SeekingAnswers: Struggling after completed tapering off Celexa

[Altostrata]

I strongly urge you to talk to your son about the content of these thoughts. For example, he may be blaming himself or developed health anxiety after his bad experience. This is not unusual. 

 

Shame, guilt, regret, and self-criticism

 

Health anxiety, hypochondria, and obsession with symptoms

[SeekingAnswers]

I try to talk to him about the intrusive thoughts, but he doesn't want to talk about them at all and gets very uncomfortable when I ask. All he has told me is that they are images that flash into his mind of things that he finds disgusting, like dog poop, or cereal (he can't stand cereal and it has always grossed him out.) It's probably other things as well that he just isn't willing to tell my husband or me about. Last night at his D&D game he had his jacket hood up and draped over the left half of his face the whole time. When we asked him about it on the way home he said he didn't like the way the girl looks who was sitting to his left. I think she may have been wearing a low-cut shirt or something and he was uncomfortable about that, and she kept standing up and leaning over right in front of him to move her game pieces. I didn't ask him if that's what it was because he didn't want us to ask him any more about it. He also refuses to talk to a therapist about the images. It's pretty frustrating but I guess all we can do is wait to see if they go away with time. I don't think he's blaming himself for any of this WD stuff, but he has blamed me for suggesting that he come off Celexa in the first place. He's frustrated that he can't just go to a higher dose, but his psychiatrist is following what we want and that is to keep the dose very low so he can hopefully get off completely again by tapering VERY slowly using Brass Monkey's technique. I have mentioned using the very slow tapering to him in the future, but he doesn't even want to hear about it. I hope when he has stabilized he will be more open to it because there are many reasons for him to be off of it: he has Leiden Factor 5 which makes him more susceptible to blood clots, he take Lansoprozal which can interact badly with Celexa, certain antibiotics can interact with it, and his dentist said that the reason he's had so many cavities is from the Celexa. 

[Altostrata]

You might want to talk to him in a general way about anger, guilt, and self-blame and how our minds can change this into symbols that bother us. If it's any help, I suggest you tell him he can forgive himself for his mistakes, saying literally "I forgive myself" to himself.

 

Has the frequency of these intrusive thoughts changed over the last month? If they are becoming less frequent, he is stabilizing. If not, you might go up by 1mg Celexa. I am hesitant to attempt to "treat" a psychological symptom with drugs, it would be a good life skill for him to learn non-drug techniques. But it is possible he's having involuntary neuro-emotions from withdrawal, too. See Neuro-emotions

[SeekingAnswers]

Thank you, I'll try talking to him about anger, guilt, and self-blame. Is there a book or article that you can recommend that explains how it can affect our mind? If not, no problem, I can try to find it online. 

 

He SAYS the intrusive thoughts are just as bad as they were a few months ago, but all of us in the family can tell that he is doing better (especially in the last 3 weeks or so) by his actions. He came downstairs and had a nice Christmas with us, and he was able to enjoy his birthday on Dec. 18th, too. I can tell just by the tone of his voice when he is having a block of a few hours that the intrusive thoughts are not as bad. So he IS improving, just very slowly. He doesn't always remember when he has had a window, and tends to think every day has been bad. I have been keeping a detailed record/diary since the WD symptoms started, and there has definitely been improvement. He DID mention to his psychiatrist in the last zoom appt that he knows he is doing better than he was a few months ago. 

 

I completely agree with you about the importance of him learning life-skills to deal with emotions and thoughts. I believe he IS having neuro-emotions, as you suggested, because sometimes he will say he's depressed and that he knows there is no reason for it. He recognizes that it's a withdrawal symptom. He's very smart, but he can be stubborn, too, and doesn't like to talk about emotions or anything like that. Thank you again, Altostrata:)

[SeekingAnswers]

On 1/3/2022 at 3:48 PM, Altostrata said:

Has the frequency of these intrusive thoughts changed over the last month? If they are becoming less frequent, he is stabilizing. If not, you might go up by 1mg Celexa.

Hi again Altostrata. I hope you are doing well, and thank you again for your help and support. My son is still at 3mg Celexa after reinstating. He has had some good days, when he describes the intrusive thoughts as "minimal" and his voice is cheerful. I've been very encouraged on these days. Last Thursday was a good day and he actually said he thinks he is recovering, even though he knows he's not completely better yet and it will take more time. But the last couple of days have been hard. Today I tried to get him out for a walk and we had to come back home because he was so anxious. I had thought he was taking his magnesium yesterday but he thought I had put it in with his other supplements, so he didn't get any yesterday. Could that be why his anxiety was so high today? Also, he wants to increase his Celexa to 4mg at the end of this month, which is what his psychiatrist has suggested he do. I'm wondering if the Celexa is actually making his symptoms worse sometimes. When he was completely off of it for 9 weeks at least he could leave the house, and somewhat enjoyed going places. Now he can barely leave his room. What do you think? Could the Celexa be keeping him from recovering, even though it's a small dose? 

[Altostrata]

It sounds like his nervous system is settling down. 

 

What makes him anxious when he leaves his room? Is he sensitive to light or noise? Some people wear dark glasses, even indoors, for a while because of light sensitivity.

 

Magnesium is calming but he must be extraordinarily sensitive if a lack of it caused him to feel anxiety.

 

To see if 3mg Celexa is causing problems, you need to find out how he feels before and after taking it. Does he feel worse after taking it? Does it make him feel sluggish? This can happen right away, or several hours after taking citalopram.

[SeekingAnswers]

The only reason he doesn't want to leave the house, is because when we do leave he sees things that trigger the intrusive thoughts. When at home, he does video games on his laptop to distract himself from the intrusive thoughts and is able to keep them at bay this way. From what I have read, other people have said it took 8 to 9 months for their intrusive thoughts to go away after stopping their SSRI withdrawal. It has been 6 months since he went off Celexa (and of course reinstated after 9 weeks, so it seems to me that he just needs more time and should stay at 3 mg for now. After he went up to 3 mg it seemed like he was in a state of disequilibrium for about 2 weeks with depression and anxiety, then started to calm down again. He is convinced that he will not get better until he is on a higher dose. His psychiatrist told us in our last zoom meeting that 3 mg is not a "therapeutic dose" and she recommended going up to 10 over the next few weeks to get the intrusive thoughts to go away, and he agrees with her. Of course, we know that the higher he goes in his dose the longer it will take to get off again. Also, he may never agree to come back off. He does trust my judgement though. It's interesting that even though he is 30 years old and could contact his psychiatrist on his own and demand to go up to a higher dose, he does what I decide is best for him.  But I'm really not sure what to do, as far as increasing to 4mg or staying at 3. He didn't have OCD before going onto Celexa, so I believe the intrusive thoughts will go away on their own in time, but I could be wrong. He was only 13 when he went onto Celexa and he thinks he did have OCD before, but no one in our family ever saw any signs of it. He does have Aspergers and I believe what he now thinks was OCD was just his Aspergers. He was put on Celexa to "even out" his emotions while going through his teen years, not for OCD. It's very disconcerting to see him in his bed all the time with his laptop 6 inches from his face all the time, so maybe I should let him increase the Celexa if that will help him. I wish I knew what to do, but I go around in circles in my mind trying to figure out what the best solution is. Since you started this website and have seen thousands of people in withdrawal, have you observed that the intrusive thoughts do go away on their own in time? 

[Altostrata]

7 hours ago, SeekingAnswers said:

Since you started this website and have seen thousands of people in withdrawal, have you observed that the intrusive thoughts do go away on their own in time? 

 

They can, but some people develop habits of thought while worrying about withdrawal. There's a natural process of recovery, but it can be affected by the way people think of themselves and their symptoms.

 

His system may be recovering from the shock of withdrawal, but *psychologically* he may have developed a new habit of thought out of his anxiety. Does he also see a psychotherapist?

 

"Therapeutic dose" is irrelevant, whatever works, works. You might try increasing to 3.5mg citalopram and see what that does. If it doesn't help, that will show him the limits of the drug. Or, it may be that he'll want to stay at this dose or higher long-term because he's so afraid of withdrawal.

[SeekingAnswers]

Interesting about people affecting their own recovery by worrying about withdrawal. He won't see a psychologist, he doesn't want to talk about the intrusive thoughts (they are really images, not thoughts . . . . mages of things he finds disgusting like cereal, or dog food.) He thinks talking about it will do no good. He is very stubborn about this. I do find it encouraging that on some days he says the images are "minimal", so that gives me hope, and gives him hope as well. 

 

I like your idea of going to 3.5 mg and seeing if that helps at all. It's a good compromise rather than going up to 4 or 5mg. I'm hoping that after he stabilizes he will see the benefits of coming off the Celexa and he can then do it very slowly using Brass Monkey's technique. 

 

Thank you again. You are amazing for helping so many people. 

[SeekingAnswers]

On 9/1/2021 at 5:57 AM, getofflex said:

Hello @SeekingAnswershow are you doing these days?  How are your symptoms?  Thinking and praying for you.

@getofflex I hope you are doing well. I don't know what to do about my son's situation right now. As you may remember he came off Celexa back at the end of July and then reinstated at 1mg, 2mg, 3mg, and is now at 4mg as of 6 days ago. Every time he goes up in his dose he has several days of depression and is pretty miserable (which is what is going on right now.) Before he went up to 4mg he was having days when the intrusive thoughts were "minimal" as he would say. He had been telling me that he knew he was recovering but was not out of the woods yet, meaning the thoughts were not completely gone. But he thinks the only way that the intrusive thoughts will go away completely is to be back on Celexa at 20mg, or even 40mg as he was before. I guess my question is, do you know how long does it typically take for the intrusive thoughts to go away during withdrawal? Do they always go away for people in withdrawal? It has now been 6 months since his went off Celexa. I can't believe this has been going on for so long, I had no idea it would be like this when I suggested he go off Celexa. He trusts me and will do what I think is best, even though he disagrees.) So I don't know whether to keep him at 4mg and keep waiting for the intrusive thoughts to go away or let him keep upping his dose by 1mg each month. His personality is so much better when he is off the Celexa . . . very kind, talkative, and social. When he is on it (even at these very low doses) he becomes withdrawn, barely talks to us, and just stays in his room. This is why we want him to be off Celexa, along with the fact that he has Factor 5 which means he has an increased risk of getting blood clots and I found out that SSRIs can actually cause blood clots. Do you know if TMS therapy works for intrusive thoughts? If it wasn't for the intrusive thoughts, his withdrawal wouldn't be so bad, but they really upset him. Thank you for any advise you might have. 

[getofflex]

3 hours ago, SeekingAnswers said:

reinstated at 1mg, 2mg, 3mg, and is now at 4mg as of 6 days ago.

 

3 hours ago, SeekingAnswers said:

His personality is so much better when he is off the Celexa . . . very kind, talkative, and social. When he is on it (even at these very low doses) he becomes withdrawn, barely talks to us, and just stays in his room.

Why are you increasing his dose every month?  What is the goal - to get back on a full dose of Celexa, or to ultimately get off of it?  You want to be very careful updosing - going off and on psych meds can lead to kindling the nervous system.  

 

Kindling and Nervous System Hypersensitivity

 

I, too, have intrusive thoughts.  The secret to dealing with this is to recognize that they are just thoughts, and not to take them seriously, and not get upset by them.  There are various techiques for dealing with intrusive thoughts, and there is therapy for persons with OCD that can help with these thoughts.  I would look for a therapist that works with OCD clients (obsessive thoughts I assume would be similar to intrusive thoughts) Here are some simple techniques here that may help:  

 

Acknowledge Accept Float

 

APPLE Technique

 

I just came across a very nice technique that really helps me.  It's called APPLE. I have printed it and have it where I can see it every day and be reminded of it so I internalize this technique. 

 

A - Acknowledge Notice and acknowledge the thought or uncertainty as it comes to mind. 

 

P - Pause Don't react as you normally do.  Don't react at all.  Just pause and breathe.   

 

P - Pull Back Tell yourself this is just the thought or worry talking, and this apparent need for worry or analysis or certainty is not helpful and not necessary.  It is only a thought or feeling.  Don't believe everything you think.  Thoughts are not statements or facts.   

 

L - Let Go Let go of the thought or feeling.  It will pass.  You don't have to respond to it.  You might imagine the thought floating away in a bubble or cloud.   

 

E - Explore Explore the present moment, because right now, in this moment, you are OK.  Notice your breathing and the sensations of your breathing.  Notice the ground beneath you.  Look around and notice what you see, what you hear, what you can touch, what you can smell.  Right now.  Then shift your focus of attention to something else - on what you need to do, on what you were doing before you noticed the thought or worry, or do something else - mindfully - with your full attention.  

 

[SeekingAnswers]

1 hour ago, getofflex said:

Why are you increasing his dose every month?

I don't want to increase his dose, but he does. I would like him to be off completely off Celexa again. His psychiatrist is supporting his decision to stay on Celexa, and she has told him he can go up 1 or 2mg every month. I wish I could find a psychiatrist that would support him not being on it at all, and would encourage him to wait out the withdrawal symptoms until they go away on their own. I haven't been able to find anyone to do that. There are some, but they have all stopped taking new patients. Do you know of any psychiatrists or general practitioners who will do that for people? It's hard to see him suffering from the intrusive thoughts (they are really images, not thoughts, of things he finds disgusting like cereal, cat food, dog poop, and things like that) and that is why we have compromised by letting him reinstate at a low dose. Unfortunately the reinstatement hasn't made the ITs go away, so he keeps wanting to go up more and more until they go away. From what I've read online it seems that for most people in withdrawal the ITs go away after 8 or 9 months, and he went off Celexa 6 months ago. So hopefully they will stop soon. He never had them before. Did you have them before SSRI withdrawal?

 

I agree with you that CBT would help him but he is completely resistant to trying it. I'm thinking of telling him that we will not increase his dose unless he does go to CBT. Thank you for the info on the APPLE technique. I found that on SA a few months ago and sent it to him, but I'll show it to him again and maybe he'll be more open to it since he has been suffering longer now. He has Asperger's so he can be very stubborn about things and thinks CBT and other things like that won't work. It's pretty frustrating. 

[Altostrata]

It matters greatly exactly what these thoughts are. Working with a therapist is a good way to defuse them.

[SeekingAnswers]

10 hours ago, Altostrata said:

Working with a therapist is a good way to defuse them.

Thank you, Altostrata. I will keep on him about seeing a therapist. 

[getofflex]

It sounds like the issue here is that you and he have different ideas about what to do.  It will be up to you to find a way to convince him that going back on the med may not be in his best interest in the long run, or find a way to compromise with him in some way.  

23 hours ago, SeekingAnswers said:

Did you have them before SSRI withdrawal?

Yes, I did.  I use the apple technique, and I just don't take the thoughts seriously, and I try not to dwell on them or act on them.  It helps to keep myself busy doing a physical activity.  Taking the walks helps a lot.  I suspect intrusive thoughts may be a part of anxiety, at least for me.  

 

23 hours ago, SeekingAnswers said:

I'm thinking of telling him that we will not increase his dose unless he does go to CBT.

That's a possibility.  I assume you have physical control of the drug, and he cannot get to it?  

[SeekingAnswers]

Yes, 

42 minutes ago, getofflex said:

It will be up to you to find a way to convince him that going back on the med may not be in his best interest in the long run

Yes, absolutely, I don't want him to go back up to what was his full dose before he went off. He believes he was just fine at 40 mg and wants to be there again. The only reason that I really have to tell him about stay off is that SSRI's can cause blood clots. It's stressful because he is an adult, even though he has Asperger's and is emotionally more like a 14 year old. I want what's best for him. I just don't know if these thoughts will go away on their own with time or not, so I don't know if I'm causing him to suffer by not letting him go back up to a higher dose. Although they ARE less than they were a few months ago. He told me last week that he knows he is recovering but is not out of the woods yet. I hate seeing him suffering. And by that I mean that he doesn't want to go to movies or do things that he has always loved doing, because he is afraid of being "triggered" and having the intrusive thoughts. He has even stopped going to his D&D game because there is a woman there who he says is "ugly" and disgusts him so much that he can't look at her. He told me the other night that he was frustrated that he can't even look at people anymore. He finds a lot of things disgusting that didn't used to bother him. He went to that game for months and she must not have bothered him back then. That's why I was wondering if you (or anyone else on the site) knows if the intrusive thoughts (images in his case) eventually go away after a while if a person didn't have them before being on an SSRI and going through withdrawal. I'm a people-pleaser by nature so it's really hard for me to just say "No, you aren't going back up in your dose", but I guess I just have to be strong and do that. AFter he increased to 4mg a few days ago he had a day of depression and I reminded him that this happens whenever he increases his dose. He doesn't remember that it happened before. This is the hardest thing I have ever lived through. It's also so difficult that he doesn't want to even consider CBT. I do have control of the liquid Celexa. The interesting thing is that he could at any time call his psychiatrist and say "My parents aren't letting me increase my dose fast enough" and she legally would have to give him an RX for a higher dose, and since he has a driver's license he could go get it. He hasn't done this. He seems to trust me and believes me when I tell him I'm doing what I think is best for him. But I have constant anxiety every day, pretty much all the time because I don't honestly know what is the best thing for him and if I am doing the best thing or not. I go around in circles in my mind about it. Probably doesn't help that I came off Lexapro last March and am now only on Wellbutrin, which from what I have read can cause anxiety to be worse. I want so much for him to be back to his normal, happy self and it's been 6 months of this. Then I read about how some people have withdrawal symptoms for 18 months, and that's scary to hear. Sorry if I'm rambling. I do so appreciate you and Altostrata trying to advise and help me. 

[getofflex]

22 hours ago, SeekingAnswers said:

I just don't know if these thoughts will go away on their own with time or not, so I don't know if I'm causing him to suffer by not letting him go back up to a higher dose. Although they ARE less than they were a few months ago.

It's good that they have improved some from a few months ago.  I personally believe the thoughts will probably decrease in time.  It would be nice if he would be open to doing some non drug techniques to dealing with the intrusive thoughts.  

 

22 hours ago, SeekingAnswers said:

I was wondering if you (or anyone else on the site) knows if the intrusive thoughts (images in his case) eventually go away after a while if a person didn't have them before being on an SSRI and going through withdrawal.

 Here are some links that discuss intrusive thoughts with respect to withdrawal: 

 

Repetitive Intrusive Thoughts

 

WD Causing Intrusive, Repetitive Thoughts

 

 

[SeekingAnswers]

11 minutes ago, getofflex said:

It would be nice if he would be open to doing some non drug techniques to dealing with the intrusive thoughts.

That is for sure! Thank you for the links.

[Altostrata]

We've had people report withdrawal-induced intrusive thoughts do go away with time.

[SeekingAnswers]

37 minutes ago, Altostrata said:

We've had people report withdrawal-induced intrusive thoughts do go away with time.

Thank you Altostrata, I'm glad to hear this. I was just reading the posts in the link that Getofflex posted in her answer to me. Some of the people posted there that the withdrawal-induced intrusive thoughts DID go away in time, so that's very encouraging. I am really going to stress to my son that he shouldn't go up any higher in his Celexa dose because every time he goes up, even though it's only 1mg, it causes him such emotional distress for a few days. Last night was really hard. He seems to be doing a little better today though. 

[getofflex]

This sounds like a good plan, @SeekingAnswers.