Hamster: intro - is it withdrawal or recurrence of depression?

[Hamster]

Hi to everybody,

 

I just signed up to the forum to contribute and to get support for my issues.

 

The "Intro" part: I always considered myself a very "stable" person, psychological issues were for others, not for me.

I have seen quite some people in my environment struggle with that (siblings, colleagues), I tried to be understanding and helpful -  but I never thought that something similar could affect me.

That changed when I voluntarily changed my job last year, from an employee working more than a decade for a big company to a self employed consultant.

Unluckily I did not have the time to take a break in between my jobs, so I left my old office and started the training and preparations for the new job right away.

Everything went well for the first couple of months but it was extremely stressful. My sleep quality degraded more and more, I was unable to relax  and by end of October 2018 I had the first breakdown in my life.

I could not stop ruminating, endless negative thoughts, no sleep, no future ...

 

I started taking St. John's Wort and it became somewhat better within 2-3  weeks. But then I experienced a panic attack, likely caused by the AD. So I reduced the medication within 2 weeks and stopped taking anything.

All in all I was on the med/herb extract for maybe 7 weeks including the fast taper. I felt really OK afterwards, but for maybe 2 weeks only ... then the combination of bad sleep (early morning awakening) and low mood became worse and worse again. The mornings were unbearable ... in the evenings I sometimes felt 100% normal.
 

So beginning of this year I made an appointment with my GP and was put on mirtazapine (30 mg/d) for sleep and citalopram (10 mg/d, later increased to 20 mg/d) to treat the depression + one shot of a neuroleptic substance for instant relief. I improved a bit, but the symptoms never disappeared.

I managed to work a bit and keep my business alive, but not enough to really get the business going. And after some weeks I panicked again. That seems to be a pattern for me: After two/three weeks with a (new) AD, something strange happens ... the web search led to the term "acivation syndrome" and I kept taking the meds.

 

Since February this year I am visiting a therapist for talk therapy which helps quite of lot.  We went through some issues during my childhood and I was diagnosed as a "hypersensitive person" (HSP).

At first I was a bit reluctant to accept that, but it explains a lot of behaviors and issues I had in the past.

 

As HSPs may also be more sensitive to drugs (I can kill nearly every pain with 100 mg of Ibuprofene ...) and the side effects of the ADs were really bothersome I reduced them by half and continued to reduce them stepwise ever since. In comparison to the recommendations here in the forum rather fast, far beyond the 10% / month ... I was not yet aware of how slow some people have to taper.

So finally my question:

How do you distinguish between AD side effects / WD symptoms and recurrence of the depression?

My last reduction step of mirtazapine (5mg -> 3.75 mg/d) was 16 days ago and the morning lows are pretty bad right now. Sleep is OK, but I am also very tired throughout the day, not much energy to do anything. The citalopram I currently keep at 5mg/d. 

 

In the past as soon as I got better I did the next step to reduce the side effects of the ADs ... probably way too fast. On the other hand I only took them for a couple of months.

Now my plan is to stabilize on the current dosage but when my mood is low I really have a hard time to resist the urge to change my meds (up or down) ... just want to try out something to make it better instead of just waiting ....

 

Any ideas are highly appreciated ... thanks!

 

[Gridley]

Welcome to SA, Hamster.

 

 What were the side effects you experienced and how soon after taking the drug did you experience them?  Did they diminish as your dose got smaller?   

 

Regarding relapse vs. withdrawal, the symptoms you mention, fatigue and low mood, are common withdrawal symptoms.  Given your very rapid taper, it is probable that they are the result of withdrawal rather than relapse.  Here are two links to help you:

 

Is it withdrawal or relapse?  Or something else?

 

Here is some information on withdrawal and typical withdrawal symptoms:

 

What is withdrawal syndrome.

 

Glenmullen’s withdrawal symptom list.

 

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. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.  

 

These explain it really well:

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

   On 8/30/2011 at 2:28 PM,  Rhiannon said: 

When we stop taking the drug, we have a brain that has designed itself so that it works in the presence of the drug; now it can't work properly without the drug because it's designed itself so that the drug is part of its chemistry and structure. It's like a plant that has grown on a trellis; you can't just yank out the trellis and expect the plant to be okay. When the drug is removed, the remodeling process has to take place in reverse. SO--it's not a matter of just getting the drug out of your system and moving on. If it were that simple, none of us would be here. It's a matter of, as I describe it, having to grow a new brain. I believe this growing-a-new-brain happens throughout the taper process if the taper is slow enough. (If it's too fast, then there's not a lot of time for actually rebalancing things, and basically the brain is just pedaling fast trying to keep us alive.) It also continues to happen, probably for longer than the symptoms actually last, throughout the time of recovery after we are completely off the drug, which is why recovery takes so long.

 

You mention that you were only on the AD's for a couple of months.  It only takes a month to become dependent on an antidepressant, with the risk of withdrawal symptoms.

 

It's very important not to keep adjusting your meds when you feel low.  Your brain and central nervous system crave stability, and by tinkering with your dose you are increasing your chances of feeling worse.

The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable.

 

I suggest you hold where you are and make no changes for at least three or more months to allow your system to stabilize.

 

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) 

 

Please research all supplements first and only add in one at a time and at a low dose in case you do experience problems.

 

Please add a signature.  Include drugs, doses, dates, and discontinuations & reinstatements in the last 12-24 months. Also include supplements. This will help us give you the most accurate advice we can. 

• Any drugs and supplements prior to 24 months ago can just be listed with start and stop years. 
• Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago) 
• Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016. 
• Please leave out symptoms and diagnoses. 
• A list is easier to understand than one or multiple paragraphs. 
• This is a direct link to your signature:  Account Settings – Create or Edit a signature.

 

Please continue to use this thread to document your taper and to ask questions. 

 

 

 

 

 

 

 

 

 

 

 

Edited June 12, 2019 by Gridley

[RichT]

Hi Hamster,

 

Do your symptoms now feel the same as your original depression? For me, the wd symptoms are different from the original depression, so it’s easy to see that i’m suffering wd symptoms and not a recurrence. If your symptoms are the same, i’ll leave it to others to advise you on this!

 

Warmest wishes,

 

Rich

[Hamster]

Dear Gridley,

 

thanks for the warm welcome!

 

Added my signature (was a bit tricky to find the way to do it ...) and read some of the links you posted I was not yet aware of.

 

Side effects of my ADs (Citalopram + Mirt) which were most bothersome:

• tiredness / hangover in the morning (from the mirt?). It become somewhat better over time and for some time I split my dose between morning and evening (15mg each time), but it never went away. My GP promised that I would not be too sleepy from Mirt and could continue driving. I think I was quite lucky that not accident happend - my "guardian angel" had to work overtime ...
  (On the other hand: the immediate relief from my bad insomnia was a fantastic experience ...) 
• blurred vision (mirt ?) - gone after lowering the dose
• overly agitated a couple of hours after taking the citalopram. Heart pounding, slight but noticeable tremor, feeling restless, ...
  This started a couple of weeks after starting the AD and never went away - lowering the dose helped.

The combination of this was being tired and agitated at the same time ... this did not compensate to something like "normal" for me, I just felt weird.

 

The plan right now to stick to your suggestion and not to change anything for quite some time. My challenge will come on either very bad days (-> I have to do something "immediately" to feel better) or in a prolonged window (-> I feel so good that I can go down further to minimize side effects). I will try hard to stick to 3KIS whatever comes ...

 

@Rich: Excellent question ... my main issue right now is that I have low mood and "depressed" feelings for a couple of hours nearly every morning before these feelings disappear.

It's frightening for me to go to bed in a good mood with an optimistic view of the future and maybe half an hour after wakeup everything turns black.

(Do you know the Dementors in the Harry Potter Films? That's close to my experience on bad days ). These days it's not as pronounced as it was a few month ago but I still feel bad most days in the morning.

 

The symptoms before taking any ADs were somewhat different I think. I started to develop insomnia (woke up after maybe 3-4 hours of sleep full alert and with racing thoughts), I lost my appetite and quite a few kilograms and I could not stop thinking about my job and all the disasters ahead. Which was kind of true as not everything with my self-employment went as expected, but nothing really frightening from an outside view.  I do not remember any more how much variation there was during the day. 

 

After stopping St. John's Wort the symptoms were similar to what I experience now. My explanation back then (had not yet discovered SA) was that my depression was back and that I needed professional help. Maybe that was true, maybe the symptoms back then were WD of St. John's Wort ... I am not sure.

 

Regards,

Hamster

 

[Altostrata]

Welcome, Hamster.

 

Do your symptoms follow any daily pattern?  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 include your sleep pattern.

 

This will help determine if any of your symptoms are side effects.

[ChessieCat]

15 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. Please include your sleep pattern.

 

This is an example of what Alto requires:

 

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

[Hamster]

Dear All,

 

as I am lazy with writing journals, I started to track my mood with an app ... here are some results:

 

Chart over the last week (top is good mood, down is low mood)

 

 

Daily average with a clear "morning low"

 

I take 5 mg Citalopram every morning after wakeup (during this week this was anything between 6 am and 7:45) and 3.75 mg Mirtazapin every evening (between 7pm and 9 pm).

Waking up my mood is usually OK, but then I start with rumination, anxiety, mood drops etc. Tiredness is an issue on some days.
This clears up between 2 hours later and the early afternoon.

 

Here is my journal: mood is between 0 ("couldn't be worse") and 10 ("Insanely great").

During this week I only used 4 ("Meh") to 8 ("very good").

 

day / time		mood (0-10)	activity / comments
Mon	5:30	7	wake up
Mon	6:00	7	5 mg Citalopram, get up
Mon	6:30	6	breakfast
Mon	8:30	5	very tired
Mon	10:00	6	Business Meeting, getting better
Mon	12:00	7	Business Meeting, getting better
Mon	13:00	7	Lunch
Mon	17:30	6	slight anxiety before tasks of next day, but OK in general
Mon	18:30	7	some work done
Mon	20:00	6	slight anxiety before tasks of next day, talking to kids
Mon	20:45	7	Mirtazapine 3.75 mg
Mon	22:20	7	Bed
Tue	6:30	7	Citalopram 5mg, getting up
Tue	6:50	6	small breakfast
Tue	7:05	5	feeling unwell
Tue	7:20	5	agitated, anxious
Tue	9:10	4	tel call with colleagues, exhausted, agitated, progressive muscle relaxation with no effect
Tue	10:00	7	before meeting with client
Tue	11:00	7	after meeting with client
Tue	11:20	6	back @home
Tue	13:10	6	tired after nap
Tue	17:00	7	lot of phonecalls done
Tue	18:20	8	tired but happy
Tue	20:40	8	Mirtazapine 3.75 mg
Tue	21:00	8	fine after dinner
Wed	6:40	6	Citalopram 5mg, getting up
Wed	8:25	5	small shopping duties
Wed	8:55	7	telephone calls w customers
Wed	10:20	7	telephone calls w customers
Wed	11:25	7	telephone calls w customers
Wed	15:50	7	office work, headache
Wed	19:40	8	dinner
Wed	21:45	8	3.75 mg mirtazapine
Wed	23:00	8	bed
Thu	7:45	7	Citalopram 5mg, stayed in bed (holiday)
Thu	8:25	7	get up
Thu	8:45	6	after breakfast
Thu	9:50	7	household tasks
Thu	11:40	7	visiting relatives (1 hour by car), headache, tired
Thu	13:40	7	after lunch
Thu	14:40	7	after nap
Thu	16:30	8	walk with kids
Thu	18:30	6	returned home
Thu	20:30	8	tired, but happy
Thu	21:00	7	Mirtzapine 3.75 mg
Thu	22:50	7	bed
Fri	7:20	7	woke up, stayed in bed (holiday)
Fri	7:45	6	Citalopram 5mg
Fri	9:20	5	slightly naseous after jogging + breakfast
Fri	10:45	6	household tasks, unable / unwilling to start job-related tasks, tired
Fri	13:10	7	lunch
Fri	14:30	6	some job-related tasks in homeoffice after nap
Fri	16:00	7	job finished
Fri	17:00	8	reading + some tinkering (hobby)
Fri	18:00	6	tinkering (hobby)
Fri	21:00	7	Mirtazapine 3.75 mg after dinner
Sat	7:45	6	woke up
Sat	8:00	6	Citalopram 5mg
Sat	8:50	5	after breakfast
Sat	9:40	4	sad
Sat	10:50	5	after walk with family, dry mouth
Sat	14:00	5	after nap
Sat	15:00	6	mood getting better
Sat	16:20	7	gardening
Sat	17:10	7	thinking about my situation
Sat	21:15	8	reading, 3.75 mg Mirtazapine
Sat	23:00	8	bed / sleeping

[RichT]

Hi Hamster,

 

how is your work situation now? Do you feel more at ease with your consultant role?

 

warmest wishes

 

Rich

[Hamster]

Hi Rich,

 

difficult to tell right now. I have underestimated the change from being senior staff at a fortune 500 company to starting a business on my own (and I estimated it be be quite a change!). 

The work with my clients is fulfilling and I really like it, but mid term I will need more customers to make a living from my new job. 
Being in a low mood during the waves and having limited energy makes it difficult to acquire new clients.

 

But all in all: I think I'd do it again. I'd take a break (a long one) before the start and I'd listen more to my body and mind for early warning signs and I'd try to avoid psych meds ...

 

Regards,

 

Hamster

[Hamster]

Hi,

 

time for a short update: I'm doing quite OK. Mood for the last 6 weeks attached ... not too many low mood ratings recently 😀.

The daily trend is unchanged, it's still a bit more difficult in the morning and gets better in the evening. But inside a "window" that's OK.

 

I reduced my mirt from 3.75 mg/day to 3.12 mg/day four days ago (-17 %) ... a bit more and a bit earlier than planned, but I could not resist the urge to try it. 

Let's see what happens, the idea is to reduce the Mirt to 2.5 mg/d next month , keep it there for quite some time to avoid issues with sleep and then start reducing the citalopram.

 

Reading the book "The user's guide to the human mind" (Shawn Smith, the author or the book were mentioned somewhere in the forum here) has helped my quite a bit to cope.

I found an explanation why last year my mind tried to protect me from doing something stupid (from the point of view of my mind) and tried to force me into intense rumination.

Unluckily my mind was more than successful with that, I could not stop ruminating any more and went into depression.

 

As I am a scientist I am glad to have a scientific explanation for what happened and it helps me to cope with the anxiety and ruminations right now.   

 

Best wishes

 

Hamster

[Hamster]

Hello,

 

time for an update again. Life is not perfect, but my WD symptoms are manageable.

In fact the situation improved to the point that I had to cut corners again ... so I dropped another 20% of my mirtazapine dose during my holidays.

Physical symptoms like nausea were quite manageable this time, but the morning lows returned.

Not as bad as they have been in the past, but some were bad enough to make me stick to the 10% rule in the future ... maybe ... hopefully.

 

My question for today: I'm now down to 2.5 mg/d mirtazapin (last reduction 3 weeks ago) and 5 mg/d citaloprame (last reduction 3 months ago).

I'd like to keep the mirt for a while and start a 10% taper with citalopram in september. Any thoughts on that? 

 

Hamster

[jozeff]

Hi hamster, interesting stuff here.

 

I'll dive into it when I have some more energy.

Hope You're doing fine!

 

Cheers

 

Jozeff

 

[RemeronHell]

@Hamster   hello there.  Just wondering how you were doing now?      All the best.

[Hamster]

@RemeronHell thanks for asking ... I'm not 100% back to normal, but on a good path. Drug free for about 6 months now. 
I'm still having regular appointments with my therapist and I'm glad about that as there are quite some symptoms and issues waiting to be addressed or maybe even "solved". Some maybe WD related, some may have been there before. 

I hope to be able to write my "success story" in another 6-12 months.