Lizzzy: Can't continue my taper – any ideas?

[Lizzzy]

Hi everyone.

 

I'm Liz and I need some counsel. First things first: I'm not a native english speaker, I'm german. So please excuse my poor language and mistakes, I'll try to express myself as clearly as I can.

 

As you can see in my signature, I was put on Citalopram (it's Celexa in the US, right?) in 2007. I had developed quite a harsh anxiety disorder with massive panic attacks. At the point that I couldn't manage my everyday life anymore, I went to my GP and asked for help. He prescribed me 20mg Citalopram to "get back on track" and advised me to seek therapy, which I did immediately. While that therapy person wasn't the real deal, the pills worked well for a while. A year later I tried to quit them, but felt miserable. I went cold turkey because I didn't know any better. My GP sent me to a psychiatrist who put me on 30mg. This also worked for a while.

 

Another year or so later (you can see a timeline in my signature) I tried to quit again. My psychiatrist told me to taper over the course of few weeks. It was basically another cold turkey, it failed, and I tried again and again. By the end of 2012 I managed to be completely off pills for 6 months, but then things got so bad that I went back on 20mg. As many of you may have experienced, my doctor told me I would need the meds and could take them forever and that there was no such thing as withdrawal. I changed the psychiatrist, but the second one told me the same. My GP told me the same. They basically labeled my withdrawal symptoms as hysterical. They all advised to stay on the meds. Which I did not want, because I missed my "human-ness" so much.

 

Then I got pregnant, landed stable on 10mg somehow and stayed on that dose, it was the best I could. I'm really lucky my kid has not shown any signs of harm after her birth. She's developing perfectly normal, but I'm still feeling guilty because I couldn't fully quit the meds. I've been stable on 10mg for a long while, but as time went on, I desperately wanted to feel the "real me" again and began researching the topic of tapering and withdrawal. Turns out,  withdrawal exists. For real. That gave me new hope.

 

So. In the least years I've been tapering very slowly from 10mg. Things got bad from 7mg on, there was a full year of horrendous depression and anxiety and sheer terror. It took me another year to recover from this. Now I'm at 5.75mg, and I can't seem to go further. I tried a single reduction of 1% in May, some kind of microtapering plans in mind, and 3 weeks later I wanted to die. I reinstated and stabilized. Three weeks ago I dropped the dose about 0.5% and expected things to go mellow. Tiny dose, right? They didn't. I don't exactly want to die now, but 2 weeks after the reduction I developed severe anxiety with bizarre thoughts, vertigo, nausea and most of the other stuff I know so well. I reinstated two days ago and the bizzare thoughts are gone today, the nausea also.

 

I really don't know what to do. With reductions of 0.5% every few months (because I can't bear it more often), I would not be able to come off meds in this lifetime. I'm 40 years old. 

 

Is this real? Is there a chance I'm really this sensitive? Or am I making things up in my mind? Is someone else here who can't do the tiniest of drops? And is there any way out of this hypersensitivity? It feels like symptoms are getting worse with every failed reduction. The citalopram itself doesn't exactly bother me at the given dose. I tolerate it quite well, I guess. Feeling no side effects (or I might be so used to them I can't feel them anyway).

 

So, what's a girl gonna do when nothing works?

 

(Short background info: I'm the main provider in my family and we have a toddler. My job is about creative thinking. So I have to function as a employee and a mum to some degree and I need a relatively clear mind to do my job. That's why I tried these tiny reductions, and of course because I don't want wanting to die, obviously).

 

Thanks heaps for reading this.

 

All the best

Liz

[Gridley]

Welcome to SA, Lizzzie.

 

First off, here's SA's links on microtapers.  That will at least give you some background and information about the subject.

 

The slowness of slow tapers

 

It's very possible that symptoms are getting worse with every failed taper.  It's called kindling, where the system becomes more and more sensitive after the failed tapers.  If you want to read more about this, Google "SurvivingAntidepressants kindling"

 

You write that you tapered very slowly.  Please tell me the rate at which you tapered.  It's possible you tapered too fast.  We recommend no faster that 10% every four weeks.  Some people have to go slower.  

 

Why taper by 10% of my dosage?

 

Brain Remodelling 

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

Please put this taper rate in your signature.  Account Settings – Create or Edit a signature.

 

What I would suggest is a very long hold of several months at your current dosage in order to allow your brain and nervous system to stabilize.  You write that you tolerate the Celexa well, so that's good.  Then, when it feels right,  you could again try a very small drop and see how that goes.

 

One other thing I'd suggest is omega fish oil and magnesium, now and whenever you start the taper again.  Many people find these calming and could aid you you in your taper.  Try them one at a time at a low dose to see how you react.

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

[ChessieCat]

Hi Lizzzy and welcome to SA,

 

(Gridley has answered before I finished my reply, but I will post it anyway because it has some different information)

 

Thank you for completing your drug signature.

 

Yes, there is such a thing as withdrawal symptoms from going off a psychiatric drug too quickly.  See:  Dr Joseph Glenmullen's WD Symptoms Checklist

 

We need to know is how much you have been reducing by.  Please change the 1% and 0.5% in your drug signature and write how many mg you were taking.  Thank you.

 

SA recommends tapering by reducing 10% of the current dose and staying on that dose for about 4 weeks which allows the brain to adapt to not getting as much of the drug.  Why taper by 10% of my dosage?  

 

Many members find that the lower their dose gets the slower they need to go by reducing less and/or for holding longer.  And they also mention some doses seem to be harder to get past than other doses.  Why taper paper: dose-occupancy curves  

 

Once we have the information about the mg doses you took we will be better able to offer suggestions about how much you could try to taper next time.

 

This is your own Introduction topic where you can ask questions about your own situation and journal your progress.

[Lizzzy]

Thank you both for the kind welcome!

 

Here's the timeline of the last years. The years before I don't remember exactly because of going up and down and off a few times, without knowing any better.

 

I'll put this in my signature too.

 

2014/2015: Two years stable on 10mg after tapering down from 30mg

16/04/26: 9mg, no symptoms

16/06/08: 8mg, no symptoms

16/07/27: 7.5mg, mild vertigo

16/08/15: 7mg, vertigo, anxiety, nausea, neuro emotions, depression and akathisia

17/01/05: 6.3mg same symptoms as above

17/02/18: 5.89mg same symptoms as above but slightly milder

17/05/04: 5.6mg same symptoms, underlying and steady feelings of despair and suicidal thoughts, can't really stabilize

17/08/11: 5.75 due to persisting depression and neuro emotions 

18/05/17: 5.7mg, after 3 weeks onset of suicidal thoughts and severe anxiety, jaw clenching, nausea

-> reinstated 5.75mg, things got better quickly

18/10/14: 5.725mg, after 2 weeks onset of anxiety, vertigo, nausea, bizarre anxious thought

-> reinstated 5.75mg, feel better after 2 days

 

I take fish oil (3.000mg) and magnesium (400mg) on a daily basis and tolerate it well, I take also a vitamin B-complex. 

 

It seems my body reacts on the tiniest reductions since I crashed so bad in 2016/2017. Withdrawal got unbearable back then and I really thought I'm gonna die. Thinking about it now makes me miserable, although I had a good year in 2018. That's why I tried to go on with my taper in the first place, because I felt so stable. But it seems to fail and I have no idea why...

 

Thank you for your time and help.

 

Liz
 

[ChessieCat]

Thank you for the extra information.  It makes it much clearer.

 

Q:  Are you taking any other drugs?

 

[Gridley]

 

While it is often a first response to stress to take a B-Complex, in withdrawal it can be overstimulating.

 

Hypersensitive to B Vitamin or B-Complex  

 

[Altostrata]

Hello, Lizzzy.

 

You may find this interesting Why taper? Paper demonstrates importance of gradual change in plasma concentration

 

How are you feeling now?

[Lizzzy]

9 hours ago, ChessieCat said:

Thank you for the extra information.  It makes it much clearer.

 

Q:  Are you taking any other drugs?

 

No, Citalopram is the only med I ever had.

 

I'm not drinking alcohol anymore, because I became so sensitive to it in the last few years. I used recreational drugs when I was in my twenties (not very extensive though), but quit long before the Citalopram.

 

When I'm stable and happy, I enjoy a cup of coffee, just one per day.

[Lizzzy]

8 hours ago, Gridley said:

 

While it is often a first response to stress to take a B-Complex, in withdrawal it can be overstimulating.

 

Hypersensitive to B Vitamin or B-Complex  

 

Oh, that's interesting. I'll quit the B-Complex and wait what happens.

[Lizzzy]

9 hours ago, Altostrata said:

Hello, Lizzzy.

 

You may find this interesting Why taper? Paper demonstrates importance of gradual change in plasma concentration

 

How are you feeling now?

 

Hey Altostrata.

 

Thank you. I've seen this paper before while reading here. It makes sense, regarding what is happening to me. I just can't explain to myself why I can't even tolerate these very small reductions. When I continue to go this slow, the taper would take fifty years or even longer. And I wouldn't even feel okay while doing it. That's somehow bizarre.

 

Today, I'm feeling...fragile. I reinstated to 5.75mg two days ago and many symptoms I named above faded away already. But I'm feeling lost now. I always thought: once I'm recovered from the really bad withdrawal phase that happened two years ago, I will be able to continue if I'm being extra careful. But turns out – I can't? I talked to a few people in a forum in Germany who helped me start tapering properly few years ago. They advised me to post here, cause SA is much bigger and there would maybe be someone who can help further. 

 

I don't know, maybe it's all...psychological. Out of fear or something.

 

 

[ChessieCat]

are-there-some-who-cant-taper-off-no-matter-how-slow-they-go

 

[Songbird]

I've had many failed tapers and often wonder if I'll ever get off meds in this lifetime.  I've tried to stop thinking about getting to zero as the be-all-and-end-all, and be happy to just be at a lower dose.   I've found side effects like emotional blunting are much milder at lower doses (i.e. feeling more "human").  During an earlier taper I found my body was feeling drops of just 0.05mg, which I thought very tiny, but still my body noticed them.  I definitely don't think it was psychological.  Later in the taper it became less difficult and I was able to make slightly larger drops.  I believe that some people have a lot of difficulty in certain dose ranges.  For me (as well as many others), around 5mg seems to be especially tough.

 

How are you creating your doses?  Are you making your own liquid?

[Lizzzy]

2 hours ago, Songbird said:

I've had many failed tapers and often wonder if I'll ever get off meds in this lifetime.  I've tried to stop thinking about getting to zero as the be-all-and-end-all, and be happy to just be at a lower dose.   I've found side effects like emotional blunting are much milder at lower doses (i.e. feeling more "human").  During an earlier taper I found my body was feeling drops of just 0.05mg, which I thought very tiny, but still my body noticed them.  I definitely don't think it was psychological.  Later in the taper it became less difficult and I was able to make slightly larger drops.  I believe that some people have a lot of difficulty in certain dose ranges.  For me (as well as many others), around 5mg seems to be especially tough.

 

How are you creating your doses?  Are you making your own liquid?

 

Yes, I'm diluting tablets with water. 20mg per 40ml. I switched to my own liquid a while ago from using a jewelry scale, which I find hard to use with very tiny reductions.

 

You know, reading you post almost made me tear up. I don't wish you such a hard taper, I don't wish this to anyone, but I'm relieved to hear I'm not alone. When I'm stable and not withdrawing actively, I feel good with my current dose. Emotional blunting ist much much better, and the libido stuff also recovered. I'm still not really able to cry though, I'm only crying as a w/d symptom (and then I can't stop, it's ridiculous).

 

 

@ChessieCat Thank you for the link! So there actually might be people who can't stop...I read something from Prof Healy a while ago. There's a theory that some people might not able to taper below an individual dose, no matter how slow they go...can't find the source right now. But I never thought I could be one of them. I always expected to come off some day.

 

Maybe I should reconsider my expectations like @Songbird does? I just cannot image the rest of my life revolving around withdrawal somehow. Ugh.

[Gridley]

5 hours ago, Lizzzy said:

Oh, that's interesting. I'll quit the B-Complex and wait what happens.

 

I would go off them gradually.

[Altostrata]

LIzzzy, it could be that at dosages less than 5.75mg, your system is metabolizing the drug so fast, its half-life is less than the usual 35 hours.

 

One way to overcome this is to split the dose. If you take part at a later time, you might be able to cover 24 hours at a level acceptable to your nervous system.

 

What time of day do you take citalopram? When you were taking 5.7mg, were your withdrawal symptoms worse at any particular time of day?

 

An alternative would be to switch to Prozac (fluoxetine), stabilize, and then taper from that. The best way to to it is to add some fluoxetine, wait a few days, and gradually reduce citalopram over a couple of weeks until you're taking only fluoxetine.

 

Many doctors will recommend this. People have been successful with it, but there is a risk the switch will not go well.

 

The Prozac switch or "bridging" with Prozac

 

Tips for tapering off Prozac (fluoxetine)

[Lizzzy]

1 hour ago, Altostrata said:

LIzzzy, it could be that at dosages less than 5.75mg, your system is metabolizing the drug so fast, its half-life is less than the usual 35 hours.

 

One way to overcome this is to split the dose. If you take part at a later time, you might be able to cover 24 hours at a level acceptable to your nervous system.

 

What time of day do you take citalopram? When you were taking 5.7mg, were your withdrawal symptoms worse at any particular time of day?

 

An alternative would be to switch to Prozac (fluoxetine), stabilize, and then taper from that. The best way to to it is to add some fluoxetine, wait a few days, and gradually reduce citalopram over a couple of weeks until you're taking only fluoxetine.

 

 

Thank you! 

 

Do people metabolize drugs in different paces? Could this be one reason why some people have such a hard time quitting? I think I'll try splitting the dose first, and if that does not work, I might consider fluoxetine. Do I split portions for my stable dose first to adjust, before I would start to taper again? Would I take the second dose about 12 hours after the first one?

 

I take the citalopram every morning after breakfast, usually around 8AM, maybe 9 on the weekends. I always find symptoms getting worse from noon, expanding in the afternoon. When I wake up, things are mostly okay, even when the withdrawal is going badly. And in the evenings, when my kid is asleep, chores are done and the house is getting quieter, I feel slightly better than in the afternoons. Sometimes I wake up at night and feel panic, but this doesn't happen very often. Lucky me.

 

I'll definitely read the threads about prozac and think about that option.

 

(I'm struggling ab bit with my english, I'm sorry. Trying to explain everything as precise as I can, but I'm not sure if its understandable.

I hope it is.)

[Altostrata]

Yes, you might be a fast metabolizer of citalopram.

 

Which symptoms get worse about noon? Have you had this symptom pattern as long as you've been taking citalopram?

[Lizzzy]

13 minutes ago, Altostrata said:

Yes, you might be a fast metabolizer of citalopram.

 

Which symptoms get worse about noon? Have you had this symptom pattern as long as you've been taking citalopram?

 

I'm getting more and more anxious as the day goes on. Around noon I'm extremely nervous, a horrific inner restlessness. Can't sit still, but don't know what to do either. It's a feeling of dread. Then there are these toughts, mean things my head is saying about me: You're worthless, you're ugly, your kid would have a better life if you were dead. I can't stop these thoughts and it goes on for hours. On really bad days I did hurt myself because something in me hated me so much. It is really hard to explain. Jaw clenching occurs regularly (all day long), nausea in the evenings, but that I can bear.

 

This symptom pattern is the same from the beginning, I guess. I took me years to identify it as a pattern though. It was much milder in my first attempts to quit and got worst below 7mg. 

 

Since I reinstated 5.75mg three days ago, I have a mild headache, but I think it will pass in the next days.

[Altostrata]

Did you have these symptoms when you were taking 20-30mg citalopram?

 

If I were you, I'd let the updose to 5.75mg settle for a week. Then, I would move 3mg of the 5.75mg later each day by a hour each day, until you are taking it at 6 p.m.

 

Please keep daily notes about your symptoms, when you take your drugs, their dosages. Use a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

 

Let us know how you're doing.

 

[Lizzzy]

1 minute ago, Altostrata said:

Did you have these symptoms when you were taking 20-30mg citalopram?

 

 

 

 

No, I had no problems with tapering to 15mg from 30mg, I didn't feel those symptoms at all back then. I did feel depressed though, that's why I went back and forth a few times, but never over 20mg after 2012. Symptoms like above were mild when a began a structured taper from 10mg, this dark wall hit below 7mg.

 

I might give myself time to settle for a few weeks until I split doses. At the moment, I don't dare to do it. I'm just so exhausted.

[Altostrata]

Please be sure to post your daily drug and symptom notes, I'd like to know more about this afternoon symptom pattern.

[Lizzzy]

1 minute ago, Altostrata said:

Please be sure to post your daily drug and symptom notes, I'd like to know more about this afternoon symptom pattern.

 

I will, as soon as I'm starting with splitting. I plan to wait one week from now and then do as you advised above. Can I keep my DIY-liquid in the fridge or do I have to make a fresh one for the second dose?

[Altostrata]

Please post your daily drug and symptom notes so we have a baseline, before you start splitting the dose.

 

Please read

 

Making a citalopram solution yourself

 

Tips for tapering off Celexa (citalopram)

 

You can keep a mixture in the refrigerator for several days.

[Gridley]

 

On 11/3/2018 at 8:17 AM, Gridley said:

 

I would go off them gradually.

 

Lizzzy, if you're going to be splitting your Celexa dose, I would wait on stopping the B-complex.  Make only one change at a time.

[Lizzzy]

5 hours ago, Gridley said:

 

 

Lizzzy, if you're going to be splitting your Celexa dose, I would wait on stopping the B-complex.  Make only one change at a time.

 

I already cut the B-tablet in half, yesterday and today. Seems to have no bad effect so far. I'll wait a little while until I split my Citalopram dose, I still feel mild symptoms from the failed reduction. I didn't take the B-Complex very long. Two or three weeks maybe.

 

Today's stuff for Altostrata:

 

04/11/18                             5.75mg Citalopram / 9AM 

                                              – Irritation/restlessness still lingering, worst around noon, but much much better 

                                              –Vertigo is gone, jaw clenching very mild, nausea gone, bizarre thoughts gone. 

 

 

Altostrata: Should I post new every day or regularly edit this actual post?

[Altostrata]

Hi, Lizzy. Please post your drug and symptom notes every day, in a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

 

I need to know when you take your drugs, and the symptoms before and afterward. Please include your sleep pattern.

 

[Lizzzy]

Okay, thank you. I edited the post above and will keep this list format if it looks okay to you.

[Lizzzy]

05/11/18                             5.75mg Citalopram / 8AM 

                                              – no symptoms

 

06/11/18                            5.75mg Citalopram / 8.30 AM

                                             – no symptoms

 

 

My client told me today that I'll have to attend several business trips in the next 4 weeks – I will start splitting my dose afterwards. The extra-time to stabilize might be beneficial...I think. Changing something about my meds while having stress at work didn't go well for me in the past, that's why I'm extra careful. I'm a freelancer, so I can't call in sick or something without losing the money.

 

Have a nice evening everyone!

[Lizzzy]

07/11/18                             5.75mg Citalopram / 8AM 

                                              – no symptoms

 

08/11/18                            5.75mg Citalopram / 8.30 AM

                                             – no symptoms

 

09/11/18                             5.75mg Citalopram / 8AM 

                                              – no symptoms first, got very irritated in the evening

 

10/11/18                            5.75mg Citalopram / 8 AM

                                             – still irritated. Did an intensive exercise session, overall feeling got worse. Like I had to cry, but I can't. 

 

Two days ago I started to store my DIY-liquid in the refrigerator to get more portions out of one pill. Never did it before, I always made a fresh one daily. Maybe the storage time has any effect on me? I don't know. People don't seem to have problems with this.