remakeremodel: advice needed after too-fast taper of Celexa

[remakeremodel]

Hi all,

I'll try to keep this concise. I began a taper of Celexa 30mg, the dose that I had been on for around three years, this past August. Things seemed to be going well for the first couple months; I had a few minor "blips" of nighttime anxiety, but I unfortunately didn't see them for the warning signs that they were. Full-blown withdrawal hit me after about four weeks on the 10mg dose: severe anxiety, rapid mood swings, terrible insomnia, heart palpitations, brain zaps, etc. 

 

On November 2 I updosed to 15mg; I'm not sure what effect this updose had, as by November 5 I was suffering from severe psychomotor agitation (possibly akathisia?) and took myself to emergency. There they gave me Ativan, which calmed me down, and the psychiatrist who saw me advised me to go back on 20mg of Celexa and gave me two-week script for 1mg clonazepam to ease the withdrawal symptoms. My symptoms improved after a couple of days, and I seemed to be steadily improving, but for the past few days I've been feeling worse again and my sleep has gotten worse. My current worst symptom is nocturnal adrenaline surges/panic attacks that wake me just as I'm about to drift off. 

 

A few things to note:

• My GP advised me to taper the clonazepam down to 0.5mg after two weeks on 1mg, which I did, but then my sleep and anxiety started to worsen. I've also noticed that the clonazepam now seems to be agitating me; I feel a marked increase in agitation about 20 minutes or so after taking a dose. 
• I seem to feel better a few hours after taking Celexa, which I take in the afternoon. 

 

Questions:

• I understand that stabilization after updosing/reinstatement often follows the "windows and waves" pattern, which is what I seem to be experiencing. How long can/should I wait to stabilize on my current dose?
• I'm a bit concerned that I've further destabilized my nervous system by adding the clonazepam, especially as I now seem to be reacting paradoxically to it. Should I continue the fast taper, as my GP advised, or just stop taking it? Or something else?

 

Thanks for reading this, and thanks for all the invaluable work you do here.

[Gridley]

Welcome to SA, remakeremodel.  Thank you for completing your signature.

 

You already understand that you were/are experiencing withdrawal from a too-fast taper of Celexa.  Your symptoms are typical of withdrawal.

 

What is withdrawal syndrome.

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

14 hours ago, remakeremodel said:

My GP advised me to taper the clonazepam down to 0.5mg after two weeks on 1mg, which I did, but then my sleep and anxiety started to worsen. I've also noticed that the clonazepam now seems to be agitating me; I feel a marked increase in agitation about 20 minutes or so after taking a dose. 

 

14 hours ago, remakeremodel said:

• I'm a bit concerned that I've further destabilized my nervous system by adding the clonazepam, especially as I now seem to be reacting paradoxically to it. Should I continue the fast taper, as my GP advised, or just stop taking it? Or something else?

 

 

Your benzo situation is tricky.  You're been on the Clonazepam for around 3 weeks now.  Physiological dependency can result from 2 to 4 weeks of regular use.  I'm going to bring your situation to the attention of Shep, one of our administrators who is very knowledgeable about benzos to get her input.

 

14 hours ago, remakeremodel said:

I understand that stabilization after updosing/reinstatement often follows the "windows and waves" pattern, which is what I seem to be experiencing. How long can/should I wait to stabilize on my current dose?

Very likely it will take several months.  You'll need to monitor your symptoms.  Keeping a daily log of symptoms is helpful.

 

The Windows and Waves Pattern of Stabilization

 

 

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. Get supplements that are single ingredient (not mixed with other types of supplements).

 

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

 

 

 

 

 

 

[remakeremodel]

Hi Gridley,

Thanks very much for your reply. I've actually been taking magnesium and fish oil since the beginning of my taper, but I haven't noticed any real effect from them. I will try taking a small amount of each one individually and monitoring my reaction. 

 

I will do my best to keep a symptom journal. Right now my main issue is anxiety, which is worse at night and in the early morning and better in the afternoon and evening. 

 

Another data point: I was on a ketogenic diet from late August to mid-October in the hopes that it would help with my taper, as it's often touted as neuroprotective and beneficial for depression and anxiety. I noticed that my symptoms began to appear around the time I switched to a more relaxed low-carb diet. It would be helpful to hear from members who have had symptoms either worsen or improve on a keto diet. 

[Shep]

15 hours ago, remakeremodel said:

I will do my best to keep a symptom journal. Right now my main issue is anxiety, which is worse at night and in the early morning and better in the afternoon and evening. 

 

 

Thank you, Remakeremodel. This will really help us guide you in your taper. I'm wondering when these symptoms are coming into play within the context of when you take your drugs.  Benzodiazepines are notorious for causing rebound and paradoxical symptoms, which can be helped by changing the timing. So we'll be on the lookout for these kinds of things. 

 

Please use the below format for your journal and also include the number of hours you sleep and any supplements you are taking, along with the dose. 

 

On 9/27/2016 at 2:49 PM, Altostrata said:

In the course of discussion in your Introductions forum topic, you may be asked to keep notes on paper of your daily symptom pattern, including when you take your drugs, their dosages, and any symptoms. We ask this because there may be something we can do to reduce the symptoms.

 

What we need to see for every single day over several days is what symptoms you get before and after you take your drugs. If you're not taking any drugs and have withdrawal symptoms, we still need to see your symptom pattern throughout the day:

 

The time of day, dosage, and severity of symptoms are essential information. Include

 

- Time and dosage for all drugs taken throughout the day, psychiatric and non-psychiatric.

- Following each dose, note any symptoms. If you are having a reaction to the drug, it may take hours for a symptom to show up -- that's why we ask you to keep notes all day long.

- If you're not taking any drugs, your symptoms throughout the day.

- Your sleep pattern. Since so many drugs disturb sleep, if you find you're waking in the middle of the night, it could be from a drug you took earlier in the evening. If you're not taking any drugs, there may be ways you can improve your sleep.

And so forth. A diary, in chronological order, looking something like this:
 

Example:

DATE:

 

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

 

[Shep]

16 hours ago, remakeremodel said:

Another data point: I was on a ketogenic diet from late August to mid-October in the hopes that it would help with my taper, as it's often touted as neuroprotective and beneficial for depression and anxiety. I noticed that my symptoms began to appear around the time I switched to a more relaxed low-carb diet. It would be helpful to hear from members who have had symptoms either worsen or improve on a keto diet. 

 

Please see:

 

Ketogenic diet

 

Diets that may cause problems: Restriction, Ketosis, Raw, Low Carb

 

SCD/GAPS/Paleo Diets

 

Diet is very individual - what works for someone else may not work for you. And that maybe because withdrawal is so unique to every person. 

 

I was a vegetarian for over 30 years prior to withdrawal but once I developed sensitivities to supplements, I went to a Paleo diet in order to get enough B12. But the Paleo diet causes problems with some other people going through withdrawal. So you'll have to find what works for you. Feel free to explore the site and use the search feature, as some members discuss their various diets within their own intro threads. 

 

The best diet advice I received was to avoid alcohol, caffeine, sugar, MSG, and processed foods. And to drink plenty of water. 

 

If you felt better on Keto, you may want to go back to it and see if it helps again. 

Edited November 26, 2020 by Shep
added more info

[remakeremodel]

Thanks so much, Shep. I'm already avoiding all those things, thankfully. I'm a bit a wary about making any major dietary changes right now; I may go back to keto when I feel a bit better.

 

Here is my symptom journal from yesterday:

 

9/26

10am - woke with anxiety; took 150mg magnesium. Afraid to get out of bed; stayed in bed trying to sleep for several hours but kept experiencing adrenaline surges
1pm - got up, took 20mg celexa
2pm - ate lunch; anxiety slightly lower
3pm - diarrhea (but mild)
4:30pm - acupuncture treatment
5:30pm - anxiety slightly lower
6pm - snack
7pm - dinner
7:15pm - anxiety slightly higher
8pm - 0.25mg clonazepam
9:30pm - anxiety slightly lower
11pm - increasing anxiety
2am - went to bed, had insomnia, but adrenaline surges not as intense
4am - took 1mg clonazepam, no effect; may have made anxiety worse
10am - managed to fall asleep, had frequent awakenings until around 3pm

 

I'm getting pretty concerned about the clonazepam. I'd like to stop taking it as it no longer seems to be working, but I'm worried about WD from it. I'm not sure whether switching to a different, longer-acting benzo, perhaps diazepam, would be helpful or harmful. I plan to call my doctor soon to let her know my concerns.

 

 

[Shep]

16 hours ago, remakeremodel said:

8pm - 0.25mg clonazepam
9:30pm - anxiety slightly lower
11pm - increasing anxiety
2am - went to bed, had insomnia, but adrenaline surges not as intense
4am - took 1mg clonazepam, no effect; may have made anxiety worse

 

Thanks for starting your daily notes. How often do you usually take clonazepam throughout the day and night? Do you usually take a small amount near bedtime and then a larger amount in the early morning when you wake up? 

 

Please continue with your notes over the weekend. 

[remakeremodel]

Hi Shep,

 

Here are my notes from the past three days:

 

11/27
3pm - woke with anxiety and slight headache, took 20mg celexa and 500mg acetaminophen
3:30pm - had lunch
7:30pm - had snack, took probiotics, anxiety lessening
8pm - dinner
8:30pm - Epsom salt bath
11:30 - anxiety slightly higher
1am - took 0.25 clonazepam and 150mg magnesium
1:30am - went to bed, anxiety bad until around 5am
5am - fell asleep, had frequent awakenings, but generally slept well until 1pm

 

11/28
1pm - woke up with less anxiety than usual, took 20mg celexa
1:30pm - lunch
3pm - anxiety slightly higher, slight headache
5pm - snack, anxiety slightly lower
8pm - dinner
10:30pm - bath, anxiety slightly lower
10:30-1am - window of feeling almost "normal"
1am - took 150mg magnesium, went to bed
3am - anxiety rising, took 0.5mg clonazepam
4am - anxiety severe with a "chemical" feel
6am - managed to fall asleep, slept well but with frequent awakenings until 11am; would probably have slept longer but was staying at hotel

 

11/29
11am - woke with anxiety
1:30pm - took 10mg celexa
2:30pm - lunch, anxiety no better
5:30pm - slight decrease in anxiety but feeling depressed 
6:45pm - 10mg celexa
8pm - dinner
9pm - meditation
10pm - anxiety and depression about the same
2am - went to bed, anxiety slightly lower but still "depressed" - possibly just hyper emotional? Had insomnia with adrenaline surges
4am - took 0.5mg clonazepam, fell asleep shortly thereafter
6am - woke in a panic but managed to fall back asleep. Slept with frequent awakenings until around 1pm

 

I've been inconsistent with my clonazepam dosing lately because I've been afraid that I've been having an adverse reaction to it, but since I do seem to sleep when I take it, I've decided to take my 0.5mg at bedtime for now.

 

The depressed feeling from last night is lingering a bit today, but the anxiety seems slightly less intense. I tried splitting the dose of Celexa yesterday in the hopes that it would help with the nighttime anxiety, but I ended up feeling worse, so I think that was a mistake.

 

I'm still not sure whether the updose to 20mg Celexa is working (I realize it's probably too soon to assess this). I'm suspicious that the improvement I experienced in the first couple weeks on clonazepam was just the benzo masking Celexa WD symptoms.

 

Thanks again for your help.
 

[Shep]

On 11/27/2020 at 4:15 PM, remakeremodel said:

11/26
1pm - got up, took 20mg celexa
8pm - 0.25mg clonazepam
4am - took 1mg clonazepam, no effect; may have made anxiety worse

 

16 hours ago, remakeremodel said:

11/27
3pm - woke with anxiety and slight headache, took 20mg celexa and 500mg acetaminophen
1am - took 0.25 clonazepam and 150mg magnesium

 

11/28
1pm - woke up with less anxiety than usual, took 20mg celexa
3am - anxiety rising, took 0.5mg clonazepam

 

11/29
1:30pm - took 10mg celexa
6:45pm - 10mg celexa
4am - took 0.5mg clonazepam, fell asleep shortly thereafter
 

 

 

We really won't be able to give you advice until you're on a set schedule with your drugs - same time(s) of day everyday and the same dose.   As you move toward a more regular dosing schedule, we can provide more guidance. From your notes, you mentioned staying in a hotel, so perhaps after your travels your routine will become more stable. 

 

Please note, you're working against your body's natural sleep / wake cycle by taking a benzo to sleep so late. In the melatonin thread, Alto writes:

 

On 4/6/2011 at 9:26 PM, Altostrata said:

Your adrenals also run on a sleep schedule of approximately 10 p.m. to dawn. They tend to reactivate if you stay up later, which may keep you from sleeping. If you can, get to bed by 10 p.m. and retrain your sleep cycle.

 

You may want to add in a tiny bit of melatonin in order to get your sleep cycle back to normal. If so, please see:

 

Melatonin for Sleep

 

Questions:

 

• do you find Celexa to be a stimulating drug? If so, you may want to move it to in the morning. We recommend moving drugs very slowly, only one hour per day.

 

• you've been on Klonopin since November 5, so you really need to decide soon if you wish to continue taking the benzo. It's hard to say if you're dependent or not (dependency can happen in as little as 2 - 4 weeks, sometimes as quick as 10 days for some people, even with periodic use). 

16 hours ago, remakeremodel said:

I've been inconsistent with my clonazepam dosing lately because I've been afraid that I've been having an adverse reaction to it, but since I do seem to sleep when I take it, I've decided to take my 0.5mg at bedtime for now.

 

This sounds like a wise decision if you're going to continue taking this drug. Picking a reasonable dose and sticking to it at the same time and dose every night will help your nervous system settle down. 

 

Please see these links which will provide more context about taking an antidepressant and a benzo:

 

Tips for tapering off citalopram (Celexa)

 

Taking multiple psych drugs? Which drug to taper first?

 

Please continue posting your notes.

 

 

[remakeremodel]

Hi Shep,

 

I will do my best to keep my dosing consistent and get to bed earlier. The latter may be difficult for me, as I've been a night owl since I was a teenager and my body seems to naturally prefer a later bedtime. I should add that I've also struggled with sleep anxiety since a very bad episode of drug-induced insomnia three years ago. I tend to delay bedtime because I'm anxious about whether I'll sleep. Meditation and acceptance techniques (e.g., Claire Weekes) have been helping with this anxiety somewhat, as well as the anxiety about the WD anxiety.

 

8 hours ago, Shep said:

Questions:

 

• do you find Celexa to be a stimulating drug? If so, you may want to move it to in the morning. We recommend moving drugs very slowly, only one hour per day.

 

• you've been on Klonopin since November 5, so you really need to decide soon if you wish to continue taking the benzo. It's hard to say if you're dependent or not (dependency can happen in as little as 2 - 4 weeks, sometimes as quick as 10 days for some people, even with periodic use).

 

The Celexa feels more sedating to me. I am thinking that this is why I usually feel less anxious in the late afternoon/early evening. I've also been experiencing daytime fatigue for the past couple of years on it, which is one of the reasons I wanted to come off. Would you recommend moving the dose forward by one hour?

 

As I don't know whether or not I'm dependent on the benzo, I would like to try to stop taking it. I want to avoid benzo dependency if I can, especially as the eventual Celexa taper is going to take so long. Can I do this without tapering? If my symptoms worsen after stopping it, should I reinstate?

 

Here are my notes from yesterday:

 

11/30
1pm - woke with slight anxiety and depression
1:30pm - 20mg celexa
2pm - lunch
2-8pm - anxiety and depression lessening, but heart rate still elevated most of the time
8pm - dinner
9pm-2am - anxiety rising
2:30am - bed, took 0.5mg clonazepam, had some anxiety while falling asleep but generally slept well until 11am

[Shep]

14 hours ago, remakeremodel said:

The Celexa feels more sedating to me. I am thinking that this is why I usually feel less anxious in the late afternoon/early evening. I've also been experiencing daytime fatigue for the past couple of years on it, which is one of the reasons I wanted to come off. Would you recommend moving the dose forward by one hour?

 

If it makes you sleepy, it would be better to take it later in the day, however, there's a "moderate" drug interaction between Celexa and Klonopin:

 

Drug Interaction Checker - Celexa and Klonopin

 

So you'll want to space these drugs at least 2 hours apart. 

 

14 hours ago, remakeremodel said:

As I don't know whether or not I'm dependent on the benzo, I would like to try to stop taking it. I want to avoid benzo dependency if I can, especially as the eventual Celexa taper is going to take so long. Can I do this without tapering? If my symptoms worsen after stopping it, should I reinstate?

 

 

I'm not really sure. You've been on the benzo for 27 days, so it's really possible that you're dependent. Because of inconsistent dosing, it's hard to tell from your notes. 

 

Last night you slept a little over 8 hours, which is excellent. 

 

I would not stop cold turkey after 27 days. Whether or not you'd have problems stopping is unknown, especially since you weren't getting consistently good results on the nights when you did take it. But that could have been from inconsistent dosing at different times with different doses, as well as your travels (you mentioned staying in a hotel). 

 

 

On 11/24/2020 at 7:49 PM, remakeremodel said:

My GP advised me to taper the clonazepam down to 0.5mg after two weeks on 1mg, which I did, but then my sleep and anxiety started to worsen. I've also noticed that the clonazepam now seems to be agitating me; I feel a marked increase in agitation about 20 minutes or so after taking a dose. 

 

Your previous history of trying to come off clonazepam suggests that you're dealing with both dependency and a paradoxical reaction. But again, some of this could be rebound or interdose withdrawal due to inconsistent dosing. 

 

I would go another couple of nights to see how you do with consistently dosing, taking .5 mg Klonopin at the same time each night. If it helps, I would stay on it and taper it after you come off the Celexa. That would be the safest way to protect your nervous system, which doesn't register one drug being worse than another, but rather, it measures the level of trauma caused by any sudden change. 

 

I hope this helps because there's no clear answer here. 

 

NOTE: please don't make any changes to the Celexa timing while you're trying to see if the benzo is helpful. You need to be VERY consistent in the dose amounts and the times you take each of these drugs. 

[remakeremodel]

Hi Shep,

 

It's become increasingly clear to me that the benzo isn't helping and is probably making me worse -- I think it might actually be causing my nighttime anxiety, as the evening windows I've been getting seem to go away after I've taken it. I think I've slept well on some of the nights I've taken it only because of the psychological comfort of taking something to "help me sleep."  My sleep has unfortunately gotten worse over the past few days, and I've been dealing with increasing feelings of depression and despair over the past week or so. My GP psychotherapist thinks I should come off the benzo as it's clear to him that it's not helping me. As I don't want to CT it, last night I went down to 0.25mg. Here are my notes from the past three days:

 

 

12/1
1pm - anxiety high again, took 20mg celexa
1:30pm - lunch
2:30pm - acupuncture treatment
3:30pm - snack
4:30pm - anxiety lessening somewhat
5pm - anxiety back, along with some depression
9pm - dinner
9:50pm - took 150mg magnesium and 1.5mg melatonin
12am - bed, insomnia
3am - 0.5mg clonazepam, slept until around 7am

 

12/2
7am - woke with anxiety, tried to sleep for several more hours unsuccessfully
1pm - lunch, took 20mg celexa
1:30pm - therapy appointment
5pm - took 1000mg fish oil and 1000 IU vitamin d
2:15-6pm - fluctuating anxiety levels
6pm - dinner
10pm - 0.75mg melatonin
11pm - 0.5mg clonazepam, no effect on anxiety
1am - bed, insomnia and bad anxiety until around 6am
6am-11:30am - sleep

 

12/3
11:30am - woke with anxiety
1pm - 20mg celexa
1:30pm - lunch
5pm - anxiety decreasing somewhat
7pm - dinner
8-11pm - window of feeling mostly okay
10pm - 0.75mg melatonin
11pm - 0.25mg clonazepam
12:30pm - bed
1:30am - anxiety rising
2:30am - sleep
4:30am - woke in a panic, took 25mg diphenhydramine, managed to fall back asleep
7:30am - awake again, 25mg diphenhydramine
7:30am-12pm - slept fitfully with high anxiety
 

I would really appreciate some advice on what to do here. I'm feeling very confused and scared and am worried that the clonazepam is hindering my stabilization on the Celexa updose.

 

[ChessieCat]

On 12/2/2020 at 11:56 PM, Shep said:

NOTE: please don't make any changes to the Celexa timing while you're trying to see if the benzo is helpful. You need to be VERY consistent in the dose amounts and the times you take each of these drugs. 

 

Please provide notes for 4th December.  On 1st December you took clonazepam at 3am.  2nd and 3rd December it was at 11pm.

 

3 hours ago, remakeremodel said:

acupuncture treatment

 

Acupuncture - Posts #6 & #8 (not detox or stimulation)

[Shep]

On 12/1/2020 at 8:22 AM, Shep said:

We really won't be able to give you advice until you're on a set schedule with your drugs - same time(s) of day everyday and the same dose.  

 

@remakeremodelI'm really going to emphasize this. It's important. Again, we really won't be able to give you advice until you're on a set schedule with your drugs - same time(s) of day everyday and the same dose. 

 

Here is what you just posted: 

 

13 hours ago, remakeremodel said:

12/1

1pm - 20mg celexa
9:50pm - 150mg magnesium and 1.5mg melatonin
3am - 0.5mg clonazepam

 

12/2

1pm -  20mg celexa
5pm - took 1000mg fish oil and 1000 IU vitamin d
10pm - 0.75mg melatonin
11pm - 0.5mg clonazepam

 

12/3

1pm - 20mg celexa
10pm - 0.75mg melatonin
11pm - 0.25mg clonazepam
4:30am - 25mg diphenhydramine
7:30am - 25mg diphenhydramine
 

 

 

The only constant in the equation is the celexa. The melatonin was cut in half and the benzo was reduced in half and replaced with diphenhydramine. Please see:

 

Antihistamines for withdrawal insomnia (diphenhydramine, doxylamine, hydroxyzine)

 

If you continue to take this drug, you'll have to taper off it. It should never be considered a substitute for a benzo. If you feel you're now dependent on the benzo, it's best to slowly taper off the benzo, usually after coming off the antidepressant. 

 

You also took fish oil and vitamin D one day but not the other days. 

 

Why are you taking vitamin D at 5 pm? Please note that vitamin D is a stimulating supplement and can keep you awake. You may be okay with the fish oil, but I'm not sure if that's a good dose if you're just starting out with it. You may want to try a lower dose at first. Or instead of using a supplement, eat fish. That's a safer way of getting fish oil in you when you need to limit any drug and supplement changes. 

 

Magnesium is a good idea, but it needs to be taken consistently - same time(s) of the day and the same dose. 

 

Please research everything you put into your body, including supplements. And then only add them in one at a time, and only when you're not making changes with your drugs. ONLY ONE CHANGE AT A TIME PLEASE. This includes supplements and dose changes. For more please see: 

 

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

 

Vitamin D3 (cholecalciferol or calcitriol)

 

King of supplements: Omega-3 fatty acids (fish oil)

 

Magnesium, nature's calcium channel blocker

 

Melatonin for sleep

 

 

Please continue posting your notes for a few more days, but no more changes. We really need to see your symptoms within the context of taking these drugs, but with all of the drug and supplement changes, it's impossible to do that right now. Please be kind to your nervous system and get on a set schedule and then stick to it. 

 

Also, please take note of what ChessieCat just posted above about acupuncture. Make sure you're not getting a reaction to that, as some acupuncture treatments can be stimulating. 

 

[remakeremodel]

I think I've made a huge mistake. I was panicking (hence all the changes), and on the advice on my doctor and her consulting psychiatrist I updosed to 30mg of Celexa on Tuesday. I also stupidly allowed her to prescribe Seroquel for sleep (as I'd be on it before), and I had an adverse reaction to it -- tachycardia. I still took it two nights in a row. I am still on 0.5mg of clonazepam per day. I now believe that the updose to 20mg of Celexa was a mistake as I've been getting worse and worse over the past few weeks. I've been feeling acutely suicidal over the past day and don't know what to do. Please help.

[Shep]

Remakeremodel, you'll have to decide if you wish to continue on with whatever your doctor prescribes or if you can take the same drug(s) every day, at the same time(s) of the day, and work with non-drug coping skills to get you through the hard times. As you're finding out, continuing on with these drugs in this random and dangerous way is only making you worse. 

 

Please re-read your thread, as we've provided the best advice we know to provide here.

 

If you're still struggling with suicidal thoughts, please see:

 

For those who are feeling desperate or suicidal

 

You may also want to switch doctors, if possible. Please see:

 

SA's Recommended doctors

 

Mad in America - Service Provider Directory for Canada

 

There may be a doctor near you in Canada who is informed on withdrawing from these drugs. Definitely worth calling around. 

[remakeremodel]

Hi Shep,

 

I apologize for being so reckless with the drug changes; my anxiety was at an all-time high, and I wasn't thinking rationally. I am thankfully no longer experiencing SI, which I believe was an adverse reaction to the Seroquel (which I've now stopped taking). I also had a day a couple days ago of feeling almost completely normal, which I hope is a sign that I'm finally beginning to stabilize. 

 

I'm planning on staying the course with the 30mg Celexa for now and am also considering increasing the clonazepam to 1mg per day again, as things seemed to go sideways when the dose was cut in half. 

 

I do have one question: I've read many accounts on here of people taking supplements or drugs on an as-needed basis (e.g., the occasional dose of diphenhydramine for sleep). Is this now against SA protocol?

[ChessieCat]

4 hours ago, remakeremodel said:

I do have one question: I've read many accounts on here of people taking supplements or drugs on an as-needed basis (e.g., the occasional dose of diphenhydramine for sleep). Is this now against SA protocol?

 

It's up to members to make the decision about what drugs and supplements they will use.  All SA does is make suggestions.  The best thing to do is to try a small dose first to see how you react, and to keep notes of what you take and when so that if things worsen/improve you have a record of it.  Also be aware that sometimes something might help for a while but later might make things worse.  And just because something works/does not work for someone else does not mean that the same will be true for you.

 

I very occasionally take some Phenergan/promethazine antihistamine; sometimes for hives, sometimes to help me sleep.

 

But also remember that if you try something and it makes you worse you also need to take responsibility for that and cope with the result as best you can.  SA doesn't have any magic cures.

[Shep]

15 hours ago, remakeremodel said:

I'm planning on staying the course with the 30mg Celexa for now and am also considering increasing the clonazepam to 1mg per day again, as things seemed to go sideways when the dose was cut in half. 

 

When were you last at 1 mg clonazepam? According to your signature, you started 1 mg clonazepam on November 5.

 

Please note that benzo updoses work best within 2 - 4 weeks of the last change. When did you change the dose from 1 mg? 

 

15 hours ago, remakeremodel said:

I also had a day a couple days ago of feeling almost completely normal, which I hope is a sign that I'm finally beginning to stabilize. 

 

Why are you increasing the benzo when you're already stabilizing? 

 

15 hours ago, remakeremodel said:

I do have one question: I've read many accounts on here of people taking supplements or drugs on an as-needed basis (e.g., the occasional dose of diphenhydramine for sleep). Is this now against SA protocol?

 

Adding diphenhydramine for sleep may go paradoxical, meaning you'll be hyper-alerted. From the Antihistamines for withdrawal insomnia  thread:

 

On 6/2/2012 at 1:38 PM, Altostrata said:

The problem with is diphenhydramine is its beneficial sleep effect can wear off and it can go paradoxical -- it will keep you awake instead. So use it sparingly if you can.

 

The likelihood of a paradoxical reaction increases the closer you to take it to a benzo. The more you dampen down your nervous system, the more it fights to stay awake. This creates a paradoxical reaction. 

 

Also, there's a "moderate" drug interaction between diphenhydramine and clonazepam:

 

Drug interaction report - diphenhydramine, Celexa, clonazepam

 

Please update your signature to reflect the changes in doses for your drugs. Your signature is here:

 

Account Settings - Create or Update Your Signature

 

Please pick a dose for each of your drugs and stay there for several months. Be consistent for best results. The fact that you're already experiencing windows is a great sign, so now is the time to go into a long hold and work on non-drug coping skills so you're prepared when you feel it's time to taper. At that point, you don't want to keep reaching for a drug or upping the dose of your current drugs in order to cope with withdrawal. You'll need to learn these skills:

 

Non-drug techniques to cope with emotional symptoms

 

Pick non-drug coping skills specific to your symptoms and add guided videos, mindfulness and breathing exercises, etc. into your daily life. By the time you're ready to taper, these skills should be automatic. 

 

For insomnia, please see: 

 

Tips to help sleep: so many of us have that awful withdrawal insomnia

 

 

 

 

Edited December 14, 2020 by Shep
added bolding

[Altostrata]

On 12/10/2020 at 4:07 AM, remakeremodel said:

I think I've made a huge mistake. I was panicking (hence all the changes), and on the advice on my doctor and her consulting psychiatrist I updosed to 30mg of Celexa on Tuesday. I also stupidly allowed her to prescribe Seroquel for sleep (as I'd be on it before), and I had an adverse reaction to it -- tachycardia. I still took it two nights in a row. I am still on 0.5mg of clonazepam per day. I now believe that the updose to 20mg of Celexa was a mistake as I've been getting worse and worse over the past few weeks. I've been feeling acutely suicidal over the past day and don't know what to do. Please help.

 

Did you discuss this with your doctor? You're free to follow your doctor's advice, but it's only fair that it it goes bad, you hold your doctor responsible, not bring it here to us unpaid volunteers for a solution.

 

12 hours ago, Shep said:

Why are you increasing the benzo when you're already stabilizing? 

 

Agree with Shep. What you're doing goes against common sense.

[remakeremodel]

On 12/14/2020 at 6:47 PM, Altostrata said:

 

Did you discuss this with your doctor? You're free to follow your doctor's advice, but it's only fair that it it goes bad, you hold your doctor responsible, not bring it here to us unpaid volunteers for a solution.

Apologies, Alto. I was very desperate/panicked when I wrote that and not in my right mind. I don't expect you to remedy anything that goes bad as a result of my following my doctor's orders.

 

On 12/14/2020 at 5:47 AM, Shep said:

When were you last at 1 mg clonazepam? According to your signature, you started 1 mg clonazepam on November 5.

 

Please note that benzo updoses work best within 2 - 4 weeks of the last change. When did you change the dose from 1 mg? 

Please see my updated signature. I updosed to 1mg on December 16 because I had been inconsistent with the dosing beforehand; I was sometimes taking another 0.5mg when I woke and couldn't get back to sleep. I have been on 1mg consistently since December 16.

 

Here is the dosing schedule I've been on since December 16:

• 30mg Celexa, taken at 1pm
• 4000mg fish oil, taken at 8pm
• 150mg magnesium, 1.5mg melatonin, and 1mg clonazepam, taken at 1am

Since updosing to 30mg Celexa on December 8, I've had several full-day windows, my sleep has improved, and the waves have been getting gentler. Unfortunately, I now feel awful again. I woke up on Sunday with a feeling of deep despair and had SI throughout the day; the despair isn't quite as intense now, but I still feel very, very low, almost as bad as I did when I wrote that post on December 10. I should mention that these symptoms coincided with my period; I also had intense feelings of despair and SI around the same time last month. Is this "just" a wave or a possible indication of something else? The intensity feels very frightening and has me worried that I'm not actually stabilizing. 

[Shep]

12 hours ago, remakeremodel said:

Here is the dosing schedule I've been on since December 16:

• 30mg Celexa, taken at 1pm
• 4000mg fish oil, taken at 8pm
• 150mg magnesium, 1.5mg melatonin, and 1mg clonazepam, taken at 1am

 

You could be going through a wave due to your period and / or it could be due to taking so many sedating supplements with your benzo at night. 

 

The 1.5 melatonin is a high dose. Please see:

 

Melatonin for sleep

 

Note that melatonin is one of those less-is-more type of supplements. 

 

You may want to wait a few days to see if the wave resolves on its own. If it doesn't, you may want to reduce the melatonin and see if that helps. 

 

[remakeremodel]

I reduced the melatonin to 0.75mg on Wednesday. That night my mother also took me to the psych hospital in Toronto as my SI had intensified. They switched me from clonazepam to the equivalent dose of lorazepam, which I took for two nights, but now my depression is unfortunately worse. I will go back to the clonazepam tonight. 

 

I hope I won't be judged too harshly for the drug change as I was feeling desperate. This is the blackest depression I've ever experienced, and is particularly devastating after weeks of improvement. Could really use some words of encouragement that this will end. I've been trying non-drug coping techniques, but they aren't doing much of anything right now. I'm seriously considering a voluntary hospital admission (where fortunately they don't force drugs on patients unless they're there involuntarily). 

[remakeremodel]

One other question: I know that benzos can cause depression. Is it possible that two months of daily benzo use have caused/worsened the depression I'm now experiencing? If so, what do I do?

[Shep]

Yes, benzos are central nervous system depressants, so they can cause depression. 

 

Did you have less depression when you were on the Keto diet? If you felt better on Keto, you may want to work on your diet to see if that helps. 

 

 

On 12/14/2020 at 6:47 PM, Altostrata said:

Did you discuss this with your doctor? You're free to follow your doctor's advice, but it's only fair that it it goes bad, you hold your doctor responsible, not bring it here to us unpaid volunteers for a solution.

 

Remaker, I'm going to emphasize what Alto wrote. You're seeking guidance in an inpatient situation now and making changes, like this one:

 

11 hours ago, remakeremodel said:

I reduced the melatonin to 0.75mg on Wednesday. That night my mother also took me to the psych hospital in Toronto as my SI had intensified. They switched me from clonazepam to the equivalent dose of lorazepam, which I took for two nights, but now my depression is unfortunately worse. I will go back to the clonazepam tonight. 

 

11 hours ago, remakeremodel said:

I'm seriously considering a voluntary hospital admission (where fortunately they don't force drugs on patients unless they're there involuntarily). 

 

If you're going to continue going into the hospital, please work with your doctor, not an online forum. As we've noted again and again on your thread, being consistent with your drugs is required if you wish to taper off these drugs safely. Otherwise, you're creating your own problems. 

 

Please see:

 

• what's required from you and your ability to self-manage

 

 

[remakeremodel]

I haven't yet gone inpatient but am feeling increasingly desperate as this wave doesn't seem to be lifting. If the benzos are causing/contributing to the depression, what are my options if it's too dangerous to just stop taking them? I really think they may be doing this as I take the clonazepam at night and the depression/anxiety is always worse upon waking. 

[Gridley]

32 minutes ago, remakeremodel said:

If the benzos are causing/contributing to the depression, what are my options if it's too dangerous to just stop taking them?

I find myself in a similar situation, having crossed over from Ativan (no longer available) to Diazepam, which I believe is causing/contributing to current depressive feelings.  Once I've stabilized from my cross-taper I'll begin a slow taper and just have to deal with the depressive feelings.  

 

Since you're been on the Clonazepam for over two months, it is very likely you are physiologically dependent.  You're correct that it's dangerous to just stop taking them.

 

The only way out that I see is with a slow taper.  10% a month may be too much.  You could start out with 5% a month and see how that works. Believe me, I know staying on and slow tapering a drug that is/may be causing a depression isn't appealing but I know of no other option.  If 5% works without causing withdrawal you could slowly increase to to 10%.  Another option is the Brassmonkey slide taper, which worked very well for me with my Lexapro taper.  

 

The Brassmonkey Slide Method of Micro-tapering

 

The following post, also from Brassmonkey, may also be helpful to you.  I'm speaking specifically about the second part of the post, which deals with what to do when after a couple of months you find the drug isn't treating you well.  As he says, a fast taper may be possible but is risky.  Again, I'd recommend a slow taper.

 

But I only took it for a Week

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[remakeremodel]

Thank you very much for the information, @Gridley. I still don't know whether the benzos are causing/worsening the depression. On the morning of January 13 I had a severe panic attack where I was genuinely afraid I was going to harm myself -- I took double my dose of lorazepam (4mg) in desperation, which immediately eased the anxiety and depression. I then had around four days of feeling relatively normal before the depression returned. I've now been on 2mg of lorazepam daily instead of 1mg of clonazepam since January 13. Could I be in clonazepam withdrawal? I was assured by two doctors at the psych hospital that I could switch directly from clonazepam to lorazepam if it was an equivalent dosage.

 

I was also advised by the doctors to increase my dose of Celexa to 40mg -- I took this dose from January 19 to 21 but it seemed to worsen the anxiety and depression, so I stopped. 

 

I apologize again for the drug changes. The severe wave I experienced at the beginning of this month really threw me. I've been feeling increasingly desperate and am losing hope that I can stabilize on the Celexa. If the current depression is the result of these changes, how long might it be until I level out again?

[Gridley]

1 hour ago, remakeremodel said:

I've now been on 2mg of lorazepam daily instead of 1mg of clonazepam since January 13. Could I be in clonazepam withdrawal? I was assured by two doctors at the psych hospital that I could switch directly from clonazepam to lorazepam if it was an equivalent dosage.

Different types of benzos affect people differently, so yes, you could be in Clonazepam withdrawal. These drugs are not one-size-fits-all nor are they across-the-board interchangeable, as I've learned.  

 

 There's no way to predict how long it will take to stabilize.  I've begun to stabilize from my crossover, after 2 months, but we are all different.   Clonazepam has a much longer half-life than Lorazepam, so the shorter half life of Lorazepam could also be affecting your mood. Benzos are tricky and can have depressive effects.

 

Another possibility is that you're having interdose withdrawal.  Do you take the 2mg Lorazepam at the same time?  You might consider spreading out your dosage and see how that works.  How do you feel after taking your dose(s)?

 

40mg of Celexa is a very high dosage.  

Edited January 25, 2021 by Gridley