rickoshea Hi ... and help please

[Altostrata]

Did you reduce to 9mg? Again, that decrease will take about 4 days to fully register.

[rickoshea]

i reduced 2 nights ago by not adding the remaining amount in the tip of the syringe to my dose and not dosing about 0.01mls above the 0.2mls mark (which is 10mg here... 40mg/ml). This I think would equate to roughly a 1mg dose reduction. So that was 2 days on that slightly lower dose. Apparently 0.2mls is the equivalent to 10mg as the liquid is stronger than the pills..

[Rhiannon]

Rick, I suspect that you're going to find that your symptoms come and go and get better and worse fairly randomly to some extent, until your nervous and endocrine systems manage to find a stable homeostasis, which could take a while. 

 

Meanwhile do bear in mind that every time you change a med or change how much you take, you are disrupting that process of stabilizing and disrupting the progress toward homeostasis.

 

It's always a tricky thing to balance the effects of the drugs against the effects of changing the drugs, and you have to figure that out for yourself, but I suspect at this point the effect of changing is going to be more disruptive to your ability to heal and function than the effect of taking a little more or a little less than is optimal.

 

In plain English: it's probably time to pick a dose and then just stick to it for a few months (two to six) and ride out the symptoms, focusing on other ways to help yourself without changing meds around. Over time things will change less chaotically from one day to the next and you'll be less tempted to react to every bad wave by tweaking meds.

 

Hopefully, ideally (but typically for most folks), you'll eventually settle down and feel better and fairly stable, at which point you can begin a slower, safe, stable taper with cuts of no more than 10% (although in your case with your recent history I'd suggest starting with an initial cut of 5% or less).

[Nikki]

I am finding out that reinstatement can take a good while to work.  There was a time when I felt it right away.  Now it comes with a feeling better - to a drop in mood once again.

 

I am sure the CFS has it's spot in this.  I had Epstein Barr a number of years back and it caused anxiety and depression and other problems.  Can you sift thru or figure out which symptoms belong to the cfs or the citalopram?  Sometimes it helps to compartmentalize symptoms. 

 

Sorry you are experiencing this

[Altostrata]

When one overshoots a reinstatement, it's okay to make adjustments at a faster rate than you would while tapering. You've only been on the excessive amount a short time.

 

Give it a few more days, Rick, and see if you can say symptoms are better or worse.

[rickoshea]

thanks everyone, just home from a trip away which was tough, usually i love it. I'll post more tomorrow but still really struggling here :-(

 

I'll be sticking with this dose though. Strange that my GI symptoms are worse just before all my others, bit of a chicken and egg thing as in which causes which. I've had these symptoms in the past together even when not on Citalopram, at least I dont think I was. My memory has gone too. More to come tomorrow and thankyou all again :-)

[rickoshea]

actually I've never had symptoms this bad thinking about it. I'll think about the CFS/Citalopram withdrawal/side effects differentiation but both are similar.. the big difference for me is that with CFS I never had such severe CNS symptoms, especially the crippling anxiety, DP/DR and feelings of completely losing control. My CFS I can deal with but this is altogether on another level.

[mammaP]

I'm sorry you are having such a hard time Rick, but all this will change. 

When you settle onto the right dose, you will need to give it a good while to stabilise. Some days will

be fine but others will be bad, it's the windows and waves pattern.  In case you haven't seen the topic

on windows and waves, here is the link. http://survivingantidepressants.org/index.php?/topic/82-the-windows-and-waves-pattern-of-recovery/

 

I hope you can get through to your medical friends about AD's and withdrawal, they need educating on the subject!

[rickoshea]

thanks MammaP. I haven't been really able to distinguish CFS from w/d or reinstatement symptoms ... they're all pretty similar. The aching muscles are probably the CFS but I never had severe anxiety/nervousness/panic attacks etc etc with CFS. Depression yes but not this stuff. Today I can't really say to be honest how things are as some will be masked by the CFS after travelling (that always hits me). I've been tired (CFS after travelling probably) and feeling very shaky and distant at times. Sort of a low blood sugar feeling but it got worse with eating (weird I know ... but then, what isn't at the minute). I had a couple of episodes at work of the dreadful almost manic like feeling where I'm far too "switched on" and could do everything at a million miles an hour, plus feeling like I had a fever. I could control it and it passed though. I've also been feeling very very weak, shaky legs etc. I think Alto the severe "wired" feelings are a bit less, I still have a blinding headache but I've dealt with those for 20 years so I can handle that. This morning I woke in a complete cold sweat (thats the first time for that symptom) but with less anxiety actually on waking. That started about 10 minutes later. I still feel "hyper stressed" at times and almost completely exhausted from all this.

 

I'm going to stick to the about 9.5mg dose. I sometimes think I'll just go off it and suffer but that's the side effects of reinstating talking and my "sensible self" knows that is definitely not an option. I can't remember my symptoms starting Citalopram all those years ago but do remember feeling very weird for a while when I did. I think I'm having start up side effects at the minute and I do get moments of clarity but it's almost like feeling too good (hard to describe). Occasionally I get moments of feeling like I did when I was stable.

 

Nikki ... I hope you got over the Epstein Barr ok, CFS is a miserable disorder and some say it stems from EB (I think it's a complete dysregulation in the ANS combined with adrenal insufficiency due to the HPA axis being completely unstable.

 

Rhi - thanks and yes, I'm sticking on this dose for a long long time but I will come off this once I get good and stable.

 

Alto ... as always, thankyou for your advice

[rickoshea]

Hi again all. I haven't posted for a while as I have been trying to stabilise after my reinstatement on 10mg Citalopram. A few "things" have happened along the way.

 

Firstly, the initial weeks were quite simply horrendous. This has gradually settled but I'm still shaky/anxious a lot of the time and feel very weak sometimes too. I also just feel too "wired" a lot of the time .... as in feel "too alert" (hard to describe).

 

So - I went and saw my local GP who is great. She ordered a lot of blood/urine tests just to make sure all is ok and (interestingly enough) my 24hr cortisol came back about 2.3x higher than the upper normal value. She was concerned about this and got me in for a CT of my abdomen and adrenals which was fine thankfully. I'm thinking this is due to my playing with my doses and too fast withdrawal before reinstating to 10mg?. I'm having further ones done so will let you know what happens with those. I have read that cortisol may be implicated with SSRI use/withdrawal but haven't been able to find any research to actually prove that.

 

I'm now 6.5 weeks into reinstatement on 10mg. I'm just wondering if I may have reinstated at too high a dose which may be causing this "wired" feeling and weakness/shakiness? I think I would like to decrease a tiny bit but really don't want to destabilise again so would I be better staying at 10mg for a few months then seeing how things are? There has been an improvement but the "hyper" feelings are still there and hard to deal with. I also get times of feeling almost "too good", not manic but maybe too happy/stimulated would be a better way to put it. 

 

Basically I want to stabilise so I can taper. My GP was excellent actually. I was ready for the "oh its ok, just stop them over a couple of weeks" approach but she told me I have to be very very careful, recommending reducing from 10 to 9, waiting at least 4 weeks, then 9 to 8, wait at least 4 weeks and if symptoms become bad upping the dose by 0.5mg and again waiting 4 weeks, then trying a smaller reduction. It seems young French GP's (or at least my one) are well versed on SSRI withdrawal techniques.

 

I thought it would be interesting to post about the cortisol and if anyone has any advice or thoughts on sticking with 10mg or reducing a tiny bit to see if the "wired" feeling goes (and maybe destabilising again?!) that would be most welcome.

 

I hope all is well for everyone,

 

Rick

[Rhiannon]

It's hard to say but I think it might not be a bad idea to cut a small amount, say 0.25 or 0.5 mg, and hold it for a week and see if the overstimulation gets better. If it does, you could maybe ease your dose down a bit in small increments slowly.

 

Again it's that balance between the excessive effect of the drug and the effect of changing things around a lot, but it sounds to me like your CNS got adapted to a lower dose and now 10 mg is too much, so you might be okay with decreasing. Just keep the cuts small, less disruptive.

 

I don't know if we have some studies somewhere on the cortisol thing, but anecdotally it's very common for people to have trouble with what appears to be high cortisol levels in withdrawal. The typical pattern with that is feeling your worst in the morning and then improving later in the day, often feeling pretty good in the evening. When I see that pattern I usually suspect excessive cortisol or disruption of cortisol secretion or metabolism. So I'm not at all surprised to hear about your high level.

 

Your GP does sound good! You might want to give her this information:

http://survivingantidepressants.org/index.php?/topic/6036-why-taper-paper-demonstrates-importance-of-gradual-change-in-plasma-concentration/

so she can see why it's important not only to taper slowly, but to reduce the size of the decrements as you go (don't just go from 10 to 9 to 8 to 7, basing cuts on the original dose, but rather base your cuts on the CURRENT dose--10 to 9 to 8.1 to 7.3, 10% of the current dose--so you get a curve that more closely approximates the effect of the drug on receptor occupancy--see the charts in that article, to see what happens at lower doses.) I think any doctor who's seriously interested in tapering would find those graphs quite helpful.

[rickoshea]

many thanks Rhi for your reply. I think I may well try a very slight reduction, I'm just a bit wary of it after my last experience!

 

Thats exactly my experience at the minute. Bad during the day, waking up trembling then I improve as the day goes on.

 

I'll take the info into my GP, thanks for that too :-)

[rickoshea]

I'm still wary about even reducing a small amount! .... after about 7.5 weeks on my original 10mg (its actually 8mg I take as I use the liquid form and it says that's the equivalent dose) - 40mg/ml so I take 0.2mls which I think is correct? That is 6 drops but I read somewhere that 8mg is 4 drops? I should have maybe just stuck to the tablets if I'm not dosing correctly ....

 

I really want to start tapering this but is the general opinion that I should stabilise on this dose for a longer period (several months) beforehand? I still have morning anxiety and shakes when I wake up but this wired feeling. It is better than a month ago but the stabilisation is very slow. Evenings are usually good times when I sometimes can feel almost normal but getting to sleep and staying asleep after 5am still isn't easy.

 

I'd be most grateful for any advice

 

thanks,

 

Rick

[Altostrata]

I have reservations about the accuracy of the drops. Can you get a 1mL or 0.5mL syringe with more precise markings? If it's 40mg/mL (quite strong!), .2mL would be 8mg.

 

You may be able to dilute that concentrated solution for more convenient measurement.

 

It's a good sign you've seen some improvement.

[Addax]

Hi Rickoshea.

 

I'm very new to this site and have been reading through people's journey and came upon yours. I'm tapering from fluoxetine/Prozac, but I've had and have some of the same wd symptoms.

 

I too have the anxious, shaky feeling in the morning, and I hate it. Intermittent irritability too... Actually, a great deal of what you've written resonates with me.

 

The cortisol issue is of significant interest to me, and until reading rhi's post, I had no idea about the wd-cortisol connection. Though it make sense. If your anxious/stressed, cortisol is going to hanging around.

 

I know I'm not really offering you much with this post, but I did want you to know that there's another person here you on a similar journey and experiencing similar things. Although, you sound more patient than I am.

[rickoshea]

thanks Alto ... yes, here we have 40mg/ml and I use a 1ml syringe taking 0.2mls (which actually comes out at 6 drops despite some places saying 4 drops is 8mg so I think you're right, measuring in "drops" is far from accurate) I think in view of what you said (that there has been some improvement) I should maybe stay at my 0.2mls for a month or two longer until this settles then start a slower taper?

 

Hi Adelsax - the morning shakes plus anxiety are dreadful. I redid my 24hr cortisol last week and will have the results on Tuesday (plus a few other hormonal ones .... I have a great GP thankfully) and she suggested we do these. It'll be interesting to see if it has come down a bit. 

 

I feel again slightly better today ... and believe me, I'm not at all patient but the problem is, we don't have much choice!

[Rhiannon]

Definitely get the dosing thing under control. With such a highly concentrated solution it's going to be tricky to taper. If it were me I would dilute it to something more manageable, and definitely get the smaller syringes as well.

 

My own citalopram solution (which I make myself by dissolving tablets) is 10 mg per 20 mL, for example, so 1 mg per 2 mL, which makes it easier to taper, and actually I'm planning to go to 10 mg per 30 mL soon so I can taper it even more incrementally. (I'm at 1 mg now so need to go down by very small amounts once I start tapering it again.)

 

Find out if you can dilute your liquid. Your pharmacist should be able to tell you, I think.

 

The drug itself may be causing some stimulation but the cortisol thing (worse mornings, better evenings) is typical of withdrawal. It may be that will get better over time if you just hold on. It's always hard to say but if it's not actually getting noticeably worse, you might do best to just hold where you are until you're more stable. I'm sorry I can't give you something more definite, it's hard to predict which way the frog will jump in these situations. Some studies show that citalopram actually suppresses cortisol, others that it increases, and in withdrawal nothing happens like it's "supposed" to anyway.

[rickoshea]

Hi everyone, just an update on my "progress" trying to stabilise again on 10mg Citalopram before starting my taper (and a few questions!)

 

Things have been very up and down ... I'm 3 months now into the 10mg reinstatement and when I think back I do think initially going back to 10mg hit me very hard (probably worse than the withdrawal was) about 2 to 3 weeks after I reinstated. Since I have had a slow, slight improvement but still have the morning shakes when I wake up and overall feelings of anxiety/depression (not constant but "there") plus the overstimulation is still there (though not as bad). I'm wondering if I really did reinstate too high?

 

I looked back through some notes I kept when I started the taper last year and I was actually feeling pretty good (in fact very good apart from some minor physical w/d symptoms)) for quite a while after the first reduction (10mg to about 7.5/8mg) for maybe about 6 weeks then that was when I went wrong and started reducing too quickly. Could this mean that I'm maybe better on a slightly lower dose and should maybe stabilise there before tapering (sensibly slowly this time!)

 

Also ... the morning cortisol thing as you mention Rhi. I still have that problem but could that have been caused by too high a reinstatement? I find it confusing that I still have that (though less severe) 3 months on from going back to 10mg.

 

About the dosing, it's still confusing with the liquid here. 40mg/ml is the concentration so to give 8mg (equivalent to 10 in tablet form) is 0.2mls. This is apparently 4 drops. But 0.2mls in my syringes (0.5ml syringes) that come with with the box actually give 6 drops. So ... simply I went back to tablets a short while ago as I thought it best not to mess with dosing inaccurately. I must have a look at your method of making the solution Rhi.

 

So ... any advice on my next step? Should I wait it out for a few more months on 10mg to get hopefully more stable, or try tapering very slightly with the worry that that could upset things again?

 

as always all your experiences and advice are invaluable and greatly appreciated,

 

Rick

[rickoshea]

suffering again here with shaking and anxiety plus almost panic attacks at times. There doesn't seem to be any real pattern to things - I am taking antibiotics for a supposed kidney infection which probably isn't helping matters. Got very depressed last night and had problems getting to sleep (this had been improving a lot) and for the past few nights I've been waking at 4.30am again, plus the feelings of not being able to cope with anything. I had some bloods done and my white cell count is up which suggests infection but can also happen due to stress ... plus the cultures for a kidney infection were negative. This makes me wonder if this is all down to the Citalopram reinstatement/withdrawal. I just know I really can't take much more of feeling like this again ...

 

any help please? should I try a small reduction ... stay put at 10mg or even increase a bit to try to get some sort of stability before tapering?

 

thanks,

 

Rick

[Altostrata]

rick, it could very well be the antibiotics. Do you need to continue to take them?

[rickoshea]

thanks for the reply Alto. This I think started before the antibiotics (Rocephin IM) ... back pain plus polyuria etc made my doc think it was Kidney (plus extreme shaking and shivering). I put it all down to Cit s/e's again and I'm still not sure to be honest. The anxiety is again crippling, the uncontrollable shakes are slightly better but I just have this feeling of "not being able to cope with anything", even leaving the house. I'm desperate to achieve some stability and then taper. My GP suggested a change to Escitalopram but to be honest I'm very very wary of doing anything. The thought that maybe that might get me "back" is tempting. I just don't know what to do but I do know I can't continue like this.

 

thank you again

[mammaP]

I'm sorry you are feeling so bad Rick, you sound like you are at the end of your tether  .

I wouldn't change anything until you are off the antibiotics, they could be making things worse

and a kidney infection can have all kinds of awful symptoms too.  Once you are off the

antibiotics and recovering from that the withdrawal symptoms might ease up a bit. 

 

Rest and take care of yourself in the meantime,  sit back and let your body recover. 

[rickoshea]

thanks mammaP ... I'll try but I seriously feel like I'm losing my mind here. My GP wants to increase the Citalopram to 15mg, get stable, then slowly reduce. Really ... this is hellish at the minute

[Skyler]

Rick.. what AB are you taking? The quinolones are notorious for side effects.

 

Sorry... just caught a more recent post above "Rocephin IM" I had ABs amplify my WD symptoms this time last year. I was on for 4 weeks. Don't underestimate the mayhem they might cause.

 

I'm really sorry to read you are having so much distress. Merdre.

[rickoshea]

thanks Skyler, yeah, it's killing me at the minute and still 7 days on them. Was a bit like this before them though. Horrible feeling so hopeless.

[Skyler]

The ABs affected me by amplifying the WD Sx. They did not cause anything that was not already there, but spiked those I already had. Don't underestimate cross over WD effects. Hope you feel better when you are finished the course of ABs. Keep us posted.

[rickoshea]

I will thanks Skyler. It seems afternoons as always are slightly better ... but only slightly - in that I can get off the sofa. I keep debating wether I should take my GP's advice and updose a bit but I think I'll wait until I get some advice here. My GP is great actually but she just won't have the experience of people here. It may stabilise me, it may be worse .... a crystal ball would be nice.

[Northcoastboy]

thanks Alto ... yes, here we have 40mg/ml and I use a 1ml syringe taking 0.2mls (which actually comes out at 6 drops despite some places saying 4 drops is 8mg so I think you're right, measuring in "drops" is far from accurate) I think in view of what you said (that there has been some improvement) I should maybe stay at my 0.2mls for a month or two longer until this settles then start a slower taper?

 

His

I'm on Citalopram liquid from boots (cipramil. I take 1 drop.

1 drop is 2mg but is equivalent of 2.5 mgs of Citalopram

So if your on 6 drops are you taking equivalent of 15mgs go Citalopram and not 10 mgs?

 

I get the awful cortisol tension as well. I know how u feel.

I wake in night sometimes with big anxiety attacks.

 

For the daytime stuff I practice mindfulness. John kabat zinn is good. You can find him on you tube.

Also recovery rd is a UK recovery site with some good relaxation videos.

Also CEPUK.org will interest you I think. Baylissa Frederick who runs recovery rd also has a great video on this site about withdrawal.

[Skyler]

Also recovery rd is a UK recovery site with some good relaxation videos.

Also CEPUK.org will interest you I think. Baylissa Frederick who runs recovery rd also has a great video on this site about withdrawal.

I was just Googling Baylissa last week... she's closed! I was very sorry to read this..

[Northcoastboy]

She went quiet for a while. You can read about it on the recovery Rd site. Try links below:

 

http://cepuk.org/withdrawal-advisers/

http://recovery-road.org

https://www.facebook.com/BloominWellness

[Skyler]

Sorry, error, thanks to my revitalized html issue.

[Skyler]

Indeed, she lives! Hmm, I'll put those links in http://survivingantidepressants.org/index.php?/topic/3107-benzo-support-sites-blogs-facebook/

[rickoshea]

many thanks NCB ... you seem to be almost mirroring me in my "journey" with Citalopram. Just out of interest, did the Boots pharmacist advise that 1 drop is 2.5mg? If so my advice leaflet in my Seropram may be wrong. It states that basically I should take 0.2mls to get the equivalent of 10mg active Citalopram (8mg liquid form). My syringes are 0.5ml ones so I fill to just above (very slightly above - again as advised on the leaflet) 0.2 mls and this gives me a good 6 or 7 drops. So basically I really don't know which dosing is correct. I reinstated to what was my usual dose of a tiny bit above 0.2 mls and whatever dose that is I'll just have to work with using the syringe graduations. Confusing!

 

Many thanks for the links too .. I've looked at them all and Baylissa's videos do give me hope. The sites are great as well.

 

My doctor called last night and discussed this with me. She wants me stable on my original dose before doing anything else, so I'm back to that. I was concerned about the drop/syringe issue so had been taking 5 drops which again probably destabilised things for me (being highly sensitive). So - back to my "tiny bit above 0.2mls" last night and we'll see how we go from here. I think I feel a small bit better this morning.

 

thanks again Skyler for the link too

[Northcoastboy]

Hi

yes it is confusing. It must be difficult drawing it out with syringe because of amount in nozzle that you describe.

The cipramil drops you merely invert the bottle to get a drop.

one drop equals 2mg of Citalopram

Now a big but! 

It goes on to say and I quote on the bottle,

 

"Note: 4 drops (8mg) is equivalent in therapeutic efficacy to one 10 mg tablet, which is what I made the switch from.

 

i was fairly lucky that i didnt get withdrawals until 2.5mgs that seems to be limit. After that the S..t hits the fan!!

 

I went cold turkey and had awful withdrawals

I then reinstated at 2.5mgs and was ok

I then got impatient again and made cuts to 2.35 and 2mgs and hit the wall again.

I am now like you waiting to stabilise and will then make tiny cuts over a year or more (turtle taper)

I have 30ml medicine cup.

I fill it with 25ml of water and put one drop of cipramil in and mix it up. you can then get a baby syringe and draw off tiny amounts.

see my posts here:

http://survivingantidepressants.org/index.php?/topic/6164-northcoastboy-my-withdrawal-from-citalopram-celexa/

[mammaP]

Glad you are feeling a bit better Rick. I think it is the right decison to stay as you are and stick with the syringe. 

I suspect that once you are off the anti biotics you will feel a whole lot better. 

Personally I stop them when the infection seems under control if they are making me sick. I know that isn't

what is advised and I'm not suggesting you do the same but I do know they make me go really weird! 

I once had such a buzzing in my head with them, it was like bees were nesting in my brain it was horrendous

and I couldn't get out of bed!  

 

Hang in there Rick, it will get better. 

[rickoshea]

sounds like you're doing well on only 2.5mg NCB ... nice one. I assume a "drop" is the same whether it's from a syringe or a bottle and if that's the case I have been taking 15mg ... now that's annoying as I always took 10mg tabs. Seems I have to stick at my dose now for a while though (if it improves things).Again ... congrats on getting to 2.5, that's fantastic

 

thanks again mammaP for the support. I thought maybe it was a bit better today but no. I feel completely spaced and "weird" plus the all too common overstimulation feeling (feel too alert but not in a good way at all). I had to go into town and came back and had to lie down due to just feeling completely spaced. Waves of tears now too which I think is due to the frustration and depression feeling like this. I'm sort of hoping it's the antibiotics like you say - being me I started taking Doxycycline 3 days before I saw my GP (I can prescribe for myself here) who changed me to the Rocephin. That's 5 days taking that and 3 on Doxy. I think to be honest that will have to do as I truly can't deal with this much more.

 

I hope this reinstatement will get me back to some form of stability, if not my GP wants to switch me and, frankly, I've had enough of these meds so am not keen on starting another if possible. Maybe if it gets me stable and to a decent level of health it could be worth it. Then at last I could begin my taper and get "myself" back eventually.