VeganLife: introduction - citalopram

[VeganLife]

Hello, 

 

This is my introduction post where I will be sharing my drug history, experience, and goals towards a drug free life. 

 

A little about me: I am a 26 years old male with interests in animals, nutrition, fitness, socializing, movies, and other things. I have been taking citalopram for 21 years and my goal is to taper off of my current 10 mg dose down to zero. I would appreciate tapering advice from anyone with experience with successful SSRI tapering, especially citalopram.

 

Backstory: I started medication around the time I was 5 years old, just starting kindergarten. My parents had recently gotten divorced and I was taken to a child therapist and then a pediatrician. I had a lot of tantrums as a toddler, poor eye contact, trouble making decisions, and I would frequently get in trouble at preschool. At the advice of the pediatrician I was put on 40 mg of citalopram, brand Celexa, and what seemed to be at about the same time, 60 mg of dextroamphetamine, brand ProCentra. I still would get in trouble a lot at school up until high school, but I was a very happy kid. I stayed on both of these medications at the same doses till I was 17 when I successfully requested to be taken off of some medication. I tapered off of dextroamphetamine with no trouble at all. It was a little tougher to concentrate on hw, but I didn't mind. After graduating high school and starting studies at my local community college, I decided to taper off of citalopram. As with the dextroamphetamine, I worked with my pediatrician to help me taper off of the medication. I was told this would be difficult so I tapered off between spring and summer studies. I didn't notice any negative effects all the way down to 10 mg of citalopram. I felt different being on a lower dose, but I liked how it felt. Tapering from 10 mg to zero, however, did not go well. I developed pretty unbearable irritable bowel syndrome (IBS). At this time I am starting my second year of community college and I am 19 / 20 years old. Besides having IBS, I had heightened senses, a bit of depression and anxiety, and I was less hyper and less enthusiastic. I became diet obsessed and tried to find food I could eat without getting bloated and or having digestive pain. I lied to my pediatrician and I said I was fine and decided to stayed off of the medication. I visited digestive doctors, got blood tests, and looked for diets to solve my problems. After about 6 months, I saw my general care doctor and asked to go back on citalopram at 10 mg. Before taking citalopram I requested to try a different medication, a tricyclic antidepressant. I can't remember why I thought this was a good idea. I started at a low dose and had unpleasant headaches among other weird feelings. After a month or so I decided to go back to citalopram. I believe I started with 5 mg and then worked my way up to 10 mg. I had almost constant headaches getting back on the medication, and driving felt different, possibly due to the medications effects on balance. I can't remember if I had headaches tapering off of the medication. After two to three weeks, I felt pretty good. At this time I believe I was entering my third year at my community college. I found my digestive system was generally okay if I ate whole foods and stayed away from cooking oils. My anxiety was still much more present than when I was taking 40 mg, and I didn't feel as happy. I have stayed on my 10 mg dose of citalopram since then. To help manage my anxiety, I meditate, stay physically active, eat as healthy as I can, and socialize as often as I can.

 

There is so much misinformation out there, even in scientific research. I am not sure what to believe about the harms and benefits of antidepressants. I was for sure much happier on a higher dose, but I was also a kid when things were easier and I was still growing up, so its hard to say. These are very stressful times in the world, but there might never be a perfect time to try to taper off of the citalopram. I would appreciate any advice on tapering or any shared stories of similar experiences. 

 

Thanks for reading,

 

VeganLife

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  I'm sorry that you had trouble getting off of the last 10 mg of citalopram.  

 

Can you please give us specific information in your signature about your drug history for all drugs you are on and have been on, especially for the past 18-24 months?  It would be especially helpful to have the details of your drugs in a concise vertical list (no symptoms), only drug names, specific dates (as best you can say for example early March if you don't recall the day) and dosages of each medication decrease or increase.  Use this format:

 

Drug name: date, dose, date, dose, date, dose…

Drug name: date, dose, date, dose, date, dose…

Etcetera

 

Please read the link below for instructions.  This will allow us to give you the best guidance.  

 

How to List Drug History in Signature

 

Here is some important information about how these drugs actually work.  This explains why we get symptoms from going off of these medications, and why it's so important to taper slowly and carefully, and be very cautious about changing our doses: 

 

How Psychiatric Drugs Remodel Your Brain

 

 

This helps you understand what withdrawal syndrome is: 

 

Video on Recovery from Psych Drugs

 

Windows and Waves Pattern of Stabilization

 

 

How long ago did you reinstate to the 10 mg of Citalopram?  Are all your symptoms of withdrawal gone now?  Please don't start a taper unless you are completely stable, with no withdrawal symptoms.  Tapering is best done extremely slowly, and we generally taper by 10% of the current dose no more than once every 4 weeks, so that the reduction becomes exponentially smaller.  An even gentler method is called micro tapering.  I will give you information about both methods.  

 

 Why Taper by 10% of my Dosage  

 

Brassmonkey Slide Method of Micro Tapering

 

Tips for Tapering Citalopram

 

Here is a link with checklists of common WD symptoms, which should be minimal to none if you taper correctly: 

 

Dr Joseph Glenmullen Withdrawal Symptom Checklists

 

 

Here are some techniques to cope with symptoms: 

 

Non Drug Ways to Cope with Withdrawal Symptoms

 

Stability is really important when we are tapering off psych meds.  Please read the link about stability:

 

Keep It Simple, Slow, and Stable

 

 

We don't suggest many supplements, but 2 that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. It is suggested to add one at a time, and start with a low dose to see how it affects you. 

Magnesium

Omega 3 Fish Oil

 

SSRI drugs are harder to get off of on the lower doses, because at the lower doses, they have stronger effect on our brains.  That is why we suggest the exponential taper, and making smaller and smaller reductions.  This link explains why, take a look at the chart.  Even at very low doses, an inordinately large number of our brain receptors are still affected. 

 

SERT Transporter Occupancy Studies

 

Good luck, and we look forward to hearing from you again soon. 

[VeganLife]

Hello getofflex,

 

Thank you for replying with all of this information. I added my medication and dose history in my signature.

 

I reinstated my citalopram 10 mg during Dec 2016 to Jan 2017, after being drug free for about a year. It has been five years and I would say I am withdrawal symptom free. I still struggle with anxiety, sadness, and occasional digestive problems, but everyone struggles with these things.

 

I didn't realize that going from 10 mg to 0 mg is more dramatic than going from 40 mg to 10 mg. Though this makes a lot of sense based on my experience tapering down to zero in the past. It's too bad they dont make tapering easy by providing smaller doses than 10 mg in tablet form. Based on the things I have read here in your reply. It looks like I will need to see my general care doctor about switching from tablet to liquid citalopram. Then I can very slowly taper to 90 mg, 80 mg and so on. Or my other option would be to get a chemistry scale and measure out all my doses from split tablets, though this seems pretty difficult. 

 

I am curious if switching from 10 mg tablet to 10 mg liquid will create a difference because of how liquid vs tablet is absorbed.

 

Best,

 

VeganLife

 

 

[getofflex]

23 minutes ago, VeganLife said:

Then I can very slowly taper to 90 mg, 80 mg and so on

Did you mean 9.0 and 8.0?  I assume so.  Going from 10 mg to 9 mg is fine, but don't do a linear taper, dropping by 1.0 mg each time.  Please do the exponential taper as explained in my links above.  If you look at the chart in the last link above, you can see that even at 3, 4, or 5 mg citalopram, the curve is nearly vertical, showing how even a tiny reduction has a big effect on the brain and serotonin receptors.  So for example, a 10% exponential taper would look like this: 10 mg, 9, 8.1, 7.3, 6.6, etc. Each reduction gets smaller and smaller.  

 

27 minutes ago, VeganLife said:

I am curious if switching from 10 mg tablet to 10 mg liquid will create a difference because of how liquid vs tablet is absorbed.

Yes, it will.  Therefore, we suggest you gradually cross over from the tablet to the liquid first, before doing any reductions.  This link will explain how: 

 

Changing Form of Drug: Tablet to Liquid, Liquid to Tablet

[VeganLife]

Yes I meant 9.0 mg and 8.0 mg, sorry about that. And you're right, I looked at the chart and you can't jump down by 1.0 mg each time. Based on a 10 % reduction every 4 weeks from my current dose of 10 mg, it looks like it will take me two to three years or longer to reach 0 mg. That is quite a journey. At what dose to you make the jump to 0 mg?

 

Looking at your signature, I see you did a slower taper. How did you measure such an accurate dose and why did you decide to taper slower than 10% reduction every four weeks?

 

Thanks for your help.

 

 

[getofflex]

Hello, yes, it will take a very long time to taper properly, but it is well worth it!  When people jump off cold turkey or fast taper, they often end up very very sick, with terrible suffering, and this can last for many months to years.  It took our founder, Altostrata, 11 years to fully recover from a cold turkey off Paxil.  

 

It is suggested to go as low as you can before you jump off.  I would say, go all the way down to 0.01 mg, if you can.  I used the liquid Lexapro, which makes it very easy and simple to measure any dose.  You measure the liquid with a syringe.  I went slower than every 4 weeks, because I listened to what my body was telling me.  I waited until I was stable for a couple of weeks (no major swings in symptoms) to do another reduction.  What you don't see in my drug signature, because it got too long, is that in the first 2.5 years, I tapered way too fast, and did a couple of big reinstatements.  This was before I found this forum, I was doing what my doc mistakenly told me to do.  This sensitized me, and caused me to have protracted withdrawal, so it made sense to taper super slowly.  I'm glad that I did.  I'm almost off my Lexapro, my next reduction will be to zero!  

Edited July 3, 2022 by getofflex

[VeganLife]

I am also curious what to expect when I am down to zero. Even though it is so far away, I want to know what to hope for or expect. Should I expect to feel the same, or a little more anxious? Yeah, I felt pretty mentally sick when I went off of it too fast. Wow, I am shocked that Altostrata stayed off of her medication for so long with continued symptoms. That must have taken a lot of courage.

 

I went to the doctor a few days ago and I switched my medication to liquid citalopram 10 mg / 5 ml and I have taken it twice. I have been taking my medication at night, before bed, for the longest time because I used to throw up if I took my medication in the morning before eating. I often eat a late breakfast so I switched my timing to before bed. I feel a bit of a difference taking the liquid medication. To me, it feels a bit stronger and I feel a little out of it and weird until I wake up the next morning. The next day I feel pretty normal. Did you have any similar experiences when switching from a tablet to the liquid form? I am wondering if I should wait till I get used to this or it goes away before switching to my  1st 10% reduction. 

 

Congratulations on being drug free!

 

[getofflex]

14 hours ago, VeganLife said:

I am also curious what to expect when I am down to zero. Even though it is so far away, I want to know what to hope for or expect. Should I expect to feel the same, or a little more anxious?

I can't say, as it is different for everyone.  I just went to zero on my Lexapro 6 days ago, and I'm feeling pretty good.  That is why I did an extremely slow taper.  I don't feel the same as I did before I started the med,  because that was 20 years ago, and I was a younger and different person then.  Life experiences and aging tend to change us.  I will say, I feel less depressed and anxious since before I went on the drugs, because my life circumstances are simpler, and different, and I've also learned how to deal with life in such a way that I don't get as anxious. 

 

14 hours ago, VeganLife said:

Wow, I am shocked that Altostrata stayed off of her medication for so long with continued symptoms. That must have taken a lot of courage.

 

Yes, that and determination.  

 

14 hours ago, VeganLife said:

I went to the doctor a few days ago and I switched my medication to liquid citalopram 10 mg / 5 ml and I have taken it twice.

 

I hope you are switching from tablet to liquid gradually, as I suggested in my post from July 3.  I switched immediately to liquid, because I had not yet found this forum and didn't know better.  I don't remember what happened, as that was over 3 years ago.  

 

14 hours ago, VeganLife said:

I switched my timing to before bed.

Please only make one drug change at a time.  You switched the timing of your drug, and the form of your drug, at the same time.  A drug change includes changing the form of the drug (pill to liquid, etc) as well as changing the time of day we take the drug.  Your nervous system needs and craves stability, so please make these changes very gradually and carefully in the future, and only do 1 change at a time, so if you have symptoms, you know what caused them. If you read that link about stability I gave you in my first post, it talks about that.  Here is the link again: 

 

Keep It Simple, Slow, and Stable

 

14 hours ago, VeganLife said:

I am wondering if I should wait till I get used to this or it goes away before switching to my  1st 10% reduction. 

Yes, definitely wait a while after making 2 drug changes (change in form, and change in timing of dose) before you do your first 10% reduction.  Listen to your body, and wait until you have been stable for a couple of weeks.  

 

Stability

Edited July 14, 2022 by getofflex

[VeganLife]

I have a pill cutter so I could do half liquid and half tablet. I did read all of your links from your original response, but I don't know how you can accurately cut a pill into thirds so I went directly from tablet to liquid. If suggested I will consider half tablet and half liquid. I guess I could cut the pills into quarters as well. I didn't see any harm in going straight to liquid, since both the doctor and pharmacist had no comments. But something isn't right and I am wondering if tablet to liquid is a different dose because liquid is absorbed so much faster than a tablet.

 

I have being taking my medication at night for 5 years, so timing is the same for me.

 

I also read online that liquids are much stronger than tablets at the same dose because you lose half or more of the drug in digestion. https://medicare-europe.co.uk/science-clinical-data/liquids-vs-pills.html

Do you agree with this? If so, that means my current liquid dose of 10 mg / 5 ml is too much.

[getofflex]

17 hours ago, VeganLife said:

I don't know how you can accurately cut a pill into thirds so I went directly from tablet to liquid.

I see.  Yes, half tablet and half liquid would work.  Another option is to grind the tablets into a powder, and weigh this with a scale.  There is info about that in the link.  Tablet to liquid is not a different dose, but yes, the liquid drug gets into your system faster than a tablet. 

 

17 hours ago, VeganLife said:

I also read online that liquids are much stronger than tablets at the same dose because you lose half or more of the drug in digestion

My husband, who is a registered pharmacist, says this is not true.  Both tablets and liquid go through the digestive tract.  There is lots of info on the internet, a lot of it false, so take stuff like this with a grain of salt.  

 

 

 

 

[VeganLife]

How do you copy and comment on sections of my last post?

 

I believe I am over the hump and I am getting a little used to the full liquid medication. I am going to stick with it and see if things even out and feel back to normal. If things get worse, I will use my pill cutter and do half and half for a bit. All this talk of crushing pills, using scales, and measuring small doses reminds me of my chemistry classes  

 

Thanks for letting me know. I was a bit panicked yesterday so I jumped to that conclusion. It makes more sense that it's the same dose. I'll get used to the 10 mg / 5 mL of liquid, hopefully in a week or two, then I will start my first 10% reduction down to 4.5 mL. Eventually when I get down to 1 mL or lower, I will buy myself a lab pipette so I can accurately measure down to 0.01 mL.

[ChessieCat]

1 hour ago, VeganLife said:

How do you copy and comment on sections of my last post?

 

You highlight the text you want to use and a pop up Quote Selection will appear.  You click on that and it will appear in the Reply Box.  You then click underneath the quote to type your text.  Make sure you don't click in the box otherwise the response will not be easily seen.

 

Edited July 16, 2022 by ChessieCat

[VeganLife]

Hello,

 

Thank you for the information on how to create a reply box. When I highlighted sections previously a quote selection button did not appear. Though it seems to be working now.

 

I had a few follow up questions to tapering that I am hoping for some help with understanding. I have been taking the liquid citalopram for 2 weeks now at the 10 mg / 5 mL dose. I take 5 mL. I am surprised how different I feel, even two weeks in, compared to the 10 mg tablet I have been taking for so long. I was wondering if I had a "poop out" effect with the tablet where the body gets used to the medication and it is no longer effective. Anyway taking the liquid medication I feel less alert, a little drowsy, and sedated. Should I wait till this goes away or is this the new normal and I should start my taper when ready. 

[getofflex]

2 hours ago, VeganLife said:

Anyway taking the liquid medication I feel less alert, a little drowsy, and sedated. Should I wait till this goes away or is this the new normal and I should start my taper when ready. 

If it were me, I would wait 2-3 week before starting your taper, or better yet, listen to your body.  Wait until you feel stable.  This link explains what we mean by stability: 

 

Stability

[VeganLife]

Hi, I wanted to give an update on my medication dose.

 

As suggested I waited another 2 weeks, 4 weeks total before lowering my liquid dose. Switching from pill to liquid I felt off for about 2 weeks, the last two weeks I felt fine. Currently, I have been taking 4.5 mL (9 mg) previously from 5mL (10 mg) for a week. I felt a little off the second day, but otherwise pretty normal. I will continue at this dose for another 3 weeks, then lower down to 4.05 mL (8.1 mg) for 4 weeks. 

[getofflex]

17 hours ago, VeganLife said:

As suggested I waited another 2 weeks, 4 weeks total before lowering my liquid dose. Switching from pill to liquid I felt off for about 2 weeks, the last two weeks I felt fine. Currently, I have been taking 4.5 mL (9 mg) previously from 5mL (10 mg) for a week. I felt a little off the second day, but otherwise pretty normal. I will continue at this dose for another 3 weeks, then lower down to 4.05 mL (8.1 mg) for 4 weeks. 

This sounds excellent.  I'm glad it's going smoothly for you.  Please update your signature box to show your recent reduction from 10 to 9 mg with the specific date, thank you.  

[VeganLife]

I updated my signature. I actually realized now that I am two weeks into my taper that I am having some unfortunate side effects. Although I have no physical side effects like when I switched from pill to liquid, I do feel a bit more anxious on a lower dose of 9 mg and it takes me 1-2 hrs to fall to sleep. I am going through a very stressful time in my life and I do have night owl roommates, but I wanted to try tapering off of the medication. Hopefully things get better soon. 

[VeganLife]

To whom it may concern,

 

I have been successfully tapering my citalopram from 5 mL down to 1 mL over the last several months, reducing by 10% every two weeks. I can see the finish line in sight and I wanted to ask when should I stop taking the medication. The forums say to stop taking an SSRI when I am at less than 98% of my initial dosage. I started out a long time ago at 40 mg. However, the beginning of my successful tapering journey began at 10 mg, after managing that dose for several years. Should the less than 98% rule go to the 40 mg or the 10 mg dose?

 

 

[Altostrata]

Hello, @VeganLife Have you had any withdrawal symptoms while tapering? When and how much was your last reduction?

[VeganLife]

Hello, @Altostrata 

 

Thank you for responding to my question. I would say I have not had any obvious withdrawal symptoms. I was struggling with depression, anxiety, irritability, and IBS before I started tapering and I feel that I am relatively the same. I might not sleep quite as deeply since tapering and I do get bloated when eating while thinking about something stressful. But these are pretty minor differences that could be from more than just lowering my dose. Such as more stress in my life, noisy roommates, diet changes, and possibly other things. My last reduction was Monday May 1st, where I went down to 0.835 mL from 1.05 mL. I started out reducing every 4 weeks by 10% as suggested in August 2022 from 5 mL / 10 mg and then followed the instructions and made my way down to reducing by 10% every 2 weeks by around November. 

 

Also I read your introduction post. I can't imagine the amount of suffering and confusion you have gone through. I would not be where I am today without this website, so thank you. I hope all is well with you. 

 

Let me know if you have any other questions,

 

Best,

 

Michael

[Altostrata]

You're welcome.

 

If I were you, I would hold at this level for a month, let your system consolidate the drug changes, and then consider more tapering. For citalopram, somewhat less than 0.5mg would be the jumping-off point.

[VeganLife]

Okay, so if I decide to hold for a month, then continue tapering, would I stop around 0.25 mL, a 0.5 mg equivalent? I'm trying to map out when I reach zero. Also I made a mistake in my comment above. My last reduction was to 0.835 mL from 0.925 mL, still on May 1st.

[Altostrata]

On 5/8/2023 at 10:40 PM, Altostrata said:

For citalopram, somewhat less than 0.5mg would be the jumping-off point.