Geezer2BNormal - Experiencing extreme depression and anxiety

[Geezer2BNormal]

In reference to my inquiry about what James Heaney(I'm not sure who he is or what qualifies him to make statements in that article regarding SSRI withdrawal), but he was talking about reinstating at a level 10% less per month since one started to taper.  My post above said in that case, my reinstatement should have been at 13 mg or so.  Do you think that is way to high?  I was dropping faster than what my brain was able to accommodate so if I'm back on 5 mg, is my brain expecting a much higher amount?  Will I keep getting withdrawal symptoms until I stabilize at 5 mg?  I find this topic confusing as to what I'm supposed to be doing.  I am going to try to stay at 5 mg. and see how stable I get but can I expect waves and windows at this level before I try to taper down?  

[Geezer2BNormal]

So may I ask who James Heaney is?  In his post on SSRI reinstatement, he suggested reinstating at a level 10% less than your original dose for every month since you started to taper.  Is what he says accurate or not?  The reason I'm asking is I did the math and I should be at 13.1 mg if I had tapered at 10% per month.  I'm now at 5 mg.  Here is how the taper schedule should have been:

 

20 2 18   June 18 1.8 16.2   July 16.2 1.62 14.58   Aug 14.58 1.458 13.122   Sept 13.122 1.3122 11.8098   Oct 11.8098 1.18098 10.62882   Nov 10.62882 1.062882 9.565938   Dec 9.565938 0.956594 8.609344   Jan 8.609344 0.860934 7.74841   Feb 7.74841 0.774841 6.973569   March 6.973569 0.697357 6.276212   April 6.276212 0.627621 5.648591   May 5.648591 0.564859 5.083732  

June

 

So is this schedule out of the question now?  Is reinstating at the higher dosage not a good idea?  What I'm concerned about is if the brain only adjusts to a 10% drop in the drug per month, can I not expect to be stable until next June?  James Heaney said that it was better to not reinstate at to low a level and suffer the withdrawal symptoms than to start higher and just take longer to taper.  Is he incorrect?  I do not want to look forward to a year of waves/windows until my brain acclimates down to 5 mg or is this not the case?  Sorry for the questions but my biggest concern is maintaining stability to keep my job.  If I lose my job because of this, it will be financially devastating since I am the sole bread winner and am nearing retirement.  Finding another job if I lose this one is going to be next to impossible.  

[doggiemama]

Hi Geezer I never reinstated because it was far to late and not understanding what was going on with me but your symptoms sound about right, the same was happening to me.and if you read around the forum its quite normal not great but when we know there are so many suffer the same.GOD BLESS

[AliG]

Geezer. You might be overthinking this.  Stay stable at 5 mg. Keep notes on symptoms and see how you go. It can take a while to stabilize. That is what we are aiming for. 

[brassmonkey]

Hi Geezer-- Many "experts" tend to talk in terms of theory/science/biochemistry and the like and on paper what they say can make a lot of sense. When you get into practical applications it all falls apart. Before I came to SA I was a vary active member of another board frequently referred to here as Prior Place. While there we tried using this approach to reinstatement and it caused a lot of people a lot of unnecessary pain.

 

The thing the paper model doesn't take into account is the sensitization of the nervous system that happens because of the CT/rapid taper that proceeds the reinstatement. During the intervening time between the CT/RT and the reinstatement the brain is in massive confusion trying to figure out how to function without the drug.  It sorts itself out in a very chaotic fashion, but it does make progress.  To dump a large quantity of drugs back on the chaos only adds fuel to the fire and has a very good chance of causing an adverse reaction or tripping off the "kindling Effect" because of the sensitization.  Neither of which I would wish on anybody.  A reinstatement at full dose is frequently possible for a few days to a week or so after a CT/RT.  After that time a very reduced amount is called for.

 

The small doses we recommend for reinstatement have been painfully determined (we are all guinea pigs in learning this process) and have been proven over time to be the most effective and least painful method. 

 

Adjusting a personal dose is a long frustrating process, especially after a RT/CT.  It's only been just over two weeks since you reinstated.  The process is only just now getting started. It took the best part of the first week just for the drug to reach a steady state level in your blood.  Then your brain gets to start figuring out how to react to the drugs presence.  Reaching stability after a reinstatement takes time, some people are lucky and it happens in a few weeks, while some people are not so lucks and it takes a good many months to happen.  There is no way of predicting who is who, but in the end stability does happen.  With any luck you should be feeling some positive effects in the next couple of weeks.

 

Maintaining a job while going through this is a major challenge. I found that the concentration required for work was an excellent distraction from the WD symptoms.  They were still there and had to be worked around and compensated for, but for the most part while at work they slipped into the background. It's one of those cases where there is something more important than WD in ones life and the WD must take a back seat to personal/family survival. It puts us in a very tough spot, but personal survival will prevail if we do what needs to be done. 

[Altostrata]

James Heaney is a smart, insightful person but I don't know of any grounds for his calculations for reinstatement amount. It's his own guess, that's all.

 

I would go by symptoms. What you want to do is take the lowest amount of drug that reduces your symptoms. As I said earlier, the effect can be gradual. You may wish to give it a month or more before you decide to increase the dosage.

 

A higher dosage means more tapering later.

 

On the other hand, if what you want is the numbing effect of the citalopram, you may not want to go off it at all and postpone confronting your psychological issues indefinitely.

[Geezer2BNormal]

AliG/BrassM/Doggiemomma,

 

Thank you for your responses.  I truly appreciate your input and especially the background provided by BrassMonkey.  I had a "stupid" moment of frustration  and took 10 mg yesterday. I wanted to see how I would be and I got a sense of what you were talking about.  I wasn't feeling depressed but was on a hair-trigger agitation-wise.  I was in a highly-elevated state of being on edge the entire day.  It was not a comfortable feeling to say the least so I would agree that 5 mg is where I will stay going forward until I feel that I'm stable enough to try to taper some more.  I'm just getting used to the idea that this is going to be a difficult, long-term process and it just really makes me angry that my doctor had me pull the plug so quickly.  It's amazing how ignorant the medical profession is of the impact of these drugs and what the proper way to withdraw should be.  I just find that mind-boggling. Thanks again for your counsel and advice.  Patience has never been one of my strong points but patience is something I'm going to have to learn going forward.  I agree, working is beneficial to keep the mind focused.  

[Geezer2BNormal]

Altostrata

 

I had not seen your post prior to my previous response.  That's what I thought re: James Heaney.  I could find no information on the man to see if what he said had any legitimacy.  I am going to stick with the 5 mg. going forward and give it time.  Before I went off this medication, I can honestly say that the only issue that I could point to this med was a tendency to have a hard time staying awake after lunch.  Other than that, it kept me on an even keel.  I started taking it because I was just angry all the time and was an irritable SOB to live with.  My doctor suggested that I try an A/D and it did alleviate those problems.  If it was numbing my emotions, I just can't say.  All I know is when I went off this drug, I was nothing but raw emotion on steroids.  My wife is concerned that if I get off the drug I'll be back to being Old Mr. Angry again and man I don't want that.  I should have addressed those issues without relying on some lousy brain-addling drug to do that for me.  20/20 hindsight. Thank you for your insight and advice. 

[Geezer2BNormal]

Just looking for some advice from folks who have either dissolved Celexa pills into a suspension and then took in liquid form or cut up the pills and measured out the powder.  I had to refill my prescription and the mail order outfit changed the manufacturer on me.  The pills are no longer nice and round but are now larger and oblong and much harder to cut up.  I used to be able to quarter a tablet pretty accurately but not now.  The new pills are also 100+ mg larger with filler so I would not feel sure that I was getting an accurate dose just cutting them.  I tried to cut one and the quarters were way off on my scale.  I tried a suspension for one day two weeks ago or so and found it wore off pretty quickly.  I was not feeling to well by the end of the day so I went back to measuring out a 1/4 pill.  The only way to take this current medication dry would be to crush/cut (razor blade) and then measure out a dose using a scale then what?  Transfer it somehow to a gelatin capsule or lick it off weighing paper or something?  For today, I went back to making a suspension and going that route to see how well it works.  I probably have 3 weeks of the old medication left but I think it's smarter to stabilize on the pill that I have a 90 day supply of and more if I can get 3-4 days from the suspension?  I think I should only expect to get 3 doses from one 20 mg pill(5 mg/day) because I would think you'd lose some medication from deterioration or adhering to the bottle.  Not sure on that point.

 

I would appreciate comments from folks who have tried both ways and what they prefer.  Also, does anyone split their liquid dose in the AM and PM to try to alleviate any "fall off" of the drug by the end of the day?  Thanks for any advice you might have.  

[scallywag]

In the first 6 weeks of tapering Cymbalta, I didn't want to fiddle with putting the tapered dose into a gel capsule so I took it with a tablespoon or two of applesauce. Because citalopram (Celexa) can be made into a suspension/liquid, this would probably work with a citalopram crumbs and powder (from cutting a tablet) weighed to achieve the desired dose.

[brassmonkey]

Hi Geezer-- Trying to set up a good system for making up ones doses can be tricky. I have had very good luck with crushing the tablets and weighting the powder. I then put the powder into gel caps to make it easier to take.  Trying to take the plain powder is just nasty, it tastes horrible. Please be careful with making a lot of changes in your dosing method.  Even if you stay on the same dose a change of manufacturer or a change from dry to liquid or liquid to dry counts as a dose change event and calls for a hold period to let the brain stabilize.  Making a number of rapid changes this way can cause a spike in symptoms. O plan would be to "cross taper" between the two brands of tablets to make the change from the old to the new brand.

 

We have a large number of members who split their dose with positive effects.  Part of the dose needs to be moved an hour at a time over the course of several weeks so as to not cause any major upset.

[Geezer2BNormal]

Thank you for your responses. Can you please explain how I would cross taper between two manufacturers of the same drug? What I taper down off the one I had been taking and then taper up using the new one? How would that work?

 

I would prefer to stay on the powder because Liquid Joe's doesn't sit with me very well. I did it today because of the change in drug manufacturer but again I feel out of sorts and down in the dumps. Also when you said that people split their doses that you need to move it an hour at a time through the day? I didn't quite understand that. Does that mean for example I would take two and a half milligrams at 5:30 a.m. then take the other two and a half milligrams at 6:30 a.m. then hold for a week or two? Then move the second dose to 7:30 a.m. and hold for another week or two? If you could please explain that I would really appreciate it as well as tapering between the two drug manufacturers thanks.

[brassmonkey]

For cross tapering two manufacturers you would basically alternate days.  Every other day for several days, every second day for several days, every third day for several days etc. A A B A A B A AB A B A B A B A B B A B B A B B A B B B A B B B A B B B

 

That's the idea on splitting the dose, but you don't need to wait that long between changes, 3 or 4 days should be sufficient.

[Geezer2BNormal]

Has anyone had their pharmaceutical supplier for their medication change and then have see a BIG difference between the two medications?  My mail-order supplier changed to a different supplier for citalopram and I've tried it twice and was planning on tapering in to it but both times I felt very on edge, irritable, more depressed.  Both days were very unpleasant.  Has anyone else experienced this?  Did you stick with the new supplier and how long did it take to adapt?  I'm weighing out the medication so I'm being exact as I can but there is a very big difference between the medications.  That's the problem with generics because their actual dosages can vary and that's what I probably am dealing with.  I don't know if I should back off on the amount I'm taking of the new pill or what?  I think it may actually be stronger because of the way I have felt both days: very on edge, irritable, my found my heart pounding at times, so it sure seems like I was on a higher dose based on what I've read from folks who went  back to too high of a dose to reinstate and then had bad reactions.  If I do back off, then I have no idea what the actual dosage is.  I have another option as well. My doctor gave me a subscription for 10 mg tablets which I can use but, again, it's a different supplier and I tried that one one day and it didn't turn out so well either.  

 

Also, I'm not sure who I should be feeling during reinstatement.  After 2 weeks or so, I was feeling pretty good after I took my medication but now, it seems to be taking longer and longer to feel better during the day and some days are just not good.  I'm 4 weeks into reinstatement so I know I may have a ways to go and this med switch-up isn't helping but should I hopefully be feeling better, not worse?  

[nick1990]

Hey mate. I reduced cit too quick last year and crashed, toughed it out 3 months then updosed to my previous dose. I was very destabilized. Exactly one year on now, I am pretty much back to my old self. It takes time and a great deal of patience and discipline, but if you can hold many months you will re stabilize. Then and only then, do I believe, the taper can be resumed and you can get off these drugs whilst remaining functional. If you taper while your destabilized, you will crash again. Even if its a small/ tiny/ slow taper. Be patient. You'll get there !

[ChessieCat]

Here are a couple of links discussing changing brand:

 

generic-vs-brand-versions-of-antidepressants

 

change-of-the-manufacturer

 

Do you have any of the old ones left?  If you do, or you can get some, you could go back to the original and then do a cross-over.

[Geezer2BNormal]

I have maybe a month's worth of the old ones left. Alto said to taper over to the new ones but I have felt terrible the two times I have taken it. The new one is much bigger so who knows what other chemicals are in it. I was taking an Indian genetic and the new one is too but I can really tell the difference. It's like night and day.

[ChessieCat]

"I have felt terrible the two times I have taken it"

 

So have you done a cross over like Alto suggested and you are now on the new ones and feel terrible?

 

If you did this, how did you cross over?

 

In what way do you feel worse?

 

If you aren't able to get any more of the original drug, is there a different one that you can get instead of the Indian one?  This may be worth trying instead of using the Indian one.  It would at least give you better peace of mind

 

We have recently been able to get a generic Pristiq here in Australia but even though I didn't want Pfizer getting money, I had always been on the brand name and didn't want to risk messing up my taper.

[Geezer2BNormal]

Hi Nick,

 

Thanks for the encouragement.  It's a bit discouraging when I thought I was going to feel normal most of the time, but I'm finding I'm having a hard time doing so, waking up feeling depressed and anxious and my daily Citalopram does doesn't seem to alleviate these horrible thoughts of being an old man and my life being about over.  It's awful and I can't escape it.  It used to wane after an hour or two of taking my daily dose, but it doesn't appear to be working like it did which has me concerned that this reinstatement is going to be successful.  I'll have to ride it out.  I would agree.  Now is not the time to taper off but I'm beginning to wonder if my dose is high enough.

 

ChessieCat,

 

Alto said to start with this type of taper pattern:

 

AABAABABBABB

 

I took the new med on my first "B" alternate day and felt so irritable, on edge, and depressed the entire day.  It was really bad.  A week ago, the only other time I tried this new med is by dissolving in water and using a syringe to measure it out sticking with 5 mg.  I felt really lousy then too and tried to take 1 more mg via liquid, and it made it a lot worse.  I just wanted to curl up in a chair and close my eyes/sleep the rest of the day.  It was terrible.  I'm really uptight about taking it again.  On Saturday, I was careful to measure out 1/4 of the tablet(20 mg/4) and It was not a good day.  I don't know if it's really a matter of tapering it in or this new med is just bad news.  Maybe there is something else in it that is doing this or the dosage is way stronger than what I was taking.  I'm really concerned about this given that I'm not stabile yet and now I have to deal with this. 

[JanCarol]

Hey Geezer - I'm sorry you are going through this, but you're taking a scientific approach.

 

I'm sorry the new drug isn't working.

 

I have one friend here who travels between Australia and New Zealand, and he ensures that he has exactly the same brand for the entire duration of the travel - it's that important.

 

Maybe you need to look at how you are sourcing your drugs, and as Chessie suggested, go to name brand, so that it is the same for the entire time of your taper.  I know it's hard to get a new script when the last one was bad, but this happened to my brother on Lexapro - his insurance would no longer pay for brand name, and he went spare on the generic.  He persisted, and while he has to pay (I think that's how it worked out) for the brand name, at least he's not put through the wringer every time he gets a refill.

 

You've had a few weeks setback with trying liquid, a couple of updoses, changing forms, etc.  Please, find a simple, stable thing that you can stay on for awhile.  The more time spent with trying things, is more time destabilised.  It's really important that you get back to a stable place.

 

I recognize that you didn't intend to try this new generic - but - you need to make a decision quickly, if you cannot take it.  Tell the pharmacist (or was this internet purchase from India?) that this one is hurting you, giving you severe side effects.

 

I hope you see the sun today.  And hello, Chicago! (I'm from Indiana, now living overseas)

[JanCarol]

Hey Geezer, you asked repeatedly about splitting doses.  Sorry I missed that before.

 

It's a mixed bag.

 

Pros:  you don't get spikes from taking one big dose

Cons:  Half life of citalopram is 35 hours, so you should be covered dose to dose

When it comes time to reduce, the maths are more difficult, and you can induce greater sensitivity to each dose change.

 

If it were me, I'd stick with one dose - and work on getting a stable supply of the same drug, with every batch.

[Geezer2BNormal]

Hi JanCarol,

 

It looks like my mail-order provider was able to order me citalopram from the original supplier.  It's in the mail, so I'm hoping that is the case.  I'm just going to stay at my 5 mg. dose and hopefully stabilize.  I'm still having a lot of difficulty with thought about my age and getting old.  Frankly, I'm not sure if it's withdrawal or the fact that the drug kept that tucked away where it didn't affect me.  Now, it's horrible.  I am terrified of getting old and my ultimate demise.  I'm hoping as part of stabilization those those may start to recede.  I just bought a book on minfulness CBT so I'm hoping that may help.  Either way, I did not have these thoughts until I dropped the medication.  I have a history of clinical depression in my family and I can't help but wonder that going off this medication was a bad idea to begin with.  I've had some "depressive" episodes in my life but nothing like this.  It's frightening. 

[direstraits]

you're not alone...I feel terrified of aging and dying...especially since this horrific experience...thought I'd be so much better by now..almost 2 1/2 years off paxil but right now am worse than ever..can hardly get off the couch.

 

still can't believe what these drugs can do to us.

 

hope you can get stable.wish you well.

[Geezer2BNormal]

It has been 6 weeks since I reinstated but I seem to be getting worse not better.  Morning anxiety has been horrible and I'm feeling more and more depressed.  I am managing to make it through the work day but weekends are awful.

 

I have an appointment with a psychiatrist this week to discuss options. His bio states that he is not big on medications but more on alternative treatments.

 

I don't know how much more of this rollercoaster I can stand before I consider trying a different medication. However I have found myself to be extremely sensitive to increased dosages. I've tried bumping my dosage up by one or two milligrams and each time have found it to be extremely stressful and awful. I so strongly don't want to go down the multi-drug route but at this point I don't think this reinstatement is going very well.

 

It's been suggested that I try to give it at least three months but you would think I would be seeing progress not taking steps back. Does anyone know if waves and windows occur during reinstatement? I was only off the drug for 7 weeks and I'm finding it hard to believe that I can't reinstate. I am not having any physical withdrawal symptoms only mental with extreme anxiety and depression.

 

Has anyone ever had success in switching drugs? I'm a bit frightened to try it given that I seem to have become very sensitive to at least citalopram. I would appreciate any insight for those who have tried switching or have had difficulty reinstating citalopram.

Edited October 16, 2016 by ChessieCat
Added paragraphs

[ChessieCat]

"His bio states that he is not big on medications but more on alternative treatments."

 

Alternative treatments may cause issues.  Especially if they are in combination.  I suggest that you post here what is suggested before you take anything so you get others opinions.  Also use google and type in survivingantidepressants.org + topic (eg supplement name/type) to find existing discussions.

 

I would be very cautious if the psychiatrist is selling the treatments because he will be making money from them and would probably be available elsewhere at cheaper price.  Also, I suggest that you ask for specifics about what each thing is for.  If he isn't forthcoming with the information or explain it clearly that would be an alert for me.

 

 

Are you keeping daily notes on symptoms?  Improvement / worsening / staying the same.  Sometimes when we are feeling awful we don't realise that there has been a bit of improvement.  Rate Symptoms Daily to Check Patterns and Progress

 

waking-with-panic-or-anxiety-managing-cortisol-spikes

 

You've been provided a lot of information since arriving at SA.  I suggest you read back your topic from the beginning and re-visit the links given.  Sometimes we miss things the first time around, and sometimes reading something else makes what we read prior to that make more sense because we have additional information.

 

I suggest you re-read these:

 

What should I expect from my doctor about withdrawal symptoms?
How do you talk to a doctor about tapering and withdrawal?

 

Also, have you considered Acupuncture - Posts #6 & #8 (not detox or stimulation).

 

Yoga for calming (very simple poses can help greatly).  JanCarol like the legs up the wall position.
 

[Geezer2BNormal]

Hi,
 
I went to see a psychiatrist on Tuesday and after I ran through my history of depression and alcoholism, he strongly felt that I had been depressed for most of my life and felt that I needed to stay on an antidepressant.  He wanted me to switch to Lexapro which I started to take on Wednesday at 5 mg. He said to stop the citalopram since he felt that 5 mg was not doing me any good.  

 

On Wednesday, I felt great.  I couldn't believe it.  I don't know if out of pure chance I hit a window or what but I thought that maybe this would normalize me.  

 

Every day since then, I have gotten more and more anxious and uptight but did feel somewhat improved over the weekend from what I had felt the previous weekend.  However, this morning, I was very tense and uptight and still am.  I had taken a full mg Lexapro dose yesterday and felt pretty tense for the first couple of hours but felt a bit better as the day went on.  However, this morning is not good at all.  

 

I have not taken any citalopram since Tuesday and don't know if how I feel is the Lexapro or the lack of citalopram.  

 

I don't know whether to keep going on the Lexapro and see if things improve or cease and desist and go back to the 5 mg citalopram.  I was not doing well at 5 mg and had a terrible day of anxiety and feeling quite depressed the day I went to see the psychiatrist so given I felt so much better after taking the first dose of Lexapro gave me a lot of hope that I had turned the corner.  I just don't know what to do now and am just so depressed that there is no way out of this hell hole.

Edited October 25, 2016 by scallywag
add emphasis on medication change + white space added

[scallywag]

It sounds like things weren't going too well for you, Geezer. Going to a psychiatrist and hearing what he said must be at least somewhat discouraging. I'm sorry to read that.

Thanks in advance for understanding my being obtuse in this reply to your recent post. Ok, with that being said, here goes:

It seems to that you have a question. I would like to address your actual question and not the one that I'm guessing you have. If there's something specific -- or more than one thing -- you're asking about, would you post your question(s)?

[Geezer2BNormal]

My question is has anyone that you know of successfully switched from citalopram to lexapro after withdrawing from citalopram?  

 

I was off the drug for 7 weeks and went back on 5 mg for 6 weeks and did not seem to be stabilizing.  I was told it might take 3 months but I would think I would be feeling better not worse if that was the case.  I was shocked to be honest the first day I took 5 mg lexapro last Thursday.  I don't know if I happened to hit a window or what but I had a really good day relatively speaking and thought that I might be able to transition to this drug.  However, it just seems to me that my CNS is still quite sensitive and I cannot take the lexapro.  

 

I had a horrible night's sleep last night and feel completely wired, agitated, tense, you name it.  I'm talking to the psychiatrist today to get his opinion about staying on this or not.  If I listen to my body, I need to stop but then what?  I guess back to 5 mg citalopram to try to stabilize.  

 

I shudder to think if he recommends switching to another medication and then I have to worry about adapting to a new med and weaning myself off the old one.  If I try that route, do I have to do the 10%/month taper to get off the citalopram as well as try to get used to a new med, and as I have read, lexapro was one of the drugs with the fewest side effects.  I sure do not want to go down the multiple med route based on other folk's stories I have read, but at this rate, I'm not sure how I'm going to hold down a job.  

 

I think given my history that I should probably stay on an antidepressant because life is not goiong to get any easier going forward.  It was all I could do to make it to work today on no or little sleep.  If I lose my job, I stand to lose everything at my age.  I'm 63.  That's why I'm so afraid of the prospect of having years of recovery from this as opposed to getting on another med where I can hopefully get some semblance of normalcy back in my life.  

 

I am under such tremendous stress right now.  My blood pressure is sky high and I'm afraid that this is ultimately going to kill me.  It is very depressing to realize that my retirement may be hell on earth.  I don't think my marriage will withstand this as well.  Sorry to dump but I'm an emotional mess right now.  

Edited October 25, 2016 by scallywag
white space added