SATIety: Should I go back on citalopram?

[SATIety]

Hi folks! I'm very grateful for the resources you've offered. It helps me feel less alone as I struggle through this.

 

I'm a 39yo male. I've been on SSRIs (paxil first and then citalopram) for 18 years. I've tried going off citalopram (10mg) several times, and ended up going back on each time because the withdrawal symptoms were so excruciating (extreme insomnia, panic, rage, fear, mania, confusion, etc.). I'd always tried to go off basically cold-turkey, but this past time I took a few weeks to taper down from 10mg, before completely stopping 1 month ago. (I would've gone much slower if I'd come across this site earlier.) Things have been tenuous; last night was my worst night so far—I came very close to going back on the citalopram because I was in such anguish. At this moment, I'm unclear as to whether to re-start the citalopram and then taper down very slowly, or to try to ride this out and see if I can handle it. Any thoughts would be much appreciated.

 

I take magnesium regularly and find it very helpful. And I just ordered some Omega-3's.

 

Thanks again for any insights!

[Gridley]

Welcome to SA, SATIety.

 

Your system has been sensitized by your fast taper.   Going back on the full dose of 10mg could overwhelm your system and cause you to become more unstable.

 

That said, reinstatement of a very small dose of the original drug is the only known way to help alleviate withdrawal syndrome.  The only other alternative is to try and wait out the symptoms and manage as best you can until your central nervous system returns to homeostasis.  Unfortunately no one can give you an exact timeline as to when you will start feeling better and while some do recover relatively easily, for others it can take many months or longer.  

 

Reinstatement isn't a guarantee of diminished symptoms for everyone but it's the best tactic available.  You're still in the time period where reinstatement predictably works, up to 3 months after last dose.  It is best to reinstate as soon as possible after withdrawal symptoms occur. We usually suggest a much smaller reinstatement dose than your last dose.  These drugs are strong, your system has become sensitized and If you take too much it may be too much for your brain and, as I said, can cause you become more unstable.   Once you've stabilized on the small reinstated  dosage, which can take several months,  you can begin a 10% per month taper down to zero.   Please read:

 

About reinstating and stabilizing to reduce withdrawal symptoms. -- at least the first page of the topic

 

I would recommend reinstating 1mg Citalopram-- no more.  The following link explains how to get the 1mg Citalopram you'll need for your reinstatement dose.

 

Tips for tapering off Celexa (citalopram)

 

We need to see how 1mg affects you. It will take about a week for it to get to steady-state in your bloodstream; the effect should get stronger during that time.  If 1mg is enough, it still may take some weeks or months for your nervous system to settle down. You probably will continue to have ups and downs, but symptoms won't be as intense.  Please let us know what you decide to do.

 

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.

 

[SATIety]

Thanks very much, Gridley. I've been feeling better the past few days, so I'm holding off from reinstating. If I do reinstate, I'll start taking 1mg.

[SATIety]

Going through a really tough stretch of insomnia (6 weeks). Have tried many supplements (melatonin, many herbs, mag, L-theanine, etc.), to no avail. Just feels like cortisol is flying through me. Contemplating trying delta-8 CBD gummies. If there's any advice out there, please let me know!

[lookingrelief]

@SATIetyI had a 1/2 of a 20 mg delt 8 gummy for sleep. The first night I slept and thought I finially found something to help with the insomnia. The 2nd night I did the same thing but woke up at 2 am so I took another one and was up for the rest of the night with increased anxiety.

a couple of weeks later I tried 1/2 of a 50 mg delta 8 gummy during the day and it was horrible. I had major anxiety that lasted all day into the night and could not sleep.  The delta 8 has THC, so I think it played havoc on my CNS and I will not be taking any more of those.

I am having lots of issues with insomnia too. For me the delta 8 gummies were  not helpful, and I think set me back.

[SATIety]

@lookingrelief 

Thanks for sharing!

I started sublingual CBD oil (not Delta-8), and it's the only non-pharmaceutical that has helped me sleep. It really calmed my nighttime anxiety. My sleep is still not perfect, but much better since I started the oil.

Hope you get some sleep soon!

[lookingrelief]

@SATIetyI had a 1/2 of a 20 mg delt 8 gummy for sleep. The first night I slept and thought I finially found something to help with the insomnia. The 2nd night I did the same thing but woke up at 2 am so I took another one and was up for the rest of the night with increased anxiety.

a couple of weeks later I tried 1/2 of a 50 mg delta 8 gummy during the day and it was horrible. I had major anxiety that lasted all day into the night and could not sleep.  The delta 8 has THC, so I think it played havoc on my CNS and I will not be taking any more of those.

I am having lots of issues with insomnia too. For me the delta 8 gummies were  not helpful, and I think set me back.

[lookingrelief]

@SATIety

I was wondering if the CBD oil you have is full spectrum or something else. Where did you get it and what brand is it?

 I would look in to that if it could possibly help me too.

I got 4 hrs last night from about 10:30 - 2am. The night before I got 3 hrs using an anithistamine Hydroxyzine.  The insomnia, cortisol spikes/anxiey is pure hell.

Thank you

[SATIety]

 

@lookingrelief

Yes, it's full spectrum. Just a 500mg, 30ml bottle from a reputable local hemp shop. It was expensive ($55); next time I'll order online for $20 or so.

I know, the cortisol spikes are hell. I know that the root of mine is trauma, so working on that is my primary focus.

[Anya324]

I am majorly struggling with the cortisol spikes as well. I can fall asleep but cannot stay asleep. I am awakens with racing heart in the early hours of the morning. I dose off and on the rest of the night, continuing to wake with racing heart and each time my anxiety levels up a little. I decided to try and go back in the meds because I cannot do this any longer. Not sure updosing is going to work…haven’t felt great since the second dose. I’m so scared. 

[SATIety]

Really sorry to hear that, Anya324. My heart goes out to you.

 

Have you looked into Somatic Experiencing at all? If not, check it out; Peter Levine's book is Waking the Tiger. It's all about being stuck in the stress response; the stress cycle hasn't been allowed to complete itself, so instead of mounting a response and ultimately accessing safety, you only ever feel unsafe. Anyway, I find it very useful. The key is in seeing how you're perpetuating the stress response, and how you can complete it so that you feel safe; it's helpful to have a practitioner on board to help you with this.

 

In the meantime, take whatever supplements you can to help you get some sleep. For sleep, I've found sublingual CBD oil to be helpful, along with magnesium and some Chinese herbs. If you need to go back on meds because it's too excruciating otherwise, by all means do so. It's not a failure. It can get you back to a decent baseline so that you can do what you need to do to start to shift this stress response pattern.

[Anya324]

I looked that book up. Does it matter that I don’t have any “traumatic” things to recover from? My childhood was sucky because I had divorced parents and a step monster but it wasn’t Traumatic. And adulthood has been fine too. Stressors and disappointments sure but nothing beyond the norm.
 

On 5/24/2020 at 5:25 PM, SATIety said:

I've tried going off citalopram (10mg) several times, and ended up going back on each time because the withdrawal symptoms were so excruciating (extreme insomnia, panic, rage, fear, mania, confusion, etc.).

I am strongly considering jumping from 5 to 10 this weekend. I moved a tiny bit, from 3.75 to 5 Sunday and feel very agitated. I think my body wants more.  The first day I felt ok, calmer but then agitated since. I just want to give it what it needs to settle. This is awful. But I’m so scared of making things worse by updosing/going back on completely. 
 

when you did go back on, how long did it take to feel better? Did you go straight back to your original dose or work up to it? 
 

thanks! 

[SATIety]

Some people can point to a specific traumatic event; others can't. The important part is that you're stuck in a survival response; that stuckness is trauma. It's the perpetual activation of fight-flight-freeze. The key is in learning how to "complete" the survival response cycle, so that your system feels like it can return to a rest state.

 

When I went back on Citalopram, I went back to a small amount first (like 1-3mg), but it was too weak; I went back up to 10mg and started to feel much more normal, pretty quickly. Eventually, I'll wean off again, but I'll do it MUCH more gradually than I have in the past. In the meantime, I have a lot of re-training to do in my nervous system, so that I'll be prepared to wean off the next time.

 

What was your process for weaning off? Do you think you did it too quickly?

[Anya324]

Oh my heavens, yes. I followed my 

Doctors advice on how to taper. I went from 20 to 10 in feb and then 10 to 5 to 5 every other day to five every third day and then just quit in about 4 weeks may/June. After finding SA I now know that that was terrible awful horrible advice. I also have read some documentation that people that have been on an antidepressant for more than 10 years stands very little chance of getting off of it with out difficulty.

 

I reinstated July 5th at 2.5, it wasn’t enough to be functional so I upped it again to 3.75. Felt good for 3.5-4 weeks and the wheels fell off again. Upped to 5mg Sunday but now Im

getting some mild akathesia symptoms and I’m so scared. I have read a few stories here where people updose but not enough and causes trouble. so I think I need to just bite the bullet and go back up to 10mg—I feel like my body just NEEDS more in order to get back to normal. That’s all I want at this point. Normal (meaning I can live my life daily with little disruption). 

[Anya324]

21 hours ago, SATIety said:

When I went back on Citalopram, I went back to a small amount first (like 1-3mg), but it was too weak; I went back up to 10mg and started to feel much more normal, pretty quickly.

@SATIetydid the small updoses bother you at all? Make you feel worse at first? No matter what I do it makes my heart RACE and POUND. I jumped to 7.5 last night and have to take 75mg beta blocker to get it to settle. Also got terrible insomnia once all that med hit my bloodstream. My goal would be to get to 10 but I think my nervous system is too hypersensitive to get there. 
 

i effing hate this. 

[SATIety]

@Anya324Ugh, sorry to hear that. The updoses didn't really bother me, maybe because I was already so messed up, so I moved pretty quickly back up to 10mg.

 

If it's useful: Try to keep "feeling in" to your body despite the discomfort, see if you can use your imagination to feel the "breath energy" underneath the discomfort, using imagery if desired (like soothing white light bathing your tissues), calming your heart tissue, your lungs, your digestive organs, and especially your kidneys/adrenals, and so on (skin, bones, etc.). Talking to yourself with kindness, like you're cooing to a crying baby.

 

I realize this isn't a cure, but I find these sorts of inner habits to be pretty crucial to my process. Meanwhile, keep tinkering with supplements to try to find something that helps you as you re-acclimate to the pharmaceutical. You can do this!

[lookingrelief]

@SATIety Did your cordisol surges calm down after you reinstated/updosed?

[SATIety]

@lookingrelief The surges got better initially after I reinstated last Feb, but they've returned for periods of time. Most recently, I was going through a 6-week period of insomnia with surges, which the CBD has helped to calm down. My surges are typically associated with trauma triggers and supplements (I'm really sensitive to a lot of supplements—I react with anxiety/panic/insomnia when most people react with sedation); with this 6-week period of insomnia, however, the initial cause for the insomnia seemed to be digestive (reflux, primarily). After a couple weeks of insomnia from the reflux, I was exhausted and weak and the cortisol surges kicked up.

[Anya324]

@SATIety @lookingrelief

How are y’all feeling today?

 

I had my first window in 16 days. I don’t know what tomorrow holds but today has been blissful. No beta-blockers, actually ate and ENJOYED my food. 
 

one day at a time, right?

[SATIety]

@Anya324 Great to hear! Very happy for you

 

Doing alright here, sleep's iffy, but at least not having any big surges. 

[lookingrelief]

@SATIety So its ok to take the CBD along with your SSRI?  No adverse reactions?

[SATIety]

@lookingreliefSo far, so good!

[Anya324]

On 9/19/2021 at 10:08 AM, lookingrelief said:

@SATIety So its ok to take the CBD along with your SSRI?  No adverse reactions?

It’s really an individual basis. Some can take it and some cannot.