LisaK: Why go off Celexa?

[LisaK]

Hi Everyone,

 

I started using 20 mg/day of Celexa almost 20 years ago for severe PMS symptoms. I resisted using antidepressants for a long time, trying supplements, exercise and meditation first, but nothing helped. In desperation, I tried Prozac for a few months, but quit because of the side effects (dry mouth, sexual dysfunction, tiredness). Then I tried Zoloft and also stopped after a couple months. I couldn't stand how I felt. I felt itchy and tired all the time. Finally, I found out about Celexa (which was newly approved for use for depression in 1998). Celexa helped (I experienced fewer and less intense side effects), and I was a better Mom and wife because of it's role in stabilizing my mood swings. 

 

Now, 20 years later, I am still taking 20 mg/day of Celexa and I am wondering why? I tried weaning off of the Celexa during menopause (which was a mistake), and experienced severe withdrawal symptoms (depression, anxiety, mood swings, irritability, confusion). So, I quickly went back to religiously taking my Celexa every day.

 

So here I am, trying to decide if it makes sense to discontinue the use of this medication. I have read so much about the challenges of discontinuing SSRIs, and I am afraid. My life is pretty stable right now. I feel calm, and steady, but wonder if my cognitive ability has been impacted. I have severe tinnitus (don't know if that is related to SSRI use). My memory is weak (don't know if that is related to aging - I'm 56). I have very little motivation (don't know if that is just post retirement slump). I'm about 15 pounds overweight (and I wonder if Celexa is contributing to that). So, I wonder what are the risks and benefits of weaning off this medication? And I wonder who am I without Celexa?

 

I also worry about the long term effects of continuing to take Celexa for the rest of my life: I've read about the increased risks of diabetes, hip fractures, blood clots, intestinal bleeding, and dementia. Yikes!

 

I'm just sitting here on the fence and could use some advice: to keep on taking Celexa indefinitely...or to take the leap and free myself from this medication. Please help!

[Gridley]

Hello, LisaK and welcome to SA.  We are a site dedicated to helping people taper safely off psychiatric drugs.

 

I can't tell you whether or not to go off Celexa. There is so little known about these drugs, and very little testing has been done on the effects of long-term use.   One factor to consider is tachyphylaxis (poop-out) where after a certain point the drug can just stop working.  A higher dose may give relief for a while, but ultimately poop-out sets in again.  At this point, tapering the drug becomes more difficult.  Here are some links you can read in to help you make your decision.

 

Fava 2003 Can long-term treatment with antidepressant drugs worsen the course of depression?

 

Amsterdam, 2009 Does tachyphylaxis occur after repeated antidepressant exposure...

 

Fava, 2011 The mechanisms of tolerance in antidepressant action

 

Katz, 2011 Tachyphylaxis/tolerance to antidepressants...

 

El-Mallakh, 2011 Tardive dysphoria: The role of long term antidepressant use...

 

Andrews, 2011 Blue again: Perturbational effects of antidepressants

 

Articles:

 

Now Antidepressant-Induced Chronic Depression Has a Name: Tardive Dysphoria

 

This thread also present several arguments.  You can see if they resonate with you.

Why do You Want to Quit Antidepressants? - Surviving Antidepressants

Intoxication Anosognosia how do you think this impacts your self care ...

You can Google SurvivingAntidepressants.org spellbinding for more threads along this line.

 

While I can't tell you whether or not to go off the drug, I can give you information on how to do it safely if you decide to do so.  At SurvivingAntidepressants, it is recommended that a person taper by no more than 10% of their current dose with at least a four week hold in-between decreases.  The 10% taper recommendation is a harm reduction approach to going off psychiatric drugs.  Some people may have to taper at a more conservative rate as they are sensitive to even the smallest drops.
  

Before you begin tapering what you need to know

Why taper by 10% of my dosage?

 

Brain Remodelling

 

Tips for tapering off Celexa (citalopram)

 

Everyone is different; you'll want to do what's best for your nervous system. This can make tapering a project lasting years. Still, you are minimizing your drug burden.  I started my taper of 20mg Lexapro (a cousin to Celexa but stronger) in January of 2017.  I am now at 7.6mg a year and three months later.  I am using a variation of the 10% taper that is slightly slower but, to me, easier on the system.  I haven't calculated exactly but I figure it will take me two more years to get off.  If you will look at the first post of the following link, you will see how a two year taper of 20 mg works out.  Everyone is different.  Some can go slower and some can go faster.  This is explained in the "Why taper by 10%" link above.

When to end the taper and jump to zero? - Surviving Antidepressant

There will also be some discomfort.  If you go slowly, it will be manageable.  Common withdrawal symptoms include anxiety and insomnia.

 

What is withdrawal syndrome.

 

Glenmullen’s withdrawal symptom list.

 

I hope this information is helpful to you in making your decision.  If you decide to taper the Celexa, we will be here to help you.

 

 

 

 

 

 

 

 

[Rosetta]

Hi, Lisa, 

 

Please, please, please, take the time you need to read through the site and ask all the questions you need answered.  You do not have to make a decision quickly, but I cannot emphasize enough how I wish had had the knowledge that I needed to taper before tachyphylaxis.  I see people in your position come on this site, and I want to help them avoid what has happened to me.  I want that so much because I want what I am going through to mean something, to matter, to have some silver lining somehow.  

 

Gridley is being very gentle with his words.  As a moderator, he doesn't want to scare you or scare you away.  I will not be so gentle, because as a mere member, not a Moderator, I hope you can hear me without being afraid.  There is no reason for you to be more afraid of tapering than of tachyphylaxis, in my admittedly humble opinion.  Any of us in the pain that is WD would rather have begun a taper while still healthy.

 

Knowing now that there was a way out (tapering) that was not this painful and debilitating, and that no doctor knew about it or even tried to learn about it while continuing to prescribe Zoloft to me is beyond infuriating.  This has been the most horrible experience, and the effect on my husband and child is heartbreaking.  The suffering is truly unimaginable to those who have not experienced it.  I am essentially disabled, frequently in severe emotional pain, and suffering anxiety that is so intense that I sometimes wish for an end - any end.  I fight those thoughts off, of course, but having this experience is "not what I signed up for" when I started Celexa in 2001.  The information that these drugs were very difficult to quit and are "not addictive" came out BEFORE I started taking them, but I had no idea, was never informed, and that information was continually swept under the rug.

 

The healing is not linear.  So, I get better and then worse, better then worse.  It is very discouraging, and I fight off depression from the setbacks.  If I had found this website before I tried to increase my dose over and over again, I think I could have avoided a lot of this suffering.

 

I see you as a person who, through some divine intervention or incredible stroke of luck, has stumbled upon an opportunity to avoid months or years of pain by finding this website prior to having your central nervous system destabilized by tachyphylaxis and subsequent increases in dose which each cause more and more severe destabilization of your CNS.  I would urge you to read through my thread and see the pain and misery I have suffered and am still suffering after 13 months drug free.  

 

What I want you to know, most of all, is that raising the dose isn't a risk free option, in my opinion, if tachyphylaxis occurs.

Tachyphylaxis can be very much like cold turkey withdrawal, I think, if one tries to increase the dose and it does not work.    Sometimes raising the dose can cause a lot of problems -- paradoxical reactions.  Once the CNS is destabilized any additional psych drug, even an updose of the same one, can cause (added:) further CNS destabilization.  I think that is what happened with me.  I was on Celexa for several years, and I had the cognitive decline that is caused by the drug, but I didn't realize it.  

 

4 hours ago, LisaK said:

So here I am, trying to decide if it makes sense to discontinue the use of this medication. I have read so much about the challenges of discontinuing SSRIs, and I am afraid. My life is pretty stable right now. I feel calm, and steady, but wonder if my cognitive ability has been impacted. I have severe tinnitus (don't know if that is related to SSRI use). My memory is weak (don't know if that is related to aging - I'm 56). I have very little motivation (don't know if that is just post retirement slump). I'm about 15 pounds overweight (and I wonder if Celexa is contributing to that). So, I wonder what are the risks and benefits of weaning off this medication? And I wonder who am I without Celexa?

 

I was switched (a cold switch) to Zoloft, and my problems got worse.  Eventually, I quit Zoloft cold turkey after trying to raise the dose several times.  Raising the dose caused increased confusion, "brain fog," OCD, and intense anxiety.  Quitting the drug cold after these problems became intolerable caused all the symptoms to get worse, much worse.  Quitting cold turkey is the worst decision I have ever made.  I didn't know better.  I now understand that I should have tapered (very, very slowly) off Celexa instead of switching drugs.  The sudden switch started me down this road of disability.  To "treat" the problems that caused I was prescribed ever increasing doses with each further destabilizing my system.

 

Your fear of tapering off is not unfounded as it is apparently not comfortable, but I've been reading here for many months, and the people who were healthy and "stable . . . calm, and steady" when they start the taper tend to have the fewest problems.  People who are already in withdrawal due to quitting the drug too fast or being in tachyphylaxis have the hardest time tapering.  From my perspective, there isn't really a choice whether to taper the drug for a person like you.  The risk that the drug will eventually "quit you" will always be there.  Tapering from a point of stability and good health is the only way to avoid that.  

 

One last note.  The fact you have previously tried to get off of Celexa may be an important fact to deciding when and how you begin to taper.  I urge you to post the dates that you tried to stop on here and let a moderator help you decide when to begin your taper.  You should look at the Glenmullen list of withdrawal symptoms, and disclose which, if any, you feel you have.  The timing of the beginning of your taper could depend upon the time that has elapsed since you last tried to get off the drug and whether you have certain types of withdrawal symptoms at this time.  People who have made multiple attempts to get off the drug in the wrong way often need time for their system to stabilize before trying a taper.

 

I wish you the best of luck,

Rosetta

http://survivingantidepressants.org/topic/16629-rosetta-ct-may-2011-too-fast-taper-feb-2017/

 

[LisaK]

Thanks Gridley and Rosetta,

I have been doing a great deal of research and have been thinking about weaning off the Celexa for years. I studied Joseph Glenmullen's book: The Antidepressant Solution, as well as Julia Ross's book: The Mood Cure. Thanks to this website I also printed out a copy of James Harper's book: How to get off Psychoactive Drugs Safely. I've ordered Haper's suppliments and will start those first. I'm going to go slowly (slower now than I originally planned, now that I've read many posts and the guidelines on this website). Thank you so much for your help! I watched a couple videos you suggested Gridley by Roger Whitaker detailing the impact of taking SSRIs long term. I also found this video that balanced the concerns stated by Whitaker and others regarding the possibility of permanent neurological damage and the equal possibility of repair (I'm just about ready): 

 

[FarmGirlWorks]

5 hours ago, Rosetta said:

The healing is not linear.  So, I get better and then worse, better then worse.  It is very discouraging, and I fight off depression from the setbacks.  If I had found this website before I tried to increase my dose over and over again, I think I could have avoided a lot of this suffering.

Hi, I second Rosetta's strong suggestion to read thru this site before making any decisions. Withdrawal is the most difficult experience I've had and that includes the brain tumor surgery I had 14 years ago.

[ChessieCat]

Hi Lisa, and welcome to SA from me too.

 

We ask all members to create a drug signature.  Please update it whenever you make a change.  Please keep it nice and simple.  We only need details for the last 2 years.  Date, drug and dose only, no symptoms or diagnoses.  The other years can just be an overview.  

 

This is the preferred format which is helpful for the mods.  Thank you.

 

A request: Would you summarize your history in a signature - ALL drugs, doses, dates, and discontinuations & reinstatements, in the last 2 years particularly?

• Please leave out symptoms and diagnoses.
• A list is easier to understand than one or multiple paragraphs. 

• Any drugs prior to 2 years ago can just be listed with start and stop years.
• Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago)
• Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016.
• Link to Account Settings – Create or Edit a signature.Before you begin tapering what you need to know

 

I'm going to give you lots of links to check out.  Please don't feel overwhelmed, just work your way through them one at a time as you feel able.

 

SA recommends tapering by no more than 10% of the previous dose followed by a hold at that dose for about 4 weeks to allow the brain to adapt to not getting as much of the drug.  This is because psychiatric drugs create a physiological dependence, not physical like caffeine or nicotine.

 

Patience is needed to get off these drugs.  We suggest throwing out the calendar and listening to your body and your symptoms.  If after 4 weeks you don't feel stable, are unwell or life circumstances are a bit more stressful than usual (for example the Christmas period, winter time, or job change) it is better to stay at that dose for a bit longer until things settle down.

 

Why taper by 10% of my dosage?

 

About going off mirtazapine plus venlafaxine (Effexor) aka "California rocket fuel"

 

Tips for tapering off Remeron (mirtazapine)

 

Tips for tapering off Effexor (venlafaxine)

 

Dr Joseph Glenmullen's Withdrawal Symptoms

 

Windows and Waves Pattern of Stabilization

 

How do you talk to a doctor about tapering and withdrawal?

What should I expect from my doctor about withdrawal symptoms?

 

Brain Remodelling

Video:  Healing From Antidepressants - Patterns of Recovery

 

Keep it Simple, Slow and Stable

Keep Notes on Paper

 

Rate Symptoms Daily to Check Patterns and Progress

Tapering Calculator - Online

 

The only supplements which SA recommends are Magnesium and Omega-3 Fish Oil.  Try a small amount one at a time to see how you react.  It is best to make only 1 change at a time.  It is also better not to start taking a complex vitamin because if you experience issues you will not know what exactly is causing it.  B vitamins can be stimulating especially B6.  hypersensitive-to-b-vitamin-or-b-vitamin-complex  If trying anything new, start with a small amount to see how you react and build up to the recommended amount.  

 

Even with a careful and slow taper you will most likely experience times of discomfort.  It is best to learn and use Non-drug techniques to cope

 

There are many existing topics and discussions on this site.  You can use the site search function on the main page of the site at the top right, or use a search engine and include survivingantidepressants.org in your search string.

 

This is your own Intro topic where you can ask questions and journal your progress.  We suggest that members visit each others Intro topics so that can support and encourage each other.

[LisaK]

Thanks so much ChessieCat. I will review the links you've shared, and take my time. I so appreciate your conscientious care and support! 

[LisaK]

Hi Everyone,

I'm struggling with irritability and fatigue which is resulting in miscommunication and distance between my husband and I. I find myself lacking in my usual empathy. I'm distant and cold - and I can see it but can't seem to change it. It's frustrating because I am not getting any support. My husband would be perfectly happy if I returned to my original dose of Celexa and stopped being so moody. I also have read a lot of stories on this website about protracted withdrawal and I wonder if I will be worse or better after weaning off Celexa. The thing is, I was prescribed Celexa for PMS. Now, my hormones are no longer fluctuating (I'm post menopausal) - so I should be at a pretty steady state once I'm off Celexa unless my brain has been permanently damaged by this drug. Aargh, I don't want to jeopardize my relationship, and I don't want to be held hostage by this drug. Either I get off it now, or stay on it until I die...I just went down 10% on June 3, so hopefully my mood will stabilize soon. I think I'll stay longer on this dose and see how I feel in a month. Any other suggestions or advice or encouragement?...

[ChessieCat]

My first thought is:  Have you had your thyroid blood test done recently?

 

Another thought:  You may still be experiencing occasional fluctuations in hormones.

 

As far as tapering, you might do better making smaller reductions.  Some members are doing what has been nicknamed The BrassMonkey Slide.  This method does increase the time it will take to get off the drug but it is a gentler way of getting off the drug.  The simple explanation is: divide your 10% reduction by 4 then reduce the 2.5% amount each week for 4 weeks and then hold for 3 weeks after the 4th reduction.

 

The other option is to reduce by 5%, keep notes of symptoms for 2 weeks and if you don't experience withdrawal symptoms you could reduce another 5%.  If you did experience any symptoms after a reduction it would be probably better to hold for 3 weeks and then reassess.

 

I'm currently on 9mg Pristiq.  I've already been tapering for about 32 months and I'm not going to be off until at least the 2nd half of 2020.  I'd rather get off with minimal withdrawal symptoms than to go too quickly.  My starting dose was 100mg, so I am now at 91% less than I was.

 

Have you tried magnesium?  For me personally it takes the edge off my anxiety.  There have been several times when I have stopped taking it and my anxiety increases.  When I resume, my anxiety lessens.  When introducing something new try a small amount to see how you react.  Magnesium

 

Only make one change at a time:  Keep it Simple, Slow and Stable

 

Here is SA's sleep topic:  Sleep problems - that awful withdrawal insomnia

[Songbird]

3 hours ago, LisaK said:

I think I'll stay longer on this dose and see how I feel in a month. Any other suggestions or advice or encouragement?...

 

I think a longer hold is a good idea.  You've been holding at each dose only about three weeks.  I think it would be better to hold longer after each drop before dropping again, at least four weeks, or longer if needed, to stabilise.

 

Are you still taking tryptophan?  It should not be used with SSRIs as it affects serotonin and there is a risk of a dangerous interaction.  It could also cause fluctuations in serotonin levels which may make it more difficult for your system to stabilise.

[LisaK]

Thanks, ChessieCat for the tip on the BrassMonkey slide. I will try that next month after I feel stable at this dose. I'm also having my thyroid checked again next week, so will see how that is doing. I just read that up to 86% of depressed people have some kind of thyroid malfunction...and without enough thyroid in the brain the brain can't use amino acids or sometimes even SSRIs to increase serotonin (Prange, 1996). I've taken Magnesium (Calm) at night occasionally to help me sleep (although I haven't noticed it helping), but I will take it this afternoon and see if my anxiety and irritability lessen a bit. 

 

 

[LisaK]

Thanks Songbird, As far as the l-tryptophan. You are right, it is an amino acid that works as a precursor to Serotonin, and although Celexa works to inhibit the re-uptake of serotonin, as I decrease my dose, my serotonin levels are also dropping. In small doses (500 to 1500 mg) it is highly unlikely someone would experience Serotonin Syndrome (although it is possible). According to Julia Ross (2004) "Our clients routinely take 5-HTP and tryptophan with their antidepressants in the process of tapering off their SSRIs and they typically feel much better as soon as they begin adding the nutrients." (p. 225) She does caution people and tells them to make sure they take the SSRI and the 5-HTP or tryptophan at least 6 hours apart. I take my SSRI right away in the morning when I wake, and 500 mg of tryptophan before bed. It does seem to make me sleeply (which helps with insomnia). But, maybe it is contributing to my morning sluggishness... I'll try it in the afternoon and see how it affects me.

 

One other study Ross (2004) cites is one done in Canada where they found that 2 to 4 grams of tryptophan combined with 20 mg of Prozac increased antidepressant benefits, and preserved the deep, slow wave sleep that Prozac alone tends to disrupt, and there was no evidence of serotonin syndrome. Of course these people were closely followed by their physicians and I wouldn't recommend this dose to anyone. Still, I feel pretty comfortable trying out 500 mg/day to see if it helps with my mood. Eventually, when I'm off the Celexa I'm still going to have to work on keeping my serotonin levels up. This may help. Anyone else use tryptophan?

[Songbird]

We have a topic about it: 5-HTP 5-hydroxytryptophan and l-tryptophan