TreeFrog: trying to stabilize from Cymbalta withdrawal

[TreeFrog]

"Anxiety" at 6-7/10 and up gives physical sensations of buzzing/quivering in my chest, heat and clenching in my gut, gripping in my throat, weakness in my legs and arms and hands. At 5-6/10 and less, it is a mild to moderate "buzzing" feeling throughout my body; unless otherwise noted.

 

May 23:

• 7:20 am: awake; anxiety 5-6/10; mild night sweats; about 8.5 hours sleep
• 7:30 am: got up; moderate "stunned" feeling for ~1 hour
• 8 am: anxiety 6-7/10
• 9:30 am: breakfast; citalopram 15 mg; depression 7/10
• 10 am: tylenol 500 mg
• 12:30 pm: tea with neighbour; depression 5/10
• 2:30 pm: lunch
• 3:30 pm: nap for one hour
• 5 pm: emotional distress linked to depression?
• 7 pm: dinner; arthrotec; anxiety 5-6/10
• 9:40 pm: trazodone 18.5 mg (1/4 tablet and 3 ml liquid)
• 10:05 pm: lights out

May 24:

• 6 am: awake; anxiety 6-7/10; mild night sweats; about 7 hours sleep
• 7 am: got up

 

[TreeFrog]

"Anxiety" at 6-7/10 and up gives physical sensations of buzzing/quivering in my chest, heat and clenching in my gut, gripping in my throat, weakness in my legs and arms and hands. At 5-6/10 and less, it is a mild to moderate "buzzing" feeling throughout my body; unless otherwise noted.

 

May 24:

• 6 am: awake; anxiety 6-7/10; mild night sweats; about 7 hours sleep
• 7 am: got up
• 9 am: breakfast; anxiety 7-8/10
• 9:30 am: citalopram 15 mg; anxiety 8-9/10
• 10 am: CBT skills class; anxiety 7-8/10
• 1:30 pm: lunch; anxiety 6-7/10
• 3 pm: meeting with volunteer supervisor
• 4:30 pm: home; anxiety 5-6/10
• 7 pm: dinner; arthrotec
• 9:40 pm: trazodone 18.5 mg (1/4 tablet and 3 ml liquid)
• 10:25 pm: lights out

May 25:

• 3 am: awake; upset; anxiety 4-5/10
• 4:30 am: back to sleep
• 6:45 am: awake; anxiety 6-7/10; heavy night sweats; about 6 hours sleep
• 7:15 am: got up; depression 4/10
• 9:30 am: breakfast; citalopram 15 mg; magnesium citrate 150 mg
• 10:30 am: anxiety 8-9/10; emotional distress; depression 7/10
• 2 pm: lunch
• 2:30 pm: nap; anxiety 4-5/10
• 3:30 got up; depression 8/10; emotional distress
• 7 pm: dinner; arthrotec
• 9:30 pm: calcium citrate 500 mg; magnesium citrate 200 mg
• 9:45 pm: trazodone 18.5 mg (1/4 tablet and 3 ml liquid)
• 10:30 pm: lights out

May 26:

• 4:40 am: awake; then back to sleep; heavy night sweats; about 7 hours sleep
• 6:45 am: got up; anxiety 4-5/10
• 7:30 am: anxiety 6-7/10
• 8 am: breakfast; calcium citrate 500 mg; magnesium citrate 200 mg
• 9:30 am: citalopram 15 mg

 

•  

[TreeFrog]

"Anxiety" at 6-7/10 and up gives physical sensations of buzzing/quivering in my chest, heat and clenching in my gut, gripping in my throat, weakness in my legs and arms and hands. At 5-6/10 and less, it is a mild to moderate "buzzing" feeling throughout my body; unless otherwise noted.

 

May 26:

• 4:40 am: awake; then back to sleep; heavy night sweats; about 7 hours sleep
• 6:45 am: got up; anxiety 4-5/10
• 7:30 am: anxiety 6-7/10
• 8 am: breakfast; calcium citrate 500 mg; magnesium citrate 200 mg
• 9:30 am: citalopram 15 mg
• 11 am: anxiety 5-6/10
• 2:30 pm: lunch
• 3 pm: acupuncture for low back pain; anxiety 4-5/10
• 6:45 pm: dinner; arthrotec
• 9:20 pm: trazodone 18.5 mg (1/4 tablet and 3 ml liquid)
• 10:05 pm: lights out

May 27:

• 4:45 am: awake a while
• 6:30 am: awake; anxiety 5-6/10; mild night sweats; about 7 hours sleep
• 8 am: anxiety 6-7/10
• 9:30 am: breakfast; calcium citrate 500 mg; magnesium citrate 200 mg
• 9:50 am: citalopram 15 mg

Just wondering if I should continue to post these daily notes?

[TreeFrog]

"Anxiety" at 6-7/10 and up gives physical sensations of buzzing/quivering in my chest, heat and clenching in my gut, gripping in my throat, weakness in my legs and arms and hands. At 5-6/10 and less, it is a mild to moderate "buzzing" feeling throughout my body; unless otherwise noted.

 

May 27:

• 4:45 am: awake a while
• 6:30 am: awake; anxiety 5-6/10; mild night sweats; about 7 hours sleep
• 8 am: anxiety 6-7/10
• 9:30 am: breakfast; calcium citrate 500 mg; magnesium citrate 200 mg
• 9:50 am: citalopram 15 mg
• 10 am: anxiety 7-8/10
• 1:45 pm: lunch
• 3 pm: anxiety 8-9/10 (found out I have a lumbar compression fracture/osteoporosis)
• 6:45 pm: dinner; arthrotec; anxiety 7-8/10
• 9:35 pm: trazodone 18.5 mg (1/4 tablet and 3 ml liquid); anxiety 6-7/10
• 10:30 pm: lights out

May 28:

 

• 4:30 am: awake a while; back to sleep
• 7 am: awake; anxiety 6-7/10; mild night sweats; about 7 hours sleep
• 7:20 am: got up
• 8 am: anxiety 7-8/10
• 9:30 am: breakfast; calcium citrate 500 mg; magnesium citrate 200 mg; citalopram 15 mg
• 10 am: anxiety 6-7/10
• 1 pm: lunch
• 2:30 pm: anxiety 5-6/10
• 6:45 pm: dinner; arthrotec
• 9:40 pm: trazodone 18.5 mg (1/4 tablet and 3 ml liquid)
• 10:35 pm: lights out; anxiety 4-5/10

May 29:

• 3 am: awake; read until 4:15 am
• 6:45 am: awake; anxiety 5-6/10; heavy night sweats; about 6 hours sleep
• 7:20 am: got up
• 8 am: anxiety 6-7/10
• 9:30 am: breakfast; calcium citrate 500 mg; magnesium citrate 200 mg; citalopram 15 mg
• 10 am: anxiety 7-8/10
• 11 to 12:30 pm: nap; anxiety 6-7/10
• 2 pm: lunch
• 2:30 pm: to shelter
• 7:15 pm: dinner; arthrotec
• 8 pm: anxiety 7-8/10
• 9:45 pm: trazodone 18.5 mg (1/4 tablet and 3 ml liquid)
• 11 pm: lights out; anxiety 4-5/10

May 30:

• 6 am: awake; back to sleep
• 7 am: awake; anxiety 5-6/10; heavy night sweats; about 7 hours sleep
• 8 am: anxiety 6-7/10

 

 

 

 

[TreeFrog]

"Anxiety" at 6-7/10 and up gives physical sensations of buzzing/quivering in my chest, heat and clenching in my gut, gripping in my throat, weakness in my legs and arms and hands. At 5-6/10 and less, it is a mild to moderate "buzzing" feeling throughout my body; unless otherwise noted.

 

May 30:

• 6 am: awake; back to sleep
• 7 am: awake; anxiety 5-6/10; heavy night sweats; about 7 hours sleep
• 8 am: anxiety 6-7/10
• 9:30 am: breakfast; citalopram 15 mg
• 11:30 am: toast; calcium citrate 500 mg; magnesium citrate 200 mg; tylenol 500 mg; anxiety 7-8/10
• 12:30 pm: anxiety 6-7/10
• 2 pm: lunch; magnesium 150 mg; anxiety 5-6/10
• 3 pm: nap
• 4:15 pm: up from nap
• 5:45 pm: tylenol 500 mg
• 6:30 pm: dinner; arthrotec; anxiety 6-7/10
• 9:30 pm: trazodone 18.5 mg (1/4 tablet and 3 ml liquid); anxiety 6-7/10
• 10:30 pm: lights out; anxiety 5-6/10

May 31:

• 5:45 am: awake; dozed a bit
• 6:30 am: awake; anxiety 6-7/10; moderated night sweats; about 6 hours sleep
• 6:45 am: got up
• 7 am: anxiety 7-8/10
• 8:30 am: breakfast; calcium citrate 500 mg; magnesium citrate 200 mg; anxiety 8-9/10 (upcoming first volunteer shift)
• 9:15 am: citalopram 15 mg
• 9:30 am: anxiety 6-7/10
• 10 am: anxiety 5-6/10
• 1 pm: lunch
• 2:15 pm: nap
• 3:15 pm: got up
• 6:30 pm: dinner; arthrotec
• 9:40 pm: trazodone 18.5 mg (1/4 tablet and 3 ml liquid)
• 10:20 pm: lights out

June 1:

• 6:30 am: awake; anxiety 5-6/10 (a couple of 7-8/10 jolts woke me up overnight); mild night sweats; about 7.5 hours sleep
• 6:50 am: got up
• 9:30 am: breakfast; calcium citrate 500 mg; magnesium citrate 200 mg; citalopram 15 mg
• 11:30 am: toast
• 1:30 pm: protein shake
• 6:30 pm: dinner; arthrotec; tylenol 500 mg; anxiety 4-5/10
• 9:45 pm: trazodone 18.5 mg (1/4 tablet and 3 ml liquid)
• 10:20 pm: lights out

June 2:

• 7:10 am: awake; anxiety 5-6/10; moderate night sweats; about 8 hours sleep
• 8 am: anxiety 6-7/10

 

Hello, wondering if I should continue to post these daily notes? I am finding that the level of anxiety is gradually decreasing, although it is still constantly there while I'm awake. My appetite is much better and my sleep is too (though of course I'm taking trazodone). I've been on this hold for 5 weeks; should I just hold a while longer?

 

[Shep]

19 hours ago, TreeFrog said:

Hello, wondering if I should continue to post these daily notes? I am finding that the level of anxiety is gradually decreasing, although it is still constantly there while I'm awake. My appetite is much better and my sleep is too (though of course I'm taking trazodone). I've been on this hold for 5 weeks; should I just hold a while longer?

 

 

If you're going to hold for awhile, you could stop posting daily notes. You may want to keep notes on paper or on a Word doc for your own reference or to post later if you have a question. 

 

Very glad you're feeling better. I would hold long enough to establish a really solid baseline before making another reduction. 

[TreeFrog]

I will take your advice, Shep.

I appreciate your kindness and support so much. It has really helped me through what has been the toughest experience of my life. Thank you!

 

[TreeFrog]

I still have a somewhat higher than normal level of baseline anxiety (5-6 to 6-7/10), but my appetite is good and I've gained a couple of pounds back. My sleep is positively leaden, even too much so, and over the past four weeks I've averaged almost 7.5 hours of sleep a night. The last time I got less than 7 hours was May 31, and the last time I got less than 6 hours was May 17.

 

I would like to reduce the trazodone from 18.5 to 15.5 mg (even though on June 3 I said I'd continue to hold, I know!) Not sure where this compulsion is coming from, but I'm sure you see a lot of that here....your thoughts?

[Shep]

18 hours ago, TreeFrog said:

I would like to reduce the trazodone from 18.5 to 15.5 mg (even though on June 3 I said I'd continue to hold, I know!) Not sure where this compulsion is coming from, but I'm sure you see a lot of that here....your thoughts?

 

Going from 18.5 to 15.5 mg is about a 16% decrease. I would slow your taper down at this point. You've done a great job of lowering the dose, but I wouldn't push the limit, as sometimes symptoms from a too fast taper may not show up for awhile. 

 

I would stick to a taper that's no faster than 10% of the previous month's dose (not the original dose). 

 

Since trazodone is helping with sleep, you may want to consider leaving it at that dose and setting up a taper plan for the Citalopram. 

 

Please post your thoughts. 

[TreeFrog]

This morning I'm not sure.

 

I've been doing some reading in topics like "Stabilizing, what does that mean?" It sounds like ideally a person is stable before they start to taper, and that "stable" means that there are few or no withdrawal symptoms. I feel a lot better than I did a month ago, but I'm still experiencing a pretty high and steady level of anxiety, especially in the morning...this morning, it's 6-7/10.  Whatever "stability" I have doesn't feel all that solid, plus I am going to visit my 90-year-old mother in California next month, which is a real source of anxiety. I'm also concerned of course about having osteoporosis and what that's going to mean for me.

 

So in my case, it is probably premature. But if I was going to taper (or when I do start to taper), I'd prefer to start with trazodone. When I was on it from mid-September 2019 to August 2020, I didn't know anything about a 10% taper, but had no issue stopping it at 12.5 mg, with no effect on my sleep. I certainly wouldn't be that aggressive this time, but it's reassuring that I was able to do it successfully in the past. Then I'd tackle citalopram; for me, that's the biggie.

 

It's really strange how so many people, including me now, have this strong urge to taper and get off the drugs, whether they're ready or not....

[Shep]

17 hours ago, TreeFrog said:

I've been doing some reading in topics like "Stabilizing, what does that mean?" It sounds like ideally a person is stable before they start to taper, and that "stable" means that there are few or no withdrawal symptoms.

 

This depends. For some people who come into the forum destabilized, they may start their taper when they've reached a baseline that allows them to be functional, even though they may have a few symptoms. 

 

Here is a post you may find helpful in determining when it's a good idea to start tapering:

 

WD Normal

 

17 hours ago, TreeFrog said:

Whatever "stability" I have doesn't feel all that solid, plus I am going to visit my 90-year-old mother in California next month, which is a real source of anxiety.

 

Whenever you know you're going to be stressed, it's always best to hold and work on self-care to get you through these stressful times. So it's great you're taking note of everything that's going on in your life. In withdrawal, everything matters. 

 

17 hours ago, TreeFrog said:

So in my case, it is probably premature. But if I was going to taper (or when I do start to taper), I'd prefer to start with trazodone. When I was on it from mid-September 2019 to August 2020, I didn't know anything about a 10% taper, but had no issue stopping it at 12.5 mg, with no effect on my sleep. I certainly wouldn't be that aggressive this time, but it's reassuring that I was able to do it successfully in the past. Then I'd tackle citalopram; for me, that's the biggie.

 

You can play it by ear and see how you feel when the time comes. You may want to stay on a bit of Trazodone while you come off the Citalopram, just to have a bit of sedating drug at night for sleep. With a lower Trazodone dose, you won't have as many side effects. 

 

[TreeFrog]

@Shep, Hello.

 

I reduced my trazodone dose by just over 10% on June 23, from 18.5 mg to 16.5 mg. At first all I really noticed was that I was having a bit of trouble staying asleep past 6 am, and then that I was getting jolts of early morning anxiety that I hadn't had in a while. In the past few days, I've started to feel more depression, which I thought was due to the constant back and jaw pain I'm having. In the last two or three days,  though, I've had increasing anxiety throughout the day, and I'm seeing the return of symptoms I haven't felt in weeks: less appetite, less interest in activities. I had really thought I had turned a corner on this level of symptoms; now I'm not sure if it was just a long window, or more closely related to the drop in the trazodone dose. Or, the ongoing struggle with pain? Or, that I have my ex-partner, who has cognitive issues, as a houseguest for a few days? He has lived aboard his boat for years, but it sank at the dock on Wednesday and he lost everything. His cat almost drowned, but was revived at the dock. You can imagine his distress, and I think I am replicating it in myself. In fact, I know I am. I'm in quite a wretched mind state.

 

I'm wondering whether to updose back to 18.5 mg trazodone or not...what are your thoughts? I haven't been keeping good notes, but I'm starting to now.

[Shep]

9 hours ago, TreeFrog said:

I had really thought I had turned a corner on this level of symptoms; now I'm not sure if it was just a long window, or more closely related to the drop in the trazodone dose. Or, the ongoing struggle with pain?

 

Is pain a withdrawal symptom for you or are you dealing with another health issue? 

 

9 hours ago, TreeFrog said:

Or, that I have my ex-partner, who has cognitive issues, as a houseguest for a few days?

 

Dose your ex-partner make noise that keeps you awake at night? That could definitely ramp up symptoms especially if you're used to a quiet home. 

 

9 hours ago, TreeFrog said:

I'm wondering whether to updose back to 18.5 mg trazodone or not...what are your thoughts? I haven't been keeping good notes, but I'm starting to now.

 

Since it's been 8 days from your last reduction, you could safely updose back to where you were, or even a tiny bit less. It's hard to know exactly what is causing the uptick in symptoms, but likely, it's a combination of everything you wrote about. 

 

Going forward, you may want to switch to a microtaper of 5% a month, but I would go into a long hold for now and see if you can stabilize back to a solid baseline. By going forward with a microtaper, you'll give your nervous system a bit of cushion to handle life stressors that catch you off guard. 

 

Please let us know how you're doing over the coming days.

[TreeFrog]

3 hours ago, Shep said:

Is pain a withdrawal symptom for you or are you dealing with another health issue? 

The back pain started during withdrawal, in early April, so could very well be a symptom. The TMJ problem has been ongoing, but it's gotten a lot worse since withdrawal started. Osteoporosis is my other health issue, probably not related to withdrawal at all.

 

3 hours ago, Shep said:

Dose your ex-partner make noise that keeps you awake at night? That could definitely ramp up symptoms especially if you're used to a quiet home

 

He doesn't make any noise at all, but I'm used to being alone here and so just the presence of another person is disruptive. But beyond that, he's in a great deal of distress and I think I'm picking that up and feeling it myself.

 

Last night for the first time in weeks I woke up very early, at 3:30, and couldn't go back to sleep. Intense anxiety and distress. 

 

I will go back to 18.5 mg trazodone tonight and hope for the best. I'll start posting daily notes again too.

 

Thank you Shep.

[TreeFrog]

My doctor has just suggested I start nortriptyline 10 mg for back pain. I am still holding at citalopram 15 mg and trazodone 18.5 mg, not sure I want to add a tricyclic into the mix and have one more AD to deal with. Any thoughts?

 

Aside from back and jaw pain, I am doing fairly well mentally, especially given that I just visited my 90 year old mother in California for the first time since Sept 2019, to find her really struggling with dementia. She lives alone in a place with stairs--not good--It's a very stressful situation and I am totally immersed in trying to find assisted living for her.

[ChessieCat]

SA is a site for going of psychiatric drugs.  We cannot suggest what drugs you could try.  We don't know what would happen if you added another drug.

 

SA encourages members to be vigilant and do their own research to see possible side effects and also what drug interactions there might be.

 

This is a good site to see possible side effects of a drug:

 

https://www.drugs.com/

 

These 2 interaction checkers provide similar information but in a different format.  I suggest that you use both.  I've already done this out of curiosity and am shocked at the results (Medscape checker).  I would print this out and show it to your doctor.  And because of the seriousness of the possible interactions of this suggestion of adding nortriptyline, if I were you, I would be trying to find a different doctor.

Medscape Drug Interaction Checker

 

Drug.com Interactions Checker

 

And remember, the doctor is not going to be affected by the drugs your take (other than getting benefits from the pharmaceutical company for prescribing  their drug), you are.

[Shep]

8 hours ago, TreeFrog said:

My doctor has just suggested I start nortriptyline 10 mg for back pain. I am still holding at citalopram 15 mg and trazodone 18.5 mg, not sure I want to add a tricyclic into the mix and have one more AD to deal with. Any thoughts?

 

Aside from back and jaw pain, I am doing fairly well mentally, especially given that I just visited my 90 year old mother in California for the first time since Sept 2019, to find her really struggling with dementia. She lives alone in a place with stairs--not good--It's a very stressful situation and I am totally immersed in trying to find assisted living for her.

 

Did you injure yourself or is the pain related to withdrawal? If the back and jaw pain are related to withdrawal, you may want to try gentle yoga or stretches.

 

This is a physical therapist's channel:

 

TMJ Pain Relief with Simple Exercises & Stretches - Ask Doctor Jo video (6.5 minutes)

 

And this is a playlist on a really good yoga instructor's channel. You may want to target the area of your back that's hurting (upper or lower) and find some stretches to help:

 

Yoga by Adriene - Yoga for Back Pain

 

You may want to watch videos all the way through before trying them, just to make sure it looks safe to do with your level of pain. 

 

Psychiatric drugs can come with tight muscles, not only the effects of the drugs and withdrawal, but also because we become more sedentary when we don't feel well. And this can make our muscles tight and weaker than they would be if we were out living our lives to full capacity. Also, if you're doing a lot of withdrawal research on a computer or phone, that can also cause back pain. 

 

For the jaw pain, if you're grinding your teeth at night (a common withdrawal symptom), you may want to get a night guard to protect your teeth. 

 

More information is here: 

 

Non-drug techniques to ease chronic pain

 

Body Pain

 

Facial tics, jaw, tongue muscle tension and pain, bruxism, teeth clenching, TMJ

Edited August 13, 2022 by Shep
fixed typo

[TreeFrog]

On 8/13/2022 at 2:55 AM, Shep said:

Did you injure yourself or is the pain related to withdrawal? If the back and jaw pain are related to withdrawal, you may want to try gentle yoga or stretches.

Thanks for the info, Shep. Re your question, both are longstanding and started to really flare up when I was in withdrawal. Thinking I will hold off on the nortriptyline.

[Shep]

If you're not sensitive to magnesium, you may want to try warm epsom salt baths. That can be very helpful for pain. 

 

[TreeFrog]

I've been holding at 15mg citalopram, 18.5 mg trazodone since April 29, except for a temporary 8-day drop to 16.5 mg trazodone in late June. Guess I thought the stability I've experienced since early June (except for the one-week "relapse" in early July) was a permanent state, and that once I "achieved stability" I'd be largely free from the thoughts, feelings and sensations I experienced in the spring, when withdrawal was at its most intense. But now...

 

I've been feeling intense anxiety (average 8-9/10) all day for the past 2 days, starting as soon as I wake up. I had been taking 1000 mg methocarbamol and 400 mg ibuprofen (Robax Platinum) morning and late afternoon for 10-14 days (sorry, I wasn't keeping records) for chronic back and jaw pain, but I stopped that yesterday, thinking it might be a factor.

 

Not sure if this is just the latest manifestation of withdrawal, or if the stressors in my life (chronic pain, mother who is starting to slide into dementia, loneliness) have just become overwhelming.

[Shep]

16 hours ago, TreeFrog said:

I had been taking 1000 mg methocarbamol and 400 mg ibuprofen (Robax Platinum) morning and late afternoon for 10-14 days (sorry, I wasn't keeping records) for chronic back and jaw pain, but I stopped that yesterday, thinking it might be a factor.

 

There are numerous drug interactions. I've placed them in a drug interaction checker but because of the number of drugs, I had to sign in (you can register for free to use this interaction checker).

 

Drug Interaction Report - methocarbamol, IBU (ibuprofen), citalopram, trazodone

 

16 hours ago, TreeFrog said:

Not sure if this is just the latest manifestation of withdrawal, or if the stressors in my life (chronic pain, mother who is starting to slide into dementia, loneliness) have just become overwhelming.

 

Probably a combination of all of this. That's a LOT to have to handle. 

 

Please do as much self care as you can. Gentle stretching, warm epsom salt baths with lavender oil, soft music, etc. can be helpful for chronic pain and may help you avoid needing other medications. 

[TreeFrog]

Thanks Shep. My sleep is starting to degrade as well; the intense anxiety wakes me up very early despite the trazodone, so I slept 6 hours Tuesday, 7 hours Wednesday and 6 hours today. That's a concern.

[TreeFrog]

Shep, I have a question for you: as I mentioned in my earlier post, I started my hold April 29, and began to move into a long period of minimal WD symptoms in early June, which lasted until the end of August. But if a person is holding at a particular dose, and becomes "stable" (what Brass Monkey called WDNormal; I read some of his piece on "are we there yet?") for so many weeks, I didn't think WD symptoms would suddenly return full force. Is that a common occurrence? 

 

 

[Shep]

20 hours ago, TreeFrog said:

Thanks Shep. My sleep is starting to degrade as well; the intense anxiety wakes me up very early despite the trazodone, so I slept 6 hours Tuesday, 7 hours Wednesday and 6 hours today. That's a concern.

 

Sleeping 6 - 7 hours during withdrawal is very good. How many hours were you sleeping before? Has the quality of the sleep changed? 

 

4 hours ago, TreeFrog said:

Shep, I have a question for you: as I mentioned in my earlier post, I started my hold April 29, and began to move into a long period of minimal WD symptoms in early June, which lasted until the end of August. But if a person is holding at a particular dose, and becomes "stable" (what Brass Monkey called WDNormal; I read some of his piece on "are we there yet?") for so many weeks, I didn't think WD symptoms would suddenly return full force. Is that a common occurrence? 

 

 

 

When you take other drugs that cause drug interactions, yes, it's very common. Because withdrawal takes so long, many of us have had to deal with this. Also, having a flare-up of pain can ramp up withdrawal symptoms. 

 

Are you able to resolve the pain without the pain meds? Is this something that physical therapy can help? 

[TreeFrog]

2 hours ago, Shep said:

 

Sleeping 6 - 7 hours during withdrawal is very good. How many hours were you sleeping before? Has the quality of the sleep changed?

I got 4 hours this last night so things are really deteriorating. Before this started, I was sleeping 7 or 8 hours and not waking up with a huge rush of anxiety.

2 hours ago, Shep said:

 

When you take other drugs that cause drug interactions, yes, it's very common. Because withdrawal takes so long, many of us have had to deal with this. Also, having a flare-up of pain can ramp up withdrawal symptoms. 

 

Are you able to resolve the pain without the pain meds? Is this something that physical therapy can help? 

Yes I am getting physical therapy. I won't be taking any more pain meds, it's not worth it.

 

It is very difficult to suddenly find myself back in intense withdrawal symptoms. I'm really battling the feeling of despair

[Shep]

20 hours ago, TreeFrog said:

Yes I am getting physical therapy. I won't be taking any more pain meds, it's not worth it.

 

It is very difficult to suddenly find myself back in intense withdrawal symptoms. I'm really battling the feeling of despair

 

I wouldn't despair, TreeFrog. You know what caused this wave and you have a plan to feel better without drugs so you don't have to go through this again.

 

That's reason for hope. 

[TreeFrog]

I'm starting to think about beginning to taper and would appreciate advice, because I'm not sure if I'm stable enough to start a taper. I've been holding citalopram at 15 mg since April 29, and I just reduced trazodone slightly, from 18.5 mg to 17.5 mg, on November 3. I haven't noticed any changes from doing so, so far.

 

Thing is, I'm still experiencing some major waves, without an obvious explanation like there was in September, when I was using the muscle relaxant. I haven't been keeping great records, but the last one was for maybe 5-6 days in late October. If I'm still getting waves, despite the long hold, does that mean it's not a good time to start a taper? Or could it be possible that I might feel better on a lower dose of citalopram? Feeling very confused about where to go from here.

 

Thank you for your help.

[ChessieCat]

22 minutes ago, TreeFrog said:

I just reduced trazodone slightly, from 18.5 mg to 17.5 mg, on November 3. I haven't noticed any changes from doing so, so far.

 

I don't think making a reduction of a the citalopram would be a good idea because if your symptoms worsen you will not know if it caused by the trazadone reduction or the citalopram reduction.  It's only been about 6 days since your reduced.  Withdrawal symptoms do not always appear straight away.  And even if you don't feel symptoms, it doesn't mean that the brain isn't making adaptations.

[TreeFrog]

1 hour ago, ChessieCat said:

I don't think making a reduction of a the citalopram would be a good idea because if your symptoms worsen you will not know if it caused by the trazadone reduction or the citalopram reduction.  It's only been about 6 days since your reduced.  Withdrawal symptoms do not always appear straight away.  And even if you don't feel symptoms, it doesn't mean that the brain isn't making adaptations.

 

Thanks, Chessie. What do you think about if I wait for at least a couple of weeks for the traz reduction to settle; if things seem ok, maybe try to lower the citalopram by say 5% at that point?

[Shep]

@TreeFrog Does Trazodone help with sleep? If so, why were you reducing it before reducing the citalopram? Are you overly sedated during the day? 

[TreeFrog]

6 hours ago, Shep said:

@TreeFrog Does Trazodone help with sleep? If so, why were you reducing it before reducing the citalopram? Are you overly sedated during the day? 

Hi Shep, thanks for getting back to me. Yes, I feel really groggy for a couple of hours after I wake up, though not all day, so I thought I would try and cut back on the trazodone a bit to reduce that effect while still preserving my sleep; it is quite effective for that. I hardly ever get less than 7 hours now and frequently 8, even with the 1 mg dose reduction a week ago.

 

But my main goal is to start tapering citalopram. I can certainly leave the trazodone dosage alone while I do, as you have suggested before.

 

As I mentioned above, I'm concerned about starting a citalopram taper because I'm still getting intense waves of anxiety, but I'm not sure if that in itself means I shouldn't start a taper. The wave that started in late August lasted for almost a month (we think that one was due to the methocarbamol). I stabilized, though at a higher level of anxiety than before, in late September and had another 5-6 day wave of intense anxiety starting around October 21; I'm not sure what set that one off. And my baseline level of anxiety is a lot higher than it was before all this started. Still, maybe that is just part of WD normal. I'm certainly doing a lot better than I was in the spring, except during the waves.

 

 

[Shep]

18 hours ago, TreeFrog said:

I hardly ever get less than 7 hours now and frequently 8, even with the 1 mg dose reduction a week ago.

 

Since you just made a reduction of one of your drugs a week ago, as ChessieCat mentioned, I would hold for awhile to see what your baseline is. You may want to give yourself a month from your last reduction before you make another reduction. And then you can reassess where you're at. 

 

18 hours ago, TreeFrog said:

As I mentioned above, I'm concerned about starting a citalopram taper because I'm still getting intense waves of anxiety, but I'm not sure if that in itself means I shouldn't start a taper. 

 

What times of day to you take each of your drugs? What time(s) of day is the anxiety worse? 

 

We had discussed Trazodone's mCPP issue earlier in your thread - this is explained in the first post in this thread: Tips for tapering off trazodone (Desyrel)

 

It's possible that some of what you're dealing with is the day-after effect of the Trazodone. Reducing the citalopram may not help with that. You'll need to weigh the pros and cons of staying on the Trazodone for sleep and using non-drug coping skills to deal with it's daytime anxiety effect. 

 

If you're able to handle the upticks in anxiety during the day, it may be worth it knowing you'll get a decent night's sleep. 

 

[TreeFrog]

On 11/11/2022 at 2:51 AM, Shep said:

 

What times of day to you take each of your drugs? What time(s) of day is the anxiety worse? 

 

I take the citalopram at 8:30 am and the trazodone at 9:45 pm. The anxiety tends to be the worst when I wake up and for the next 2 or 3 hours. It can recur in the late afternoon around 4 or 5 pm.

 

 

[Shep]

9 hours ago, TreeFrog said:

 

I take the citalopram at 8:30 am and the trazodone at 9:45 pm. The anxiety tends to be the worst when I wake up and for the next 2 or 3 hours. It can recur in the late afternoon around 4 or 5 pm.

 

 

 

Does the anxiety get worse after taking citalopram? Or is it worse when you first wake up? If the anxiety ramps up after taking the citalopram, it could be a side effect. Or it could be withdrawal anxiety that comes from a destabilized nervous system. Unfortunately, it may be hard to gage. 

 

The late afternoon anxiety sounds too late in the day to be the Trazodone's mCPP issue.

 

When you stabilize enough to make another reduction, I think you're right to target the citalpram and hold the trazodone steady. 

[TreeFrog]

19 hours ago, Shep said:

Does the anxiety get worse after taking citalopram? Or is it worse when you first wake up? If the anxiety ramps up after taking the citalopram, it could be a side effect. Or it could be withdrawal anxiety that comes from a destabilized nervous system. Unfortunately, it may be hard to gage. 

 

It starts when I first wake up, so it's already been happening for at least an hour or two before I take the citalopram. Does that sound more like withdrawal anxiety then?

19 hours ago, Shep said:

When you stabilize enough to make another reduction, I think you're right to target the citalpram and hold the trazodone steady. 

 

That's what I'd like to do. Will keep you posted.

 

Thanks again for all your help, Shep.

[Shep]

5 hours ago, TreeFrog said:

It starts when I first wake up, so it's already been happening for at least an hour or two before I take the citalopram. Does that sound more like withdrawal anxiety then?

 

It could be early morning cortisol:

 

Early-morning waking - managing the morning cortisol spike