☼ lionboy: protracted withdrawal from citalopram

[lionboy]

Been there done that .... I see now.

Do you mean that you need to make smaller reductions as your dose gets lower ? (Sorry didn't quite follow)

 

Alto, I think I will ask Dr Healy for his opinion and see what he says.

[Skyler]

Do you mean that you need to make smaller reductions as your dose gets lower ? (Sorry didn't quite follow)

The first 'rule' of tapering is to listen to what your body says.. so if you are symptomatic, go slower (or hold). A friend who posts on the forum is tapering Paxil (see link below) at an awesomely slow rate... bottom line, she is getting off with a good quality of life. I got off diazepam at a crawlll. After I hit .75 mgs I had to taper at consistent cuts of .025 mgs. I was going cross eyed trying to measure such small amounts in the 1 mg oral syringe!

 

And don't forget, your taper needs to be the % you cut off the last dose. So if you are at 9 mgs, the next cut would be to 8.3, etc., to use 10% as an example (sounds like you know this already). As you can see, when I got way down, I left the % cuts behind because they were no longer measurable.. and at those very tiny doses, the body does seem to adapt. (I was not going to cut 10% off .1%! Yikes)

 

You really are doing quite well you know.. you are taking the time to learn, and looking at your options. I am sorry your circumstances are so stressful however, just know we are all 'rooting' for you.

 

S.

 

http://survivingantidepressants.org/index.php?/topic/2359-lp51-going-off-paxil/

and

http://survivingantidepressants.org/index.php?/topic/2364-the-slowness-of-slow-tapers/

 

PPS.. I had one of the longest holds I've seen on this forum.. one full year. There were several reasons for this, but know that I never, not once during that time, believed my prolonged hold meant I would not get back to tapering. And when I was able to get off the ABs that were aggravating my primary WD Sx, tinnitus (for a series of severe infections), I started again. The hold made my benzo taper 3.5 years total. Most of the time the quality of my life was not impacted. And I did get off. When I finished, my doc shared that I was the only one in his practice who had gotten off benzos once addicted.

[btdt]

What what I have seen the lower you get the smaller the drops for some drugs ... read long ago this was a good idea as the drug changes how you liver works and the less you take the better it can work the more drug your getting into you system.. think that is how it goes...

old name from other sites means been there done that... was at the time looking for what was next had been drugged for 18 years thought I had done it all... was 8 months into cold turkey when I made that name up at my first withdrawal website years ago... it stuck.

Yes but what Skyler says should cover that... as each drop is based on currant dose... until the very end perhaps when you may have to make smaller drops.

listening to you body is paramount and trumps all else ... smaller drops or waiting longer between drops if you feel it is too much. 

[lionboy]

Thanks for those kind words Sky and yes I take your points, and btdt's, re the tapering.

My tapering schedule was all about listening to my body. If I'm honest I am in no rush to get to zero, I find it a bit daunting.

Because I suffer side effects when stable at a dose I know when I'm ready for another drop as I get the side effects. That being so, holding at a dose is not really an option for me.

In terms of percentage drops, I only seemed to get a positive response from 1mg drops. I tried smaller drops twice and both times the side effects returned in a couple of days and I then had to reduce again meaning that the smaller drops ended up being larger than 1mg if you follow me ?

I tried a 0.75ml drop from 16ml to 15.25ml and the side effects returned in 3 days. That is approx a 4.6% drop.

When I dropped from 21mg to 20mg I got the right result i.e 10 or so decent days and then side effects and drop again. That reduction was also 4.6%. So why did the 0.75ml not work ?

A later reduction of 1mg from 14.25ml to 13.25ml again provided the right result of 10 days to two weeks of decent days and again the following 1mg drop.

 

Complex ?

[Skyler]

Complex ?

TRICKY

[bubble]

maybe you are describing windows and waves?

 

did you expect to feel sort of mended after 10 days and was disappointed when the symptoms got back? getting better means windows get longer, waves shorter. But it doesn't mean they disappear. Is it possible that what you call side effects could actually be waves?

 

The way I see your story if I try to compare it to mine: I tried smaller drops twice and both times the side effects returned in a couple of days and I then had to reduce again meaning that the smaller drops ended up being larger than 1mg if you follow me ?

 

When I make a cut, my symptoms increase after 4 days since this is the time necessary for the effect of change to register. Unlike you, I don't call these symptoms side effects but withdrawal. And I don't respond to them by changing the meds but I just wait for them to pass allowing my brain the period to adjust without disatabilisng it further with another change. Reducing is not necessarily good. It just just a change. and brains don't like change, they like stability...

 

sorry if I got something wrong. My brain is more foggy than usually today

[bubble]

This is what petu jsut wrote for somebody else saying what I wanted in a lot nicer way

 

See if you can apply it to your situation:

 

If it were me, I would stay on exactly the same amount you have been on the last 2 weeks, no more, no less.  Its not about the dose, but about giving your NS enough time to adjust to the current chemical situation, if you keep changing it, it keeps getting confused.

 

I know its tempting to want to tweak your meds, based on a particular day when you felt slightly better, but I've been here on this site long enough to know that never works and usually makes the situation much worse.

[lionboy]

Indeed Sky !

Bubble I understand the advice you are trying to give me and I know that the symptoms of withdrawal and side effects can overlap and it can be a confusing picture.

When I first came to survivingantideppresants I was mentally in a right mess. I didn't know what was going on, why or what to do about it.

Without this site then who knows where I would be now.

I thought a Professor and specialist such as Healy, Cohen, Breggin etc would be my best bet and I have been in contact with all of them and read their books.

Everything I have learned has brought me to where I am however as I write this today, the truth is that it is this site and the people who give their time to help others that have really given me the most valuable information I can use.

Of course the work of Healy, Cohen, Breggin etc is invaluable as it cannot be dismissed by the industry as the ramblings of mentally ill drug takers such as ourselves !

Of course that's not my opinion, however without credence from brave people like Healy it is easy for the drug companies to dismiss our opinions in that way.

I feel now that I am pretty in tune with my body and what is going on re: side effects / withdrawal effects etc.

I was off work last year for 5 months with terrible problems and I had been stable on a dose of 25mg for about 3 years. I thought I was experiencing a wave until I was convinced, by Atlo, Sky etc, to consider that it was side effects and to try a taper. I started the taper and within a few days I was fine and back at work. 10 or 14 days later the side effects returned. Again a 1mg decrease and again fine for 10 days. It wasn't all plain sailing and the odd reduction rocked me for a day or two but the pattern was, in my mind, undeniable.

I firmly believe that when stable at a dose I suffer side effects and that the 1mg cuts were enough to stop the side effects and make me better until 10-14 days later when my body stabilised at the new dose and thus the side effects returned.

The evidence I have is, in my mind, indisputable on this.

Of course I am always prepared to reconsider and to be wrong but on this I just don't feel I am.

I can't explain my current problem so confidently however I do believe it to be destabilisation as a cumulative effect of the decreases.

Why I didn't seem to have success with drops of less than 1mg is a real mystery to me and I can't think of a credible reason for it however in my case the evidence seems to be there to suggest that is the case.

 

I hope you don't feel any of the above in any way dismissive of your opinion ? I certainly respect everyone's views and it is this collective brainstorming that I feel eventually teaches people to listen to their body and find their own answers. It certainly has helped me in that way.

[Skyler]

Hi again Lion.. you are correct in following what your body tells you.. I had lost touch with just how much of a challenge tapering is for you. My apologies for that.. thanks for the refresh. I hope you can start to reduce by less than 1 mg. as you get further down in dose. My hunch is, you are not far from being able to do so, at least hopefully! I truly admire your perseverance and fortitude. To be succinct, Yin and Yang, side effects vs. WD effects.. this is the most difficult type of taper to manage.

[bubble]

Oh no, not at all!

 

I'm sorry I didn't have the time to read through your thread then I would've understand your situation better ;( I'm still a beginner and what you wrote will help me a lot to learn more. I also find this collective brainstorming extremely helpful and effecient way of coming to important insights.

 

It's beautiful what you wrote about this site and the work of the psychiatrists who are on our side and understand what we are talking about although it can't be easy for them not siding with their "sacred profession"... I would so much want to have more energy to invest in spreading the insights we have gained here to broader public to spare people of the suffering we'd been subjected to in the name od "science" before we came here...

 

You have a vast knowledge and understand your body the best (of course and your gut feeling is most valuable asset. So only Alto and Skyler can advise a person like you

 

all the best!

 

bubble

[lionboy]

Thanks Sky I'll get there !

Thanks for your praise Bubble. I welcome all opinions and consider them all valid.

I know for some people just being listen to and responded to is a massive, massive help so nobody should ever hesitate to add their opinion.

 

The fact is that no one fully understands what causes depression / anxiety, what these drugs do to the brain and why and certainly not how to get off them. With people like Healy campaigning and Alto developing and running sites such as this then one day they probably will.

Left unchecked the drug companies will feed people anything to turn a profit.

[Skyler]

I welcome all opinions and consider them all valid. I know for some people just being listen to and responded to is a massive, massive help so nobody should ever hesitate to add their opinion.

Ditto... Bubble, fear not! Your good intentions shine thru.. and there are enuf of us here to fix the more technical stuff (I make my share of blunders), not to worry. Btw.. I like that you pull up Rhi's posts, she spends a lot of time on them. Good call.

[bubble]

 

I welcome all opinions and consider them all valid. I know for some people just being listen to and responded to is a massive, massive help so nobody should ever hesitate to add their opinion.

Ditto... Bubble, fear not! Your good intentions shine thru.. and there are enuf of us here to fix the more technical stuff (I make my share of blunders), not to worry. Btw.. I like that you pull up Rhi's posts, she spends a lot of time on them. Good call.

 

thanks a lot Lion and sky

[lionboy]

Update to my situation and some more advice please ! Calling Alto, Sky and others.

I am still off work in a mess and have been since end Dec '13.

As per previous discussion I was considering trying to change meds etc (more in desperation than anything else).

I contacted Professor Healy for his opinion (I have tried to post up my letter and his in response, however I am useless with computers !)

Essentially I told him my current situation as detailed to date in the thread and he responded as follows:

He said my taper by 1mg each time and pattern of symptoms, i.e a bit destabilised for a couple of days and then good for a week or so followed then by a return to side effect problems and the need to taper again was fascinating.

He then said, of my current difficulties, that as people taper down they can hit shelves. ( shelves being points when they have much greater difficulty than they were before and that these difficulties can last many weeks or longer. )

He then said that just because I am having extreme difficulty at this stage does not mean I will have even more difficulty as I continue to taper down. He predicted that I should be relatively o.k again further down.

He said that he cannot of course guarantee that I won't hit any more shelves further down.

He concluded by saying that his hunch was that I should stick with citalopram and that the less drugs I expose myself to the better.

 

Professor Healy's letter put my mind at ease that I should stick with citalopram and ride out my problems until this shelf ends. By that I would expect to feel much better again and back to my good (in withdrawal) self and then enjoy that period until the side effects start and then taper again as has been my experience so far.

My problems is this:

I started to feel better mid to late march and whilst not what I expected from better / the end of the shelf there was improvement as if the shelf was ending / soon to end.

Then in early April I seemed to slip back into a worse state that has pretty much gone on ever since. I have become more withdrawn than I have been throughout this whole shelf I think. It has been on an off to some extent but I would say generally getting worse.

I am sleeping in much later, only eating in the evening etc.

I go to the gym every third day to train without fail as this has been my therapy throughout this battle. I start to feel agitated on day 3 and need to train. I have a set routine I do that brings me relief.

Due to a worsening back injury I spent a few days stuck in bed over the last week or so and I missed a training day this week and had go the following day and complete a changed routine. I don't seem to have achieved the same therapeutic effect with this and I have developed insomnia and extreme inner restlessness to the point of being unable to eat, making myself sick and feeling suicidal ( although not seriously considering or attempting that) just so restless and wired that I felt desperate.

This could be to do with my changed gym routine or be part of my withdrawal / shelve however I strongly suspect that after 5 moths since my last 1mg reduction that this is side effects and ever worsening ones.

With this as a possibility I did a 1mg reduction yesterday morning and felt some immediate relief within the first hour or so. Yesterday was a much better day albeit feeling derealised a bit and a funny tummy a bit. The restlessness seemed to subside and although I didn't sleep perfectly last night I did sleep about six hours and then fell back asleep this morning at 9am for another 4 hours. I feel very apprehensive about what is going on now.

 

Can you please advise me your thoughts ? Do you think that what has happened seems like bad side effects returning and that I am right to taper again ?

[Altostrata]

lionboy, it seems to me this is your typical pattern with reductions.

 

My guess is citalopram fundamentally affects you adversely. When you reduce, you experience some relief from the adverse symptoms, but when your nervous system accommodates to the lower dose, you get the adverse effects again.

 

This would suggest a faster taper for you, but I don't know how withdrawal symptoms would affect you. They might be preferable to the adverse effects.

 

As ever, you are between a rock and a hard place.

[lionboy]

Hi Alto

Yes, I think you are right (and much more succinct than my ramblings !)

I take it that you concur that I am right to reduce again ?

That being so, I feel there is hope as I successfully reduced 25mg to 12mg from mid July to mid December last year (5 months) before I then went to 11mg and became destabilised.

I am now on 10mg so who knows the end could be in sight ?

[Altostrata]

What you might want to do is a micro-taper -- very small reductions more often. See http://survivingantidepressants.org/index.php?/topic/2878-micro-taper-instead-of-10-or-5-decreases/

[lionboy]

Yes I would love to do that however, if you remember I tried smaller reductions earlier in my taper without success.

The side effects returned quickly after each smaller taper and thus I ended up destabilised as the series of smaller cuts over say a week amounted to more than a bigger cut once every week or two ?

I think I'll stick with 1mg drops until a 1mg drop is clearly too much and I start to get destabilised and then I'll go back up half a mg and see if I can then do half mg cuts.

As you suggested a bit of destabilisation is really better for me than the side effects when I am stable.

The agitation and insomnia I had earlier this week was desperate ! I don't ever want to go back there.

These drugs really are poision !

I dread to think where I would be without this site, it's a wonderful thing.

[Altostrata]

lionboy, as ever, you are the best manager of your taper. I leave the decisions to you.

[lionboy]

I've managed to cock it up so far ! Lol.

Thanks for your help Alto.

[Altostrata]

I don't think anyone else could do it better, lionboy.

[lionboy]

Alto since my 1mg reduction I have not really experienced the positive effects that I have come to associate with each small drop ?

I am certainly in a better place than I was last week before the reduction though.

So far it has gone like this:

Day 1 Friday

Took a reduced dose in the morning at 9am and started to feel some relief within an hour. Over the first couple of hours I felt myself relaxing as the terrible agitation I had been suffering seemed to subside. I then started to get a funny tummy and feel derealised (which I recognise as typical early withdrawal).

The day overall seemed to be early withdrawal but not severe withdrawal and whilst not a great day it was more positive than the last weeks have been. I got a bit done around the house and I was a bit more normal albeit funny from withdrawal. I slept reasonably well this night which I hadn't done for a few days.

Day 2 Saturday

I woke up feeling a bit agitated but nothing compared to the days before the dose drop. After an hour or so, say by 9am I fell back asleep and laid in till 1pm which would not have been possible at all before the dose drop. I was waking up wired and agitated and unable to relax despite having very little sleep.

I got up at 1pm and showered and went to my parents house. Despite feeling weird and withdrawal like I felt I needed to do something.

I have not really felt like this for weeks and instead I was happy to stay in bed or at home on my own.

At about 6pm I went for a long drive on my own with my music on and started to really feel good. The sun was out and the music was great I felt I may have started on the path to freedom again. In the days before the drop I was not interested in listening to any music as I felt too much inner turmoil.

I felt pretty good all that night although a little bit unable to properly concentrate on things and maybe a bit edgy ( typical withdrawal ).

I didn't sleep great this night but managed to get from about 3.30am to 8.30am. I didn't feel really agitated I guess this was the effects of sleeping in so long yesterday.

Day 3 Sunday

Got up and went to the gym. Felt a bit apprehensive and a bit withdrawn. Again seems like withdrawal. No signs of agitation and restlessness. Enjoyed my workout and felt some therapeutic benefit during the workout. When I left the gym I did not get the therapeutic rush that I have come to depend on so much. This left me feeling frustrated, deflated and confused with it all. Despite this I managed to eat o.k and seemed to become more relaxed as the evening wore on.

I settled down to sleep at about 11.30 and by 12.30 latest I was fast asleep. I slept soundly until my wife got up at about 7 am.

Day 4 Monday (today)

I then went back to sleep quite easily and slept in until 1pm.

I have so far felt relaxed and quite happy at times today with patches of tension and uncertainty.

 

In general, my sleeping, eating and ability to relax seem to have all improved since the dose drop, however the really good feeling of "yes I'm on my way again" doesn't seem to have kicked in ?

I normally expect that feeling by day 3 or 4 latest.

 

In your opinion do you think I just need to give it more time and that it will come ?

My main fear now is that I am caught in a paradox where my body isn't really ready for a reduction yet the side effects are such that I can't stay where I am any longer. This being the case I feel a very difficult time ahead and the temptation is to just stop from 10mg cold turkey albeit I know that is probably stupid.

 

Am I getting ahead of myself and not giving this reduction time ? How long would you expect it to take if the good results are to kick in ?

[Altostrata]

I don't know, lionboy. It does seem you are in that paradoxical state, which is unusual. Your guess is as good as any in extrapolating from your pattern.

 

I would think that allowing your nervous system to get used to the change would be the best course.

 

You might be interested in this discussion http://survivingantidepressants.org/index.php?/topic/6036-why-taper-paper-demonstrates-importance-of-gradual-change-in-plasma-concentration/

[lionboy]

Hi Alto

Thanks again for responding and for your help. That paper certainly makes interesting reading doesn't it ?

As Dcrmt points out though I think we need to be careful not to consider SERT as an exact measure of what the drug is doing. It is most likely much more complex and as pointed out if these curves demonstrated exactly the effect of the drug then there would be no appreciable difference between a dose of 10mg of citalopram and 60mg.

Also if you look at the graph for citalopram it would suggest that you could drop from a dose of 60mg to 40mg with very little effect on SERT and thus no real problems, when in reality that type of a drop would most likely give rise to extreme difficulties.

Of course they could also be bang on ?

People that have already tapered from 10mg to zero would probably have a much better perspective on this than me as I have yet to experience that joy !

My earlier experience with half mg and 0.75mg drops seems contradictory to the % theory being gospel.

 

I fear that I may be getting stuck in a position of dammed if I don't reduce and dammed if I do.

I have put this to Prof Healy tonight for his opinion.

 

I re read the thread you send me before on switching to Prozac and I can't help wondering if Prozac might not cause me the same adverse reaction when stable as Citalopram and thus allow me the chance of a successful 10% taper.

If I was to attempt a cross taper to say 12mg of Prozac then the first step would surely be to take my 10.25mg dose of citalopram and add in say 4mg or 6mg of Prozac. If I am sensitive to adverse reactions now from all ssri's I would think that the combined dose would very soon give rise to problems and I could then just stop the Prozac ?

Of course this is wishful thinking and it could go very wrong ?

 

I feel very trapped at the moment.

The other thing in the back of my mind is that the real unbearable problems with citalopram only showed themselves last week when I was unable to do my gym workouts.

My back could be fixed in 6 to 8 weeks and if I can muddle on until then I can get back to that training.

Of course it is worrying to be stuck on a drug that can make you unable to sleep and feel suicidal if you can't do a gym workout !

[Altostrata]

I wish I could say one way or the other, lionboy.

 

Dr. Healy would be the best source for advice on a Prozac switch.

 

I would think at your level of citalopram -- about half the usual dosage -- 5mg Prozac would be suitable.

 

I agree, SERT occupancy is not the whole story, it's only indicative.

 

We do see people who can reduce faster when taking more of the drug, then have to slow down. In your case, you could be on a very steep portion of the curve already.

[lionboy]

Thanks Alto. I'll see what Prof Healy says. Do you mean convert from the 10.25mg citalopram I am on to 5mg Prozac ? (As appose 10 or 12mg Prozac)

Or do you mean add in 5mg Prozac as the first step ?

 

I agree re: SERT etc.

complex ?

[Altostrata]

Personally, I would always overlap drugs at least 4 days to accomplish a switch.

[lionboy]

Sorry Alto, can you explain exactly what you mean ?

Would I carry on taking 10.25mg citalopram per day and add in 5mg Prozac then drop the citalopram on day 5 ?

I.e

 

Day 1-4

10.25mg citalopram and 5mg Prozac

 

Day 5 on wards

5 mg Prozac

 

Sorry to sound stupid, just want to be clear what you are saying.

 

Also do you think that I should now take the risk and try the switch ?

I am now on day 5 since I did my 1mg reduction and I am not really getting a positive response from it.

The reduction seems to have stopped the really bad agitation and insomnia but I just feel uncomfortable and worried now basically like I've done a reduction I wasn't ready for.

Or lastly do you have any recommendations for what else I could try with citalopram ?

Maybe try putting the 1mg back in for a day and seeing if the agitation returns or try putting half a mg back ?

[Altostrata]

Would I carry on taking 10.25mg citalopram per day and add in 5mg Prozac then drop the citalopram on day 5 ?

 

 

Yes. Some people prefer to drop the citalopram in steps, such as 25% every few days.

 

I can't predict how a switch will work for you. It may be better, it may be worse.

[lionboy]

Hi Alto

Why do you suggest 5mg Prozac ? In the thread you sent me on bridging with Prozac you have posted up guidelines from Healy which says 20mg cipramil is equivalent to 20mg Prozac.

This being so, would I not switch from 11mg citalopram to 11mg Prozac ?

[Altostrata]

You are taking a partial dose of citalopram, therefore a partial dose of Prozac. The other switching techniques aim low on the Prozac. This limits the risk of too much serotonin during the overlap phase, plus seems to work otherwise.

[lionboy]

Sorry Alto I'm not following what you are saying ?

If 20mg citalopram is equivalent to 20mg Prozac then wouldn't I need to switch from 11mg citalopram to 11mg Prozac ?

Surely going from 11mg citalopram to 5mg Prozac would be like doing a 50% drop ?

[Altostrata]

If you read the various Prozac bridge methods, you will see some switch to a lower dosage of Prozac for the reasons I gave. That topic advises working with a doctor who will take responsibility for whatever happens.

 

I can't tell you what to do.

[lionboy]

Sorry Alto, my head is a fog at the moment. I guess a switch to 5mg Prozac could be enough . I'm waiting for prof Healy to return my email from a few days ago.

[lionboy]

Hi Alto / everyone

Professor Healy has replied to me and has made no mention of switching ssri.

He has sent me a document on managing the shelf.

I can't for the life of me work out how to post it up on here though ?

 

As discussed earlier in the thread he seems to think I have hit a shelf (being a period of much greater difficulty than before).

These seems correct to me and it seems like I have been in this shelf since 20th December '13.

I have been off work and withdrawn since then.

This last month or so my symptoms have got worse and these last 10 days / 2 weeks have been the worst of my life with extreme anxiety and agitation.

The document prof Healy sent seems to suggest this can happen during shelf and offers some ideas on possible ways to overcome this such as a short course of benzos etc.

I will post up the document if I can.

I feel really trapped and scared.

I don't know what to do. The 1mg reduction I tried brought some relief in the first couple of days and then I became increasingly aware that my body didn't want the reduction so I have reinstated to 11.25mg.

I just hope this really bad patch ends soon, I feel I can cope with the rest of it.

Healy suggested I involve my GP and take along the document he sent although I don't feel well enough to see the GP and I am scared to start using benzos.

Trapped and scared at the moment !

[Skyler]

Hi LB, I've been reading your recent posts and am so very sorry your travail continues as it is. It has to be VERY discouraging to have the symptoms intensify as they have of late. I wish there was something more I could suggest. Wow... just know I'm thinking of you and following your journey. I hope things start to improve soon and you get a much needed respite. You have a lot of heart.. hang in there.

 

Skyler