Witsend: desperate for advice

[Witsend81]

Hi.  Hoping for some advice.  Unfortunately I didn't do my research properly before trying to taper off and discontinue citalopram.  See signature.

 

I managed to completely cut the citalopram out at the beginning of April this year and ploughed on through the horrible withdrawal, mostly emotional with mood swings.  Mood gradually worsened and at the end of May had a massive crash - couldn't stop crying, the world seemed to be a different place, it looked different, and I could no longer function.  Terrified the next morning I took a 10 mg pill of citalopram I had left over from last time.  Saw the doctor the following Monday who encouraged me to continue with them.  By Friday 7 June, my anxiety levels were that high with constant whooshes of panic that I went back to the doctor. He wanted to up the dose to 40mg but I said I was afraid this would lead to more anxiety.  Agreed to up to 20 mg and he prescribed a weeks course of 2mg diazepam to help alleviate the panic.  Diazepam helps but the underlying anxiety doesn't seem to be settling.  Took the 20mg of citalopram this morning, have hardly been able to function all day.

I'm at a loss at what to do.  Should I stick at it and hope the citalopram will kick in again?  Do I reduce right back down to say 5mg?  Do I stop completely and ask for another medication to help stabilise me?  I suspect nobody knows the answer.  Feeling extremely restless when the diazepam wears off - I can't go on like this 😞

[Witsend81]

Should also add, I've never had these side effects with citalopram before...not sure if the anxiety is related to the withdrawal or restarting the drug.

[manymoretodays]

Hi Witsend81 and welcome,

Thanks for getting your signature done as well.

 

How are your symptoms now compared to what they were before reinstatement? 

 

About reinstating and stabilizing to reduce withdrawal symptoms

Definitely worth a read through, especially the first post there.

We usually do suggest smaller doses to reinstate with, than what your doctor may have.  You may be sensitized, if symptoms are now worse.

 

Tips for tapering off Celexa(citalopram)

What form of citalopram are you working with now?

I think a 5 mg dose now sounds reasonable.

 

Caution with the diazepam usage too, often it only takes about 2 weeks to form another dependency.

 

More on WD and WD symptoms:

 

Brain Remodelling

What is withdrawal syndrome.

The windows and waves pattern of stabilization

 

Dr.Glenmullen’s withdrawal symptom checklist

 

 

When we take medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made.  The CNS likes stability. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system.  

 

Magnesium, nature's calcium channel blocker 

Omega-3 fatty acids (fish oil) 

 

 

This is your introduction/journal page where you have now introduced yourself to the community, you can ask questions here regarding your tapering, and reinstatement, give updates, and just keep a record of your journey.

 

Welcome aboard,

Love, peace, healing, and growth,

manymoretodays

 

Edited June 10, 2019 by manymoretodays
additional question and thoughts

[Witsend81]

Many thanks for your reply, manymoretodays.  

Since my original post I became so agitated and suicidal that I ended up in accident and emergency.  The on-call community psychiatric team saw me and took an assessment.  She recommended I carry on with the citalopram and either up my dose of diazepam to 5mg or try propranolol to take the edge off my anxiety.  

As you say, diazepam is addictive so I'm planning to swap to the propranolol tomorrow short term while the citalopram gets back in my system.

I wish I'd came across this site sooner and not reinstated at such a high dose, but now that I'm on the 20mg citalopram, I'm going to hold it until I restabalise (hopefully), so as not to confuse my CNS further.

Before I reinstated, i was just starting to get the serious withdrawal affects with the panic attacks, and that's when I knew I'd pushed withdrawal too far.

I'm lucky enough to work in a hospital with an excellent neurologist who instantly recognised that indeed this is withdrawal syndrome- he is going to discuss my case with a neuropsychiatric consultant colleague.  He warned me not to rely on the diazepam for more than a week.

I will hold fast for now and let you know how I get on.  Uunfortunately this situation has meant I've not been able to function at all and I haven't seen my 9 year old son for a week while I get through this trauma.  I just cannot believe the damage these drugs can do to people and they are handed out like sweets!

Again, many thanks for your reply, I will let you know what happens.  

[manymoretodays]

(((((Witsend))))))) hugs.

Okay and thank you for the update.  And trauma it is!  So sorry Witsend.

 

Yes, update again when you can. 

 

Meantime, Love, peace, healing, and growth,

mmt

[Altostrata]

Witsend, if you're getting an adverse reaction from 20mg citalopram, your nervous system is saying it's too much.

 

If I were you, I'd immediately drop to 10mg citalopram. See how that goes for a week. It could be that 5mg would be better.

 

Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms. You can post them in this topic with a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

 

Please let us know how you're doing.

[ChessieCat]

 

Hi witsend and welcome from me too,

 

12 minutes ago, Altostrata said:

Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms. You can post them in this topic with a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

 

Example of what Alto is asking for:

 

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

 

[Witsend81]

Hi

 

Please forgive me but I did not follow your advice and I fear this may have been a mistake.

 

I continued on the 20mg of citalopram but went back to the doctor when my symptoms of agitation continued.

 

He persuaded me to do a direct switch from 20mg of citalopram to 50mg of sertraline and gave me promazine 25mg/5ml to be taken 5-10ml up to four times per day.  His reasoning was that he had seen a good response to sertraline and that promazine would quell the agitation.

 

I have been on this regime now for 11 days.  I've been slightly less agitated, however have been having crying spells, disturbed sleeps, panic attacks and struggling to cope.

 

My question is what would you suggest now? I suppose the most logical thing would be to hold this regime and hope that the sertraline does indeed begin to work, however, I'm not confident.  

 

Throughout all this I'm rapidly losing weight and I'm struggling to look after my son.

 

I'm so confused.

 

Yours hopefully 

[Witsend81]

Ps, the doctor wants me to up dose to 100mg sertraline.  I'm terrified of doing this in case it makes matters worse with the nausea and agitation 

[ChessieCat]

I've asked the others mods for their assistance.

 

So they can assess your situation please post 3 days of daily symptom notes.  See example given in blue above.

[Witsend81]

Unfortunately they are not successive days:

Monday 24 June

6.30am awoke panicky, cortisone spikes

No appetite and crying spells.  Jittery.

Took 50mg sertraline and 2mg promazine and Complan meal replacement

11.30am 2.5 mg promazine.  Still crying spells.  Complan.

3.30pm  panicking, restlessness and fear began to subside

5.30pm began to feel on edge again.  Appetite still poor.

8pm symptoms begin to subside.  2mg promazine.  Small meal.

10pm bed.  Broken sleep.  Vivid dreams.  Sweating and panicky feelings with pounding heart.  Managed to get back to sleep until 6am.

 

Tues 25 June

6am  panic, cortisol spikes, pins and needles.

6.45am

50mg sertraline 

4mg promazine 

Complan

11am 2 biscuits, 4mg promazine 

12am

Agitation settled, felt spaced out

1am bowl of cereal

2pm

45min nap.  Awoke panic attack.  Then spaced out.  Fell over on way to pick son up from school, not fully awake.

5pm small bowl of pasta

8.30pm  symptoms begin to settle, 4pm promazine

10pm bed

 

Friday 28 June

5am.  Awoke panicky 

2mg promazine 

Complan

50mg Sertraline 

Crying throughout morning, hopeless thoughts 

8am  short walk

10am

Attended CBT group course, got very upset and arranged to come back on 121 basis.

11.30am.  Still nauseous.  Small bowl of cereal.  4mg promazine.

Crying jags.

1.30pm

Picked son up from school.  Nervous and jittery.

2pm

Dizzy and spaced out, trouble focusing.

On edge and nauseous 

7pm

Symptoms began to subside.  Ate small meal.

10pm

4mg promazine. Broken sleep, vivid upsetting dreams.

5.30am awoke.  Nervous although not as intense.  Managed to lie in till 6am.  

Got up, nervousness and apprehension about day increased.  4mg promazine.

 

[Witsend81]

I'm wondering whether to decrease the sertraline to 25mg to reduce the side effects, especially the nervousness, restlessness and nausea.  I'm finding that nothing seems to take my focus off the symptoms/side effects other than trawling the internet for hopeful stories and looking after my son.  

 

My aim here is just to get stabilised.  Long term goal will be to get off Ads but I just need to be stabilised.

 

I'm going back to the GP Monday morning as bottle of promazine running out/update him.

 

I'm certainly in a better place to where I was when taking the 20mg citalopram.  Symptoms have abated a little, especially the agitation and restlessness - not sure if that's promazine making it.

 

Id be interested to hear your advice.

[ChessieCat]

Please update your drug signature.

[Witsend81]

Hi ChessieCat

I'm not sure how to do this from my mobile, however I can get access to a computer later on

[Witsend81]

Hi

 

I've now updated my signature.

[Witsend81]

Feeling pretty rotten, it's 5pm and had a massive crying jag after suicidal thoughts/feeling of dread.  Don't know what to do.  I don't want to die.

[BreathofAir]

Hi Witsend, 

 

You are not alone.  Just wanted to send you hugs. A moderator will be along as soon as they can with advice regarding the reinstatement and switch.  Do you have any help with your son at all? 

 

Rachel xxxxx

 

[Witsend81]

Thank you.  I have my son today, he is happily playing outside.  I took myself off and had a cry and then came back feeling a bit better having let it out.  Feel a bit silly now.  What seems to happen is the pressure/negative thoughts and panic/agitation build and then I have to cry, it's all I can do.  I think the thought of being like this forever made me think of suicide and then I felt really guilty for my son.

 

Not knowing what to do for the best med wise is bothering me - I know the GP will want me to increase on Monday but I'm pretty sure that will make me worse, however part of me thinks it might make me feel better.  It's so confusing and I'm not really in the right frame of mind to make decisions.

 

Thank you for the virtual hug xxx

 

[Sassenach]

@bubble @ChessieCat @Altostrata

 

 

Hi Witsend

 

First you are not going to die, you are in a bad place at the moment.

As you appear to be on no other medications than the Sertraline and Promazine what you are experiencing are withdrawal symptoms and your GP has got it wrong.

Whatever you do at the moment do not change anything and I will get one of the more experienced mods to contact you.

GPs know nothing about withdrawal from these drugs but the senior mods on here do.

It is unfortunate that you did not follow their advice but I remember that rock and a hard place feeling.

You can get better I am currently stabilising on Citalopram and slowly  improving.

Hang in there and come here whenever you need to talk.

[Witsend81]

Thank you Sassenach

 

I second that, I wish I'd taken the advice from here 😞

 

xx

[Sassenach]

It is not too late but do not change anything until a senior mod looks at the best way forward.

We all listen to the doctors to start with and then find this site.

Your nervous system is in disarray and needs time to settle but there is a way back.

It may be tomorrow before you get a response because of saturday night and time differences.

Once your son is in bed try and relax, stay quiet and keep telling yourself you will be ok.

 

Sassenach

[Altostrata]

What does "complan" mean?

 

On 6/28/2019 at 4:08 AM, Witsend81 said:

Hi

 

Please forgive me but I did not follow your advice and I fear this may have been a mistake.

 

I continued on the 20mg of citalopram but went back to the doctor when my symptoms of agitation continued.

 

He persuaded me to do a direct switch from 20mg of citalopram to 50mg of sertraline and gave me promazine 25mg/5ml to be taken 5-10ml up to four times per day.  His reasoning was that he had seen a good response to sertraline and that promazine would quell the agitation.

 

I have been on this regime now for 11 days.  I've been slightly less agitated, however have been having crying spells, disturbed sleeps, panic attacks and struggling to cope.

 

My question is what would you suggest now? I suppose the most logical thing would be to hold this regime and hope that the sertraline does indeed begin to work, however, I'm not confident.  

 

Throughout all this I'm rapidly losing weight and I'm struggling to look after my son.

 

I'm so confused.

 

Yours hopefully 

 

You have us in a bit of an awkward position here.  You chose not to follow our earlier advice and chose your doctor's plan, but now you are asking us to improve upon his cocktail.

 

I would not have made the drug switches. It could have been that your nervous system would have settled down on citalopram or you would have done better with less citalopram.

 

I don't know which of the drugs, if any, is causing the improvement or which, if any, is causing side effects. That would take understanding your symptom pattern over a number of days, which is a lot of work.

 

I agree with Sassenach, if you're feeling better, I would not change anything. There are no miracle cures. Good to hear you're doing a bit better.

[Witsend81]

Thank  you for your input Astrostrata

 

Complan is a meal replacement drink, handy when you are nauseous and struggle to eat solids.

 

I'm going to continue on the current regime as I'm too terrified to change anything and upset the cart further.

 

Hopefully I'll settle on the 50mg of sertraline and then be able to withdraw the promazine. 

[Altostrata]

Please let us know how you're doing.

[Sassenach]

Good morning Witsend81

 I would like to ask some questions to help us help you.

Only answer if you are comfortable doing so.

Only short replies are needed and ensure you protect your anonymity please.

You said you live with your son, is that correct.

Do you have a job?

Do you always see the same GP?

Is he/she understanding and willing to listen.

Are you confident when discussing the drugs, if not can someone who is go with you?

Are you aware of your rights under the NHS.

It is important for you to understand how busy this site is and particularly the senior mods.

If someone ignores advice and follows their doctors it is understandable they have to move on to those who need them.

An early reply could help me to help you for tomorrow.

 

Sassenach

[Witsend81]

Hi Sassenach

 

I've cut and pasted and put replies in:

 

You said you live with your son, is that correct.  Yes

Do you have a job?  yes currently on sick leave

Do you always see the same GP? yes

Is he/she understanding and willing to listen.  They are willing to listen but I don't think truly understand 

Are you confident when discussing the drugs, if not can someone who is go with you?  my dad

Are you aware of your rights under the NHS.  Not really 

 

I'm feeling rubbish this morning, not hardly slept, restless.  I'm sure I've developed akathisia as a result of restarting the Ssris rather than withdrawal as the terrible symptoms didn't appear until 5 days after restarting the 10mg of citalopram, and this it's what's driving my suicidal thoughts, the severe inner restlessness.  I know it's hard for you to advise now as I've muddied the waters 😞

I'm seeking help on Monday, push for referral to a specialist urgently.

 

thanks 

[Sassenach]

Good

Back to you during day.

Hang in there.

Got to go out but will send you links later.

Please ensure you keep you keep your diary. Use phone alarm bit of paper anything but it is crucial in view of the med changes.

Keep it short, show the times drug/doses, how you feel.

Later

[Witsend81]

Sat 29 June

6am Awoke nervous and anxiety, restless.  Broken sleep.

6.30am 4mg promazine

50mg sertraline

Felt nervous and restless, couldn't focus

12pm  2mg promazine

2pm  still restless

5pm Massive wave of dread, suicidal thoughts, cried.

Negative feelings subsided a little.

9pm 2mg promazine

 

Noticed jaw clenching today

 

[Sassenach]

Hi Witsend

 

If you click on the above it will help you understand the need for not changing doses and meds as well as the process of stabilisation.

It is good that you see the same doctor as long as they are open minded.

You need to decide whether you want to go with the the help on here or follow your GP's recommendations.

If the GP wants to increase your doses that is not the purpose of this site.

We are here to help stabilise and eventually taper off these meds.

If you decide you want help here, and I hope you do, you will need to effectively take charge of your care.

Under NHS rules your GP has a duty of care to you as long as you do not abuse, threaten or assault a staff member.

That duty of care continues even if you do not follow their advice.

The medical profession does not understand AD withdrawal although they are slowly beginning to accept its existence.

If you tell your GP that you do not want to increase but stay on your present dose for the time being, he/she must accept it and work with you.

Stay cool, calm and collected and take your dad with you for moral support provided he can do the same.

You may be surprised how easily the GP  accepts this decision.

I wish you well whatever you decide.

It is important to remember there is no short cutit takes time for your brain to heal, but it can as the success stories on here show.

Please let us know how you get on ( even if you are the wrong side of the Pennines, I was born in York )

Good luck

 

Sassenach

[Witsend81]

Thank you for the advice Sassenach

My long term goal is to get off or take as little medication as possible.  For now I just want to stabilise.

There is no way I'm increasing the dose of sertraline, it would send me over the edge.

I will let you know how I get on,

 

Best wishes

 

[Sassenach]

Good luck, be stong, be calm and we go from there.

 

Sassenach

[Sassenach]

Good Morning

 

Hope you are ok today and sending you strength from a rainy Scotland.

You can begin the fightback today and if you take your time, be polite but firm you will create base for moving forward.

Good luck

 

Sassenach

[Witsend81]

Hi Sassenbach

 

I'm stood outside the doctors.

Did not sleep all last night now two nights no sleep.

Had racing heart and sweating all night.

Got up this morning extremely agitated.

Shaking all over.

I cannot go on taking this tablet.  

I've only been on this one two weeks so going to halve it.

Should I consider bridging with a small dose of Prozac or withdraw the sertraline and restart 5mg of citalopram?

 

I simply have to do something, I'm losing my mind but still holding on.

 

Witsend

 

 

[Sassenach]

Do not change anything we will speak to you later today if you make a change when you are feeling really bad you will regret it tomorrow please stick with this and give us a chance to sort it out for you if you keep moving your meds up and down you will only make yourself feel worse speak to you this afternoon you will get through it sassenach

[Witsend81]

I've taken 50mg sertraline this morning, not made any changes yet. 

 

I'm having an adverse reaction to it, I think - I have to come off it, it's causing me to become akathisic and have suicidal thoughts + 0 sleep.

[Sassenach]

Wits end what did your GP say and what have you agreed with him please reply asap sassenach