Rocksandhardplaces: Stuck between a tapering rock and a hard place

[Rocksandhardplaces]

Hello

 

Well I'm in a bit of a tricky situation my friends..

 

First things first

 

I'm 18-19 in 1996 and I'm diagnosed with major depressive disorder. I'm given the relatively new citalopram at this time. I feel relief almost immediately. Not only are my depressive symptoms reduced but so are my anxiety ones.

Slowly over the next ten years I make considerable progress through university and ultimately as a full time teacher.

For this whole period I remained on 20mg citalopram, nothing more and nothing less. I didn't see a p-doc but merely got my scripts from a GP. I tried to get off a total of 2 times. Of course I went very rapidly and naturally symptoms became intolerable so I went back on and everything seemed to go back to normal.

 

At the end of 2009 my first born daughter dies at birth. The following two years are met with increased depressive and anxiety symptoms. By the end of 2010 I'm advised to see a new p-doc who dutifully listens to my main complaint - I can't sleep - and prescribes temazepam. So my poly drugging begins. At some point the temazepam stops working and my p-doc prescribes seroquel for sleep instead. I only ever use 10 mgish

 

From late 2010 I start experiencing almost intolerable tiredness. No-one can tell me what is wrong despite numerous Drs and drug tests. At some point in 2012 I taper my 20mg citalopram down to 10mg in the hope it will reduce my tiredness. I don't experience any overly uncomfortable side effects besides a month of low blood pressure, some dizziness and nausea.

 

Mid 2013 and I want to have another child. I want to reduce my psych meds as much as is possible, in particular I know that benzodiazepines are not recommended for pregnancy, so I taper off the small amount of seroquel without any real problems and next up is temazepam. My p-doc recommeds I coldturkey. Well it takes me 1 day of doing that to realise that doesn't feel altogether right so I go to the pharmacist who recommends a different taper that will see me off 20mg temazepam in 1-2 months.

 

Near the end of this taper things really go very very wrong. I get some minor seizures and every other sort of hellish acute benzodiazepine withdrawal symptom. I attempt to reinstate but by this point I'm so sensistised I get horrible interdose withdrawal on the temazepam. I'm crossed over to diazepam equivalent 10mg and stabilise. In addition, because of the increased anxiety, my p-doc suggests going back up to 20mg citalopram. At the time I didn't think much of it. I was in such a state from benzo withdrawal I didn't notice that part of the sleep and adrenaline issues may have been from the increased SSRI. I'd had what I thought was a good history with the SSRI. I had trusted psych meds for some time.

 

Since then I've been tapering the valium. I've been going slowly, as my symptoms dictate. By 5mg valium or so I started becoming increasingly suspicious that the SSRI was causing a great many problems: insomnia, increased agitation etc. So I - perhaps stupidly - thought I would again try the taper down to 10mg.

 

Things didn't go too badly. I didn't notice any side effects however after fortnight or so at 10mg I did experience depression. At this point I'm so desperate to get off the benzos - not least because I'm not getting any younger and want a child - that I think I may as well just have more SSRI to help with the benzo symptoms. Well that was a mistake. Sure 20mg at first felt better and got rid of the depression but then it began to give what was probably serotonin syndrome. I got overheated, akasthesia, tics, agitation, anxiety, restless legs particularly the first 5 or so hours after dosing. Since then I tried to go back to 15mg. At first that seemed to work but a week into that and again I was getting increasingly agitated and anxious till the SSRI's active time wore off. I should note since this craziness I have stopped withdrawing off benzos. It is obviously hard to differentiate SSRI symptoms from benzo w/d ones but the agitation and anxiety is significantly worse after dosing the SSRI, through its active phase and drops off once it has reached half life. In addition I am best - most relaxed and least symptomatic - if I put off taking the SSRI. The upshot - the further I am away from the SSRI the least symptomatic I am.

 

Now the problem here folks is I now have a little more experience of psych med withdrawal then I'd like. I know that you can't make rash decisions. I know it is hard to tell one psych med's side effects from another's withdrawal. What is more I really really really want off the benzos and I would like to think that the SSRI could go back to being somewhat helpful on the depression and anxiety front whilst I get off the freaking benzo.

 

So that is this sad, convuluted tale of one woman's polydrug chaos

Fun reading huh?

 

Any advice appreciated. Note in answering these questions I really want off the benzo most of all and I'd prefer to be just on a doable dose of SSRI for now

Do I go back to 10mg and try to wait it out?

Is this like benzo w/d where the more you wait the more things settle down?

Or am I suffering from symptoms from the drug not wd so will just continue to get this response?

Is wd from the SSRI potentially just as bad as the symptoms from the drug in other words put it in the too hard basket whilst I get off the benzos?

 

p.s I've moved my SSRI dose to night time so I don't have to put up with the symptoms although it means a lot more doxylamine to sleep. Are we having polydrugging fun yet?

 

p.p.s Current meds: 3.5 mg valium; 10mg Citalopram (as of today only before that 15mg for 1 week, 20 the week before, 15 the week before, and 10 the week before that which I'd tapered down too .. and I KNOW I KNOW this going up down and around is very very stupid but I'd never been down the SSRI rabbit hole before.. now I just need stability but suffering from oversensitvitiy to the med

[Petunia]

Hi Rocksandhardplaces,

 

Welcome to Surviving Antidepressants, thank you for sharing you story with us, I'm so sorry you lost your daughter and have been through so much.   Unfortunately we hear a lot of similar stories of polydrugging which quickly get out of control.  How are you feeling at the moment?  Are you having any symptoms?

 

It would be helpful if you put your drug and tapering history in your signature, with doses and dates, it helps people understand your context, it appears below each of your posts.  Here are instructions for how to do it:

 

http://survivinganti...your-signature/

 

You have been tapering too fast.  We suggest reducing by no more than 10% of the current dose every 4 weeks, this reduces the risk of withdrawal symptoms arising.  Please read through this post which will explain why:

 

http://survivinganti...0-of-my-dosage/

 

... the nervous system does best in a stable environment. Help your nervous system adapt to life without drugs by maintaining as much stability as you can. This is the way you can take care of yourself and help your nervous system to recover. We are our own worst enemies when it comes to stressing our nervous systems!

 

Please see:  Keep it simple. Keep it slow. Keep it stable

 

Are you currently on 10mg of citalopram?  What dose did you want to taper down to?  If you want to reduce the citalopram more, and then come off the benzo completely, we recommend only tapering one drug at a time and the most activating one first, which would be the citalopram.  But because you have been jumping around recently, I suggest you hold for a while before making any more changes to give your nervous system a chance to settle down.

 

Here are our Tips for tapering off Celexa (citalopram)

 

For information and support related to benzo tapering and withdrawal, please go to our members only benzo forum, here:

 

http://survivinganti...ing-discussion/

 

Once you get back to us with a few more details, we will be in a better position to offer support and suggestions.

 

Petu.

[Rocksandhardplaces]

 

You have been tapering too fast.  We suggest reducing by no more than 10% of the current dose every 4 weeks, this reduces the risk of withdrawal symptoms arising.  Please read through this post which will explain why:

 

http://survivinganti...0-of-my-dosage/

 

... the nervous system does best in a stable environment. Help your nervous system adapt to life without drugs by maintaining as much stability as you can. This is the way you can take care of yourself and help your nervous system to recover. We are our own worst enemies when it comes to stressing our nervous systems!

 

Please see:  Keep it simple. Keep it slow. Keep it stable

 

Are you currently on 10mg of citalopram?  What dose did you want to taper down to?  If you want to reduce the citalopram more, and then come off the benzo completely, we recommend only tapering one drug at a time and the most activating one first, which would be the citalopram.  But because you have been jumping around recently, I suggest you hold for a while before making any more changes to give your nervous system a chance to settle down.

 

Hi Petu

 

I know normally these drops would be considered too fast. I had however been on the lower dose for a while and the higher doses were only recent. So though I'm going down I'm going down in response to symptoms to the increased drug rather than regular tapering if you know what I mean. Still, I understand it isn't ideal but I don't know if I have a choice. The symptoms from the increase in dosage are intolerable.

 

I've only just come back down to 10. Last time I was at 10 was about 3-4 weeks ago. I really wasn't doing badly on it and I should have stayed there but I was getting impatient with my benzo w/d. Now I know I can't fix benzo w/d with SSRI increase.

 

I do agree about the nervous system and consistency. My nervous system/brain is most unhappy with me at this point. I was so obsessed with the benzo I forgot what a significant psych med the SSRI was. I've learned my lesson. I'm hoping it can stop being overly reactive to the SSRI.

 

I'm happy to stay at 10mg for now. I have no interest in tapering more at this point if I can absolutely avoid it. Obviously if I keep having symptoms in response to the drug I may have to reassess but I'm hoping I can avoid it. If I must though I'd get a liquid citalopram and taper 10% a month till 5 and see if that was enough to stop the over activation (I already liquid daily taper with the benzo so I'm already plagued with syringes and measuring cylinders).

My first priority is getting off the benzo though.

 

As for how I'm doing now on the 10 well it has only been a day so I can't tell overly. I am still get hypo and agitated after taking the drug though there is less anxiety then at the 15. In the next few days to weeks I'll know more.

 

Thoughts? Wait it out at 10 and see if I can stabilise?

 

Many thanks

[Rhiannon]

It sounds to me like you've reached and gone over that cliff that so many of us have passed before you, where your CNS chemistry is just so destabilized by all the meds and all the changes that you're going to be extra sensitive to meds and to changes from now on.  It seems to happen to everyone eventually.

 

So you'll do best if you realize the game rules have changed. What worked in the past isn't going to work any more. What you were able to do in the past (as far as tapers and changes of meds) you probably aren't going to be able to get away with again. 

 

Also, do keep in mind that tapering is not a straight line, it's a curve. The lower your dose, the smaller the cuts you need to make. It sounds like you got in trouble with a taper once before when you got to the low doses. That's very common. People cut too much too fast at the end, when what is needed is to base ALL cuts on the CURRENT dose, so you're cutting a percentage of your current dose. That can mean some pretty small cuts. There's a link under the Tapering section to a paper that shows why that is.

 

It's possible you need to slow your benzo taper down (well, hold it for a while, actually, but slow it when you go back to it.) If you're getting a lot of withdrawal symptoms, to the point that you felt you needed to up the SSRI, you're probably going too fast or not taking enough holds or not holding for long enough.

 

Do I go back to 10mg and try to wait it out?

Is this like benzo w/d where the more you wait the more things settle down?

Or am I suffering from symptoms from the drug not wd so will just continue to get this response?

Is wd from the SSRI potentially just as bad as the symptoms from the drug in other words put it in the too hard basket whilst I get off the benzos?

 

Sounds like you already decided to go back to 10 mg. I would have recommended less extreme of a reduction, but as you say, you've been up and down a bit for a while, and you're having a bad reaction to the med when you take it, so it's not straightforward, and it may be that holding on 10 mg is your best bet for now. It's probably what I'd do, or maybe 12 or so.

 

Regardless of the dose you pick, you need to stop changing things, and regardless of the dose you pick, you're going to have some unpleasant symptoms and this is going to be a bumpy ride for a while. There's no obvious easy solution that stands out to me. So yes, probably hold right where you are and change nothing for as many months as it takes to settle down. The alternative I would consider would be maybe going up just a bit and picking a slightly higher dose to hold at. I can't say which will be best for you, just that at this point changing and tweaking to try to get just the right dose is problematic, because the changes themselves at this point are likely to cause as much trouble as the choice of dose will cause. It's a tricky spot and there's no simple answer.

 

Yes, with AD withdrawal, if you hold long enough the symptoms will eventually settle down. It can take a while and you'll probably need to reduce stress and do gentle self-care. And the symptoms will go up and down in roller coaster fashion same as with benzo withdrawal; just hang in there.

 

It does sound like you're suffering from a reaction to the drug as well as to withdrawal. So it's a tricky dance, to balance the problems caused by the drug with the problems caused by not taking it. As I said above, there's no simple, easy solution. Overall people seem to get the best results by keeping things as steady as possible and not changing around. But it's not overnight. It takes time.

 

I'm not sure about the too hard basket part but definitely SSRI withdrawal can be every bit as rough as benzo withdrawal, and the best thing to do is taper only one at a time, although you can alternate (get one down to a lower goal dose, hold a bit to settle, then work on the other one for a while).

 

And one more thing: there's some evidence that SSRI use in pregnancy may carry more risks than merely doing rat studies and looking for obvious birth defects would indicate. The nervous system is a delicate thing. In particular there's a greatly increased risk of autism, higher in boys than in girls, when mothers use SSRIs during pregnancy.  (You can Google that for more info I think.)

 

I'm sorry, I know none of this is what you want to hear, and I would love to be able to give you better news, but I've been doing this for a long time with hundreds of people, and your story is fairly typical; this seems to be how it goes.

 

The good news is that you CAN get out of the tangled mess. But it's going to take time, and for a while it's not going to feel too good.

[Rocksandhardplaces]

Ok. I'm willing to be guided by you absolutely.

I know nothing about this stuff sadly. I know a lot about benzo w/d but not about SSRIs.

Should I stay on the 15?

That is where I have been most of the time for the last month (I was on that for 3 weeks or so before I tried the 20)

I stuffed up big time by going to 20 for a week. Ever since then it has been craziness.

I thought going to 10 may be the answer because it was the drug making me sick but I can see it isn't so simple. I am having a bad reaction to the drug but I don't want to add withdrawal to it. In some ways on 10 I'm less amped and anxious but in other ways I feel like I'm already suffering a withdrawal and considering hte half life of citalopram and this is the first time I've taken 10 that isn't a good sign (having said that I'm probably slightly better on the 10 then I was with the 15 at this stage).

I don't know anymore so I absolutely hear you that I have to stay somewhere.

Ride it out on 15? 12? 10?

[mammaP]

Hi from me too Rocks,  You have to decide the dose you want to settle on.  You know your

body and how you feel. Rhi is very experienced and is tapering very carefully herself so I would 

read her post again, then again to digest it because it is hard to concentrate and get understand things

when in withdrawal. then make a decision. Once you decide which dose is best then stick with 

it until you have stabilised, don't change anything for a good few weeks to give your nervous system

chance to recover. 

 

I can understand that you want to have a baby and you need to be in the best of 

health to carry and care for him/her. You are still young enough to allow that time to get yourself off 

those drugs and in the very best condition so you can enjoy your pregnancy and give your precious 

baby the love and care without any withdrawal making things difficult.  Keep us posted wont you? 

[Rocksandhardplaces]

Ok. Thank you for your help

Yes it is hard to stay calm when you are flipping between hyper-serotogenic and SSRI withdrawal.

Fun times.

I'll go to 12mg and wait it out.

I suspect something that may have made me so reactive was the addition of B6. I added it to my supplements before this craziness because of a hormonal issue. Well I should have known better on how sensitive I am now. There isn't much in the way of brain brakes with so little benzo. B6 does I believe assist the production of serotonin so that could have resulted in the extra serotogenic action of the SSRI.

I think it best to cease that too to get back to the point I was before I was this reactive to the SSRI.

Then I just sit it out.

Yes I want a baby but I can't rush my brain. As we all know it is can be a little slow on the uptake (well mine is literally as well as figuratively too slow on the uptake including the damn excess serotonin).

I'll keep you posted.

Thanks again

[Rocksandhardplaces]

And just to be clear you have definitely seen this before with people getting a bad reaction to their meds and it settles down?

Sorry to be painful

It is just so counterintuitive because I feel so much better once the SSRI has stopped working. Till then I'm very very very uncomfortable.

[Rocksandhardplaces]

Things have impoved rapidly with a dose reduction

I am already expeiencing some withdrawal - nausea, shakiness etc - but it is at this stage far more bearable then the over serotogenic crazy ride I was on when I took my dose at the higher dose.

I'm now at 12ish (my tablets are tiny so imprecise. I'll be seeing a dr in a week and will ask for a compounded product for the right dose)

[mammaP]

Glad you are feeling better Rocks, I find that ginger helps the nausea, fresh ginger grated into

hot water then allowed to cool is refreshing and helps my nausea. 

[Rocksandhardplaces]

I may have spoken too soon.

It is like when I went down to 15mg. It was good and then after a few days I'm back to hyper serotogenic

 

I don't know what to do

 

I've never experienced this. I've experienced withdrawal from SSRI but never this hyper serotogenic agitation and anxiety

 

I may have to see my p-doc. I wish I trusted anything she said.

[Altostrata]

Welcome, Rocks.

 

What is your daily symptom pattern relative to when you take your drugs?

[Rocksandhardplaces]

Welcome, Rocks.

 

What is your daily symptom pattern relative to when you take your drugs?

 

Hey

It is getting better but there is definitely a symptom pattern

 

I take the drug in the morning: from half hour to the next 5ish hours quite unpleasant agitation and anxiety. For a few hours I still have risidual nausea from withdrawal

Then that drops off and I'm quite good for a bit.

Then by the time I wake in the middle of the night I am in withdrawal with some shakes, anxiety and nausea.

 

So it is getting better. Sure I have withdrawal now but it is an improvement on the out of control serotogenic crazyness.

I dislike the SSRI anxiety more than I dislike the withdrawal anxiety. I like neither but the withdrawal one I have some experience of. It isn't as scary. It feels like withdrawal rather than being a bit out of control.

 

My p-doc says go to 10mg. I'm now kind of on 12ish. My citalopram tablets are tiny and 20mg so I can cut it in half but getting smaller amounts than 5 is very imprecise. If I decide to stay on 12 I'll ask for some compounded 2mg caps next week when I see her.

 

My p-doc also suggested an updose on the benzo. I did a .5mg updose so that will put the brakes on the SSRI a little. But I'll be back to withdrawing from the benzo when I can so I wonder whether being at 10mg is not better as I continue to go down.

 

I suspect the SSRI action partly went out of control from: my fooling around; being lower in benzo so less brakes (and I will be going lower again when I can); the advent of summer and lots of sun; and introduction of B6.

 

I don't know...

Thoughts?

[Altostrata]

When do you take your other drugs -- each of them? When do you take B6?

 

Are you taking anything else? Please put ALL the drugs you take in the Drug Interactions Checker http://www.drugs.com/drug_interactions.html and post the results in this topic.

 

It sounds like you may be having adverse activating reactions from the citalopram. When you take it in the morning, it's too much for your system. You may benefit from dividing the dose, taking part in the morning and a smaller amount in the afternoon.

 

You can make a liquid from citalopram tablets. Read this carefully Tips for tapering off Celexa (citalopram)

[Rocksandhardplaces]

When do you take your other drugs -- each of them? When do you take B6?

 

Are you taking anything else? Please put ALL the drugs you take in the Drug Interactions Checker http://www.drugs.com/drug_interactions.html and post the results in this topic.

 

It sounds like you may be having adverse activating reactions from the citalopram. When you take it in the morning, it's too much for your system. You may benefit from dividing the dose, taking part in the morning and a smaller amount in the afternoon.

 

You can make a liquid from citalopram tablets. Read this carefully Tips for tapering off Celexa (citalopram)

 

7.03am: Valium 1.5mg; Citalopram 12mg; Fish oil; Now Cal-Mag with Bs -

Vitamin C (as Ascorbic Acid) 120 mg 200% Thiamine (Vitamin B-1) (from Thiamine HCl) 10 mg 667% Riboflavin (Vitamin B-2) 5 mg 294% Niacin (Vitamin B-3) (as Niacinamide) 40 mg 200% Vitamin B-6 (from Pyridoxine HCl) 5 mg 250% Folate (Folic Acid) 800 mcg 200% Vitamin B-12 (as Cyanocobalamin) 20 mcg 333% Biotin 300 mcg 100% Pantothenic Acid (Vitamin B-5) (from Calcium Pantothenate) 20 mg 200% Calcium (from 80% Calcium Carbonate, 10% Calcium Citrate, 10% Amino Acid Chelate) 1.0 g (1,000 mg) 100% Magnesium (from 80% Magnesium Oxide, 10% Magnesium Citrate, 10% Amino Acid Chelate) 500 mg 125% Choline (as Choline Bitartrate) 20 mg † Inositol 20 mg † PABA 10 mg † †Daily Value not established.

 

3pm: B6 1/4 of the tablet I was taking (I've stopped taking B6 in the morning but I was wary to stop taking it al all because I didn't want to make for too many changes. I have however stopped the vit D because it is revving things up significantly and I'm getting so much of it from the sun at this point.)

 

7 pm Valium 1mg

2am: Valium 1.5mg

 

At this stage I'm improving with dropping (I was worse on 20mg; improved on 15; and improved again on 12mg) but I am getting withdrawals that as we know can worsen. So citalopram is part of the problem as you say but that doesn't mean I want to swap that problem for withdrawal particularly when my CNS is so sensitive from benzo tapering. I know I wont feel well any time quick but obviously I want the best path back to stability.

 

What do you suggest?

 

*Continuing to take the 12mg citalopram but divide the dose? I'm wary to use the liquid citalopram that I make over a day because I called the compound pharmacist and they said that if I do it at home I'm likely to not make it stable and they could only guarantee the compounds would be active for 1/2 hour in water. But I could try particularly since I'm seeing a Dr wed and can get a compounded liquid at that point

 

*Take the 10mg and wait till it settles over the 24 hour time?

 

*Move the cal/mag with B complex away from the citalopram?

 

*Ditch the B6 (I am already getting it in the cal/mag with B complex on the other hand I don't want to suffer from too little serotonin from the drop in citalopram and the drop in B6)?

 

Many thanks. I know it is hard to give advice when there are so many things going on and individual differences. But I know also from the benzo forum that when you've seen enough of these things you get some better senses of what can help (though as we know nothing is guaranteed)

 

*The only drug interactions

Interactions between your selected drugs

magnesium citrate ↔ citalopram

Applies to: magnesium citrate, citalopram

{CS2} can cause an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. The risk is increased if you have low blood levels of magnesium or potassium, which can occur with bowel cleansing preparations or excessive use of medications that have a laxative effect. Do not exceed the dose and duration of use recommended on the product label or prescribed by your doctor. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications. In addition, you should let your doctor know if you experience signs and symptoms of low magnesium or potassium blood level such as weakness, tiredness, drowsiness, confusion, muscle pain, cramps, dizziness, nausea, or vomiting. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

No other interactions were found between your selected drugs.

Note: this does not necessarily mean no interactions exist. ALWAYS consult with your doctor or pharmacist.

[Rocksandhardplaces]

So still on 12ish and now experiencing significant withdrawals

I've never experienced withdrawals from SSRI like this.

It is just bizarre. I know it isn't benzos because they've been stable, even updosed for a while.

 

I'm not going to change anything at all. My brain is having a conniption and needs stability. At least it isn't over reacting to the drug so now it just needs to bring itself up to dealing without it.

 

It sure aint pretty when it gets this messed up. There is no going up either because of the over activation reaction.

 

So I guess I just sit out in messed up land.

 

Tell me how things get better. Like I said, I've done benzo w/d but not SSRI wd like this.

The other confounding thing is with benzo wd if you are really in deep you can updose out. The updose eventually calms things down. There is no calming with updosing SSRIs, in fact you have the opposite when you go up.

 

So yea.. tell me positive things please

[Altostrata]

Don't worry about your serotonin.

 

Many people react badly to B vitamin supplements. You might skip everything you take containing a B vitamin for a few days and see if that helps.

 

The information the pharmacist gave you covered his or her *ss nicely but was incorrect. We have many, many people who are using DIY citalopram liquid to taper. It won't keep forever, but it will certainly be good for a few days.

 

Updosing for both antidepressants and benzos is the same, it sometimes works and sometimes does not. Your benzo reduction may have left your nervous system more sensitive to further drugs changes. The patterns you saw while reducing the benzo don't apply now because your nervous system is hyper-reactive.

 

Try to remove anything that's stimulating from your supplements and diet -- minimize caffeine, alcohol, sugar, and artificial additives. When you take magnesium with calcium, the calcium cancels out the calming effect of the magnesium.

 

You may find magnesium glycinate, magnesium oil, or Epsom salt baths to  be a more effective way to get magnesium. (I've never heard of that interaction with citalopram before; we haven't seen it here.)

[Rocksandhardplaces]

Don't worry about your serotonin.

 

Many people react badly to B vitamin supplements. You might skip everything you take containing a B vitamin for a few days and see if that helps.

 

The information the pharmacist gave you covered his or her *ss nicely but was incorrect. We have many, many people who are using DIY citalopram liquid to taper. It won't keep forever, but it will certainly be good for a few days.

 

Updosing for both antidepressants and benzos is the same, it sometimes works and sometimes does not. Your benzo reduction may have left your nervous system more sensitive to further drugs changes. The patterns you saw while reducing the benzo don't apply now because your nervous system is hyper-reactive.

 

Try to remove anything that's stimulating from your supplements and diet -- minimize caffeine, alcohol, sugar, and artificial additives. When you take magnesium with calcium, the calcium cancels out the calming effect of the magnesium.

 

You may find magnesium glycinate, magnesium oil, or Epsom salt baths to  be a more effective way to get magnesium. (I've never heard of that interaction with citalopram before; we haven't seen it here

Thanks for the response

 

You don't think I need to worry about my serotonin given I've taken a cut of SSRI?

I'm now at 12 and I was at 20 for 5 days and 15 for 3 weeks before that.

 

I'll stop the other B6. I'll try to stick with my other supplement at this point just because i've had it the whole way through this taper. And I'm at the stage where I don't want to make too many changes if I can help it. I dont want to overshoot this settling down thing and end up deep in depression. But I may move it away from the citalopram. At the moment I'm not getting the same level of over activated response to the SSRI. I'm more in withdrawal than hyperactivation now (fun to have one or another right    ). Which I don't mind as long as either the hyperactivation doesn't get worse again or I don't land too low on the depression front.

 

I've been free of those other hyper active stuff for a while due to benzo taper (though sometimes have some sugar).

 

Thank you all for your help.

I'll keep checking in.

You can keep telling me good stuff on how I'll get better

I've got to the stage of being relaxed with benzo wd but I haven't had as much experience with crazy SSRI reactions. In the past if I got depressed I'd just updose the SSRI. I can't do that anymore which is a little scary but probably ultimately good for me.

 

Thanks again xxx

[Altostrata]

Problems with withdrawal go far beyond serotonin. Don't worry about "balancing" serotonin -- that was always a myth anyway. You can't do anything about receptor downregulation, just let them adjust themselves.

[Rocksandhardplaces]

P-Doc said to go to 10 and I am many many times better on 10.

I'm still uncomfortable but much better.

Hopefully withdrawal doesn't get too bad but even if it did I believe 10 is the right choice because at least I'm not on freakin bad speed/meth/ecstacy

 

Thank you for your help. I'll try to give follow ups

[Petunia]

Hi Rocks,

I'm pleased to hear that you are feeling better now.  You have been making a lot of changes to your dose recently, so I think its important you hold for long enough to give your nervous system time to settle down before making any more changes.  Please go back and read Rhi's post earlier in your thread, especially this part:

 

So you'll do best if you realize the game rules have changed. What worked in the past isn't going to work any more. What you were able to do in the past (as far as tapers and changes of meds) you probably aren't going to be able to get away with again. ....

 

 

Regardless of the dose you pick, you need to stop changing things, and regardless of the dose you pick, you're going to have some unpleasant symptoms and this is going to be a bumpy ride for a while. There's no obvious easy solution that stands out to me. So yes, probably hold right where you are and change nothing for as many months as it takes to settle down. The alternative I would consider would be maybe going up just a bit and picking a slightly higher dose to hold at. I can't say which will be best for you, just that at this point changing and tweaking to try to get just the right dose is problematic, because the changes themselves at this point are likely to cause as much trouble as the choice of dose will cause. It's a tricky spot and there's no simple answer.

 

Yes, with AD withdrawal, if you hold long enough the symptoms will eventually settle down. It can take a while and you'll probably need to reduce stress and do gentle self-care. And the symptoms will go up and down in roller coaster fashion same as with benzo withdrawal; just hang in there.

 

 

You may experience some waves of increased symptoms, this is to be expected, but please don't keep changing your dose.  Let us know if anything changes.

[Rhiannon]

Just to add, that pharmacy didn't do much research about the stability of citalopram in water. Most of my meds I don't have actual data on but that one I actually did find where they had studied and observed it and it's stable for a long time.

 

The water suspensions work great for me and I don't really worry about it because most of these drugs are not soluble in water and don't really interact with water molecules a lot. So if they're not exposed to light or heat there's not really anything that's going to provide the energy to break them down.

 

Now the binders, yes, the things that hold the pill together and make it a pill, those things do dissolve in water, it appears, as they should.

 

I currently make up and keep (in brown glass bottles in the fridge) ten days' worth of citalopram suspension at a time. In plain distilled water. I used to keep just three days at a time till I found the above-mentioned article. I have noticed no difference between freshly made and ten days, no symptoms of erratic dosing or withdrawal that I can detect. So I would say give the water suspension a try, when you're ready for that part of your taper.

[Rocksandhardplaces]

Heya

 

So I was feeling a big improvement until just a few days ago I started again feeling that old over activation sensation.

 

Rhi, I'm particularly interested on your thoughts here for the following reason. My PDoc is now talking bipolar 2. I'm pretty sure I don't have bipolar but I also know the combination of SSRI plus benzo wd could easily set off something that looked very very similar chemically.

 

Did you have that diagnosis? Is that why you were on lamictal etc?

 

And you've definitely seen people with hyper activation in response to SSRI calm down with holding?

Of course I'd like most to do that - hold. I'm scared the SSRI will just continue to make me worse on the hypermania front. I'm sure you've seen plenty of people where the SSRI is essentially creating bipolar like issues.

 

Also, given what I've said do you think when/if I'm stable I should taper at least part of the SSRI first? Get to maybe 5mg or something.

 

Thankyou for the information re cipramil and water. When I taper it I'll do that or compound depending on how much in house laboratory work I want to do. That crap depresses me to be honest. I use liquid valium and even that is depressing.

 

Thanks for your thoughts.

I much preferred just dealing with one psych med. It is a little scary to have the SSRI turn so on me.

[Rocksandhardplaces]

Just another note and hopefully a bit of an update:

I did cut out all activating supplements about a week ago. I'm now just on fish oil and magnesium glycinate (on its own).

I'm even partly avoiding direct sunlight because it is revving me up (of course this being affected by the light helps fit my PDocs bipolar 2 narrative). Fortunately my PDoc recognises I'm sensitive to meds so hasn't yet started trying to push mood stabilisers on me or ask me to cut more SSRI. She said 'normally' she'd suggest cutting more SSRI and moving to a mood stabiliser but because I was sensitive she thought we should wait. I'd most certainly like to wait and have things improve. The last thing I need is more polydrugging and not knowing what is what drug and what is what withdrawal.

 

I feel a bit better today so hopefully the spike in over activation wasn't something that will hang around.

 

I've been in varying degrees of withdrawal: some teariness/hoplelessness though not much, shakes, nausea, other stomach upsets, feeling cold, anxiety, some feelings of dread

 

I actually don't mind the withdrawal as much as I dislike the hyperactivation. The waves of withdrawal tend to dissipate quicker than the hyperactivation.

 

Again, hopefully the recent bout of hyperactivation was just a blip as everything is settling.

 

If you could still tell me reassuring things about hyperactivation settling with holds (I understand withdrawal will settle with holds) that would be most helpfu.

 

Many thanks

[mammaP]

I was awarded the bi polar label after reacting to drugs 20 years ago and it has stuck.

The waves and windows  pattern of recovery is why many people are mis diagnosed with bi polar.

http://survivingantidepressants.org/index.php?/topic/82-the-windows-and-waves-pattern-of-recovery/

 

You will experience periods of hyperactivity which is part of withdrawal but it is short lived and will settle.

It is usually a result of a dosage change that is too much or something else that has been changed. 

One day quite recently I felt very agitated and wired, it was quite some time since I had felt that way and

I was worried it was here to stay for a while. Then I remembered I had drunk too much caffeine while 

I was out with my family. The bottles of coke were handed to me and I drank them, added to the full

caff coffee I had because the restaurant didn't have decaff!  I don't drink caffeine, I cut it out ages ago

and just did not think of that with the coke, I only thought about the sugar then dismissed it because it was

just one day.  My symptoms settled down again but took a couple of days. 

 

The important thing for you now is stability, don't change anything for a few weeks, ride out the waves and

enjoy the windows.

[Rhiannon]

Being unable to tolerate bright light is typical in withdrawal. It's very common. Also loud noises; just general sensory overreactivity, very common in withdrawal. When I'm having WD symptoms, I wear earplugs and sunglasses just to go for a walk outside, and even then sometimes just the cars driving by are too stimulating for me. There are lots and lots of posts about this, if you search back a bit.

 

I highly suspect that 80%+ of the diagnoses of bipolar people get these days (especially that bipolar 2 business and bipolar spectrum and stuff like that) are iatrogenic, due to psych med reactions or withdrawal reactions. Certainly that was my case, I'm about as bipolar as I'm a fish. And it seems like everyone who is on psych meds long enough ends up with that label. I've never met anyone diagnosed with bipolar 2 who hadn't been on and off and on some psych meds first.

 

In my case, I got it because after a suicide attempt (when I was trying to quit Wellbutrin) they filled me with strong ADs that caused a manic reaction, and since I was then Superwoman I quit all my meds and crashed into an intense depression. Diagnosis: bipolar. Nothing to do with meds. Nothing to see here, move along.

 

Have you tried taking the citalopram some time other than the morning? Due to cortisol elevations (very common in withdrawal) mornings can be pretty rough with overstimulation when in withdrawal. (Do a search for "cortisol" here or "cortisol mornings", it's a big issue in withdrawal.) Cortisol levels are at their highest first thing in the morning, then drop throughout the day. 

 

You might see if you do better taking it later in the day. It would be good to sort that out and make sure of what is what.

 

Let us know if you try that, how it goes.

 

Also: if you haven't yet read Anatomy of an Epidemic by Robert Whitaker--it's time, do it. :-)

[Rocksandhardplaces]

Thanks Mamma and Rhi

 

Yes it is altogether scary. I did say to the pdoc that the symptoms of 'hypermania' - read agitated and anxious with stomach churning - subsided once the SSRI half life was through but that was just further confirmation of bipolar because SSRIs can bring about bipolar (not the SSRIs fault though, it is already there etc).

 

I'm well versed on the cortisol stuff. I took a crash course in it in my first few months of tapering benzos. I'm also used to hyper sensory stuff from my benzo taper. Sound is my main sensitivity. The revving up from the sunlight is a slightly different phenomena for me. It gives me a weird energy. But that isn't surprising. It is an energiser, full of vitamin D, and I am one seriuosly sensitive person at this point. Thanks for the tips though cause I could move the SSRI to later in the day. I know I can no longer take it at night. I've taken it at night for much of the 10+ years I've been on it. Now it revs me up too much. Still, at some point later in the day might help.

 

I really appreciate the encouragement. I have been doing an unpleasant benzo withdrawal for a bit over a year but the SSRI stuff was new. Looking back I can see the SSRI was part of the picture of my insomnia that led to the temazepam script in the first place. But I hadn't until now got such strong adverse effects from it.

 

As way of an update: I'm doing ok-ish. I have some waves, some are bigger and there are smaller intenser ones within the bigger ones. At least the small intense ones are moving on fairly quickly - few hours or  more. I wouldn't mind if my gut didn't stop hurting, aching, churning though. That is a constant the last few days. It's alright. As you know you get some coping mechanisms pretty quick with this BS. As long as I'm low enough on the SSRI to not get over activated for long spells I'm ok with this process at this point.

 

Thanks again. I'll go back to holding my stomach now (actually hot water bottle on the stomach is one of the few things to give some relief)

[Altostrata]

I did say to the pdoc that the symptoms of 'hypermania' - read agitated and anxious with stomach churning - subsided once the SSRI half life was through but that was just further confirmation of bipolar because SSRIs can bring about bipolar (not the SSRIs fault though, it is already there etc).

 

 

This is utter baloney. Whether antidepressants "trigger" bipolar disorder is highly debatable. People have adverse effects to antidepressants and psychiatrists confuse this with bipolar disorder. Your symptom pattern clearly indicates an adverse effect from citalopram. That your psychiatrist doesn't catch on to this indicates a serious lack of ability.

 

Few psychiatrists have any grasp of withdrawal syndrome. Throwing out a diagnosis of bipolar disorder is a common way to define it.

 

Your destabilized nervous system is generating those symptoms of activation. This may come in waves for a while but should settle down as you hold on further drug changes.

[Rocksandhardplaces]

Yes. It is a all a little scary. And the weird logic that leads to thinking a reaction to a drug is an underlying disorder is the establishment.

 

I'm doing pretty well last few days.

[Rhiannon]

Good to hear you're having some better days! Don't worry if things get worse again, you didn't do something wrong, that's just the typical way it goes, waves and windows. They will come and go regardless of what you do or don't do. But over time as you stabilize, you will get more and longer windows and fewer and shorter waves.

[Rocksandhardplaces]

I've had a week of good really. I can't think of any overt SSRI withdrawal symptoms

The cold, nausea, shakes stuff has been gone for 6 days in a row. I haven't had any more teary stuff. Anxiety is also low to non existant.

We'll see....

Thanks again for your help

[Altostrata]

Very good to hear!

[Rocksandhardplaces]

Thanks.

Still good really. My gut has been terrible since the SSRI stuff though. But I'm working on that.

I've started slowly tapering benzo again.

[Rocksandhardplaces]

Hello all

 

I did recieve your help about a year ago when I got very unstable on my SSRI. I recovered from that relatively well. It wasn't pretty for a while, but it passed. I do however feel like I am now more sensitised to changes in my SSRI. In the past I was able to change, and skip doses. Now I feel the panic brunt of it virtually immediately. Whether that is the benzo taper sensitising me to everything or a sensitised CNS to SSRI disruption specifically it is hard to say.

 

In any case I am now offically off my benzo after a 2 year taper.

 

I began my benzo taper when we wanted a second child, and I was aware I could not take temazepam/restoril during pregnancy. At the time I knew little of psych med withdrawal; the past two years has brutally insured that is no longer the case. The withdrawal didn't go well, a valium conversion was required and then a 2 year painful taper.

 

I'm only just off so I'm not doing wonderfully though I do get relief at different times during the day and that is mostly enough for me. My worst times are in the early hours of the morning - from about 3am - up until midday-ish. Things seem to slowly improve from then on. Incidentally SSRI withdrawal was also most terrifying in those very early hours of the morning, as my stomach churned and the world seemd to spin out of control.

 

Anyway, after 2 years of a benzo taper I have now hit 36 and the prospect of a second child is slowly closing. I am though no longer willing to take an SSRI during pregnancy. My experience of the withdrawal has instilled in me the due respect for that particular psychoactive substance.

 

Next up then is an SSRI taper. I'm not suggesting I begin the taper straight away. I'm hoping I can begin in three months or so but I'll only be able to judge when I get there. I do however want to start planning, and getting as informed as I can. I know y'all recommend 10% a month but I do not have an endless amount of time to work with. I have a biological clock that is ticking and somehow I need to manage the needs of that with the needs of a tolerable taper and withdrawal period.

 

For reference I have been on celexa for 17 years so I have no illusions this will be easy. What makes matters worse potentially is I started taking it at the young age of 19. The dose has virtually always been 20 mg but I was successfully on 10mg for sometime before the benzo taper and am currently on 10mg.

 

Any advice appreciated

 

Thank you

[Nomoreheadmeds]

hi 'rocksandhardplaces' you've gone about things the right way unlike myself.well done for tapering the benzo.

I wish you well

[Altostrata]

Rocks, I merged your topics to keep your history all in one place.

 

Since you are getting withdrawal symptoms when you take citalopram irregularly, that's a very strong indication tapering faster than 10% per month is not going to work for you.

 

You may wish to try a taper of 10% per month to see how it goes. If it goes well, you might want to gradually pare down the time period, but I would not reduce any faster than every 2 weeks. You may end up with an infant and withdrawal syndrome.

 

See Why taper by 10% of my dosage?

 

Why taper? Paper demonstrates importance of gradual change in plasma concentration

 

Tips for tapering off Celexa (citalopram)

 

Many people do better with fish oil and magnesium supplements, see
http://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/
http://survivingantidepressants.org/index.php?/topic/1300-magnesium-natures-calcium-channel-blocker/

 

I hope all goes well for you.