PurplePaisley: tapering citalopram

[Greatful]

@PurplePaisley 

34 minutes ago, PurplePaisley said:

I'm so disheartened by the response of the psychiatrist (see my previous posts). I don't even want to read the messages that she sent through my electronic chart.

 

I go through anger spell when I think of the doctors and their lack of knowledge.  I really don't know how they can still be so in the dark.  There is so much information surfacing through the web, anywhere there are books,  Shame on them for listening to the Big Pharma for their education.

When I get enough energy together I want to compile information on Sert  transport occupancy, withdrawal symptoms, kindling, whatever I can find and send them to my old Physiatrist who messed me up bad and then gave up on me,  and ask him to educate himself and his colleagues about how to safely prescribe these meds and how to safely get off of them.  I mean really, some of the drugs shouldn't even be taken together. And they were never meant to be taken long term. 

 

Here is another site that is interesting, and full of information on  psychiatric drugs and withdrawal.

https://withdrawal.theinnercompass.org/page/wondering-where-start

 

55 minutes ago, PurplePaisley said:

I got myself out of the house (alone! without my husband!) a couple of weeks ago

It is so liberating to gain some time outside of your house.  

You should be very proud of yourself.  You are finding ways to get through each day.

Hang in there, I know how tough this road to travel is, remember you are never alone and just a post away from support.❤️

[PurplePaisley]

Thank you, @Greatful.

Yes, I'm getting through each day with the help of breathing, my husband, mild exercise, and distraction. I'm hopeful that I can start to regain some of my mental and physical health that I've already lost to the WD process. For now, I'm hanging on. If I could just give up the several years of my life that I expect tapering to require, and come out the other side without the SSRI and without withdrawal symptoms, I would consider it. That's just a cry of frustration.

[PurplePaisley]

@Greatful, I've just updosed citalopram from 6.5 mg/day to 7 mg/day today. I have continued to suffer strong, debilitating physical and emotional symptoms (anxiety, shaking, insomnia, brain fog, headaches, poor appetite alternating with snacking, emotional lability/swings, anhedonia, neuroemotions running wild, emotional spirals, and more) the great majority of days since increasing 7 weeks ago (from 6 mg/day to 6.5 mg/day).

 

I can't function as an adult the way I feel now. I can't make decisions; I can't understand most of what I try to read that relates to things that I absolutely need to do; I can barely function as if I were a child, despite receiving a great deal of support and care from my husband.

 

If I don't see improvements over the next week or two, I will have to consider another updose. I hoped to be feeling and functioning better 7 weeks after my last updose, but I'm really not, except for a couple of periods that lasted 2-1/2 days each. I have no stability, no consistency, and no predictability.

 

Any suggestions for a moderator to bring into the discussion while Gridley is taking a break?

 

Please let me know your thoughts.

 

Thank you so much,

 - PP

Edited September 9, 2021 by PurplePaisley
Edited to "@" Greatful without bolding (which appeared to prevent "@" from working properly).

[Greatful]

@PurplePaisley  I am so sorry that you are still struggling.  It is a terrible drug when you can't function without it.  You get yourself stable and then we can walk you through getting off these horrible drugs.  We will get there you and I❤️

 

I think @Altostrata @brassmonkey @Go2zero One of these will be able to help you.

[Altostrata]

Hello, @PurplePaisley 

 

What times o'clock do you take your drugs, with their dosages? Are these symptoms worse or better at any times of the day? What is your sleep pattern?
 

 

[PurplePaisley]

Hello, @Altostrata.

 

My only psych med is citalopram, which I take ~ 8 - 9 am. I updosed just today, from 6.5 mg/day to 7 mg/day. I have kept my SSRI dosing info up to date in my Sig, but I see that I have to add the info that I've continued to experience bad symptoms after each updose. I've made the needed edits.

 

The symptoms begin at lower levels right when I wake up (generally ~ 6 - 7 am) and quickly start to increase, generally reaching a peak by late morning or the middle of the afternoon, and generally staying high until I sometimes get some relief starting in early evening (say, ~ 6 pm). Sometimes the symptoms remain very bad until I finally fall asleep at night.

 

I need a lot of sleep (optimally ~9 to 9-1/2 hours), so I generally get into bed anywhere from 8 to 9:30 pm. It often takes me a long time to get to sleep, and I wake up between ~ 1-1/2 to 3 hours after getting to sleep; I often feel some anxiety and require a long time to return to sleep. Then I generally wake up 1 to 3 more times (with ~1-1/2 to 3 hours between awakenings), often with some anxiety, and usually have difficulty getting back to sleep. I've generally been getting ~ 5-1/2 to 6-1/2 hours of sleep a night (sometimes less, sometimes more).

 

Thank you.

 - PP

Edited September 9, 2021 by PurplePaisley
Re "@" 'd Altostrata (didn't seem to work originally). Added reasons for updosing to Sig; noted this in post. Added more detail re later awakenings.

[Altostrata]

How do you feel after taking citalopram in the morning? How has your symptom pattern changed since July 22?

[PurplePaisley]

Hi, @Altostrata. I don't seem to experience any relief soon after taking citalopram. In fact, the symptoms often ramp up to their maximum (for the day) between dosing time and late morning or mid-afternoon. So I don't think that the issue is interdose variation in drug levels.

 

I have not been able to track my symptoms well in a spreadsheet (I shake so much that it's hard to type numbers into the correct cells), but based on my recollections and what I have put into the spreadsheet, I can say that I've had a lot of variability since July 22. A week and a half after July 22, for example, I had a mediocre day (say, 3 out of 5 on a rough "how bad?" scale), followed by a truly horrible day (5 out of 5), followed by a pretty good day (2 out of 5).

Since then, I've had mostly bad days (4 out of 5) (with some awful ones -- say, 4.5 out of 5); some bad days (4 out of 5) that were followed by a slightly less-bad day (3.5 out of 5), and a couple of periods of feeling pretty good (2 out of 5) that lasted 2-1/2 days each. So there's slightly less variability than before July 22.

I haven't captured enough data in the spreadsheet to say more than this.

 

Except for the unpredictable periods of feeling good, I'd say that my symptoms have simply remained quite bad since July 22. However, compared with the horrible (5 out of 5) days I experienced in early to mid July, I have had fewer horrible days than before July 22.

 

And, as mentioned, lately I sometimes get some relief in the evenings, which wasn't noticeable before my last updose.

 

Thank you,

PP

[Altostrata]

Have you taken an antibiotic or had covid-19 since mid-April?

 

Please keep daily notes of times o'clock you take your drugs, their dosages, and your symptoms throughout the day. We need to know how you feel before and after taking each drug, and your symptoms in between. Post 24 hours of notes at a time in this topic, in a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right. This can show if your symptoms are adverse effects from one of your drugs.

[PurplePaisley]

@AltostrataI tried to post a reply soon after you posted, but it didn't go through.

 

It's been a truly horrific day. My symptoms continued to worsen until early evening, when I had a crisis. After discussing the situation with my husband, I have this evening reinstated at 10 mg/day -- will post a detailed update tomorrow.

 

My most horrible symptoms improved greatly, within an hour and a quarter after taking an additional 3 mg (for a total of 10 mg today).

 

Regards,

PurplePaisley

 

 

[Altostrata]

You may have needed a higher dose for reinstatement. If you get new symptoms, we will need to see those daily notes as requested.

[PurplePaisley]

Quote

 

Thank you, @Altostrata. I just hope that I have not sensitized myself to the point that I need to push the dose higher.

To answer your previous questions, I have not taken antibiotics this year, and I have not, as far as I know, had a COVID-19 infection. (I'm fully vaccinated, so an infection is unlikely to be severe.)

 

Last night, at about the time that my symptoms sometimes start to ease up in the evening, I had a flash of an urge to hurt myself. it's been a stressful week, but not so stressful that I would normally think about self-harm. Thoughts of self-harm were not part of my pre-WD self except when under extreme personal stress (e.g., personal crisis plus no sleep, with no support). My other symptoms yesterday were worse than I'd ever experienced before taking any antidepressant.

 

I filled out the daily med/symptom sheet for yesterday through last night. Please advise how best to make this clearer to read -- I'm not seeing a good way to make this detailed info into a simple list without a lot of retyping. I will continue to monitor my symptoms and document on this sort of sheet, in case symptoms worsen again or a new symptom develops.

Note: I use a "zero to 5" rating system.

Time	Dose (mg) or Symptom	Describe symptom in your words	onset: S or G	how long	resolution: S or G	Rating (out of 5)
~ 1:15 am	Migraine	Moderate migraine (throbbing head pain) felt on awakening during night; 2nd night in a row of nighttime migraine	S	~1 hour	G	3
~ 1:15 am	Sumatriptan 50 mg	For migraine
~ 1:15 am	Ibuprofen 400 mg	For migraine
~7 am	Levothyroxine 25 mcg	For hypothyroidism
~7 am	Anxiety	On awakening: anxiety, feeling of impending doom	S	Until evening	G	3 @ 7 am, 4 @ 8:30 am, 5 @ 2 pm
~7 am	Shaking	On awakening or a few minutes after: Internal & external (visible) shaking	S	Until evening	G	3 @ 7 am 4 @ 8:30 am
~7 am	Depression	On awakening or a few minutes after:Feeling worthless, helpless, and without pleasure in life	S	Until evening	G	3 @ 7 am, 4 @ 2 pm
~7:30 am	L-theanine 100 mg	Taken for anxiety; not effective
~8:30 am	Anxiety	Worsened: Anxiety, feeling of impending doom, difficulty typing (writing by hand nearly impossible)	G incr.	Until evening	G	3 @ 7 am, 4 @ 8:30 am, 5 @ 2 pm
~8:30 am	Shaking	Worsened: Internal & external (visible) shaking	G incr.	Until evening	G	3 @ 7 am, 4 @ 8:30 am, 5 @ 2 pm
~8:30 am	Brain fog	Hard to think, remember, focus; difficulty understanding non-simple speech, or reading much of anything	S	Until evening	G	3 @ 8:30 am, 4 @ 2 pm, 5 @ 6 pm
~8:45 am	Citalopram 6.5 mg	SSRI
~8:45 am	Magnesium citrate (250 mg magnesium)	Was on magnesium oxide (400 mg magnesium) once daily since well before SSRI WD; switched mid-July
~8:45 am	Loratatadine 10 mg	Antihistamine -- Have been on this since well before SSRI WD
~8:45 am	Lisinopril 5 mg / hydrochlorothiazide 6.25 mg	For high blood pressure -- Have been on this since well before SSRI WD, though was off it for several weeks in July-August due to lower BP
~8:45 am	Vitamin D3 2,000 IU (50 mcg)	Have been on this since well before SSRI WD
~8:45 am	Fluticasone nasal spray 50 mcg in each nostril	For nasal allergies - Have been on this since well before SSRI WD
~8:45 am	Calcium 500 mg / Vitamin D3 400 IU (10 mcg)	Have been on this since well before SSRI WD
~8:45 am	Niacinamide 500 mg	Have been on this since well before SSRI WD
~8:45 am	Flaxseed oil 1,400 mg (700 mg omega-3)	Have been on this since well before SSRI WD
~8:45 am	Kirkland (Costco) Mature Multivitamin / Mineral	Have been on this since well before SSRI WD
~8:45 am	Nature's Bounty Probiotic 10: 20 billion live culture CFU	Have been on some form of probiotic (not necessarily this product) since well before SSRI WD
~8:45 am	Psyllium 3 g	As fiber supplement for better bowel function - Have been on this since well before SSRI WD
~9:30 am	Racing, pounding heart	Racing, pounding heart: HR 99	G		G	4
~ 10 am	Pseudoparkinsonism: jerky, stiff movements	Jerky, stiff movements	G	Until ~ 7 pm	G	2
11:00:00 AM	No interest in food	Very little interest in food	G	Until ~ 7:30 pm	G	4
~ 2 pm	Anxiety	Worsened: Anxiety, feeling of impending doom, difficulty typing (writing by hand nearly impossible)	G incr.		G	3 @ 7 am, 4 @ 8:30 am, 5 @ 2 pm
~ 2 pm	Shaking	Worsened: Internal & external (visible) shaking	G incr.		G	3 @ 7 am, 4 @ 8:30 am, 5 @ 2 pm
~ 2 pm	Depression	Worsened: Feeling worthless, helpless, and without pleasure in life	G incr.		G	3 @ 7 am, 4 @ 2 pm
~ 2 pm	Brain fog	Worsened: Hard to think, remember, focus; difficulty understanding non-simple speech, or reading much of anything	G incr.		G	3 @ 8:30 am, 4 @ 2 pm, 5 @ 6 pm
~ 2 pm	L-theanine 100 mg	Taken for anxiety; not effective
~ 6 pm	Calcium 500 mg / Vitamin D3 400 IU (10 mcg)	Have been on this since well before SSRI WD
~ 6 pm	Niacinamide 500 mg	Have been on this since well before SSRI WD
~ 6 pm	Psyllium 3 g	As fiber supplement for better bowel function - Have been on this since well before SSRI WD
~ 6 pm	Brain fog	Hard to think, remember, focus; difficulty understanding non-simple speech, or reading much of anything	G incr.	Until ~ 8 pm	G	3 @ 8:30 am, 4 @ 2 pm, 5 @ 6 pm
06:10:00 PM	Flash of urge to hurt myself	Flash or urge to hurt myself so that I could feel something other than the distress I've been flooded with all day. Decided to reinstate 10 mg/day after discussion with my husband	S	Brief	G	3
06:15:00 PM	Citalopram 3 mg	Took citalopram 3 mg for total of 10 mg today. Will continue on this until I stabilize, then decide whether to try a LONG taper.
07:30:00 PM	Feeling much better	Feeling much better: Anxiety lower Shaking lower Depression lower	G			2 2 2
07:45:00 PM	Headache	Brief return of migraine – this is typical. Migraines often return for 2 or 3 days.	S	Brief	G	2
08:00:00 PM	Vital signs better	Heart no longer racing, just slightly pounding: BP 102/62; HR 83	G			1
08:30:00 PM	Went to bed
10:00:00 PM	Unable to sleep; developing some migraine symptoms	Some migraine pain				2
10:00:00 PM	Sumatriptan 50 mg	For migraine
10:00:00 PM	Ibuprofen 200 mg	For migraine
10:00:00 PM	Magnesium citrate (250 mg magesium)

 

Thank you for your input and support.

Regards,

PP

 

[Altostrata]

How often do you take a triptan for migraine?

 

Please put ALL your drugs in this Interactions Checker and post the report or a link to it in this topic.

[PurplePaisley]

I have a spate of migraines generally every 6-8 weeks (or farther apart). When a migraine starts, I can take 50 mg sumatriptan every 2 hours until the headache has resolved, with a maximum of 200 mg in 24 hours. Since migraines often come back for 2 or 3 days, I generally take 50 mg one day, then 50 mg the next day, etc., for a maximum of 250 mg in a week.

I've pasted info from the interactions report at the end of my post.

I left out: the 2 minor warnings (which don't even have details in the consumer version of the report); the food/alcohol warnings (I don't drink alcohol, and I already know about the psyllium issue -- see my note below); and the therapeutic duplication info.

I tweaked the format to take up less space.

 

Notes relating to the warnings:

• I have taken potentially interacting meds citalopram, lisinopril/hydrochlorothiazide, sumatriptan, ibuprofen (nearly always taken with sumatriptan), and calcium/vitamin D for years without problems, they're all in my electronic medical record, and my healthcare providers are aware that I take all of these.
• The combined vitamin D sources bring me up to recommended daily doses.
• Citalopram's risk of heart rhythm problems is quite low at doses below 40 mg/day; I don't take magnesium at laxative levels.
• My kidney function is good; I get regular lab tests to monitor it.
• I included inhaled albuterol in the list (I take it very rarely) -- since it's inhaled, it has very low systemic absorption and a very low risk of interactions.
• I forgot to include inhaled beclomethasone (QVAR) originally -- since it's inhaled, it has very low systemic absorption and a very low risk of interactions.
• My dose of lisinopril / hydrochlorothiazide is very low, and I get regular lab tests for relevant electrolyte levels (potassium, sodium).
• I've always taken psyllium along with my other meds (except levothyroxine, which I take an hour before anything else), so any needed dose adjustments have been made.

Drug Interaction Report  This report displays the potential drug interactions for the following 18 drugs:

• psyllium
• loratadine
• PreserVision AREDS 2 (multivitamin with minerals) [I couldn't find the specific lutein / zeaxanthin product that I use, or the 2 individual components]
• Calcium 600 D (calcium / vitamin d)
• Vitamin D3 (cholecalciferol)
• magnesium citrate
• sumatriptan
• ibuprofen
• levothyroxine
• citalopram
• hydrochlorothiazide / lisinopril
• fluticasone nasal
• albuterol
• beclomethasone
• niacinamide
• Flax Seed Oil (flax)
• Procycle Multi Vitamin with Minerals (multivitamin with minerals) [I couldn't find a more general multivit/mineral product]
• Nature's Bounty Probiotic (bifidobacterium infantis / lactobacillus acidophilus) [I couldn't find the specific product that I use]

Major (2)

Moderate (18)

Minor (2)

Food (6)

Interactions between your drugs

Major    SUMAtriptan citalopram       Applies to: sumatriptan, citalopram

Using SUMAtriptan together with citalopram can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Major   ergocalciferol cholecalciferol        Applies to: Calcium 600 D (calcium / vitamin d), Vitamin D3 (cholecalciferol)

Using ergocalciferol together with cholecalciferol should generally be avoided unless otherwise directed by your doctor. Both of these medications are forms of vitamin D, and taking too much vitamin D can lead to toxic effects related to excessive calcium levels in the blood and urine, such as irregular heart rhythm, seizures, kidney stones, and eventual calcification of blood vessels, cornea, and soft tissues of the body. If you take digoxin, a common heart medication, having a high blood level of calcium can also increase the risk of developing digoxin toxicity. Talk to your doctor if you have any questions or concerns. You will need close monitoring of your calcium and phosphorus levels to safely use these medications. You should avoid an abrupt increase in your dietary calcium intake, and seek medical attention if you experience early symptoms of vitamin D intoxication such as weakness, fatigue, headache, drowsiness, vertigo, ringing in the ears, loss of appetite, nausea, vomiting, constipation, dry mouth, metallic taste, muscle pain, bone pain, muscle incoordination, and low muscle tone. Late symptoms may include frequent urination, excessive thirst, weight loss, conjunctivitis ("pink eye"), light sensitivity, runny nose, itching, increased body temperature, and irregular heart rhythm. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate    hydroCHLOROthiazide ergocalciferol        Applies to: hydrochlorothiazide / lisinopril, Calcium 600 D (calcium / vitamin d)

Using hydroCHLOROthiazide together with ergocalciferol can cause your blood calcium levels to become too high. Contact your doctor if you experience symptoms such as dizziness, drowsiness, weakness, lethargy, headache, nausea, vomiting, or seizures. You may need a dose adjustment or special test if you use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate    magnesium citrate citalopram        Applies to: magnesium citrate, citalopram

Citalopram can cause an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. The risk is increased if you have low blood levels of magnesium or potassium, which can occur with bowel cleansing preparations or excessive use of medications that have a laxative effect. Do not exceed the dose and duration of use of magnesium citrate recommended on the product label or prescribed by your doctor. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications. In addition, you should let your doctor know if you experience signs and symptoms of low magnesium or potassium blood level such as weakness, tiredness, drowsiness, dizziness, confusion, tingling, numbness, muscle pain, cramps, nausea, or vomiting. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate    albuterol citalopram        Applies to: albuterol, citalopram

Using albuterol together with citalopram can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). The risk exists even when albuterol or similar medications are given by oral inhalation directly into the lungs, and more so if these products are overused. Do not exceed the dose and frequency of use recommended on the product label or prescribed by your doctor. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate    hydroCHLOROthiazide citalopram        Applies to: hydrochlorothiazide / lisinopril, citalopram

Treatment with citalopram may occasionally cause blood sodium levels to get too low, a condition known as hyponatremia, and using it with hydroCHLOROthiazide can increase that risk. You should seek medical attention if you experience nausea, vomiting, headache, lethargy, irritability, difficulty concentrating, memory impairment, confusion, muscle spasm, weakness or unsteadiness, as these may be symptoms of hyponatremia. More severe cases may lead to hallucination, fainting, seizure, coma, and even death. Citalopram can also affect your blood pressure and heart rate. You may need a dose adjustment or more frequent monitoring of your blood pressure and pulse to safely use both medications. You should avoid rising abruptly from a sitting or lying position while taking these medications, especially at the beginning of treatment or after an increase in dose. Call your doctor if you experience dizziness, lightheadedness, fainting, or a rapid heart beat. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate    ibuprofen citalopram        Applies to: ibuprofen, citalopram

Using citalopram together with ibuprofen may increase the risk of bleeding. The interaction may be more likely if you are elderly or have kidney or liver disease. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you experience any unusual bleeding or bruising, or have other signs and symptoms of bleeding such as dizziness; lightheadedness; red or black, tarry stools; coughing up or vomiting fresh or dried blood that looks like coffee grounds; severe headache; and weakness. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate    levothyroxine multivitamin with minerals        Applies to: levothyroxine, PreserVision AREDS 2 (multivitamin with minerals), Procycle Multi Vitamin with Minerals (multivitamin with minerals)

Using multivitamin with minerals together with levothyroxine may decrease the effects of levothyroxine. You should separate the administration of levothyroxine and multivitamin with minerals by at least 4 hours. If your doctor does prescribe these medications together, you may need a dose adjustment or special test to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate    magnesium citrate cholecalciferol        Applies to: magnesium citrate, Vitamin D3 (cholecalciferol)

Using cholecalciferol together with magnesium citrate can lead to elevated magnesium blood levels, particularly in individuals with reduced kidney function. Symptoms of high magnesium levels may include nausea, vomiting, flushing, drowsiness, dizziness, confusion, muscle weakness, reduced reflexes, low blood pressure, slow heart rate, and impaired breathing. You should seek medical attention if you experience these symptoms. If you are on dialysis and treated with cholecalciferol or other vitamin D medications, you should generally avoid taking products that contain magnesium without first talking to your doctor, as high levels of magnesium over time can lead to bone problems. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate    hydroCHLOROthiazide cholecalciferol        Applies to: hydrochlorothiazide / lisinopril, Vitamin D3 (cholecalciferol)

Using hydroCHLOROthiazide together with cholecalciferol can cause your blood calcium levels to become too high. Contact your doctor if you experience symptoms such as dizziness, drowsiness, weakness, lethargy, headache, nausea, vomiting, or seizures. You may need a dose adjustment or special test if you use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate    magnesium citrate ergocalciferol        Applies to: magnesium citrate, Calcium 600 D (calcium / vitamin d)

Using ergocalciferol together with magnesium citrate can lead to elevated magnesium blood levels, particularly in individuals with reduced kidney function. Symptoms of high magnesium levels may include nausea, vomiting, flushing, drowsiness, dizziness, confusion, muscle weakness, reduced reflexes, low blood pressure, slow heart rate, and impaired breathing. You should seek medical attention if you experience these symptoms. If you are on dialysis and treated with ergocalciferol or other vitamin D medications, you should generally avoid taking products that contain magnesium without first talking to your doctor, as high levels of magnesium over time can lead to bone problems. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate    ibuprofen hydroCHLOROthiazide        Applies to: ibuprofen, hydrochlorothiazide / lisinopril

Before taking hydroCHLOROthiazide, tell your doctor if you also use ibuprofen. You may need dose adjustments or special tests in order to safely take both medications together. If you are receiving this combination drink plenty of water. Blood pressure and kidney function should be monitored as well. It is important that you tell your healthcare provider about all other medications that you are using including vitamins and herbs. Do not stop using your medications without first talking to your doctor.

 

Moderate    albuterol magnesium citrate        Applies to: albuterol, magnesium citrate

Albuterol can cause an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. The risk is increased if you have low blood levels of magnesium or potassium, which can occur with bowel cleansing preparations or excessive use of medications that have a laxative effect. Do not exceed the dose and duration of use of magnesium citrate recommended on the product label or prescribed by your doctor. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications. In addition, you should let your doctor know if you experience signs and symptoms of low magnesium or potassium blood level such as weakness, tiredness, drowsiness, dizziness, confusion, tingling, numbness, muscle pain, cramps, nausea, or vomiting. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate    hydroCHLOROthiazide magnesium citrate        Applies to: hydrochlorothiazide / lisinopril, magnesium citrate

Talk to your doctor before using hydroCHLOROthiazide together with any kind of medication that has a laxative effect. Combining these medications, especially over a prolonged period, may increase the risk of dehydration and electrolyte abnormalities. In severe cases, dehydration and electrolyte abnormalities can lead to irregular heart rhythm, seizures, and kidney problems. You should use magnesium citrate exactly as prescribed by your doctor or as directed on the label of the medication. Contact your doctor if you experience potential signs and symptoms of fluid and electrolyte depletion such as dizziness, lightheadedness, dry mouth, thirst, fatigue, weakness, muscle cramps, decreased urination, palpitation, and increased heart rate. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate    hydroCHLOROthiazide beclomethasone        Applies to: hydrochlorothiazide / lisinopril, beclomethasone

Before using hydroCHLOROthiazide, tell your doctor if you also use beclomethasone. You may need a dose adjustment or special tests in order to safely take both medications together. This combination may cause muscle pains or cramps, loss of appetite, weakness, dizziness, or confusion. If you take both medications together, tell your doctor if you have any of these symptoms. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate    hydroCHLOROthiazide albuterol        Applies to: hydrochlorothiazide / lisinopril, albuterol

Using hydroCHLOROthiazide together with albuterol may increase the risk of developing hypokalemia, or low blood potassium. In severe cases, hypokalemia can lead to muscle weakness, paralysis, breathing and swallowing difficulties (due to muscle paralysis), and irregular heart rhythm. The risk may exist even when albuterol or similar medications are given by oral inhalation directly into the lungs, and more so if these products are overused. Do not exceed the dose and frequency of use recommended on the product label or prescribed by your doctor. Let your doctor know if you experience nausea, vomiting, constipation, abdominal cramping, confusion, dizziness, lightheadedness, fainting, muscle weakness, muscle cramps, numbness, tingling, rapid heartbeat, chest pain, and/or swelling in the legs or feet, as these may be symptoms of hypokalemia. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate    hydroCHLOROthiazide lisinopril        Applies to: hydrochlorothiazide / lisinopril, hydrochlorothiazide / lisinopril

Although hydroCHLOROthiazide and lisinopril are frequently combined together, their effects may be additive on lowering your blood pressure. You may need a dose adjustment or special tests to safely take both medications. Contact your doctor if you have a reduced heart rate, dizziness, fainting, or headaches. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate    ibuprofen lisinopril        Applies to: ibuprofen, hydrochlorothiazide / lisinopril

Talk to your doctor before using lisinopril together with ibuprofen. Combining these medications may reduce the effects of lisinopril in lowering blood pressure. In addition, these medications may affect your kidney function, especially when they are used together frequently or chronically. You are more likely to develop impaired kidney function during treatment with these medications if you are also using a diuretic ("water pill") or if you are elderly or have preexisting kidney disease. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Contact your doctor if you experience signs and symptoms that may suggest kidney damage such as nausea, vomiting, loss of appetite, increased or decreased urination, sudden weight gain or weight loss, fluid retention, swelling, shortness of breath, muscle cramps, tiredness, weakness, dizziness, confusion, and irregular heart rhythm. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate    levothyroxine calcium carbonate        Applies to: levothyroxine, Calcium 600 D (calcium / vitamin d)

Using calcium carbonate together with levothyroxine may decrease the effects of levothyroxine. You should separate the administration of levothyroxine and calcium carbonate by at least 4 hours. If your doctor does prescribe these medications together, you may need a dose adjustment or special test to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate    hydroCHLOROthiazide calcium carbonate        Applies to: hydrochlorothiazide / lisinopril, Calcium 600 D (calcium / vitamin d)

Using hydroCHLOROthiazide together with calcium carbonate can cause your blood calcium levels to become too high. Contact your doctor if you experience symptoms such as dizziness, drowsiness, weakness, lethargy, headache, nausea, vomiting, or seizures. You may need a dose adjustment or special test if you use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

 - PP

[Altostrata]

What are all the drugs and supplements you take at the same time as citalopram?

 

When was the last time your thyroid treatment was reviewed? Please look up adverse effects of excessive levothyroxine.

[PurplePaisley]

Hi, @Altostrata. I generally take the following together with citalopram:

 

loratadine

Preservision [or something close in formulation to this product]

calcium / vitamin D

vitamin D

[Previously, I took magnesium citrate along with it (but I'm changing to once daily in the evening, now that my anxiety is much lower)]

hydrochlorothiazide / lisinopril

fluticasone nasal

beclomethasone (which is inhaled)

niacinamide

flax seed oil

multivitamin w/ minerals

probiotic (though sometimes I take this in the evening instead)

psyllium

 

I get tested for thyroid function each year -- I'm scheduled to go to the lab this week, so I'll know soon whether my levothyroxine dose needs changing. My occasionally high heart rate correlates pretty well with external stress, not just anxiety.

 

Thank you,

PP

 

 

[Altostrata]

Please figure out how to take that basketful of drugs and supplements at a time at least 2 hours removed from citalopram. Once you do this, we need your daily notes for the next week.

[PurplePaisley]

Hi, @AltostrataSorry, I’m not understanding. I reinstated 10 mg/day on September 9. Won’t an additional regimen alteration (separating out citalopram from other meds) make it harder to figure out which symptom changes in the near future are due *only* to the reinstatement?

Sorry if I’m being a bit dense.

 — PP

[Altostrata]

14 hours ago, PurplePaisley said:

Won’t an additional regimen alteration (separating out citalopram from other meds) make it harder to figure out which symptom changes in the near future are due *only* to the reinstatement?

 

No, it will make it easier, that's why I requested it. Also, you might be getting an adverse reaction to your supplement cocktail.

[PurplePaisley]

Here's my symptom and med (Rx/OTC/supplement) log for yesterday (9/12/21):

Time	Dose (mg) or Symptom	Describe symptom in your words	onset: S or G	how long	resolution: S or G	Rating (out of 5)
~7 am	Levothyroxine 25 mcg	For hypothyroidism
~7 am	Anxiety	On awakening: slight anxiety	S	All day & night	N/A	1 @ ~7 am, 2 @ ~9:30 am, 3 @ ~12 noon, 1 @ ~6:30 pm, 1 @ ~8:30 pm
~7 am	Shaking	On awakening or a few minutes after: slight internal & external (visible) shaking	S	Until ~ 8:30 pm	G	1 @ ~7 am, 2 @ ~9:30 am, 1 @ ~6:30 pm, 0 at ~8:30 pm
~7 am	Depression	On awakening or a few minutes after: slight symptoms of feeling worthless, helpless, and without pleasure in life	S	Until ~ 8:30 pm	G	1 @ ~7 am, 2 @ ~2 pm
~8:30 am	Citalopram 10 mg	SSRI
Note	Stopped morning magnesium citrate dose	Stopped morning magnesium citrate dose, since anxiety much better
~8:30 am	Fluticasone nasal spray 50 mcg in each nostril	For nasal allergies - Have been on this since well before SSRI WD
~8:30 am	Beclomethasone inhaled 160 mcg	Have been on this since well before SSRI WD
~9:30 am	Anxiety	Slightly worsened: Anxiety, feeling of impending doom, difficulty writing by hand	G incr.	All day and night	G	1 @ ~7 am, 2 @ ~9:30 am, 3 @ ~12 noon, 1 @ ~6:30 pm 1 @ ~8:30 pm
~9:30 am	Shaking	Slightly worsened: Internal & external (visible) shaking	G incr.	Until ~bedtime	G	1 @ ~7 am, 2 @ ~9:30 am, 1 @ ~6:30 pm, 0 at ~8:30 pm
~ 9:30 am	Brain fog	Slight symptoms: Hard to think, remember, focus; difficulty understanding non-simple speech	G	Until ~ 6 pm	G	1 @ ~9:30 am, 2 @ ~2 pm, 0 @~ 6:30 pm
~11:15 am	Loratatadine 10 mg	Antihistamine -- Have been on this since well before SSRI WD
~11:15 am	Lisinopril 5 mg / hydrochlorothiazide 6.25 mg	For high blood pressure -- Have been on this since well before SSRI WD, though was off it for several weeks in July-August due to lower BP
~11:15 am	Vitamin D3 2,000 IU (50 mcg)	Have been on this since well before SSRI WD
~11:15 am	Calcium 500 mg / Vitamin D3 400 IU (10 mcg)	Have been on this since well before SSRI WD
~11:15 am	Niacinamide 500 mg	Have been on this since well before SSRI WD
~11:15 am	Flaxseed oil 1,400 mg (700 mg omega-3)	Have been on this since well before SSRI WD
~11:15 am	Kirkland (Costco) Mature Multivitamin / Mineral	Have been on this since well before SSRI WD
~11:15 am	Nature's Bounty Probiotic 10: 20 billion live culture CFU	Have been on some form of probiotic (not necessarily this product) since well before SSRI WD
~11:15 am	Psyllium 3 g	As fiber supplement for better bowel function - Have been on this since well before SSRI WD
~ 11:30 am	Chest discomfort, heart pounding	Some chest discomfort, feeling that heart is pounding – I often have this midday or early afternoon. Late-morning meds haven't had a chance to be absorbed yet.	G	~ 1/2 hr.	G	2
~ 11:30 am	Vital signs	BP 118/72 – good! HR 80 – this is not high for me lately
~ 12 noon	Anxiety	Anxiety slightly worsened: Anxiety, feeling of impending doom, difficulty writing by hand	G	All day and night	G	1 @ ~7 am, 2 @ ~9:30 am, 3 @ ~12 noon, 1 @ ~6:30 pm 1 @ ~8:30 pm
~ 12 noon	Sense of unreality	Slight sense of unreality (this was a prominent symptom while trying to taper)	G	~ 4 hrs.	G	1
~ 2 pm	Brain fog	Slightly worsened: Hard to think, remember, focus; difficulty understanding non-simple speech	G	Until evening	G	1 @ ~9:30 am, 2 @ ~2 pm, 0 @~ 6:30 pm
~ 2 pm	Depression	Slightly worsened: Feeling worthless, helpless, and without pleasure in life	G	Until ~bedtime.	G	1 @ ~7 am, 2 @ ~2 pm, 0 @ 8:30 pm
~ 2 pm	Feeling unwell	Some general feelings of coming down with something; occasional flashes of slight disequilibrium	G	~ 4 hrs.		2
~ 6 pm	Epsom salt bath
~ 6: 30 pm	Calcium 500 mg / Vitamin D3 400 IU (10 mcg)	Have been on this since well before SSRI WD
~ 6:30 pm	Niacinamide 500 mg	Have been on this since well before SSRI WD
~ 6:30 pm	Magnesium citrate (250 mg magnesium)	Stopped morning dose, since anxiety much less Was on magnesium oxide (400 mg magnesium) once daily since well before SSRI WD; switched mid-July
~ 6:30 pm	Psyllium 3 g	As fiber supplement for better bowel function - Have been on this since well before SSRI WD
~ 6:30 pm	Feeling much better	Feeling much better: Anxiety lower   Shaking lower Depression lower Brain fog gone	G	Anxiety remained; shaking, depression, brain fog gone by ~8:30 pm	G	1 (continued overnight) 1 1 0
~ 8:30 pm	Went to bed	Difficulty getting to sleep, and multiple awakenings, as usual				3

 

[PurplePaisley]

 

Here's my symptom and med (Rx/OTC/supplement) log for yesterday (9/13/21):

Time	Dose (mg) or Symptom	Describe symptom in your words	onset: S or G	how long	resolution: S or G	Rating (out of 5)
~6 am	Levothyroxine 25 mcg	For hypothyroidism
~6 am	Anxiety	On awakening early (got back to sleep briefly): slight anxiety	S	All day & night	N/A	1 @ 6 am, 2 @ 7 am, 1 @ 5:30 pm
~ 7 am	Anxiety	On awakening for the day or a few minutes after: slightly worsened anxiety	G	All day & night	N/A	1 @ 6 am, 2 @ 7 am, 1 @ 5:30 pm
~7 am	Shaking	On awakening for the day or a few minutes after: slight internal & external (visible) shaking	S	Until ~ 8:30 pm	G	1 @ 7 am, 2 @ 8:30 am, 1 @ 5:30 pm
~7 am	Depression	On awakening for the day or a few minutes after: slight symptoms of feeling worthless, helpless, and without pleasure in life	S	Until ~ 5:30 pm	G	1 @ 7 am
~7:30 am	Vital signs	BP 107/67 HR 78 (this is typical for me lately)
~8:20 am	Citalopram 10 mg	SSRI
Note	Stopped morning magnesium citrate dose	Stopped morning magnesium citrate dose, since anxiety much better
~8:20 am	Beclomethasone inhaled 160 mcg	Have been on this since well before SSRI WD
~8:30 am	Shaking	Slightly worsened: internal & external (visible) shaking, hard to write by hand	G incr.	Until ~ 8:30 pm	G	1 @ 7 am, 2 @ 8:30 am, 1 @ 5:30 pm
~ 9:30 am	Brain fog	Slight to some brain fog: Hard to think, remember, focus, do math	G	Until ~8:30 pm	G	1 to 2
~10 am	Fluticasone nasal spray 50 mcg in each nostril	For nasal allergies - Have been on this since well before SSRI WD
~10 am	Beclomethasone inhaled 160 mcg	Have been on this since well before SSRI WD
~ 11:30 am	Chest discomfort, heart pounding	Some chest discomfort, feeling that heart is pounding – I often have this midday or early afternoon.	G	~1/2 hr.	G	2
~11:40 am	Loratatadine 10 mg	Antihistamine -- Have been on this since well before SSRI WD
~ 11:40 am	Lisinopril 5 mg / hydrochlorothiazide 6.25 mg	For high blood pressure -- Have been on this since well before SSRI WD, though was off it for several weeks in July-August due to lower BP
~ 11:40 am	Vitamin D3 2,000 IU (50 mcg)	Have been on this since well before SSRI WD
~ 11:40 am	Calcium 500 mg / Vitamin D3 400 IU (10 mcg)	Have been on this since well before SSRI WD
~ 11:40 am	Niacinamide 500 mg	Have been on this since well before SSRI WD
~ 11:40 am	Flaxseed oil 1,400 mg (700 mg omega-3)	Have been on this since well before SSRI WD
~ 11:40 am	Kirkland (Costco) Mature Multivitamin / Mineral	Have been on this since well before SSRI WD
~ 11:40 am	Nature's Bounty Probiotic 10: 20 billion live culture CFU	Have been on some form of probiotic (not necessarily this product) since well before SSRI WD
~ 11:40 am	Psyllium 3 g	As fiber supplement for better bowel function - Have been on this since well before SSRI WD
~ 5:30 pm	Feeling much better	Feeling much better: Anxiety lower Shaking lower Depression essentially gone			G	1 1 0
~ 6: 30 pm	Calcium 500 mg / Vitamin D3 400 IU (10 mcg)	Have been on this since well before SSRI WD
~ 6:30 pm	Niacinamide 500 mg	Have been on this since well before SSRI WD
~ 6:30 pm	Magnesium citrate (250 mg magnesium)	Stopped morning dose, since anxiety much less Was on magnesium oxide (400 mg magnesium) once daily since well before SSRI WD; switched mid-July
~ 6:30 pm	Psyllium 3 g	As fiber supplement for better bowel function - Have been on this since well before SSRI WD
~ 6:30 pm	Feeling much better	Feeling much better: Anxiety lower Shaking lower Depression lower	G			1 1 1
~ 8:30 pm	Went to bed	Difficulty getting to sleep, and multiple awakenings, as usual				3

[PurplePaisley]

Here's my symptom and med (Rx/OTC/supplement) log for yesterday (9/14/21). I hope to have my thyroid lab test results by tomorrow.

My major symptoms continue to improve since reinstatement, except for sleep.

Time	Dose (mg) or Symptom	Describe symptom in your words	onset: S or G	how long	resolution: S or G	Rating (out of 5)
~5 am	Levothyroxine 25 mcg	For hypothyroidism
~7 am	Anxiety	On awakening: slight anxiety	S	All day & night	N/A	1 @ 7 am, 2 @ 8:30 am
~7 am	Shaking	On awakening or a few minutes after: slight internal & external (visible) shaking	S	Until 5 pm	G	1 @ 7 am 2 @ 8 am
~7 am	Depression	On awakening or a few minutes after: slight symptoms of feeling worthless, helpless, and without pleasure in life	S	Until 5 pm	G	1 @ 7 am
~7:15 am	Citalopram 10 mg	SSRI
~7:15 am	Fluticasone nasal spray 50 mcg in each nostril	For nasal allergies - Have been on this since well before SSRI WD
~7:15 am	Beclomethasone inhaled 160 mcg	Have been on this since well before SSRI WD
~ 8 am	Shaking	Slightly increased shaking	G	Until 5 pm	G	1 @ 7 am, 2 @ 8 am
~ 8:30 am	Anxiety	Slightly increased anxiety	G	All day & night	N/A	1 @ 7 am, 2 @ 8:30 am
~9:15 am	Loratatadine 10 mg	Antihistamine -- Have been on this since well before SSRI WD
~9:15 am	Lisinopril 5 mg / hydrochlorothiazide 6.25 mg	For high blood pressure -- Have been on this since well before SSRI WD, though was off it for several weeks in July-August due to lower BP
~9:15 am	Vitamin D3 2,000 IU (50 mcg)	Have been on this since well before SSRI WD
~9:15 am	Calcium 500 mg / Vitamin D3 400 IU (10 mcg)	Have been on this since well before SSRI WD
~9:15 am	Niacinamide 500 mg	Have been on this since well before SSRI WD
~9:15 am	Flaxseed oil 1,400 mg (700 mg omega-3)	Have been on this since well before SSRI WD
~9:15 am	Kirkland (Costco) Mature Multivitamin / Mineral	Have been on this since well before SSRI WD
~9:15 am	Nature's Bounty Probiotic 10: 20 billion live culture CFU	Have been on some form of probiotic (not necessarily this product) since well before SSRI WD
~9:15 am	Psyllium 3 g	As fiber supplement for better bowel function - Have been on this since well before SSRI WD
~ 1 pm	Brain fog	Slightly difficult to think, remember, focus	G	Until 4 pm	G	1
~ 6 pm	Calcium 500 mg / Vitamin D3 400 IU (10 mcg)	Have been on this since well before SSRI WD
~ 5 pm	Anxiety	Improved	G	All day & night	G	1
~ 5 pm	Shaking	Resolved			G	0
~ 5 pm	Depression	Resolved			G	0
~ 6 pm	Niacinamide 500 mg	Have been on this since well before SSRI WD
~ 6 pm	Magnesium citrate (250 mg magnesium)	Stopped morning dose, since anxiety much less Was on magnesium oxide (400 mg magnesium) once daily since well before SSRI WD; switched mid-July
~ 6 pm	Psyllium 3 g	As fiber supplement for better bowel function - Have been on this since well before SSRI WD
~ 8:30 pm	Went to bed	Great difficulty getting to sleep, and woke early				4

 

[PurplePaisley]

Here's my symptom and med (Rx/OTC/supplement) log for yesterday (9/15/21).

My thyroid lab test results are in ~ the middle of the normal range.

My major symptoms continue to improve since reinstatement, except for sleep and brain fog (re the latter, I'm seeing this more clearly now that anxiety and depression are less).

Time	Dose (mg) or Symptom	Describe symptom in your words	onset: S or G	how long	resolution: S or G	Rating (out of 5)
~5 am	Levothyroxine 25 mcg	For hypothyroidism
~7 am	Anxiety	On awakening: slight anxiety	S	All day & night	N/A	1 @ 7 am, 2 @ 8 am, 1 @ 5 pm
~7 am	Shaking	On awakening or a few minutes after: slight internal & external (visible) shaking	S	Until 5 pm	G	1 @ 7 am
~8 am	Citalopram 10 mg	SSRI
~8 am	Fluticasone nasal spray 50 mcg in each nostril	For nasal allergies - Have been on this since well before SSRI WD
~8 am	Beclomethasone inhaled 160 mcg	Have been on this since well before SSRI WD
~ 8 am	Anxiety	Slightly increased anxiety	G	All day & night	N/A	1 @ 7 am, 2 @ 8 am, 1 @ 5 pm
~ 8 am	Brain fog	Slightly difficult to think, remember, focus	G	Until ~ 2 pm	G	2 @ 8 am
~10 am	Loratatadine 10 mg	Antihistamine -- Have been on this since well before SSRI WD
~10 am	Lisinopril 5 mg / hydrochlorothiazide 6.25 mg	For high blood pressure -- Have been on this since well before SSRI WD, though was off it for several weeks in July-August due to lower BP
~10 am	Vitamin D3 2,000 IU (50 mcg)	Have been on this since well before SSRI WD
~10 am	Calcium 500 mg / Vitamin D3 400 IU (10 mcg)	Have been on this since well before SSRI WD
~10 am	Niacinamide 500 mg	Have been on this since well before SSRI WD
~10 am	Flaxseed oil 1,400 mg (700 mg omega-3)	Have been on this since well before SSRI WD
~10 am	Kirkland (Costco) Mature Multivitamin / Mineral	Have been on this since well before SSRI WD
~10 am	Nature's Bounty Probiotic 10: 20 billion live culture CFU	Have been on some form of probiotic (not necessarily this product) since well before SSRI WD
~10 am	Psyllium 3 g	As fiber supplement for better bowel function - Have been on this since well before SSRI WD
~ 6 pm	Calcium 500 mg / Vitamin D3 400 IU (10 mcg)	Have been on this since well before SSRI WD
~ 5 pm	Anxiety	Improved	G	All day & night	G	1
~ 6:30 pm	Niacinamide 500 mg	Have been on this since well before SSRI WD
~ 6:30 pm	Magnesium citrate (250 mg magnesium)	Stopped morning dose, since anxiety much less Was on magnesium oxide (400 mg magnesium) once daily since well before SSRI WD; switched mid-July
~ 6:30 pm	Psyllium 3 g	As fiber supplement for better bowel function - Have been on this since well before SSRI WD
~ 8:30 pm	Went to bed	Got to sleep more easily; didn't awaken multiple times, but woke very early				3

 

 

[PurplePaisley]

Here's my symptom and med (Rx/OTC/supplement) log for yesterday (9/15/21). My most bothersome symptoms now are brain fog/poor cognitive function, and some sleep problems.

Time	Dose (mg) or Symptom	Describe symptom in your words	onset: S or G	how long	resolution: S or G	Rating (out of 5)
~4 am	Levothyroxine 25 mcg	For hypothyroidism
~7 am	Anxiety	On awakening: slight anxiety	S	All day & night	N/A	1 @ 7 am, 2 @ 9 am, 1 @ 1 pm
~7 am	Shaking	On awakening or a few minutes after: slight internal & external (visible) shaking	S	Until ~1 pm	G	1 @ 7 am
~7:30 am	Citalopram 10 mg	SSRI
~ 8 am	Brain fog	Slightly difficult to think, remember, focus	G	Until ~ 2 pm	G	2 @ 8 am
~ 9 am	Anxiety	Slightly increased anxiety	G	All day & night	N/A	1 @ 7 am, 2 @ 9 am, 1 @ 1 pm
~10 am	Fluticasone nasal spray 50 mcg in each nostril	For nasal allergies - Have been on this since well before SSRI WD
~10 am	Beclomethasone inhaled 160 mcg	Have been on this since well before SSRI WD
~10 am	Loratatadine 10 mg	Antihistamine -- Have been on this since well before SSRI WD
~10 am	Lisinopril 5 mg / hydrochlorothiazide 6.25 mg	For high blood pressure -- Have been on this since well before SSRI WD, though was off it for several weeks in July-August due to lower BP
~10 am	Vitamin D3 2,000 IU (50 mcg)	Have been on this since well before SSRI WD
~10 am	Calcium 500 mg / Vitamin D3 400 IU (10 mcg)	Have been on this since well before SSRI WD
~10 am	Niacinamide 500 mg	Have been on this since well before SSRI WD
~10 am	Flaxseed oil 1,400 mg (700 mg omega-3)	Have been on this since well before SSRI WD
~10 am	Kirkland (Costco) Mature Multivitamin / Mineral	Have been on this since well before SSRI WD
~10 am	Nature's Bounty Probiotic 10: 20 billion live culture CFU	Have been on some form of probiotic (not necessarily this product) since well before SSRI WD
~10 am	Psyllium 3 g	As fiber supplement for better bowel function - Have been on this since well before SSRI WD
~ 1 pm	Anxiety	Slightly improved anxiety	G	All day & night	N/A	1 @ 7 am, 2 @ 9 am, 1 @ 1 pm
~ 6:30 pm	Calcium 500 mg / Vitamin D3 400 IU (10 mcg)	Have been on this since well before SSRI WD
~ 6:30 pm	Niacinamide 500 mg	Have been on this since well before SSRI WD
~ 6:30 pm	Magnesium citrate (250 mg magnesium)	Stopped morning dose, since anxiety much less Was on magnesium oxide (400 mg magnesium) once daily since well before SSRI WD; switched mid-July
~ 6:30 pm	Psyllium 3 g	As fiber supplement for better bowel function - Have been on this since well before SSRI WD
~ 9:15 pm	Went to bed	Got to sleep more easily; awoke multiple times, but generally got back to sleep quickly				2

 

[PurplePaisley]

Correction to my post of Friday, 9/17/21: That chart is for 9/16/21, not 9/15/21.

Here's my symptom and med (Rx/OTC/supplement) log for two days ago (9/17/21).

Time	Dose (mg) or Symptom	Describe symptom in your words	onset: S or G	how long	resolution: S or G	Rating (out of 5)
~6:30 am	Levothyroxine 25 mcg	For hypothyroidism
~6:30 am	Anxiety	On awakening: slight anxiety	S	All day & night	N/A	1
~7:45 am am	Citalopram 10 mg	SSRI
~ 9:30 am	Brain fog	Somewhat difficult to think, remember, focus	G	Until ~ 2 pm	G	2
~9:45 am	Fluticasone nasal spray 50 mcg in each nostril	For nasal allergies - Have been on this since well before SSRI WD
~ 9:45 am	Beclomethasone inhaled 160 mcg	Have been on this since well before SSRI WD
~ 9:45 am	Loratatadine 10 mg	Antihistamine -- Have been on this since well before SSRI WD
~ 9:45 am	Lisinopril 5 mg / hydrochlorothiazide 6.25 mg	For high blood pressure -- Have been on this since well before SSRI WD, though was off it for several weeks in July-August due to lower BP
~ 9:45 am	Vitamin D3 2,000 IU (50 mcg)	Have been on this since well before SSRI WD
~ 9:45 am	Calcium 500 mg / Vitamin D3 400 IU (10 mcg)	Have been on this since well before SSRI WD
~9:45 am	Niacinamide 500 mg	Have been on this since well before SSRI WD
~ 9:45 am	Flaxseed oil 1,400 mg (700 mg omega-3)	Have been on this since well before SSRI WD
~9:45 am	Kirkland (Costco) Mature Multivitamin / Mineral	Have been on this since well before SSRI WD
~9:45 am	Nature's Bounty Probiotic 10: 20 billion live culture CFU	Have been on some form of probiotic (not necessarily this product) since well before SSRI WD
~ 9:45 am	Psyllium 3 g	As fiber supplement for better bowel function - Have been on this since well before SSRI WD
~ 6:30 pm	Calcium 500 mg / Vitamin D3 400 IU (10 mcg)	Have been on this since well before SSRI WD
~ 6:30 pm	Niacinamide 500 mg	Have been on this since well before SSRI WD
~ 6:30 pm	Magnesium citrate (250 mg magnesium)	Stopped morning dose, since anxiety much less Was on magnesium oxide (400 mg magnesium) once daily since well before SSRI WD; switched mid-July
~ 6:30 pm	Psyllium 3 g	As fiber supplement for better bowel function - Have been on this since well before SSRI WD
~ 8 pm	Went to bed	More difficulty getting to sleep; awoke multiple times				3

 

[PurplePaisley]

Hi, @AltostrataHere's my symptom and med (Rx/OTC/supplement) log for yesterday (9/18/21).

This completes a week's worth of daily charting, as you requested.

I'm feeling much better than the day that I went back up to 10 mg/day citalopram (September 9). My moods are more consistent and predictable. I can function much better now.

I can deal with "slight to some" anxiety, depression, and brain fog (1 to 2 on a 5-point scale). I've had anxiety for nearly as long as I can remember. With the symptoms at lower levels, I'm in a much better position to address my issues through meditation, exercise, and therapy, etc.

Difficulty with sleep has been with me nearly all my life, so I can say that I feel better even though sleep problems  are sometimes bothering me at a level of 3 out of 5.

 

In a few weeks to a couple of months, I will review my situation and consider starting a very slow taper (likely 5 % per month).

 

In other news, I'm finally about to have my first therapy appointment tomorrow, so many weeks after asking for help from my HMO.

 

Thank you,

PurplePaisley

Time	Dose (mg) or Symptom	Describe symptom in your words	onset: S or G	how long	resolution: S or G	Rating (out of 5)
~7 am	Levothyroxine 25 mcg	For hypothyroidism
~7 am	Anxiety	On awakening: slight anxiety	S	All day & night	N/A	1
~8 am am	Citalopram 10 mg	SSRI
~9 am	Depression	Slight symptoms of feeling worthless, helpless, and without pleasure in life	G	Until ~ 4 pm	G	1
~10 am	Fluticasone nasal spray 50 mcg in each nostril	For nasal allergies - Have been on this since well before SSRI WD
~ 10 am	Beclomethasone inhaled 160 mcg	Have been on this since well before SSRI WD
~10 am	Loratatadine 10 mg	Antihistamine -- Have been on this since well before SSRI WD
~ 10 am	Lisinopril 5 mg / hydrochlorothiazide 6.25 mg	For high blood pressure -- Have been on this since well before SSRI WD, though was off it for several weeks in July-August due to lower BP
~ 10 am	Vitamin D3 2,000 IU (50 mcg)	Have been on this since well before SSRI WD
~ 10 am	Calcium 500 mg / Vitamin D3 400 IU (10 mcg)	Have been on this since well before SSRI WD
~ 10 am	Niacinamide 500 mg	Have been on this since well before SSRI WD
~ 10 am	Flaxseed oil 1,400 mg (700 mg omega-3)	Have been on this since well before SSRI WD
~10 am	Kirkland (Costco) Mature Multivitamin / Mineral	Have been on this since well before SSRI WD
~10 am	Nature's Bounty Probiotic 10: 20 billion live culture CFU	Have been on some form of probiotic (not necessarily this product) since well before SSRI WD
~ 10 am	Psyllium 3 g	As fiber supplement for better bowel function - Have been on this since well before SSRI WD
~ 7 pm	Calcium 500 mg / Vitamin D3 400 IU (10 mcg)	Have been on this since well before SSRI WD
~ 7 pm	Niacinamide 500 mg	Have been on this since well before SSRI WD
~ 7 pm	Magnesium citrate (250 mg magnesium)	Stopped morning dose, since anxiety much less Was on magnesium oxide (400 mg magnesium) once daily since well before SSRI WD; switched mid-July
~ 7 pm	Psyllium 3 g	As fiber supplement for better bowel function - Have been on this since well before SSRI WD
~ 9 pm	Went to bed	Slept better, with less trouble getting to sleep and fewer awakenings				2

 

[Altostrata]

It's very hard to interpret your symptom pattern because you are taking handfuls of drugs or supplements at about the same times of day. For example, 4 drug and a bunch of supplements at 10 a.m.

 

You are not reporting any symptoms in the middle of the day. You feel normal then?

 

I am not so much interested in the details of your supplements as your symptom pattern. I'd much prefer this simple list format.

 

You've repeated "Have been on this since well before SSRI WD" many times. That does not mean the drug or supplement is excluded from causing an adverse reaction now. You've added other things that might conflict and your nervous system has been sensitized by withdrawal. You might react badly to anything.

 

If you take calcium and magnesium together, the calcium cancels out any calming effect the magnesium might have.

 

 

[Greatful]

@PurplePaisley  Stopping by to see how you are doing?

[PurplePaisley]

General update: My first therapy appointment today went well; my therapist understands that my issue is primarily anxiety and negative thoughts, stemming largely from trauma beginning in early childhood. She has recommended some resources, and some meditation approaches, and is interested in trying EMDR for me.

 

Hi, @Greatful. I'm doing much better; thank you for asking.

 

Hi, @Altostrata. I've retyped the info in a list format, per your request. I'll post one day's info in a box, below (7 boxes for 7 days).

The link that you've provided twice leads to a page that has links to charts -- I originally used the .docx chart for gathering the info. There's also a quote on that page re using a "diary" format. Since the chart format isn't what you're looking for, I assume that the diary format is the way to go.

[Quote function not working for me right now.]

Quote: "You are not reporting any symptoms in the middle of the day. You feel normal then?"

       ==> My symptoms continue at the same level until I note that they've changed in severity, or have gone/resolved. I think I've made this clearer in the retyped notes.

Quote: "You've repeated "Have been on this since well before SSRI WD" many times. That does not mean the drug or supplement is excluded from causing an adverse reaction now. You've added other things that might conflict and your nervous system has been sensitized by withdrawal. You might react badly to anything."

        ==> Point taken. I was trying to be clear that these are products that I've taken without difficulty for some time. If that weren't the case, then my system would be juggling even more changes (on top of the sensitization of my system), so it would be even harder to figure out what might be causing which symptom.

             Fortunately, with my symptoms much more tolerable overall since I've gone back to 10 mg/day, the puzzle seems to be less of an issue. I'm looking at temporarily discontinuing all supplements except calcium/vit D, mature multivit/mineral, and fiber for a while, then try adding one supplement back every couple of weeks.

Quote: "If you take calcium and magnesium together, the calcium cancels out any calming effect the magnesium might have."

        ==> I didn't feel much benefit from magnesium, even when I took it apart from calcium when my symptoms were bad last month. I'll try adding back magnesium as one of the first supplements that I reintroduce, spaced away from calcium.

 

Again, I'm feeling much better, so this may be mainly a good exercise in documenting my meds and symptoms in a way that's clearer to the reader. I don't see a strong need for you to analyze the lists I'll enter below.

 

Thank you both for your support.

 -- PP

 

[PurplePaisley]

Meds/symptoms list in diary format for 9/12/21:

7 am Woke for the day

Slight anxiety (1/5), slight shaking (1/5), & slight depression (1/5)

Levothyroxine 25 mcg

 

8:30 am Citalopram 10 mg

Fluticasone nasal spray (50 mcg per nostril)

Beclomeethasone inhaler (160 mcg)

 

9:30 am Anxiety has gradually increased (2/5); similar for shaking (2/5)

Slight brain fog (1/5)

 

11:15 am Loratatadine 10 mg

Lisinopril 5 mg / hydrochlorothiazide 6.25 mg

Vitamin D3 2,000 IU (50 mcg)

Calcium 500 mg / Vitamin D3 400 IU (10 mcg)

Niacinamide 500 mg

Flaxseed oil 1,400 mg (700 mg omega-3)

Kirkland (Costco) Mature Multivitamin / Mineral

Nature's Bounty Probiotic 10: 20 billion live culture CFU

Psyllium 3 g

 

11:30 am Some chest discomfort & feeling of heart pounding (2/5) –

I have often have this midday or early afternoon.

Late-morning meds haven't had a chance to be absorbed yet.

 

BP 118/72

HR 80 – this is not high for me lately

 

12 noon Anxiety has increased to “moderate” (3/5)

Slight sense of unreality (1/5)

– this was a prominent symptom while trying to taper too fast

 

2 pm Increased depression (2/5) & brain fog (2/5)

General feelings of being unwell (2/5), like I'm coming down with something,

with occasional flashes of slight disequilibrium (1/5)

 

4 pm Sense of unreality resolved (0/5)

 

6 pm Epsom salt bath

No longer feeling unwell; disequilibrium resolved (0/5)

 

6:30 pm Evening supplements:

Calcium 500 mg / Vitamin D3 400 IU (10 mcg)

Niacinamide 500 mg

Magnesium citrate (250 mg magnesium)

Psyllium 3 g

 

6:30 pm Feeling much better:

anxiety lower (1/5 – lasted all evening & night);

less shaking (1/5) & depression (1/5).

Brain fog basically gone (0/5)

 

8:30 pm Went to bed. Slight anxiety (1/5) – lasted all night.

Shaking gone (0/5); depression gone (0/5).

Sleep difficulties moderate (3/5):

Unable to get to sleep for some time, and multiple awakenings, as usual

[PurplePaisley]

Meds/symptoms list in diary format for 9/13/21:

6 am Woke briefly with slight anxiety (1/5)

Levothyroxine 25 mcg

Got back to sleep briefly

 

7 am Woke for the day with more anxiety (2/5), sl. shaking (1/5) & depression (1/5)

 

7:30 am BP 107/67

HR 78

 

8:20 am Citalopram 10 mg

 

8:30 am Increased shaking (2/5)

 

9:30 am Brain fog (1 to 2 / 5)

 

10 am Fluticasone nasal spray 50 mcg in each nostril

Beclomethasone inhaled 160 mcg

 

11:30 am Some chest discomfort & feeling of heart pounding (2/5)

 

11:40 am Loratatadine 10 mg

Lisinopril 5 mg / hydrochlorothiazide 6.25 mg

Vitamin D3 2,000 IU (50 mcg)

Calcium 500 mg / Vitamin D3 400 IU (10 mcg)

Niacinamide 500 mg

Flaxseed oil 1,400 mg (700 mg omega-3)

Kirkland (Costco) Mature Multivitamin / Mineral

Nature's Bounty Probiotic 10: 20 billion live culture CFU

Psyllium 3 g

 

6:30 pm Less anxiety (1/5); similar for shaking (1/5)

Depression resolved (0/5)

Calcium 500 mg / Vitamin D3 400 IU (10 mcg)

Niacinamide 500 mg

Magnesium citrate (250 mg magnesium)

Psyllium 3 g

 

8:30 pm Went to bed. Slight anxiety (1/5) – lasted all night

Sleep difficulties moderate (3/5):

Difficulty getting to sleep; multiple awakenings, w/ difficulty returning to sleep

[PurplePaisley]

Meds/symptoms list in diary format for 9/14/21:

5 am Woke briefly w/ slight anxiety (1/5)

Levothyroxine 25 mcg

Got back to sleep

 

7 am Woke up for the day

Slight anxiety (1/5), shaking (1/5), & depression (1/5)

 

7:15 am Citalopram 10 mg

Fluticasone nasal spray 50 mcg in each nostril

Beclomethasone inhaled 160 mcg

 

8 am Increased shaking (2/5)

 

9:15 am Loratatadine 10 mg

Lisinopril 5 mg / hydrochlorothiazide 6.25 mg

Vitamin D3 2,000 IU (50 mcg)

Calcium 500 mg / Vitamin D3 400 IU (10 mcg)

Niacinamide 500 mg

Flaxseed oil 1,400 mg (700 mg omega-3)

Kirkland (Costco) Mature Multivitamin / Mineral

Nature's Bounty Probiotic 10: 20 billion live culture CFU

Psyllium 3 g

 

1 pm Brain fog (1/5)

 

4 pm Brain fog resolved (0/5)

 

5 pm Anxiety lower (1/5); shaking resolved (0/5); depression resolved (0/5)

 

6 pm Calcium 500 mg / Vitamin D3 400 IU (10 mcg)

Niacinamide 500 mg

Magnesium citrate (250 mg magnesium)

Psyllium 3 g

 

8:30 pm Went to bed. Slight anxiety (1/5) – lasted all night.

Sleep difficulties (4/5):

Very hard to get to sleep; woke very early

[PurplePaisley]

Meds/symptoms list in diary format for 9/15/21:

5 am Woke briefly w/ slight anxiety (1/5)

Levothyroxine 25 mcg

Got back to sleep

 

7 am Woke for the day w/slight anxiety (1/5)

 

8 am Increased anxiety (2/5)

Brain fog (2/5) – lasted until 2 pm

Citalopram 10 mg

Fluticasone nasal spray 50 mcg in each nostril

Beclomethasone inhaled 160 mcg

 

10 am Loratatadine 10 mg

Lisinopril 5 mg / hydrochlorothiazide 6.25 mg

Vitamin D3 2,000 IU (50 mcg)

Calcium 500 mg / Vitamin D3 400 IU (10 mcg)

Niacinamide 500 mg

Flaxseed oil 1,400 mg (700 mg omega-3)

Kirkland (Costco) Mature Multivitamin / Mineral

Nature's Bounty Probiotic 10: 20 billion live culture CFU

Psyllium 3 g

 

1 pm Shaking resolved (0/5)

 

2 pm Brain fog resolved (0/5)

 

5 pm Anxiety improved (1/5)

 

6:30 pm Calcium 500 mg / Vitamin D3 400 IU (10 mcg)

Niacinamide 500 mg

Magnesium citrate (250 mg magnesium)

Psyllium 3 g

 

8:30 pm Went to bed. Slight anxiety (1/5) – lasted all night.

Sleep difficulties (3/5):

Got to sleep more easily; awoke just a few times, and got back to sleep without much delay, but woke very early

[PurplePaisley]

Meds/symptoms list in diary format for 9/16/21:

4 am Woke w/ slight anxiety (1/5)

Levothyroxine 25 mcg

Got back to fitful sleep

 

7 am Woke for the day w/ slight anxiety (1/5) & shaking (1/5)

 

7:30 am Citalopram 10 mg

 

8 am Some brain fog (2/5)

 

9 am Increased anxiety (2/5)

 

10 am Fluticasone nasal spray 50 mcg in each nostril

Beclomethasone inhaled 160 mcg

Loratatadine 10 mg

Lisinopril 5 mg / hydrochlorothiazide 6.25 mg

Vitamin D3 2,000 IU (50 mcg)

Calcium 500 mg / Vitamin D3 400 IU (10 mcg)

Niacinamide 500 mg

Flaxseed oil 1,400 mg (700 mg omega-3)

Kirkland (Costco) Mature Multivitamin / Mineral

Nature's Bounty Probiotic 10: 20 billion live culture CFU

Psyllium 3 g

 

1 pm Anxiety lower (1/5); shaking resolved (1/5)

 

2 pm Brain fog resolved (0/5)

 

6:30 pm Calcium 500 mg / Vitamin D3 400 IU (10 mcg)

Niacinamide 500 mg

Magnesium citrate (250 mg magnesium)

Psyllium 3 g

 

9:15 pm Went to bed. Slight anxiety (1/5) – lasted all night.

Sleep difficulties (2/5):

Got to sleep more easily; awoke multiple times, but generally got back to sleep quickly

[PurplePaisley]

Meds/symptoms list in diary format for 9/17/21:

6:30 am Woke for the day w/ slight anxiety (1/5)

Levothyroxine 25 mcg

 

7:45 am Citalopram 10 mg

 

9:30 am Brain fog (2/5)

 

9:45 am Fluticasone nasal spray 50 mcg in each nostril

Beclomethasone inhaled 160 mcg

Loratatadine 10 mg

Lisinopril 5 mg / hydrochlorothiazide 6.25 mg

Vitamin D3 2,000 IU (50 mcg)

Calcium 500 mg / Vitamin D3 400 IU (10 mcg)

Niacinamide 500 mg

Flaxseed oil 1,400 mg (700 mg omega-3)

Kirkland (Costco) Mature Multivitamin / Mineral

Nature's Bounty Probiotic 10: 20 billion live culture CFU

Psyllium 3 g

 

2 pm Brain fog resolved (0/5)

 

6:30 pm Calcium 500 mg / Vitamin D3 400 IU (10 mcg)

Niacinamide 500 mg

Magnesium citrate (250 mg magnesium)

Psyllium 3 g

 

8:30 pm Went to bed. Slight anxiety (1/5) – lasted all night.

Sleep difficulties (3/5):

More difficulty getting to sleep; awoke multiple times, with delay returning to sleep

 

[PurplePaisley]

Meds/symptoms list in diary format for 9/18/21:

7 am Woke for the day w/ slight anxiety (1/5)

Levothyroxine 25 mcg

 

8 am Citalopram 10 mg

 

9 am Slight depression (1/5)

 

10 am Fluticasone nasal spray 50 mcg in each nostril

Beclomethasone inhaled 160 mcg

Loratatadine 10 mg

Lisinopril 5 mg / hydrochlorothiazide 6.25 mg

Vitamin D3 2,000 IU (50 mcg)

Calcium 500 mg / Vitamin D3 400 IU (10 mcg)

Niacinamide 500 mg

Flaxseed oil 1,400 mg (700 mg omega-3)

Kirkland (Costco) Mature Multivitamin / Mineral

Nature's Bounty Probiotic 10: 20 billion live culture CFU

Psyllium 3 g

 

7 pm Calcium 500 mg / Vitamin D3 400 IU (10 mcg)

Niacinamide 500 mg

Magnesium citrate (250 mg magnesium)

Psyllium 3 g

 

9 pm Went to bed. Slight anxiety (1/5) – lasted all night.

Sleep difficulties (2/5):

Slept better, with less trouble getting to sleep and fewer awakenings