Sonia009: Citalopram discontinuation/reinstatement

[Sonia009]

Hi everyone,

I'm new here but have used other sites trying to fathom out why I feel the way I do, trying to make sense of it all. I started taking 10 mg citalopram about 10 years ago when I suddenly started to get mild anxiety symptoms and they worked well for me. A couple of years ago I decided to come off them, I tried cold turkey which was a stupid idea and quickly went back on 10mgs. Next I tried halving my tablet but that didn't work either so I went back on 10mg. A year ago I decided on a slower approach and reduced down to 7.5 mgs. Two months later I reduced to 5mg, probably too soon in retrospect and here I am 10 months later still getting withdrawal symptoms. My symptoms seem to come and go, sometimes in phases. The head zaps are not so severe now, I just get the occasional one. Night sweats have stopped and so have the horrific nightmarish dreams. I still get strange dreams but not the horror ones. I never had nausea until recently. I get dizzy feelings, head dropping sensations, sometimes balance issues, digestive issues, aches and pains, flu like symptoms, headaches neck and shoulder stiffness, ear fulness, tinnirtus dry mouth, anxiety, crying spells, the list goes on. 

I am 58, retired from my office job, married with one grown up independent daughter who has her own home. My husband has his own health issues but he just gets on with things. I sometimes struggle to make him see how and why I feel the way I do when I don"t understand myself. I get gum infections which may or may not be caused by citalopram but antibiotics and citalopram don't mix well and after a course my anxiety seems to flare up. Lockdown hasn't helped and I believe my symptoms have worsened since the start of it. I don't know what to do for the best, whether to increase or try another antidepressant or come off all together. Could the reduced dose, which I achieve by using a pill cutter and they are not precise, be prolonging my symptoms, I could be 1 mg out either way? Thanks for reading.Regards.

 

Edited December 2, 2020 by ChessieCat
removed name title in post

[Gridley]

Welcome to SA, Sonia001.

 

You're feeling the way you do because you tapered too fast, causing the withdrawal symptoms you're now experiencing.  The symptoms you describe are common and typical of withdrawal.  Imprecise measurements are also probably contributing.  More about that later.

 

What is withdrawal syndrome.

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

Symptoms coming and going is typical of withdrawal.  Also common is periods of feeling bad (waves) alternating with periods of feeling better (windows).

 

The Windows and Waves Pattern of Stabilization

 

When we take psychiatric 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 the healing process really well:

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

Brain Remodelling 

 

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 (glycinate is a good form) 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.

 

I would recommend you hold at your current dose until your symptoms are stable and you're feeling pretty good.  This may take take several months.  I would not recommend you increase your dose or switch to another drug.  For accurate dosing, I recommend you order an AWS Gemini-20 digital scale, available on Amazon, and some size 00 gelatin capsules.  You can weigh your whole pill, cut it in half as best you can, then, by shaving,  add or subtract as necessary to get one-half of the the 10mg pill and put it in a gelatin capsule.  Save anything left over for the next pill.  I usually make a week's worth at a time.

 

After you have stabilized, you should taper down from 5mg at a rate of 10% of current dose every four weeks.

For example, your first taper would be to reduce by 10% of 5mg, which is 0.5mg, giving you your next dose of 4.5mg.  This would be done, as before, with the scale.  But we're not at that point yet.  First you need to stabilize.  When you're ready to taper, I can walk you through the process.

 

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

 

 

 

 

[Sonia009]

Thank you Gridley for your prompt and very reassuring reply. I've read so many versions of withdrawal, some say it takes a few weeks, others months and some say years. I thought I would have felt better by now after 10 months on 5 mg. It's so reassuring to hear you say that my symptoms are normal withdrawal symptoms and that my mistake was withdrawing too fast. I do have good days but I have noticed I am worse since lockdown, it's probably the extra anxiety brought on by it. My symptoms give me health anxiety and I imagine all sorts of insidious diseases.

Thank you for the information about the Gemini digital scale which I will almost certainly need for future reductions, I will definitely look into that later. I have magnesium supplements that I started a while back but then disregarded, I will try that again too. I will hold on my current dose as advised and try to get it as accurate as possible for now. I will read all the attachment you sent.

Thank you so much for your invaluable advice. 

[Gridley]

36 minutes ago, Sonia001 said:

I will almost certainly need for future reductions,

Since you mentioned you were possibly getting inconsistent doses varying by as much as 1mg, you might want to get the scale now (I'm assuming you're diving a 10mg tablet into half) and use for your current 5mg dose.  The lower doses are the most potent, and if you're inconsistent it could be contributing to your symptoms.

 

39 minutes ago, Sonia001 said:

I do have good days

That's a very encouraging sign.

 

39 minutes ago, Sonia001 said:

I am worse since lockdown

I think most of us have has ramped up symptoms due to lockdown.  I know I have.

 

40 minutes ago, Sonia001 said:

extra anxiety

 

This restorative yoga pose has been very helpful to me with anxiety. If you're not limber enough to get your legs on the wall (I'm not) hooking your lower legs on a chair also works.

 

10 minute Restorative Yoga for Relaxation | Up the wall

[Deblou46]

HI Sonia

 

I am similar to your story I was taken of citalopram after 18 years between 10-40mg in 2.5 months and put on sertraline, I went through horrendous withdrawals, I was finally going back to work in January and still suffering withdrawals and the past few weeks all of my symptoms have come back again!!! and I know it is due to the virus....I am scared I will always feel like this but know that I wont,  I kn ow need to hold on sertraline until I have levelled and then taper off..it is very hard. stay strong

[Sonia009]

Thank you Gridley for your prompt and very reassuring reply. I've read so many versions of withdrawal, some say it takes a few weeks, others months and some say years. I thought I would have felt better by now after 10 months on 5 mg. It's so reassuring to hear you say that my symptoms are normal withdrawal symptoms and that my mistake was withdrawing too fast. I do have good days but I have noticed I am worse since lockdown, it's probably the extra anxiety brought on by it. My symptoms give me health anxiety and I imagine all sorts of insidious diseases.

Thank you for the information about the Gemini digital scale which I will almost certainly need for future reductions, I will definitely look into that later. I have magnesium supplements that I started a while back but then disregarded, I will try that again too. I will hold on my current dose as advised and try to get it as accurate as possible for now. I will read all the attachment you sent.

Thank you so much for your invaluable advice. 

[Sonia009]

Oops, seem to have hit the post button twice, sorry for my duplicate post Gridley.

Thank you Deblou46 for your reply. I'm so sorry you are going through this too and hats off to you for working whilst withdrawing, that can't be easy. I know what you mean about being scared of always feeling this way, I have those thoughts too. The virus has taken us all by surprise and it has affected my anxiety for sure. I'm hoping and praying that we are now past the peak and each day is a step nearer to returning to normal just as each day for us is a step nearer recovery. You take care too, keep safe.

[Sonia009]

Good morning everyone,

Someone has suggested to me using liquid citalopram so before I purchase a digital scale for measuring my dose I wondered if anyone has had success by using the liquid version. Thanks.

[Sonia009]

Hi, just dropping by to say a huge thank you to Gridley for his reassurance because the day after my first post I drove my car for the first time in months. I've also ordered a digital scales alas not the Gemini one, although it has the same calibre, as they are out of stock on Amazon UK. I feel more confident and hope and pray it will last and too, the prospect of a more accurate dose is giving me hope.

[Sonia009]

Hi everyone

Thanks Gridley, I have been using my new scales for a few days and my dose is now more consistent. I have been getting some muzzy heady feelings, some slight dizziness, ears buzzing and was wondering if this is because my dose has altered since measuring it. It feels like starting up a new dose with these symptoms. I can see now how my dose was fluctuating daily by not measuring accurately. I'm sort of answering my own question but need reassurance. Hope everyone is doing ok and if not I hope you all find the strength and patience to see this through.

Kind regards

[sunnysideup69]

Hi @Sonia001, your thread caught my eye whilst I was searching 'intense dreaming.'

 

My situation is a little bit different in that I came off Citalopram nearly 10 months ago, actually I did a cold switch to Venlafaxine. So I'm on a different med, however, I'm still in WD from the Citalopram and having absolutely mad dreams, especially in the early morning, usually around 4am. 

 

Just wondered, have the crazy dreams subsided for you, now? I'm hoping mine will go as they often disturb my sleep cycle and wake me up.

[Sonia009]

Hi sunnysideup69,

Oh I remember those crazy dreams , or should I say nightmares, when I started withdrawing. They stayed for a while with nightsweats, then went away for a while then started to come back a few weeks ago, just the dreams though not nightmares. Lately, I've measuring my dose and I have been getting the all too familiar increase/withdrawal effects plus the weird dreams that happen for me around 6am, before I wake up. Some nights I sleep good, other nights I don't get off until around 3am.  

[Sonia009]

Dizziness back with a vengeance this morning, do you think I should increase slightly? Since measuring my dose I'm probably taking a tiny bit less than I would if I cut my tablet in half. If I thought it was only going to last a week I'd persevere with it but I seem to be sensitive to these meds as I have been on half dose for over 10 months now so goodness knows how long it will take for me to stabilize on this measured dose. Any advice greatly appreciated. Thank you.

 

[Sonia009]

Any thoughts, anyone? Would be much appreciated. Thanks.

[Shep]

On 5/29/2020 at 5:40 AM, Sonia001 said:

Dizziness back with a vengeance this morning, do you think I should increase slightly? Since measuring my dose I'm probably taking a tiny bit less than I would if I cut my tablet in half. If I thought it was only going to last a week I'd persevere with it but I seem to be sensitive to these meds as I have been on half dose for over 10 months now so goodness knows how long it will take for me to stabilize on this measured dose. Any advice greatly appreciated. Thank you.

 

 

Sonia, how much did you reduce and when? Is citalopram the only drug you're taking? 

 

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. 

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• Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago) 
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[Sonia009]

I've added my signature, hope it's ok. Thanks.

[gn11]

On 5/13/2020 at 4:34 AM, Sonia001 said:

Good morning everyone,

Someone has suggested to me using liquid citalopram so before I purchase a digital scale for measuring my dose I wondered if anyone has had success by using the liquid version. Thanks.

Hello Sonia! I have used the liquid formulation for withdrawing from Citalopram. I have been withdrawing for 4 years with several holds of two or three months. I moved twice during this time and one of those was across the state to a new city so I held and didn't cut my doses for several months to maintain stability. I find doing the liquid cut relatively easy. You can order it from a pharmacy although some people do their own. I still have a number of symptoms but mostly mild.I did have bigger symptoms on my last cut. I made a mistake and cut more than my usual 10%. My symptoms are  primarily ringing of the ears which seems to be related to histamine sensitivity. I found out that a lot of my symptoms were related to histamine and other sensitivities from food. You may want to check on this. Diet has helped me in this way. I'm at 0.45 and hope to be done later this year. I may have to hold for a couple of months due surgery sometime in June. I hope this helps.

[Shep]

21 hours ago, Sonia001 said:

I've added my signature, hope it's ok. Thanks.

 

Please only list the date, drug, and dose. I'm having a hard time figuring out what you're taking. 

 

Also, please use exact dates and not "around a year ago."

 

The first post in this thread may help:

 

Please summarize your withdrawal history in your signature

 

On 5/29/2020 at 5:40 AM, Sonia001 said:

Dizziness back with a vengeance this morning, do you think I should increase slightly? Since measuring my dose I'm probably taking a tiny bit less than I would if I cut my tablet in half. If I thought it was only going to last a week I'd persevere with it but I seem to be sensitive to these meds as I have been on half dose for over 10 months now so goodness knows how long it will take for me to stabilize on this measured dose. Any advice greatly appreciated. Thank you.

 

 

Please note there's a moderate interaction between bendroflumethiazide and citalopram:

 

Drug interaction report - bendroflumethiazide and citalopram

 

Do you take these two drugs at the same time? 

[Sonia009]

Hello Shep

I've amended my signature, apologies for the confusion.

I take the diuretic at 3pm and Citalopram at 5.30pm. 

Blood tests normal.

 

 

[Sonia009]

22 hours ago, gn11 said:

Hello Sonia! I have used the liquid formulation for withdrawing from Citalopram. I have been withdrawing for 4 years with several holds of two or three months. I moved twice during this time and one of those was across the state to a new city so I held and didn't cut my doses for several months to maintain stability. I find doing the liquid cut relatively easy. You can order it from a pharmacy although some people do their own. I still have a number of symptoms but mostly mild.I did have bigger symptoms on my last cut. I made a mistake and cut more than my usual 10%. My symptoms are  primarily ringing of the ears which seems to be related to histamine sensitivity. I found out that a lot of my symptoms were related to histamine and other sensitivities from food. You may want to check on this. Diet has helped me in this way. I'm at 0.45 and hope to be done later this year. I may have to hold for a couple of months due surgery sometime in June. I hope this helps.

Hi gn11,

Thank you for responding to my post. I'm still getting used to finding my way around so it's taking me a bit of time.

I recently purchased a scales on Gridley's advice and am weighing my cut dose to try to get a more accurate 5mg dose. I considered the liquid version but thought I'd weigh my current tablet instead rather than risk any adverse effects of something new.

I get tinnitus and was interested to see you mentioned histamine sensitivity. I will look into that, thank you. I seem to be sensitive to any slight alteration in dose hence the need for scales.

Congratulations for getting down to 0.45, that's amazing. It's been a long haul but you're almost there. So nice to hear a success story.

kind regards,

[gn11]

Wishing you the best! It has been a long journey but I see that others have recovered and you will as well!

[Shep]

On 5/29/2020 at 5:40 AM, Sonia001 said:

Dizziness back with a vengeance this morning, do you think I should increase slightly? Since measuring my dose I'm probably taking a tiny bit less than I would if I cut my tablet in half. If I thought it was only going to last a week I'd persevere with it but I seem to be sensitive to these meds as I have been on half dose for over 10 months now so goodness knows how long it will take for me to stabilize on this measured dose. Any advice greatly appreciated. Thank you.

 

 

On 5/12/2020 at 8:43 AM, Sonia001 said:

A year ago I decided on a slower approach and reduced down to 7.5 mgs. Two months later I reduced to 5mg, probably too soon in retrospect and here I am 10 months later still getting withdrawal symptoms.

 

14 hours ago, Sonia001 said:

I take the diuretic at 3pm and Citalopram at 5.30pm. 

 

Thanks for updating your signature, Sonia. 

 

I highlighted your question from the other day in purple. With the information you've provided, since you've been on the same 5 mg dose for 10 months,  increasing likely won't improve your symptoms. Increases work best within the first few months of a reduction. 

 

Here is some information on this symptom:

 

Dizziness, vertigo, light-headedness, rocking or swaying sensations

 

Have you had any changes to the diuretic since this time? Does the vertirgo start and stop at any specific time during the day? 

 

 

[Sonia009]

1 hour ago, Shep said:

 

Have you had any changes to the diuretic since this time? Does the vertirgo start and stop at any specific time during the day? 

 

 

Hi Shep

Thanks for replying.

I don't get vertigo -  room spinning sensation or nystagmus.

Since reducing citalopram 10 months ago and for a year before that when I was messing around with my dose (stopping, restarting, changing dose), I'd get the common withdrawal/start up effects but since measuring my dose just over a week ago the dizziness/light headed feeling is more noticable. I felt it this morning yet I carried on as normal and it passed. 

I also get neck and shoulder pain and tinnitus and I have been checked out by ENT and everything was ok. Epley manoeuvre showed no nystagmus. I've also had an echocardiogram and that was ok.

I stopped taking my diuretic 3 months ago because I was aware of the interaction with citalopram and because my bp is ok. I had to restart because my migraines came back and they help prevent my migraines which I've had for 30 years.I used to take my diuretic in the mornings but a few months ago I changed this to late afternoon, two hours before I take citalopram. Cannot remember why I did this.

I also take aspirin/paracetamol/caffeine combo tablet for my aches and pains, probably too often and I know aspirin is not good with citalopram but I cannot take anything else as they disagree with me. I take them at night.

I am going to cut out the aspirin and start taking my diuretics in the morning again to see if that makes a difference.

Aspirin has a histamine content too which I wasn't aware of until recently after doing some reading, thanks to gn11's post to me.

I have only felt worse since weighing my dose so I think it is to do with getting used to the adjustment. Also, whenever I try something different I think it makes me more anxious.

Thanks for reading.

[Sonia009]

Hi everyone

I'm still weighing my dose since around May 25th and am feeling worse now than before I started weighing it. It equates to 5mg citalopram. The dizziness is on/off throughout the day, even when I'm in bed. Some nausea too. Can anyone explain what could be going on please? Thank you.

[Sonia009]

Hi again

Does anyone know if these symptoms are normal since measuring my dose more accurately. I realise that they are causing me more anxiety so my symptoms could be a combination of both. I'm frightened to be honest because the last few days I have been getting more headaches, nausea, dizziness (not room spinning), unsteadiness, loss of appetite. I try to keep busy but I have to give in to it eventually. It's on and off throughout the day. I feel better about an hour after taking my med at 5.30pm. Any comments welcomed. Thank you.

[mstimc]

Hi Sonia

 

Headaches, dizziness, etc. are pretty common effects of withdrawal.  I think you're doing the right thing by trying to stay busy and go about your day to the extent possible.  I understand when it gets to bad you need a break.  The fact its intermittent is good--it means your nervous system is trying to stabilize.  It does take time and can be miserable while you're enduring it but you are moving toward healing!

 

[Sonia009]

Thank you so much mstimc for replying so quickly. I've been so worried I was contemplating ringing my doctor or increasing my dose. I keep wondering what if it's covid 19, and how do I know for sure. I've been on my reduced dose for 10 months but these symptoms have been worse since I started measuring my dose in May. I didn't realise the impact such a tiny change make. I'm obviously stressed because I burst into tears when I received your reassuring reply. Thank you.

 

Edited June 16, 2020 by ChessieCat
corrected typo

[ChessieCat]

Are you still taking the diuretic?

 

If you are still taking the diuretic, do you get your blood pressure checked regularly?

 

Some of the symptoms that you mentioned show up in the drug interactions.

 

If you are still taking the diuretic it might be worth being tested for hyponatremia.

Interactions between your drugs

Moderate

bendroflumethiazide citalopram

Applies to: bendroflumethiazide, citalopram

Treatment with citalopram may occasionally cause blood sodium levels to get too low, a condition known as hyponatremia, and using it with bendroflumethiazide can increase that risk. You should seek medical attention if you experience nausea, vomiting, headache, lethargy, irritability, difficulty concentrating, memory impairment, confusion, muscle spasm, weakness or unsteadiness, as these may be symptoms of hyponatremia. More severe cases may lead to hallucination, fainting, seizure, coma, and even death. Citalopram can also affect your blood pressure and heart rate. You may need a dose adjustment or more frequent monitoring of your blood pressure and pulse to safely use both medications.

[ChessieCat]

4 minutes ago, Sonia001 said:

I keep wondering what if it's covid 19

 

It might be the stress from Covid.  Other members have been experiencing unexpected or worse waves than usual in the last few months.

 

There is an excellent diagram on this page which explains what happens in our body when we are stressed:

 

https://www.getselfhelp.co.uk/anxiety.htm

 

 

Edited June 16, 2020 by ChessieCat

[mstimc]

10 minutes ago, Sonia001 said:

I didn't realise the impact such a tiny change make.

I glad my reply helped, Sonia.  When our nervous systems are hyper-sensitized, even small changes can have outsized effects.  And a bad wave at 10 months is not unheard of, either.  Bursting into tears is a good thing!  Its a great way to release endorphins and other positive hormones into your system, and it brings a measure of emotional relief as well.

[Sonia009]

Thanks ChessiCat

I am getting all of the symptoms in the diagram so stress is definitely part of my problem.

My last blood check was almost 2 years ago and potassium sodium levels were normal. I have been on diuretics for 10 years. I should probably arrange for another but things are not normal at the surgery these days. Just to add, I had these symptoms before when reducing I thought the same as you back then, hyponatraemia, but my bloods works then were normal. Potassium 4.0 (3.5-5.3 normal range) and sodium 143 (133-146 normal range).

[Sonia009]

3 minutes ago, mstimc said:

I glad my reply helped, Sonia.  When our nervous systems are hyper-sensitized, even small changes can have outsized effects.  And a bad wave at 10 months is not unheard of, either.  Bursting into tears is a good thing!  Its a great way to release endorphins and other positive hormones into your system, and it brings a measure of emotional relief as well.

Quote

 I've been getting palpitations too, weird dreams again so I'm thinking anxiety/stress and withdrawal. If course the covid19 things is hovering over us all. Thank you.

 

[Sonia009]

Hi 

Thank you for your help today. I have made an appointment for my doctor to ring me this afternoon to hopefully get my bloods checked for peace of mind. 😊

[Sonia009]

Hi again,

I've made an appointment for my bloods and BP to checked next week. My doctor doesn't think it's hyponatraema as I have been on both meds low dose for 10 years and never had a problem. He thinks I am stressed, which I am and has advised me to go back on 10mg citalopram. We may look at changing my diuretic to another BP med after the blood tests at my request. My BP is high today, I took it after lunch,  but he said it's anxiety/stress causing it. 179/89. I may go back on 10mg, if I am getting these withdrawal effects they may as well be start up effects. He said you can stay on citalopram for life and they worked well for me for 10 years so he couldn't understand why I want to come off seen as though I am still getting anxiety. 

[jozeff]

Ok well done as far as you appointment is concerned. To rule out some things is always a good thing.

 

My opinion is that you are still in wd from your 33% decrease in dose last year. I have similar issues and I have decreased from 18 mg to 11 mg which cost me a lot of effort and pain. I would not just double your dose now and hope for the best. That's double the dose to taper from again!

 

Just my 2 cents.

 

Think very well before you decide to double your citalopram intake!

 

Cheers

Jozeff

[Sonia009]

Hi Josef

Thank you for your post. I took my usual 5mg this evening, need to think this over, as you say. I'll get my bloods and results before I make a decision whether to increase or not. It's the dizziness that bothers me most, sends me into panic mode. Best wishes to you.