mic576: taper, change, stay the same?

[mic576]

I have a long history with depression and I have been experiencing real struggles with severe depression over the last year.  I think it is getting worse even though I eat well, sleep, exercise, in talk therapy etc.  I have had some really significant struggles lately.

The challenge is I am on 20mg of Citalopram daily for 15 or so years.  I have been reffered to a new psychiatrist to discuss updating meds.  I have no idea what they are going to say.

 

I am not sure what to do. 

1. Keep my Citalopram regimin the same - knowing that I seem to be getting worse but certainly not better

2.  Allow someone to change my SSRI

3.  Begin a taper of Citalopram

 

Any thoughts?  I feel lost.

 

[Gridley]

Welcome to SA, mic576.  We are a site dedicated to helping people to taper off psychiatric drugs and to deal with withdrawal symptoms from going off these drugs. The decision of whether to switch your SSRI, or to stay where you, are must be yours.  If tapering off the Citalopram is what you decide to do, we can help you.  In he meantime, here is some information so you can make an informed decision. 

 

 It is very possible that you are in "poop-out" or tachyphylaxis, which means that after long use your Citalopram is no longer working but your body requires it to maintain "normal function."  This is common.  SSRI's were not tested for long-term use when they were in the approval phase, nor were they originally intended for long-term use.  This link provide a good explanation:

 

Tachyphylaxis or As It’s Lovingly Known “Poopout”

 

Does that sound like what's going with you?

 

Should you decide to taper the Citalopram, we recommend tapering by no more than 10% of current dose every four weeks.  

 

Why taper by 10% of my dosage?

 

Here is specific information about tapering Citalopram.

 

Tips for tapering off Celexa (citalopram)

 

Doctors will almost invariably advise tapering at a much faster rare than what we recommend.  This puts the patient at risk of withdrawal symptoms that can be very unpleasant and long-lasting.  

 

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.

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[mic576]

Thank you so much Gridley.  I read further on some of the information you provided.  I am hoping I can gain some insight to help my desicion making process.  I can see that many people here have much more experience than  I do and maybe there are some 'if I had it to do over again' type thoughts.  

 

After reading here, if I do anything trying to go off meds I will taper using the guidelines here, its all very hepful.

[Onmyway]

Hi Mic, 

I am no expert in this but one thing you need to consider is to switch to a new drug you need to cut this one and usually doctors cut you rather quickly (if you take two at a time I think you risk serotonin syndrome). It is possible that that in itself might trigger withdrawal symptoms. It might  or it might not, but for many people in these boards it seems to. 

 

The therapy that you are doing - is it CBT? CBT has been shown to help as much as ADs in clinical trials. If you can't do that kind of therapy, I really like The anxiety and depression workbook for dummies by Charles Elliot and Laura Smith. 

 

As Gridley said, we can't tell you what to do but do check out the links to non-drug techniques to manage emotions. I don't know how to add links here but they are pinned under the Symptoms section. 

 

Hope you get there soon. 

[Onmyway]

10 minutes ago, mic576 said:

Thank you so much Gridley.  I read further on some of the information you provided.  I am hoping I can gain some insight to help my desicion making process.  I can see that many people here have much more experience than  I do and maybe there are some 'if I had it to do over again' type thoughts

Mic, if I had to do it over again I'd never have gone on antidepressants. And I am saying that not just because of withdrawal but because of the research that shows that they are no better than placebo (or minimally better) and that they create significant long term problems. I.e. even if they work in the short term, they make things worse in the long term. And if I knew what I know now, I'd have stopped them many many years ago. If you get a chance, read "Anatomy of an Epidemic" by Robert Whitaker. 

HOWEVER, I was not seriously depressed at the time, I was anxious. You are the one who knows your situation best.  And you will be the one who lives with the consequences of your decision so it would be presumtuous to say what you should do.

 

If I were depressed now, I'd find a CBT therapist. It doesn't work for everybody but it does for many. I'd try to change the situation that is making me depressed (if it is situational) - bad boss, divorce etc. etc. Not always possible of course. I'd do many other things before thinking of drugs. I'd also wait it out with enough support - i.e. plan what to do if you get suicidal, have a support system if things get really bad etc. I also like the book The Upward Spiral a lot. I am sure you are doing many of the things that they recommend but it is quite good. 

[Gridley]

2 hours ago, Onmyway said:

non-drug techniques to manage emotions

 

Here are some links that many members have found helpful:

 

Non-drug techniques to cope

 

And some links for dealing with anxiety, which is such a common symptom. 

Audio:  How to Recover from Anxiety - Dr Claire Weekes

VIDEO:  Peace from Nervous Suffering - Claire Weekes (1 hour) (http://sendvid.com/vgquc1dg)

Anxiety Stuff - all kinds of stuff about anxiety attacks and things that help …

10 minute Restorative Yoga for Relaxation | Up the wall

[mic576]

Onmyway,

Thank you for your insight.  You identified one of my concerns with agreeing to a change in antidepressant is what is done with my current citalopram dose.  I hadn't even considered seratonin sysndrome.  I have no doubt that a new med will cause an effect, maybe positive, but what happens after that short term effect is over.   It all seems really scary to me.

 

Yes I am doing CBT and with some issues it has helped a great deal. 

 

Does anyone ever experience any level of positive effect on depression when they taper off antidepressants?

 

You have given me a lot to read and think about.  Thank you 

[mic576]

Gridley,

 

You mention (August 2016, discovered SA, updosed to 25 mg and holding )

What is SA if you don't mind sharing?

[ChessieCat]

SA = Surviving Antidepressants, the name of this website

[mic576]

7 minutes ago, ChessieCat said:

SA = Surviving Antidepressants, the name of this website

 

Oh gosh, do I ever feel silly missing the obvious!