Gibby's citalopram taper

[Gibby]

I had a terrible night. Feels like something is interfering with me absorbing my meds, or they are interacting in some way. I was tired, took my usual meds at the usual time, then suddenly got this burst of energy. It took 5mg of zopiclone to finally knock me out. 

 

It feels like withdrawal even though I've changed nothing. I took an antacid at night like I usually do, it's a different brand of the same chemical, maybe that's it?

 

I'm calling my pharmacy today to see what advice they have. I'm for sure not going to go through with the med change until I'm back to baseline. I'm also planning on going to the doctor today to see if there's something wrong with my body.

 

I'm scared, I don't know why this is happening to me, especially BEFORE I changed anything. Nobody has really interacted with this thread so far but ANY help or advice is appreciated. 

[Altostrata]

There are 144 responses in this thread.

 

What drugs did you take last night, at what dosages?

 

Antiacids can block the absorption of some drugs.

 

On 7/5/2021 at 12:57 PM, Gibby said:

In a few days, I will begin a cross-taper from citalopram to fluoxetine, with the idea that the longer half life of the fluoxetine will make it easier to taper.

 

This is not necessarily so. We advise people to make as few drug switches as possible, as they sometimes do not go well.

 

We have many people here tapering directly from citalopram, which also can be prescribed in a liquid form.

[Gibby]

30 minutes ago, Altostrata said:

There are 144 responses in this thread.

 

What drugs did you take last night, at what dosages?

 

Antiacids can block the absorption of some drugs.

 

 

This is not necessarily so. We advise people to make as few drug switches as possible, as they sometimes do not go well.

 

We have many people here tapering directly from citalopram, which also can be prescribed in a liquid form.

I meant from when I returned from being away. It's alright. 

 

Last night I took my 1.8 olanzapine, 40mg citalopram, and a tablet of regular strength Tums. I'd been feeling a bit unsettled all week but had been able to sleep okay, but last night, even though I was tired from a big walk, about ten minutes after taking my meds I was super super energized and felt like I'd been shot up with some stimulant. I eventually took 5mg of zopiclone (I usually only take 1.25mg) and fell asleep from 4am to about 10am. 

 

Up until this past week, I had felt perfectly normal, was sleeping well, etc. Starting on Monday I was feeling a bit antsy, then it got worse. 

 

I spoke with the pharmacist this morning, she told me she will fax my psychiatrist with what I told her so he's in the know and can keep my old prescription going until I've figured out whatever is going on. I will not take the antacid tonight to see if that makes a difference. I had been taking them for a long while with no problems, maybe because I'm using a different brand?

 

I have tried a liquid taper of citalopram, in fall 2015. I had withdrawal symptoms for months after a 5% cut, never got any better, I eventually went back up to 40 because I was starting a new job and needed to be able to sleep properly. 

 

I'm not taking this cross-tapering lightly. Fluoxetine's longer half life MAY make it easier to taper. It may not. I have to try something new. 

 

Thank you for your input. 

[Altostrata]

Have you taken any of your drugs on an irregular schedule or skipped doses in the last few months? Is it possible you took double doses of something?

 

We can't figure out a drug problem from a single incidence of something. You will have to see if this pattern continues. 

 

Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. We need to know how you feel before and after taking each drug, and your symptoms in between. Post 24 hours of notes at a time in this topic, in a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right. This can show if your symptoms are adverse effects from one of your drugs.

[Gibby]

2 hours ago, Altostrata said:

Have you taken any of your drugs on an irregular schedule or skipped doses in the last few months? Is it possible you took double doses of something?

 

We can't figure out a drug problem from a single incidence of something. You will have to see if this pattern continues. 

 

Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. We need to know how you feel before and after taking each drug, and your symptoms in between. Post 24 hours of notes at a time in this topic, in a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right. This can show if your symptoms are adverse effects from one of your drugs.

 

No, I've been taking everything at the same time in the same dosages. It came on kind of slowly before everything "broke". That's why I'm confused, and I think that something to do with my body is causing this rather than any dose changes. But, as you say, we need the data. I am going for blood work tomorrow to see if anything is amiss in that regard. 

 

I will post a detailed log of what's happened today tomorrow morning. As a brief update before then: I took my medicine at the regular dosages at about 11pm. I had taken some Pepto Bismol beforehand due to heartburn which I knew the meds would make worse.  I went to sleep okay last night but woke up at 3:35 drenched in sweat and with a sore abdomen. I fell back asleep by 5ish and woke up at 9. Felt kinda weird all day (foggy head, not as articulate as I usually am, etc.) and now (6pm) feel very nauseous. I'm going to eat some soup to settle my stomach a bit. 

[Altostrata]

3 minutes ago, Gibby said:

It came on kind of slowly before everything "broke".

 

What came on slowly? Please describe symptoms in more detail.

 

Have you been fully vaccinated for covid-19?

[Gibby]

2 minutes ago, Altostrata said:

 

What came on slowly? Please describe symptoms in more detail.

 

Have you been fully vaccinated for covid-19?

 

Starting on about Monday, I was feeling a little more antsy, unsettled, sometimes lightheaded, and was having some trouble sleeping. Something just felt "off", and it built up as the week went on. Thursday night I did not sleep very well, Friday night was the really bad night. 

 

I am fully vaccinated, I got my 2nd dose (Moderna) on June 30th, so I'm over two weeks out from that and pretty much fully protected, I hope. 

 

As an addendum, the nausea started when I was taking a shower a few hours ago. 

[Altostrata]

How are you taking 1.8mg olanzapine? What are the expiration dates on all your drugs?

 

You take all your drugs together, regularly at 11 p.m.?

[Gibby]

4 minutes ago, Altostrata said:

How are you taking 1.8mg olanzapine? What are the expiration dates on all your drugs?

 

You take all your drugs together, regularly at 11 p.m.?

 

I take 1.8 olanzapine via compounded capsules that my pharmacy makes up. I take both of my medications together right before bedtime, which is a bit later in the evening now than when I'm teaching, so anywhere from 11am to midnight depending on the day. This protocol has been working out fine for years, I haven't tried to change any doses since 2018. I do get "episodes" from time to time where it feels like the meds are not absorbing right or what have you, this could be one of those. 

 

I get both my meds filled on 30 day prescriptions, I don't know if that's enough time for them to expire. 

[Gibby]

Okay, update:

 

Saturday

10am: Woke up pretty groggy from zopiclone (had taken 5mg in order to sleep, real bad night)

Most of the day: Nausea and abdominal pain, frequent urination

11am: Took 1.8 olanzapine, 40mg citalopram. 

12am: Fell asleep

3:30am: Woke up drenched in sweat, bad abdominal pain, had to pee a lot

5am: Fell back asleep

 

Sunday

 

9am: Woke up

10am: Ate breakfast. Still urinating a lot and abdominal pain. Head felt like somebody had hit it with a hammer, almost a "concussed" feeling. 

4pm: Had a nice hot shower. Started to feel very nauseous while showering. 

5:30pm: Had some tomato soup, seemed to settle my stomach for a bit. Abdominal pain remained.

9pm: Did some progressive muscle relaxation. Head felt more "normal", less concussed feeling. Wasn't very sleepy though. 

11pm: Took my usual dosages. Still urinating a lot, abdominal pain/pressure.

12pm: Tried to sleep, having to get up all the time to urinate didn't make for a very relaxing time. 

1am: Finally got frustrated, took 1.25mg of zopiclone, kicked in about an hour later.

 

Today

 

9am: Got up feeling very groggy, nauseous, abdominal pain, had to pee right away.

9:30am: Went to get blood work done.

Currently: Same ol' nausea, abdominal pain, and frequent need to urinate. 

 

 

My current hypothesis is that I have some kind of UTI that is throwing my system out of whack. I generally don't handle being sick well in terms of my nervous system. I'm going to my regular doctor today to get it checked out. If that's not the case, well, back to square one I suppose. 

 

 

[Desiderata]

I hate to hear you are feeling so poorly! Sending positive, healing vibes your way! Kind regards, Desiderata 

[Gibby]

1 hour ago, Desiderata said:

I hate to hear you are feeling so poorly! Sending positive, healing vibes your way! Kind regards, Desiderata 

 

Thank you, I appreciate it. 

 

Turns out all my blood work and urine samples were totally fine, so there goes my UTI theory. 

 

Two theories I have now, I guess:

 

- the clobetasol cream I used for about a week did something to my adrenals (the blood tests didn't check for those), but my doctor seems to think this is unlikely since it was the cream and I wasn't taking it internally. 

 

- something is going on with my meds, maybe something is expired? I don't know, this doesn't feel like withdrawal has in the past.

 

So in short, I feel sick but I am not sick. My doctor ordered an abdominal CT scan so maybe something will come of that. Kind of unlikely though, I'm guessing. 

 

Right now I feel pretty nauseous, I'm going to try to take it easy until the CT people call me. 

[Altostrata]

1 hour ago, Gibby said:

the clobetasol cream I used for about a week did something to my adrenals

 

You did not mention this before. Yes, a steroid (or antibiotic) can quite badly upset a system sensitized by withdrawal.

 

In the future, please consider and report ALL your drugs when you have an odd reaction, it will save us all a lot of time and work.

[Gibby]

5 minutes ago, Altostrata said:

 

You did not mention this before. Yes, a steroid (or antibiotic) can quite badly upset a system sensitized by withdrawal.

 

In the future, please consider and report ALL your drugs when you have an odd reaction, it will save us all a lot of time and work.

 

Will do. 

 

I didn't consider myself in withdrawal before this as I didn't change any meds. I haven't used the clobetasol cream in a few weeks. My doctor seemed miffed when I brought it up as a possible cause of my current condition. I am going to call the dermatologist that prescribed it and see what he thinks. 

 

My blood tests showed perfect kidney function but they didn't check my cortisol levels or anything like that. 

[Altostrata]

An adverse reaction to a steroid probably is not going to show up in blood tests. Doctors do not take into account hypersensitivity caused by psychiatric drug withdrawal in assessing adverse effects of other drugs, if they take those adverse effects seriously at all.

 

Trust me, we have many people here reporting significant adverse reactions to steroids, antibiotics, and other drugs they had taken before without noticeable problems.

[apace41]

19 minutes ago, Altostrata said:

Trust me, we have many people here reporting significant adverse reactions to steroids, antibiotics, and other drugs they had taken before without noticeable problems.

 

Trust her, Gibby.  Even the smallest dose of steroids, and in cream form, can send someone spiraling for short time during w/d.  I had that happen to me on several occasions before I realized that the med I was taking had a small dose of steroid in it to go with the antibiotic.  It was for a minor skin condition but it created a bit of havoc for several days.

 

I know you are uncomfortable in the moment, but when we add fear to the mix we send ourselves further into the tailspin.  Try to breathe, accept and understand this will pass.

 

Best,

 

Andy

[Gibby]

16 minutes ago, Altostrata said:

An adverse reaction to a steroid probably is not going to show up in blood tests. Doctors do not take into account hypersensitivity caused by psychiatric drug withdrawal in assessing adverse effects of other drugs, if they take those adverse effects seriously as well.

 

Trust me, we have many people here reporting significant adverse reactions to steroids, antibiotics, and other drugs they had taken before without noticeable problems.

 

My understanding is that a blood test that was specifically looking at adrenals would show low levels of cortisol since the adrenal glands would've been suppressed by the clobetasol. I am waiting for a call from my pharmacist to see what they think. Really, all I want is an answer in hard numbers so I can stop thinking about "what ifs". 

 

The timeline of using the cream was:

 

Used it for about a week (probably less) on various areas that had broken out in hives due to an immunotherapy treatment was I getting for plantar warts (that's a whole other adventure).

 

I stopped using it after most of the hives had cleared up. About a week after that, is when I started feeling weird which leads to this point. 

2 minutes ago, apace41 said:

 

Trust her, Gibby.  Even the smallest dose of steroids, and in cream form, can send someone spiraling for short time during w/d.  I had that happen to me on several occasions before I realized that the med I was taking had a small dose of steroid in it to go with the antibiotic.  It was for a minor skin condition but it created a bit of havoc for several days.

 

I know you are uncomfortable in the moment, but when we add fear to the mix we send ourselves further into the tailspin.  Try to breathe, accept and understand this will pass.

 

Best,

 

Andy

 

Andy, while I don't consider myself in w/d at the moment due to not changing any of my doses for years, I am indeed very sensitive to medications, though some more than others to be fair. Even when I was a teenager I was pretty sensitive and the intervening years hasn't helped this. 

 

I appreciate your input. I always fear the "doom spiral" that will wind me up back in the hospital or on higher doses of meds; my first experience with the system in 2010 was quite traumatic and it still pains me to think about it. 

 

It never feels temporary when you're in the middle of it, but I know deep down that it is. Thank you for the encouragement. 

 

[Gibby]

Update:

 

- Felt VERY amped up in the evening, agitated, etc. This lasted until about 9pm. 

 

- Took my usual meds at 11:30pm, had to go to the bathroom a few times and felt uncomfortable BUT fell asleep pretty quickly, slept all night, no zopiclone

 

- Woke up about 8:30, feeling groggy but better. I haven't had caffeine since about Thursday so that's likely contributing, I'm going to lay off the tea for a good bit

 

- Spent quite a bit of this morning trying to track down my psychiatrist so he can refill my original prescription. So far no luck, getting pretty anxious about this since I run out of meds on Thursday night

[Altostrata]

You might have had a stomach bug. Not everything is due to the drugs.

 

Your morning grogginess is likely hangover from olanzapine.

 

Please let us know when you want to discuss tapering.

[Gibby]

Just now, Altostrata said:

You might have had a stomach bug. Not everything is due to the drugs.

 

Your morning grogginess is likely hangover from olanzapine.

 

Please let us know when you want to discuss tapering.

 

Hi Alto,

 

It very well could've been. I also think the morning grogginess is due to me hating waking up in the morning, and also me cutting out caffeine. 

 

My psychiatrist has refilled my old prescription, I think I'll begin the taper within a month or so once I'm settled down. Thanks for the support, everyone. 

[Gibby]

Just as a health update, the nausea and night sweats are mostly gone. I'm left with a "sick" feeling in my head, tension around the eyes, and I'm never really tired...I'm sleeping through the night without taking zopiclone, but I never nod off before bed like I was before, and I just kind of transition from awake to asleep without any real in-between feeling of being sleepy. Essentially, I go to bed when I think I should and I don't think I'm taking any longer to fall asleep, but it still doesn't feel normal. 

 

I got to the doctor again tomorrow for a follow up. One of the doctors I saw suggesting upping my dosage of olanzapine but that's not happening. I will eliminate all possible physical causes before thinking it's a medication issue. 

 

Anyways, this will be the last update from me until I'm ready to taper unless somebody asks me a question here. 

[Gibby]

Okay, I'm breaking my promise as my symptoms have shifted over the last 36 hours or so. They feel very "withdrawal-like". Last night I felt VERY anxious, tight pressure in my chest, very emotionally labile (like I was going to cry), just unstable in general. I took 1.25mg of zopiclone at around midnight, this did help and I slept. 

 

Woke up with the same tight pressure in my chest, head felt like it was full of cement. Oddly, despite the pressure in my chest, my heart wasn't racing. Took me a while to get out of bed. These feelings have persisted all day. I saw my family doctor today and he told me my CT scan showed I was "pretty constipated" and he gave me an RX for a laxative which I'm not sure I'll use. He absolutely did not want to talk about my symptoms ("they're psychological, etc.") so that was really dispiriting. CT scan showed my adrenal glands are normal so I guess I can stop blaming the steroid cream??? I'd still like my cortisol tested...

 

Anyways, I feel a bit less wiped out now but still very "withdrawal-like." I know that poop-out is a thing, but for it to happen so fast and to have symptoms beforehand that haven't matched with what I feel when I taper? I'm so confused and generally worried about what is causing this...but I'm also not panicking.

 

It does feel unfair that this is happening during a summer where I had a lot of plans. Can't focus on that too much I guess. 

 

If things don't improve in the next few days, I'm going to a different doctor. I haven logged all my symptoms and when they occur on a Word doc. 

[Gibby]

Update:

 

Possible reaction to stress, anticipating big life changes, is what might have caused this. Had some good talks with some good folks that helped quite a bit yesterday. 

 

Still getting cortisol/anxiety spikes, especially in the morning and evening. Head feels really "medicated", groggy this morning. Tightness in chest. 

 

Talked to my psychiatrist yesterday. He suggested updosing but I declined. Main bothersome thing is the anxious feeling in my chest...dunno why that's happening. 

[Gibby]

I went to the ER today. Based on my urine sample, the doctor said I am diabetic and that explains my symptoms. My urine was fine two weeks ago.

 

He gave me prescription for metformin and told me to go back to my family doctor to get some tests done to determine if it's really diabetes. I wasn't having problems with my sugars until this "episode". 

 

This is a hard blow. I know it can be controlled and I can live a full life if I'm careful, but this is not the news I wanted to hear all the same. I personally think it's too much a coincidence that I was using that clobetasol steroid cream and then this happens a week later. I'm hoping this is temporary, and that I can get it under control with diet and exercise (and time). 

[Desiderata]

Wow, that is a hard blow Gibby. But perhaps a second opinion from your doctor will be different. So sorry to know you are having a difficult time. Please keep us posted! Kind regards, Desiderata 

[apace41]

Gibby,

 

Do you have other factors that would have led you down the path of diabetes?  Are you overweight?  How's your diet?  Do you exercise?

These things don't just happen "out of the blue" with no warning, and, if they do, it can be a function of the psych meds throwing metabolism out of whack.  In addition, since we are talking about Type 2 diabetes, it's not like "you have it or you don't" -- doctors just come up with an arbitrary number above which they medicate.  Lifestyle changes can clearly bring you down below those levels.

 

This is not something horrible -- it could be a function of the meds or it could be a wake up call.

 

Best,

 

Andy 

[Gibby]

6 hours ago, Desiderata said:

Wow, that is a hard blow Gibby. But perhaps a second opinion from your doctor will be different. So sorry to know you are having a difficult time. Please keep us posted! Kind regards, Desiderata 

 

Thank you for the kind words of support. I'll be okay, I'd just like to get back to something close to normal. Takes time! 

[Gibby]

1 hour ago, apace41 said:

Gibby,

 

Do you have other factors that would have led you down the path of diabetes?  Are you overweight?  How's your diet?  Do you exercise?

These things don't just happen "out of the blue" with no warning, and, if they do, it can be a function of the psych meds throwing metabolism out of whack.  In addition, since we are talking about Type 2 diabetes, it's not like "you have it or you don't" -- doctors just come up with an arbitrary number above which they medicate.  Lifestyle changes can clearly bring you down below those levels.

 

This is not something horrible -- it could be a function of the meds or it could be a wake up call.

 

Best,

 

Andy 

 

Andy,

 

I'd say the olanzapine has a role to play, as I've gained quite a bit of weight on it. Granted, I was underweight when I started it, but I'm probably 15 pounds overweight for my height. However, my blood sugar and urine sugar levels were stable for years before this...my guess is that the steroid cream I was using set something off, but I can't prove that yet. 

 

I see my regular doctor tomorrow to get the hemoglobin test done. I'll have a better plan of attack then. I've taken the first metformin tablet and I ate healthy tonight (lentil and chickpea stew), this is indeed a bit of a wakeup call!

[Gibby]

Well, I saw my family doctor today after getting more bloodwork, and the results do not indicate diabetes. I asked about the sugar in my urine and he didn't really give me answer for that. He suggested that this has all been caused by stress and that I should increase my meds, which I don't want to do. So back to square one!

 

I've thought about if this is some kind of med poop out, but how would that happen so suddenly? I still have symptoms that match diabetes, too. Frankly, I am frustrated and annoyed. I'm getting punted off to a specialist so we'll see how that goes. 

 

Anyways, since this doesn't have much to do with meds and tapering/withdrawal (I hope!), I won't be posting in this thread unless somebody asks a question or posts advice or something. 

 

Take care, everyone. 

Edited July 27, 2021 by Gibby
changed "taper" to "tapering"

[hayduke]

On 7/28/2021 at 8:23 AM, Gibby said:

Well, I saw my family doctor today after getting more bloodwork, and the results do not indicate diabetes. I asked about the sugar in my urine and he didn't really give me answer for that. He suggested that this has all been caused by stress and that I should increase my meds, which I don't want to do. So back to square one!

 

I've thought about if this is some kind of med poop out, but how would that happen so suddenly? I still have symptoms that match diabetes, too. Frankly, I am frustrated and annoyed. I'm getting punted off to a specialist so we'll see how that goes. 

 

 

I measured in at pre diabetic blood sugar levels 2 or 3 times, coinciding with increased lethargy and fatigue - hard to believe but they can actually get worse on this drug than they are to start with.

 

Fasting worked for me to revert my resting blood sugar to non diabetic levels.  My GP was happy with that.  Takes a bit of effort to start but a life skill I'm glad to have in my toolbox now.  Noting that SA does not generally recommend fasting but it worked for me.

 

As to the phenomenon puzzling your doctor - as we see too often, most of the professionals issuing this drug don't know very much about it in reality.  Have a look at https://thelastpsychiatrist.com/2010/10/zyprexa_and_fat.html which covers the phenomenon.  

 

While I noticed improvements below 2.5mg, somewhere below 1.25mg I was able to eat bacon much more comfortably, but zero is a clear difference again.  My metabolism was keen as mustard to discard the chemical interference when I jumped.

 

Even when I had been exercising more often while taking olanzapine, I found I can ride my push bike up hills with less strain after zero.  There's just more ease in my body now.  That cardio over the last 15 years probably helped me survive this well enough to have a good shot at health now.  It didn't let me get slim, but it definitely helped overall.

 

Post zero I feel my body is about ready to shed this fat in a way it couldn't quite sustain on even low amounts.

[hayduke]

Our moderator ChessieCat has been doing excellent research into managing incipient or actual type II diabetes recently

 

 

[ChessieCat]

On 7/28/2021 at 8:23 AM, Gibby said:

Well, I saw my family doctor today after getting more bloodwork, and the results do not indicate diabetes.

 

What test/s did he do and was it a fasting blood test?

[ChessieCat]

On 7/23/2021 at 2:06 PM, Gibby said:

my guess is that the steroid cream I was using set something off, but I can't prove that yet. 

 

That may be the case.  I recently found out that stress increases cortisol and cortisol causes a craving for sugar and carbs (which the body turns into sugar).  I have had a lot of major stressors in my life since the age of 20 and a period of 15 years during that time of continuous low-medium level stress.  I knew I was an emotional eater but I did not understand why.

 

From https://www.healthdirect.gov.au/the-role-of-cortisol-in-the-body

 

Cortisol is a steroid hormone that is produced by the adrenal glands, which sit on top of each kidney. When released into the bloodstream, cortisol can act on many different parts of the body and can help: the body respond to stress or danger. increase the body's metabolism of glucose. control blood pressure.

 

I refused to go on a statin (which can increase diabetes) and Metformin (which can cause weight gain) and opted to try diet first.  I told the doctor that it does not make any sense to start a drug and change diet at the same time.