☼ Brighteningup - Tapering off citalopram - advice welcome

[brighteningup]

Just a post to introduce myself - hope I've posted this in the right place.

 

I've been reading posts here for a couple of weeks here and find the advice and comments really helpful. You seem like really caring and supportive people.

 

Compared to some other people, I've only taken a low dose of citalopram (20mg) for a very short length of time.

 

In the early stages it may well have helped, but side effects were no fun - the worst were insomnia (light sleeping), lethargy and confusion. So after 6 months on the drug, with my Doctors agreement, as I was feeling much revovered from depression, I've started to taper off; I've been doing this for about 3.5 months now.

 

I want to taper as safely as possible to avoid side effects. Every time I've stepped down in dose I've had some improvements - I'm getting my emotions back and confusion and lethargy are much improved. However, there have also been side effects, mostly headache, earache, chronic wind and vivid dreams though these have been bearable and have subsided each time.

 

I'm now in the final phases and struggling to cut the pills down smaller than 2.5mg (the 2.5mg are quarters, cut with a pill cutter, of a 10mg tablet - a 10mg tablest is the smallest I can get prescribed - the liquid form available is apparently strong and could not easily be split into small portions my GP says).

 

I was considering taking 2.5mg every other day, though I just spotted the warnings against this on this site and am not now.

 

Incidentally I tried not taking one this morning and by the afternoon had a chronic headache so I've not taken a quarter but shaved down a bit.

 

Any hints or advice on the best way to finish off this tapering would be very gratefully received.

 

All the very best,

 

Brighteningup.

[summer]

Hi Brightening... welcome to SA.

 

Your doctor is wrong. Many people use the liquid form, especially at the lower doses. I'm tapering citalopram also, and tossing around taking the liquid. I don't see why you can't take the pill and the liquid also. If I'm wrong, someone else will chime in I'm sure.

 

Don't skip days - a really bad idea!

 

Just my opinion - but, if your taper thus far has been tolerable, I'd wait a month or so after your last taper, and then I'd just stop taking it altogether.

 

Good luck whatever way you decide to do it!

[Altostrata]

Hello, Bright!

 

summer is correct. How long have you been at 2.5mg?

 

What was your previous rate of taper?

 

You might wait a bit to see if the withdrawal symptoms you're suffering so far abate.

[brighteningup]

Hi Summer and Alto,

 

Thanks for getting back so quickly.

 

As I'm in the UK, I can only get drugs prescribed for me by the GP, but I'm sure if I was to specifically request the liquid from the doctor, she'd be happy to prescribe it. I'm not sure on the precise type of liquid form available, the doctor was looking it up and said it would be difficult to measure small doses accurately - I dont' know if this was right.

 

I've been tapering about 3-4 weeks per step down, I haven't been monitoring it precisely. I've gone 20mg to 15mg to 5mg now 2.5mg. I was getting the withdrawal symptons within about 3-4 days I think and then I think they were tailing off by about 2.5 weeks.

 

I've only been on 2.5mg for a week so far - so thinking about how I've been so far, it's probably a bit too quick to start trying to cut down further.

 

When my doctor suggested I might be able to finish off the taper in a fortnight I was keen to give it a try. She also suggested I could do this at 5mg every other day - and I wasn't sure about so cut the pills into quarters instead.

 

(I hasten to add my GP is great, she's happy for me to taper however works best for me, she just doesn't seem understand the best way to taper that well). [As a side point how can we educate our doctors better?]

 

I think maybe it was a mistake thinking I could do the last stage so quickly - just keen to get off them now...

 

Summer, your suggestion to carry on at 2.5mg for a bit sounds like a good one. I'll try this for another 2-3 weeks I think and see how I can go.

 

I can then, as you suggest try stopping altogether, and if this brings problems go back to my doctor and ask some more searching questions about the liquid form. I don't think I could get the tablets into eigths, their tiny as it is

 

Thank you again so much for your advice,

 

Brighteningup.

[summer]

After reading that you have been on 2.5 for a week now, this is what I would suggest:

 

The goal is that you want to be off this medication as soon as possible. However, I'm sure you want to feel good during your taper and after. You've been fortunate that your WD symptoms have been bearable - very similar to mine. I would stay where you are now (2.5) for at least another six weeks. For some people, their symptoms don't even begin for several weeks. This will give your body a chance to adjust to this lower dose. If, in six weeks you feel you have stabilized, I would just stop it altogether. Just an FYI, my daughter slowly tapered and stayed at 2.5 (starting dose 10mg) for three months, and then stopped. She is totally fine and feels great.

 

As far as educating doctors, that discussion is ongoing here. Keep reading.

 

Again, lots of luck... and don't hesitate if you have any more questions.

[Patience]

I can then, as you suggest try stopping altogether, and if this brings problems go back to my doctor and ask some more searching questions about the liquid form.

 

Hi Brighteningup,

 

I wouldn't recommend you wait until you're having problems to go back to your doctor. I've read about others who, while in the throes of withdrawal, go back to their doctors seeking relief, and take whatever the doctor suggests. That's how a lot of people end up on more drugs and higher doses when they taper too fast.

 

I tapered off Celexa (citalopram) over about 11-12 weeks. I went from 5mg to zero in mid-February of 2008. The withdrawal felt somewhat manageable, but by June, I was having horrendous anxiety. I had some Xanax on hand before tapering because I knew I could get in a bad state (I only needed 1/2 tablet to get through it, thankfully).

 

I also learned through my numerous attempts to quit to never throw the pills away just because you think you're done with them. I've had to make lots of desperate phone calls to my doctor's offices over the years to get back on the drugs. I was lucky back then because poly-drugging wasn't the norm yet.

[Altostrata]

bright, summer and Patience have good suggestions.

 

As summer said, the purpose of holding at 2.5mg for 6 weeks is to see if worse withdrawal symptoms develop from your previous reductions. If they do, that will give you an indication as to whether you need the liquid to taper off.

 

If they don't, it could mean your system can tolerate a faster taper.

 

It doesn't seem that jumping off now is the most cautious course. If you can handle it, I'd stay at 2.5mg for a bit.

[brighteningup]

Thank you all for your advice.

 

Sticking at 2.5mg for 6 weeks sounds like a really good plan.

 

As you say, if after the initial withdrawal symptons I seem to be fine then I can then stop.

 

Here's to hoping it works out ok. Summer what you said about your daughter is really positive

 

And my thoughts and compassion to all of you suffering with bad symptons right now. I hope you all have many more good days than bad.

 

All best,

 

Brighteningup

[brighteningup]

So it's now a week on I realise, which means 2 weeks at 2.5mg.

 

The earache is gone though my ears still feel a bit weird - like their under pressure.

 

Sleep is improving a bit.

 

However, now I'm feeling really vulnerable, and I really don't want to do anything, go anywhere, or talk to anyone. I also was feeling pretty exhausted.

 

This morning I gave in and went back to bed - not sure if this helped, I feel less tired but more vulnerable.

 

I would say maybe this was because my anxiety levels were high for various reasons in the previous week, and now those external pressures are gone i'm feeling a bit flat (this has been a comon cycle for me for years).

 

EXCEPT (and now I wish I'd journaled this somewhere) I think I had much the same experience when I stepped down dosage before. Certianly since I began to taper i have days when all i wanted to do was go back to bed.

 

I don't think this is just the depression coming back because I never used to feel like that BEFORE I went on the ADs. My depression used to come in waves, but was always quite short lived, I would feel really rubbish for about an hour, it would pass and I would be able to carry on with stuff - not this kind of scared lethargy that lasts all day I've been getting sporadically over the months I taper off the pills.

 

Any thoughts from anyone on this?

 

And any tips for feeling really scared and vulnerable. I'm not good at just sitting with and accepting negative emotions I find it really hard, although this is what my psychologist has been encouraging me to do (and I think she is probably right) my gut reaction is try and push them away (this doesn't work they come back and bite me later).

 

It's just no fun feeling scared like this and I find it really so hard to motivate myself, everything feels like hard work.

[Nadia]

Hi... I know just what you mean about how everything feels hard, like so much effort. And how difficult it is when you feel like rubbish and vulnerable. I think the acceptance way IS the way to go, but it does not come easily or immediately. What you posted about self-compassion yesterday really helped me, though!

[Altostrata]

Well, brightening, your system is adjusting to the lowered dosage with mild withdrawal symptoms. Since they seem to be improving, that's a good sign.

[brighteningup]

Thanks Nadia and Alto,

 

And I'm glad the withdrawal symptons are mild.

 

Here's hoping it stays that way.

[summer]

Yes, I agree... mild withdrawal symptoms. I seem to get mild symptoms about 2-3 weeks after a drop also. Some say to go with it, others find outlets. Do what feels best.

[brighteningup]

Not sure if this belongs in the intro and updates section or somewhere else, I'm putting it here as it seems to fit best - please move it if it's in the wrong place.

 

I've been reading people's stories about their experience with AD withdrawal. I feel for you all and hope things start to improve greatly soon for those of you still suffering.

 

I'm so glad I found this site and can take your expert advice on tapering off the AD I'm on, and hopefully this will protect me from any possible long term withdrawal effects.

 

Thinking about it I'm very struck by how your experiences with attitudes of the medical proffession, and how their solution is often to give you more of the same style of drug (but a different brand or weaker) even if it may be causing more harm than good, in some ways parrallels my own for another drug - topical corticosteriods.

 

Whilst my experiences have certainly not been anything like as serious as some things some people have experienced as a result of taking ADs and Benzos, and then not having withdrawal recognised, discussed on this site, there are, I think some disturbing similarities.

 

I have a very rare genetic skin condition that looks a bit like excema, and a bit like some other skin diseases but actually is much much rarer. It makes my skin blister under friction. It's not caused by allergies or diet, although these can make it worse, but actually because my skin cells work slightly differently to most peoples.

 

It does not usually manifest itself until your mid 20s and then often gets mistaken for eczema. This is what happened to me. I was intially prescribed very mild topical steroids - they didn't work very well. Then a stronger topical steroid which did work and I used for about a year, before I was advised it was not a good idea to use it long term by a GP (wise advice I should have listened too later, but no other alternative treatment strategies were offered).

 

In my early 30s, as symptons worsened, I was finally referred to a dermatologist, diagnosed with the condition I have, and prescribed a very strong topical steroid to use (Dermovate - it's about 600 times as strong as hydrocortisone). I wasn't warned about dangers of frequent usage, I asked about it at the time, and pretty much got a shrug of the shoulders.

 

As the condition worsened I used the drug more and more, I used it regularly at very strong doses for about 3 years. I also made lots of lifestyle changes over this time, changing the clothers I wore, the way I walked, the exercise I did, which did help too (probably more than the steroid did....)

 

My skin began to show signs of thinning (an accepted and well documented problem with prolonged use of topical steroids) so I was encouraged to go onto a slightly milder (but still pretty strong - about 150 - 100 times as potent as hydrocortisone) topical steroid and I tried to use it less regularly (but still was using it at least 3-4 days a week).

 

About 2 years ago I had blistering so serious I couldn't walk. I discontinued the steroid for a week, sat very still and used a rather odd treatment given to me by an elderly dermatologist which helped dry and repair the skin. About 6 months later I had another really serious outbreak, I had moved area by then and an insightful young dermatologist sugested I might have an allergy to the medication I was using - turned out I was allergic to one of the ingredients in the topical steroid I was using so I switched to a lower dose and different steroid again.

 

About 10 months ago, as nothing seemed to be working well in the area where I'd used the most steroid, I swapped to a topical steroid with a much lower dose (2-25 times hydrocortisone), and simplified my treatement to a powerful anti-septic wash and powerful anti-microbial / anti-bacterial ointment to keep the skin infection free. My skin began to slowly noticebably improve. By then I was getting all sorts of problems with low mood, mood swings, tiredness, and muscle aches. I'd had these off and on over the previous eighteen months as I reduced the steroid, blood tests had showed I had no thyroid problems or any obvious problems, so I put the symptons down to not doing enough exercise and being unfit, and getting depressed because I was struggling to manage the skin condition, and also being stressed by my postgraduate studies. I did also later find out I was vitamin D deficient so this may also have contributed too.

 

By November 2010 things had got so bad I crashed out and ended up on an SSRI for the depression.

 

Googling very recently I have found that the area in which I mostly use the steroid (the groin) may be an area that is more likely to absorb the steroid than many other areas, so this may mean that I may have been exposed to side effects usually only likely if you take steroids orally. (It's a reliable site that gives advice to the New Zealand dermatology profession and is well respected by a number of dermatologists I've talked to).

 

I also read on the same site "Potential side effects from reducing dose {of corticosteroids} include tiredness, headaches, muscle and joint aches and depression" - Hang on a minute this sounds like an exact description of the symptons I've been having since reducing the level of topical steroid I use and ultimately led to me being put on yet another drug - this time citalopram.....

 

Ho hum, doesn't this story sound disturbingly familiar...

 

Bright

[Altostrata]

It sure does sound familiar. Sadly, medical science is limited. We are taught to trust the judgment of doctors but have to learn to listen to our own bodies -- a forgotten skill.

 

Good for you that you finally figured it out, bright.

[brighteningup]

Thanks Alto and thanks Summer for your kind words elsewhere.

 

Listening to our bodies is a lost skill indeed.

 

I've been looking into things a bit further and think it's quite likely that my prolonged use of potent to moderate topical corticosteroid as completely messed up my cortisol delivery system, I hope that it's starting to recover now but don't know what the long term effects will be especially as I may still need to use the corticosteroids (in moderate to low dose) to manage my skin condition.

 

I was so angry the night before I couldn't sleep for 4 hours.

 

 

I've calmed down and am now thinking about what I can do practically to help myself.

 

Sucks though..

 

I think I finally understand emotionally one of the reasons this AD prolonged withdrawal (and any other prlonged withdrawal / side effects from meds) is so tough for so many, I got it intellectually before, but not emotionally ...it's the fact that the medicines that are actually supposed to help have actually made things worse - this isn't what we're told medicine should do...they're supposed to make us all better...it's not what we've been led socially and culturally to expect...it's a huge betrayal

[Altostrata]

It's really hard to come to grips with the betrayal, Bright. But turn your anger into action, educate yourself and others, get some good out of it.

[alexjuice]

It's really hard to come to grips with the betrayal, Bright. But turn your anger into action, educate yourself and others, get some good out of it.

 

I second this.

 

I'm sorry about your situation, bright. It was a shock to really understand what i've learned -- Doctors and scientists are people. People are people. & Science ain't (always) exact science.

 

Alex.i

[Rhiannon]

 

It's really hard to come to grips with the betrayal, Bright. But turn your anger into action, educate yourself and others, get some good out of it.

 

I second this.

 

I'm sorry about your situation, bright. It was a shock to really understand what i've learned -- Doctors and scientists are people. People are people. & Science ain't (always) exact science.

 

Alex.i

 

I third this.

 

Still struggling with anger and grief--right now it's mostly anger, about being used for profit by the pharmaceutical industry. My wasted life is just a little piece of some pharmaceutical CEO's third vacation home. That's all my 20 years, my children's suffering and the impact on their entire lives of having a mother who couldn't be there for them, the impact of that on my grandchildren as well, and so on and so forth... is worth, to them.

 

But on my better days I think at least it does motivate me to spend time on these forums and maybe I help others a little. If even one person avoids my fate, it's one life saved, a life worth a lot more than a little piece of somebody's third vacation home.

 

Also have to add--the problem isn't even that science isn't science. Science, when practiced as real science, is pretty effective. The problem is, what's being practiced isn't actually science.

 

But that's another long story. Another day.

[brighteningup]

I have taken your words to heart and done some further research in cortisol and SSRIs.

 

As I think other people might be interest in this I've put this in a do it yourself editorial post here.

 

And yes scientists are people, I'm a postgraduate research I SHOULD know this! Somehow the men (and women) in white coats still have a hold over me though...

 

Rhi, I really feel for what you have suffered, there is so much for you to be angry about.

 

 

Also have to add--the problem isn't even that science isn't science. Science, when practiced as real science, is pretty effective. The problem is, what's being practiced isn't actually science.

 

 

Yep, from what I've read this is so true.

 

Lets hope that sites like this raise awareness and help a bit.

 

Felt physcally rubbish today (almost flu like symptons) - very similar to when I first started taking the AD.

 

So seems like sticking at 2.5mg for more than 2 weeks as originally advised here is a very good idea, look slike my body is going to need a bit of time to adjust.

 

On the plus side mind seems to be working better so inspired to post something long here...

[Nadia]

I'm glad you have improvement in some areas even as you have additional symptoms in others. Good idea to go slowly... hopefully it will pay off later!

[Nadia]

I'm glad you have improvement in some areas even as you have additional symptoms in others. Good idea to go slowly... hopefully it will pay off later!

[brighteningup]

Just to give an update and to request some further advice.

 

I was feeling much better over the weekend and went away for a short break which was lovely Tues 30 - Wed 31.

 

But I've possibly now managed to make a mistake in tapering approach.

 

On Tues I forgot to take anything, and when I realised decided not to head back home to pick up tablets, I was feeling good, it would have meant losing a couple of hours of a well earned break to driving back home...possibly the wrong decision I know but so far the withdrawal symptons have been relatively minor so I decided to risk it.

 

On Wed when I got back I decided rather than go back to 2.5mg having missed a dose, I would cut tablets into eighths, roughly, and just take an eigth for next two weeks rather than hold at 2.5mg as I'd previously planned.

 

I figured allowing for half life, which for some reason for citalopram I have in my head is about 36hrs, it might be gentler now there was less in my system to continue at a lower dose.

 

Today I seem to have picked up a cold/fluey type infection. Sore throat, aching weak limbs, tired, bit snuffly. I'm presuming this is an infection not withdrawal symptons. I can't tell for sure as I've had mild flu like side effects from withdrawal too.

 

So any thoughts if I should now stick at the approx 1.25mg (eighth of a tablet), for a couple of weeks; go back up to 2.5mg; or just come off them altogether now.

 

My concern is that it's quite dificult to be accurate in getting an eighth of a tablet so I could end up on rather variable all be it small dosage, so in that case would I do better just to come off them. Stopping now would mean I had been on 2.5mg for about 4 weeks (which given I was only on citalopram for 6 months in the first place kind of sounds ok - but from what I've been advised so far might also be too quick).

 

Stopping now is attractive, as if I'm going to get a further wave of withdrawal symptons I'd like to get them out of the way if possible before I fly out to the US for a fortnight on 10th October. So far withdrawal symptons seemed to have lasted about 3vweeks for me at each step down - varying as to exactly what they are before pretty much fizzling out. Giving myself 6 weeks before I go away to let the drug fully clear the system is tempting, though I know some people seem to be still hit for a while by WD after they stop, even when they've tapered and this is can be worse for faster tapers.

 

Alternately does it make more sense to go back up to 2.5mg, approx quarter tablet, as it's easier to cut into quarters, so the dose might be a bit more stable, and hold for another fortnight then stop.

 

Or should I even hold until after I've been away, all the way through October. (tho taking quarter tablets on the plane might not be possible cos of all the restrictions on carrying stuff on international flights, and so I'd have to find somewhere selling a pill cutter pretty quick when I got out there. This feels like a big hassle, but then I'd rather have some hassle rather than prolonged withdrawal...)

 

Any thoughts, views, on best course of action at this stage?

 

Bright

[Altostrata]

Half-life of citalopram is around 35 hours.

 

If I were you, I'd go back to your prior dose, 2.5mg, and continue the gradual taper.

 

You may be able to get liquid citalopram to taper at smaller amounts, or make a solution with pills and water.

[summer]

I would just stop. My daughter stopped at 2.5mgs almost two months ago, and she is fine.

 

You may get some WD symptoms, but at this point you can handle them. No expert tho... just what I would do.

[Altostrata]

Wait, wait -- what happened to the 6-week plan?

[summer]

Wait, wait -- what happened to the 6-week plan?

 

Alto... not sure if you are talking to me or Bright?

 

In any event... you are probably right on about the 6-week plan. I so would not want to lead anyone down the wrong path!

[brighteningup]

Thanks for the advice I'll err on the side of caution.

 

Am now back up to 2.5mg for now. Am getting quite good a gettting fairly even quarters.

 

I've decided that I'm going to talk to a pharmacist at the weekend about getting liquid citalopram, what doses are available in the UK, can I mix with water, does it need to be distilled water, could they pre-mix a diluted version, etc.

 

This gives me the option of a slower ending to the taper if I want to, and I'd be able to get the liquid onto the plane easy enough provided I have a doctors letter to go with it (this avoids messing around with pill cuttters - they definately will not be allowed on a plane).

 

If I do decide to switch to liquid form it looks like I'm going to have a similar problem to that which Phil has with Lexapro (escitalopram). My GP has been telling me I can only get it as a liquid at 40mg/ml.

 

Checking on the UK medicines info site, a useful source of info for medicines available in the UK it looks like the GP is right, citalopram in liquid form is only available as citalopram hydrochloride (it's citalopram hydrobromide in tablet form but I guess that won't make much difference) and yes it's only available at 40mg/ml.

www.medicines.org.uk/guides/citalopram%20hydrochloride/anxiety

 

These drug companies / whichever body in the UK has decided we don't need a lower dose liquid available, really don't make a slow taper easy do they!!

 

Thanks for the advice.

 

Bright.

[brighteningup]

Had a word with a pharmacist over the weekend, was told they WERE able to get a lower strength of citalopram in liquid form, 20mg per 5ml, but it would need to be prescribed by my GP and ordered in specially.

 

 

They are not allowed to premix to a weaker strenghth the 40mg per ml preparation. Guess there must be some difference in licensing between UK and US here- I'm not aware of a UK equivalent of the compounding pharmacy.

 

Good to know, however I've decided to try stopping altogether on Friday, this'll be about 6 weeks, and see how I go.

 

If I get difficult WD symptons I'm quite prepared to reinstate at either 2.5mg, or if need be 5mg, liquid and taper down more slowly, hopefully I can get my GP on side with this when I see her on Friday.

 

Have a rotten cold just now, which seems to be really difficult to get rid of.

So feeling very lousy and sorry for myself just now (definately a cold not WD, my husband has had the same thing just didn't seem to hit him so hard).

 

Is there any evidence that your immune system gets a bit weaker during tapering down from ADs?, I seem to think I read this somewhere but probably imagined it. Brain somewhat woozy with cold just now.

 

Bright

[Rhiannon]

Bright, good luck, keep us posted!

 

I'm tapering citalopram by dissolving the tablet in water, so there's always that as a last resort, if you find you need to reinstate and taper by smaller amounts.

 

However, given your success so far, I think there's a good chance you'll be able to get through your withdrawal in a few months and move on with your life.

[Altostrata]

Seems like a plan, Bright, good luck! Please let us know how you do.

[brighteningup]

Thanks Alto and Rhi,

 

I'll keep you all updated.

 

Bright

[brighteningup]

So today is the first day now full off citalopram.

 

Will let you know how it goes, probably try and report back in a week.

 

Bright

[Altostrata]

Excellent!

[brighteningup]

Just a quick update.

 

It's been just over a week off (approx 10 days) off ADs now.

 

And generally I'm doing pretty good.

 

Physically I've had virtually no symptoms, possibly a little wind but nothing else.

 

My sleep is pretty good (despite the fact my skin is acting up and is a bit sore which can wake me up).

 

My energy levels are slowly improving - on a daily basis.

 

My emotions still seem to be a bit raw, and a bit up and down, - I'm not sure how much this is due to WD and neuro-emotion and how much just a recovery from the system shock of my initial mini-breakdown and then the ways (initially positive and then negative) that the ADs affected me while I was taking them.

 

It still feels like my emotional system is re-setting.

 

My biggest issue now is lack of self-confidence both in my mental and physical inner strength - not quite sure how best to rebuild this (will post elsewhere in the symptoms and what helps to see if anyone has ideas).

 

But the the really good news is, apart from the feelings of vulnerability and mood swings (some which is probably still fallout from the things going back years that led me to depressed and anxious in the first place), so far no bad side effects from being off the ADs at all, in particular no nasty physical side effects. So far, seems like the slower taper has worked really well for me.

 

I can feel my mind starting to get back up to speed and that's a really great feeling.

 

All best,

 

Bright

[summer]

I'm happy for you, Bright, and can't wait to be where you are!

 

Keep updating us... it's great hearing from you and knowing how you are getting along.