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

[miomio]

I have a job but are only able to work 4 days a week 4 hours a day, and i am most at the time not able to do much in the Hobby area, but i try(force myself) to do something to activate myself.

I really feel you man, but as a Prisoner in my Body (that's how i feel) there is at the Moment no other option for me than surviving. Yesterday i had a really bad day to start with and the other half was better.

 

[crashcourse]

Extreme anxiety again. Going though it as I write. I was able to calm down somewhat by reading some verses of the Quran. 

 

I just came in to make a note, while I can. The anxiety might return. This is my second serious bout of anxiety after my recent cut. Now, I'm dreading going out. But I've made a commitment and feel I can't back out. Still a few hours to go so hopefully I'll feel calmer by then.

 

But the mood is definitely darker. 

 

PS: I also suddenly started feeling cold, even though its quite nice and warm here. So I put on my socks and dragged out my heater, and turned it on for a while. I warmed my feet. Now I'm feeling better. Wonder why the sudden chill came over me, all of a sudden.

[crashcourse]

So I made it fine through the friends meet yesterday. In fact it was quite good, since these are buddies from school, and we're quite close to each other. Had a few laughs.

 

Today has been okay. Had a hard morning with a total inability to concentrate. I was trying to read one of Alto's posts, and simply gave up. Now it's better. Actually I did lie down for over an hour and listened to a podcast. Don't know of that is what helped.

 

I'm thinking of taking up a job (if I get it.) But I'm also afraid I'll underperform. Plus with the problems of sleep, mood, and general low performance, I am quite unsure if this is the right time to do so. It will lead to an increase in stress. I'll give it some more thought.

[crashcourse]

Okay I'm back. I've had a struggle these past few weeks, what with insomnia, lethargy, depression, anxiety (low grade), no interest in activity of any sort, boredom.

 

Sleep pattern was definitely disturbed. I slept extra hours on many days. Plus the digestive system was out of whack. Especially I couldn't take breakfast, which is my favorite meal of the day usually. 

 

Many of the above have approved. Especially appetite and some aspects of sleep. Getting better with my thinking. Based on experience with previous episodes of post tapering periods, I'm still not out of the woods. Theres a possibility any of the above symptoms will reappear.

 

On the negative side, while the symptoms have improved, there's no resolution to life issues such as getting motivated to resolve my problems ie employment, finances etc. I know Im going to be hit seriously in the coming days. When that happens things can go bad, seriously bad.

 

I'll hold for the entire month of june. Next taper will be when I feel confident enough my system is in balance. 

[crashcourse]

There has been some improvement in mood. Not feeling the same level of lethargy or detachment from the world as I experienced in the past few weeks.

 

There has been another change in sleep pattern. Now I go to sleep around 2 am, and get up around 8 am. Earlier I was unable to sleep, and when I did, I got up around noon. So that is an improvement. I wonder if this has to do with the cortisol spike and other hormonal issues mentioned on this site.

 

I got my son's Guyton's book of Physiology. I haven't been able to study the chapter on Nervous system, since I cannot maintain my concentration. My idea was to reacquaint myself with basic medical knowledge on the nervous system, which I had read back in college days. But I can barely read a paragraph or two, and then I get lost and my eyes start skimming/swimming over the text. Same happened when I tried to read the cortisol topic here. For someone who has read quite a few dense subjects in life this is a bothersome experience.

 

The upshot of this is that instead of using my time positively, I return to looking at Youtube videos and Netflix and other time drains.

 

There's a number of letters on my desk which I need to look at, or I'll be hit by a financial penalty. I don't think Im going to look at them. Actually I know I wont. Why? Who cares. The real estate company that sent the letters wants me to pay some unwarranted money/penalty. And I don't have the energy to fight them. I know I sound like a loser. But that's my new avatar. 

 

These days I do think about how people perceive me. Do they remember the go-getter I was? Do they wonder 'what has happened to this once-active person?' Or do they just think I'm a lazy leech, living on the last dregs of my now limited financial resources?

 

I personally think, people tend to not focus on others lives in details. We just look at the now and present, and that is what defines the person for us. No one has to time to do a detailed psychoanalysis of another.

 

What really bothers me is how my family perceives me. But that is for some other day, since I'm tiring out.

[miomio]

How are you doing?

I suck at the moment but had 2 better days this week, seems like a brutal  Wave hit me today !

One thing that seem to be long lasting is detachment i often feel strange and not able to conect with my surroundings.

[crashcourse]

Hello @miomio So sorry to hear you are going through a wave. It will get better, stick in there. I think by detachment you mean apathy i.e you feel no joy, no sorrow, no care to what is happening around you, whether good or bad. If so, this is one of my biggest problems and one of the major reasons why I'm trying to quit ADs. I just don't feel anything or any emotions about the situations around me. The only time I do feel something is when I get anxiety, that is when I feel dread. But the bad thing about it is that normally when we are in a bad situation, we look to fight it, however in apathy we don't care about fighting, we just feel helpless.

.......

On another note I did get better and stabilised on my current dose. But now there is a shortage of citalopram in the market, most likely due to COVID. So I am unable to find any drugs and thus am not taking any citalopram for 5 days now. 

 

My sleep got seriously disturbed, But it has been improving. I do not know what to do if the drugs don't arrive in the market soon. I might be forced to CT. Let's see. But at the moment I am feeling okay, all things considered. It is sort of like a see-saw, one day good, one bad.

.....

Also @miomio I noticed you did a rather fast taper on both Effexor and Escitalopram. Are you taking anything now? Btw my effexor taper was fast too...6 months or so. But I didn't feel so bad once it was done. Probably the citalopram was giving cover. 

 

Here's to wishing you good luck, and feel better soon.

[crashcourse]

There's a drug shortage. What do I do?

Citalopram and all generic variants have vanished from the market. Most likely due to COVID 19 disrupting supply chains and production. I have not taken any medicine for 5 days now. So far I am feeling okay.

 

The way I see it, I have two options:

 

1) Shift to another drug, which I really don't want to do.

 

2) Cold turkey, and see what happens. I don't like this option either, but it seems I'll be forced into this.

 

What recommendations do you folks have if any?

 

Edited June 16, 2020 by ChessieCat
added topic title

[ChessieCat]

From your drug signature:  25 Apr 2020 Tegral 200 mg BD- Citalopram alternate days 20 mg and 10 mg OD - Lumark 500BD

 

Have you been alternating your doses of citalopram?  Or have you been skipping days?  SA recommends taking your drug at about the same time, same dose, every day, even for drugs which have a longer than usual half life.  Required doses of citalopram can easily be created by making your own liquid.

 

Have you tried the hospital?  Have you contacted your prescriber?

 

You could try contacting the major drug manufacturer of citalopram and explain that you have run out and that you are unable to get more.  They might be able to do something.

 

I would certainly be trying all avenues to get citalopram instead of switching because you switched from Effexor only about 9 months ago. 

 

The only other option I can think of is to change to Prozac.  Usually you would do a cross taper, but you post seems to indicate that you have already run out of citalopram.  Your doctor may have sample packs of citalopram.

 

the-prozac-switch-or-bridging-with-prozac

 

https://www.nps.org.au/assets/Products/Guidelines-switching-antidepressants_A3.pdf

 

 

 

 

[Altostrata]

These shortages tend to be regional. Where are you located?

 

Often you can get generics by mail order.

 

Obviously, cold turkey is not desirable. If there is an absolute shortage of an SSRI, you might take the opportunity to switch to fluoxetine or Prozac.

 

DO NOT SKIP DOSES TO TAPER.

[Altostrata]

If you cannot get an SSRI -- paroxetine, sertraline, citalopram, escitalopram, fluvoxamine -- you might take the opportunity to cross-taper to fluoxetine (Prozac) (or citalopram if fluoxetine is not available).

 

Many doctors routinely substitute fluoxetine to enable their patients to taper off an antidepressant.

 

Cross-taper means you gradually substitute one drug for the other, for example, take half your dose in sertraline, half in fluoxetine for a few days; then a quarter of your dose in sertraline, 3/4 in fluoxetine for a few days; finally, your entire dose in fluoxetine.

 

Substituting another drug may be a little bumpy for some weeks, but it is preferable to running out of your antidepressant and taking nothing.

[crashcourse]

On 6/13/2020 at 1:33 PM, ChessieCat said:

Have you been alternating your doses of citalopram?  Or have you been skipping days? 

 

Have you tried the hospital?  Have you contacted your prescriber?

 

You could try contacting the major drug manufacturer of citalopram and explain that you have run out and that you are unable to get more.  They might be able to do something.

 

I would certainly be trying all avenues to get citalopram instead of switching because you switched from Effexor only about 9 months ago. 

 

the-prozac-switch-or-bridging-with-prozac

 

I have been alternating doses of citalopram - 20 mg on Day 1, followed by 10 mg on Day 2. After an initial wave, it seemed this dose was stabilising. But now I am all at sea. Yesterday was pretty bad. I was light headed and in a serious wave.

 

No use contacting hospital or prescriber. In Pakistan, where I am, pharmacies are the only route to getting drugs. So I am searching for a pharmacy with some leftover stock. 

 

In case I find citalopram, would you recommend going back to old dosage ie 20 mg followed by 10 mg? Or I was thinking I should treat this like a reinstatement and go for a larger drop like 10 mg. Does this sound right?

 

I really don't feel like adding Prozac to the mix. I'm terrified and tired of drugs. I've had plenty of drugs my entire life, and every-time there's some new problem to contend with. But yes, I get your point.

 

One clarification: I didn't switch from Effexor to Citalopram. I was taking both. I have successfully tapered off Effexor, while citalopram continues.

 

On 6/14/2020 at 1:12 AM, Altostrata said:

These shortages tend to be regional. Where are you located?

 

Obviously, cold turkey is not desirable. If there is an absolute shortage of an SSRI, you might take the opportunity to switch to fluoxetine or Prozac.

 

DO NOT SKIP DOSES TO TAPER.

 

Located in Pakistan.

What advantage would I get from switching to Fluoxetine or Prozac? Or do you say this as a method of last resort?

[ChessieCat]

52 minutes ago, crashcourse said:

I have been alternating doses of citalopram - 20 mg on Day 1, followed by 10 mg on Day 2.

 

On 6/14/2020 at 6:12 AM, Altostrata said:

DO NOT SKIP DOSES TO TAPER.

 

 

And that also applies to alternating doses.

 

Start taking 15mg every day NOW

 

If you cause your own problems we will not be able to help you.

 

You can make a liquid with tablets or you can cut up a tablet, or crush it and halve or quarter the powder.There is no excuse for not taking 15mg every day. 

 

how-to-make-a-liquid-from-tablets-or-capsules

 

 

 

Edited June 16, 2020 by ChessieCat

[crashcourse]

thanks Chessie Cat,

 

I've been able to locate one box of tablets. Starting tomorrow I'll try to get a new routine going as you suggested. Not feeling well, so have trouble getting things done. 

[crashcourse]

Drugs still unavailable.

 

Insomnia is bad. Feeling extremely low for many days.

 

Plus there is pressure to start earning money. I just do not have the energy, drive, will, or even confidence to do so. I feel as if I will make a disaster of it, and theres no point trying. 

 

Terrible feeling of being low all the time.

 

Socially isolated. With no desire to come back.

 

I would commit suicide, but I know I wont. I love my kids too much to do this to them. I hope this remains like this. Fact is I do know life for me is over. There's nothing left for me to offer anyone. 

[ChessieCat]

  

1 hour ago, crashcourse said:

I do need to add: Perforce I had to give up citalopram, since it wasn't available due to production shortages, linked to COVID. So for the past few weeks I have basically gone CT.

 

Please update your drug signature with the last dose you took and the date you stopped the drug.  Thank you.

[crashcourse]

Need to make a short comment.

 

I started Somna 2 mg, 3 weeks ago. I use it 2 hours before sleep time. Happy to report insomnia is gone. A few days ago I totally gave up Somna and my sleep is fine even without the med.

 

Even better, the low feelings I had have also gone. Makes me wonder if that was an effect of citalopram + insomnia that was making me feel so low. Because ever since my sleep has improved I feel much better. Even though I still lack confidence, motivation, and prefer isolation, still I feel much better. Nowadays I have begun thinking about opportunities that I may take to improve my financial and professional situation. This has happened after a lon time. Does this have to do with improved mental and physical energy due to better sleep?

Of course the problem of acting on these desires persists. But at least the desire is back.

 

Other important things:

1)   I have finally felt some emotion when watching a movie scene. This has happened a few times now in the past few weeks, that a lump formed in my throat during a poignant movement. That had all disappeared many years ago.

 

2)  I have begun reading novels again. I finished 2 novels in the past fortnight. Basically my concentration has improved, and the ability to plough through a few hundred pages. I hadn't finished a novel ever since I started ADs.

 

WORRIES:

 

What my next step has to be:

 

1- I need to remain vigilant about mood/emotions and report it. This will need consistent journalling.

 

2 - I realise with the lessening of apathy, I will be subject to mood swings. Since I don't have a career, I will feel this more acutely now. I need to take steps (How?) to start being active and have a goal. I feel it's too early to start raising hopes. So I need to have a better strategy; Otherwise I'll be disappointed later and get into a funk. So there's going to be a fine line between "wait and watch" versus "action."

 

3: I need to be vigilant about withdrawal. I will have to distinguish between withdrawal reactions, and genuine life issues. Already, I am realising that other's sentences are hurting me. Yesterday my father passed a comment about my lack of action on a certain problem that needs solving; it really got me down, and I was stewing for a few hours. In my pre-AD era these comments never harmed me. Now they impact on my already low self-confidence.

 

Will report back later.

[crashcourse]

On the whole I have been fine these past few weeks. Of course, fine is a relative term, and indicates I haven't felt totally depressed, just the usual inactivity and inability to start getting active.

 

Last week I was in a bit of a wave--low and not feeling cheerful. Since my father, wife, and son all had Covid19 that might have contributed to my low mood.

 

Over the weekend I have been thinking my biggest enemy at this point is FEAR. I am afraid to step into normal life again after so many years. The fear is true. I do feel concerned if I start a business I will fail, and if I fail there might be a dark rabbit hole waiting to devour me. I do realise only I can help myself overcome my Fear. And yet I don't take any solid steps, I haven't even outlined a course of action for myself, a To-Do list.

 

In a corner of my mind theres a lingering doubt: Yes, I have done a successful WD (so far) from ADs, but what if this is the early honeymoon period. And I need to sit tight for a few more months to ensure a successful taper.

 

Of course, the counter-argument is that since I am now in a slightly better emotional and mental state, I do feel less detached from the world around me, I am better able to appreciate my circumstances; this appreciation of my current dismal stage could move me back to depression if I don't start taking steps for constructive engagement of my mind and body. Why? Because I will feel once again the loss of years, goals, business, friendship, family, and I'll feel these more if I do not have something to do.

 

So currently I am see-sawing between two mental processes. And somehow I will need to take a step.

 

But perhaps I need to start off with small things. Like clearing my desk, organizing my room and cupboard. Perhaps I should stop thinking about big goals, and set up small ones. In the past week I have done certain tasks, but not in a consistent organised manner. 

 

So here's Step 1: Write down my To-Do list. Today.

.....

Short note:

Insomnia -- None.

Appetite -- Neutral. Eating less than normal.

Socializing -- As necessary. On the Lower end.

[ChessieCat]

11 minutes ago, crashcourse said:

I do feel concerned if I start a business

 

Starting and running your own business can be very stressful.

[crashcourse]

1 hour ago, ChessieCat said:

 

Starting and running your own business can be very stressful.

 

That is something I have in my mind, and which also deters me from starting a business. I have started multiple businesses in my life before depression, and have a good idea how much mental and physical strength you need to actually make a business work. There are more downs than ups in the early phases. I have been looking for a partner, but no luck so far.

 

And then again, if I wait too long I might start spiralling downwards. Catch 22.

 

Unfortunately I am at an age where employment is not possible.

 

[crashcourse]

On 9/28/2020 at 12:51 PM, crashcourse said:

So here's Step 1: Write down my To-Do list. Today.

 

Well I didn't write the To-Do List yesterday. And neither I do any of the things which would have been on the list.

 

And that right there is the problem. All my plans stay inside my head. I had all day today, and yet I've been busy listening to podcasts and watching Youtube, basically just wasting time. 

 

This tells me right away I am not ready to start a business on my own. Unless I start running errands, clean up my desk, do unfinished tasks, and create a routine that resembles a will to use my time productively, I am only day-dreaming about a business.

 

I was wondering in fact if I should ever start a business. But then what do I do? Now that I have put down these words I am in a bad mood. Feeling crummy and low. Life slips away from me, has slipped away from me, and I have no intention of taking a plunge at it, save it somehow.

 

As a teenager with Epilepsy, I made a vow to myself that Epilepsy would not define my life. I would overcome every obstacle and lead a full life; that I as a person am not going to cow down or shrink into a corner just because I have a problem that frequently embarrassed me in public.

 

And it worked. I fell in love, married, had kids, set up a great business, and was a success. In between I often had epilepsy attacks: in business meetings, at airport lounges, family gatherings, with friends, you name it, and it happened. I would fall to the ground having fits, and going unconscious. But I would get up, shake myself out of falling into self-pity or self-loathing, and act is if nothing had happened. Was it easy? Hell no. I would have a bad day or two, and then it was in the past. Only the future mattered.

 

I survived, even flourished for decades. I was popular amongst my friends, colleagues and wider family.

 

And yet, now I cannot gather the courage to make the same vow, that Depression and Anti-depressants will not conquer me, or define my life. I have thought many times why I can't make the same vow to myself. I just cannot. Every time I think about it, the words feel empty. The conviction lacking. Is it age? Is it the medicines? Have I changed? I don't have the answers.

 

Even now I am wondering why can't I behave like I did before, just make the promise to myself, without any theatrics, in my heart, repeat it day and night, and every time I feel low, and Voila: magic will happen. I have done this before. I know each step, each word, each obstacle that will happen and what reaction is needed to brush it off, and power forward.

 

Somehow I will have to summon the courage. Life can't just happen to me. I have to change things. No one can do it for me.

[crashcourse]

It is December 2020. Life is stuck in a rut. I feel so low. 

 

I frequently think of suicide. Then I think of my kids and what that will do to them, and I know I cant do it. In my heart I know I don't want to live.

 

I have so much lethargy. I do nothing. I don't want to speak to anyone, meet anyone, do anything. Life is over.

 

God please help. Theres so much emptiness. A hollow feeling inside me. My mind feels slow and heavy. Theres a wight on my back and shoulders. A knot in my stomach. I am sitting doing nothing. Totally bored with social media and youtube. Spending an entire day like this is so hard. 

 

I need to summon courage and push through. Is there light at the end of the tunnel? How long do i wait? I keep revisiting my past; the points at which I made mistakes which landed me here.

 

My wife is great. I don't know how she puts up with me. Manages things for the family and the kids. She's the rock on which everything stands. I have fallen to bits. Before I was the rock. Even now she looks at me for help. I pretend I still know stuff, but i'm playing a role. This role play does help her. I think. A semblance that Im still around.

[miomio]

I actually think it will be better. Its now 2,5 years i am Drugfree and still struggling a lot, especially in the waves. Then it feels like nothing has changed. Well symptoms still are changing over the Weeks but overall iam much better. You don't need to push yourself, but keep ya selv alive. I was siurviving like u with Gaming youtube and other stuff to distract myselv from all the pain, and later on i startet to expierience that i felt ok while distractet. My girlfriend never rally supportet me nor the medical system, all Just deal with a useless hyperconder. sad story! 

[Marian]

Hey, meds make it difficult to concentrate to read the whole thread, but i read your first posts and last two. Im sorry you are feeling low. Hang in there...you can come through this. My prayers for you. 

 

When i read epilepsy and meds and being depressed maybe from meds, i also wondered: did you ever look into ketogenic diet? They increasingly use it against epilepsy here instead of meds. I was looking into the benefits for psychosis and depression. 

 

Wish you find hope and strength again...it can get better! 

[crashcourse]

On 12/21/2020 at 1:29 PM, miomio said:

Well symptoms still are changing over the Weeks but overall iam much better. You don't need to push yourself, but keep ya selv alive. I was siurviving like u with Gaming youtube and other stuff to distract myselv from all the pain, and later on i startet to expierience that i felt ok while distractet.

Thank you miomio for the message. The distractions help us pass time, but the real cause still exists. And then it hits hard how low we have fallen.

 

I am struggling to stay alive, but hopefully I'll hang in. I hope you get wave free.

On 12/21/2020 at 1:44 PM, Marian said:

Hey, meds make it difficult to concentrate to read the whole thread, but i read your first posts and last two. Im sorry you are feeling low. Hang in there...you can come through this. My prayers for you. 

 

When i read epilepsy and meds and being depressed maybe from meds, i also wondered: did you ever look into ketogenic diet? They increasingly use it against epilepsy here instead of meds. I was looking into the benefits for psychosis and depression. 

 

Wish you find hope and strength again...it can get better! 

Thanks for the prayers Marian. I really need those. 

 

Over the years I have studied epilepsy treatments, but then gave up, since epilepsy has its own unique challenges and no easy treatment. I haven't studied the effects of ketogenic diets relationship to epilepsy. Part of this is due to my lack of concentration, low motivation to do anything, and frankly I've given up on life.

 

Before depression I coped with epilepsy pretty well and with great courage. Now depression is the bigger problem.

 

I did try to get off epilepsy drugs under medical supervision earlier this year. But it brought on severe fits, so I had to go back on medication. The doctors though think the epilepsy drugs have little to do with my depression. I don't know. Some of the scientific literature does indicate epileptic drugs have effects on mood and behaviour.

 

Perhaps someday when I have the motivation I'll look up ketogenic diets. For now I am just trying to keep myself alive, day by day. That's the goal. Everyday I get up wanting to end life. But then I manage to stay alive. 

 

This particular wave is going on for 2 months. I wish I get out of it. Thanks once again for the support.

[Marian]

Hey, i understand you are struggling now. Things can get better, they really can, even if you dont feel it right now. Hope a window will come along soon for you.  

 

About the diet: it is very understandable you dont have the energy and motivation right now to undertake something like this. If you ever want to know more, give me a shout and i can send you a website with good basic info. I researched it for stabilization of mood/anxiety/psychosis. 

 

But for now, i just wish you well and keep sending you my prayers and positive thoughts for your feelings to change. Sometimes something suddenly or slowly changes and lightens up your thoughts. 

 

Hang on! 

[crashcourse]

Thanks @Marian for the wishes. Do send me the website. You never know when I'll take a look at it, and see if I can fit the recommendations into my lifestyle.

 

I wish you well in your struggles. btw, how much did ketogenic diets improve your symptoms?

[miomio]

How are u doing? 

[arbor]

Dropping by to see how you are, @crashcourse

Arbor