Trampled27: New Member, citalopram

[Trampled27]

Hello, 

 

I have been reading this forum off and on for the past few years.

 

I have been on antidepressants, specifically Celexa for about 10 years. It was started in college due to panic symptoms while giving presentations, and also general social anxiety. It did seem to help to tamper the anxiety, I was ultimately able to get through speeches, face more social situations and accomplish more in the college setting. I experienced minimal to no side effects initially. 

 

It was perhaps two years into taking the medication that I began to realize that my emotions seemed numb, I no longer cried or felt much in general. I discussed this with the prescriber who asked whether I would prefer this effect, vs the anxiety that had been somewhat crippling, and I decided it was better to remain on medication than not. I have also been offered/considered other medications such as wellbutrin to counteract the "side effects", and do not think I am interested in going down that road.

 

About 8 years into taking the medication I became more concerned about the above side effects, noting I had not cried in about a decade, and not identifying with my own emotions, or empathizing with others as much either. Not feeling as much love for my partner or others, not responding as positively to things I enjoy, though probably not as negatively to stressors either. I had reached a max dose of 40 mg at one point, had slowly tapered to 10 mg without too much difficulty. Following grad school before starting my first job I decided to go off altogether. The withdrawal itself was not too bad, though there was a noticeable return of emotions. It was refreshing to "feel" again, yet I felt a growing anxiety as my first job approached, fearing my inability to perform without medication, and ultimately went back onto 10 mg of Celexa. 

 

I started my new job about 1 year ago, which actually was in the field of mental health, and did deal to an extent with the prescription of psychiatric medication. My concerns about my own medication remained, and I had a growing concern about the impact medications may be having on others as well, which contributed to my resignation, along with other factors, such as work stress impacting my life. I should add that I am not necessarily against all medication, though still in the process of understanding how I feel about this. Around that time a long-term relationship also ended. And despite these major life events, I felt unable to emotionally process anything. 

 

Therefore, I am again interested in attempting to get off of medication altogether, to experience emotion, try to feel like myself again. I have been off for about four days. I feel I have more resources this time around; therapy, meditation, exercise, etc. all our helpful. I am concerned that the taper is too fast (especially when comparing to the recommended tapers and others' experiences), but currently do not have health insurance to be prescribed a lower dosage...though may need to pursue this in the future if the current "experiment fails". My other concern is that this is not the "right time", given major life changes that have occurred recently (job and relationship loss), and currently needing to look for a new job. Concerns about whether I can remain in my current career while off medication, and/or how tapering would impact my emotional stability in my new position.

 

I am interested in others input/experiences. Specifically, others experiences with lack of crying/emotion, and whether these emotions have returned during the tapering process, and whether they were manageable. I also am wondering whether it would be helpful to have one person who I communicate with directly, like a peer support to share experiences with and if anyone on the forum would be interested in this, or if there is a way of finding a peer/mentor/buddy to mutually share experiences with. 

 

Thank you for reading!

 

 

 

 

[Sassenach]

Hello    Trampled 

and welcome to SA.

 

This site is run entirely by volunteer Administrators and Moderators, all have been through or going through withdrawal.

There are no commercial interests or influences  involved .

 

I am sorry you are having such a rough time but you are now in the right place.

 

On 11/3/2019 at 4:34 PM, Trampled27 said:

I have been off for about four days.

Does this mean you cold turkeyed 10mgs Celexa 4 days ago?

If so I advise a lower dose reinstatement to try and prevent you entering withdrawal.

We are unable to advise a dose until we have answers to the questions in this post.

What symptoms are you currently experiencing?

Are they better or worse at any particular time of day?

When do you take Celexa?

about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/

the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable/

derealization-or-depersonalization-dr-and-dp/

dr-joseph-glenmullens-withdrawal-symptom-checklist/

why-taper-by-10-of-my-dosage/

On 11/3/2019 at 4:34 PM, Trampled27 said:

ultimately went back onto 10 mg of Celexa. 

What month/year did you go back on Celexa?

 

On 11/3/2019 at 4:34 PM, Trampled27 said:

currently do not have health insurance to be prescribed a lower dosage

 

We can help with this please see

how-to-make-a-liquid-from-tablets-or-capsules/

tips-for-tapering-off-celexa-citalopram/

As soon as we recieve the drugs info. we can assess your situation.

In the meantime DO NOT MAKE ANY CHANGE TO YOUR CURRENT MEDS please.

Please feel free to browse the site, it is a wealth of info.

Other members threads will give you an insight and the opportunity to share experiences.

 

Again welcome.

 

Sassenach

 

 

[Trampled27]

Hi Sassenach, 

 

Thank you for the detailed response! In response to your questions:

 

- I went off the Citalopram 10 mg, cold turkey, 1/2018, and reinstated that dose 3/2018 (somewhere around there, I can't remember exactly). I did not perceive myself as having "withdrawal" at that time, it was more so a recurrence of anxiety that had caused me to restart it.

- Yes I cold turkey'd the Citalopram 10 mg on 10/20/2019, so about 5 days ago. 

- In terms of withdrawal symptoms, pretty minimal thus far. Perhaps a very vague, mild sense of disequilibrium/lightheadedness at times, but not interfering with daily life, still able to work out/exercise without a problem. Have not noticed any particular time of feeling better or worse. Also, I feel I have a slightly stronger emotional response, which thus far has been welcomed. No crying or significant mood swings, or anything like that. 

- Typically, I would take my citalopram in the early afternoon. I was not always consistent with the timing, would fairly frequently miss doses as well.

- I appreciate the link you provided on how to make liquid citalopram. If I do have withdrawal symptoms, I likely will attempt that method and reinstate at a lower dose. 

 

Thanks!

 

 

[Sassenach]

Hi Trampled

 

Have just read your post on FleeingFluoxetine and am somewhat confused.

If you have a degree of knowledge, you could apply that to own situation.

You have now C/Ted Citalopram twice despite presumably having to reinstate the first time.

20 hours ago, Trampled27 said:

In terms of withdrawal symptoms, pretty minimal thus far.

This is very common early in a C/T, I experienced it myself with Escitalopram, known as a honeymoon period.

 

20 hours ago, Trampled27 said:

I appreciate the link you provided on how to make liquid citalopram. If I do have withdrawal symptoms, I likely will attempt that method and reinstate at a lower dose. 

The chance of not experiencing W/D symptoms is very small.

The only known way to mitigate this is by reinstatement and a proper taper.

Cold Turkey is not a quick way off these drugs.

If you decide to reinstate please do not do so without asking us for a suitable dose.

 

Sassenach

 

 

 

 

[Trampled27]

Hi Sassenach, 

 

Thanks for the response. I suppose you are right. I appreciate your input on the honeymoon phase, and that I may be having a false sense of feeling ok for now. 

 

You are right that I did reinstate after cold turkey from 10 mg in the past, probably tricking myself into thinking it will be "different" this time.  I guess I am a little skeptical of the dissolving method... It looks like citalopram is not very dissolvable in water therefore it is hard for me to imagine how you can get an accurate dose. I think the liquid version would be great... thinking about forking over the money out of pocket to see if primary care would provide this to me. But certainly open to a dose suggestion.

 

Sorry, don't mean to confuse you on making posts. My knowledge more in the prescription of psychiatric medications. There are many people on here asking questions about why they were prescribed certain medications, what the medication is supposed to do for them etc., and feel I may have some insight into this that could be helpful.  Perhaps this is not my place, or is not helpful, and certainly open to feedback on this. 

 

I have much less knowledge of tapers. As many have pointed out there is a general lack of knowledge of tapers in the medical community. Hence why this forum exists, and why I am here, to seek hear from those such as yourself with more experience. I could probably determine from other posts how to go about tapering (follow the 10 % rule, etc), I guess my goal of posting is less to get concrete advice on exactly how to taper (though I do appreciate this), and more so to document my own experiences over time, start conversations with others such as yourself. 

[Trampled27]

So in brief, yes I know cold turkey from 10 mg is dumb. I guess I hoped someone would say, actually I did that and it was totally fine! but I know better than that...just got to figure out on my own how to make the logistics of the taper work out

 

[Sassenach]

Hi Trampled

19 minutes ago, Trampled27 said:

Sorry, don't mean to confuse you on making posts. My knowledge more in the prescription of psychiatric medications. There are many people on here asking questions about why they were prescribed certain medications, what the medication is supposed to do for them etc., and feel I may have some insight into this that could be helpful.  Perhaps this is not my place, or is not helpful, and certainly open to feedback on this. 

Provided the info you give is accurate we welcome it.

We are mods not doctors and are learning all the time.

The methods and info. we use on this site are anecdotal because no large case trials have been done.

Indeed most doctors and psychs do not even accept W/D from A/Ds exists, although that is changing in the UK at least.

 

25 minutes ago, Trampled27 said:

It looks like citalopram is not very dissolvable in water

The active ingredient is dissolvable, the reason you see a residue is that the filler used to bind the tablets does not dissolve well but is inactive.

The following is from @brassmonkey who is very knowledgeable on this issue.

 

"We generally use the average weight of the tablets.  However, it's only relevant when establishing the starting dose of a taper.  After that we calculate a specific weight that is to be measured for each dose based on the average weight starting point.  The powder used to make up the dose comes from a stockpile of one or more ground up tablets, so their weight is irrelevant.

 

The strength of the pill is divided by the average pill weight to provide a ratio that is referred to as the AIC or Active ingredient Concentration.  In this case it would be 100/309 = 0.323 which means that there are 0.323 mg of active ingredient for every 1mg of pill weight.  Using this ratio we can calculate the pill weight of any dose strength we need. When we measure out that specific dose weight the differences in weight of the original pills goes away.

 

If you divide your desired dose strength of 67.5mgai (milligrams active ingredient) by the AIC 0.323 you get 208.  67.5/0.323 = 208 which would be the weight of your desired dose that you would measure on the scales."

 

Many people do very well making their own liquid and I am sure you could do the same.

33 minutes ago, Trampled27 said:

I could probably determine from other posts how to go about tapering (follow the 10 % rule, etc)

We are here to help you with this because the price of getting it wrong can be high.

The most common mistake is not realising that the taper is not 10% of starting dose, but 10% of current dose as you reduce.

36 minutes ago, Trampled27 said:

I guess my goal of posting is less to get concrete advice on exactly how to taper (though I do appreciate this), and more so to document my own experiences over time, start conversations with others such as yourself.

We encourage everyone to document their progress, indeed if symptoms increase it is an essential part of monitoring.

This is a peer support site so please talk to other members, you will find most more than happy to share.

I cannot make a reinstatement dose suggestion at present as the suggested dose changes with the time you are off it.

The general rule is the sooner the better.

 

Sassenach

[Trampled27]

Hi Sassenach, 

 

Thank you! so from my understanding what I would need is a scale, a pipette, and some kind of container to dissolve the solution in. 

 

I was on 10 mg (for about 9 months), which I have been off for about a week now. assuming I could start today, does a 9 mg reinstatement seem reasonable?

 

Thanks

 

 

[Sassenach]

18 minutes ago, Trampled27 said:

Thank you! so from my understanding what I would need is a scale, a pipette, and some kind of container to dissolve the solution in. 

Correct.

The dose is going to be considerably less than 9mgs.

We are not trying to medicate you again just mitigate W/D onset.

As soon as you get the equipment we can recommend a dose.

The AWS Gemini scale is available from Amazon and is good piece of kit even though made in China nowadays.

I have just purchased one and the calibration was perfect even after being in the post.

It is about 60 UK pounds and there are cheaper alternatives, if money is an issue..

Let us know when you are ready to begin.

 

Sass

[Rhiannon]

It's pretty common for people not to have a lot of acute symptoms after stopping an SSRI but to get hit weeks or months out. You can read through the stories of people here. Three months is a pretty common time frame for withdrawal to hit hard. It's usually "diagnosed" as a "relapse" but with a slow taper those "relapses" don't happen, oddly enough.

 

Please read through the discussions on dissolving tablets in water and using the water suspension to taper.  Citalopram tablets are particularly easy to use for this method.

 

I've tapered from 10 mg citalopram to almost nothing, dissolving the tablets in water. You can use other media besides water but I have found water works fine and according to what references I've been able to find, citalopram is very stable in aqueous suspension. (So much so that like many SSRIs it is becoming an environmental pollutant.)

 

I'm not sure what you would need a scale for, but people have developed various methods so there may be one where they weigh something. I just use distilled water, my tablets, a graduated cylinder, a glass cup, and a pipette (syringe is fine, I just prefer pipettes). You can measure your water with the syringe, I just like using a graduated cylinder for speed and convenience.

 

Dissolve the tablet, measure out the quantity you want and take it immediately or store it, then dump the rest or store it for later. 

 

You're lucky to be on citalopram, it's pretty easy to dissolve and taper, unlike some of these meds.

[Trampled27]

Thanks the reply. I guess the 3 month mark is about where I struggled last time I went cold turkey from 10 mg so that makes sense. I have ordered the scale online as Sessenach recommended. I would be happy to "get going" in the meantime. However, I am not sure about doing so without a scale. I understand that without a scale, you could simply dissolve the entire tablet in water, and measure out the amount of liquid you want. However, I don't think that the tablet necessarily dissolves evenly throughout the entire solution, and additionally you could end up with varying amounts of "active ingredient" throughout the solution. Therefore it seems like you could end up with varying amounts of active ingredient day to day. Not sure if that makes sense, and I could be wrong, or perhaps the difference would end up being minimal. And certainly you should do what works for you, but that would be my concern with that method. Again thanks for the reply!

[Rhiannon]

22 hours ago, Trampled27 said:

Thanks the reply. I guess the 3 month mark is about where I struggled last time I went cold turkey from 10 mg so that makes sense. I have ordered the scale online as Sessenach recommended. I would be happy to "get going" in the meantime. However, I am not sure about doing so without a scale. I understand that without a scale, you could simply dissolve the entire tablet in water, and measure out the amount of liquid you want. However, I don't think that the tablet necessarily dissolves evenly throughout the entire solution, and additionally you could end up with varying amounts of "active ingredient" throughout the solution. Therefore it seems like you could end up with varying amounts of active ingredient day to day. Not sure if that makes sense, and I could be wrong, or perhaps the difference would end up being minimal. And certainly you should do what works for you, but that would be my concern with that method. Again thanks for the reply!

No, your concerns make sense.  I think if you dissolve a tablet and just observe, you might be reassured. What you see visually is of course not the actual drug, it's the binders and fillers in the tablet, but when you dissolve it and stir it you can see that they suspend pretty evenly, and I think (based on my background in science) it's safe to assume that the invisible bits are behaving much the same as the visible bits.

 

What I do is dissolve the tablet (which means letting it sit in the water for a few minutes), then stir it well until it is visibly evenly suspended, then draw up the amount I am measuring while it is still well suspended. Sometimes I stir while drawing up as well just to make sure. 

 

If you want to check in with someone who has a background in chemistry and lab stuff you might be reassured. That's my own background, which is a big advantage for me in this tapering business, I realize.

 

 

[Trampled27]

Hi Rhiannon, 

 

That makes sense. Thank you. I have the necessary means for that method, so could start that anytime. At this point I have been off the citalopram 10 mg for 8 days. As Sessenach mentioned, the main goal is to mitigate withdrawal at this point. Since I am not experiencing much in terms of withdrawal right now, I wonder if it is best to wait it out and reinstate as withdrawal symptoms occur or start reinstatement as soon as possible.

 

Thanks,

 

Edited November 7, 2019 by Sassenach
deleted name

[Sassenach]

Hi Trampled.

 

Deleted your full name from previous post.

It is better to reinstate asap.

Will get back to you tomorrow on dose rec. as late now in UK.

 

Sassenach

[Trampled27]

Hi Sassenach, 

 

Thought I'd give you an update and keep track of my progress. Kind of fell off the forum for a bit. So I had cold turkey'd the Citalopram 10 mg I think on October 31 st. I was off completely for a week then took a 1 time dose of 5 mg on Nov 8th to stave off withdrawal. Then I got my weighing scale recently and decided to try reinstatement, but just started at a very low dose of 1 mg as others on the site have suggested that this may be sufficient. Have been taking this the past few days. Interested in any thoughts you might have about my strategy. 

 

Thanks

[Sassenach]

Hi Trampled

 

Apologies for not getting back to you, must have missed a notification somehow.

How are you feeling since reinstating?

Have you experienced any adverse reactions?

How did you feel after 5mg dose?

What are your current symptoms?

Are they getting betteror worse?

 

Sassenach