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crashcourse: citalopram 20 mg and Effexor XR 75 mg - also take anti-epileptic drugs

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crashcourse

Seven/eight years ago, due to a peculiar set of circumstances, I ended up closing down the successful business I had founded. The loss of my business and financial resources lead to various problems in my life. About six years ago I was diagnosed with depression and anxiety.

My psychiatrist  put me on:

Citalopram 10 mg/day.

Axal (Alpralozam) 0.5 mg

 

The immediate effect was that the anxiety disappeared. The depression got better (or at least the symptoms did), however I never returned to life of extreme activity like I had lead previously.

 

About two years ago my medications were changed.

Citalopram 10 mg twice a day i.e. 20 mg

Effexor Xr 75 mg/day

Axal 0.5 mg day.

 

In these years I have tried quitting cold at least 4 times. Each time I had to go back on medications. The only success story is that I gave up Axal, a benzo, cold. I had no WD effects from giving up Axal. Today I only take Citalopram 20 mg and Effexor 75 mg.

 

I must add that I also have Epilepsy since I was 13 years old. For the past 37 years I have been taking anti-epileptic drugs.

My current drugs for Epilepsy are:

Tegral 400 mg.

Lumark 750 mg.

 

These I cannot get rid off for obvious reasons. 

My only wish is to get off Citalopram and Effexor XR. I totally believe these do not help me. My anxiety has gone away, but I have this permanent listlessness. I was once an over-ambitious person and today I am totally flat. I don’t feel much emotions, and the desire to achieve success is gone. Failures and losses don't bother me either. This is not what and who I was. 

 

I’ve read many of the subjects here, including the wonderfully detailed Taper section. I do need your advice as to how I should approach my taper. Should I quit Effexor XR first or Citalopram? 

Any other advice on muti-drug taper would be welcome.

PS: My daughter gets married in 3 months. I am planning to start a very low 5-10% taper immediately. Any advice?

 

Thanks again. 

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Altostrata

Welcome, crashcourse.

 

Congratulations on going off Axal, and congratulations on your daughter's upcoming wedding.

 

Adding Axal to epilepsy medications is redundant. Combining citalopram and Effexor is something no conscientious psychiatrist would do. It is a dangerous drug combination. If I were you, I would not go back to that doctor for psychiatric drugs.

 

Why was Effexor added?

 

I would also read up on the side effects of Tegral and Lumark -- depression might be among them.

 

What times of day do you take your drugs? How is your sleep?

 

If I were you, I would reduce Effexor first. Typically, one removes beads from the capsule to taper. See Tips for tapering off Effexor (venlafaxine)

 

Please let us know how you're doing.

 

 

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crashcourse

Hello Altostrata,

 

I was initially only on Citalopram. When I tried giving up, I had to go back to my therapist due to WD effects. It was then he added Effexor XR. He did say it would be only for a short period, depending on my response, and then we would try to withdraw from Effexor XR. The main aim seemed to be to kickstart me into getting back to a productive life i.e. business. (I assume this, since this was implicitly stated.) 2 years later and I am still on my meds.

 

My dosage timing is as follows:

Morning:

Citalopram = 10 mg

Tegral = 200 mg

Lumark = 750 mg

 

Evening:

Citalopram = 10 mg

Effexor XR = 75 mg

Tegral = 200 mg

Lumark = 750 mg

 

I also have to use Eyedrops since I have developed Glaucoma. I do not know the cause, whether this is a result of anti-epileptics or other drugs.

 

As to anti-epileptic drugs and depression, I haven't recently studied the literature. However as per memory, Epileptics have a 33% higher chance of suicide/suicide attempts as compared to rest of population. This is true since suicidal ideation has always been a part of my life. However I was pretty successful avoiding these thoughts for the most part by setting out high goals and working towards them. It was only after loss of my business that the depression truly got to me and paralysed me. 

Tegral is supposed to be a mood elevator and is thus considered good for epileptic patients by raising their spirits. I have not studied the pharmacokinetics of this.

Frankly I have not bothered reading up Lumark literature. Guess I've had my fill of reading up on drug literature after all these decades.

 

Thanks for the kind wishes for my daughter's wedding. Yes the stress is high. many people still associate me with a successful business person and have no idea of my limited financial resources. So trying to scrape through, while at the same time I really have no wish to pander to peoples fancies.

 

Btw if Effexor XR and citalopram shouldn't be given together, why would my doctor have advised them. He is supposedly a top psychiatrist.

 

Thanks for reaching out. I will start tapering soon, and will keep you guys updated.

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crashcourse

Okay I started tapering Effexor XR on 27th April 2019. 

Since I use 75 mg once a day (at night time) I take out 40 beads manually. Each bead is 0.3 mg as per info given on a thread in the forum, so 40 beads = 12 mg. This translates to a 16% reduction. 

 

Day 1 and 2 were fine. 

Day 3 was when I had my initial WD effect. I got up in the morning feeling flat, emotionless, and lethargic. Left for the office at 7.00 am. While driving I felt extremely tense. Since my mind was in an absent state, I slowed down to a crawl and kept myself focused on road ahead. Good thing is that early morning traffic was slow. Energy levels were really low, and I had no desire to work. There was a definite lack of concentration combined with inability to think clearly, and heavy or light headedness, I can't really define that odd feeling.

 

I stayed like this till 1200 noon. Since I've lost my previous hectic business to depression, I took a nap and got up feeling fresh.

 

I did have slightly less sleep (about 5 hrs instead of my 6 to 7 hrs).  Can't say if this was caused by WD. Either way just recording it here for reference.

 

Today is Day 4: Feeling fine. Btw when I say fine it means I have no physical symptoms to describe. However I do have an everyday lack of motivation and no desire to interact with people around me, or to visit friends and family, or even call them.

 

Anyway the plan is to stick to the dose of 63mg for next 3 to 4 weeks. I'll update if there is anything important to say.

 

Btw: I have been reading up on the various drugs I am taking (see my history). I need to check dates but I think perhaps Lumark (Levitiracetam) was what might have kicked off my initial demotivation and apathy. However it did and does have a good effect on my epilepsy control. The actual depression and anxiety did start off later when I shut down my business. My question is: Could Lumark be the culprit for my depression? Or was I misdiagnosed as dysthymic due to the stress I was under and would have recovered with time? I am unsure. 

I did ask my neurologist when I first had suicidal thoughts (hadn't started any psychiatric drugs) if Lumark could be the cause. He flatly said no and referred me to a psychiatrist. Thus started my saga on citalopram and Effexor.

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crashcourse

I'll be noting my progress in this thread much like a diary as I try to taper the drugs in my signature. This will help me for sure, and just might help someone else down the line. Hey moderators do let me know if this is the correct place for this thread.

 

Today is Day 7 of starting my taper of Effexor XR, since Day 1 was 27th April 2019. I have only done a 12 mg reduction in Venlafaxine, going from 75 mg to 63 mg. Over the past few days I have noticed a gradual decrease in my sleep. This is a gradual, persistent pattern. It isn't hindering me; however it does show how quick even a minor reduction of drug dose has a massive impact on the body and brain. 

 

Take last night: I slept at 1.00 am and got up this morning before 5.30 am.

The night before I slept only 5 hrs approx. The night before that was 5 hours 30 minutes, and so on. Like I said there is a pattern of gradual decrease in sleeping hours.

 

Other than that I feel fine and stable. What does concern me is what else is happening in my body that I will experience down the line as the body organs and systems adjust to the persistent lower dose of AD, and the effects this lower dose is having on other chemical pathways and interactions.

 

If anything keeping record of my signs is proving to me the significance of reducing in a slow and gradual manner. Imagine the side effects if this had been a Fast taper or CT. I can manage loss of sleep. But some of the other side-effects are killers.

 

Please note all my other drugs are in place as usual.

 

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Molder

Hi there, I am doing really good. I am completely cured from antidepressants and the withdrawals. God cured me. One night I was at the end of my rope crying and in complete torture I just dropped on my knees with my hands in the air reaching to the ceiling and yelled out to God to just give me one more chance and that I would do right in the world. A few days later I woke up and started crying because I could feel that the awful torture was gone. It has never came back. If your going through the torture of these horrible drugs turn to God and he will help. Turn to him for EVERYTHING!!!

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crashcourse

Hey there. Good to hear that. 

Like you I believe in the power of prayer. Not always been like that. There was a phase in my depression where I totally turned away from God. I couldn't believe God would wish such torture for me. It stayed that way for a long time. Eventually I turned to prayer again; somehow I thought of it as a last resort. And it helped. I can't explain it, but I felt relaxed and was able to breathe better. 

Not that prayers have cured me, however they do soothe me and make things easier to bear. Best.

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crashcourse

Okay carrying on. Past few days have been a mix. I seem to be shifting between days where I have insomnia or hypersomnia (slight.) This is to say some days I sleep 4 hours at others upto 9-10 hours. Along with this I have a low quality of sleep. I do not get up raring to go even if I have had my full quota of sleep.

 

Also past three days, I have gone into demotivated mode. I haven't finished the chores I was supposed to do. Just don't have the energy or desire to finish them. Yesterday I worked myself up thinking what a waste my life has turned out to be. Not a positive state of mind.

 

But these are not physical symptoms, rather emotional ones. On the physical side I haven't felt any massive anxiety or body pains. So that is good. I am worried though about how WD will eventually hit me as I cut down the dose further. Right now I am in a shallow wave. Deeper ones will come. They always do.

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crashcourse
Posted (edited)

Could Lumark (Levetiracetam) have caused my depression?

 

My history is in my signature. Details are in my introduction thread. (Admin: Please move thread if this is in the wrong place. I don't know where else to post this.)

 

I always believed that my depression was a result of business problems. However recently I read how Lumark/Levetiracetam has as its main side-effect psychiatric problems such as Depression, Anxiety, etc. 

 

That got me thinking. See uptil 2009 I had been taking Tegral and Rivotril (clonazepam) for my seizures. I was about 95% seizure free. However I had no depression or anxiety problem. In 2009 after a major episode of Grand Mal my neurologist shifted me from Rivotril to Lumark, while keeping Tegral. In retrospect I believe it was after this change of drugs I first began to experience a lack of motivation and energy especially in the running of my business. I am certain about this, since I've kept a daily journal for a number of years in which I keep notes about major events of my life. I've done this even prior to depression, so my history is quite clear. (Although I do think lack of energy started around 2007. Suicidal ideation started around 2011.)

 

At the time I ignored those symptoms as a case of burn-out from working too hard. As an example in 2010 I shut down one of my branch offices, not because there was a major problem, but because I lacked the energy and motivation to do the travelling and spend time on it. Like wise there are dozens of examples where I ran the business on low gear.

 

 

In 2011 I closed up the business (It was still making good money, but I felt I needed a change to get my drive and motivation back.) In 2012 I suffered major anxiety issues and depression. That is when I was put on ADs.

 

I recently saw this article: https://www.drugs.com/sfx/levetiracetam-side-effects.html  and began wondering if it was levetiracetam which was responsible for the psychiatric issues. If so my docs should have discontinued Lumark, instead of putting me on AD.

 

I must add I first went to my Neurologist when my suicidal ideation started in 2012. I did ask him if Lumark was responsible. He said no. I asked this on 3 different occasions in my early days of depression. But the answer was always no. Likewise with the psychiatrist. But the data in the link  clearly states that the MOST common side-effects of Lumark are non-behavioural psychiatric problems.

 

With this in mind what should I do?

What if Lumark is causing the underlying problems? 

Should I first with draw from Lumark to another ant-convulsant and then change WD from my AD?

 

Do remember I am currently withdrawing from Effexor XR. 

Edited by ChessieCat
added topic title

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eymen23
On 5/1/2019 at 1:02 PM, crashcourse said:

Okay I started tapering Effexor XR on 27th April 2019. 

Since I use 75 mg once a day (at night time) I take out 40 beads manually. Each bead is 0.3 mg as per info given on a thread in the forum, so 40 beads = 12 mg. This translates to a 16% reduction. 

 

Hi CC,

 

Unless I have misunderstood your dosing regimen for Effexor XR, it appears you have made a drop of 16% which is greater than the 10% per month that we advise here as a guideline for harm reduction. In reality, there many members that need to reduce by less than 10% to ensure their withdrawal symptoms are tolerable.

 

Please go steadily in regards to future reductions and if you do find that this drop causes intolerable symptoms later down the line, please hold until they settle down or consider a slight updose. 

 

Addressing your concerns over taking Lumark, it may well be the case that this drug contributed to the symptoms of depression that you experienced around the time you closed your business. However, given it was nearly a decade ago, it may be hard to truly pinpoint the contributing factors to how you felt. 

 

Given you suffered a serious grand mal seizure in 2009 and it sounds like your epilepsy has been well controlled since (please correct me if that’s not true), you may need to work with a neurologist in finding a medication that adequately controls these episodes and with less side effects. In good conscience, I could not advise you to begin reducing Lumark or suggest you change drugs, as this could lead to severe consequences in regards to your epilepsy. 

 

Whichever way you choose to proceed, we would suggest you stick with the 10% per month tapering guidelines as far as your psychiatric medications.  

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crashcourse
15 hours ago, eymen23 said:

Given you suffered a serious grand mal seizure in 2009 and it sounds like your epilepsy has been well controlled since (please correct me if that’s not true), you may need to work with a neurologist in finding a medication that adequately controls these episodes and with less side effects. In good conscience, I could not advise you to begin reducing Lumark or suggest you change drugs, as this could lead to severe consequences in regards to your epilepsy. 

 

Hello Eymen,

My epilepsy has been well controlled overall. I have suffered grand mal seizures a couple of times or more ( I cannot recall due to memory issues) after 2009. But that has been a result of missing my drugs. In fact that was also the case in 2009, when I was taken off Rivotril and shifted to Lumark. I had a new neurologist and he recommended the change.

 

I still hadn't gone into depression or started AD, when I had a sudden rush of suicidal thoughts, on at least a couple of occasions. That frightened me and I'd rushed off to my neuro. It was then I raised the issue of Lumark as a potential culprit with my neurologist and on more than one occasion. However the doc's opinion was that in his practice he hadn't seen a single patient complain of this. And he referred me to a psychiatrist.

 

I've come across the data quite recently on Lumark. My father is a surgeon and he is a hard-core opponent of psychiatric drugs. It is only that my psychosomatic symptoms were so bad in the early days of depression that AD gave me some relief. I now realise the relief was blocking out a lot of other stuff, which are as crucial to a healthy life.

 

Yes, I will take care in the future to do a smaller reduction. There is a thread here somewhere in the forum which mentions how many beads a Effexor XR 75 mg capsule has. Can you please point me to it?

Thanks.

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crashcourse

10 may 2019: 

Slept last night at about 12 pm. Woke up at 6.45 am. So sleep was enough. However had weird dreams. woke up with a start.  I normally do not have dreams or strange dreams that disturb me. Even though I had my full quota of sleep I am still feeling sleepy and fatigued. Even now when I’ve done a brisk 4 km walk to my office. 

I also took a nap in the afternoon of over 1 hour. 

 

Other than these sleep issues, my only problem is fatigue. I really don’t feel like working and would prefer to go back to bed, even though I have a lot of work to finish. My eyes are droopy with sleep and the mind is in low gear. 

 

16th May 2019.

 

Past few days have been stable. The only noticeable event is sleep issues. I am sleeping a couple of extra hours. I have also had weird dreams on a couple of occasions. But I don’t want to mark that as WD effect, since they haven’t persisted.

 

The biggest problem I am facing is a general lassitude and weariness. Again it would be premature to put this down to WD. It isn’t like I have been the chirpiest bird in town these past few years. However today is worse. I do not feel like talking to anyone, or meeting anyone. 

 

But it is so difficult to differentiate if this is an effect of the AD, a mood disorder, an actual problem, or a WD effect. Still it is worthwhile noting that today I have no intention to shower, work, or talk to anyone. I’m in my room and intend to stay here. No desire for company, even though there is no anxiety or anything like deep gloom. This is more like a dark cloud cover, and not a fog. There is light enough to see, but not enough to zip your car down the Highway.

 

Appetite is good. There is lack of concentration and fuzzy thinking and a total lack of motivation. Have put many of my to-do things on the back-burner. Memory seems lousy. I was trying to read a scientific review paper here on SA, but can’t get the concepts in my head, since my mind isn’t working. Big memory holes.

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crashcourse

10% cut on 3rd June 2019

Just wanted to make a quick note that I did another 10% approx cut on 3rd June 2019. After this cut (80 beads from 57 mg Effexor XR) my current does is 51 mg. I am aware that I did this cut earlier than the 1 month hold limit. The reasons I did so were:

 

a)  I've tolerated the previous cuts well, with minimum side-effects. So I thought this a well-calculated risk to try and see how it goes.

 

b) I intend to have a long hold at the dose of 51mg. This hold will be at least 6 to 8 weeks. This is for the simple reason that my daughter gets married in these dates, and I do not want to cut further until after the wedding. I can't take the chance of having any side-effects in coming days. 

 

Today is day 4 after the cut to 51 mg. There is hyper-somnia plus some lassitude. Yesterday I slept over 12 hours, which is pretty abnormal for me. Tiredness isn't too bad. I'm used to low energy levels these past 8 years, so I guess I'm on an even keel. If the next few days are like this then my brain will, I hope, gradually adapt to the dose of 51mg and start functioning better. Let's see.

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ChessieCat
1 hour ago, crashcourse said:

I've tolerated the previous cuts well, with minimum side-effects.

 

Side effects are the unwanted effects when you take a drug.  Withdrawal symptoms are the unwanted effects you get when you reduce the drug.

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crashcourse

Thanks Chessie for correcting me. The WD lingo is still new to me. 

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crashcourse

Been feeling depressed since yesterday. I think it isn't so much due to taper as it is from recent stress especially since last evening--major stressful event happened, where I was accused of being a sloth, lazy, and looking for an easy life. Hit me hard, especially since I had been lightheaded since morning. I have been in my shell since then. Even contemplated the futility of living and the point of tapering. I haven't really go down the suicide ideation road, though imagining death does seem more pleasurable than living.

 

Heck, what's the point of writing things out. I've read a lot of stuff on SA and I wonder if we are all acting as an echo-chamber, amplifying our heroics--which aren't so heroic--to each other, while the rest of the world looks at us with pity, and sometimes contempt.

 

What dreams lie hidden on this forum. I've read a lot of intelligent posts here from people who are certainly above the average milieu. They and others here, struggle for existence, while contributing nothing to the world, for they have been castrated, emotionally, chemically, physically. 

 

I am angry and bitter today. Success for me, for you, would mean getting back to a baseline of human existence i.e. simply feeling we are humans. Nothing more, nothing less. Is that all we are capable of? Is that all we aspire to be? And in the meantime we can't even boast of a real struggle against a physical disease. We do not have a grotesque disfigurement, a shorn off limb--I take that back. Perhaps we should feel lucky we do not have those major issues. But the reality also is that even with my limbs I do nothing. Even with my mind, I create nothing. With my fully functional body, I am of no use to anyone.

 

Perhaps I write this as catharsis for my anger. I need to today. I haven't written anything in a while, or expressed my thoughts to my family. Sure they love me. But they do not understand me. They do not comprehend what sadness lurks behind my impassive mask-like face. They know the humor inside me is dead since I rarely laugh these days, but they do not know the void that exists in the place from where my laughs and smiles came, from where my spontaneity of thought and action came.

 

Life is lonely. I sometimes used to complain about that when I would be faced with tough decisions in my business and had no one to share my decision-making with. It is only now I realise what loneliness of spirit truly is. It is when your soul, your emotions, refuse to engage with others around you. Even anger is engagement. It puts you into conflict, and then forces you to resolve that conflict, or deal with the tensions it creates. But when you have no anger, at least not directed at an issue or anyone, but anger only at yourself--when you are the source, you the recipient, you the disease, and you the treatment--that is loneliness.

 

I've ranted enough. Time to crawl back inside my hole, and see the world from there.

 

 

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crashcourse

I got rid off the apathy after last cut of 80 beads. But today seems depression day. Dont want to move. Have reached office with a shitload of work to do, but no strength to do it. Or motivation. Seems the depression, apathy, come turn by turn. Some days depression symptoms are worse. On others the apathy/anhedonia. 

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crashcourse

Since my intention with this thread is to keep a log for myself, as well as to assist others tapering off ADM and especially Effexor, I just wanted to emphasise hypersomnia

 

Its been 2 weeks since my last cut to 51mg. While insomnia was the problem mostly in earlier cuts, this time it seems to be hypersomnia. That might be due to the other drugs I am taking, since the balance of drugs has changed. The depression mode has lifted somewhat, but my lethargy and apathy continues. I've delayed getting my tax documents ready, which will lead to a serious financial crisis. Just cannot pick the phone and deal with it. Also need to message a few clients. But same problem.

 

I haven't found a way to break the shackles of this apathy. But others need to beware. If you can find someone willing to share your workload or get you to do things, that would be something to put in place before starting to taper.

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crashcourse
On 4/20/2019 at 5:08 AM, Altostrata said:

Combining citalopram and Effexor is something no conscientious psychiatrist would do. It is a dangerous drug combination. If I were you, I would not go back to that doctor for psychiatric drugs.

 

Why was Effexor added?

 

I would also read up on the side effects of Tegral and Lumark -- depression might be among them.

 

What times of day do you take your drugs? How is your sleep?

 

If I were you, I would reduce Effexor first. Typically, one removes beads from the capsule to taper. See Tips for tapering off Effexor (venlafaxine)

 

Please let us know how you're doing.

 

 

 

Hello @Altostrata  Re-reading your comment above I noticed you asked me to check Lumark and Tegral as potential candidates for causing depression. I researched the web, and found that Lumark does cause depression. The data is statistically significant. I wrote details above this post: 

I think this would be useful for others. Also perhaps you can give some feedback. Thanks.

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