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Onmyway

Onmyway: I want this to stop

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Onmyway

Hi all, thank you for being here though I am sorry that we are all suffering. I have been lurking for the past month or so but decided to come into the light..

I have been on Celexa for almost 18 years. It has worked well for me overall. I still did have occasional issues but overall did well on them. The side effects were low libido - which was OK then as I stayed  mostly single. Now I realize that I should have perhaps dealt with some important issues to not be in the boat that I am in, so  that is a big regret/issue. 

 

My drug history 

2000-2002 citalopram (celexa) 20 mg, buproprion (wellbutrin), trazodone for sleep

I was put on celexa in a difficult time period as I was changing colleges and had some OCD over picking a major (about a month or so). I had previously had an episode of OCD at age 15 which resolved after a few months. Because of blunting, wellbutrin was added, then trazodone to sleep. 

 

2003 quit citalopram cold turkey (ran out of my prescription over a holiday weekend). Did well for a week, then had severe brain zaps and hypersexuality for about a month or so (those are the ones that I remember). Then things were OK. Was put on citalopram 20 mg in November 2003 as I had anger issues and was struggling at work. Crying from anger. Wonder if these were delayed withdrawal issues now. Stayed on citalopram until Jan 2019. Every time I thought of getting off of them, the doctor would advise that it is not a good time as things in my life were changing (moved jobs/countries etc.). Decided to come off of citalopram as I wanted to get pregnant. On them have had axiety issues as well and a big bout of OCD a few years ago which also resolved in a few months/year. So not sure if it did help with OCD overall. Ocasionally used xanax briefly when things got tough. 

 

I had increased my dose to 40 mg due to severe anxiety July 2018 for about a month or so (I was put on birth control pills which always causes intense dysphoria for me), then started tapering from there to 20, to 10, to 5 and then off in January 2019. Did not have any major issues. My mood was lower at 10 mg but nothing  big.  I had also just moved jobs/coutries so it was OK. I stopped at 5 mg. First week was ok but then started having severe anxiety and the desire to crawl out of my skin (akathisia), though not involuntary movements. Had brain zaps which resolved in about a month. But the most debilitating symptoms were restlessness, anxiety and absolute obsession about decisions - I am now questioning if I want to get pregnant even though that was what I had wanted to do for over a decade. Reinstated within a month at 2.5 mg and have been tapering off of that at 10%. This was prompted by the Lancet Psychiatry article March 5. 2019

 https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30032-X/fulltext.

It goes with the SA recommendation but I saw it there first. It doesn't seem to have found its way onto the forum here yet. It is behind a paywall. This is from the abstract: 

 

Quote

We examined the PET imaging data of serotonin transporter occupancy by SSRIs and found that hyperbolically reducing doses of SSRIs reduces their effect on serotonin transporter inhibition in a linear manner. We therefore suggest that SSRIs should be tapered hyperbolically and slowly to doses much lower than those of therapeutic minimums, in line with tapering regimens for other medications associated with withdrawal symptoms. Withdrawal symptoms will then be minimised."

 

My symptoms change by the hour and right now are mostly anxiety, insomnia (I get an average of 4-5 hrs a night) and intense nausea (all the time). Ocasionally also have paresthesias - feels like the front of my face is asleep, upset stomach and the awful jolt into utter dread as I drift off to sleep. My sleep has improved a bit, used to wake up with that jolt 3-4 times a night. Recently started using light blocking curtains and ear plugs and blue light blockers on my phone/computer. Lately I have also been dealing with irritability (couldn't stand the TV on the other day! or the music at a restaurant).  About 2 times a week I take clonazepam 0.25 mg when I feel too sleep deprived. It makes me a bit depressed so I try not to overdo it and I also don't want to get addicted to something new. Doc prescibed 2 mg even though I wanted the lowest possible dose but I do 0.25.  Used to take xanax in the beginning of withdrawal, before reinstatement but started clock-watching and stopped it (about 1.5 months ago).

 

The one thing that I question obssessively when I feel a bit better for a day or two is whether this is withdrawal or just anxiety and issues that need to be dealt with. I have had a very traumatic childhood (6 ACEs). I am seeing a therapist who wanted to do EMDR but we don't feel I am stable enough to handle it right now.  I am praying for some relief.

 

 

 

 

 

 

 

 

 

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Altostrata

Welcome, Onmyway.

 

We're very familiar with the Lancet article, it originated from a discussion on this site 4 years ago.

 

On 4/21/2019 at 4:12 AM, Onmyway said:

Reinstated within a month at 2.5 mg and have been tapering off of that at 10%.

 

When did you reinstate 2.5mg? When did you start tapering it? How much are you taking now?

 

Please stop tapering, you have withdrawal symptoms. You need to stabilize before tapering again.

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Onmyway

Thanks Altostrata for your reply and for all you do on this site and for the community overall. Stopped 5 mg citalopram Feb 5th and  went back to 2.5 March 6th, I think and then in 3.5 weeks when I was feeling slightly better went to 2 mg ( April 1st) 2mg because it was really hard to measure 2.25. Then April 14  went to 1.8 mg. Now I realize that may have been too quick. Will stay on this for a while as I don't feel stable in any way. I can see that my symptoms are better ocasionally. Like many here I have awful mornings and better evenings but what I crave is sleep. I used sleep to cope with problems often (a nice distraction) but now it has itself become anxiety provoking. I dread mornings because anxiety is highest then and everything is so different every day. I have never had less control over my feelings/attitude/thoughts and less of an ability to deal with them. It is like I am being stoned but with different pebbles every day and from different directions and just want some rest. 

 

Have tried sauna/hot tub at the gym, try to walk every day, go to meetups to distract myself but in the end really need sleep.

 

 

 

 

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Onmyway

Since April 23rd made one more cut of 0.2 mg to 1.6 and have been at 1.6 for now 6 weeks and plan on staying here for a long while as I try to stabilize more. Sleep has improved (4-5 hrs a night) and so has nausea but now I have severe anhedonia and just feeling detached from the world (both also improved with the hold a bit). It doesn't seem that it reaches the level of DR but is constant and disturbing. During the last 2 weeks spent some time on a trip with family which was traumatizing (a very difficult person made the whole experience just awful). Dealt with it by dissociating and ignoring. Sleep was again difficult when changing time zones (6 hrs) and struggled with grief as I visited old haunts. Have added L-theanine, melatonin, magnesium, inositol and omega 3s recently. Have stomach issues but nothing I can't handle. I can imagine they come from the supplements but I feel that the supplements help a bit and I don't want to mess with them.

 

In the meantime realized how unhappy I am living in London (sorry Londoners) and miss old USofA, though granted my experience of London has been during withdrawal and I feel quite isolated here as I've struggled to make new friends, which is usually quite easy for me, but maybe that was the SSRIs speaking before. Have been on them since early 20s, so what do I know! Overall, I do see some improvement but mostly change - symptoms, my attitude towards life/relationships/job is changing. The most disturbing part is the inability to know what will come next. Usually, as with other people, mornings are difficult and I work to just get through them, one breath at a time. Evenings get a bit better, occasionally I have had  unnatural "highs" which are also disturbing. I had my first window last week where  was back to 50-60% for a couple of days. I still cried and grieved but it wasn't unrelenting misery. 

 

 

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Onmyway

Spoke too soon. Relentless nausea is back and brought with it relentless anger issues (over doctor bills and hospital trauma from a few years ago). I guess a new wave is upon me. Holding for over 6 weeks now. Wondering if I should updose but worried about that as well. Nausea colors everything around it with disgust. 

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ChessieCat

Hi OMY,

 

Please create your drug signature using the following format.   Keep it simple.  NO diagnoses or symptoms please - thank you.

  • details for last 2 years - dates, ALL drugs, doses
  • summary for older than 2 years - just years and drug/s

Account Settings – Create or Edit a signature

 

 

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

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ChessieCat

Have you been keeping daily symptom notes?  If yes, please post the last 7 days.

 

If no, please do this over the next 3 days and post them here in your Intro topic.  Doing this will allow the mods to assess your situation to try to work out the best thing to do.

 

Example:

 

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

 

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Onmyway

Hi Chessiecat

Thank you for the support. Just updated my signature. Don't have such detailed notes but will keep some for the next couple of days. 

 

7 am woke up with anxiety 

7:30 am inositol 600 mg, fish oil, magnesium citrate 250 mg

10:30 ate bakery item 

7-12 nausea and anhedonia, exhausted

1-1:30 sleep, woke up with panic a couple of times, rumination, anxiety, anger, nausea till 5:30 

5:30 ginger cookies, nausea,  general miserable feeling

6:30 smoked trout sandwich, tonic water

9:30 pasta with olives, peppermint tea

12:00 citalopram 1.6 mg, still nausea

2 am melanonin 1.5 mg, L-theanine 250 mg

 

Will try to keep better notes here. 

 

 

 

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Altostrata

Onmyway, you've been tapering too fast. Withdrawal symptoms are a warning sign that your nervous system is shaken up. Further tapering makes this worse.

 

Yes, please keep posting your notes. I hope you feel better in a few days.

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Onmyway

Thanks, Alto. I realize it only a bit too late. My plan is to hold here for a few months if needed. Everytime I feel a bit better (relatively speaking) I want to cut but the long term prognosis of that is so much worse. I suspect I am also a bit of a masochist and need to learn to both listen to my body and be more compassionate with myself. It is so much easier when I am in a better mood. 

 

Another question, I find that inositol and L-theanine help. As an expert on the wd process, what is your opinion on them. They seem to cross the BBB. I have read the two threads here but would like to know if you think they are safe long term if they work and granted that no paradoxical effects occur. I.e. do you think they would mess up the withdrawal long term? 

 

Thanks for checking on me. 

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Onmyway
12 hours ago, ChessieCat said:

Hi OMY,

 

Please create your drug signature using the following format.   Keep it simple.  NO diagnoses or symptoms please - thank you.

  • details for last 2 years - dates, ALL drugs, doses
  • summary for older than 2 years - just years and drug/s

Account Settings – Create or Edit a signature

 

 

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

ChessieCat, the link to the signature was so helpful. I had wanted to create one for a while but never got the energy to find the instructions. Thank you for making it easy. 

 

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AlanC

Onmyway, I thought it'd be more appropriate to reply to your question about changing doctors here rather than on the "Guardian: Royal College of Psychiatrists accepts re-adjustment in guidelines for patients coming off Anti-Depressants" thread:

 

Quote

Alan, I am new to the UK and I did, in the end, get the prescription but is it possible to switch to a different GP practice if one GP refuses? Did you manage to get yours?

 

You can change doctors by visiting the surgery of the GP you want to switch to and asking them to register you; they'll give you a form to complete. You don't have to say anything to your previous doctor, and you don't have to tell the new doctor why you wanted to change. The new surgery must accept you if they have the capacity for more patients, although they could refuse if you live outside their practice boundary and they think you're too far away to make visiting easy.

 

I'm very glad you did manage get your prescription. Unfortunately I didn't, and at the time I didn't understand the possible consequences. You can read about what happened in my introduction topic, although you may prefer not to since it's about the results of tapering too fast.

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Ruthmcg

Hey there,

Thanks for your message on my thread. I'm feeling miserable today- and the weird weather in London isn't helping!

I agree that we are really bad, us wders, at trusting our own bodies and their wisdom. I see you're doing really well with your taper- how are you feeling?

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Onmyway

8:10 am woke up with dread. Calmed down but mind racing (slept about 4 hrs)

8:30 1.3 mg inositol to calm down

8-10 in bed trying to sleep a bit more, exhausted, no luck, calm but with occasional terror thoughts

10-11 wrote some emails (conflict with former landlord)

11-12 some more rumination 

12 pm L-theanine 240 mg, a toast with avocado

12-5 some sleep with terror and dread wakings, heart pounding, extreme nausea (terror of getting on bus out of nowhere popping into mind! It's absolutely ridiculous). These terrors stay with me for a long time after. 

5:30 walk for 25 min with friend, 2 ginger cookies for nausea, a protein drink (disgusting but kept it down)

8 pm - 1 am out playing board games, still extreme nausea and feeling of tension in chest

8:30 pm salmon with mashed potatoes, veggies, barely managed to down it as extreme nausea

1:30 am to 3 am a bit better in terms of anxiety and nausea

2 am citalopram 1.6 

3 am going to bed. Hoping for at least 5 hrs of sleep and no terror attacks

 

Nausea seems to be the most dominant symptom again and terror/intrusive neuro anxiety. Problem with the nausea is that it is bad when I don't eat and hungry and feels like eating will relieve it but eating does not help a bit. 

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Onmyway

Just discovered that during my reinstatement and tapering I have measured things wrong. I used the liquid to measure 2 mg/drop but seems like the availability of the liquid is 0.125* that of the tablets. So 1 drop=2mg liquid citalopram=2.5mg tablet citalopram. As a result I have renstated at 3.125 tablet mg (had jumped off a month before) and have been also dropping faster than I thought. When I dropped by what I thought 0.2 mg liquid, I was in fact dropping 0.25 mg tablet. So now that I am on 1.6 mg liquid citalopram, I am in fact on 2 mg tablet form. It doesn't change my hold right now. But perhaps means that I would not be updosing for now. 

 

Woke up 9 am (fell asleep at 4) so 5 hrs of sleep yaay! 

(I am an extreme night owl and have recently returned from a month long trip to the US East Coast. 

9 am - 8 pm was unusually calm. ruminating, dealing with difficult problems but no palpitations. Some sleep.

Was so surprised by the fact that I  was calm that stayed in bed hoping to continue this state avoiding any contact with the outside world that would change this. In the end, could probably have used exercise and some sunshine but I have never been calm for this long in the last 4 months so wanted to keep it. Note, this was not happy, just no palpitations and anxiety. Small blimps of anxiety here and there but just that. Also first naps that did not end in terror. 

8 pm -  ate chicken and rice and large salad, some anxiety creeping in 

11 pm 1.6 mg liquid citalopram (2 mg tablet), 150 mg magnesium glycinate, Omega 3s, 0.25mg melatonin

4 am 0.25 mg melatonin 

11 pm - 4:30 am TV series, some anxiety, mostly anxiety that tomorrow will wake up with terrors again and avoiding sleep 

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AlanC
7 hours ago, Onmyway said:

Just discovered that during my reinstatement and tapering I have measured things wrong. I used the liquid to measure 2 mg/drop but seems like the availability of the liquid is 0.125* that of the tablets. So 1 drop=2mg liquid citalopram=2.5mg tablet citalopram. As a result I have renstated at 3.125 tablet mg (had jumped off a month before) and have been also dropping faster than I thought. When I dropped by what I thought 0.2 mg liquid, I was in fact dropping 0.25 mg tablet. So now that I am on 1.6 mg liquid citalopram, I am in fact on 2 mg tablet form. 

 

It's so very easy to get caught out by that when switching to the liquid. My doctor actually told me 1 drop = 2mg, but then this was the doctor who had previously told me 20mg Citalopram was equivalent to 20mg Escitalopram so I was being extra cautious and spotted the bit about equivalence in the leaflet.

 

Hoping everything is going OK despite the fact you've been tapering a bit faster than you intended.

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Onmyway

Yes, I am appalled at the lack of information of GPs. I have fantasized about creating a guide on how to prescribe SSRIs... maybe with a flow chart which 90% of the time leads to - "do not prescribe SSRIs." I do think that these drugs can be useful in some situations, I am not entirely anti-drug. Such as post suicide attempt etc. but I balk at the ease with which they are given. Seems like in the UK citalopram is the preferred one from all the reports here. The US seems to have gone full on with atypical antipsychotics. I was there recently and every other TV ad is either for a cancer drug or some psychiatric drug. Arghhh... 

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Onmyway

8 am woke up with a jolt - 3 hrs of sleep but feel OK 

8-12 moderate level of anxiety and restlessness 

12 - chicken with rice, magnesium

12-3 trying to take a nap, dread with palptitations, very scared, hard to come back to baseline; nausea

3-5:30 pm nausea worse, retching , rumination, worried about obssessons coming back

7:30 - 9 - grocery shopping, dizzy and weak feeling, dissociated and guilty feeling, paresthesias stronger (pins and needles in both feet and hands)

9-11 cook and eat with some nausea but tolerable (chicken, rice, salad), laundry

11:30 citalopram 1.6 mg liquid=2 mg tablet, levothyroxine-50mcg, magnesium 120mg 

12:30 -1:15 fall asleep watching TV, jolt with fear, can't go back to sleep or calm down, feeling sad and guilty, tearful (crying had been hard before)

 

A few notes:

The pins and needles sensations started about 3 weeks ago, initially just the legs and it was more like RLS, now it is just as if my feet are falling asleep. Initially it was only before going to bed now it is the whole day. The last few days it has also gone to the hands and arms. Compared to other things, I am not as worried about this symptom. It is there to remind me that this withdrawal brings its own strange "gifts" and is changing all the time. Also I'd take this over the anxiety and nausea any day. 

 

I have been remiss in taking my levothyroixine 50 mcg as I am worried it will activate me. Thursday will do tests to see how blood levels are. 

 

The last few days my symptoms have not been easing in the evening  but quite the opposite. Granted the last two days they were tolerable. The terrors when trying to fall asleep are staying with me and creating anticipatory anxiety. I had thought that was a symptom I was done with as it was really intense in the beginning but I guess it is back. Tomorrow former landlord and insurance calls so not looking forward to it. 

 

Finally, after waiting for  4 -5 months now I managed to get a CBT therapy 12 session pack on the NHS for this Thursday. It worries me. Avoidance of issues has been my survival mechanism the last few months so I am worried that this will be activating. 

 

I am also discovering a general aversion and distance to people these days. As in I am scared that I will see them. Also, going out today really changed and intensified symptoms. I had been very active the 3 weeks before and maybe the rest had helped a bit the last couple of days. 

 

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Onmyway

Today was sadness day. Neuro-sadness really as there isn't anything new. Neuro-grief, neuro-anxiety.

8 am woke up but stayed in bed napping/sad with periods of anhedonia, no desire to talk to anybody, anxiety at thought of talking to people

4 pm got up 

5:30 pm - walked 9000 steps, sad, grief, guilt, despair and hopelessness; hard to enjoy anything, some nausea but manageable, pins/needles in legs

8 pm - sauna/jacuzzi at the gym 

11 pm - chicken/rice, yoghurt, magnesium, salad, melatonin 1.5 mg (delayed release supposedly)

12 midnight levothyroxin 50 mcg, citalopram 1.6mg liquid=2mg tablet

 

 

 

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Onmyway

7 am wake up (2 hrs of sleep, had trouble falling asleep but mostly due to delayed sleep phase), magnesium, inositol 600 mg 

7-11 am low mood (not sadness, just not feeling content), some restlessness

11 am bout of anger - dealing with former landlord 

2 pm lunch salmon and rice

11-19 am generally OK mood 3/10 (if 0 is awful, 10 is elation and 5 is neutral), restlessness, achieved quite a lot at work, some nausea but very mild

19-23 - reading Kirsch book, anger, restlessness, dozing off on train, waking up with jolt

23 dinner, citalopram 1.6, levothyroxine 50 mcg, magnesium 

23-1 am restless, too activated for sleep, paresthesias on face

 

Today I thought was a window as I achieved quite a lot at work but realizing that it is a restless kind of work more hypomanic than calm and content. Learned of a suicide of a student today. Warned a colleague not to medicate her unruly daughter. After all the activation today, tomorrow will probably be very difficult. 

 

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Onmyway

10 am wake up (6 hrs of sleep)

10-2 try to get some more sleep unsuccessfully, anxiety 

12 pm l-theanine, magnesium, inositol to help calm down caused extreme nausea

3 pm CBT appointment, went well despite anxiety 

4-5:30 shopping, tired, weak legs

5:30-20:30 physically rest (customer service calls/some work)

20:30 dinner - salad, chicken

22:30 citalopram 1.6 mg, 230 mg magnesium 

22:30 - 3 am restless the whole time even though at a fairly low level 

3 am - 1.5 mg melatonin 

 

Main symptoms today: Anxiety, restlessness 4/10; nausea (caused by L-theanine) 8/10 for about 2 hrs

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Altostrata

Why are you taking citalopram at night? Does it make you sleepy?

 

It seems you are taking citalopram on an irregular schedule. A few hours variation here and there can cause odd symptoms, particularly at low doses.

 

Please choose a time when you can take citalopram consistently. This may help settle your symptom pattern -- continue to post your notes.

 

What is your usual sleep schedule? Not getting enough sleep can make you feel poorly, fatigued, and exacerbate some withdrawal symptoms.

 

Our nervous systems are designed to respond to morning light. This causes a natural leap in cortisol, the daytime activity hormone. Withdrawal syndrome can make your nervous system hypersensitive to the cortisol peak and jolt you awake with anxiety.

 

If you have a tendency to go to sleep at 3 a.m., waking at 4 or 5 would not be unusual -- that's the cortisol peak.

 

Please consider a more normal sleep schedule. At the very least, you may want to use a sleep mask so you might sleep more in the early morning. See

 

Tips to help sleep -- so many of us have that awful withdrawal insomnia

 

Music for self-care: Calms hyperalertness, anxiety, aids relaxation and sleep

 

What is the sleep cycle?

 

Melatonin for sleep: Many people find it helpful

 

TV or computer use in evening can disrupt sleep: Bright light signals the brain that it's daytime


Waking with panic or anxiety -- managing cortisol spikes

 

White noise devices for sleep

 

On 6/8/2019 at 5:01 AM, Onmyway said:

I find that inositol and L-theanine help.

 

Please go to the Symptoms and Self-Care forum, use search to find our topics on those supplements.

 

On 6/9/2019 at 8:35 PM, Onmyway said:

So now that I am on 1.6 mg liquid citalopram, I am in fact on 2 mg tablet form. It doesn't change my hold right now. But perhaps means that I would not be updosing for now. 

 

You are taking 1.6 milliliters, rather than milligrams, of liquid citalopram? Please correct your signature. We prefer to see your dosage in milligrams.

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Onmyway

Hi @Alto, 

thanks for the response. Please see my answers below: 

 

Before withdrawal my sleep  cycle was 4 am to 12-1 pm. It's been like that since at least college. When wthdrawal happened my cycle went to 12 am to 5 am and then I went to the US (from the UK) for 3 weeks where it stayed 12 am to 5 am and when I got back to the UK it has been delayed again. Luckily I read here about blackouts and currently, because my windows are east facing and large, I have 3 layers of curtains (each double-layered) as well as felt covering. I also use an eye mask and ear plugs. Funnily, since I came back, my evenng windows have not been coming until past midnight. Before they used to be around 9 pm. I now get jolts when I try to nap and wake up during the afternoon. I have been able to get 6 hrs a night lately which has been great! I try to sleep more as I hope that sleep is restorative to the CNS. 

 

Regarding citalopram, when I switched to liquid I was taking it after waking up but that was increasing the nausea so moved to nighttime. But you are right, I need to be more consistent with the time I am taking it. When I reinstated from 0 to what I thought was 2.5 I looked at the liquid where it said that 2 ml=2mg. However, later discovered that the bioavailability of 2 mg liquid is the same as 2.25 tablet. So I had stopped at 5 mg (tablet) and within a month reinstated to 2.5 mg liquid=3.125 tablet. So now I am taking 1.6mg liqud (which does happen to also be 1.6 ml) but is equivalent to 2 mg tablet (after some tapering). I am holding now and plan to do so for another month or so depending on how I feel. I am defintely seeing improvement from how it was 4 months ago but I also have a lot to go. 

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Onmyway

10:10 am wake up (6 hrs again, yaay!)

10 am to 2 pm - in bed, trying to fall asleep, some drifting off, anxious, new symptom - left side whole body paresthesia which increases with anxious thoughts; depression and sadness, but can't cry  - anxiety 5/10; sadness 6/10

2 pm to 4 pm - nausea, 6/10

4 pm to 6 pm - walk, sauna (5 min), jet pool (15 min), nausea, at times 8/10

6 pm - 7:30 pm rest from walk, paresthesias on legs

7:15 toast with avocado, milk, orange juice

7:30 - 11 pm out with friends,  feeling OK but dissociated a bit, leg weakness, mild intermittent nausea 2/10

11 pm - dinner, chicken, large salad, apple, toast, feeling OK

12 am - citalopram 1.8 mg tablet=(1.6 mg liquid)

1:30 am melatonin 1.5 mg, Mg=130mg, inositol=600 mg, feeling OK

2:30 - try to sleep

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Onmyway
7 hours ago, Onmyway said:

Regarding citalopram, when I switched to liquid I was taking it after waking up but that was increasing the nausea so moved to nighttime. But you are right, I need to be more consistent with the time I am taking it. When I reinstated from 0 to what I thought was 2.5 I looked at the liquid where it said that 2 ml=2mg. However, later discovered that the bioavailability of 2 mg liquid is the same as 2.25 tablet. So I had stopped at 5 mg (tablet) and within a month reinstated to 2.5 mg liquid=3.125 tablet. So now I am taking 1.6mg liqud (which does happen to also be 1.6 ml) but is equivalent to 2 mg tablet (after some tapering). I am holding now and plan to do so for another month or so depending on how I feel. I am defintely seeing improvement from how it was 4 months ago but I also have a lot to go. 

Sorry Alto, 

Miscalculated that 1.6mg liquid citalopram (also 1.6 ml) is equivalent to 1.8mg tablet citalopram because of bioavailability (as says on bottle leaflet). Fixed the signature. I was on 20 mg tablet for 19 years almost, 40 mg last August (2018) and tapered from 40 to 20 starting September 2018 to Feb 2019, reinstated 3.125 tablet=(2.5 mg liquid) March 6th, and then down to 1.8 mg tablet (1.6 mg liquid now, holding for 5 weeks).

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Onmyway

10:00 am woke up but back to bed until 14:00 (went to bed at 6 am due to late night out playing cards - was feeling miserable so needed the distraction). Longest sleep ever since Feb 5th  but quite broken

14:00 - depression and anhedonia, can't cry, hopelessness

17:00 - some food (fruits, toast with avocado) - very restless, almost manic, cleaning kitchen, doing laundry 

18:00  out to play cards, depressed, but distraction helps

20:00 dinner Sunday roast 

2:30 am citalopram 1.6 mg liquid

3 am melatonin, magnesium, levothyroxine 50 mcg

 

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Onmyway

Last week was generally OK. My thinking was clearer, felt more like before wd. On Thursday I had a beautiful window, though Wed was quite depressed, and thought that maybe I am one of the lucky ones and I might have escaped wd hell. If so, I'd stay at 2 mg indefinitely until I deal with this again. But woke up today and sadness and depression hit. I don't really have a specific thing I am sad about - all past things come flooding in. Worse thing is, I can't cry. 

 

My sleep has also been quite bad as in it has become very irregular. I feel so activated (energetic/restless) that I can't fall asleep until 4 am and sometimes until 6 am. Then some broken sleep during the day a few hours and then back again. It is influencing my work. 

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Altostrata

Please pick one time that you can take citalopram and take it every day at that time. Your irregular dosing may be causing your waves.

 

If you're concerned about the length and quality of your sleep, I would keep a conventional sleep schedule of roughly nightfall to dawn, such as 11 p.m. to 7 a.m. This is what your nervous system was telling you when it was waking at 5 a.m. Sunrise is actually a normal time to wake.

 

When you push your sleep schedule out of shape with late nights, artificial lighting, etc., it goes off-track and may not be dependable.

 

Do you have citalopram prescription liquid? Look on the label -- how many milligrams of drug are in a milliliter? Please disregard explanation of "bioavailable."

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Onmyway

Have been traveling and forgot my melatonin. Slept 3 hrs last night and 2 tonight (can't fall asleep because restless and wake up early). Took 0.25 mg Xanax. Hoping to not have the nausea that has recently started to follow Xanax for me and hoping for 2-3 extra hrs of sleep at least.

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Onmyway

Sorry Alto for the late reply. I have started to do the dosing at midnight (and go to bed promptly after). I have always had issues with sleep - not sure if it was caused by ADs or it was just my body - I suspect I have delayed sleep onset disorder. Luckily my work is flexible so it has not been an issue but it is really hard to keep up a regular schedule for me even tough I have blue light blockers on phone and computer. 

 

Yes, I have been using the liquid citalopram whch says that a drop is 2 mg. I take 1.6mg of that but the bottle gives equivalecy of that to tablets as 1 mg liquid=1.25 mg tablet. It doesn't really matter much with the lowering but I wanted to keep good notes. 

 

the last few days Sat-Wed I was traveling and was very active - 14,000 steps on average a day. Could not sleep well either. Had to take 0.25 mg xanax on two consecutive days to be able to get 4 hrs of sleep. Had forgotten melatonin so that could be the reason but it could also be just the change of place, heat etc. I also suspect that I had hypomania type window for a week or so. 

 

I slept better last night at home, though did wake up early morning again with palpitations. Anxiety is back and partly situational but I also notice that my emotional responses to more regular things are also exaggerated. I feel sad more often and without cause. Simple things provoke intense anxiety. Also, the pins and needles are back. They had gone away on their own but are back now. 

 

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Altostrata

The "drops" measure is not very helpful for our purposes. Please get an oral syringe from a pharmacist or veterinarian so you can measure your dose in millilters.

 

Please ask your pharmacist how many milligrams of active ingredient are in a milliliter, or phone the manufacturer for this information. This tablet equivalency doesn't make any sense to me.

 

How long have you been taking citalopram at midnight? I still need to see daily drug and symptom notes to unravel any questions.

 

If you're staying on the computer until bed, that alone may be keeping you from sleeping more.

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Onmyway

Hi Alto, 

Falling asleep has now been resolved with the melatonin but I do wake up after 3-4 hrs and falling asleep then is problematic. A bit more melatonin + magnesium + inositol after waking up helped fall back asleep today. I think traveling, being away from routine and a lot of physical exertion - up to 20,000 steps a day did cause the return of the symptoms. I also think I had slight hypomania while traveling so that hurt sleep. Have been resting a bit so will see how things resolve. I did pull the citalopram to 11 pm last night and will work on pulling the sleep time to earlier as well. 

 

Regarding citalopram liquid dosing, here is what the manufacturer says on the leaflet: 

"Each 1ml of Citalopram Oral Drops contains 40mg of citalopram (as hydrochloride).

Each 1ml of Citalopram Oral Drops, solution contains 20 drops.

Each drop contains 2mg citalopram (as hydrochloride)."

 

The liquid is very concentrated. I started measuring 0.05 ml with a 1 ml syringe but at that low level, it was hard to push the liquid out from the syringe as it would mostly remain in the tip and not fall and I felt it is less accurate than the drops because of it. The liquid is slightly viscous so hard to manipulate in a syringe. So now I dilute 1 drop in 20 ml of water and take with a syringe 16 ml of it. for 1.6mg liquid citalopram. This will allow me to do 5% drops when I feel ready. 

 

The bioavailability stuff I saw a month or more later and it also comes from the leaflet and the online info. It will impact my jumping point I guess but for now it will not impact much. 

 

 Copy/pasting below: 

 

"Citalopram oral drops have approximately 25% increased bioavailability compared to tablets. Consequently doses of tablets correspond to doses of drops as follows:

Tablets

Solution

 

10mg

8mg

(4 drops)

20mg

16mg

(8 drops)

30mg

24mg

(12 drops)

40mg

32mg

(16 drops)

https://www.medicines.org.uk/emc/product/3349/smpc

 

 

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Onmyway

So I've been having a serious wave since my last post. Sleep is back to waking up multiple times a night (every hour or so), anxiety is amped up quite a lot (8/10 most of the day) and the paresthesia is getting difficult. At times it will be just half my body which is freaking me out. At other times it will be tingling in the feet, especially after walking. Anxiety sometimes makes it worse but it also is around when I am not anxious. Part of it is because I got some bad news and feel an urgency to make some decisons but a lot of it also feels chemical - like out of proportion. I have also been having quite a lot o sadness and depresson and a general "yucky" feeling. I don't know how to describe it - it is not quite necessarily sadness, maybe closer to anhedonia - like I feel bad, miserable, unpleasant. Also exhausted a lot of the time. 

Went to GP to ask about the paresthesias - he claimed that it was somatization of my anxiety about withdrawal. I told him that it happened even when I did not feel anxious and it was worse when I exerted myself and all my blood tests of magnesium, thyroid, B12 etc are normal (folic acid is elevated even though I don't take supplements). He insisted it was somatization without doing further tests. I am not super worried about them except when the tinging is only half of my body. It is an MS symptom and it has been around for a while and while I am 99% conviced it is just withdrawal, a part of me wonders if this wd can cause autoimmune reactions that could activate MS. I so hope not! I am going to wait and see for now. 

 

I was hoping that holding at this dose for a few months (now 2+) would bring stabilization and after feeling well for a week or so I had hoped that that was it until I cut again. The last week has crushed that hope. I keep saying that to the GP, that I don't expect wd symptoms as he thinks I get them because I expect them. Quite the opposite - I, like many here, latch onto the windows and hope that that's it, I'm free. The somatization "diagnosis" was quite awful actually - He claims that he is not denying my feelings, he just thinks they are wrong! "I think you should be more resilient. Live with the difficult times and get on with your life. Don't worry about it." Right! I want him to be put in the middle of a cortisol surge morning and get over it just like that. Why would anyone choose to be like this?  Also, how can one "deny" a somatization or nocebo effect. It's like he is arguing "God is causing it" and you can't prove it one way or the other.  That was quite upsetting unfortunately. Hoping for more windows...   

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Onmyway

Another wave today. I had gotten slightly better from the last one but today was quite bad. Mondays and Fridays for some reason end up being hard. The last few days have started waking up with cortisol spike-type dread/self-loathing/depression. It's hard to describe. The palpitations/fear are there but the predominant neuro-emotion is self-loathing/shame/guilt. I need to wake up fully and get out of bed to reconnect with my surroundings as the feeling is so severe. The rest of the day then is full of restlessness and background anxiety and background depression. 

 

The paresthesias (in my case pins and needles/numbness in legs and arms) have lessened but they get worse after walking. Nausea was back today but intermittently and at a level of 1/10 rather than 8-10/10. 

 

A new symptom has emerged which is a type of dizziness that gets worse if I look up - tilt back my head (like while taking a shower, for example). It feels like I have hyperventilated, breathed too fast, too much. That feeling gets really intense a couple of hours before I take the citalopram. I wonder if my body is telling me to divide the dose in two and take it two tymes a day. Citalopram has a half life of 30 hrs (average) so it should be OK but at these low doses not sure if the metabolism is different. I haven't made changes for 2.5 months now so not sure why it is appearing now - I am at 1.6 mg liquid citalopram which apparently is equivalent to 2 mg tablet one due to bioavailability per manufacturer. I had been regularly taking 1.5 - 3 mg melatonin at night. Will stop it and see if anything changes with the dizziness even though the dizziness did not emerge at the start of melatonin treatment. But doesn't hurt to check. Have also been more lax on the magnesium/fish oil. 

 

But the appearance/disappearance of the symptoms (relentless nausea before, then paresthesias, now this dizziness) make me think of that great analogy of rebuilding the WTC while people are still working in it. 

 

Hoping for a cortisol-spike-free-morning.  

 

 

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Gridley
50 minutes ago, Onmyway said:

 I haven't made changes for 2.5 months now so not sure why it is appearing now -

 

There is just no telling when these symptoms will appear.

 

Delayed onset of withdrawal symptoms

 

 

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AlanC

So sorry to hear you're suffering from the dizziness, and I really hope you see the back of it soon. It really is one of the nastier symptoms because of the way it can impact your ability to get on with normal daily activities.

 

As for your GP, I think he's gaslighting you: trying to delegitimise your statements that the symptoms are down to withdrawal since he clearly doesn't believe that is possible. I'm really not sure what you can do in such a situation other than try to find another, more sympathetic, doctor.

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