KaitieB: tapering liquid Celexa / citalopram - any advice is welcome

[KaitieB]

Hello all! I’m new to this site so forgive me if I am doing something wrong (ie. No signature yet, have to figure that out!). I was prescribed 20mg of Celexa back in 2015 and (unfortunately) took it through my pregnancy. This was after a few years of many other SSRI trials (Prozac, Lexapro, Wellbutrin etc; all of which I didn’t take for very long, all had side effects I could not tolerate; all I had no difficulty coming off of). Fast forward to 2016 and I was experiencing terrible postpartum depression so my meds were increased to 40mg. I was on this dose for about 6 months when I dropped myself down to 20 with no real issues. Have now been on the 20 mg again for about two years and wanted to wean off. Went to 10mg and then 5mg, with some dizziness so I took it slow. Then went to the liquid form of Celexa and took myself down to 1mL (no, I don’t know what that converts to in mg’s; sorry for my ignorance) It’s been a wild ride to say the least. If I miss that dose of 1ML or try to go down to 0.5mL, then the agitation, irritability, intense mood swings, hopelessness, and crying spells start. I don’t even know who I am, and the feelings are more intense than I ever felt before I was ever on medication. Bring it back up to 1.0mL and I’m relatively ‘fine.’ (Well, I’m always tired but I have a 3 year old, so...😉).

 

The psychiatric nurse practitioner I go to isn’t that helpful. She recommended tapering slowly (.9mL for a few weeks, then .8mL etc) and 50mg of 5HTP but I am scared to take the 5HTP because of serotonin syndrome. She said she ‘would not have recommended it if she felt it would lead to that’, but I’m still cautious to try it as I’m very sensitive to all medications. I have started to take Omega 3’s too as recc’d by my therapist but I don’t really know if that helps.

 

I guess I’m here because I’m lost, have never felt this bad before and I know I can attribute it to discontinuation symptoms but I honestly think if I keep going this way I won’t be able to make it. I can’t imagine going any slower than 0.1mL a week (or more) but the thought of it is exhausting. I just want off this stuff! It’s ruining my marriage and my relationship with my small child. 🥺

 

I guess I’m just feeling helpless and like doctors/NP’s just don’t understand this is real. I’ve been told it’s my ‘depression coming back’ but I don’t believe it. Anyway, any advice is appreciated. 

 

Thank you! 

[Gridley]

Welcome to SA, Katie.  I'm sorry you're feeling so bad.

 

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You tapered very fast, with several 50% cuts.  We recommend tapering by no more than 10% of current dose every four weeks.  It is especially important to taper very slowly at the low doses.  

Why taper by 10% of my dosage?

 

It's not surprising that you get withdrawal symptoms when you attempt to drop from 1mL to 0.5mL, which is another 50% cut.    Doctors have no understanding of withdrawal and will invariably say what yours said, that it's the return of the underlying condition.

 

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.

 

I know you want to get off this drug, but it's very important to throw away the calendar and listen to your body.  I recommend that you stop tapering and hold for several months, perhaps six, to let your system catch up with all the 50% drops.  Then, once you have stabilized, you can begin a much slower taper than 0.1mL per week, perhaps 0.1mL per month with holds to stabilize between each drop.  Tapering safely takes a long time and is very frustrating.  That's the unfortunate reality.  Going too fast ends up taking longer, as you're already seen when trying to drop to 0.5mL and then having to updose.  Each of these attempts is destabilizing and requires yet more time to recover.

 

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 the omega 3 (fish oil) you're already taking. Many people find these to be calming to the nervous system.  Magnesium glycinate is a good form of magnesium.

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Only add in one at a time and at a low dose in case you do experience problems.

 

We don't recommend 5HTP.  This link contains some positive and negative comments about the supplement but bottom line is that we don't recommend it.

 

 

5-htp-5-hydroxytryptophan-and-l-tryptophan

 

This is your Introduction topic, where you can ask questions, post updates and connect with other members.  We're glad you found your way here.

 

 

 

 

 

[KaitieB]

Hello Gridley, 

 

Thank you for your quick reply. I guess I wasn't too accurate in my original post about tapering. I went through and tried to think it through more clearly (including referencing when my doctor's appointments were) and added the guesstimate of how I've been tapering down from the 20mg in my signature. I think it wasn't as fast as it may have previously seemed, but you're right, it was 50% tapers due to doctor's recommendations. I've been at the 1.0ml (which I believe is approximately 1.25mg? although I'm trying to write this all out with a 3 year old climbing on me, so I may be incorrect). Regardless of what the conversion is, do you mean 10% from 1.0mL each time I taper (i.e. 0.9, then 0.8) or 10% from the current dosage I would be taking, so even less... like 10% of 0.9 which I believe is .81mL? If so, I wouldn't even know how to go down to that accurate of a dose as my dropper isn't in that small of increments. Than at what point do you say "OK, I've done 0.9, 0.81 (10% of 0.9), 0.72ML (10% of 0.8), etc" and it's time to just drop off? What's the lowest possible dosage before drop off? 

 

Also, since I've technically been on 1.0mL for 2 months, but keep trying to go down (with a lot of trouble!) and then bumping back up, do you still recommend another 6 months of 1.0mL? or 4 more months? I guess I'm just dreading the amount of time it seems I have left on it, especially because the time clock is ticking if I want to have another child (which I do, and which is why I wanted off of these meds to begin with - besides the fact they probably stopped working for me 2 years ago, but I stayed on - don't ask me why!) and I want off of these completely. I actually couldn't wait another year, I technically want to start trying to have a baby within the next 2-3 months. (Sorry if that's too much info, but that's the ultimate reason of getting off them!)

 

I haven't obviously read the articles you've posted yet so I am sure a lot of my questions are answered there, but I thought I'd write this out before I forget my train of thought completely.

 

Thank you!

 

KaitieB

 

 

[Gridley]

1 hour ago, KaitieB said:

10% from the current dosage

 

KaitieB,

 

It's always 10% of current dosage.

 

I would hold at 1.0mL for four months at least and see how you feel.  Your body needs to catch up after all those large cuts.  I know you're anxious to get off the drugs and have another child, but as I said, please don't rush it.  

 

Regarding when to jump off to zero, it varies from person to person but should be as low as possible.  This link will give you some guidance.

 

When to end the taper and jump to zero?

 

The thinking several years ago was that 1mg was a good target for jumping off.  Sadly that has been proven wrong on many occasions.  It is best to taper as low as possible before jumping.  If at all possible 0.1mg or smaller.  Those tiny doses are a pain to try and work with, but it will really pay off in the end.

 

Check with your pharmacy or look on Amazon about the dropper.  I weigh rather than do liquid but I'm sure you could find a dropper with smaller increments.

 

Please feel free to write back with any questions.

 

Gridley

 

 

 

 

 

[KaitieB]

Hello again,

 

I just want to make sure I'm getting this correct. 1.0mL for another 4 months; then 0.9 for 4 weeks, then 0.81, 0.73, 0.66, 0.59, 0.53, 0.48, 0.43, 0.39, 0.35, 0.31, 0.28, 0.25, 0.23, 0.21, 0.19, 0.17, 0.15, 0.14, 0.12, 0.11, 0.1 and then off? Each for 4 weeks? So that leaves me another 2.5 years on this stuff? 😫 That can't be right...Am I getting that correct? 

 

 

[brassmonkey]

That's about it, if everything goes smoothly.

 

Reducing 10% every 4 weeks is the fastest pace that we recommend, many times this will have to be slowed down and several longer holds added to make sure that things have stabilized before proceeding.  The alternative is a buildup of unresolved symptoms in the background that will suddenly appear in the form of a crash.  This crash will take months to stabilize before any tapering can be resumed.

 

There is no predetermined exit point either, 0.1 is a good place to start thinking about jumping off but not necessarily the best time.  We recommend that a person taper as low as possible before ending the taper. In many cases this is 0.016 or 0.008.  It only adds a small amount of time and is good insurance after a long taper.