Dee22: Serious Adverse Reaction to Low Dose Celexa

[Dee22]

Firstly, sorry for the lame photo and yes, that's a real photo of the functioning me (I look nothing like that now). Wondering if anyone has insight as my adverse reaction is kind of strange. Please read my signature for history as it's the important factor in this case.

 

Been off Celexa for 8 months, was feeling somewhat okay, decided to go back on my last taper dose of 2.5 MG because I was having parathesia in my hands and feet for 3 months which made me nervous (remember, I have already been off completely for 8 months - I know I made a mistake). Did the 2.5 dose for 2 days, on the 3rd day I took 5 MG since I figured it was such a small dose. I went into a complete akithesia fit with intense fear, burning skin, muscle spasms, etc. went through it all night and the next day could not eat and still felt it somewhat effected.

 

The 3rd day after the reaction, I was 100% back to normal as if nothing had happened. One whole week later after feeling normal, it hit me again. I kept switching off between normal and this intense state until I started to plateau at a medium level of the state almost regularly. I have lost a lot of weight as I have no appetite (even when I feel a little better). Now I feel like I have PTSD because I don't know when these fits will hit me or how intense they will be or how long they will last.

 

This has been going on for the past month now. I am totally out of work as I can not function at all when it's happening. During Paxil withdrawal I was able to function (miserably) but this feels very different. A couple weeks in, I felt like I was starting to feel better then I got my monthly period and got hit with a big reaction once again, up all night crying and saying I wanted to be checked into an institution.

 

The day after that, I decided I needed medication to help me to so I would try again to reinstate the Celexa. First day I took about 2MG (It was a little less than a quarter 10MG pill). Second day after next dose, I had a huge setback that evening so I stopped the pills again. Here is where it gets weird, two days after the fit following the medication, once again, I feel somewhat better and perhaps a little better than I have felt in weeks. I see a connection to here to my first reaction - horrible reaction, 2 days bad, next few days significantly better but not back to normal as the first time. Maybe my body liked the Celexa but it just couldn't handle the dose? My worry is that after this "honeymoon" period of a few days is over and the medication leaves my system I will be back to where I was a few weeks ago? Should I try taking tiny doses like .5 MG? Advice would be helpful as I have not seen anything like this on any of the forums. 

[scallywag]

Dee22 -- Welcome to Surviving Antidepressants (SA) and thanks for starting your own Intro & Update topic.
 
Your deductions about the akathisia reaction you had are probably right. You could test a very small dose, 0.5 mg OR LESS, for a week or so to see if you get relief.  It's a good idea to take notes of your symptoms on paper because details can be difficult to remember. Please read the topics at both these links:

About reinstating and stabilizing to reduce withdrawal symptoms
Take notes of doses and symptoms  
 
Recently a member reinstated 0.1 ml (0.1 mg) of a commercial Lexapro (escitalopram) solution and is doing well with it. When I remember who that person is, I'll post a link.
 
You'll need to use either a scale or a liquid solution, either commercially produced or home-made.
Using a digital scale to measure doses
Making a liquid from a tablet or capsules, there's a link in this topic to a video showing someone making a solution from citalopram/Celexa tablets
 
If the reinstatement works, you would then settle at that dose for 2-3 months to stabilize, then taper very gradually. We suggest no more than 10% per month.
Tapering -- what you need to know
Why taper by 10% of my dosage?
Tips for tapering off Celexa (citalopram)  
 
I hope you'll find the information in the SA forums helpful for your situation. I'm sorry that you are in the position that you need the information, but am glad that you found us.

[Dee22]

Thank you so much for your response and your thought out advice. So you think it still might be okay to reinstate after 8.5 months at the low dose? I also want to mention that during the 8 months I didn't really have any withdrawal symptoms except for minor tingling so those akathesia aftershocks are either "aftershocks" or me withdrawing from the 2-day dosing. I don't know if that effects your thoughts on reinstating. Have you ever heard of a reaction turning totally on and off like this? Thanks again for your insight.

[scallywag]

One of the reasons that a test reinstatement dose after more than 6 months is so low, 0.5 mg, is because of the uncertainty.
 
Going off a neuro-active substance is destabilizing to the CNS (central nervous system). The parasthesia was a sign/symptom that your CNS was "rewiring" to undo the changes it made when you started and continued on citalopram, an indication that your CNS was still destabilized.  The akathisia was a "shock" CNS response to the reinstatement while you were already sensitized/destabilized.
 
Have a look at these links; they may give you a model to understand more about what happened:
How your brain responds to psychiatric drugs - aka "Brain remodeling"
Youtube video, 4 minutes: Healing from antidepressants

Using the metaphor in the video, the 2.5 mg doses in September/October scrambled the developing partial solution of your Rubik's cube.
 
Symptoms come and go during recovery from discontinuation: The Windows and Waves pattern of stabilization
 
The decision to reinstate is yours and should consider the frequency and intensity of current symptoms, how they affect your life and the risks. Some people have family and work situations that are accommodating, others do not.

[Dee22]

My Akathisia is extreme (I pasted these from somewhere and removed the ones that didn't apply to me - the list is true to how I am feeling) 

• Extreme agitation/restlessness
• Profound anxiety/terror/panic
• Feeling like you’re jumping out of your skin or want to rip your skin off and escape
• Feeling a need to run away
• Agoraphobia/claustrophobia
• Dark, scary thoughts
• Psychotic-type behaviors
• Self-harm or thoughts of self harm
• Inability to sit still or lie down
• Feeling like it will never end
• Muscular tension/strain/weakness/ticks
• Blurred vision
• Loss of appetite
• Confusion
• Flushing/hot flashes
• Erratic heart beat
• Extreme, chronic thirst

I have read that it clears up once the offending drug is out of the system. Is it common for this to persist some time after the drug has cleared from the system (Celexa is out at 7 days but it has been over a month)? Also which treatments work the best for alleviating this as I have been suffering every day now as opposed to the beginning when it was on and off. It's very serious. 

[scallywag]

Dee, it's not a matter of the drug being in your system. Drug manufacturers admit that there can be a period of acute withdrawal of 4-8 weeks of diminishing symptoms, a time well after the last dose is eliminated.  Despite what drug manufacturers say and what their "education and information" for doctors says, it is common for withdrawal symptoms to extend beyond that acute period.

 

 

Your previous parasthesia was likely a symptom of extended withdrawal.

 

Your CNS (central nervous system) adapts to the presence of the drug, downregulating receptors and processes related to the drug's targetted neurotransmitter(s). Our bodies try to keep things level, maintain an equilbrium, homeostatis.  When the dose is reduced, after a few days the CNS adapts to the lower dose by starting to undo previous adaptations made to accommodate the drug. When dose is increased, the CNS makes further adaptations. We work on the premise that it is these changes that are the source of symptoms.

One theory of antidepressant withdrawal syndrome

 

It seems that your reintroduction of 2.5 Celexa was a shock to your already-destabilized CNS and set off new withdrawal symptoms, grouped and labelled akathisia. 

 

There are two known ways of dealing with the presence of withdrawal symptoms effectively: time and reinstatement.

 

When we discuss reinstatement, we suggest micro-doses. Doses so low that doctors and psychiatrists dismiss them as "ridiculous" or "homeopathic." Are you open to a discussion about reintroducing a dose much, much lower than the 2.5 mg you tried earlier , to see if it stabilizes your CNS thereby reducing the akathisia? I'm not suggesting that you reinstate, merely asking about your willingness to discuss the idea. For more about reinstatement, its benefits + risks, please read:

About reinstating and stabilizing to reduce withdrawal symptoms

[Dee22]

Thanks Skallywag, you're the best. YES, I am totally open to reinstating. In fact, I didn't have the liquid formulation yesterday or today so I broke off a crumb of a crumb which may be close to .5mg and have taken it for 2 days. Yesterday was pretty bad in terms of the akathesia fear/terror (but I don't think I would have felt the celexa by then) I also had a bad morning today but things are picking up a little in terms of mood. I'm struggling with 2 things here, I think... The akathesia reaction along with a feeling of a dreadful hopelessness which shuts on and off even when not having an akathesia fit - I think this might be neurotransmitters freaking out going from drugged to not drugged. Right now, that hopelessness feeling is gone perhaps due to reinstating. I do feel a little zonked right now because I took some benadryl for the akathesia which I think is helping keep it at bay to some extent. I had to do something because it was extreme and traumatizing in a way I can't even describe. I would go through horrendous Paxil withdrawal over this any time. At least with that, I knew what was happening to me and knew that I would gradually get better, I'm pretty strong and rolled with the bumps and crazy emotions - I didn't have this additional level of sheer unexplained terror. 

 

I know that one should reinstate on the same drug during withdrawal, but my withdrawal was not severe at all (just some tingles and manageable anxiety and depression). I do understand what you are saying though in terms of my sensitized nerves - even though I may not have felt horrible withdrawal, my nerves were battling it. I'm wondering about a 1mg dose of Zoloft (I think that might be the equivalent of .5mgs of Celexa (plus my mother takes it after having been on other SSRIs and it does well for her). I know immediately after reading that you were probably thinking "no way!" since it's not the traditional advice for reinstatement.  

 

Something tells me in my gut that the Celexa is still a bad idea but I really want to reinstate. For example, when I started on the Celexa 3 years ago, I recall now that felt some arm weakness before I got used to it which was a also a BIG symptom of the adverse reaction. I definitely feel like I need to try and reinstate and do want to have that discussion. 

[scallywag]

The risk with introducing Zoloft is that it is less likely to be a good fit for your CNS instability than Celexa.

 

You can make a liquid at home and use a the syringe that you can get at any drug store/pharmacy.  There's a link in this topic to a video showing someone making a solution from citalopram/Celexa tablets

Making a liquid from a tablet or capsules,

 

What is the dose of your Celexa tablet?

[Dee22]

It's 10MG, originally I was quartering them.

[scallywag]

One 2.5 mg portion of a tablet dissolved in 50 ml of water would give you 0.5 mg per 10 ml solution.

 

What are you using to cut the tablet?

How equal are the ¼-sections of the tablet after you cut them?

[LexAnger]

Just say hi Dee22.

I'm so sorry you were hurt by this evil too,!

 

How did you go off the 2.5 mg Celexa? Was your original WD tolerable? You mentioned it was bad and why you reinstated, but giving your new experience with reaction to the reinstate, was the WD livable?

 

There are quite many here with similar experience to yours with severe reaction to reinstate Celexa ( me included even I never got off Lexapro completely, just dose incraese got me in severe long term drug reaction battle).

 

if the original WD is tolerable and all the intolerable symptoms started since reinstate, what is the logic to get back to it?

 

Otherwise, if the WD symptoms are still the main issue you need to handle, reinstate most probably will help.

 

When one is stuck in between WD and reaction, it's the hardest ball to play with. You have to either deal with one or the other.

 

Reinstating a low dose is the best bet if that's what you decide to. I would consider even smaller dose than 0.5mg. You can always increase more if needed. This drug is unbelievably powerful even 0.02 mg can bring up huge reaction to a sensitized system. This is especially true giving you just had a bad reaction to it.

 

Just my thoughts though based on my own experience.

[Dee22]

My doctor actually just called in the liquid formula. I was manageable today but rebounding pretty hard this evening. The withdrawal from the Celexa was very manageable this is why I'm so mad about what happened. I'm considering something like .3mg however I have no idea what I have taken for the past 3 days except that it was an almost invisible shaving. 

 

I barely have physical symptoms even from the reaction except for an occasional tightness/burning/tingling on the right side of my head and forehead when I get a flare up. I also have difficulty walking when this happens like I really have to focus on putting one foot in front of the other. My main symptom is the inner terror and turmoil which has been shutting on and off. It's indescribable. Currently I'm taking 5mg diazapam which I split up over the course of the day. I know this can be addictive but I have no choice, I'm just trying to be conservative about it. Also taking 1-2 25mg benadryls. Somewhat low doses of each as I don't like the drugged out feeling.  

[scallywag]

The commercial Celexa liquid will make getting a consistent micro-dose a great deal easier.  Good to hear that all that's left is for you to pick it up.

 

Your signature: Would you

• edit the "At month 7" to say "Sept. 2016"?  It's less arithmetic for us if the dates are there rather than a relative time frame.
   
• change your signature to reflect the reinstatement dose of 2.5 mg? You say 2.5 mg in your first post and 5 mg in your "sig."
   
• add diazepam doses & timings as well as those for benadryl to your signature? If you hit the # of lines limit, you can delete the details  about your reaction to the 2.5 mg reinstatement in September 2016.

You're doing your best to cope. Few people really like the idea of adding another drug to deal with this. I know you're aiming for the minimum effective dose, please be as consistent as you can with timing and amounts of diazepam.

[Dee22]

I woke up this morning and could barely see out of one eye. I've had blurred vision from SSRIs before but not this severe. Very blurred as if my eye shifted while I was sleeping and never went back in place. When I look with both my eyes I have double vision because the left one is blurred. Please tell me if anyone has had anything like this.

[direstraits]

yes, I've had this for a long time now,left eye very blurry. worried I'll never see clearly again.also it often feels like there;s something in my eye; so annoying.

[Dee22]

Thanks for your response. It's weird, the blurriness is switching in and off between both eyes now. I just left the hospital.

[Junglechicken]

Dee - what did they tell you it was?

[moodyblues78]

I had triple vision. 

 

The doc just wrote down that "the patent Thinks he sees everything threefold".

 

It gets better in time

[Dee22]

They had no answer of course. I know it's from the SSRI, it was just so severe. It's improved a lot since I woke up.

[Junglechicken]

If its any consolation, I have blurry vision all the time, and feel as though I'm going blind....literally.

 

I can't read any signs at a certain distance, or number plates.

[LexAnger]

It happens to many, various situation.

from what I read, a typical symptom from re-instate celexa/Lexapro.

 

I have it too, not as severe as yours, and on-off along with my tapering (got better when I drop dose), before being bad again.

[Dee22]

Advice for lesser of two evils please

 

So some of the symptoms of my adverse reaction from reinstatement have gone or subsided like the blurred vision, ataxia, tremor/rigidity (although that comes and goes). I still have bouts of the intense fear and "black tar" depression which is the most concerning. Already out of work for 2 months. I thought I was doing better as I was having longer lasting windows of feeling better and minimized feelings during waves but I'm getting some days of really bad waves again which I have not seen in over a month. 

 

The depression is unbearable and I also desperately need to gain weight. I spoke to an expert who has written papers on the topic and he said treatment specifically for me would be a very low dose Propronal + mirtazapine + low dose diazepam as seen here. I have already been taking about .5 diazepam maybe once a week on average if I really need to since it's addicting. 

 

Mirtazapine has some nasty side effects and I have also seen it induce Akathisia for some people on this board especially if they miss one dose. I feel like at this point, I would probably skip the other two and just go for the mirtazapine because it's the SSRI reaction induced depression I really want to offset. Because of this, I was also considering Lamictal. Basically, I can't do an SSRI since I obviously can not tolerate them any longer but I also don't want to instigate the akathisia or get something like TD which I'm really afraid of. 

 

I may not even do anything at this point but I need to know the lesser of two evils which addresses the concerns mentioned above so I can have a plan in my back pocket - even if it's just for comfort. If I could research every single post I would but I know many of you already have so I'm just looking for your insight with how these have worked for others. 

[Altostrata]

Good for you, Dee, on doing that research.

 

Mirtazapine has serotonergic and noradrenergic components. If I were you, I'd avoid stimulation by both serotonergics and noradrenergics.

 

The "black holes" will go away, hang in there. Lamotrigine could potentially help your system calm down and has fewer side effects than the benzos. Dosing can be tricky, though, as your sensitized system may be able to tolerate only a very low dose.

 

Please see One theory of antidepressant withdrawal syndrome

[Dee22]

Thanks Astro. I'm still very much considering the Lamictal... 

 

I think I fall somewhere between adverse reaction and a mild protracted withdrawal.  

 

In the case of adverse reaction, I have not seen Lamictal used which is probably the only thing that's holding me back in some sense. It's odd because you would think it would work well for akathisia since it affects glutamate as does Propronal, the standard protocol. If you have seen Lamictal also work in some cases of subjective akathisia, please let me know as this would make an even more solid case for it.  

 

I'm also feeling like I should give a very low dose of Propranolol a try first (without the Mirtazapine, obviously) since it would be something that shouldn't cause much or any harm if it doesn't work. I'm still struggling to figure out if the deep depression (which comes on during and right after the adrenaline fits) is a component of the fear feeling caused by the akathisia (is does feel a bit distinctly different from that feeling which I had a lot of early on) or if it is perhaps a serotonergic issue from the reaction since this was caused by an SSRI and not an anti-nausea medication for example similar this guy's reaction. I feel like the cause, 

 

Please let know if you think the Lamictal still makes a strong case even for an adverse reaction and your thoughts on trying a low dose Propranolol first maybe on an as "as needed" basis (I'm not even sure if it can be used in that way but the idea is to stop the adrenaline wave in it's tracks before it heightens or if that would cause a hard rebound right after the half life is over). 

[Dee22]

Urgent request: I need to be under the care of a doctor who knows what they're doing. Can someone recommend a good one in San Diego and maybe even LA as well?  

Edited December 4, 2016 by scallywag
added "urgent request"; merged from new topic started in Intro forum

[scallywag]

Dee, I've moved your post/question to your introduction topic.  We have a "one-intro-topic-per-person" rule to keep all your information, questions and answers in one place.

 

Have you looked at this topic? Recommended doctors, therapists, and clinics.

[LexAnger]

Look at the last page in the link Scallywag sent to you for dr. Shipko. I met him once.

[Dee22]

Please see updated signature. I just wanted to check in after speaking to Dr Shipko as well as my doctor. My akathisia became severe and life threatening. I also developed severe debilitating tinnitus on top of that (I already had mild tinnitus that never went away from my Paxil withdrawal in 2010 but it was barely noticeable and I was able to live with it). 

 

In the first month of my akathisia, I would occasionally take diazepam, I understand it is highly addictive but I had to do something and the doctors I had access to did not know how to properly treat the condition. In mid November, I actually felt like I was starting to feel better then started tapering the diazepam (only took it for around 2 weeks) and felt like I was still getting progressively better. Then all of a sudden started getting much worse and feeling bad consistently (in the beginning the akathisia was going up and down, now it was pretty constant). 

 

I'm wondering if this was in fact some kind of diazepam withdrawal because this is when I developed the severe tinnitus - about 3 days after stopping the diazepam completely (not directly after my celexa reaction). Now I had to go back on Klonopin which I don't want to be on, been on that for 2 weeks but quitting will surely come with worsened tinnitus which is already unbearable (the Klonopin has been the only thing making me able to cope with it - really it's just getting by). I feel like I'm in a stuck position and really don't want to be on any medication at all. The longer I stay on the Klonopin, the harder it will be to get off of it. 

 

I also feel like I have developed some kind of lethargic debilitating fatigue to the point where I have several hours during the day where I can barely speak. Normally, I'm usually pretty amped up - can't say if this is the Klonopin but I never felt this way on the diazepam. There were also a couple days where I felt like this before starting the new treatment regimen. 

 

Just looking for some ideas and insight regarding my situation as well as the tinnitus.  

[Dee22]

I have some questions on Lamictal. My case is still weird because I consider myself not really having any kind of debilitating withdrawal and reinstated Lamictal to counter a side effect from trying to reinstate Celexa after a year of almost being off. I felt fine, just had some anxiety so I wanted to get back on the medication. 

 

My reaction was akathisia, but it came with an overwhelming depression which is why I had to start the Lamictal. 

 

I started at a quarter 25mg tablet and seemed to do okay with that but had no change in mood, went up to 12.5mg and now I'm having nausea and brain zaps. I don't know if my body is just trying to adjust and that's normal (I read sometimes this can happen when starting a medication and then it dissipates). I'm also having some body aches. 

 

I don't know if this is bad and I should stop or wait it out a little longer. 

 

Insight is appreciated. 

 

Thanks.

[scallywag]

When did you start the ¼ tablet?

When did you increase to a ½ tablet?

When did the symptoms of nausea and brain zaps start?

 

Actual dates or approximate dates will be the most helpful in answering your question.

[Dee22]

Sorry I didn't see your post right away. I actually settled okay on the 12.5 lamictal but it doesn't seem to have touched my depression at all. I don't feel brain zaps anymore or any nausea. 

 

I do have another question though. I want to understand why I got Akathisia in the first place. From what I've researched, it can be caused serotonergically-mediated inhibition of the dopaminergic system in the basil ganglia. What I don't get is how reinstating an SSRI can cause this effect. I understand that the CNS is sensitized but not sure why it would cause that. Is it because the receptors are now down-regulated and instead of the SSRI blocking the receptors, it binds to other sites? 

[scallywag]

Here are a few links that discuss CNS sensitization and symptoms:

 

One theory of anti-depressant withdrawal syndrome

How your brain responds to psychiatric drugs - aka "Brain remodeling"

Youtube video, 4 minutes: Healing from antidepressants

[Dee22]

It's been a while since I posted here so I wanted to provide an update as well as ask a question. In regards to the SSRI low dose induced akathisia, it was hell. Unfortunately I got put on .375 Klonopin as an emergency measure as well as 12.5 Lamictal which will I will need to taper off of very soon. I am disappointed I had to go on anything at all as I was 

 

For those who do get akathisia, it does go away even though your brain tells you otherwise and that you're going crazy. It does recover. Unfortunately for me, I now have severe tinnitus and hyerpacusis. It's reactive and unmaskable - I had tinnitus from my paxil withdrawal and it was nothing like this. It's been steady for 3 months and has not settled down. 

 

My question however is about Lamictal. I honestly don't know if it helped anything or perhaps it played a role in helping me recover from the akathisia. When I started it at 6.25mg, I got some brain zaps (I thought that was weird because that's a withdrawal symptom and not really a starting symptom but please correct me if I'm wrong). I also had some slight nausea which it a common a starting symptom. It settled after a couple weeks and I moved to 12.5mg, more brain zaps but eventually settled after a week - still wasn't sure if that was helping anything but I decided to stay there as I did not notice any worsening of symptoms either. 

 

So I'm at 3 months on the Lamictal and I started noticing I've been getting brain zaps again. I haven't missed a dose and I'm wondering if this can happen if the dose is too low. About a month ago I did miss one dose and the brain zaps came on right away. Unfortunately, I need to stay on all medications until the tinnitus at least gets a little lower or I would just taper off of the Lamictal.

 

Please let me know if you think the zaps are from some kind of tolerance because the dose is low, it's just weird because I don't seem to be reacting to negatively in any other way.

 

Thanks for your help. 

[Dee22]

Any ideas?

[scallywag]

Dee, sorry for the delay in responding, and for this imprecise and incomplete answer: Brain Zaps are a common withdrawal symptom; I'm not sure that they would arise in "tolerance."

[Altostrata]

Dee, the brain zaps might not be related to the drugs at all, but a legacy of earlier withdrawal syndrome. Withdrawal symptoms can come back temporarily in a wave and window pattern. Do they happen at any particular time of day?

 

How is your tinnitus now?