☼ lionboy: protracted withdrawal from citalopram

[lionboy]

i have been on citalopram 50mg for 12 years for anxiety.

for most of that time i also abused recreational drugs including cocaine, codeine, canabis etc etc.

once i had given up all other drugs I then began to realise I was on much too high a dose of citalopram.

it made me overstimulated, over agressive unable to properly relax etc.

at the end of 2007 i reduced from 50mg to 40mg.

i then experienced at least a year of what i now know were ssri withdrawal symptoms.

at the time i really had no idea what was going on.

i attributed it mainly to suddenly stopping taking large doses of codeine daily.

in march 2009 i reduced my citalopram again from 40mg to 30mg. after 2 months (may 2009) my doctor thought it would be a good idea to then reduce from 30 - 20mg. (cheers mate!)

as everyone on this site would probably expect i had serious withdrawal issues. all the usual, sweating, tremor, aniety, panic attacks, aggresion, akathesia, deppresion suicidial thoughts etc etc.

in august 2009 i put my dose back up to 30mg. still all over the place i then reduced my dose again to 20mg in september 2009.

i stuck at this till january 2010. still a mess i decided i must have reduced too far, so i put the dose back up to 30mg.

this brought no relieve and infact probably made me feel worse.

as all this was going on, i spent a lot of time researching ssri withdrawal and what was happening to me.

i then came to the decision i needed to continue to reduce my dose but much less drastically.

in july 2010 i reduced from 30mg to 25mg.

as 5mg tablets are not available (cheers pharma companies !) i now take one 20mg and half a 10mg tablet cut with a pill cutter.

i have stuck at 25mg to date. i still have withdrawal symptoms. they are still quite bad. they seem to come in waves now with some days i actually feel o.k.

the withdrawal symptoms are never far away but they do seem to be getting slightly better over time.

i am determined to stay on this dose untill i feel normal again, just so i know that it is possible for these symptoms to cease.

 

i am interested to hear from anyone who has experienced similar prolonged withdrawal and has come out the other side.

sometimes it seems that the withdrawal may never end.

i have had it suggested to me that some ssri withdrawal is a permanent condition similar in that respect to tardive dyskinesia.

however the fact that my symptoms seem to slightly improve over time does lead me to believe that they will eventually cease altogether.

 

please send me any reply's that you think i may find helpfull.

Edited July 5, 2011 by Altostrata
added poster's name to Intro topic heading

[Altostrata]

Thank you, lionboy, for joining us and adding your story here.

 

Some people can handle only a very, very small decrease in dosage to taper.

 

10mg at a time seems like it was too big a drop for you.

 

It's a good sign since July 2010 your withdrawal symptoms have been fading. This means, at last, your nervous system is getting accustomed to the big drop.

 

You may find much smaller decreases to be much more tolerable. You may wish to wait until you're feeling a bit better.

 

Here's a topic about tapering off cipralex http://survivingantidepressants.org/index.php?/topic/406-tapering-off-lexapro-escitalopram/

 

(Are you taking citalopram or cipralex? They're two different drugs.)

 

We can't tell how long withdrawal symptoms last. It's different for each person.

[lionboy]

hi

thanks for the reply.

i'm on citalopram (called cipramil in u.k) i though called cipralex in u.s but i think i confused that with celexa ?

it's definately citalopram not escitalopram (cipralex).

sorry for the confusion.

[lionboy]

sorry one last thing.

does any small improvment in symptoms suggest that over time the symptoms will contiue to improve untill they cease ?

[Altostrata]

citalopram is Celexa in the US. We have several people tapering off Celexa.

 

(Calling Ms. summer!)

 

Yes, small improvements are a good sign. What happens is very gradual improvement, as symptoms occur in waves and fade away over time.

[lionboy]

hi everyone.

i am currently taking 25mg per day citalopram / celexa.

this is down from 50mg 3 years ago.

i guess like a lot of you i find a 10mg reduction just too much to cope with, so i cut the pills with a pill cutter.

i currently take one 20mg tablet and half a 10mg tablet.

i only use the tablets that split evenly and i always take each half of a tablet on consecutive days.

that is to say i accurately take 50mg in every 48 hour period.

there seems to be a concensus of opinion that changing dose each day is a big no no. (i.e taking 20mg one day, 30mg the next, than 20mg again etc).

i was just wondering if anyone has had any experience or has any advice on the way i am doing it.

is what i am doing accurate enough to not provoke any adverse effects from the small discrepency in daily dose ??

It's been a year now since i dropped from 30mg to 25mg and things seem to be improving very slowly !

 

Any help or advice would be appreciated.

 

p.s i appologise for my spelling, the spell checker on this won't work for some reason

[Altostrata]

Hi, lionboy. I attached your question to your Intro topic.

 

If your withdrawal symptoms are minimized by reducing by 5mg at a time, it sounds to me like you're doing the right thing for you.

 

And your use of the pill cutter sounds like it's working, too.

 

If you can't feel the minute difference between the cut-up portions, you don't need to be more precise.

 

Some people may be extremely sensitive to those variations; you do not seem to be one of them.

 

If you wish to taper by even smaller decrements, you can cut the 10mg tablets into quarters with the pill cutter.

 

PS Please put your tapering history in your signature. Thank you.

[summer]

Hello Lionboy... sorry to say, I just saw this thread.

 

I'm tapering Celexa also, and as you can see by my signature, holding at 12 1/2mgs. So far, I'm doing okay, even tho I'm tapering a bit more than is suggested. I'm also cutting pills like you are.

 

I have given some thought to the liquid, but not sure which way I will go with this. Most people say that the liquid is easier to taper from. However, if you are doing okay with cutting the pills, that's great.

 

A belated welcome to SA. Glad you found this site!

 

PS Many people find they have to taper in small increments. Go for it! All you want is some quality of life while going thru this. I know one person who tapers about 2% every 3 weeks. Sometimes, slower is better!

[lionboy]

hi summer

thanks for your reply.

and thank you to alto as well.

 

i wish the drug companies would just offer the pills in 5mg and 1mg doses both scored so they can easily and accurately be split in half.

it surely would help a geat many people.

 

i don't really know if i am suffering any ill effects of taking a very slightly different dose each day or if i am just still experiencing symptoms of dose adjustment.

i guess only time will tell.

i would guess that as my symptoms seem to improve gradually over time that they are down to dose reduction and will hopefully cease in time.

 

in response to atlo's post, i wouldn't say i find a 5mg reducion easy or comfortable however i am reluctant to cut the pills up even more into smaller doses as that would result in even more inaccuracy in dose and then i really would be confused with what was going on and why.

i think what i really want to know is exactly what is going on, why and how long it will last.

i guess in a way that's what alot of people are looking for.

this forum is a real help in that way.

[Altostrata]

Understood, lb.

 

As summer suggested, if you want much more precise dosing, the liquid is the way to go.

 

PS Please put your drug and withdrawal history in your signature so people will know where you've been and where you're going.

[summer]

 

i wish the drug companies would just offer the pills in 5mg and 1mg doses both scored so they can easily and accurately be split in half.

it surely would help a geat many people.

 

 

The drug companies aren't interested in helping people... they are interested in helping themselves make lots of money.

 

Have you considered getting a scale to weigh the doses? We have a thread about that somewhere here... do a search at the top of this page. This is another method that works for lots of folks.

[lionboy]

hi summer

yes i did buy a really accurate lab scale that cost £600 however because the tablets are so small and light the scale proved inaccurate.

that type of scale is only really accurate at tiny weights when used under laboritory conditions because they are affected by air temprature, drafts etc.

so i resorted to cutting the tablets with a pill cutter and only using the ones that are accurate to the eye.

I guess only time will tell whether this is having any ill effect or whether i'm just going through protracted withdrawal from my last dose adjustment ?

Liquid is a good idea and i may ask my doctor again about it, however in england all prescriptions are subsidised by the NHS and i know liquid is vastly more expensive than pills so they may well be reluctant.

HAS ANY ONE ON THIS FORUM ANY EXPERIENCE OF USING THE LIQUID ? I WOULD BE KEEN TO HEAR FROM YOU.

You're right what you say about the drug companies, they are bastards.

I could write all day on that subject.

I find it frustrating they don't do the pills in smaller doses scored.

They score the 40mg and 20mg despite offering a dose half there size ?

That must be someone's sick joke ?

I intend to stay at this dose for 24 months then reduce again to 20mg.

That way I can compare the two experiences and gain some insight into the effect of cutting pills.

[lionboy]

after a few years of turmoil abrubtley changing my dose quite dramatically down, back up, down again etc i have now been on 25mg (one 20mg tablet and half a 10mg)for 15 months. My intention was to stay on this dose "a few months" until settled then reduce again.

most of the worst withdrawal symptoms seem to be behind me now BUT i am definately not content.

i still have bad days and i am over stimulated and agitated a lot of the time.

given what i have been through in the last few years should i just remain on this dose for the time being and wait untill i am totally settled before attempting further reductions or, given my history, am i just waiting for a calm that can never really come until i have ceased taking these drugs altogether ? Should i now be looking to reduce in 10% increments every few months until my dose is zero ??

 

any advice is welcome.

[Altostrata]

Hello again, lionboy. I added your new topic to your earlier Intro topic.

 

It's hard to say what your symptoms are from, because you had an adverse reaction to citalopram before -- agitation and anxiety. So it could be too much citalopram still.

 

And it could be you and citalopram just do not get along at any dose, or that you are now hypersensitive to all neuroactive medications, following your earlier ill-fated decrease.

 

If I were you, I might decrease by 1mg to see how it goes.

 

Rhi, I believe, has been dissolving her citalopram (Celexa) tablets in water to taper very gradually, see http://survivingantidepressants.org/index.php?/topic/381-rhi-got-to-5-mg-celexa/page__p__3913__hl__celexa__fromsearch__1#entry3913

[Altostrata]

[posted for lionboy]

 

Hi Alto

 

You mention in one of your posts that when you reduce your medication and suffer withdrawal symptoms you basically have a window of time in which you can reinstate the original dose for immediate releif.

 

You say that, after that window has passed reinstating the original dose can just make things worse.

 

You are spot on in what you say as I have direct experience of this myself, both reinstating within the window and feeling immediatley better and more recently trying to reinstate after the window had elapased only to suffer futher turmoil.

 

My most recent dose adjustments were 30mg to 20mg.Stayed on 20mg for 4 moths. Went back up from 20mg to 30mg after the window had closed and suffered even more turmoil. Stayed on 30mg for 5 months then reduced to 25mg. On 25mg to date, 16 months and still experiencing withdrawal problems. Whilst the withdrawal problems have improved in the last 6 or so months they are still aparent.

 

In your opinion is this simply a case of my body needing more time to stabilise itself on 25mg after all the aggressive dose changes or could it be that as I stayed on 20mg previously beyond the window I may now never settle down on a dose higher than 20mg ?

 

Your help is as ever very much appreciated.

[Altostrata]

lb, sounds to me like you're stabilizing. It's slow, as you can see, but it's happening. If I were you, I would not consider increasing dosage.

 

However it happened, you've got autonomic dysregulation. At least you are seeing some improvement by staying at one dosage.

[Altostrata]

[posted for lionboy]

 

In response to you answer, I am not considering increasing my dose. What I am trying to ask is: because I spent 4 moths at 20mg and went passed the window of return if you like, could I now expect to stabilize at 25mg ?

i.e can you adjust back up ? Or does the fact I spent 4 months at 20mg mean I need to be on 20mg or less to stabilize.

or is it just a long process of adjustment up / down no matter.

 

hopefully that makes my question a bit clearer ?

[Altostrata]

Hmmmm....

 

Unfortunately, stabilizing at any level cannot be predicted. You just have to see how your system responds.

 

Since you're slowly improving at 25mg, I would think this at least indicates the dosage level is not injurious to you. I would not increase it.

 

It's up to you if you wish to stay at this level to see if the autonomic disruption stabilizes further. If you are functioning, you might want to do that just to maintain a normal life. What are your symptoms now?

 

At this point, it's impossible to tell if decreasing would be a good idea, since your system is sensitized to withdrawal. If you choose to decrease, I'd do it very carefully, as any jolt can make your situation worse.

 

Any changes would mean adjustment. Decreasing slowly -- and I mean maybe a tenth of a milligram (.1mg) at a time -- to 20mg might mean more disruption, or it might be the same as you're experiencing now.

 

As noted up above, our member Rhi has been making a liquid solution with Celexa tablets http://survivingantidepressants.org/index.php?/topic/381-rhi-got-to-5-mg-celexa/page__p__3913__hl__celexa__fromsearch__1#entry3913 If you decide to decrease, using the liquid will enable you to measure tiny decrements.

[lionboy]

Thanks again Alto.

I think I am improving over time by staying at this dose, so I guess the sensible thing would be to wait and see.

When I have a bad day(s) I tend to try and rationalise everything and look for a plan of action to sort it.

I guess just waiting for the time being is the best plan.

When you have a bad day it's hard to judge how far you've come / how well you are doing.

 

I think the brain definately adjusts and heals itself overtime.

I find inspiration from the british boxer Micheal Watson. He sustained a brain injury in his world title bout with Chris Eubank and was left severly brain damaged.

Doctors thought he would never speak or stand again. He went on to walk the London marathon and is now quite a charismatic speaker.

Believe I guess !!

 

Alto you mention Rhi is disolving her tablets to allow small dose adjustments however I can't see how she actually does it in the thread ? Could you post me a link ?

[Altostrata]

How Rhi does it:

 

http://survivingantidepressants.org/index.php?/topic/235-tapering-techniques/page__p__7769#entry7769

[lionboy]

I am 2 and a half years since my last erractic dose reduction and 5 years since I started to erractically reduce / change my dose and I experience week long episodes of really bad anxiety and other withdrawal symptoms such as just wanting to stay in bed, sweating, irritability, and feeling hopeless almost suicidal.

At the moment this problem keeps recurring, I have had 5 bad weeks in the last 9 and there doesn't seem to be any obvious trigger for it ?

Before these recent bad periods I had not had a bad period for 6 months.

When I am not having a bad period I am basically fine to work and live life to the full, I am still always aware I am in withdrawal and I am always overstimulated etc but nothing that effects me that bad and I can feel that over the years I am getting better.

When these bad periods hit me it is really worrying.

Does anyone else experience a similar type of thing ?

 

I am now worrying that my employers may lose patience if I am off work much more and I am considering seeing a doctor, which will most probably involve them either a. Trying to get me to increase my dose of citalopram again (NO CHANCE) or b. offering me Valium or similar for when I have these bad patches.

Does anyone have any info or advice on this ? Could option b. help or is it a whole new can of worms ?

[Nikki]

Hi and welcome.

 

Did you suddenly stop taking the Celexa from 25mgs. to Zero? That is what I am understanding from reading you history.

 

If that is the case, you would still be experiencing CT withdrawal.

 

I take Celexa and I am trying to wean off of it. I have gone thru WD a number of times in the last 12 years and I am so sensitive to it (I cannot bear to suffer from it again) so I am taking Imipramine to lessen the effects.

 

It does help and I am at a reasonably small dose of Imipramine. I would rather be on Imipramine than Celexa.

 

Alot of people do take Benzo's to deal with anxiety. Believe me, we know how bad it can feel. You have to be careful with Benzos, as they are highly addictive.

 

I certainly understand your concern over the job. It has affected us in that area. I don't hear much about Valium, more about Xanax and Kolonipin.

 

Other members will be here to help you out....

 

Hugs

[lionboy]

hi nikki

thanks for your responce.

no i didn't drop from 25mg to zero, i am currently on 25mg.

i went from 50mg straight to 40mg then a year later to 30mg then a couple of months later to 20mg then it all properly kicked off !!

i tried going back to 30mg which didn't help so i tried 25mg and I have been on that ever since (last 2.5 years).

i realise now that the cuts i made were much much too agressive ( i have been on citalopram for 13 years at 50mg or more).

i was guided (or misguided) by my doctors (same old story i guess).

 

after all the changes and 2.5 years at 25mg i am definately getting better overall, still overstimulated etc but not a life changing problem, i just get these terrible episodes that last a few day to a week which mean i can't work.

as i say these are not all the time but have been 5 of the last 9 weeks which can cause a problem at work. prior to this bout of problems i was o.k for over 6 months so i was just wondering if diazipam or similar might help me on a temporary basis when i get these episodes ?

if so which one people recommend really ? i've not heard of imipramine ?

[angie007]

Hi Lionboy, after reading your story and checking out your history with citalopram, im seriously wondering wether there is any possible chance that you have become tolerant to 25mg, tolerant meaning that the dose your on is not working any more and is creating the problems that your having, maybe a small dosage adjustment is needed at this stage, whats your thoughts??

As these are NOT forever meds and at some stage being on the same dose for x amount of time this can happen.

[Altostrata]

That's an idea, ang.

 

Lionboy, is there any daily pattern to the symptoms? Do they ramp up at a particular time of day? When do you take the citalopram?

[lionboy]

Hi ang / alto

No there is not a pattern to this as far as I can see ? I always take c same time every morning ?

As I say I have felt really bad for 8 - 9 weeks in the last year. The rest of the time I seem relatively fine and my symptoms seem to be subsiding gradually over time.

Most of the time it is mild overstimulation and then I get these few day / week long periods of being really anxious, unable to get up etc.

from what I have read myself on this site and from dr Healy, I am of the opinion that after such aggressive dose adjustments and the problems I have had, that I am best to wait it out until I am stable at 25mg before considering a further GENTLE taper.

Would you advise otherwise ?

 

 

I really was just wondering if occasional benzo may help during these tough periods ?

[Altostrata]

People do use benzos occasionally, you know what the risks are.

 

I'm wondering if the holidays were not stressful for you?

 

If you feel holding at 25mg is what you should do now, follow your intuition.

[lionboy]

Thanks for your help

[lionboy]

Alto, I have considered your comments and when you say " you know the risks " are you meaning addiction ?

I have had problems in w/d with OTC meds and these I think have set off or triggered these bad patches I speak of.

Do I run the risk of a benzo doing the same thing ?

 

I really just want some temporary relieve or help to get me back on track. As I say 5 weeks of problems in the last 8/9 weeks is not good !

I am under quite a bit of stress at work at the moment but nothing I would say I can't handle and I've not had the problem keep coming back like this before ?

[jr1985]

Sorry you're still having trouble this far out. What OTC meds did you take that triggered it?

[Skyler]

Alto, I have considered your comments and when you say " you know the risks " are you meaning addiction ?

I have had problems in w/d with OTC meds and these I think have set off or triggered these bad patches I speak of.

Do I run the risk of a benzo doing the same thing ?

 

I really just want some temporary relieve or help to get me back on track. As I say 5 weeks of problems in the last 8/9 weeks is not good !

I am under quite a bit of stress at work at the moment but nothing I would say I can't handle and I've not had the problem keep coming back like this before ?

 

Hi Lion... benzos often end up in a full taper mode. The full clinical effects usually only last for a week if they are taken regularly, and dosing as much as two or three times a week can lead to dependence. The UK guidelines suggest scripts be given no more than 2 to 4 weeks because of the risk. Of note... all psychotropics have similar issues with WD and often need tapering.

 

You can read up in our benzo sub forum here. You could also follow the link in my sig. line.

 

Skyler

Tapering diazepam/klonopin for 30 months.

[starlitegirlx]

Having used benzos to help with AD WD, and now being stuck on a dose of over 3mg when my daily norm was 1mg so I now have to spend years tapering from the benzo, I can only warn you that adding a benzo in now is the absolute worst possible thing you can do. Fact is, it never really helped me other than some psychological factor. Looking back, it actually made things horribly worse because after I adjusted to that higher dose, I was pretty much screwed because taking it as needed as I was doing caused WD from the benzo. This would mean that you would have to begin taking a stable dose daily to avoid WD issues from the benzo. Then there is the fact that you now have another drug to taper at a higher dose. Both factors seem like the worst choices.

 

Holding might be your best bet. It might just be part of the healing process your body is now doing because you are at half your original dose. I would have never taken the benzos if I knew the hell I was in for. I would have held my AD and waited for the worst to pass and to stabilize more before I dropped. I also would have titrated. I don't know if you can titrate with Celexa or if you are forced into X amount MG cuts due to the nature of the pill, but if titration is possible, then that is the safest bet as you continue. I didn't know of titration and therefore did not do it which became an issue because as the dose became lower and the pills were steady 10 mg which I had to cut in half and then in half again at really low doses, I eventually hit a wall where the cuts became quite high percentage wise and far above the recommended amount of 10% which is even high for some people.

 

Looking at your history of cuts, your first cut was a 20% cut. Your next cut was a 25 percent cut. The cut from 30 to 20mg was nearly 40%. That likely sent your system into the state it is in now and even with returning to 25mg, you are still at a 27% cut. I was in a very similar situation as you are, and my best recommendation is to hold at the 25mg until you stabilize, use whatever methods you have at your disposal (meditation, relaxation techniques, acceptance is something I'm a huge fan of and there is a thread regarding that in the finding meaning section - here's the link to it - all of those sorts of things can help if you give them a try) to help you through it. And if it is possible to titrate with celexa, then that would help with lowering the cuts to a safer percentage. Can you titrate celexa? Alto has excellent info regarding titration here on the site. That will give you more control over the percent you cut so you stay within the 10% zone now particularly after you stabilize for a while at this dose. Personally, and from my own experience, I think that it's the high percent cuts that triggered this. Best and safest bet is to hold ESPECIALLY if you feel that is what you should do and more so if you feel you are gradually improving. Give yourself time to stabilize and then a little more time so you don't jump into another cut too soon since the last cut was quite high and well above the recommended 10% cut and put you into this very uncomfortable state. Again, this is just based on my experience.

 

Also, I'd like to add that anything that is not natural like meditation type techniques that you use to help provide temporary relief run the risk of making you worse in the long run. I went that path and now I'm set up for years of tapering a benzo which has horrible risks involved with it. I know it's hell to endure it, but remember that the you can heal and your body will adapt. I think the size of the cut was just too much for your system and updosing back to 25mg still kept it at a large cut. Holding is your best bet at this point as horrible as it seems. It may mean more weeks of what you don't want, but they will pass and you will improve, even if the improvement is slow.

 

I hope your body recovers well and soon. If you are already improving, that's a great sign.

[lionboy]

big thanks to everyone for their time and help !!

starlite girlx - you have just told told me in great detail exactly what i really already knew was right. i am due to see my doctor in just over an hour and i am now going to cancell that appointment and go running instead !!!

thanks again everyone, love to you starlite girl !!

[starlitegirlx]

big thanks to everyone for their time and help !!

starlite girlx - you have just told told me in great detail exactly what i really already knew was right. i am due to see my doctor in just over an hour and i am now going to cancell that appointment and go running instead !!!

thanks again everyone, love to you starlite girl !!

 

I'm so glad I just happened to log on today and weed through the threads. It makes all this BS worth it to just be able to help one person. Thank you for posting that. You just made my week because something in all the hell I went through was able to help you. I wish you well in your continued recovery.

[lionboy]

I tend to have that effect on women lol

Thanks again everyone, this website is a massive help.

[lionboy]

Hi everyone

I have now been off work for the last 4 and a half months with symptoms I can best describe as feeling anxious, lethargic, stress intolerant and physically uncomfortable (at worst like a cold sweat and mostly just uncomfortable and not quite right).

You can see from my signature a rough outline of my history.

This last few months aside, I would say that whilst my withdrawal symptoms have changed in nature an severity all the time i.e typical waves, they have over the last few years improved considerably.

The way I have felt this last few months is not new to me I have had periods of feeling exactly like this throughout my wihdrawal however usually only a week or so at a time not the four months I have now experienced.

I have had it suggested to me that I have developed tolerance.

 

I would be extremely grateful for members opinions on the question is this most likely the latest of many phases of withdrawal or does this sound like I have suddenly developed tolerance ?