Monty: Citalopram Withdrawal after 6 months? Please help!

[Monty]

Hi everyone

 

I've been reading about protracted withdrawal for the first time today and am terrified about what to do next.

I tapered off Citalopram 6 months ago over a 2 weeks period which I now know was too fast. Since stopping Citalopram my mood has been flat and at times I felt emotionally fragile, but it was tolerable for the first few months. Things got hard hard when I started studying again and the stress kicked in. I suspect my current anxiety and depression is due to withdrawal but it could also be due to stress.

I work 40 hours per week and also study 20 hours per week on top of that for a professional qualification which is very stressful (my exam is in 4 weeks so less than ideal timing). The lack of ability to concentrate (either due to withdrawal or depression) has made study much more challenging.

I don't know if I should start taking Citalopram again (maybe 10 or 20mg?) to take care of my withdrawals and then taper off very slowly over (say) 12 months?. Alternatively, should I persevere and hope things get better given it's been 6 months already and I don't want to have to start all over again? I've been taking 1mg Lorazepam when I need it to manage the anxiety and depressive states, but things are getting progressively worse and I'm struggling to cope.

 

Yesterday I was going to start the Citalopram again after repeated crying fits over nothing (actually I saw a picture of a bumble bee and for some reason that set me off), and so I took 40mg which in hindsight was too high a dose, so hopefully that doesn't come back to bite me.

 

Should I restart Citalopram or stick it out? Please could someone help?

 

Thank you

Edited November 12, 2016 by Shep
added tags

[Shep]

Hi, Monty.

 

Welcome to Surviving Antidepressants (SA).

 

I think you're dealing with both antidepressant withdrawal and symptoms from using Lorazepam.

 

Here are some links to get you started:

 

About reinstating and stabilizing to reduce withdrawal symptoms 

 

Tips for tapering off Celexa (citalopram)

 

Why taper by 10% of my dosage?

 

What is withdrawal syndrome? 

 
The Windows and Waves Pattern of Stabilization

 

 

It's possible that a reinstatement of a small dose of Citalopram may help; however, please answer these questions first:

 

• How long have you been taking Lorazepam? This is a benzodiazepine (also called a benzo). Benzos can cause dependency in as little as 2 weeks. With a very short half life, Lorazepam can create rebound anxiety and other symptoms. 

 

• Are you taking the Lorazepam to sleep or for anxiety? Knowing why you're taking this can help us direct you to the best non-drug coping skills as you taper off. 

 

Please update your signature to include your benzo use. Once we know more about this, we can better tell if an antidepressant reinstatement may help or not. 

 

This is your thread to list your symptoms and to ask plenty of questions. I'm glad you found us for information and support. 

 

[Monty]

Hi Shep

 

Thanks heaps for your reply and for the links.

 

Before I stopped Citalopram in May it would have been many many months since last taking a Lorazepam if not years. My doctor has prescribed me Lorazepam for over 20 years now but I hardly ever used it.

 

I take one only very rarely and only when I need it for bad anxiety or when I get depressed to the point of crying. They calm me down and allow me to handle the situation better. When first coming off the Citalopram I have averaged maybe one Lorazepam every 2 - 3 weeks for the first few months. Due to depression and anxiety I've needed to take one approx every 1 to 3 days over the last few weeks. I've just started cutting each one in half as I want to minimize my use of them as much as possible.

 

The lorazepam are purely for anxious episodes and calming my mood if already upset. I don't take any for sleep or in anticipation of an event.

 

Thanks

[Shep]

Thanks for this information.

 

Due to having been on and off Lorazepam for 20 years, you may have something called "kindling". This thread gives a good explanation:

 

Limbic Kindling -- Hardwiring the brain for hypersensitivity

 

I highly advise stopping the Lorazepam now before you develop any more problems, as you are increasing your dosage, going from every 2 - 3 weeks to every 1 to 3 days. This speaks to a developing problem with dependency. Within the context of "kindling", each time you try to come off, your symptoms may be more and more difficult. 

 

Please keep in mind it only takes 2 weeks to develop a dependency, and using it every 1 to 3 days is putting you at risk. 

 

The benzo may also be causing part of your problem by creating a destabilization effect on your central nervous system and causing "rebound" anxiety symptoms, especially due to Lorazepam's short half life. 

 

There are some really great ways of handling depression and anxiety with non-drug coping skills. These links will get you started:

 

Non-drug techniques to cope with emotional symptoms

 

Neuro Emotions

 

"Change the channel" -- dealing with cognitive symptoms

 

While many supplements can cause problems during withdrawal, fish oil and magnesium can have a calming effect. It's best to start with only one supplement at a time and at a low dose just in case you have a bad reaction. These links have more information:

 

King of supplements: Omega-3 fatty acids (fish oil)

 

Magnesium, nature's calcium channel blocker

 

Please see my prior post for the links to information on reinstatement for the citalopram. If these kinds of non-drug coping skills aren't enough to handle your symptoms, you may wish to try a very small reinstatement of the citalopram. I would recommend doing this as opposed to continuing to take a benzo for your symptoms. 

 

Using another drug to handle withdrawal from an antidepressant doesn't work well and carries a lot of risks.

 

Please let us know what you decide after you have a chance to read through the links. 

[Monty]

Thanks Shep

 

You're a big help. Please bear with me.

 

I'll stop taking the Lorazepam. The concept of kindling makes sense and I certainly don't want to develop a dependency on it.

 

Its probably the withdrawal here, but just deciding what to do next is making me really anxious.

 

Ultimately, my fear is that because 6 months ago I tapered from 40mg to nothing over a period of 2 weeks, that I've possibly set myself up for unnecessary and nasty withdrawal, that would otherwise have been much better managed by a very slow taper.

 

Have I doomed myself?

 

Also I'm confused with the idea of reinstatement. I've been reading through this site and the links you gave, and given I've been off Citalopram for 6 months now, there's a chance it won't work. If I was to take maybe 1mg or 2mg per day, how do I know if it's too low a dose or the reinstatement isn't working? Would I keep upping the dose by 1mg per week until it started working again or give up if there's no benefit?

 

Also my doctor would likely suggest I go on 20mg if I were to restart. Part of me wants to do this just to feel better. Could I not do this (even at just 10mg) to get my head right again and then taper very slowly with the hope of minimizing withdrawal to less than I'm experiencing now?

 

I didn't mention it earlier as I didnt think it was relevant, but since stopping the Citalopram I've been taking St Johns Wort as sort of a safety net, and over the last few weeks I've also been taking Passionflower supplement for anxiety (although im not sure if I've noticed a benefit on it or not). Presumably these wont hinder withdrawal?

 

I'd very much appreciate your advice.

[Shep]

Hi, Monty.

 

I'm glad to hear you're not going to use the benzo anymore. 

 

Please research all supplements carefully, as many of us become very sensitive to supplements during withdrawal and for a long time after coming off the drugs.

 

Here's some information on St John's Wort:

 

St John's Wort

 

Tapering St John's Wort

 

It's possible you may need to taper off it. Please read through both threads, as it may impact your decision to reinstate. 

 

My advice would be to weigh your symptoms against how well you are doing. Are you sleeping? Can your anxiety be handled with mindfulness, breathing techniques, taking a day or even half a day off from work, reaching out to family or a friend? 

 

I'm not sure what would be the best dose to reinstate the Citalopram at, so I'm going to ask the other moderators to weigh in so you get the best information. 

 

In the meantime, please read through these links and let us know what you think. 

[Monty]

Hi, today has been awful. Terrible anxiety and sitting at my desk at work with my hands shaking and trying not to burst into tears. Awful tightness in my chest and knots in my stomach. I can't focus at work and couldn't possibly be like this in my exam in a month.

 

It's either all or one of the following: Lorazepam dependency (which I don't want to take anymore)y, St Johns Wort withdrawal, Citalopram Withdrawal in general or the after effects of the bad decision to take the 40mg Citalopram I took several days ago (which I think is why yesterday was actually a good day).

 

I'm 99% ready to restart the Lorazepam at 10 or 20mg just to stabilise myself for a while and then start a very gradual taper.

 

I'm just so uncertain. I don't know what to do!

[Monty]

I took the plunge and took 10mg when I arrived home from work. I feel better just being at home and my wife is very supportive. I have an appointment with my doc in the morning and I'll discuss my Citalopram use. I chose 10mg as I don't want to start too low and not have it work and I don't want to go as high as 20 right away. Will see how things go...

[LexAnger]

My fingers crossed for the 10 mg working for you!

[scallywag]

Did you take 10 mg Lorazepam or Citalopram?

[Monty]

Hi scallywag

 

Sorry my mistake, I meant 10mg Citalopram. That much Lorazepam would cause me serious issues! I'll take only Citalopram from now on.

[scallywag]

Yeah, I'm glad you understand the point of that question.
 
Reinstating 10 mg citalopram may be a bit much after having been off it since May. You could try ¼ of a tablet daily or even less than that. Please take the citalopram and the same time every day and keep notes on paper about your symptoms. You'll find a useful format for a daily log in this post:
Take notes of doses and symptoms

[Monty]

Thanks scallywag. Given I took 10mg last night, could I take 5mg tonight and each night thereafter or is that too much of a drop?

[scallywag]

If you've only done 1 day at 10 mg, dropping to 5 for your next dose should be ok.

 

Please keep notes on paper of your symptoms and the times of your dose(s). This post has a useful format for a daily log:

Take notes of doses and symptoms

[Happy2Heal]

I was just reading thru your thread Monty, I hope this works out for you!

[Altostrata]

Hello, Monty.

 

How did you feel after taking 10mg citalopram?

 

Many people do better with fish oil and magnesium supplements, see
http://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/
http://survivingantidepressants.org/index.php?/topic/1300-magnesium-natures-calcium-channel-blocker/

[Monty]

Hi Altostrata

 

I took the 10mg at 6pm yesterday evening and it's now 2pm in the afternoon. Physically I feel ok except for a slight tightness in my chest and emotionally I'd describe today as one of my good days.

 

I've been taking magnesium supplements to help with sleep for the past 2 weeks and started fish oil 2 days ago after Shep's recommendation.

 

My psychologist and doctor have both recommended I take 10mg of Citalopram and said 5mg wouldn't be enoughI guess they're seeing this as restarting Citalopram instead of trying to control withdrawal. I'm swayed by the fact I want to feel better as soon as possible, so while I'd prefer 5mg, I'm concerned it may not be as effective. I know I'm being frustratingly indecisive so I apologise to anyone reading

 

Thank you Shep, LexAnger, scallywag, catnapt and Altostrata for your comments and guidance. It's amazing support!

[Monty]

Quick update: Today has been one of the best days I've had in a month. Im cautious to think its the Citalopram working so quickly but hopefully something is on the right track.

 

I've reduced my dosage to 5mg as of this evening and will start a diary of dosage and symptoms. I'd be happy if I can get by on that dosage for a while.

 

I was having trouble getting the 20mg oval shaped tablets into even quarters as they would split unevenly and/or crumble. Cutting them first in half was easy as there's already a groove across the tablet, but then I found if I score each separated half of the tablet on both sides with a sharp knife then press with the knife along where I scored, then it split evenly in two without crumbling. Similiar to scoring and breaking a ceramic tile. I'll ask about the 10mg tablets when I go back to my doc next month but I don't believe they're available in New Zealand.

[scallywag]

You should be able to get a pill-cutter in a pharmacy. They can help a great deal with creating ¼-tablets.
Using a pill cutter

[Altostrata]

5mg may be fine for you. See how you do with it.

 

Not everything can be fixed by more drugs.

[joy2730]

I  have been in the unhappy scenario of reinstating citalopram and it does not sit well with me at all, it feels like I am in a trap.  But I have a heavy commitment to a late life career, and possibly because of your work/study, like me, you feel you have no choice of sticking it out.  I too have study work to do as well as working.

 

I am sure you find this difficult too, but if you are feeling better that is good.  I hope 5 mg does the trick, rather than 10 mg, I was having trouble at 14.5 and went back to 20.  Eight weeks later I still have a few withdrawal symptoms but feel a lot better.

 

It is tough.

[Monty]

Hi joy2730

 

I certainly agree on it being tough. Both working and studying is difficult on its own and the resulting stress if far far worse when trying to manage withdrawal. I've got 18 months left in my studies (I'm in my 7th year) and if I need the Citalopram to manage in that time then I'm happy to keep taking it.

 

It's good you're feeling better on 20mg as it will help with your study. Trying to read notes with an anxious sick stomach and a mind full of worries is far from ideal.

 

I will taper down slowly, but I don't know when I'll do that. At this stage I'm still not sure if 5mg is right for me. Since restarting Citalopram my days have varied. My mood is usually flat in the mornings and improves throughout the day, but every day is different. I've only been back on Citalopram for 6 days but I've been much better overall, so will stick with it and see how things progress over the next few weeks. It's as though the anxiety has largely disappeared but my mood has yet to catch up. Maybe after my exam that will change.

 

I have an online test to do in about 10 hours and I'm behind in my study, so today probably won't be one of my good days!

[JanCarol]

Hey Monty - how are you going with your reinstatement?  Did you stick with 5 mg?  Were you able to find 10 mg tablets in NZ?  (I note that 10 mg and liquid are available in UK, but I couldn't find anything for NZ).

 

Did you quit the St. John's Wort?  (Cold turkey?)

 

How did the exams go - or how do you think they went?

 

Do you plan to just hold at 5 mg until you get through your studies?

 

Let us know how you are going, and I hope you see the sun today!

[Monty]

Hi JanCarol

 

Thanks for your message

 

I'm still taking 5mg per day as that has alleviated my anxiety (until yesterday anyhow) and helped me feel much better. I'm cautious to describe myself as feeling "normal" but if I'm not quite there yet, I'm not too far away from it. My ability to concentrate is much improved as well. The difference is quite noticeable and a big help at work where people were previously noticing my work standards slipping.

 

The past 2 weeks have been good except for pre exam anxiety yesterday afternoon when the practice questions were released. I've my exam in 12 days and will be anxious on and off during that time, but the Citalopram will help me with that.

 

At this stage I plan to continue the 5mg Citalopram until I've finished my studies which is approx 18 months away. I put a great deal of pressure on myself and believe my personality type is such that I'm destined to struggle emotionally whilst studying.

 

I've not yet been to my doctor but will certainly enquire about 10mg tablets or liquid Citalopram. If not available I'll make my own solution as described by Rhiannon on this site, as even with a pill cutter I'm not able to divide a 20mg pill into quarters as well as I'd like.

 

Yes I stopped the St Johns Wort cold turkey. I don't believe I've had any effects from this, but it may have been masked by the Citalopram. At the same time I stopped taking lorazepam and passionflower supplements. Presently in addition to Citalopram I'm only taking Magnesium and fish oil supplements.

 

I'll let you know how the exams went in a couple of weeks I'm cautiously optimistic but still concerned. My anxiety has made studying difficult these last few months so I'm not as well prepared as I should be.

[joy2730]

You are doing really well to stabilise on 5 mg.  I think people's brains become very sensitive to the drug at these low doses so it would be really good if you could find a way of accurately getting a consistent dose.  People on this site say that getting hold of liquid prescriptions really help with accuracy, but my own GP could only get a preparation that has 40 mg of citalopram suspended in 5 ml of liquid and so she thought it wouldn't be practical.

 

I am not too sure how hard she tried though and haven't managed to research it as yet.

[Rockingchaircat]

Having also worked full time while trying to taper and live off of the stuff- I recommend that you continue to do what you've been doing Monty. 

If it was me- I'd worry about getting fully off - AFTER I'm in a place where I can do it. During college studies isn't that.

 

I wish you the best on  your journey. And keep in mind that even with the lowest dosage of the crap- it's still greater than none at all.

[Monty]

Thanks Rockingchaircat, I certainly want to taper off but do plan to stay on 5mg for a while yet. It'll likely be a couple of years until I've finished my study.