TreeFrog: trying to stabilize from Cymbalta withdrawal

[Shep]

On 4/26/2022 at 12:03 PM, TreeFrog said:

Just realized that for the past 2-3 nights, I've had night sweats. Haven't had that since I was on Cymbalta.

 

@TreeFrogYour latest reduction in Trazodone was on April 23, so I'm wondering if this may be a withdrawal symptom from that. 

 

Are you in perimenopause? Just want to rule out reasons other than withdrawal. 

[TreeFrog]

@Shep no I'm definitely not in perimenopause, I'm almost 70.

 

Last night the night sweats were minimal and I managed to sleep for over 7 hours. Anxiety returns as soon as I wake up though.

 

Any comment on the advice from my psychiatrist to go up to 20 mg asap? It's weird, even though I don't really have any faith in her advice now, since she tapered me off duloxetine in 4 weeks, there's still a part of me that thinks, what if she's right? 

 

I've been on 15 mg citalopram now for just over 2 weeks. If anything, I would have thought my symptoms were somewhat worse, though I had a nice bit of a window yesterday.

[TreeFrog]

April 27:

5 am: awake; dozed a bit until 7 am; anxiety 5-6/10

7:30: got up

9 am: breakfast; citalopram 15 mg; digestive enzymes; anxiety 7-8/10

11 am: anxiety 5-6/10 after tapping

1 pm: lunch

1:30 pm: naproxen 220 mg for back pain

2:30 pm: phone appointment with psychiatrist; anxiety 5-6/10

6:30 pm: dinner; enzymes

9:50 pm: trazodone 12.5 mg

10:20 pm: lights out

 

 

[Shep]

22 hours ago, TreeFrog said:

Last night the night sweats were minimal and I managed to sleep for over 7 hours. Anxiety returns as soon as I wake up though.

 

22 hours ago, TreeFrog said:

I've been on 15 mg citalopram now for just over 2 weeks. If anything, I would have thought my symptoms were somewhat worse, though I had a nice bit of a window yesterday.

 

You may be stabilizing. Please hold for a day or two and see if the window is a trend. 

 

On 4/27/2022 at 7:43 PM, TreeFrog said:

I just had an appointment with my psychiatrist. As always, her advice is totally the opposite of what I've read here: go up to 20 mg citalopram immediately (because 15 mg isn't enough) and wait to taper off trazodone until I've been on 20 mg for a week or so.

 

Do you think you're dependent on the Trazodone at this point? You've been on it for about a month now, and a month is the length of time it can take to become dependent on an antidepressant. Is Trazodone the reason you're sleeping? If so, you may need to stay on it. 

 

I wouldn't increase the citalopram, especially with the mention of a window. 

 

Please post your thoughts on what you would like to do as a game plan for coming off these drugs. Do you think it would help to stay on the remainder of the Trazodone and work on getting off the citalopram first? 

[TreeFrog]

2 hours ago, Shep said:

Do you think you're dependent on the Trazodone at this point? You've been on it for about a month now, and a month is the length of time it can take to become dependent on an antidepressant. Is Trazodone the reason you're sleeping? If so, you may need to stay on it. 

 

I don't know. I'm not sleeping as much on 12.5 mg trazodone as I was on 25 mg. I've been on 12.5 mg for 6 nights, and I'm only averaging 5 hours a night; on 2 nights I only got 3 hours sleep. For the 6 days I was on 25 mg, in late March when I first started taking it and from April 20 to 22, I averaged almost 6 hours a night. I haven't tried sleeping without trazodone since March 27. Here's the sleep data from 12.5 mg trazodone:

 

April 23: 4.5 hours sleep

April 24: 7 hours sleep

April 25: 3 hours sleep

April 26: 6 hours sleep

April 27: 7 hours sleep

April 28:  3 hours sleep

 

As you can see, it's all over the place.

 

2 hours ago, Shep said:

Please post your thoughts on what you would like to do as a game plan for coming off these drugs. Do you think it would help to stay on the remainder of the Trazodone and work on getting off the citalopram first? 

 

Again, I don't know. Manymoretoday's advice was to taper off trazodone asap. I could stop it tonight and see what happens, though I feel apprehensive about it even though 12.5 mg doesn't seem to be doing much for my sleep. My only real plan has been to hold at 15 mg citalopram and hope things stabilize. Would appreciate advice on all this.

[TreeFrog]

Forgot to mention that I had mild night sweats last night, when I woke up at 1:45 am, as per the notes below. Now wondering if I should go back up to 25 mg trazodone instead of stopping?

 

April 28:

• 6:30 am: awake; anxiety 6-7/10
• 7:15 am: got up; anxiety 7-8/10
• 9:30 am: breakfast; citalopram 15 mg; digestive enzymes
• 11 am: toast
• 11:30 am-12:30 pm: errands; anxiety 8-9/10
• 1:30 pm: lunch
• 2:15 pm: acupuncture; anxiety 2-3/10
• 3:30 pm: back home; laid down to rest
• 4:30 pm: got up; anxiety 4-5/10
• 5:30 pm: anxiety 6-7/10
• 6:30 pm: dinner; enzymes
• 7:30-8 pm: walk; anxiety 5-6/10
• 9:30 pm: tylenol 500 mg; ibuprofen 400 mg (for lower back pain)
• 9:40 pm: trazodone 12.5 mg; epsom salt bath
• 10:20 pm: lights out

 

April 29:

• 1:45 am: awake; sweaty
• 2:30 am: got up and read
• 4 am: back to bed; didn't sleep
• 6 am: anxiety 6-7/10
• 7 am: got up; anxiety 7-8/10

 

 

 

[TreeFrog]

I am trying to taper off trazodone and I'm currently at 12.5 mg, down 6 days ago from 25 mg. I've only been on it for just over a month, but I think I am tapering too fast because in the last 6 nights I've been sleeping less hours per night then I was on 25 mg. For two of the  6 nights I only got 3 hours. I'm thinking I should updose and taper more gradually.

 

It comes in a very powdery 50 mg tablet that doesn't split very cleanly. Not sure what the best way is to try and achieve a dose that isn't just a half or a quarter tablet. I've read through this topic but I'm still unsure if I can make a liquid out of it or if I'm better off getting a digital scale.

 

Thanks for any info.

[manymoretodays]

Hey there TreeFrog,

I repositioned your post in the trazodone tapering topic back here.

It's right above my post now and also quoted below.

2 hours ago, TreeFrog said:

I am trying to taper off trazodone and I'm currently at 12.5 mg, down 6 days ago from 25 mg. I've only been on it for just over a month, but I think I am tapering too fast because in the last 6 nights I've been sleeping less hours per night then I was on 25 mg. For two of the  6 nights I only got 3 hours. I'm thinking I should updose and taper more gradually.

 

It comes in a very powdery 50 mg tablet that doesn't split very cleanly. Not sure what the best way is to try and achieve a dose that isn't just a half or a quarter tablet. I've read through this topic but I'm still unsure if I can make a liquid out of it or if I'm better off getting a digital scale.

 

Thanks for any info.

 

I do understand your apprehension, as far as abandonment of any fast taper with the trazodone.  We've hit the month mark, and new symptoms too.  The night sweats sure could be WD(withdrawal) and/or indicative of some mild serotonin syndrome. 

Definitely hard to know for sure. 

In any case not perimenopause/menopause given your age and all.

 

So..........your recent trial with 25 mg trazodone was short lived, with the notable increased activation/anxiety in the day I think.  Correct me if wrong, as you were not doing Notes at that time, or prior to that time.  And then you used it at the tail end of your duloxetine reinstatement too at the 25 mg dosage. 

 

Yes, you might want to work on how to do the doses that are not available via prescription in the next couple of days.  You can make your own liquid suspension.  If it is fairly powdery......that may work for you.  You'll have to use the first post in the trazodone topic to read more on that, and then get supplies, like syringes, a mixing vessel, etc.   Follow the links in the first topic I mean, to making your own liquid with it.

You'll see links to doing it yourself "suspensions" and then even more discussion around that.

I also see an oral solution that is available in the UK......a pharmacy made solution too listed.  Any chance that is available in Canada?  You could call your pharmacy, on the off chance that it might be.

 

Liquid may be easier than getting into using the scales.  And......it may also be less time consuming for you to get what you need now to do liquid trazodone.  Going from solid to liquid form should be undertaken with some form of cross over explained here:

Cross Over: Changing form(eg tablet to liquid) of drug OR changing brand

 

While you are working out how to get non-standard doses of your trazodone, once again you have the choice to stay where you are at with the trazodone dose, or go on up again with it.  Ordinarily........you might updose just a little bit, rather than going all the way back to 25 mg.  If you can do something in between 12.5 mg and 25 mg that might be better than going all the way back to 25 mg.

Or alternately, you could stay put at 12.5 mg trazodone until you've acquired what you need for non-standard dosing. 

That might be the most realistic option now.

 

I'm just still a little worried that you might be getting too much serotonin or mild serotonin syndrome.  The sweats and then the more activated anxious component of your current existence.

Which ultimately......may be a good reason to back down on the citalopram from that 15 mg dose eventually........rather than go up.   And you were essentially just a pawn for full reinstatement  of citalopram, rather than giving it a trial to offset duloxetine WD.

15 mg of citalopram appears to be almost at the maximum receptor occupancy to me, around 75-80%.   Those doses of 40 mg used seem to me kind of irresponsible.  I don't get why in any case.

Why taper? SERT transporter occupancy studies.......

When the receptors get occupied then sometimes the serotonin that is not taken up can result in activation.  Sometimes it's calming for a short term too.  It's so hard to predict.

Anyway......that last link can be used to illustrate the minimal change really in that so called therapeutic effect between 15 mg and 20 mg.

 

And then, the interactions......and the fact that both your drugs undergo Cytochrome P450 metabolism too.......just meaning that when you make a change in one......the other often changes a bit in just how it's metabolized and then how it acts on your body.

 

I don't know if all that is going to help you at all.

I do however want to applaud you and your NOTES as well as some of the non-drug coping that frequently really did appear to reduce your symptoms for awhile.  And for soldiering through some of your daily tasks and appointment.

AND......you stayed with just one change for over a whole week I believe.  That is really good progress for you too.

 

Best to you, L, P, H, and G,

mmt

 

 

 

 

Edited April 29, 2022 by manymoretodays
minor

[TreeFrog]

Thank you for getting back to me, MMT and for your kind words 🙂

 

8 minutes ago, manymoretodays said:

So..........your recent trial with 25 mg trazodone was short lived, with the notable increased activation/anxiety in the day I think.  Correct me if wrong, as you were not doing Notes at that time, or prior to that time.  And then you used it at the tail end of your duloxetine reinstatement too at the 25 mg dosage. 

Here's what I have from my notes. I think this is the full picture:

 

March 26: 25 mg trazodone at 12:30 am; slept 7 hours; 6 beads of duloxetine at 11:35 am; anxiety 7/10 down to 5/10 in the evening.

March 29: 25 mg trazodone at 1 am; slept 6 hours; 5 mg citalopram at 9:30 am. Anxiety 7/10 down to 3/10 in the evening; trazodone 25 mg at 10 pm; slept 8 hours

March 30: 5 mg citalopram at 9:30 am. Anxiety 7/10 in the morning; 4/10 mid-afternoon to evening; 25 mg trazodone at 10 pm; slept 3 hours (updosed to 37.5 mg the next night)

 

April 20: 25 mg trazodone at 9:45 pm; slept 6 hours

April 21: 15 mg citalopram at 9:30 am; anxiety 7/10 down to 4/10 in the evening; 25 mg trazodone at 9:45 pm; slept 7 hours

April 22: 15 mg citalopram at 9:30 am; felt very dull and sedated with anxiety 2/10 until mid-afternoon; then anxiety 4/10; 25 mg trazodone at 9:45 pm; slept 5.5 hours

April 23: 15 mg citalopram at 9:30 am; anxiety 8-10/10 all day

 

31 minutes ago, manymoretodays said:

While you are working out how to get non-standard doses of your trazodone, once again you have the choice to stay where you are at with the trazodone dose, or go on up again with it.  Ordinarily........you might updose just a little bit, rather than going all the way back to 25 mg.  If you can do something in between 12.5 mg and 25 mg that might be better than going all the way back to 25 mg.

Or alternately, you could stay put at 12.5 mg trazodone until you've acquired what you need for non-standard dosing. 

That might be the most realistic option now.

 

Given the level of distress I have after a night of such limited sleep, I would like to updose tonight. As I mentioned, the tablet is very crumbly and doesn't split well, but I was able more or less to split a quarter tab into halves. That would give me an updose of roughly 18.75 mg. What do you think? Meanwhile, I will look at the info re liquid suspensions.

 

Today was so miserable that I again was tempted to increase the citalopram to 20 mg. I will read the link you sent.

 

[TreeFrog]

Well brain dead as I am, I believe I just succeeded in making my first liquid suspension of trazodone. For the record it's a 50 mg tablet (which dissolved perfectly in water without any prompting from me) in 25 mL of water. Pretty sure that means there's 2 mg in every ml 😏 

 

I'll take a quarter tablet tonight (12.5 mg) plus 6 mg (3 ml) of the liquid.

[Altostrata]

@TreeFrog please take your drugs on a consistent daily schedule. In April alone, you've made drug changes 6 times, more than once a week.

 

What effect do you feel from 12.5mg trazodone, as compared to higher dosages? Do you feel better or worse after you take 15mg citalopram?

 

What times o'clock do the night sweats and back pain appear? How long do they last?

 

We need to see a series of daily reports to detect a trend. We can't leap to treat random symptoms and promise you immediate correction, we leave that to doctors. You may have to cope with periods of poor sleep or other odd symptoms while we sort this out.

[TreeFrog]

Thank you for having a look at my situation, Altostrata.

 

4 hours ago, Altostrata said:

@TreeFrog please take your drugs on a consistent daily schedule. In April alone, you've made drug changes 6 times, more than once a week.

 

I do take citalopram (9:35 am) and trazodone (9:45 pm) at the same time every day, give or take 5 minutes at most. You're right of course about the number of drug changes.

 

4 hours ago, Altostrata said:

What effect do you feel from 12.5mg trazodone, as compared to higher dosages? Do you feel better or worse after you take 15mg citalopram?

 

Trazodone:

Sedation: It has a bit of a sedating effect, that seems to knock down the anxiety from a half hour or so after I take it to (usually) the next morning when I wake up. So perhaps 7-8 hours altogether? This effect isn't as strong at the 12.5 mg dosage. At higher dosages (25 mg and up), I would sometimes get a groggy, sedated, dull feeling that persists into the next morning for an hour or two (with the exception of April 22, when it lasted til mid-afternoon.)

 

Night sweats: I have been sleeping hot on and off for years (i.e., clammy at night), but in terms of actual night sweats, they began the last night I took 25 mg trazodone (the night of April 22). On 12.5 mg,  I have had them every night since, except the night of April 27), sometimes enough to make the sheets damp. I also had them last night, on 18.5 mg.

 

Sleep: When I was higher doses of trazodone (25, 37.5 and 50 mg), I averaged 6 hours of sleep a night. For the 6 days on 12.5 mg, I averaged 5. Last night on 18.5 mg, I got 7 hours.

 

 

Citalopram: I can't say I feel better after I take 15 mg citalopram (say, within an hour or two). It seems like there is a broad pattern of waking up with anxiety that quickly increases in intensity through the morning, starting even before I take the citalopram. The intensity may stay high all day, until evening, or I may get a bit of a window in the afternoon. Evenings after dinner, the anxiety usually diminishes. I have been keeping detailed notes, and I am thinking I should do some further analysis re the anxiety levels I've had on 15 mg.

 

4 hours ago, Altostrata said:

What times o'clock do the night sweats and back pain appear? How long do they last?

 

The night sweats wake me up in the early morning (1 or 2 am?) I'm not entirely sure of the time, because I try not to look at the clock when I wake up during the night. The one time I did look, it was 1:45 am.

 

The back pain started around April 16, the day after what I thought was a normal walk. It isn't usually too bad while I'm in bed, but it is basically all day every day, to some degree. I saw my physio yesterday and he thinks it's related to some muscular issues I developed after a hip replacement in March 2021.

 

4 hours ago, Altostrata said:

We need to see a series of daily reports to detect a trend.

 

I've been posting daily notes for every day since April 22, as per MMT's request. Please let me know if I need to provide more detail, or if you want to see the notes from before that. I'll post yesterday's notes shortly.

 

Thanks again.

[TreeFrog]

Notes

 

April 29:

• 1:45 am: awake; mild night sweats
• 2:30 am: got up and read
• 4 am: back to bed; didn't sleep
• 6 am: anxiety 6-7/10
• 7 am: got up; anxiety 7-8/10 (3 hours sleep in total)
• 8 am: anxiety 8-9/10
• 9 am: breakfast; digestive enzymes
• 9:30 am: citalopram 15 mg
• 11 am: anxiety 9-10/10
• 11:30 am: toast
• noon: walk with friend
• 1:30 pm: protein shake
• 2 pm: physio; errands
• 7 pm: dinner; digestive enzymes; anxiety 7-8/10
• 9:45 pm: trazodone 18.5 mg
• 10:15 pm: lights out

April 30:

• moderate night sweats (not sure of time)
• 6:30 am: awake; anxiety 6-7/10
• 7 am: got up; anxiety 7-8/10 (7 hours sleep in total)
• 9:30 am: citalopram 15 mg; anxiety 8-9/10

 

[Altostrata]

Your last drug change was *yesterday*. You need to stick to a consistent dosing schedule -- NO DRUG CHANGES -- for a week before we can see a trend in your symptom pattern.

 

If I were you, I'd leave well enough alone with the trazodone. Physical therapy for the back pain sounds like a good idea. It could be coincidental.

 

I'm going to be honest, I am feeling unfairly burdened with following up on your doctor's dumb advice and your constant ad hoc drug changes. It seems you want to increase citalopram now? If you make any more drug changes over the next week, I personally will not answer your questions further.

 

 

[TreeFrog]

I understand and I will leave everything as is, both citalopram and trazodone, for the next week.

 

I'm sorry to have added to your load with my behaviour. I am very grateful that you are responding to my posts. I will continue to post daily notes.

[TreeFrog]

April 30:

• moderate night sweats (not sure of time)
• 6:30 am: awake; anxiety 6-7/10
• 7 am: got up; anxiety 7-8/10 (7 hours sleep in total)
• 9 am: breakfast
• 9:30 am: citalopram 15 mg; anxiety 8-9/10
• 10 am: anxiety 9-10/10
• noon: tried ice pack on face for 20-30 seconds; laid down and listened to guided meditation; dozed off 2x; anxiety 5-6/10
• 1:30 pm: got up; anxiety 6-7/10
• 2:30 pm: protein shake
• 3:30 pm: anxiety 7-8/10
• 4:30 pm: walk with friend; anxiety 6-7/10
• 5:30 pm: anxiety 5-6/10
• 7 pm: supper
• 9:30 pm: trazodone 18.5 mg
• 10:15 pm: lights out

May 1:

• 4:30 am: awake for 1? hour; moderate night sweats
• 7:30 am: awake; got up; anxiety 6-7/10; felt low mood, dull, a bit nauseated

[Altostrata]

Do you feel better or worse after you take citalopram?

 

1 hour ago, TreeFrog said:

9:30 pm: trazodone 18.5 mg

 

Why does this say 18.5mg?

[TreeFrog]

2 hours ago, Altostrata said:

Do you feel better or worse after you take citalopram?

 

I had a look at the 18 days I've been on 15 mg citalopram. In the next half hour to two hours after taking it, I felt better (i.e., less anxiety) on 1 day, worse (i.e., more anxiety) on 10 days and the same on 1 day (some days I felt better but there was some other plausible reason for it, like a counseling session or an acupuncture treatment, or the use of a coping method, within 2 hours of taking it.) Let me know if you meant something other than feeling better or worse within half an hour to two hours after taking it.

 

For whatever it's worth, I had a closer look at my anxiety levels since I reinstated citalopram:

 

• For 6 days on 5 mg, I had anxiety at or above 6/10 for 64% of my waking hours
• For 7 days on 10 mg, I had anxiety at or above 6/10 for 51% of my waking hours
• For 18 days on 15 mg, I've had anxiety at or above 6/10 for 62% of my waking hours

 

As I mentioned earlier, it seems like there is a broad pattern now of waking up with anxiety that quickly increases in intensity through the morning, starting even before I take the citalopram. The intensity may stay high all day, until evening, or I may get a bit of a window in the afternoon. Evenings after dinner, the anxiety usually diminishes.

 

2 hours ago, Altostrata said:

Why does this say 18.5mg?

 

I increased the dose to 18.5 mg on April 29, after conferring with mmt about updosing.

 

Thank you, Altostrata

[Altostrata]

We need to see a series of your daily notes with consistent dosing.

[TreeFrog]

May 1:

• 4:30 am: awake for 1? hour; moderate night sweats
• 7:30 am: awake; got up; anxiety 6-7/10; felt low mood, dull, a bit nauseated
• 9:30 am: breakfast; citalopram 15 mg; digestive enzymes; anxiety 8-9/10
• 11:30 am: cold gel pack to face; breathing; guided meditation; anxiety 7-8/10
• 12:30 pm: anxiety 8-9/10; lunch
• 1:30 pm: anxiety 9-10/10
• 1:45 pm: walk with friend
• 3:00 pm: back home
• 7:00 pm: supper; enzymes
• 8:00 pm: anxiety 7-8/10
• 9:40 pm: trazodone 18.5 mg
• 10:25 pm: lights out

May 2:

• 1:30 am: awake; got up to use cold gel pack
• 2:00 am: back to sleep?
• 6:00 am: awake; anxiety 6-7/10
• 8:00 am: got up

It just occurred to me that maybe the caffeine in the cup of black tea I drink after I get up is adding to the anxiety. Today for the first time I substituted decaf tea.

[Shep]

16 hours ago, TreeFrog said:

It just occurred to me that maybe the caffeine in the cup of black tea I drink after I get up is adding to the anxiety. Today for the first time I substituted decaf tea.

 

Substituting decaf tea sounds like a great idea. How is your diet overall? Are you eating lots of protein and veggies and avoiding sugar, processed foods, and alcohol? Since withdrawal can cause unpredictable drops in blood sugar with symptoms that mimic withdrawal, eating smaller meals with more frequency can keep blood sugar levels steady.

[TreeFrog]

Hi Shep, I'm doing my best to eat a healthy diet; the main problem is my lack of appetite and trying to get enough calories in. But no sugar, alcohol or processed foods, at least.

[TreeFrog]

May 2:

• 1:30 am: awake; got up to use cold gel pack
• 2 am: back to sleep?
• 6 am: awake; anxiety 6-7/10
• 8 am: got up
• 9:30 am: breakfast; citalopram 15 mg; digestive enzymes
• 10 am: anxiety 7-8/10
• 10:30 am: laid down; guided meditation; dozed off; anxiety 6-7/10
• 12:30 pm: got up
• 1 pm: lunch
• 2:15 pm: guided meditation
• 3:15 pm: protein shake
• 5 pm: walk with friend; anxiety 5-6/10
• 6:30 pm: dinner; anxiety 4-5/10
• 9:30 pm: trazodone 18.5 mg
• 10:10 pm: lights out

May 3:

• 6 am: awake; dozed a bit; moderate night sweats during night
• 7 am: guided meditation; anxiety 5-6/10
• 7:20 am: got up; anxiety 6-7/10

[Shep]

21 hours ago, TreeFrog said:

Hi Shep, I'm doing my best to eat a healthy diet; the main problem is my lack of appetite and trying to get enough calories in. But no sugar, alcohol or processed foods, at least.

 

Glad your avoiding the problem foods. Having small snacks of healthy foods can be easier for people with not much appetite. Having two or three bites every 30 minutes or so can add up to getting enough protein and calories in over the course of the day.

 

Make sure you're also getting enough liquids, especially clean filtered water. Dehydration can mimic withdrawal symptoms, such as anxiety and fatigue.

[TreeFrog]

May 3:

• 6 am: awake; dozed a bit; moderate night sweats during night
• 7 am: guided meditation; anxiety 5-6/10
• 7:20 am: got up; anxiety 6-7/10
• 9 am: breakfast; digestive enzymes; anxiety 7-8/10
• 9:30 am: grocery store; anxiety 9-10/10
• 9:50 am: home; citalopram 15 mg; anxiety 7-8/10
• 10 am: online CBT class
• noon: anxiety 8-9/10
• 12:30 pm: lunch; anxiety 9-10/10
• 1:30 pm: walk with friend; anxiety 7-8/10
• 3:30 pm: home; anxiety 9-10/10
• 4:30 pm: protein shake
• 7 pm: dinner; anxiety 7-8/10
• 9:30 pm: trazodone 18.5 mg
• 10:20 pm: lights out

May 4:

• 2:45 am: awake; finally got up for an hour; mild night sweats
• 4:45 am: back to bed; anxiety 5-6/10
• 7:40 am: awake; anxiety 5-6/10
• 8 am: up; anxiety 7-8/10

I'm on track today for another day of intense, constant anxiety. I've been doing meditation; muscle relaxation and adbominal breathing but nothing seems to be bringing the level of anxiety down at all. I'm really struggling, especially with the thought that things seem to be getting steadily worse.

[Shep]

16 hours ago, TreeFrog said:

I'm on track today for another day of intense, constant anxiety. I've been doing meditation; muscle relaxation and adbominal breathing but nothing seems to be bringing the level of anxiety down at all. I'm really struggling, especially with the thought that things seem to be getting steadily worse.

 

When you say "anxiety," do you mean anxious thoughts? Or is it more like a "chemical" anxiety in your body, like drinking a ton of coffee?

[TreeFrog]

3 hours ago, Shep said:

When you say "anxiety," do you mean anxious thoughts? Or is it more like a "chemical" anxiety in your body, like drinking a ton of coffee?

 

I do have anxious thoughts that I try and detach from; the main one right is "I made a terrible mistake reinstating to 15 mg citalopram and I'm in a kindling reaction now." I do my best to just let them go by.

 

However, by anxiety I mean the physical sensations and the fear that I feel. It is like a chemical anxiety. My body seems to stuck in fight or flight mode.

[TreeFrog]

May 4:

• 2:45 am: awake; finally got up for an hour; mild night sweats; about 6 hours of sleep
• 4:45 am: back to bed; anxiety 5-6/10
• 7:40 am: awake; anxiety 5-6/10
• 8 am: up; anxiety 7-8/10
• 9 am: breakfast; digestive enzymes
• 9:30 am: citalopram 15 mg; anxiety 8-9/10
• 10:45 am: grocery store; physio; gas
• 12:30 pm: home; anxiety 9-10/10
• 2:30 pm: walk with friend; anxiety 7-8/10
• 4 pm: home; anxiety 8-9/10
• 6:30 pm: dinner
• 7:30 pm: visit with neighbour; anxiety 7-8/10
• 9:40 pm: trazodone 18.5 mg
• 10:15 pm: lights out

May 5:

• 7:45 am: awake; anxiety 4-5/10; moderate night sweats; about 8.5 hours of sleep
• 8 am: got up
• 8:30 am: anxiety 6-7/10

 

[Shep]

18 hours ago, TreeFrog said:

I do have anxious thoughts that I try and detach from; the main one right is "I made a terrible mistake reinstating to 15 mg citalopram and I'm in a kindling reaction now." I do my best to just let them go by.

 

However, by anxiety I mean the physical sensations and the fear that I feel. It is like a chemical anxiety. My body seems to stuck in fight or flight mode.

 

It sounds like you're already learning to let your negative thoughts go. If you haven't already done so, you may want to check out the work of Dr. Claire Weekes. She talks about both the physical and the psychological aspects of anxiety. Granted, it's by far worse due to withdrawal, but the talks are still worth checking out.

 

Dr Claire Weekes How To Recover Part1

 

Dr Claire Weekes How To Recover Part2

 

Dr Claire Weekes How To Recover Part 3

 

Dr Claire Weekes How To Recover Part 4

 

Hypersensitivity Recovery Part 1 | Dr Claire Weekes

 

Hypersensitivity Recovery Part 2 | Dr Claire Weekes

 

And this is a great short video on acceptance without adding "second fear," how not to attach words to your physical feelings of anxiety:

 

Dr. Claire Weekes: How to accept the physical symptoms of nervous illness

 

Try not to attach your thoughts to your bodily sensations. If you're feeling trembly and anxious, just let those sensation flow through you without attaching a narrative.

 

18 hours ago, TreeFrog said:

7:45 am: awake; anxiety 4-5/10; moderate night sweats; about 8.5 hours of sleep

 

Sleep seems to be improving, which is a great sign.

[Altostrata]

Specifically, we need to know how you feel before and after taking citalopram. Did you just say you felt more anxiety afterward? If so, how do you feel this, what happens after you take citalopram?

[TreeFrog]

5 hours ago, Altostrata said:

Specifically, we need to know how you feel before and after taking citalopram. Did you just say you felt more anxiety afterward? If so, how do you feel this, what happens after you take citalopram?

 

I take the citalopram at 9:30 am. Before that, I feel anxiety as soon as I'm awake, and the anxiety level continues to rise before I take the citalopram. After I take the citalopram, between 9:30 and noon over the past week, I felt more anxiety four days, less anxiety two days (possibly due to meditation and abdominal breathing and/or a nap) and the same level of anxiety one day.

 

So I don't always feel more anxiety afterward. When I do, the physical sensations (buzzing in my chest, heat in my gut, gripping in my throat,  weakness in my legs and arms and hands) intensify and I often feel more mental distress, almost panicky, which I think may be a reaction to the anxiety itself and the thoughts that go with it.

 

[TreeFrog]

7 hours ago, Shep said:

If you haven't already done so, you may want to check out the work of Dr. Claire Weekes. She talks about both the physical and the psychological aspects of anxiety.

 

I have seen her work, but I will check out the videos...thanks, Shep.

[TreeFrog]

May 5:

• 7:45 am: awake; anxiety 4-5/10; moderate night sweats; about 8.5 hours of sleep
• 8 am: got up
• 8:30 am: anxiety 6-7/10
• 9 am: breakfast; digestive enzymes; anxiety 7-8/10
• 9:30 am: citalopram 15 mg
• 11:30 am: toast
• noon: anxiety 8-9/10
• 2 pm: lunch; listened to anxiety podcast; anxiety 7-8/10
• 2:30 pm: went to volunteer job at animal shelter
• 4:45 pm: left shelter; anxiety 5-6/10
• 6:45 pm: dinner; anxiety 4-5/10
• 9:40 pm: trazodone 18.5 mg
• 10:15 pm: lights out

May 6:

• 7 am: awake; got up; anxiety 5-6/10; just slightly sweaty overnight; about 8 hours of sleep
• 7:30 am: anxiety 6-7/10
• 8:30 am: anxiety 7-8/10
• 9 am: breakfast; digestive enzymes; anxiety 8-9/10
• 9:30 am: citalopram 15 mg
• 10 am: muscle relaxation, breathing and meditation practice; anxiety 7-8/10

[TreeFrog]

May 6:

• 7 am: awake; got up; anxiety 5-6/10; just slightly sweaty overnight; about 8 hours of sleep
• 7:30 am: anxiety 6-7/10
• 8:30 am: anxiety 7-8/10
• 9 am: breakfast; digestive enzymes; anxiety 8-9/10
• 9:30 am: citalopram 15 mg
• 10 am: muscle relaxation, breathing and meditation practice; anxiety 7-8/10
• 11:15 am: errands; anxiety 8-9/10
• 12:30 pm: anxiety 5-6/10; home; headache until 4:30 pm
• 1:15-2:15 pm: visit from friend
• 2:30 pm: lunch
• 3-4 pm: laid down
• 5:15-6:15 pm: walk with friend
• 6:45 pm: dinner; enzymes
• 9:40 pm: trazodone 18.5 mg
• 10:15 pm: lights out

May 7:

• 5 am: awake; dozed off again; anxiety 5-6/10; moderate night sweats; about 6.5 hours of sleep
• 6:45 am: awake; anxiety 6-7/10
• 7:10 am: got up
• 8 am: anxiety 5-6/10
• 8:30 am: anxiety 7-8/10
• 9:30 am: breakfast; digestive enzymes; citalopram 15 mg

 

 

[TreeFrog]

May 7:

• 5 am: awake; dozed off again; anxiety 5-6/10; moderate night sweats; about 6.5 hours of sleep
• 6:45 am: awake; anxiety 6-7/10
• 7:10 am: got up
• 8 am: anxiety 5-6/10
• 8:30 am: anxiety 7-8/10
• 9:30 am: breakfast; digestive enzymes; citalopram 15 mg
• 10 am: progressive muscle relaxation; adbominal breathing; anxiety 6-7/10
• 11:30 am: anxiety 8-9/10
• noon: anxiety 5-6/10; depression 6/10
• 12:30 pm: walk
• 2:30 pm: lunch; anxiety 7-8/10
• 3 pm: laid down; dozed; anxiety 7-8/10 "jolts" while dozing
• 4:30 pm: got up; anxiety 7-8/10
• 5 pm: protein shake
• 6 pm: anxiety 6-7/10
• 7 pm: dinner; enzymes
• 8 pm: anxiety 7-8/10
• 9:40 pm: trazodone 18.5 mg
• 10:20 pm: lights out

May 8:

• 3:15 am: awake; no night sweats, just a bit sweaty; about 4 hours of sleep
• 3:30 am: got up to read
• 5 am: back to bed; awake; anxiety 6-7/10
• 7 am: got up
• 8 am: anxiety 7-8/10
• 9 am: breakfast; digestive enzymes
• 9:30 am: citalopram 15 mg

 

[TreeFrog]

May 8:

• 3:15 am: awake; no night sweats, just a bit sweaty; about 4 hours of sleep
• 3:30 am: got up to read
• 5 am: back to bed; awake; anxiety 6-7/10
• 7 am: got up
• 8 am: anxiety 7-8/10
• 9 am: breakfast; digestive enzymes
• 9:30 am: citalopram 15 mg
• 10:30 am: laid down; dozed 30?"
• noon: anxiety 9-10/10; mental distress
• 3 pm: went to volunteer job; anxiety 8-9/10
• 5 pm: home; protein shake
• 5:30 pm: walk with neighbour; anxiety 7-8/10
• 7 pm: dinner; enzymes
• 9:40 pm: trazodone 18.5 mg
• 10:10 pm: lights out

May 9:

• awake for 30?" during night but back to sleep; mild night sweats; about 7 hours of sleep; anxiety 6-7/10
• 7 am: awake; got up; anxiety 7-8/10
• 8:30 am: breakfast; digestive enzymes; anxiety 9-10/10
• 9 am: counselling session; anxiety to 6-7/10
• 10:30 am: anxiety 8-9/10

The physical sensations and feeling of anxiety seem to be intensifying steadily (e.g., I haven't typically been anxious overnight before). I guess they are not unbearable, since I am bearing them, but it's very hard.

 

If I am in a kindling reaction to the citalopram reinstatement, what is the best course of action?