Gibby's citalopram taper

[Gibby]

Hi friends,

 

My name is Gibby and I'm a 25 year old male with a diagnosis of generalized anxiety disorder. I have been on medication for 5 years.

 

I have been fairly stable while on medication, but I've been unhappy about taking olanzapine, even though my dose is very low (1.8mg for five years) and the physical side effects are more annoying than dangerous. However, I understand that serious complications can arise from taking this drug for a long time, so I've been looking to come off it for quite awhile.

 

I started a withdrawal at the beginning of June, but it was mostly an experiment and I lasted about three days; I didn't really know what I was doing. 

 

Last Saturday night (with my doctor's consent!), I decided to try again with some more supports in place and some more coping techniques. These helped but I wasn't sleeping at all, and these last few days have been very bad. I haven't been able to eat or exercise much and my parents are exhausted in trying to care for me. I still feel like "me", my personality hasn't changed but I feel physically really unwell and anxious and depressed. 

 

I've decided to go back on the medication for awhile to get stable again (I expect to be a little zonked for the first five days or so back on, no big deal) and then try a different plan. My family wanted me to keep trying to get over the hump, but I can feel my nervous system freaking out and I don't have the practice in CBT techniques or keeping my mind safe, especially with no sleep and no real plan. 

 

I did my best for five days, and I hope that giving up now to try later doesn't make me some kind of chicken. I really wanted to but I guess my body-mind isn't ready.

 

Do you guys/gals/others have any advice for next time? Anybody else gone through this? I'm also going to go off the citalopram eventually but the olanzapine is the main goal for right now. 

 

Thank you!

[oskcajga]

You may consider tapering your dose next time, rather than going off completely.  Have you tried this? 

 

Here's a statement produced by one of the moderators on this site that you might find helpful:

 

A lot of people, including healthcare practitioners; in fact, I guess, most people-- are operating from entirely the wrong paradigm, or way of thinking, about these meds. They're thinking of them like aspirin--as something that has an effect when it's in your system, and then when it gets out of your system the effect goes away.

That's not what happens with medications that alter neurotransmitter function, we are learning.

What happens when you change the chemistry of the brain is, the brain adjusts its chemistry and structure to try to return to homeostasis, or biochemical and functional balance. It tries to restabilize the chemistry. 

For example: SSRI antidepressants work as "serotonin reuptake inhibitors." That is, they cause serotonin to remain in the space between neurons, rather than being taken back up into the cells to be re-used, like it would be in a normal healthy nondrugged brain.

So the brain, which wants to re-establish normal signaling and function, adapts to the higher level of serotonin between neurons (in the "synapse", the space between neurons where signals get passed along). It does this by removing serotonin receptors, so that the signal is reduced and changed to something closer to normal. It also decreases the amount of serotonin it produces overall. 

To do that, genes have to be turned on and off; new proteins have to be made; whole cascades of chemical reactions have to be changed, which means turning on and off OTHER genes; cells are destroyed, new cells are made; in other words, a complex physiologic remodeling takes place. This takes place over time. The brain does not grow and change rapidly. 

This is a vast oversimplification of the amount of adaptation that takes place in the brain when we change its normal chemistry, but that's the principle.

When we stop taking the drug, we have a brain that has designed itself so that it works in the presence of the drug; now it can't work properly without the drug because it's designed itself so that the drug is part of its chemistry and structure. It's like a plant that has grown on a trellis; you can't just yank out the trellis and expect the plant to be okay.

When the drug is removed, the remodeling process has to take place in reverse.

SO--it's not a matter of just getting the drug out of your system and moving on. If it were that simple, none of us would be here. 

It's a matter of, as I describe it, having to grow a new brain. 

I believe this growing-a-new-brain happens throughout the taper process if the taper is slow enough. (If it's too fast, then there's not a lot of time for actually rebalancing things, and basically the brain is just pedaling fast trying to keep us alive.) It also continues to happen, probably for longer than the symptoms actually last, throughout the time of recovery after we are completely off the drug, which is why recovery takes so long. 

With multiple drugs and a history of drug changes and cold turkeys, all of this becomes even more complicated. And if a person is started on these kinds of drugs at an early age before the brain has ever completely established normal mature functioning--well, it can't be good. (All of which is why I recommend an extremely slow taper particularly to anyone with a multiple drug history, a history of many years on meds, a history of past cold turkeys or frequent med changes, and a history of being put on drugs at a young age.)

This isn't intended to scare people, but hopefully to give you some idea of what's happening, and to help you respect and understand the process so you can work with it; ALSO, because you are likely to encounter many, many people who still believe these drugs work kind of like aspirin, or a glass of wine, and all you need to do is stop and get it out of your system. 

Now you can explain to them that no, getting it out of your system is not the issue; the issue is, you need to regrow or at least remodel your brain. This is a long, slow, very poorly understood process, and it needs to be respected.

Edited September 4, 2015 by Petunia
unnecessary quote deleted

[Gibby]

Thank you for your reply! 

 

I tried a taper last year, but I did it too fast, instead of the 10% per month based on the dose I was taking but based the 10% on the ORIGINAL dose. I hit a wall and chickened out. I know more now about what's going on now and thought I could just do it all at once ("It'll only take a week!"). I thought I could handle it, as we all probably thought at some point.

 

I'm going to look up more plans when I'm more stable. I shouldn't have been so arrogant, I guess. I though the last taper didn't work so why try again? Looks like I was wrong. 

Edited September 4, 2015 by Petunia
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[oskcajga]

Please keep in mind that every time you come off and on a medication (after not being on it for 1-2 weeks) it can potentially cause stress on your nervous system next time your nervous is forced to adapt to the subsequent exposure. 

 

So if you choose to taper again, I would recommend starting with 10% and then proceeding from there - preferably not increasing your dose again once you've gone down.

 

Stay in touch and let us know what you decide to do.

Edited September 4, 2015 by Petunia
unnecessary very long quote deleted

[Gibby]

Yes, I am somewhat worried that it won't work the same way as it should when I take it again tonight, or that I'll have some crazy reaction to it. There is no evidence that this will occur, because I HAVE gone off it before and was able to take it again and get back to normal within a week. But I'm still a little scared. I'm going to take my original dose plus a zopiclone just to guarantee sleep. I usually don't need to take zopiclone for too many days before I can stop using it when I'm on olanzapine. Does anything I'm saying sound dangerous?

 

I'm not planning the taper until I have a good therapy base and a good support group and am stable and happy and employed. So who knows when, minimum of one month, probably more. 

 

I don't like the subtle effects that olanzapine has on my brain (feeling a bit fogged, bored, sweaty) but they aren't so bad that I can't deal with them with therapy and good eating and exercise until I start the taper. It's going to be a very slow taper, I feel, but worth it.

 

Any olanzapine success stories you know of?

Edited September 4, 2015 by Petunia
unnecessary long quote deleted

[Gibby]

I mean, going back on the olanzapine after 5 days shouldn't cause any emergencies, right?

[Skyler]

Hold on Gibby... one of the AD mods will be getting to you soon (I advise in a different area)... 5 days should not cause an emergency.  Don't worry..  There are olanzepine success stories, but for now you only need to focus on what you need to do next.

 

Skyler

[Gibby]

Thank you Skyler, you know how an anxious mind works! I've just been so UP these last few days it's hard to think straight. 

 

Still a long time until bedtime so I'll await the mod...a nurse I spoke to on the phone (a VERY good nurse, wow) said that there shouldn't be any problems I didn't have when I went off for three days in June.

 

Still, you know...

Edited September 4, 2015 by Petunia
unnecessary quote deleted

[brassmonkey]

Hi Gibby-- welcome to the group.  As you have just found out, these are very powerful drugs and need to be treated carefully.  Firstly stopping CT for a few days and then going right back on shouldn't cause any harm, but it can make you feel really bad for a while. An important point to remember is not to panic over what this stuff throws at you, that will just make things worse.  In general any dose change, either down or up takes a minimum of four days to stabilize in the blood.  So things were just starting to sort themselves out when you reset the clock by starting to take the drug again.  No big deal, it just adds a bit of time before things stabilize.  Best thing to do right now is to continue taking your medication as usual and let the effects of this little detour settle out.  Once you are stable, then you can start a slow taper which should get you off of them with a minimum of pain.  While you're getting stable we have a bunch of information you should look over;

 

Tips for tapering off olanzapine (Zyprexa)

 

What is withdrawal syndrome?

 

Why taper by 10% of my dosage?

 

Also, what are your plans for the Citalopram and the Zopiclone?

[Gibby]

 

Thanks! When I went off it for three days in June, I felt a little groggy after starting it again but that went away, I didn't feel "really bad". Do you think that means I won't feel really bad this time?

 

I don't take the Zopiclone every night, just when I feel I need it, maybe once a week if I'm not tiring myself out. I'll take it tonight with the olanzapine to make sure I sleep and then not take it when I feel I don't need it. I don't think I took it the second night back on olanzapine.

 

Citalopram doesn't hurt me that much, I'll get off it later. Olanzapine seems like it's more harmful.  

 

I called a nurse and my pharmacist and they said I should be fine taking it again like I was in June after the three day "vacation". I feel so much smarter already!

Edited September 4, 2015 by Petunia
unnecessary quote deleted

[brassmonkey]

From the tone of our posts I can tell you're not in agony, so there doesn't seem to be any adverse reaction happening.  Stopping and starting these drugs multiple times can cause the CNS to become sensitive so the reaction to the last change doesn't always foretell how the next one will go.  It's a good idea to work on one drug at a time, so we can revisit the others later.

[Gibby]

I haven't taken the olaznapine yet, waiting until bedtime. I have to say I'm pretty anxious about it, but it has to be done because I can't cope with the withdrawal in this way. The last time I stopped was at least two months ago...I hope that gave me some time to take this one well.

 

Citalopram does affect my sexual function but I can deal with that for now.

 

My anxiety is really bad! I don't want the med to kill me!

 

Edit: I mean, all the professionals said I should be okay just like last time. I'm being pulled in many directions at once here

 

Edit 2: Sorry to be dramatic, but I'm obviously pretty stressed. Very lightheaded and tingly. Hence why I want to go back on to get stable

Edited September 4, 2015 by Petunia
unnecessary quote deleted

[Gibby]

Alright, well, I'm going to take my regular dose tonight plus a little zopiclone, not sure how much yet. I know 5mg would put me to sleep and stop the anxiety but it might be more responsible to do 2.5. Mom says I should take the higher dose just so I can sleep. I know the zopiclone is temporary either way. 

 

Still of two minds about that. I'll update in the morning with how I feel. 

[Meimeiquest]

Exactly how did you get to your current treatment plan (when and why first drug started, when and why more added?). Sometimes antipsychotics get added for the actual reason of covering side effects from the anti-depressant (doc may not even realize this) and then coming off of them with both rebound symptoms from stopping combined with the re-emerging side effects can be really tough.

 

Generally speaking it works better to stop the "accelerators" (AD in your case) before the "brakes" (the other two). I know you weren't thinking of going off everything, and maybe that's not the case for you....it sure was for me.

 

In chronic anxiety, one issue to consider is gut health. There can be a huge connection. I think we have several threads on it. Good luck in your healing journey!

[Gibby]

Hi everyone

 

I took my regular dose of olanzapine plus 5mg of Zopiclone last night. The calming affect was pretty immediate, all that tension I had built up over five days vanished, though I had a weird experience of...well, not auditory hallucinations, but the usual run of thoughts I have in my head become something like a soap opera. Must have been the exhaustion! 

 

I still have some anxiety today, still a bit shaky and my legs are pretty restless, need to be stretched to relieve the tension, I noticed this became more pronounced in the mornings when I wasn't on the olanzapine. I think it will take a few days for things to settle down, after all, I was full of stress hormones for five days!

 

I'm going to try sleeping without zopiclone tonight to see how it goes. 

 

My treatment history: Five years ago, an undiagnosed anxiety disorder, combined with life stress, killed my ability to sleep. Eventually I was voluntarily admitted to the psych ward and given citalopram and zopiclone. After I got out, I told my doctor that the zopiclone wasn't keeping me asleep all right, so so gave me a script for olanzapine to help me sleep through the night. Stupid 20 year old me didn't ask what it was or what it was really for.

 

I was on zopiclone and olanzapine every night for 2 1/2 years, gradually lowering my dose of zopiclone until one night in January 2013 when I feel asleep without it. I've only used it on an occasional basis since then. I was on 1.25mg of olanzapine for a few years before I had to bump it up to 1.8 (3/4 of a tab) in summer 2013.

 

So yeah, at 25 I'm on a low dose of an antipsychotic that is ONLY used for sleep and to keep my thoughts from racing, I guess. Every other doctor I've talked to said that that's "very strange" but here we are. 

 

Like I said, still feeling pretty amped up today, and my rational brain knows that it will take a bit before things settle down again...does that make sense? I wonder if the restlessness in my limbs is due to some side effect or just all the stress, I've always been fidgety.

 

As for the future, I'm starting to put a plan in place for a slow taper. Trying to settle down a bit first and get my life in a little better place (I have no job and nothing to do which needs to change) before starting that. I hear what you say about titrating down the citalopram first, and my doctor told me to start taking it in the morning instead of at night because it was "activating", but it sort of kills my sex drive during the day so I dunno. I think y'all can probably tell I'm still anxious!

 

Edit: I called my pharmacist and he said that 48-72 hours should have me back to "normal", which I agree with. Still, being so jumpy still is bothersome. I get really anxious when thinking about taking zopiclone for more than a few days so hopefully I settle down enough that that's not an issue. 

[Altostrata]

Welcome, Gibby.

 

How often do you take zopiclone?

 

The reason this site exists is because people are not getting the support and information they need from doctors. Which is probably why you're here, right?

 

You probably will find differences between what you hear from your doctor and what you see here.

[Gibby]

Welcome, Gibby.

 

How often do you take zopiclone?

 

The reason this site exists is because people are not getting the support and information they need from doctors. Which is probably why you're here, right?

 

You probably will find differences between what you hear from your doctor and what you see here.

 

Hi Alto, thanks for posting on my thread.

 

How often I take it depends on how I'm feeling. Some months I might only take it once or twice or some months it might be once a week. I find that I don't cope well with stress during the day so by bedtime on a bad day I might reach for it. Usually I wait for a bit of not falling asleep on my own before taking it. Hopefully that's all okay? I know I need to work on coping skills and sleep anxiety. 

 

And yes, I see that a lot of people here were badly served by their doctors. I know that my old psych is to blame for giving me a neuroleptic for sleep! I can't dwell on that, though, and the med HAS helped me progress in my life without anxiety, and I haven't been hurt too badly by it. I'm really sorry to see how some people here suffer and I kind of feel like a tourist since I'm fairly well off...

 

My psych said withdrawal would last a week, which is obviously wrong after five years even on a low dose. Other doctors have told me that withdrawal from olanzapine doesn't exist (I'm sure we've all heard that one). So I'm glad I found this community full of support and ideas, and seeing the success stories makes me optimistic about my own chances of living drug free someday. 

 

I find the pharmacist knows me pretty well, though, he is generally right about how I respond to things, and suggested a compound pharmacy for use during a taper. The nurse I spoke to on the phone was also a big help. If only they were all that good!

[Altostrata]

Taking zopiclone occasionally is okay. Taking it often can cause dependency.

 

It can take a while for your nervous system to settle down after going off a psychiatric drug too fast.

[Gibby]

Yes, I know how zopiclone can be, I was on it for a few years. I know how to ween off it, too, I usually don't take it more than three days in a row on rare occasions. 

 

I feel better than from this morning, just unsettled and "not normal". It will come with time, I've felt this before. The anxiety is getting better.

[Altostrata]

Okay, please let us know how you're doing.

[Spookypaws]

Gi by,

I just wanted to say I'm on zyprexa too for sleep issues. I had a breakdown in December which led to me being put on it so I could sleep. I wish I had known then what I do now, I'm hoping to be off before a full year has come and gone, but yeah it's odd to be put on an anti psychotic for not sleeping. I had the racing thoughts too.

[Gibby]

Gi by,

I just wanted to say I'm on zyprexa too for sleep issues. I had a breakdown in December which led to me being put on it so I could sleep. I wish I had known then what I do now, I'm hoping to be off before a full year has come and gone, but yeah it's odd to be put on an anti psychotic for not sleeping. I had the racing thoughts too.

 

Hi Spookypaws,

 

Yeah, it's tough, though they seem to use antipsychotics for a lot of things now. Was your taper very fast? Mine is going to be super slow even though I'm on a low dose. 

 

The drug HAS helped me in some ways, I won't lie. Not fighting against my own brain to sleep was a big help. However, I've come to the point where I want to learn how to do that on my own, for the first time in my life. 

 

One thing that might help you is doing some insomnia CBT while you are still on the drug. Bad sleep habits aren't masked by a pill, I've found. As you start your taper, you can put what you learned into practice if a rough night hits. 

 

I'm a little antsy still about bed tonight, I put that down to still adjusting to being back on the drug. Once you get put out of your routines, it's easy to get disoriented and not feel like you're at home and can relax. 

[ang]

Yes, I am somewhat worried that it won't work the same way as it should when I take it again tonight, or that I'll have some crazy reaction to it. There is no evidence that this will occur, because I HAVE gone off it before and was able to take it again and get back to normal within a week. But I'm still a little scared. I'm going to take my original dose plus a zopiclone just to guarantee sleep. I usually don't need to take zopiclone for too many days before I can stop using it when I'm on olanzapine. Does anything I'm saying sound dangerous?

 

I'm not planning the taper until I have a good therapy base and a good support group and am stable and happy and employed. So who knows when, minimum of one month, probably more. 

 

I don't like the subtle effects that olanzapine has on my brain (feeling a bit fogged, bored, sweaty) but they aren't so bad that I can't deal with them with therapy and good eating and exercise until I start the taper. It's going to be a very slow taper, I feel, but worth it.

 

Any olanzapine success stories you know of?

Olanzapine?  Never worked for me!           Sent me nuts in 3 days, all time record!  But valium that just takes 6 hours and I am psychotic............. Anyway, do what you think is right, stick with it for at least three weeks,,,,,,,,,,,,, and damn we are stronger than we ever thought possible,                      once I realised the drug reinstatements werent helping, and we actually survive, the fear is gone............. the only thing we have to fear is fear itself, and damn the drug dealers (oops Merck et al), know that................. dont fear,,,,,,,,,,,,,,, we need to sleep ( a bit),, eat  (a bit), and we survive, and we heal.......... good luck! Never, ever give in, our own bodies will heal, our own brains, will heal, given time................   only 12 months for me, and damn I am finally surviving, not thriving, but I do get glimpses of me being well,,,,,,,,,,,,,,,, I will get well!  You will too! 

[ang]

Antipsychotics, off label use, low dose are sometimes great for a sedative for sleeping.;...........some drugs yes antispychotics, used off label, are a sedative, and help us sleep, in big doses, then become an antispychotic............ so if you are on a low dose antisphychotic, it was prescribed as sedative..................off label..............     

 

let us know how you are going, sign in every day................this whole site is here to support you................. I know nothing, more than anyone else, but I know enough to try and help, and you will heal........................

[Katy91]

I'm tapering Olanzapine, the only way to go is by making a liquid with the orodispersible tablets or zyprexa wafers.  Then you can choose how much you want to taper.

 

I'm curious how do you take a dose of 1.8mg Olanzapine when the pills are only available in 2.5, 5, 10 and 20mg?

[Gibby]

I'm tapering Olanzapine, the only way to go is by making a liquid with the orodispersible tablets or zyprexa wafers.  Then you can choose how much you want to taper.

 

I'm curious how do you take a dose of 1.8mg Olanzapine when the pills are only available in 2.5, 5, 10 and 20mg?

 

I used a compounding pharmacy last taper to "custom make" my pills in the amount I wanted them in. As long as you have a plan in place (and the money!) that seems to be a good way to go and it's how I'm going to do it next time when I'm ready. 

 

I take 1.8 by taking 3/4 of a 2.5 pill. It's not an exact science but it's what has worked for me for quite a while now. 

 

 

As a status report, I slept last night w/o taking a zopiclone even though I wasn't really tired at bedtime and had an awful stomachache. I feel okay today, just kind of fuzzy and floaty and not quite myself. This is only the second day back on it so I know I have a while yet before I feel more like normal. Hopefully I can start driving again soon so I don't feel so cooped up in my house. 

 

The support on here has been great : )

[Gibby]

Feeling better today, though kinda wiped out still. I think I might go back to taking the citalopram at night, it always made me feel weird during the day.

 

The doctor said that it might keep me up at night but 5+ years of taking it at night with a calming med never seemed to be a big issue. 

 

I've been talking with my mom about this and she is being very supportive of whatever path I choose to feel better. She herself is on Effexor and tried to go off it once and felt "whacky" so gave up. If she ever wants to get off it, I'll send her here!

 

It was mentioned here that tapering the citalopram first might be better than the olanzapine. Is that generally the case? It feels like it would easier, but I don't want to say any of this will be easy!

[Gibby]

I'm on 40mg of citalopram (even my GP says that's the high dose!) and was thinking of tapering it after the olanzapine, but maybe I should do it first? That seems to be the pattern here.

 

It doesn't affect me too badly other than some light anorgasmia and keeping me up at night if I don't take an olanzapine (I usually took it at night because it made me feel kind of crummy during the day)

[Altostrata]

Gibby, I moved your post here -- your Intro topic is the place for those "what should I do?" questions.

 

If you're taking olanzapine for sleep, which sounds like the case, we suggest you taper the citalopram first, because the olanzapine may assist your sleeping through withdrawal.

 

If you go off the olanzapine first, you'll have to deal with the citalopram being too activating and keeping you from sleeping.

 

In your case, if I were you, I'd reduce citalopram first. It sounds like you have some adverse effects from it.

[Gibby]

Gibby, I moved your post here -- your Intro topic is the place for those "what should I do?" questions.

 

If you're taking olanzapine for sleep, which sounds like the case, we suggest you taper the citalopram first, because the olanzapine may assist your sleeping through withdrawal.

 

If you go off the olanzapine first, you'll have to deal with the citalopram being too activating and keeping you from sleeping.

 

In your case, if I were you, I'd reduce citalopram first. It sounds like you have some adverse effects from it.

 

Sorry about that!

 

Yes, I understand your point and agree with it 100%. I guess I was in a hurry to get off of the olanzapine because I perceive it as more "damaging", but if the long game is indeed the best game, I suppose the one that has the worst side effects (the weight gain on olanzapine hasn't been too drastic) should go first. 

 

I'm going to go back to taking the citalopram at night, I think. If I take it with the olanzapine it doesn't keep me awake and I don't feel weird during the day. 

 

Oh and I know I'm getting back to normal when I can take the controller from my friend and beat a level for him. Small steps

[Altostrata]

That is unusual, Gibby. Ordinarily citalopram would have a stronger "alerting" effect soon after you take it.

[Gibby]

That is unusual, Gibby. Ordinarily citalopram would have a stronger "alerting" effect soon after you take it.

 

 

It does have that effect if I don't take the olanzapine...I guess it sort of cancels it out? I took them that way for years and mostly slept well. I've only ever noticed the activating effect if I took them too far apart. Hopefully that's still the case, it was a week ago...I dislike taking it in the morning for a few reasons

[Altostrata]

Well, take it at night, then. If it works, it works.

[Gibby]

I will tomorrow night, it will probably be fine so long as I don't worry about it too much, like most things. 

 

Citalopram is kind of a "darned if you do, darned if you don't" thing. Take it at night without a sedative, goodbye sleep. Take it in the morning, feel like your head is in a vice. 

[Altostrata]

Have you tried dividing the dose -- half in the a.m., half in p.m.?

[Gibby]

I did that once, but taking only half a pill at night caused insomnia for whatever reason.