☼ lionboy: protracted withdrawal from citalopram

[Altostrata]

lionboy, I merged your various topics into this one so we can better see your progress.

 

I'm not sure what "tolerance" would mean in your situation. You've been taking 25mg since July 2010?

[lionboy]

Yes, 25mg since July 2010.

I think by tolerance they mean that I have become tolerant of the drug at 25mg. Meaning that my latest difficulties are as a result of experiencing a new onset of withdrawal problems despite not further reducing the drug. I guess like poop out.

This doesn't sit correctly with me for 3 reasons:

1. If it was graduall tolerance I would have slowly got worse over time when in fact, these last few months aside, I have slowly got better.

2. If I had suddenly become tolerant to the drug and that had caused this last few month period I would expect the symptoms of withdrawal to be similar to the pattern of symptoms I have experienced each time I have reduced my dose and they are not.

3. The symptoms I have been having these last 4 months that have kept me off work are the same symptoms I have had time and again throughout my withdrawal although never before over such a prolonged period.

I think this is the same for a lot of withdrawal symptoms however. An example is tremor in my jaw. I have had tremor in my jaw on and off through the whole of my withdrawal. I had it earlier today fairly mildly and only for a few minutes however there was a time when it went on constantly for weeks and weeks if not months and seemed as if it would never stop.

 

The fact this latest period has kept me off work makes it seem different to other phases of withdrawal although in reality it may just be another different phase.

 

Members opinions on this would be most welcome.

[Skyler]

I think by tolerance they mean that I have become tolerant of the drug at 25mg. Meaning that my latest difficulties are as a result of experiencing a new onset of withdrawal problems despite not further reducing the drug. I guess like poop out.

 

Lionboy, maybe you have developed side effects because you have been on for some time.  If this is the case, you would feel better as you taper off.  WD symptoms can be similar to side effects, so the picture can be confusing.  If it's the latter (my guess), you would feel better as you taper.

 

Skyler

[Altostrata]

The only way to tell if it's time to taper would be to reduce slightly and see if symptoms get better.

[lionboy]

Thanks for your answers, I need to give it some thought. Do you really think people can feel better AS they taper ? My experience of dose reduction has been horrific albeit I made very large % reductions.

Before this latest few months off work, I had felt that as I was improving over time the sensible thing to do was just wait it out on 25mg and maybe in time stabilise and get well on that dose then take it from there.

Is this realistic ? Or given my situation do I need to get off the drugs totally ?

[Skyler]

I had felt that as I was improving over time the sensible thing to do was just wait it out on 25mg and maybe in time stabilise and get well on that dose then take it from there.  Is this realistic ? Or given my situation do I need to get off the drugs totally ?

 

Are you still improving?.. if you have plateaued, for how long have you felt the way you do now?

 

Always best to get off completely, but the big question is when, and what type of taper.  A friend of mine is tapering off Paxil.  At the 8 mg. mark she started to have more difficulty.  At present, she's cutting something to the effect of 2% a month, and is relatively comfortable.  She figures it will take her 5 or 6 years to get off at that rate (she is tapering at one of the slowest rates I'm aware of)... and all the way down, she will get more of the toxic drug out of her system while maintaining a good quality of life..

[lionboy]

Thanks again skyler. I wouldn't say I have plateaued. It's hard to describe really. All through my withdrawal I've had what I termed my bad weeks. These were weeks when the symptoms were much worse than usual meaning I would be off work and stay at home sometimes in bed.

The bad weeks were typically that a week.

Aside from these bad weeks I have slowly improved over time. Last April time I had 4 bad weeks in 8 which was most unusual. I was then fine for 6 months. Not fine exactly but no bad weeks, life as usual working etc.

Between nov last year and feb this year I then experienced bad week good week on and off for 3 months until mid feb when the bad week lasted 5 weeks ! I was then ok for a few days then bad again for 2-3 weeks then o.k a few days and so on until now, hence I have not worked since feb and not had more than 5 good days in a row ?

When I do get the good days I am totally fine ?

 

It's all very strange and hard to figure out.

 

I take your point re being drug free but I really just want some quality of life for me and my family and if that means sticking on a dose so be it.

[Skyler]

I take your point re being drug free but I really just want some quality of life for me and my family and if that means sticking on a dose so be it.

 

Yes, you need to do what is right for you... If you are improving where you are now, and you want to hold, by all means do so.  You are the only one who knows and have to decide accordingly.  All the best.. you deserve it!

[Altostrata]

Sometimes the drugs cause adverse effects; reducing dosage can help this.

[lionboy]

Thanks alto and skyler. Do you think that is what is happening to me ? The drugs are causing side effects that are making me bad ? This being the case, would you suggest I try a dose reduction ? If so, by how much ? And how would you manage it ? I.e if it makes me a bit better or worse ?

 

 

Do you consider it unlikely that what I am experiencing is just another phase of withdrawal ?

[Altostrata]

No way to tell for sure, lionboy. It could be a wave. If you want to try a reduction, I would make it very small, perhaps 5% or less.

[lionboy]

What is your hunch alto ? Stick or twist ? If I try a 5% reduction and feel worse, how long would you give it before reinstating my dose ?

[Altostrata]

I really don't know. You probably will be able to tell if a change is helping or hurting within a week.

[lionboy]

Ok, I'll try a 1mg reduction (4%) and see what happens.

As always, thanks for your help and advice.

[lionboy]

Help day 2 !

I went ahead and reduced my dose yesterday by 1mg (4%) to see what would happen.

It has certainly not provided immediate relief !

 

Yesterday I had a funny tummy for the first half of the day and fairly strong feelings of derealisation and feeling strange and awkward. I recognise that as typical early withdrawal.

These symptoms are different to what has kept me off work these past few months.

Until yesterday I was, mentaly, in a place where I felt completely comfortable in the gym once I start training and in some ways it has become my sanctuary ! No matter how bad I feel when I go in as soon as I start training and sweating etc i feel much better and I ALWAYS come out feeling better than when I went it.

I have also made many mates there that I chat to whilst training.

Yesterday I felt uncomfortable throughout my workout and the buzz afterwards was not really there.

I also felt somewhat uncomfortable chatting to my mates there.

 

Today I have not left the house so it's harder to gauge how I'm feeling however I would guess very similar and I also have a headache today which is most unlike me.

 

Opinions please on what is going on and conclusions that can be drawn from this if any ?

 

My intuition has told me all along that what I had been experiencing before my reduction was a big long wave.

As it had gone on and on for 8 months (on and off, but very much more on than off) I had very much started to question my own judgement. I had the same thing last year in April that was on and off for two months before disappearing for 6 months.

 

As I have been of work now for 5 months and am now risking trashing a good career I made an appointment to see prof Healy for his help and opinion.

He was very non specific and really said that " we just don't know what's going on, or what the future holds ? "

In his letter to my doctor and I he basically concludes that I have developed tolerance to the ssri and have breakthrough withdrawal happening.

This being breakthrough withdrawal doesn't really sit right with me, I think it most likely adverse drug effects / side effects that have developed as per Alto and Skyler's suggestion or possibly a wave ?

 

Any further advice guys if massively appreciated !

Do I need to give the reduction more time ? Another few days ?

And is it conceivable that at 2 and a half years since my last reduction I could have a wave lasting months ?

 

(In appreciation of the work you guys do and the help and support I have received on here I made a donation to the cause yesterday. Hope it helps with the good work !)

[Skyler]

Today I have not left the house so it's harder to gauge how I'm feeling however I would guess very similar and I also have a headache today which is most unlike me.Opinions please on what is going on and conclusions that can be drawn from this if any ?I made an appointment to see prof Healy for his help and opinion.  He was very non specific and really said that " we just don't know what's going on, or what the future holds ? " In his letter to my doctor and I he basically concludes that I have developed tolerance to the ssri and have breakthrough withdrawal happening. This being breakthrough withdrawal doesn't really sit right with me, I think it most likely adverse drug effects / side effects that have developed as per Alto and Skyler's suggestion or possibly a wave ?

And is it conceivable that at 2 and a half years since my last reduction I could have a wave lasting months ?(In appreciation of the work you guys do and the help and support I have received on here I made a donation to the cause yesterday. Hope it helps with the good work !)

 

Alto is the person to address how long you would need to see if a dose reduction worked, or if the dose reduction would be enough to make a significant difference at the outset...

 

On this site, we've been having a running conversation on Tolerance Withdrawal (for benzos and ADs).. and have arrived at a consensus that many times what is thought to be TD is the emergence of side effects, plain and simple.  If you developed side effects to blood pressure medication after you were on for several years, the doc would realize you had side effects.  But when psychotropics are concerned, it's TD. But maybe what Healy is calling TD is just what we here would call side effects anyhow.

 

IMHO, though you could be having a wave after 2.5 years, it would seem more likely you have developed side effects.. though your particular pattern is curious.  Alto??

 

Glad you posted about donating... it reminds others to do same!

[lionboy]

Thanks skyler ! Two days ago I was inclined to agree with you however now I don't know what to think. I have a splitting headache in my temples which again I recognise as withdrawal and some jaw clenching !

I feel like **** to be honest and just want to put my dose back up !

I really hope it is not side effects as really that means that I have either got to stay as I am with a load of bad side effects or spend the next months and years going through more withdrawal hell like yesterday and today !

 

I really want it to be a wave so I can reinstate my dose and just wait ! It feels like after all the struggles I have gone through some one has just moved the goalposts miles away !

 

Everyone who is helped by this site should donate what they can ! It's one of the only places to get sound advice.

Of course if you want wildly inaccurate mis information, you doctor is just up the road.

[Skyler]

Lion, it's too soon to tell if you will need to go as slow as my friend, Ip52 (we met on a now defunct benzo site several years back and have worked on a couple of projects together since), but you might find her experience an interesting read.

 

Skyler

[lionboy]

Thanks Skyler, I'll have a read.

[lionboy]

Day 3 !

Feeling better today, much more get up and go than I've had for ages !

Might just be a good day that come from time to time or could be my 4% reduction helping ?

Still feel withdrawal symptoms bit derealised in patches, clenching and jaw ache in others but overall good.

Hopefully the way forward is revealing it's self !

[tezza]

Hi lionboy,

 

It might help you determine what is best for you by keeping a daily log of all your symptoms. Rate the symptoms on a day to day basis....This has been a big help to several members here, including me.

 

Hoping you feel even better soon!

[lionboy]

Hi Tezza

Yeah, that's not a bad idea. I might just do that, thanks for your comments !

[lionboy]

Skyler / Alto, what next ?

I went ahead as suggested and made a small dose reduction of 4%. Day one was typical early withdrawal (for me), feeling strange and derealised. Day two was more like advanced withdrawal, splitting headache, clenching jaw short tempered etc.

Day three I felt much better as if someone had turned me back on. I had my get up and go back, I was positive and thought I was much much better. This feeling carried on consistently for a week and I thought I had cracked it !

 

After that great 7 or 8 days I seem to have started to feel worse. Uncomfortable, sweaty, a bit anxious similar to before my reduction.

 

Question is this:

- is this most likely part of the withdrawal process ?

- or does this mean it's time to reduce again by 4% ?

 

Is this my body telling me how often i should reduce ? A 4% reduction followed by two crap days, followed by a good period and when that good period ends time for another 4% ?

Or am I being overly hopeful and is a 4% reduction every 12-14 days much too aggressive ?

[Skyler]

Hi Lionboy, My take is go for another drop of 4%.  As long as you are in the 10% a month rate of reduction, it's unlikely you will do any real damage for one cycle, and this way you can find out if the pattern repeats. And you will have 10% less giving you side effects.

 

When there is as much sensitivity as you have, your body might be responding to the initial cut as well as the subsequent hold. If you are having a combination of side effects AND withdrawal symptoms, the picture would seem contradictory. I'm curious to know if Alto concurs.

 

It's pretty common for people to take a series of smaller cuts when WD symptoms are problematic.  However, the symptoms you get when you hold are not so common, and you need to monitor these carefully.  Good job with the log.

[lionboy]

Thanks Skyler, that was how I figured it also. It seems that it was holding on a dose at 25mg that caused me the worst problems I have had so far so why look to hold now ?

The fact that a 4% reduction provided a positive outcome over 10 days (2 bad days followed by 8 great days) seems to suggest this is the way to go.

If I have to go through that twice a month until this poison is out of my body, I'll take that.

Holding at 25mg gave me months of problems so the evidence supporting me holding at a dose doesn't seem to be there ?

 

Thanks so much skyler !

[lionboy]

Hi again.

Reduced another 4% last Sunday down to 23mg and immediately felt better and have felt better ever since. Not perfect some uncomfortable feelings, bit sweaty and derealised in patches but mostly good.

Next question is this: when I start to feel bad again should I just cut another 4% ?

If that's within 8-10 days of my last cut (as before) that will mean 3 or 4 cuts of 4% per month i.e 12 or 16%.

Is that too fast ?

[Skyler]

Hi Lionboy, My take is go for another drop of 4%.  As long as you are in the 10% a month rate of reduction, it's unlikely you will do any real damage for one cycle, and this way you can find out if the pattern repeats. And you will have 10% less giving you side effects.

 

Hi Lionboy... glad to hear you are feeling better... I would stay within an overall reduction rate of 10% a month given you seem to be having some WD.  It's a balancing act, and you need to weigh what appear to be side effects against the presence of WD symptoms..

 

Skyler

[lionboy]

Thanks Sky !

I'll see how I go. If I feel bad again in the next week I'll do a 2% cut and hopefully that will see me through the month, then I can do 3% cuts in future in anticipation of 3 cuts per month with a 1% cut in reserve if needed.

 

Cheers for all your help on this you really seem to have sussed it for me !

[lionboy]

Hi again

I have now cut 3 times. Twice by 4% and most recently by 2%.

After each 4% reduction I have had approx 9 days of feeling better before I start to feel bad again.

This last time I reduced by 2%, however that seems to have provided relief for only 3 days.

It would seem to me that my body wants me to reduce by 4% every 9 days or so.

In members opinions (particularly Alto on this one) am I ok to go this fast ?

This potentially would mean 4 reductions of 4% per month (or 16%).

[Altostrata]

All you can do it try and listen to your body.

[lionboy]

Yes, I thought you would say that. Each 4% reduction seems to give rise to withdrawal type symptoms for 3 days followed by 6 really good days and then I start to feel bad again.

It's as if it takes me 3 days to adjust to the reduction and then I am good for the 6 days before I start to experience the side effects which seem to affect me when I am stable at a certain dose.

Skyler's diagnosis, earlier in this thread, seems to be spot on with regard to what is going on.

I am just a little concerned that 16% per month may be a little fast ?

 

However it was holding at 25mg that seemed to cause me the worst problems of all ?

[Altostrata]

You have to listen to your body to find your own rate of taper.

[lionboy]

Thanks alto

[lionboy]

Merry christmas everyone ! Just to briefly update this thread. I am now down to 11.25mg !

I have found success cutting my dose by 1mg each time. My body tells me when I am ready for a further reduction as the "side effects" ,or the problems I experienced when stable at 25mg, start to appear again.

Most reductions have been fairly seem less when compared with some of the **** I have been through in the past.

My reduction from 17 to 16mg gave me a bit of a kick though (bad 3 days).

I rationalised this as 1mg was now becoming too big a percentage drop.

The next reduction I did was by 0.75mg (percentage wise, similar to my earlier reductions).

This proved to be a mistake as the 0.75mg reduction only provided a few days of relief before the "side effects returned" and I then did a 1mg reduction, meaning I had knocked off 1.75mg in a 4 day period.

This gave rise to the worst problems I have had during my withdrawal from 25mg.

It gave me 18 horrible days, all the w/d issues, followed by 10 good days then back to another normal 1mg reduction.

Given the fact that I have now tried twice to reduce my dose by less than 1mg, once at 23mg tried a 0.5mg to 22.5mg and then from 16 mg a 0.75mg drop to 15.25mg, and both times it has meant the side effects returning in a few days and the need then for a further reduction that has then really kicked me and given me 10 days and then 18 days, respectively, of problems I am finding myself having to conclude that my body just wants a 1mg reduction each time irrespective of %.

 

I would be interested to hear people's opinions on whether or not this seems a viable course of action right down to zero ?

It would of course mean that for example the 3mg to 2mg reduction would be a 33% reduction, however we will all make a 100% reduction at some point when we finally stop.

 

In contrast to my conclusion above, the last 1mg reduction I did from 12.25mg down to 11.25mg has given rise to problems in similar way to the double dose reductions as described above ?

I have so far been bad for a week.

I can't really figure this one out ?

The latest reduction meant that I had taken 3mg off in the last 3 weeks and 1 day. It could be a case of a bit too much too soon.

The only comparable period was when I reduced 3mg in 3 weeks and 3 days leaving me at 16mg with a reaction of 3 really bad days as described above.

I can't see why this latest case has given rise to a worse reaction than the previous example ? You could factor in the overall % drop and conclude the latest example to be a fair bit higher, however I seem to proven that % is not the major factor in my case and that if that were the case then how come my 13.25 to 12.25mg reduction was as seem less if not more so than my 25mg to 24mg or my 24mg to 23mg reductions despite it being a 7% drop against the the other 2 examples at 4%.

 

The only really viable conclusion I can offer is that I was not ready for my latest 1mg reduction. Whilst I thought the side effects were returning at it time for another drop, it may in truth have been a bad day or a reduction blip and I should have ideally held at 12.25mg for a longer period ?

 

As always people's opinions and advice are very welcome and appreciated.

I hope this thread may help other in a similar position.

Despite the last 5 months not being all good I do know certainly feel that I am walking in the right direction and, that although there are still a few mountains to climb and rivers to cross, I think I can see the finish line !

[Altostrata]

Very glad to hear your taper is going so well, lionboy.

 

Rather than try to extrapolate the ideal decrease, I would updose a bit and hold, perhaps a couple of months, and allow your nervous system to consolidate.

 

You may have destabilized it by decreasing 1.75mg in a 4 day period, which is why you've gotten odd results, and further destabilization by too-fast tapering more recently.

 

I doubt it wants a 1mg decrease no matter the dosage. Rather, my interpretation is you've had success decreasing by less than 10% and you should count on doing that for the rest of your taper.

[lionboy]

Hi Alto

Thank you as always for your help and perspective !

 

I have never really thought about it before, how funny your disclaimer is ! (Which I guess you have to print ?)

The only sound advice I have received, throughout all of my problems, have been from people on this forum such as yourself, skyler etc.

If I happen to run into a medical practitioner who is knowledgeable in this area, I'll be sure to let everyone know ! Lol.

 

I would concur that my problems now, and always, have been caused by cutting too much too soon. I would guess that the vast majority of people can cope with any size of dose reduction providing that reduction is undertaken over a suitable time scale i.e a taper.

I certainly agree that 1.75mg in a 4 day period caused me some destabilisation. Had I reduced by the same amount over say 15 days I would most probably have been fine. My experience of tapering over the last 5 months, I feel, demonstrates this.

The complicating factor for me is that, once stable at a dose, my side effects start to kick in.

 

(It was Skler, that first termed these problems as straight forward side effects and that to me was a real turning point. It was the first time that I had faced the realisation that for some of us, it is being on "a dose" of these drugs that causes our problems. This to me was a difficult paradox to accept for drugs that had seemingly helped me in the past. I have now reconciled this in my mind by using the analogy of a drink for Dutch courage. One or two whiskey's would most probably help a person overcome nerves to deliver an important speech etc, however if that person started to drink whiskey all day everyday to cope with nerves the alcohol itself would in time cause them physical and mental harm. Heroin would by similar in that respect and, so I believe, are antidepressants.)

 

Sorry to digress !

It was these problems / side effects that caused me to be off work for 5 months earlier this year.

So when these side effects start to reappear it is then time for another reduction. Given this, I am not really in control of when to do the next reduction.

I am sceptical myself that it will be as simple as 1mg each time down to zero, however on both occasions I have tried less than a mg reduction it has not worked out and has led to me needing to reduce again in 3 or 4 days and this "double reduction" has caused the worst of my problems ?