☼ Windsor77: Celexa - it's time for peace

[Altostrata]

If you want to go off psychiatric drugs, I strongly recommend you learn non-drug ways to manage your intrusive thoughts. A psychotherapist can coach you in this.

[Windsor77]

@Altostrata 

Thanks.  I start Friday with a new therapist specializing in OCD.   I realize that I cannot do this alone.   That goes for the medication as well.  I won’t be taking the buspirone which was suggested for me by the psychiatrist since the side effects I currently have are the reason for my lingering health anxiety depression and ocd.  
On a side note, during a camping trip this weekend, I stayed up later than usual and ended up taking my meds around 11pm-12pm rather than 8pm.  I found myself having the numbness feelings and shakiness for about half the next day and then they seemed not as severe.   Is there any credence to splitting the dose?   Could I manage somehow to get the side effects to be worst while I slept? How would I go about doing so?    Any input is appreciated.

 

 

[Altostrata]

1 hour ago, Windsor77 said:

ended up taking my meds around 11pm-12pm rather than 8pm.

 

Which meds, what dosage did you take around 11pm-12pm?

 

1 hour ago, Windsor77 said:

 I found myself having the numbness feelings and shakiness for about half the next day and then they seemed not as severe.

 

Please explain. Do you mean you had these symptoms from the time you woke up? When do they usually occur?

 

What is your usual drug schedule and symptom pattern?

[Windsor77]

@Altostrata

I take 250mg of magnesium citrate in the morning. I take 1.8 mg of citalopram liquid daily at 8pm.  Sometimes I feel the numbness symptoms in the am and they fade, sometimes I feel like they get worse in the evening.   I just cannot pin it down totally.   I have wondered if there was a way to split dose to counter act this, or to try to avoid it.  I recently had another EMG test and it was normal, again.   2.5 years out and 6.2mg down from Original dose, I’d hoped that this would have subsided more than it has by now.    Then again I went from 100mg sertraline to 50mg sertraline to 10 mg citalopram within 5 months from Jan-May 2018.   My symptoms are better with regard to the constant shakiness feeling, but it is more like the symptoms have changed/evolved over the past 2 years.    
I really wonder if switching back to sertraline could work, but it would likely restart the entire process.   
Sorry for my digression.  
Any thoughts or suggestions on splitting the dose in a way that wouldn't exacerbate side effects?

[Altostrata]

2 minutes ago, Windsor77 said:

I take 1.8 mg of citalopram liquid daily at 8pm.

 

If you're taking citalopram at night, it's hard to say the symptoms you feel in the morning are drug effects. With a dose of 1.8mg, it's more likely the citalopram is wearing off 12 hours later. You may be a fast metabolizer.

 

How often do you get these symptoms? Are there other precipitating factors, such as smoking or drinking? Are you taking any other drugs?

 

Does the nighttime citalopram make you sleepy? Do you get other sensations shortly after you take it? What is your sleep schedule?

[Windsor77]

@Altostrata

im so sorry.  I meant 1.8 ml.  Or 3.6mg. 
 

I am an intermediate metabolizer of CYP3A4 per a pharmacogenetic test.  This is why I believe I cannot restart my protonix without increased side effects.  

no alcohol, drugs.  Forgot to mention vitamin c powder in am and occasional zinc at 50mg in am.  

Citalopram does not make me sleepy.  I do feel that like some of the numbness or activated nerve symptoms come back on prior to falling asleep after my dose on some occasions.  My sleep is typically from 10pm to 7:30 am. 

[Altostrata]

Please 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.

[Windsor77]

@AltostrataI saw therapist last Friday.  She specializes in ocd and believes that CBT/Exposure therapy can help me.   She said it can be tough and many do benefit from medication during.    I told her at this point I don’t want to do anything different with the meds.  I continue to hold at 3.6mg.   Moved my dose up an hour to 7pm and I have seemed to feel less of the numbness and tremor stuff throughout the day.  could be psychosomatic.  After some review of the two past Anxious/panic episodes I have had I realized that they both had prednisone In common.  The first time this year was after a sinus infection in January, which coincided with a drop of .2mg, I got a shot of steroid.  the second was just a couple of weeks ago right after another planned .2mg drop.  
This may be circumstantial, and while am continuing to hold at 3.8 for a bit, this gives me some hope that the extremity of my anxiety feelings were caused by the steroid. 
 

creating the symptoms log is definitely work with my life and work schedule.  I am keeping close watch on this with my recent change of moving to a slightly earlier dose. 
overall feeling good.  Health anxiety is still alive and kicking though.  Hopefully my therapist can assist me with tolerating uncertainty. 
 

[Windsor77]

Windsor77- nearly there!

 

It’s been 3 years and two months since I ct’d my lexapro and began this journey.  My journey is documented here fairly descriptively.   The lows were lower than I have ever felt in my life.  I am here to report that I am feeling amazing and have been for more than 6 months now.  The fog has lifted, the depression too.  The neurologic symptoms do still show up form time to time, but in an abbreviated manner compared to the past.   My thinking is clear, my joy for life has returned. And my outlook has gone from grim to positive. I am currently at 3.2mg daily liquid citalopram, and I have been for over 6 months.   To everyone here- HANG ON - your turn is coming. I know every experience is different.   And yes, I know I am still taking a small dose of the meds.  But I must say I feel better than I have in 3 years.  If this is a window, it is my longest yet.    I have waited to post to be sure that I wasn’t too premature.  I will always be grateful to this site.  SA educated me that I wasn’t imagining the symptoms or going crazy.  It was a lifeline at every stage.  So many have helped me with advice, I cannot thank you all enough.   I’ll continue to update as I can.  I’m not thinking of AD withdrawal anymore.   That’s the best part. 

peace of mind and patience sent to all who continue to struggle.  Stay with it.  It does get better. 

 

Edited November 10, 2020 by ChessieCat
added topic title

[ChessieCat]

Because you're feeling better, I added our cheerful "here comes the sun" symbol ☼ to the title of your Intro topic, to show you're recovering.

 

Please continue to let us know how you're doing. I hope you will add your story to our Recovery Success Stories eventually!

[wantrelief]

Thank you so much for sharing how well you are feeling - that is really great news!  It is really hopeful to hear that you have felt better while tapering.  

[manymoretodays]

Yay Windsor77,

What a wonderful update, and thank you so much for coming in to post it.  I am so happy for your decent 6 months.

20 hours ago, Windsor77 said:

I am currently at 3.2mg daily liquid citalopram, and I have been for over 6 months.   To everyone here- HANG ON - your turn is coming. I know every experience is different.   And yes, I know I am still taking a small dose of the meds.  But I must say I feel better than I have in 3 years.  

That's okay, HOLDING for awhile, and letting your CNS have a break.

 

It does appear that you need to do a signature update now, Lol, sorry, always asking you to do something:

Just go to Account Settings and you'll see "signature" on the left, click on that, scroll on down to your signature, and edit/update, then click Save.

 

Oh best Windsor,

L, P, H, and G,

mmt

 

[Windsor77]

A cautionary tale regarding even the most innocuous supplements.  I have severe GERD, and I have for many years.  Due to a hiatal hernia, my stomach contents come into my throat when I sleep, causing chronic irritation.  Recently, an ENT mentioned  a product called Gaviscon Advance, which is not sold in the US.  It has an ingredient called Alginic Acid, a derivative of kelp. It creates a barrier on top of stomach contents and does not allow them to pass back into the esophagus and throat.   Sodium alginate can be purchased as a stand alone supplement.  I took the tablets at night after eating and before sleep. It works amazingly and is far less invasive than a nissen fundoplication surgery, which is the only other way to correct this mechanical defect.  My symptoms were markedly reduced.  After a few days, I noticed that ALL of neurologic symptoms that I’ve discussed at length in this thread were also curiously gone.  I feel great.  100% normal.   I knew that these symptoms would not just disappear so I did some in depth reading about sodium alginate.  Unfortunately, it is referenced in one publication I found as a strong CYP3a4 inhibitor.   UGH.  Now, after 2.5 years of this tapering process, I errantly have been boosting my citalopram levels.  I am currently taking 1.5 ml (3mg) of citalopram every evening before bed.  It is impossible to tell how high my levels have been, as I took the alginate for 9-10 days.  I skipped the alginate pill last night and I feel the familiar lightheadedness and a tiny bit of dizziness.   Not sure how to proceed.  Should I reinstate the alginate or wait a week or so to see what happens?   That said, this mistake has answered my questions about the source of my twitchy side effects.  They disappeared with this likely increase in my plasma levels of citalopram.   This tells me that they are truly a result of the absence of the SSRI.  

@Altostrata @ChessieCat Any thoughts on this?  I feel foolish for making this amateur mistake.  Not sure if it’s wise to just go back to my 1.5 ml dose or increase it????  As always, your advice is appreciated. 
W77

[ChessieCat]

Basically you have made an updose if in fact the new supplement does increase the citalopram.  If, as you say you have noticed from your symptoms, your withdrawal symptoms lessened then it sounds like you have had a "happy accident".

 

At least now you are aware of what is going on.  If it was me and the supplement is working I'd continue to take the supplement and stay on the same citalopram dose.

 

Because you are feeling improvement you might want to take a tapering holiday and enjoy being symptom-reduced for a while before recommencing your taper.

 

You might also consider doing a Brass Monkey Slide if you aren't already doing that.  When you recommence your taper you might also think about making a tiny reduction to test to see how you react.

[Windsor77]

@ChessieCat I have had this thought too.  But I worry how much I could actually be increasing my dose.   I guess it’s not relevant at this point. But I feel like I have screwed up my process.  I have had pharmacogenetic analysis tell me that I may be an intermediate (slightly faster than normal) Cyp3A4 metabolizer.  What if I’ve reacclimated  myself to double or triple the plasma concentration?  This would mean my entire reference point for measuring my taper has been thrown out the window, right? I guess I’m just afraid of serotonin toxicity or making my level too high.  Maybe I’m worrying too much. 
thanks for your advice. 

[ChessieCat]

1 hour ago, Windsor77 said:

I guess it’s not relevant at this point.

 

Exactly.

 

1 hour ago, Windsor77 said:

 Maybe I’m worrying too much. 

 

Yes.

 

1 hour ago, Windsor77 said:

I guess I’m just afraid of serotonin toxicity

 

You took it for 9 or 10 days and didn't have this issue so it may not happen.  However you will just need to keep an eye on your symptoms and if you start getting symptoms of serotonin toxicity then you will need to reduce your dose but carefully.

 

1 hour ago, Windsor77 said:

What if I’ve reacclimated  myself to double or triple the plasma concentration?  

 

I doubt that it would be double and doubt very much that it would be triple.

 

I imagine that it would only be a small increase.  No evidence, just my thoughts.

 

1 hour ago, Windsor77 said:

This would mean my entire reference point for measuring my taper has been thrown out the window, right?

 

If it was me I would be making smaller reductions than 10%.  Perhaps 7.5% maximum per month.  If you did the Brass Monkey slide of 7.5% then it works out at even less.  I think doing the Brass Monkey slide would be good because it will allow you more control, ie holding longer at any time during the cycle if your symptoms worsen.

 

Just like any of us tapering, you will need to listen to your body/symptoms and taper accordingly.

 

The good thing is that you have learned about it very early on and can make adjustments to your taper right from the start instead of experiencing issues and not knowing what is going on.

 

[Windsor77]

Thanks @ChessieCat   I have found the article I referenced.  If I read correctly it states that there could be up to a five fold increase of plasma levels with this.  Of course this wasn’t tested with citalopram and there are a lot of other factors in play. Given that I’m only taking 3 mg daily, this could mean that i could be back up to 15 mg or higher. Considering I also take pantoprazole for acid control and this is suspected of being a 3a4 low inhibitor as well.  As I think about the past weeks, I can say that I have had some bowel changes and have had some aches that were not characteristic.  I really believe that I should find a way to carefully lower.  But I am concerned about whether that means stopping the supplement or reducing the liquid citalopram.  The problem is...by how much?! 
I’m  sorry to pester you and I feel like a fool for creating this error this far into my taper with as much as I have learned over the past 2.5 years. 
 

im thinking maybe open the sodium alginate capsules and cut the contents in half?  I’d be more comfortable cutting the supplement than the actual drug.   I’d really just like to get my body back used to the lowest dose possible. 
thanks for all of your support. 

 

https://www.mdpi.com/1422-0067/21/21/8224/htm

sodium alginate is mentioned under the “Polymers” heading. 

[Windsor77]

I feel like this could be too much serotonin.  Maybe I’m thinking about it and ruminating a little, but I’m not freaking out.  I just feel like my brain is floating in a bowl of soup. Borderline headache, Kinda dizzy. Sometimes kinda nauseous.  Muscles and nerves in limbs feel a little bit activated.  Back of head near neck feels really full and heavy. Just like the acclimation during the first few weeks of when I started an SSRI.   I dont want to make any rash changes.  But I also don’t want to continue to expose myself to a high dose and delete all of my taper progress.  Maybe I am looking at this the wrong way.  Definitely increased the above mentioned feelings when I took pantoprazole this morning.  How can I be sure that the serotonin isn’t too high?  How can I ensure that the other stuff isn’t keeping the citalopram in my system too long?  
In this case, the fact that it can take a month to feel the effects of a change complicates how to triage the effects of my stupid mistake. 

[ChessieCat]

When did the symptoms you stated start?  If they started after you found the information then it might be simple anxiety.  Anxiety can cause a lot of physical sensations in the body. 

 

See the diagram on this page which shows how anxiety affects the body (I'm not able to paste the image)

 

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

 

 

Edited February 13, 2021 by ChessieCat

[ChessieCat]

If it happened before you found the information it may not be serotonin toxicity.  It may be a side effect of the supplement.

 

If you are concerned that your citalopram dose has been raised too high then you could try a small reduction in your citalopram dose and see how that affects you.  You will need to listen to your symptoms and go down by small increments so as not to bring on bad withdrawal symptoms.

 

Please note that I am not a medical professional so the suggestions I am making are just ideas.  They are in no way advice about what to do.  They are just things for you to consider.

 

What action you take will be your entirely your decision.  However I would strongly suggest that you do not keep chopping and changing your drugs/supplement/doses but to do things gradually and one at a time, keeping notes to see how it affects you.

 

And to stay as calm as possible so as not to add anxiety into the mix and thereby confuse your symptoms.

 

 

 

 

[Windsor77]

Looking back over the past couple weeks, I think that I had some more minor versions of these feelings even a few days in.  They are what brought me to read more about the supplement’s metabolism characteristics.   I know what anxiety can do for sure.  I’m not in that state.  I’m fairly certain that it’s the supplement.   One at a time is the way I’ll approach this.  Of course, reducing the citalopram is the easiest way to test the theory.  Again, my only quarrel with this method is that I have no idea what amount I am really ingesting while I’m still on the alginate.  
Quite a quandary I have created for myself.  
Don't be like me folks, read the metabolic data for EVERYTHING you put in your body.   
Thanks @ChessieCat for taking the time to share your input.  
 

I’ll keep updating with progress. 

[ChessieCat]

1 hour ago, Windsor77 said:

Of course, reducing the citalopram is the easiest way to test the theory.  Again, my only quarrel with this method is that I have no idea what amount I am really ingesting while I’m still on the alginate.  

 

That's why, if you decide to continue with the supplement it will be important to be very cautious about the amount you reduce your citalopram by.

[Windsor77]

I decided last evening that I would halve the alginate capsule.  I think I want to keep the citalopram the constant. Alginate is a powder, so very easy to measure to a half capsule.   I plan to keep this method for a couple of weeks and see what the result is.  
I’ll keep posting updates. 

[Windsor77]

Still having the dizzy type feeling and some raised heart rate.  When I’m moving around and busy I don’t notice the Swimming head feeling until I sit down or am still.  Last evening, right at about 24 hrs since my last dose of citalopram I began to feel a little bit shaky/tingly in left arm.   What I now know is a classic sign of lack of the drug in my system, or too low of a level.   I wonder if my 2.5 years of dealing with these neurologic symptoms and their disappearance when I started using a CYP3A4 inhibitor proves that I do in fact metabolize this medicine faster than average.   If I can find a way to balance the supplement and the ssri, then I’ll be in a very good spot.  Minus the times I felt a little cruddish (from too much serotonin) during the past 3 weeks, I’ve felt great.  

[Altostrata]

I believe you have misinterpreted the effect of sodium alginate. Since it coats the digestive tract, which you found beneficial, it may slow absorption of citalopram, not increase blood levels.

 

Whatever action it has on cyp3A4 is not of consequence, citalopram is primarily metabolized by cytochrome cyp2C19.

 

It's extremely unlikely this combination at these dosages could lead to serotonin toxicity.

 

On 2/12/2021 at 4:48 PM, ChessieCat said:

If it was me and the supplement is working I'd continue to take the supplement and stay on the same citalopram dose.

 

Good common sense from @ChessieCat If it's working, I wouldn't overthink it.

[Windsor77]

Thanks for taking the time to advise @Altostrata  I think that the current symptoms I have are definitely from a lessening of the level in my system.
I read this on drugs.com after reading your response. 
  “CYP3A4 and CYP 2C19 inhibitors: Since CYP3A4 and CYP 2C19 are the primary enzymes involved in the metabolism of citalopram, it is expected that potent inhibitors of CYP3A4 (e.g., ketoconazole, itraconazole, and macrolide antibiotics) and potent inhibitors of CYP2C19 (e.g., omeprazole) might decrease the clearance of citalopram. However, coadministration of citalopram and the potent CYP3A4 inhibitor ketoconazole did not significantly affect the pharmacokinetics of citalopram.”

At the regimen  was taking the drugs, i was definitely feeling something gastrointestinal going on, which lead to a sort of all over “yuck” feeling. Delayed movement with uncharacteristic constipation. The “yuck” feeling seemed to subside afterward.  
I also take 40mg daily of pantoprazole - which may be a mild 2c19 inhibitor, per the article below.  
https://journals.lww.com/drug-monitoring/Fulltext/2015/02000/Effect_of_Proton_Pump_Inhibitors_on_the_Serum.13.aspx

perhaps the combination could be having an effect.  I take the pantoprazole at 8am every morning, one magnesium citrate pill at 9:30am, then citalopram at 7pm, another magnesium pill at 8:30 and one capsule (400mg) of the alginate right before i sleep. 
 As always, your input and objective thoughts are appreciated. 

[ChessieCat]

Quote

2/20 added sodium alginate for gerd - caused updose. 

pantoprazole added 6/20. 

 

Please add the years in your drug signature.  Thank you.

 

15 hours ago, Altostrata said:

I believe you have misinterpreted the effect of sodium alginate. Since it coats the digestive tract, which you found beneficial, it may slow absorption of citalopram, not increase blood levels.

 

6 hours ago, Windsor77 said:

I think that the current symptoms I have are definitely from a lessening of the level in my system.
I read this on drugs.com after reading your response. 

 

If the supplement is slowing the absorption of citalopram, it would not necessarily be lessening the level in your system.  It could mean that you are getting the same dose but it is being released over a longer period of time, like extended release, instead of dose dumping which might happen when taking a liquid.

 

Anyway, if taking the supplement helps with your GERD issue and you've also noticed an improvement in withdrawal symptoms then it's a win win situation.  Something to be very thankful for.  And it's also good that it hasn't made your withdrawal symptoms worse.

[Altostrata]

If it helps, it helps. Don't overthink it.

[Windsor77]

Update- I’ve had a couple of fairly normal feeling days.  For whatever reason, I am getting what I think are interdose withdrawal issues that I have NEVER had this entire journey.  I take my dose around 7pm. Then the magnesium, then alginate right before I lay down.  By 3pm and sometimes sooner, I am getting an increase in the “floating brain” dizzy feeling. And some vibration sensations throughout my limbs. All of which seem to dramatically lessen or disappear completely around 30-40 minutes after I take a dose.   Originally, I took my dose at night because I thought that the tremor/numbness I was feeling was from too much drug, so I wanted to sleep through it.  Now I think I am sleeping through the calm portion of the dose and getting the withdrawal portion beginning sometimes when I wake up.  My limbs have the vibration sensation in the morning.  Any thoughts? @ChessieCat

[ChessieCat]

3 hours ago, Windsor77 said:

I take my dose around 7pm. Then the magnesium, then alginate right before I lay down.

 

On 2/16/2021 at 1:22 AM, Windsor77 said:

I take the pantoprazole at 8am every morning, one magnesium citrate pill at 9:30am, then citalopram at 7pm, another magnesium pill at 8:30 and one capsule (400mg) of the alginate right before i sleep. 

 

On 2/15/2021 at 5:03 PM, Altostrata said:

I believe you have misinterpreted the effect of sodium alginate. Since it coats the digestive tract, which you found beneficial, it may slow absorption of citalopram, not increase blood levels.

 

Are you now taking the full dose of the sodium alginate?  Has that been for a few days now?

 

If not, then you might want to wait for a few days to see if things return to how you were before when you took it at full dose for 9-10 days.

 

Ideas:

 

You could try moving your citalopram forward by one hour each day.  Because you are taking the pantoprazole at 8 am I do not think it would be a good idea to move it all the way to the morning, but you might find that taking it in the middle of the day might help.  You will need to observe your symptoms to see how the change in dose time is affecting you.

 

Only make one change at a time.

 

If after doing this you still have what you think are withdrawal symptoms/interdose withdrawal then you could try splitting your citalopram dose and take it twice a day.  You would move part of the dose by 1 hour each day.  If it was me, I would be trying to get the dose timing to mid morning and mid afternoon.  If you find that you are still getting the interdose withdrawal symptoms then you could try moving the mid afternoon to a bit later in the day.

[Windsor77]

Update.  I have passed through the dizzy head feeling fully.  That said, my random muscle twitching has returned.  I think that my anxiety level feels up too.  Seems to be the same pattern, as if I dropped dosage too fast.  I am currently at 3/4 of a capsule full of the alginate.  Looking back, there were nights when I took two alginate capsules before bed.  I don’t think that I am in a full on crash, but I didn’t sleep well last night and my stupid rumination about the twitching is ramped up slightly.   I plan to go to a full capsule this evening.  I had been at 1/2 for a week and I’ve gone up to 3/4 the past two days.   I guess I will keep attempting to titration the alginate up until I reach stasis.  Frustrating.   It’s funny.  When I was unknowingly in the midst of my accidental updose, I could feel the moment that the ruminating thoughts disappeared.  Like, I couldn’t even force myself to think worst case scenario about anything.   This keeps me torn between the desire to be free from drugs and the actual fact that, when properly dosed, ssri’s actually alleviate my ocd and anxiety.    Alas, they are not a permanent fix, but I sure wish I knew what dose I was up to a few weeks ago.  @ChessieCat  any thoughts?

[Windsor77]

Another update.  I took a full alginate capsule and, overnight, the most pronounced twitching that I had has ceased.  When I woke, I could feel that the med level had increased.   I will hold here and report back within a few days.  Still have some lingering anxiety searching for something to grab onto.  Otherwise ok. 

[Windsor77]

Another update.  Anxiety is up. Worry level is up.  Twitchiness returned by around 4:30 pm.   I used the same regimen last night with a full alginate pill.  My right thumb is twitching like crazy.  It’s reactivating my worries about having a neurological disease and making me desperate to get to a doctor to alleviate the punishing “what ifs”.  Seems like a crash is coming.  I cannot tell if I’m getting too much or too little of the drug. When I woke this morning, I had noticeably more twitchy muscles firing, including in my lips.  I feel kinda shaky in the hands and muscles.  I’ve really messed my progress up.  Trying to stay positive but the health anxiety fear has really gotten a hold on me.   With the randomness of how these symptoms are coming, I don’t know what the alginate is doing, but it’s definitely not something that can be relied on for a consistent reaction.   I’d love to stop it entirely, now I likely cannot.    I fear another six months of trudging are ahead of me in order to sort this out.  Unfortunately, I’ve thrown something into the mix that makes it impossible to quantify my taper amounts.   What a mess I’ve made after coming so far.  @ChessieCat

@Altostrata  I’m using my coping techniques and dealing as much as possible.  But every twitch breaks my focus, and makes it hard to sleep.  Especially with the rumination about worst case scenarios like ALS and Parkinson’s.   Sucks to be back in the trenches.  
Edit: current resting pulse rate is 124. 

[Windsor77]

I was thinking, (yeah yeah, it’s obvious I do that a lot) I wonder if the alginate is preventing absorption of the drug.  Could that be possible?

[ChessieCat]

It depends on the action of the supplement and/or when you take it with regards to the citalopram.

 

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.

 

Taking calcium at the same time as magnesium loses the calming effect of the magnesium.  They need to be taken at least 2 hours apart.

 

Edited February 28, 2021 by ChessieCat

[Windsor77]

I am usually taking a couple hours after the liquid citalopram in order to get the full effect of the alginate while I sleep. I’m just trying to figure out why I am having such a strong reaction.  Tremor, anxiety, bounding, high heart rate.  If my levels weren’t modified much as postulated by @Altostrata, I cannot figure out why I’m feeling the withdrawal side effects the way I am. I only quit the alginate for one day.   And I felt effects. I am wondering if the alginate could be blocking the drug partially.  I know I’m grasping for straws, but if I’ve reinstated so to speak, then I’d think that I’d see a reduction the side effects, not an increase.