ,  little improvements lead to big improvements.

 

[Gumboot]

Hi Fresh. I'm still physically better but yesterday and today have been much more anxious again.

[Fresh]

See The Windows and Waves Pattern of Stabilization here  http://survivingantidepressants.org/index.php?/topic/82-the-windows-and-waves-pattern-of-stabilization/

 

It's almost like one step forward , two steps back.  Your sleep will improve , then your nausea might increase. Then that settles

and your anxiety ramps up.  Then you feel more calm , but the insomnia might come back!

 

Just go with it , because this process is unpredictable.  So long as there's overall improvement week to week , you know you're getting back to normal.   

[Songbird]

It's normal for things to be up and down for a while day by day.  It sounds like things are improving overall.

[Gumboot]

Still very anxious. Also sweating a lot and trembling, like a panic attack ramping up but not coming to a climax. I wish it would.

[Gumboot]

Took dose 15 at 10 pm, about half an hour ago now. When I reinstated I decided to take it at night, to see if that made any difference but also because I generally feel not so bad later on and that would help me to take it consistently.

 

Anxious again today, and sweating to the point where I worried about dehydration. (And occasionally wondered if this couldn't be some organic illness.) Dry heaved a few times, which I thought and hoped had stopped. Appetite less, but I am still getting more to eat than a week or two ago.

[Songbird]

Getting more to eat is good.  Hang in there, Gumboot.

[Gumboot]

A question just occurred to me. As said in my top post, shortly after I stopped the 20mg some highly stressful things happened, which I at first thought were the whole cause of my increased anxiety. I don't think so now - but could it be that external stress triggered the withdrawal symptoms, or increased them to some extent? In other words, if everything was going along reasonably well would it be possible to stop with less or even no discomfort? I wonder.

[Songbird]

could it be that external stress triggered the withdrawal symptoms, or increased them to some extent?

 

I believe stress can be a significant factor in w/d.  I think w/d can make us a lot less resilient to stress, because the nervous system has become much more sensitive, so when we are put under a lot of stress, we can crash, or an existing w/d condition can be hugely exacerbated.  I'm not convinced that avoiding stress would allow us to simply stop with no w/d symptoms at all.

[Gumboot]

In a less stressful situation I might at least have connected my feelings with withdrawal sooner! Actually the problems we were having before Christmas have eased, more or less, so that's something.

 

Still have a flood of anxiety when it's time to get up. Also still troubled by the sense of having no inner life, not being able to distract myself. It makes the days seem so long and empty.

[Fresh]

Yup , I agree Gumboot.    

In Stuart Shipko's latest paper he talks about stressful events as a trigger for people even after stopping medications.

It stands to reason , external stressors will aggravate stability and delay healing.

 

Making plans like going out for a short walk each day have been shown to facilitate healing.  It's hard , 

but we all need some sort of structure in our day.

Even a daily shower is important - try to keep things as normal as possible.

[Gumboot]

Yes, keeping up my everyday habits is a help.

 

I was thinking, those two symptoms of morning panic and a lack of "interiority" really didn't come on till I took that one 20 mg dose on Dec 31. Before that I could wake up early and get a few things done before it got light and enjoy the feeling. What happened?

[KarenB]

My guess is that the 20mg you took was like the straw that broke the camel's back, and it got your central nervous system really spinning.  A destabilised CNS doesn't regulate cortisol as well, and so where you would normally get enough cortisol in the morning to wake you up and get you going, you now get way too much cortisol.  It ramps up w/d symptoms and so you feel a lot worse at that time.

[Fresh]

Any changes Gumboot?   I'm checking up on you  .

[Gumboot]

Thanks Fresh! I'm not having a very good day today, to be honest. Woke up at 6 am with a panic that has stayed with me. I think I've continued to feel physically more stable, but am still struggling with anxiety and with a sense of having lost my bearings. I can't get back into old habits without making a conscious effort, and often feel strange and out of place when I try. It gets a bit better at night, in fact my most peaceful time lately is bedtime, oddly. Next morning seems a long time off.

[Fresh]

Yes ,  this is a time for trying to fill time with anything that distracts you.  Just to fill in time while you recover.

There are loads of suggestions in the Symptoms and Self Care section.

Have you tried listening to relaxation / meditation tracks?    A short Tai Chi session?   You may find something

that really resonates.  Any new skills for handling anxiety now will stand you in good stead for the future.

 

This is also a time for focussing on nutrition - your body needs all the goodies it can get.

[Gumboot]

I made a post here last night but somehow it's disappeared...? I've had a mixed day, again woke up early and full of anxiety. In my lost post I wondered if it wouldn't be better to just get up and take the bull by the horns rather than wait uneasily till it's getting-up time, but this morning I didn't act on that. This afternoon I got outdoors and exerted myself a bit and I'm sure that was positive, but the anxiety has come back. I just try and get through it and do what needs to be done.