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ChickenBurrito: Citalopram Taper Down; Crashed and Burned


ChickenBurrito

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Hi, I am new.

 

Been on Citalopram since July 2007, and wish I had never started.

 

 I tried to taper down last summer and wound up in an outpatient program because of sudden, unexpected anxiety that led to insomnia that led to worse anxiety that led to worse insomnia and so on. 

 

Now I'm back on Citalopram aaaaaand Mirtazapine.....Yay.

 

I have been emotionally numb ever since starting the Mirtazapine and am now prone to fits of white-hot rage that come out of nowhere, and  I have fallen into an old pattern of self harming; I don't want to be on the Mirtazapine anymore, but am terrified of insomnia. I am effing terrified of insomnia. 

 

Thanks

Citalopram: 40mg from July, 2007 to May, 2019.

                     Tapered down to 5mg between May, 2019 and August, 2019.

                     20 mg currently.

 

Mirtazapine: 30mg since October, 2019.

 

Melatonin: 6mg since January 2020.

 

Magnesium glycinate: 120mg since January, 2020.

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  • manymoretodays changed the title to ChickenBurrito: Citalopram Taper Down; Crashed and Burned
  • Moderator Emeritus

Welcome to SA, ChickenBurrito.

 

It sounds as though the Mirtazapine is having some bad effects on you even though apparently it's helping with the insomnia.  As so often happens with these drugs, you're caught between a rock and a hard place.

 

What dosages are you on of the Citalopram and Mirtazapine?

 

We recommend tapering no more than 10% of current dose every four weeks.  Some have to taper more slowly.

Unless a drug is causing a p[roblem we recommend tapering the more activating drug first (in your case the Citalopram), leaving the more sedating drug (here, Mirtazapine) to act as a buffer to taper later.  

 

Taking multiple psych drugs? Which drug to taper first?

 

We recommend tapering only one drug at a time.  Otherwise, if problems arise you won't know the cause.  In determing which drug to taper first, you'll have to decide whether the side effects of the Mirt are worth it for the insomnia help.  Since Citalopram is an activating drug, if you taper it first it's possible your sleep will improve as your dose is lessened and with its activating effects.

 

These links are specifically about tapering Citalopram and Mirtazapine.

 

Tips for tapering off Remeron (mirtazapine)

 

Tips for tapering off Celexa (citalopram)

 

You should be aware that there's a major drug interaction between citalopram and mirtazapine, so it would be a good idea to begin slowly tapering one or the other.

Interactions between your drugs

Major

Using citalopram together with mirtazapine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should contact your doctor immediately if you experience these symptoms during treatment. In addition, combining these medications can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone.

-----------------------------------------------------------------------------------------------------------------------------------------------------------

 

 

Regarding insomnia, many members have found melatonin helpful  Start with a low dose, such as 0.25mg and work slowly upward to take the lowest effective dose.  Too much melatonin can cause a paradoxical effect (keep you awake).

 

Melatonin for sleep

 

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)

 

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

 

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

 

 

 

 

Gridley Introduction

 

Lexapro 20 mg since 2004.  Begin Brassmonkey Slide Taper Jan. 2017.   

End 2017 year 1 of taper at 9.25mg 

End 2018 year 2 of taper at 4.1mg

End 2019 year 3 of taper at 1.0mg  

Oct. 30, 2020  Jump to zero from 0.025mg.  Current dose: 0.000mg

3 year, 10 month taper is 100% complete.

 

Ativan 1 mg to 1.875mg 1986-2020, two CT's and reinstatements

Nov. 2020, 7-week Ativan-Valium crossover to 18.75mg Valium

Feb. 2021, begin 10%/4 week taper of 18.75mg Valium 

End 2021  year 1 of Valium taper at 6mg

End 2022 year 2 of Valium taper at 2.75mg 

End 2023 year 3 of Valium taper at 1mg

Jan. 24, 2024: Hold at 1mg and shift to Imipramine taper.

Taper is 95% complete.

 

Imipramine 75 mg daily since 1986.  Jan.-Sept. 2016 tapered to 14.4mg  

March 22, 2022: Begin 10%/4 week taper

Aug. 5, 2022: hold at 9.5mg and shift to Valium taper

Jan. 24, 2024: Resume Imipramine taper.  Current dose as of Feb. 22: 7.6mg

Taper is 90% complete.  

  

Supplements: multiple, quercetin, omega-3, vitamins C, E and D3, magnesium glycinate, probiotics, zinc, melatonin .3mg, anti-candida, iron, serrapeptase, nattokinase


I am not a medical professional and this is not medical advice but simply information based on my own experience, as well as other members who have survived these drugs.

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Hi, thanks for the response and the information. I'm sorry; it's probably obvious, but how do I make the drug profile that shows up at the bottom of users' posts?

 

I was at 40mg Citalopram say late spring/early summer, 2019. I tapered down to 5mg Citalopram by early August, 2019. I jumped back up to 30mg Citalopram while I was in the outpatient program in September, 2019 and then jumped back down to 20mg Citalopram in October, 2019 for the emotional numbness. I initially tapered down with approval and instructions from an M.D.. Later adjustments were made at the recommendations of two different Psy. M.D.s.

 

I Started the Mirtazapine in October 2019 and take 30mg every night. Sometimes I'll take 45mg Mirtazapine if I'm feeling more anxious.

 

I realized last night, based on cursory browsing of the S.A. forum, that I may be having Citalopram withdrawal symptoms/syndrome. I keep having ruminating thoughts on mistakes I've made in life and regrettes. These thoughts are triggering self harm, like um, rehearsals or something. I'll be having these thoughts, make a fist and then make the motion of punching myself in the face and head, but it's only like one half of one percent of my full strength. When I have an emotional spiral, like last night when I failed to get a fire started on the first try, I go full strength on the hitting. I had been free of this lifelong behavior/curse of self abuse, that I learned as a child, for several years; then it came back in full force when I crashed in August, 2019 after tapering down from the Citalopram.

 

I just want to get back to where I was mentally and emotionally at the beginning of summer, 2019. If that means that I am on 40mg citalopram daily for the rest of my life that's fine with me. I had, and still do have, everything in life that I want; a house on a big lot in a nice little town, a wife, I'm starting my dream business, finally had some inner peace, a baby on the way.  Life was all good and I screwed it up. Everything in my little universe is moving forward in the best possible direction except my head. 

 

Thanks, ChickenBurrito with everything no sour cream please.

Citalopram: 40mg from July, 2007 to May, 2019.

                     Tapered down to 5mg between May, 2019 and August, 2019.

                     20 mg currently.

 

Mirtazapine: 30mg since October, 2019.

 

Melatonin: 6mg since January 2020.

 

Magnesium glycinate: 120mg since January, 2020.

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  • Moderator Emeritus
1 hour ago, ChickenBurrito said:

I was at 40mg Citalopram say late spring/early summer, 2019. I tapered down to 5mg Citalopram by early August, 2019. I jumped back up to 30mg Citalopram while I was in the outpatient program in September, 2019 and then jumped back down to 20mg Citalopram in October, 2019 for the emotional numbness. I initially tapered down with approval and instructions from an M.D.. Later adjustments were made at the recommendations of two different Psy. M.D.s.

 

I Started the Mirtazapine in October 2019 and take 30mg every night. Sometimes I'll take 45mg Mirtazapine if I'm feeling more anxious.

 

Here's how to do a drug signature.  Doing it in the form of a list is best.  You'll need to do it from a computer rather than a phone.

 

To give members the best information, we ask them to summarize their medication history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly. Use this link:

 

Account Settings – Create or Edit a signature.

 

It's very likely you are having withdrawal symptoms from the Citalopram due to all the dose changes and the very fast taper.

 

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.  

 

Unfortunately doctors, including psychiatrists, know nothing about safe tapering or withdrawal and invariably taper their patients too fast, causing their patients to suffer withdrawal (which psychiatrists don't believe exists).  Because of all these changes, your system is destabilized.  I recommend you make no further dose changes (of either drug) for three months to stabilize.

 

You need to stay at a constant 30mg dose of the Mirtazapine.  Antidepressants don't work like aspirin which if you feel worse you take more.  You central nervous system needs stability, which means taking the same dose every day at the same time. Occasionally increasing your dose up to 45mg is very destabilizing.

 

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

 

1 hour ago, ChickenBurrito said:

 

I just want to get back to where I was mentally and emotionally at the beginning of summer, 2019. If that means that I am on 40mg citalopram daily for the rest of my life that's fine with me.

Your central nervous system has undergone many changes since you were last on the 40mg.  What worked before might not work now.  What I would recommend is that you hold where you are on both drugs, as I said, and let things stabilize.
 
Please keep in mind that there is a major drug interaction between your two drugs, as I wrote earlier. You might want to consider tapering one or the other.
 
You will heal but it may take some time.  Please be patient.  The damage is not permanent.
 
 

 

Edited by Gridley

Gridley Introduction

 

Lexapro 20 mg since 2004.  Begin Brassmonkey Slide Taper Jan. 2017.   

End 2017 year 1 of taper at 9.25mg 

End 2018 year 2 of taper at 4.1mg

End 2019 year 3 of taper at 1.0mg  

Oct. 30, 2020  Jump to zero from 0.025mg.  Current dose: 0.000mg

3 year, 10 month taper is 100% complete.

 

Ativan 1 mg to 1.875mg 1986-2020, two CT's and reinstatements

Nov. 2020, 7-week Ativan-Valium crossover to 18.75mg Valium

Feb. 2021, begin 10%/4 week taper of 18.75mg Valium 

End 2021  year 1 of Valium taper at 6mg

End 2022 year 2 of Valium taper at 2.75mg 

End 2023 year 3 of Valium taper at 1mg

Jan. 24, 2024: Hold at 1mg and shift to Imipramine taper.

Taper is 95% complete.

 

Imipramine 75 mg daily since 1986.  Jan.-Sept. 2016 tapered to 14.4mg  

March 22, 2022: Begin 10%/4 week taper

Aug. 5, 2022: hold at 9.5mg and shift to Valium taper

Jan. 24, 2024: Resume Imipramine taper.  Current dose as of Feb. 22: 7.6mg

Taper is 90% complete.  

  

Supplements: multiple, quercetin, omega-3, vitamins C, E and D3, magnesium glycinate, probiotics, zinc, melatonin .3mg, anti-candida, iron, serrapeptase, nattokinase


I am not a medical professional and this is not medical advice but simply information based on my own experience, as well as other members who have survived these drugs.

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Thank you for the information, the encouragement and the advice. I will pursue all the leads you have given me.

 

I keep reading over what you have sent to me, peeling back the layers, and it is super useful. Thanks

 

Will get my signature done ASAP. Will be out of town the next few days, so it will take a minute.

 

Ordering the magnesium glycinate now.

 

ChickenBurrito

 

Citalopram: 40mg from July, 2007 to May, 2019.

                     Tapered down to 5mg between May, 2019 and August, 2019.

                     20 mg currently.

 

Mirtazapine: 30mg since October, 2019.

 

Melatonin: 6mg since January 2020.

 

Magnesium glycinate: 120mg since January, 2020.

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Cannabis edibles may have kicked off my anxiety

 

Hi, I was tapering off Citalopram, too fast and white knuckling it, when I went to a rock concert. I had about 20mg THC in the form of little gummies. Recreational use is legal here in Ca. The experience was mixed; I managed it just fine, but it was a little unpleasant. Three or four days later I was struck with anxiety that caused insomnia that caused more anxiety and things quickly spiraled out of control.

 

I was a heavy user of cannabis in my teens up to the age of about 23 years. I gave it up, got into therapy and my life got better and progressed. I got serious about college, got out of my little hometown and have not looked back....too much. I have been a once per year, maybe twice in a busy year, user since giving up heavy use. I think now I will never touch it again. 

 

Has anyone else out there been destabilized by cannabis use while tapering off SSRIs or any other antidepressant?

 

Thanks, CB

Edited by manymoretodays
title added, merged to introduction

Citalopram: 40mg from July, 2007 to May, 2019.

                     Tapered down to 5mg between May, 2019 and August, 2019.

                     20 mg currently.

 

Mirtazapine: 30mg since October, 2019.

 

Melatonin: 6mg since January 2020.

 

Magnesium glycinate: 120mg since January, 2020.

Link to comment
  • Moderator Emeritus

Hi CB,

Please see:

Cannabis, marijuana, hashish, THC, and CBD or Hemp oil

 

to see other members experiences with this.

 

We don't recommend any of these substances for WD.  Not enough research to date. 

Some have had negative experiences as well.

 

Late 2023- gone to emeritus status, inactive, don't @ me, I can check who I've posted on, and I'm not really here like I used to be......thanks.

Started with psycho meds/psychiatric care circa 1988.  In retrospect, and on contemplation, situational overwhelm.

Rounding up to 30 years of medications(30 medication trials, poly-pharmacy maximum was 3 at one time).

5/28/2015-off Adderal salts 2.5mg. (I had been on that since hospital 10/2014)

12/2015---just holding, holding, holding, with trileptal/oxcarb at 75 mg. 1/2 tab at hs.  My last psycho med ever!  Tapered @ 10% every 4 weeks, sometimes 2 weeks to

2016 Dec 16 medication free!!

Longer signature post here, with current supplements.

Herb and alcohol free since 5/15/2016.  And.....I quit smoking 11/2021. Lapsed.  Redo of quit smoking 9/28/2022.  Can you say Hallelujah?(took me long enough)💜

None of my posts are intended as medical advice.  Please discuss any decisions about your medical care with a knowledgeable medical provider.  My success story:  Blue skies ahead, clear sailing

 

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