Calmseeker: citalopram withdrawal plan

[ChessieCat]

3 minutes ago, Calmseeker said:

It is a 250ml one so perhaps a bit big

 

It's better than what you are using at the moment.

 

2 minutes ago, Calmseeker said:

I am now double guessing whether I just go back to cutting my pills into quarters until I can get a liquid suspension made or if I just continue with the liquid. 

 

I think you should keep going with the liquid.  The cylinder will give better accuracy.

[Calmseeker]

15 minutes ago, ChessieCat said:

I think you should keep going with the liquid.  The cylinder will give better accuracy.

Thank you. Sending more virtual flowers and a big thank you for your help. 

[Calmseeker]

Some advice for any person who is considering making their own liquid is to get your method down pat before you start to move across. Another stupid decision I've made is to start moving across to liquid thinking the process would be easy but I'm finding it so hard. I just picked up my graduated cylinder which is great and seems to be very accurate. However you would assume that 100ml would equal exactly 100 pulls of a syringe but i'm getting vastly different results. I dont know what i'm doing wrong as I am doing the pulls correctly, i even checked online and my husband checked my method. i'm now in a very compromising position where i'm having to take a dose tonight but i'm not confident with the liquid method. 

 

I still have 10 x compounded capsules left at exactly 2.5mg. I am thinking of moving back to these and ordering another 50x capsules to get me through until the end of January (I already have the script for this). From here I will reduce using compounded capsules. Its more expensive but more accurate and easier. This has been an absolute nightmare and anxiety is through the roof which is not helpful. 

[ChessieCat]

Forget about comparing the syringe and the cylinder.  When using the syringe there may be air bubbles which you haven't got rid of.

 

You've only taken one dose using the 10mg in 100mL and you can throw out the rest.

 

Measure 100mL liquid and put in the 10mg tablet.  You will then extract 25mL to get a 2.5mg dose and you should get 4 equal doses.

 

Don't take them straight away.  Measure each dose out into 4 containers.

 

And don't forget to try and clear the air bubbles.

 

And as for the compounded capsules, the accuracy of them is probably about the same as what you are doing with the liquid.  In fact making your own liquid may be even more accurate.

[ccfb]

16 minutes ago, Calmseeker said:

From here I will reduce using compounded capsules. Its more expensive but more accurate and easier. This has been an absolute nightmare and anxiety is through the roof which is not helpful. 

The anxiety is something to consider. You should be confident in what you're taking. 

 

May be worth calling your primary doctor's office and seeing if they have an earlier appointment to figure this out. Many doctors will keep some open times in their schedule for current patients encountering difficulties. Medication issues certainly qualify. 

 

During appointment, may be worth asking your primary if there is a pharmacy near you that can dispense a liquid Rx. This is very common in USA, and my understanding is that doctors can special-order compounded liquids also. 

[Calmseeker]

1 minute ago, ccfb said:

The anxiety is something to consider, too. You should be confident in what you're taking. 

 

Are you sure there is no pharmacy near you that can dispense a liquid Rx? This is very common in USA, and my understanding is that doctors can compound liquids also. 

 

May be worth calling your primary doctor's office and seeing if they have an earlier appointment to figure this out. Many doctors will keep some open times in their schedule for current patients encountering difficulties. 

Thank you. Yes the anxiety is something to consider and I definitely want to have confidence what I am taking. 

 

In Australia its more difficult. We have compounding chemists who can make a formula to your specification which can take a few weeks. 

 

I am not sure the benefit of getting a liquid done at the compounding pharmacy as it only lasts a month so I may as well get capsules (which is a bit easier to take) and then when I get really low - say .5mg then I could use the capsule to do a liquid at that point which might be an easier method and less risk potentially than making a liquid the whole way down. 

 

Would appreciate your thoughts. Accuracy is key! 

 

 

 

[ccfb]

 

I know some people make their own liquid solutions, but by getting it professionally compounded you eliminate a variable and build confidence in what you're taking.  I never made my own liquids. 

 

You also build confidence in your course of action by discussing that proposed course of action with a trusted physician. If they're not up to date on SSRI deprescribing best practices, understand that it's a developing area and may not have been covered in CME until recently. 

 

This article in the Lancet discusses hyperbolic tapering as a strategy for reducing withdrawal symptoms:

 

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30182-8/fulltext

 

Note - I believe their proposed steps are still faster than the ones folks recommend on this site.  May help to bring up this article or others in your appointment, in addition to details about your situation.  

 

Edited December 18, 2020 by ChessieCat
removed quote

[Calmseeker]

Thanks so much guys! Look I think at the end of the day either method would be perfectly fine however it comes down to individual preference. Knowing myself, my anxiety would go sky high if I don't have confidence that I'm doing it right (which I don't, I'm always second guessing the measurements and accuracy). My anxiety presents in a way that I overthink everything to the point it is ridiculous and I could see myself doing that daily which would not be conducive to healing.  

 

But I am really pleased to say that I have a plan now that I am going to stick to and I feel happy/confident. I have just ordered 2.5mg capsules x 50 which will take me through to probably middle of February (I already have 10 left over from last time). This will give me enough time to stabilise hopefully. My next order will be 2.25 followed by 2>1.8>1.6>1.5>1.3> etc. all the way down to .5mg. When I get to .5mg I'll use the compounded .5 capsules to make my own liquid as we have discussed here (I already have the graduated cylinder and I've had a bit of practice now). 

 

I have an appointment on Monday to discuss with a new Doctor so hopefully she is supportive. 

 

Thanks again, my head is sore but I am pleased I have a plan. Really hope I don't get nasty symptoms from my chopping and changing my mind going from capsule to liquid. 

[Calmseeker]

I'm in a really bad way. Going on my fourth night where I can't sleep, looping songs & I feel nauseous. Really hoping going back on the capsules will help me to stabilise. I was doing so well. Feeling heartbroken 😥 Going to try to relax. Even if i don't sleep. 

[ccfb]

1 hour ago, Calmseeker said:

I'm in a really bad way. Going on my fourth night where I can't sleep, looping songs & I feel nauseous. Really hoping going back on the capsules will help me to stabilise. I was doing so well. Feeling heartbroken 😥 Going to try to relax. Even if i don't sleep. 

 

I'd suggest calling your primary doctor's office and seeing if you can be seen straight away because of an urgent medication issue (even virtually or via 15-minute phone call). 

 

Your health is important enough to be handled professionally. Online peer support can help educate, but at the end of the day you need a professional doctor to assess what's going on. 

[Calmseeker]

What will they say though? 1. I don't trust their knowledge. 2. My only options through them are to updose (I can do that myself) or change medication which I absolutely don't want to do. My honest experience with any of the Drs I've seen has not been good. 

 

Also I did have insomnia before going on any medication & I have had times in the past when I've had a few days on little to no sleep so a part of it is my underlying anxiety which I am managing through lifestyle changes. 

 

The only thing I would maybe consider is a slight updose, stabilise & then taper from there. But really don't want to do that. 

[Calmseeker]

At this stage I do trust the advice I receive on here more than the Doctor. I made a few errors in dosage this week & I had a glass of wine on Tuesday that I deeply regret. I think I've just destabilized somewhere. I am thinking I need to ride it out a few more days & consider an updose. I'd even consider going to 5mg then starting my taper from there again. Otherwise I stay strong, continue my meditation practices (which I just started & have been listening to your recommendation). I try to relax & trust that my body will sleep when it needs to. 

[Calmseeker]

I am OK. I just checked my fitbit data. I got an excellent nights sleep Monday. Tuesday was dismal. My fitbit says I slept 6 hours Wed but I think it's being generous & it was very light sleep. Last night I slept for 2 hours max. So I'm getting little bits. I think I can ride this out & hope I stabilise on my capsules (as I see think I got a couple of dosages slightly out & I was incredibly worked up trying to problem solve. 

[ccfb]

32 minutes ago, Calmseeker said:

At this stage I do trust the advice I receive on here more than the Doctor. I made a few errors in dosage this week & I had a glass of wine on Tuesday that I deeply regret. I think I've just destabilized somewhere. I am thinking I need to ride it out a few more days & consider an updose. I'd even consider going to 5mg then starting my taper from there again. Otherwise I stay strong, continue my meditation practices (which I just started & have been listening to your recommendation). I try to relax & trust that my body will sleep when it needs to. 

 

Making dose changes on your own may be a mistake.  Would suggest that you seek the advice of a physician you trust and use online resources for information—not medical advice.

 

I’d also mention that in my personal experience, going up in SSRI dose after you’ve decreased for a while can cause a reaction.  When things get topsy-turvy, sometimes stability helps.  Keep in mind, though, I’m not an MD.  I’m only a fellow (former) patient who’s been through this before.  This is another reason to discuss the situation with a qualified doctor.

 

48 minutes ago, Calmseeker said:

What will they say though? 1. I don't trust their knowledge. 2. My only options through them are to updose (I can do that myself) or change medication which I absolutely don't want to do. My honest experience with any of the Drs I've seen has not been good. 

 

Also I did have insomnia before going on any medication & I have had times in the past when I've had a few days on little to no sleep so a part of it is my underlying anxiety which I am managing through lifestyle changes. 

 

The only thing I would maybe consider is a slight updose, stabilise & then taper from there. But really don't want to do that. 

 

There’s no way to tell what medical advice you’ll receive, but you’re thinking two steps ahead and filling in the gaps with the worst possible assumptions.  I’ve also had bad experiences with physicians—several.  Doctors can be royal pains.  They can also be kind, compassionate, helpful, and healing.

 

To be perfectly open with you, there’s a culture of distrust of physicians on this site that’s a bit dogmatic and borderline inappropriate.  Yes, the pharmaceutical industry & medical profession have made mistakes with SSRI-type medications.  But that’s no reason to turn away from medicine as a whole.  It’s a reason to educate yourself and build trust with a treating physician.

 

Do you have anyone who might be willing to go into the doctor’s appointment with you?  Sometimes that can help build a sense of objectivity as to what’s going on and help you got on a steady path.

[Calmseeker]

1 hour ago, ccfb said:

There’s no way to tell what medical advice you’ll receive, but you’re thinking two steps ahead and filling in the gaps with the worst possible assumptions.  I’ve also had bad experiences with physicians—several.  Doctors can be royal pains.  They can also be kind, compassionate, helpful, and healing.

Yes I agree. I should say that I've seen many Doctors and I feel I have also tried a number of medications and I found the benefiys did not outweigh the side effects for me unfortunately. I have a strong sense for my options & I don't feel I can get any more information that I don't already know. Basically I either treat my the underlying cause of my insomnia which is my anxiety with medication or lifestyle changes. I've always chosen lifestyle changes but this year has been particularly challenging & I got overwhelmed. I'm trying to claw my way back to baseline. Actually they can help me with a mental health care plan and psychology appointments so that is something I would consider but it's Christmas & I'm not going to get an appointment for a while. But the only other thing they can do is prescribe or refer to a psychiatrist to prescribe. I also know it's hard for them to get a good feel for your whole situation in half an hour. 

 

1 hour ago, ccfb said:

ps with the worst possible assumptions.  

Yes! This is what I do! This is what I need to change about how I think. 

 

Yes I have an appointment on Monday & I am planning to take my husband. 

 

I actually did find I felt good on citalopram at around 5mg. 

 

Also I may have accidentally used the word advice. I know that is not what this site is about & that crosses the boundaries. I make my own decisions based on the information I have to hand. I appreciate all of the information on here (Not advice). 

[ccfb]

7 minutes ago, Calmseeker said:

I actually did find I felt good on citalopram at around 5mg. 

 

I’d just be careful about going back up.  Depending on how long you’ve been on the lower dose, you might have an issue with increasing again.  That’s one of the unfortunate things about these SSRI meds.  You can’t always go back to the same dose of the same med that used to work before.  Sometimes that works—sometimes not so much.  It’s kind of hit-or-miss.

 

7 minutes ago, Calmseeker said:

 

Basically I either treat my the underlying cause of my insomnia which is my anxiety with medication or lifestyle changes. I've alwayschosen lifestyle changes but this year has been particularly challenging & I got overwhelmed. 

 

This has been a really tough year.  

 

Don’t be too hard on yourself for trying to take the initiative.  Remember to show yourself compassion.  You’ll get everything figured out in time.  

[Calmseeker]

Thank you so much for your kind words. I really appreciate you being here to offer me support. 

[Calmseeker]

My poor nervous system. I have possibly inadvertently put it through the ringer this week. I truly hope I stabilise. I just had a thought though. @ChessieCatwhilst I have decided that for my long term strategy the compounded capsules will work for my situation, rather than jump straight back to the capsule I probably should have reversed back out of the liquid taper doing 3 days at 1/4 tablet 3/4 water, 3 days 1/2 & 1/2 & so on until I get back on the tablet to cross over to the capsule. Do you think I should so this step? Hope I haven't completely fallen off the wall. On a positive note I have been taking 2.5mg per day (possible allowance for error) but I do know it's absorbed differently via the different methods. 

 

Ah sorry guys... I know I may possibly get an award for being the most annoying member if there was one. I am a Gemini so I'm very indecisive which is not helpful in this situation. 

[ccfb]

4 hours ago, Calmseeker said:

My poor nervous system. I have possibly inadvertently put it through the ringer this week. I truly hope I stabilise. I just had a thought though. @ChessieCatwhilst I have decided that for my long term strategy the compounded capsules will work for my situation, rather than jump straight back to the capsule I probably should have reversed back out of the liquid taper doing 3 days at 1/4 tablet 3/4 water, 3 days 1/2 & 1/2 & so on until I get back on the tablet to cross over to the capsule. Do you think I should so this step? Hope I haven't completely fallen off the wall. On a positive note I have been taking 2.5mg per day (possible allowance for error) but I do know it's absorbed differently via the different methods. 

 

Ah sorry guys... I know I may possibly get an award for being the most annoying member if there was one. I am a Gemini so I'm very indecisive which is not helpful in this situation. 

 

Things will work out.  But imo, it would be a good idea to work with a qualified doctor here.

 

I'd suggest calling your doctor's office and letting them know you're having an issue with medications that may need to be resolved before the appointment.  They should have a means by which you can reach them.

[Gridley]

10 minutes ago, ccfb said:

I probably should have reversed back out of the liquid taper doing 3 days at 1/4 tablet 3/4 water, 3 days 1/2 & 1/2 & so on until I get back on the tablet to cross over to the capsule.

That will probably be easier on your system. 

[ChessieCat]

7 hours ago, Calmseeker said:

I had a glass of wine on Tuesday

 

It might take a couple of weeks for things to settle back down after the alcohol.

[ChessieCat]

7 hours ago, ccfb said:

Online peer support can help educate, but at the end of the day you need a professional doctor to assess what's going on. 

 

SA exists simply because there are very few medical professionals who understand psychiatric drugs.  If the majority of the professional medical community knew what they were doing with regards to psychiatric drugs, why is SA such a busy site with members' doctors not recognising psychiatric drug withdrawal, and some members being on ridiculous drug cocktails which a simple drug interaction check shows that there is a major drug interaction.  Medical professionals get the majority of "information" about the drugs from the pharmaceutical companies.  And the pharmaceutical companies are not there for the good of the people (as in their well being) but for the good of their investors (ie making money).

 

I suggest that @ccfb listens to the recent interview with Altostrata and checks out the other things I've linked below.

 

INTERVIEW with Altostrata, SA's founder  

 

Gwen Olsen was a pharmaceutical representative for 15 years, has personal experience with psychiatric drug use as well as the experience of one of her close relations.

 

Interview:  Confessions of an Rx Drug Pusher (51 minutes Gwen Olsen - ex pharmaceutical representative)
 

Video:  Ex-Big Pharma Rep:  We’re Trained To Misinform -The Drugs ARE Dangerous (6 minute video)
 

Video:  Ex-Big Pharma Rep:  Manipulating Doctors to Sell More Drugs (10 minute video)

 

AND

 

Approval Criteria Used by the FDA

Antidepressants and the Placebo Effect by Irving Kirsch (link to full article)

Abstract:

Antidepressants are supposed to work by fixing a chemical imbalance, specifically, a lack of serotonin in the brain.  Indeed, their supposed effectiveness is the primary evidence for the chemical imbalance theory.  But analyses of the published data and the unpublished data that were hidden by drug companies reveals that most (if not all) of the benefits are due to the placebo effect.  Some antidepressants increase serotonin levels, some decrease it, and some have no effect at all on serotonin.  Nevertheless, they all show the same therapeutic benefit.  Even the small statistical difference between antidepressants and placebos may be an enhanced placebo effect, due to the fact that most patients and doctors in clinical trials successfully break blind.  The serotonin theory is as close as any theory in the history of science to having been proved wrong.  Instead of curing depression, popular antidepressants may induce a biological vulnerability making people more likely to become depressed in the future.

Excerpt:

How Did These Drugs Get Approved?
....
The FDA requires two adequately conducted clinical trials showing a significant difference between drug and placebo.  But there is a loophole:  there is no limit to the number of trials that can be conducted in search of these two significant trials.  Trials showing negative results simply do not count.  Furthermore, the clinical significance of the findings is not considered.  All that matters is that the results are statistically significant.
....
(NB:  emphasis in abstract and excerpt are mine)

[ChessieCat]

28 minutes ago, ccfb said:

it would be a good idea to work with a qualified doctor here.

 

@ccfb

 

It is not as simple as saying this.

 

Q:  Are you able to find one for Calmseeker?

[Calmseeker]

24 minutes ago, Gridley said:

That will probably be easier on your system. 

I took a capsule last night not even thinking about the transition back. I'm going to stick with the capsule & hope & pray I stabilise over the coming weeks. 

 

I am soo hoping my nervous system calms down. I'm hoping that the fact I've stuck to the 2.5mg consistently is in my favour albeit different methods of administration.

[ChessieCat]

I don't think that returning back to capsules without a cross over will cause too many problems.  Things might take a while to settle back down but you won't know the cause because of other factors in the mix.  It might be from the alcohol and possibly the additional stress.

 

The main thing now is to be consistent.  And self care:  try to keep calm and be patient using non drug coping techniques.

 

I've had to pay out of pocket for my compounding for all of my taper but I decided that my health was worth the money even though I couldn't really afford the additional cost.  (I'm very thankful that I found a compounder who didn't charge me a lot.)  However I decided that I didn't want to have the stress of cutting and weighing my dose.

[Calmseeker]

4 minutes ago, ChessieCat said:

I don't think that returning back to capsules without a cross over will cause too many problems

Thank you. I hope you are right. 

 

5 minutes ago, ChessieCat said:

Things might take a while to settle back down but you won't know the cause because of other factors in the mix

Agree. I think at least being on the capsules will be better for my mental health. The fact I'm an over thinker.. well there is less to think about with taking a ready made capsule. 

 

8 minutes ago, ChessieCat said:

The main thing now is to be consistent.  And self care:  try to keep calm and be patient using non drug coping techniques.

Absolutely. This is my intention. 

 

9 minutes ago, ChessieCat said:

I've had to pay out of pocket for my compounding for all of my taper but I decided that my health was worth the money even though I couldn't really afford the additional cost.  (I'm very thankful that I found a compounder who didn't charge me a lot.)  However I decided that I didn't want to have the stress of cutting and weighing my dose

This is the same for me. Whilst the place I've found is expensive (I've compared with other places & they are similar prices), my health is the priority. 

[ccfb]

39 minutes ago, ChessieCat said:

 

@ccfb

 

It is not as simple as saying this.

 

Q:  Are you able to find one for Calmseeker?

 

@ChessieCat, this is disheartening.  I don’t need to watch videos on this topic.  I’ve lived it.  I’ve successfully withdrawn from my SSRI medication.  I know how difficult this process can be.

 

@Calmseeker has mentioned that he/she has a trusted family physician.  That’s why I suggested calling that physician to see if there was an after-hours line.

 

Please consider this.  It’s shaky ground to suggest to those in distress to ignore the advice of their physicians, to alter their own medications—or otherwise to give out medical advice anonymously, online, in the absence of qualifications.  Avoiding the word “advice” doesn’t change what’s going on.

 

Peer support is one thing.  Sharing information and experience is one thing.  Knowledge is power—including knowledge of how to talk to doctors about a problem that’s widely misunderstood, only recently coming into public consciousness, and inherently difficult to describe.

 

But in my humble estimation, suggesting courses of action in the medical realm should certainly not be done in the absence of a treating physician.

[Calmseeker]

Just to put everyone's minds at rest... I have an appointment with my trusted Dr at 11.15am today. I'll make sure I engage her in any decisions moving forward. 

[Altostrata]

On 12/16/2020 at 1:55 PM, ccfb said:

....

Is that best?  Maybe.  It depends on how continuing drug exposure is changing your brain, and how abrupt vs. gradual withdrawal changes your brain.

 

If you believe: (1) that continuing drug exposure is not harmful; and (2) that gradual taper mitigates harm of abrupt withdrawal, then moderators/admins are likely correct. There is good reason to adopt these premises. If you choose to do so, you might consider voicing your concerns & suggesting a corresponding slow tapering strategy to your treating MD for a full discussion.  This strategy involves mitigating withdrawal symptoms and being very patient with the timeline. It does make sense if you look at SERT occupancy graphs (the SSRI has a diminishing return effect - most transporter occupancy happens at lower doses). There is also good data to support better outcomes in severe withdrawal cases using a slower taper.

 

You run the risk of being on the medication for a long time - but if symptoms are manageable and if you are doing well, that's not really so bad. You can find "success stories" using this strategy in the corresponding section of the site. 

 

If, on the other hand, you believe continued medication exposure might be harmful (even at a lower dose), then you might stop more quickly.

....

 

Ultimately, this is a conversation you should have with your treating provider. If your provider doesn't understand the risks of what's going on or doesn't listen to you, it may be very wise to get a second opinion. Serotonergic withdrawal is very serious and should not be taken lightly. 

 

 

@ccfb thanks for your comments. Please note that adverse effects tend to be dosage-related. Aside from the target receptor occupancy, psychotropics affect other organs and systems as well.

 

As you must be aware, we are by no means enthusiastic about the effects of prescribed psychotropics on people's brains and bodies. But we have assessed the risk balance and, given the potential severity of withdrawal syndrome, are inclined to encourage gradual but slow tapers rather than quicker escape from drug effects.

 

If someone is having a significant adverse effect from the drug, we might suggest a faster taper.

 

Unfortunately, many members are here because they cannot find medical providers with whom to have an intelligent conversation about any kind of tapering. Usually, the best they can do is find one who will cooperating by writing the necessary prescriptions. The lack of knowledge in the medical profession about tapering is profound, particularly in the US.

 

 

On 12/16/2020 at 3:00 PM, ChessieCat said:

 

I think it is incorrect to say that antidepressants are  "drugs of addiction".  A more accurate term would be "drugs of adaptation" in that when we take them we are adding a chemical to the brain and the brain's natural reaction is to balance things out again which involves many different areas of the body.  This is why we can experience such a wide variety of symptoms, both start up and getting off, the drug/s.

 

Just to clarify with a drug of addiction there is a physical craving for the drug.  From what I understand with drugs of addiction is that once you are off the drug then the recovery happens very quickly.  Whereas for a drug of adaptation the brain can take a long time to make the necessary changes and get back to homeostasis which is why the harm reduction method is to reduce it slowly so that the brain adapts as you sneak the drug away instead of having to make a lot of adjustments when the drug has been removed too quickly.

 

All psychotropics, prescribed or not, "addictive" or not, incur neurobiological adaptation, physiological dependence, tolerance, and potentially withdrawal symptoms when you go off. Withdrawal is the unwinding of adaptation.

 

Yes, people taking all kinds of psychotropics, prescribed or not, "addictive" or not, may experience acute withdrawal and lengthy post-acute withdrawal that can last years. In fact, most detox tapers are so fast, a very lengthy post-acute withdrawal syndrome is more or less expected, and blamed for much "recidivism" or reinstatement of the drug.

 

There's an excellent paper about this:

Lerner, A., & Klein, M. (2019). Dependence, withdrawal and rebound of CNS drugs: An update and regulatory considerations for new drugs development. Brain Communications, 1(1). https://doi.org/10.1093/braincomms/fcz025

 

"Addictive" is a medico-legal term somewhat arbitrarily applied to drugs of which society disapproves. All psychotropics bring about physiological dependence. "Dependence" is often confounded with "addictive". Someone can be dependent on any psychotropic but not necessarily addicted. Public health authorities are seeing this with people who have inadvertently become dependent on benzodiazepines or opiates taken as prescribed, and are beginning to understand these people should not be vilified as "addicts".

 

To avoid argument, I would not call antidepressants addictive but drugs that incur adaptation and dependence.

 

On 12/17/2020 at 7:34 AM, Calmseeker said:

....

I just read through the pamphlet that @ChessieCatprovided to print out and talk to my Doctor about (which is an awesome resource and I am going to use it). However even that confuses me a bit because it says that for citalopram withdrawal you can do 20>10>5>2.5>1.25>0.6>stop. But I guess its a risk.

....

 

That would be the pamphlet from the Royal College of Psychiatry. I consulted on it. The reason they give that schedule is they felt they had to work with the packaged dosages, nothing too fancy about liquid preparations or weighing dosages with scales.

 

Any taper being better than what they're advising now, I suppose this may do for a lot of people. But, @Calmseeker, you've already run into trouble, so I would advise you to go the more painstaking, gradual route. Your nervous system is already bruised.

 

On 12/17/2020 at 6:45 PM, Calmseeker said:

Some advice for any person who is considering making their own liquid is to get your method down pat before you start to move across. Another stupid decision I've made is to start moving across to liquid thinking the process would be easy but I'm finding it so hard. I just picked up my graduated cylinder which is great and seems to be very accurate. However you would assume that 100ml would equal exactly 100 pulls of a syringe but i'm getting vastly different results. I dont know what i'm doing wrong as I am doing the pulls correctly, i even checked online and my husband checked my method. i'm now in a very compromising position where i'm having to take a dose tonight but i'm not confident with the liquid method. 

 

I still have 10 x compounded capsules left at exactly 2.5mg. I am thinking of moving back to these and ordering another 50x capsules to get me through until the end of January (I already have the script for this). From here I will reduce using compounded capsules. Its more expensive but more accurate and easier. This has been an absolute nightmare and anxiety is through the roof which is not helpful. 

 

Every pull from a syringe has some small measure of error, with the fewer pulls the better. When you get to 10 pulls of the syringe to fill up 100mL, for example, there is a good probability it will be off a bit. Using a graduated cylinder to measure your liquid is far less error-prone.

 

However, one drawback of a liquid is it gets into your system faster, and for a minority, this will be an uncomfortable change. You may be better off with a compounded capsule. I'm sorry they're so expensive. Ordering them 100 at a time should be more cost-effective.

[Calmseeker]

@AltostrataThank you so much for your very detailed response. It is a pleasure to e-meet you and I want to say a very big thank you for all that you have done for people out there who are suffering. You have turned your own suffering into something incredibly positive and that shows such strenght and I really admire that. 

49 minutes ago, Altostrata said:

However, one drawback of a liquid is it gets into your system faster, and for a minority, this will be an uncomfortable change. You may be better off with a compounded capsule. I'm sorry they're so expensive. Ordering them 100 at a time should be more cost-effective.

@AltostrataI did see a Doctor on the weekend and for the first time in this journey I found someone who was kind, compassionate and did not question my plan. She even said 'Slow and steady wins the race'. It was refreshing. 

 

However, I am scared. I moved across to the liquid method thinking I could do it but I found it just too difficult to do and I'm ashamed to say I was sloppy I feel. I did follow all of the advice on here but I just don't think I got my dosage right. I switched back to compounded capsules four days ago. I have had insomnia quite bad (I am getting two to three hours a night at the moment) and yesterday and today I have a burning chest. As I write this, I am sitting here with an icepack on my chest. I am scared that I have completely stuffed up my system and that I'm not going to stabilise. I am now doubting the compounding capsules even though they worked really well for four weeks before I switched back over to liquid. I've always maintained the 2.5mg but I am concerned my switching from tablet to capsule back to tablet to water back to capsule has thrown me off kilter and I am terrified. I was doing amazing for so long and  its just been the past week that this massive wave has hit me and its knocked me for six. My resting heart rate has jumped up 8 beats which is not unusual for m but it tells me my body is in stress (i wear a fitbit). It does not help that my mind is stressed. I am also very ashamed to say I had a small glass of red wine on Tuesday night and I have not been the same since then. Because of these symptoms I am doubting myself. 

 

 

 

 

[Calmseeker]

I get concerned about the 'fillers' they use in compounding capsules because I understand they have an impact on how the body processes the drug. I am so scared i've made a wrong move in my tapering. Can you offer any reassurance? 

[ChessieCat]

The different forms of a drug, brand name or generic (they can contain  different fillers/binders but still contain the specified dose), whole tablet, half tablet, cut up into chunks, ground to powder, prescription liquid, DIY liquid, compounded capsules containing fillers, are all going to be absorbed by the body in a slightly different way/amount of time.

 

The aim is to find the best method for you to use that will give you a consistent dose, doesn't cause any additional issues in your body and cause you the least amount of stress.

 

It may take the body a little bit of time to get used to a new form of the drug but if you take the same form then your body will adjust to it.

 

It is only in very occasional instances that members have had to revert back to the original method that they are using, eg changing from tablet to prescription liquid, and even fewer from tablet to DIY liquid.

 

You've been using the capsules before so why are you starting to worry about it now?

 

You have been very stressed lately and I think that much of what you are going through both physically and mentally (ie unable to make decisions) is being cause by that.

 

It's just going to take a little bit of time for your nervous system to settle down after the changes that you have made.

[Calmseeker]

1 hour ago, ChessieCat said:

The different forms of a drug, brand name or generic (they can contain  different fillers/binders but still contain the specified dose), whole tablet, half tablet, cut up into chunks, ground to powder, prescription liquid, DIY liquid, compounded capsules containing fillers, are all going to be absorbed by the body in a slightly different way/amount of time.

This is incredibly reassuring. 

 

1 hour ago, ChessieCat said:

The aim is to find the best method for you to use that will give you a consistent dose, doesn't cause any additional issues in your body and cause you the least amount of stress.

I feel that in my case, compounding capsules are definitely the best method. 

 

1 hour ago, ChessieCat said:

It may take the body a little bit of time to get used to a new form of the drug but if you take the same form then your body will adjust to it.

Also very reassuring. Hope this is the case for me. 

 

1 hour ago, ChessieCat said:

You've been using the capsules before so why are you starting to worry about it now?

One of the reasons is that when I was researching the different compounding chemists, I had a long chat with a pharmacist and I asked him about the fillers they use. I told him the name of the filler they use at the chemist I get my capsules from and he made some comments along the lines of 'that is a cheap filler' and 'that filler doesnt help the body to absorb the drug'.. he suggested that he would use a filler that helped the absorbtion process and he even said something like 'your body probably wouldnt even absorbing all the drug with those capsules or something to that effect'. My mind of course goes into overdrive, analysing every word.  

 

1 hour ago, ChessieCat said:

You have been very stressed lately and I think that much of what you are going through both physically and mentally (ie unable to make decisions) is being cause by that.

100% agree. If I didnt know anything about withdrawals I would probably be living my life happy and carefree (to a degree). Albeit I'd be a bit tired from some not so great nights of sleep and I'd be wondering why my chest felt a little hot. I have health anxiety and I am a prescription medicine phobe.. this situation is my idea of an absolute nightmare. 

 

1 hour ago, ChessieCat said:

It's just going to take a little bit of time for your nervous system to settle down after the changes that you have made.

Thank you for your kind and reassuring words. I really hope you are right. 

[Calmseeker]

When I've healed or at least further on my journey and more stable, I'd love to pay it forward and help others somewhere, maybe there will be an opportunity for me to help with some website stuff on here, I don't know but I would like to give something back. I'll keep thinking about what that might look like but for now, please know that I'm grateful. 

[ChessieCat]

2 hours ago, Calmseeker said:

One of the reasons is that when I was researching the different compounding chemists, I had a long chat with a pharmacist and I asked him about the fillers they use. I told him the name of the filler they use at the chemist I get my capsules from and he made some comments along the lines of 'that is a cheap filler' and 'that filler doesnt help the body to absorb the drug'.. he suggested that he would use a filler that helped the absorbtion process and he even said something like 'your body probably wouldnt even absorbing all the drug with those capsules or something to that effect'. My mind of course goes into overdrive, analysing every word.  

 

What filler was the "cheap filler"?  And what filler was the other chemist going to use?

 

Was he talking about time release formula being added?

 

Even if the cheap filler meant that you absorbed less of the drug the consistency would still be their.  It would only be an issue if you were chopping and changing between difference compounded capsules of the same dose.

 

As an example, there are two different cup measures for recipes, shown below.  The only time it would be a problem would be if you made a recipe and used cup A for the dry ingredients and cup B for the wet ingredients in the same recipe.  If you made all of one recipe with cup A and another different recipe with cup B they would turn out the same but one would have a slightly larger size.  I hope that helps to explain what I mean.

 

Quote

Cooking Cup Measurements & Conversions

https://www.cookingconversions.org/cupmeasurements.htm

Over time standard cup measures have come to be used at 1 cup being the equivalent of a ½ pint (US) (8 US fluid ounces). In other English speaking countries the Imperial Cup of half an Imperial pint was formerly used in recipes, this has been replaced in Australia, Canada, New Zealand and South Africa with the metric cup of 250ml.

 

[Altostrata]

2 hours ago, Calmseeker said:

When I've healed or at least further on my journey and more stable, I'd love to pay it forward and help others somewhere, maybe there will be an opportunity for me to help with some website stuff on here, I don't know but I would like to give something back. I'll keep thinking about what that might look like but for now, please know that I'm grateful. 

 

Thank you! This community thrives on members helping each other.

 

It may take you some weeks to get over this bump, but you should gradually go back to your baseline on the capsules.

 

I wouldn't worry about the filler, but all else being equal, next time I might get my capsules made by the pharmacist with the more sophisticated understanding.