☼ Windsor77: Celexa - it's time for peace

[ChessieCat]

I think the thing to do is to keep notes for yourself over the next one or two weeks whilst keeping everything the same.  So decide on what dose you are going to take and stick to it.  You have made a lot of changes since you started the supplement.  Every time you make a change it takes time before you can see the effect of that change.

 

It takes about 4 days for the dose change of a psychiatric drug to reach full level in the blood and a bit longer for it to register in the brain.

 

Assuming that the supplement is changing something (dose increase/decrease, absorption or whatever - you don't know what it is doing) with regard to the citalopram then you have been playing ping pong with your brain.  The brain likes consistency.

 

You are going to have to be the detective.  And it might take a while for you to work things out.

 

I had to do that many years ago when I was experiencing a bad reaction 6 hours after consuming MSG.  Because of the length of time for the reaction to occur it was difficult to work out was was causing it.  It was only through being extremely vigilant over a period of time that I was able to work out the cause.  However even discovering that MSG was causing a problem was not the end of it.  I was still having milder reactions every now and again.  I then found out that there are certain additives (eg soy sauce and hydrolysed vegetable protein) which contain MSG.  And again even that wasn't the end of it.  I then ended up doing an elimination diet and food challenge.  I left MSG until last and didn't end up doing that one (even though the specialist tried to convince me to do it) because I didn't have any reaction at all to every one of the other challenges.  It was then discovered that I learned that there are foods which are high in natural glutamates and I was reacting to them as well (eg grapes, mushrooms, hard cheeses, spinach, tomatoes, corn, peas, plums).  This whole process took many months and quite a few moderate encounters with anaphylaxis.  Conclusion:  After eliminating the natural glutamates for probably about two years I was finally able to start gradually introducing the natural foods back in.  However I now steer clear of added MSG and other flavour enhancers (E62x and E63x) not just because it can cause me physical issues but I've also discovered that it is a neurotoxin.

[Windsor77]

Thanks for sharing Chessie.   Just awoke with random left leg spasms, high heart rate and pulsating/tingling feeling in head and muscles, especially shoulders, thighs and calves. This feels so weird. I feel a little nauseous.  It’s definitely raising the drug.  I must say that I do not care for how my heart is feeling.  Heart beat feels strange. Not like usual adrenaline that comes with anxiety. Thanks! I’ll keep the detective work going. 

[Windsor77]

As I laid in bed this morning feeling these strange sensations washing over me, I was reminded of a few times when I took supplements that contained maca or yohimbe.  They made me feel nearly the EXACT same way as this.   Since I am taking all of this at night within a couple hours of each other, the level must be peaking 4-6 hours after I take the alginate.  
since the goal is to get to a stable point, thats what I must do.  But I do think that these levels are spiking too high, and resolving by bedtime, only to start over again. 

[Windsor77]

Sometimes this rollercoaster is ridiculous. After feeling on edge all morning and having some bothersome twitching in the edges of my latissimus dorsi and elbows,  I really feel great right now. Barely any twitching.  No rapid heart rate or anxiety.  A VERY stark reciprocal of just 12 hours ago. 

[Windsor77]

Right before 7pm est, which is my normal dosage time, I started to have a mildly higher heart rate and my jaw felt like it was vibrating a bit.  Some random twitching too.  

[Windsor77]

Took citalopram at 7pm.  Alginate at 8:45m. 2am. Awoke with bounding heart rate, same feeling of tingling/nervous system “heaviness” coursing through arms and legs and jaw.  Feeling a little hot/sweaty.  Same as last night. Same very limited random involuntary head and limb jerks.  Citalopram/serotonin is not clearing in my opinion.  
Heart rate feels funny to me.  Wondering about QT prolongation issue, but I’m only taking 3mg.  If the alginate is preventing the serotonin level from clearing as I suspect, this could be a real problem waiting to happen.   Growing tired of all of this guess work when I’m not really trained to be tinkering with my body chemistry. 

[Windsor77]

I don’t think it’s a good idea to keep elevating my serotonin this high for a week straight....... @ChessieCat  I may never be able to get stasis, as my levels are falling back to tolerable range throughout each day, then I once again each evening I compound them (by what feels like 100x) and by afternoon I feel fine again. 
 

 

[Windsor77]

I cannot understand why I am having such extreme heart rate and anxiety.   My head feels like I’ve had 6 beers. Pulsating in my temples and behind by forehead.  Thoughts are racing.  I’m really wanting to discontinue the alginate tonight as I am already in fairly prominent withdrawal.  Perhaps I can cease the alginate and raise the citalopram slowly until I reach some relief.  All of my instincts are telling me to get the supplement out of the picture so that I can get a clear understanding of how much drug is in my body, rather than working in the dark with a supplement that is causing severe symptoms 4-5 hours after ingestion.  

[Windsor77]

Saw my GP for my yearly checkup today.  He knows my history with AD withdrawal and issues well.  When asked whether he’d continue the alginate and reduce citalopram, or quit the alginate and titrate citalopram, he said that the latter made most sense.   His advice was similar to @Altostrata and @ChessieCat ‘s statement that at the 3mg daily level, he is not worried about serotonin syndrome being too high.   I also asked him if he could order a 5HT blood test to get serotonin level.  He is looking into this for me. 
This is the path I am going to take.  The nightly burst of side effects are too intense to continue. 
I realize that there will be some withdrawal side effects from this approach.  My questions to the group are: 1) how long should I wait to raise the citalopram, and by what increment should I raise when I do? 
Thanks in advance. 
W77
 

[Windsor77]

2pm. Anxiety level down. Resting Pulse at 68.  No pulsing sensations.  No head fog or dizzy feelings. Mild tremor in hands. 

[Windsor77]

Update.  Some serious dizziness and brain floating feelings are hitting me right now.  21 hours after citalopram dose.   I think I’m in the acute withdrawal phase.  

[ChessieCat]

5 hours ago, Windsor77 said:

I also asked him if he could order a 5HT blood test to get serotonin level.

 

The majority of serotonin is in the gut, about 90-95%, so getting a blood test is unlikely to be of much/any help.

 

A search for serotonin gut found these (I've created them with a link for the source)

 

Your gut produces about 95 percent of the serotonin in your body, and changes in your serotonin level affect your gut as well as your brain.

 

While serotonin is a neurotransmitter, 90% of its receptors are located in the gut

 

Less well-known is that scientists estimate 90% of serotonin is made in the gut

 

 

5 hours ago, Windsor77 said:

My questions to the group are: 1) how long should I wait to raise the citalopram, and by what increment should I raise when I do?

 

I think you would be "playing with fire" if you start messing around with your citalopram dose especially if you reduce/stop the supplement.

 

Sorry, but I'm not able to assist any further, so please do not tag me again.

 

I've already suggested keeping daily notes.

 

Consider this:   "are you adding anxiety to the situation?"  This is not to suggest that you are not getting symptoms, but are you getting anxious when the symptoms appear/worsen thereby adding "normal" anxiety symptoms to the mix.  When I have something wrong with me (eg my back injury is causing discomfort or I have a bit of a headache) I find that I do not breathe as deeply as I normally do (even when I'm concentrating I tend to hold my breath or shallow breathe).  And this then has a domino effect on other parts of my body.

 

See the labelled diagram on this page.  It's amazing what physical symptoms happen when we are anxious.  I can remember as a child when I was very excited about something I would feel nauseous and would have to eat something with a lot of sugar, like a boiled sweet/lolly or some orange juice or cordial:

 

http://getselfhelp.co.uk/anxiety.htm

[Windsor77]

Thanks for your help, Chessie. Sorry for being a pest.   Yea, can normal anxiety add to the interpretation of a symptom? maybe. In this case I have reported the actual events absent any anxiety bias.  The problem that I anticipate is this: the supplement obviously increases my serotonin levels for a period of time each day. This has been going on for 6 weeks.  Could I have been accidentally taking the equivalent of 5, 10, or 20 mg or more?  Who knows!?  If I stop the supplement, this would most certainly be more than a 10% reduction, and will likely spawn a withdrawal reaction. (If it isn’t occurring already). This site, in some cases, recommends reinstating or raising the dose in the event of harsh withdrawal as to ward off a protracted withdrawal period.   This was the only situation I in which was considering raising my level.  

Again, my apologies if my sense of urgency has annoyed you.   I apologize also if I have overused  my welcome when it comes to requesting advice. I’m just trying to have a plan in place if faced with a tough scenario. 

[ChessieCat]

Sodium alginate is not a psychiatric drug and as such is out of the purview of SA.

 

The bottom line is that nobody knows what is happening.

 

You might find another member who has experience with this supplement or a supplement which contains this ingredient.

 

SA's general recommendation is to only make one change at a time.  If you start reducing your supplement AND changing your citalopram dose at the same time then you will have no idea what is causing what.

 

I've given you all the suggestions regarding your current situation so that's it from me on this issue

 

Over and out.

[Windsor77]

Thanks Chessie. I’m certainly not going to change the psych drug. One change at a time.  I plan to discontinue the alginate supplement and gauge the reaction.  I hope it goes well, but, having gone through hell already, I am prepared for the worst.  I hope that my experience can be a cautionary tale for someone else who may stumble upon this supplement use. 
I certainly hope that I haven’t offended you in some way.  I hope that we could converse still in the future. 
thanks again
W77

[ChessieCat]

36 minutes ago, ChessieCat said:

I've given you all the suggestions regarding your current situation so that's it from me on this issue

 

[Altostrata]

On 2/27/2021 at 4:43 PM, ChessieCat said:

....

If you are taking the citalopram enough hours before you take the supplement then the citalopram would most likely have been fully absorbed before you take the supplement.

....

 

 

ChessieCat has given you good advice. We have suggested you take citalopram earlier, and keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. Post 24 hours of notes at a time in this topic, in a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right. This can show if your symptoms are adverse effects from one of your drugs or supplements.

 

You're showing signs of overthinking everything, plus being fixated on serotonin. It is possible your taking alginate so close to citalopram is blocking the absorption of citalopram -- which I mentioned before -- so you are feeling the effects of the drug a couple of hours later.

 

Serotonin need not be brought into it. We very often see the effects of an antidepressant are stimulating.

 

If you move citalopram earlier, it's very possible you will not have these effects. I would not change the dosage of citalopram as you move it around.

[Windsor77]

Thank you for responding.@Altostrata   And thank you for your thoughts and advice.  (For the second time).  I am overthinking everything for sure.  I’ll keep my journals coming in the proper format. 


 

[Windsor77]

2-28

7pm - citalopram -3mg liquid

9pm - 1 sodium Alginate capsule -400mg

Sound sleep until 2am   Bounding heart. Racing thoughts.  Pulsating/coursing muscles/nerves in limbs and jaw.  (I never have had this reaction at any time to taking citalopram alone) same as previous evenings. 
Interrupted sleep.

3-1

6am - anxiety and high heart rate.

7am take 40mg pantoprazole tablet.
Go to work

Rapid “worst case” thoughts throughout the day. Catastrophising. Trying to create a “way out”, hence my previous posts. 
slow reduction of anxiety by around 2pm.  3pm- head fog/ dizzy. 
4-5 slightly relaxed.  Heart rate still high. Dinner 

take 250mg magnesium citrate pill. 

7pm take citalopram.

7:30 slight nausea. Calves feel odd. 
8:30-9 sleep

2am awake. High heart rate. Anxiety. Catastrophic thinking.  Worry. 
interrupted sleep.

3-2

6am awake. Anxiety. High heart rate

7am - take 40mg pantoprazole. 
At work. 
8:20 I feel lightheaded and unable to focus or concentrate. 

 

 

[Windsor77]

If anyone is interested. 

 

https://pubchem.ncbi.nlm.nih.gov/compound/Sodium-alginate

 

[Windsor77]

This article states that CYP3a4 is responsible for 40-50% of the metabolism of citalopram. 
https://pubmed.ncbi.nlm.nih.gov/10575324/

[Windsor77]

3-2-21

7am- Take 40mg pantoprazole

Lightheaded. Anxious 

8:20a Eat breakfast. Scrambled eggs. Twitching calves.(the latter refers to my legs, not what’s for breakfast)

9:30a anxiety lessened. Heart rate slower

Mild tremor. Take 250mg magnesium citrate pill. 

10:30- heart rate 64 bpm. Lower anxiety.  Better focus. Still mild tremor. 

Bowels moving earlier (back to normal) than with alginate (sorry if tmi)

11:30a. Left desk for brief 10 minute walk.  

Breathing exercises. 

Not much appetite. 

12:30 - lunch. 

1:15- right thumb feels mildly twitchy.  (A recently developing occurrence which has happened briefly for a day or so, over the past year. It started again last week when I went to 1/2 alginate capsule, and subsided when I went back to a whole.  (As Chessie stated, I’m not being consistent).  

1:35 Mild pressure at back of neck and behind eyes.  

Increased feeling of brain floating in water.  Mild brief radiating pain from left shoulder to elbow.  Ceased after a minute or two. Heart rate -92bpm. 

3:15- mild head pressure continued - pulse rate 68 bpm.  Mild anxious affect.  4pm - noticeable tremor/vibration feeling in legs when standing. 

6 :15 feel ok. Some head pressure. Intestinal rumbling. Gas.  First noticeable time since alginate. BM #2. 

6:35 - took 3 mg dose citalopram (had a dinner to go to and would miss 7pm normal dose). 

7:30- feel light reduction in limb tremor. Pressure feeling in brain behind eyes. 

8 pm -Seem to be feeling more like a headache is coming on after taking the med. I’ve never had that happen before.  Heart rate feels a little bit up as well.  88 bpm. 

9pm - bed. Heart rate 68bpm. Right thumb twitching.  Not a full on headache, but it would be if I shook my head slightly.  Feels like I’m nursing a hangover.  

Total insomnia. Awake at 11pm. 1am. 2am-5:30am.  MANY new and more forceful jerking motions.  Arms and legs. Neck and tongue.  Just as I would falling asleep, I jerk preventing it.  Over and over. 

This is definitely an issue of too large a dosage drop.  I am going to be in crisis soon.  I was probably at well over max allowable dose based upon the shocking symptoms I was having. 

@Altostrata  2 days without alginate and my post dosage symptoms are getting worse.  I feel that I was exposed to a compoundingly higher and higher dose of the citalopram as the alginate accumulated.  I may seek the assistance of a family physician friend who is a psychopharmacologist to know what to do.   All I know is that no sleep is catching up with me.  

[Windsor77]

Acute withdrawal is here. My head is tingling and dizzy.  I cannot sleep, even if I try, I jerk and prevent myself from falling asleep.  I don’t know if the alginate is still clinging in my intestine keeping the drug in my system or if I dont have enough of the drug.  Either way, I feel misery.  Can’t talk to pharm doc about issue for 8 days.  Afraid to go that long without taking action to cease a protracted withdrawal situation.  

[Jennings]

I’m sorry you’re having this happen to you.  I am currently in a wave myself and am getting almost no sleep.

 

I am seven months into a CT, you’re doing everything right with the tapering.  This will pass.

 

‘’I’m getting the hypnic jerks, they are terrible.  

[Windsor77]

This is the first time that I have had them this badly.  They began only after I stopped the alginate capsules.  I believe that I have, or had serotonin toxicity.  I spoke with a psychiatrist today who, after hearing my tale, thinks that I had shut down my cytochrome 3a4 and that i was compounding my dose.   That said, he thought that raising my dose slightly was a way to alleviate these symptoms.  I am not sure that I agree.   But the jerks are the worst.  I will try to stick it out for another couple of days.  One thing is for sure, this new troubling symptom is either from too much or too little serotonin.  I just don’t know whether I could still have an overload of serotonin in my system after 2 days of not taking the supplement. 
I wish I hadn’t aggravated Chessie Cat.  Being that she has dealt with the toxicity, I’d love to know Chessie’s thoughts. 

[ChessieCat]

You didn't aggravate me.  I just ran out of suggestions so it was a waste of my time continuing to post.  You are fixated on your assumption that the supplement is changing the dose of your citalopram.  Even if it is the case, then there were ways that you could have better handled it (see below).

 

Your situation is completely different to mine.  My mild serotonin toxicity was from taking only a high dose of Pristiq.  No other drugs were involved.  So it was a simple case of lowering my dose as quickly as I could.  There was no guessing involved.  All I needed to do was listen to my symptoms and not taper too quickly.

 

You have been assuming that the supplement changed the dose of citalopram that you were getting, whether that be an increase or a decrease.  Generally SA's suggestion is to make small changes of only 1 thing at a time.

 

Because of the above I will say that it would have been better to have reduced your supplement gradually and I may have already made that suggestion.

 

You chose to stop the supplement abruptly which, if your assumption about the change of dose of citalopram is correct, you have possibly now either increased or decreased your citalopram dose.  But which way it is not possible to tell.  If you had reduced the supplement slowly it would have been making the citalopram dose change more gradual.

 

Something that you may not have taken into consideration is that you might be reacting to taking / stopping the supplement and it might have nothing to do with a change in citalopram dosing.  But nobody knows.  You are an experiment where N=1.

 

I think it is going to take some time, possibly a week, without making any changes before you might be able to see a clear/er pattern.

 

Note that you are only guessing about what is going on and I think you are adding a huge amount of stress and anxiety which can increase and/or add symptoms.  The daily symptom pattern is a better way of working out what you might do (rather than guessing) but as I said it is going to take some time without making changes.  As soon as you make a change then you have to start again.

 

Please note that I am not reviewing your notes.

[Windsor77]

Thank you for responding.

im just trying to find a quick solution for a problem that only time will resolve.  
i did recall that I also my pharmacogenetic test shows that I have the CYP3A4*22 allele that slows 3A4 function.  Add that plus alginate which is an inhibitor and pantoprazole which is a mild inhibitor, and I have created quite a undefinable situation. 

I had to stop the supplement due to how horrible it was making me feel.  I am fearful that somehow my levels are still too high, since when I have taken my dose the past two nights, it’s made me feel terrible.  I just feel trapped and I’m scared, so I’m sorry for getting on everyone’s nerves.  (Bad pun). 

I 

[Windsor77]

I just cannot rationalize why I feel so much worse after I take my citalopram dose.  I have NEVER ever felt any noticeable side effects after taking it.  Not in the 2.5 years I have been taking it.   I have dizziness and nausea and I can feel it coursing through my nerves and brain.  I can feel it in my lips. This new development is what makes me wonder if somehow I still have too high of a level of citalopram/serotonin.   As chessie said, I have no idea what’s going on.  That’s pretty frustrating. But just knowing I have another night of insomnia and jerks ahead of me is not enticing.   I’d love to take a couple of unisom tablets just to get a couple of hours of sleep.  But that would be making another change to my routine. I just cannot make sense of why I feel so much sicker after taking the citalopram.  

[Windsor77]

Update.  Getting SEVERE restlessness after taking the citalopram now. My GP gave me 5 sleeping pills for emergency, which I haven’t taken.   I slept last night for about 5-6 hours on my own.  It was not good after I woke up. Crying.  Racing thoughts. Anxiety.  Horrendous.  I broke down and took a metoprolol 25mg. It helped very little.    No alginate since Sunday night.  Funny thing. By noon the next day, I feel better. WAY less emotional sensitivity and little adrenaline/anxiety.  I take at 7 pm. By 2 am and through noon the following day I’m a mess.  Then I’m better until I take again.   
My theory, I spiked the citalopram so high that it’s now giving me mild akathisia shortly after each dose.    
I see a new psychiatrist Monday.  I plan to examine changing drugs or other options. I can no longer manage this on my own.   


 

[Windsor77]

Update. I halved my dose.  Before bed.  It still made me feel ill about a half hour later. However, I slept from 10pm- 8:30am with only minor interruption. No heart racing. No anxiety. No crying. No hysteria.  No racing thoughts.  Still had some minor jerks, but what a difference sleep makes.   Don’t know how it could be but I think my drug level is still high and adding the dose every night is adding the anxiety.   So far, this experiment has proven that without half the citalopram, my troubling side effects have left for one night. 

[Vasherr]

Hi, @Windsor77,

 

long time has passed since Your last update, please let us know how are You doing, as You seem to be struggling with a problem I also have, which is sensitivity so high that shortly after taking the drug we feel very bad.

 

Wishing You a lifelong window!

V.

[manymoretodays]

Yes.  We'd love to hear an update Windsor77.

Hope you are well enough.