Emphyrio My prozac and citalopram purgatory

[Emphyrio]

Hello, thought I'd post here as it seems like a fairly supportive place. Here's my story...
 
 
In 2003 I was put on 20mg of prozac for instrusive thoughts (mainly the fear that I would lose control and attack others). It improved my mood, however, it did cause emotional blunting. Incidentally, it didn't have any effects on either sexual function or cognition, so I was happy taking it. I was able to function fairly well whilst taking it.
 
 
I then stopped it (cold turkey) for 8 months in 2008. Had no physical withdrawal symptoms, but I did feel really depressed for all the time I was off it - more so than I had been before I started taking psych-meds. I then went back on it and experienced some minimal start up effects - was then largely back to my old self. Could work, enjoy life again, etc.
 
 
However, around 2010 to 2011, I started to find that things weren't so great. I developed really bad IBS around that time - frequent bowel movements, lots and lots of wind and bloating etc. At the time I just tried to bear it/treat it with things like peppermint oil, probiotics etc - I didn't think it could be related to the prozac (now I suspect it was).
 
 
I also started to become a bit more anxious around that time. I felt more on edge, felt very fidgety, even had some days where I had the fear of harming myself or others again. As I felt the prozac was quite activating, I felt that it was contributing to me feeling on edge. So in August 2011, I switched from fluoxetine to citalopram. The doctor told me to wait 3 days after stopping prozac, then go for 10mg cit, rising to 20mg after 10 days. I think I lasted around 2 weeks before feeling incredibly agitated with the intrusive thoughts affecting me badly. The doctor told me to stop the citalpram for the time being and gave me a small supply of diazepam to take if things got worse. However, I didn't need to take it, as after a few days of quitting, I felt much calmer. I told the GP that I wanted to remain drug-free for a while. I felt great for a while - no agitation, yet by December, the depression had kicked in again...so I went back to the GP and asked for citalopram again, and that's when the real fun began...
 
 
I took 10mg of citalopram from December through to late January - probably around 6 weeks maximum. However, I found that I had quite bad agitation around the 5-6 week mark, which was probably just when the drugs were starting to kick in. Aside from that it had minimal affects on sexual functioning, cognition and vigilance  So I then stopped taking it. I thought that cold turkeying would be fine given I'd only been on it for 6 weeks. I experienced some mild brain zaps, and then thought that the worst had passed.
 
However, the intrusive thoughts came back with a vengeance around 6 weeks after stopping it. They were really bad this time - I felt unbelievably agitated, felt like I was about to lose control, etc. In desperation I went back to the GP who prescribed clomipramine. I lasted 11 days because of bad IBS, anorgasmia, and nasty blurred vision. I then decided to go back onto 20mg prozac again as it seemed to have worked in the past. However, I experienced nasty agitation as my body was getting used to it - also, this time it gave me really bad sexual dysfunction. I took it around late July 2012, cutting down to 5mg by early November. It worked well for depression, but didn't touch the intrusive thoughts - I still had the 'pure OCD' thoughts of harming myself and others. I also had sexual problems on 5mg, so I quit at 5mg. Didn't have much in the way of physical withdrawal. Lasted around 3 months before the depression kicked in. In addition, even though I was off the drug, it seemed to have messed with my sexual function. It was ok one week, but non-existent the next. Kind of like some kind of PSSD. It was affecting my studies, and although I didn't want to take any more drugs because of my experience with citalopram, I decided it would be the best thing to do.
 
So, in March this year, I tried sertraline 25mg. I was going to give it a good couple of months but had to quit at 4.5 weeks because it literally made me stupid. I was sleeping 10 hours a night, had really blurry vision, so had to stop taking it. I just couldn't study/function like that. Incidentally though, it led to improved sexual functioning for some reason.
 
I knew that the depression/pure OCD thoughts would return unless I was on something else, so I went back on citalopram, this time at 5mg. After a month, all the intrusive thoughts were gone. I felt sedated, could drink coffee again, and it improved my mood too. However, the problem was, was that citalopram had caused visual problems just like the sertraline had. While not as bad, they were still annoying and prevented me from studying as well as I wanted to. Around 6 weeks ago I made the decision to cut 25% - I know this was a big cut, but I figured that since I'd been on it for a few months only, it would have been ok. However, while it improved my vision, around a week ago I felt the intrusive thoughts/anxiety returning again, so have updosed back to 5mg/day.
 
I am therefore in a bit of a dilemma. While ideally I want to get off these drugs, using the 10% taper this time, at the same time, 5mg of citalopram, whilst working well for anxiety and depression, has also meant that I can't function as well as I want to. I'm a postgraduate student and have to use a computer a lot. Also, I'm coming to the end of my course, and will need to find a job soon. I'm not sure how I can support myself for several months that it will take to drop from 5mg to 3.75 or lower, which is when the visual problems become less of an issue. I may even have to go slower than 10% of my previous dose each month.
 
I have a number of questions I'd like to ask you all:
 
1) Why is it that when taking prozac again last year it caused sexual side effects when previously it had not? (ps - I have had a blood test and everything, inc testosterone, is ok)
 
2) Is it possible that the 6 week spell of citalopram last year, followed by the cold turkey, changed my brain in some way? I'm saying this because I didn't have the blurred vision on citalopram when I took it for 6 weeks at 10mg, but do now at 5mg.
 
3) Would a switch to 2.5mg of escitalopram be a possible solution? I really don't want to take any more drugs, but I'm thinking that because escitalopram is so similar to citalopram, it may be ok to switch over (and could possibly have fewer visual side effects).
 
Many thanks for reading.
 
PS: I know that I was put on these meds for a reason, and that reason still remains. However, at the same time, the feelings of tenseness and agitation (which trigger these intrusive thoughts) are considerably worse than they were before taking meds, which leads me to think that the meds have messed up my brain in some way (part of me worries that its permanent). However, I am working on the deep seated issues with counselling and self-CBT.

[Altostrata]

Welcome, Emphyrio.   Over time, these drugs change your nervous system. Their effects on your nervous system change as well.  

 

It sounds like you have been fairly consistently overdosed with SSRIs. The activation you experienced from Prozac and citalopram are adverse effects from too-high dosages. This can also affect your nervous system adversely. It sounds like you got progressively more sensitized to antidepressants. If I were you, after you get free this time, I would never, ever consider taking them again.  

 

As reinstatement with a small dose of citalopram helped, this indicates your former symptoms were due to withdrawal.  

 

Lexapro is a drug related to citalopram that, milligram for milligram, is about 2 to 3 times stronger than citalopram. You are likely to react badly to that as well.  

 

Citalopram comes in a liquid, which aids very gradual tapering. This may keep you on an even keel. See http://survivingantidepressants.org/index.php?/topic/2023-tips-for-tapering-off-celexa-citalopram/ and other topics about citalopram in the Tapering forum.

Edited February 11, 2014 by Altostrata
fixed text

[Jemima]

Hello, Emphyrio~

 

I'd like to add that the changes in your nervous system from these drugs are temporary.  The CNS does take quite a while to right itself after the drugs are out of the body, however. I tapered off Lexapro way too fast in mid-December of 2011 and I'm not quite over all the effects yet. At this point I'm mostly suffering from emotional numbness and a lack of motivation to do much of anything with my life. I'm getting little glimmers of my old self from time to time, but I'm not altogether back there yet.

 

As for Lexapro, I agree with Alto.  It's a very strong drug and highly stimulating. Likely not a good idea.

 

Welcome to the forum.  You'll find lots of good information and friendly support here.

[Emphyrio]

Thanks for the replies and sorry for the delay at getting back! Been so busy with things lately :S

 

I have switched back to 5mg of prozac since around a month ago. I know I should have continued to taper off the citalopram, but the visual side effects and general cognitive dysfunction were too great to handle. Basically, I have been under a fair bit of pressure with my studies, and need to think about getting a job in the near future to survive. I had been back to 5mg of citalopram for 2 weeks after the 6 weeks on the 3.75mg - I then switched directly to 5mg of liquid fluoxetine.

 

I have found that providing I don't drink too much coffee or alcohol, I don't feel too 'energised' by the switch. The reason why I went back to fluoxetine was because it doesn't have any noticeable cognitive/visual side effects and should be easier to taper from.

 

Alto - is it possible to become sensitised to antidepressants whilst stable on a certain dose? The reason why I ask this is that I used to be able to cope with prozac easily in the past - no restless legs etc, but in the last year or so of taking it (always at 20mg) I started feeling much more restless. I also wonder whether its a GABA/Glutamate imbalance - you see, I've always drank moderate amounts most nights, but noticed that I was starting to feel more agitated the day after drinking, suggesting some kind of glutamate rebound. I had no alcohol last night and feel a lot calmer than I have done on previous days. Rather than a sensitisation to antidepressants, could my alcohol and possibly caffeine intake have possibly caught up with me? 

[Altostrata]

Your system may have been sensitized by prior adverse reactions and the switch. This affects your reactions to Prozac, caffeine, alcohol, etc.

 

It sounds to me like the Prozac dosage is slightly too high for you. If I were you, I'd try taking a bit less. And I would avoid caffeine, alcohol, etc. -- anything that causes you to feel odd -- for a good long time.

 

Listen to your body and take care of your nervous system.

[Rhiannon]

I'd highly recommend you take a look at Anatomy of an Epidemic by Robert Whitaker. I think it might answer some of your questions.

[Emphyrio]

I think maybe its a little too high, but I think that 5mg is the point where these medications are benefiting my depression/anxiety/OCD. The plan is to get some stability back in my life where I don't have to worry about money, deadlines or the future - before I consider a very slow taper off this.

 

I know that the c/t off citalopram back in early 2012 sensitised my system greatly - even though I only took 10mg for 6 weeks. I came off this dose because of high levels of restlessness/anxiety, believing that the start-up effects should have finished after 5-6 weeks. I believe that 10mg was probably too much for my system.

 

However, I also believe that there were issues when 'stable' on 20mg of prozac. I guess prozac had always made me a bit more 'energised', but in summer 2011 I was feeling very restless, and had a return of my OCD thoughts. I have three possible theories why this happened:

1) Too much caffeine and alcohol had unbalanced my gaba/glutamate levels.

2) Situational stress and anxiety was manifesting itself in a physical way.

3) My metabolism had somehow changed meaning that 20mg of prozac was too stimulating whereas beforehand it was fine.

 

Any other ideas?

[Emphyrio]

Anatomy of an epidemic is on my 'to read' list at some point. I did read something which Peter Breggin wrote which made me quite worried though. He spoke of something called 'tardive dysphoria' whereby on cessation of the antidepressant, serotonin receptors do not return to their 'pre-medication' state.

 

I previously C/T'd prozac in 2008 - I lasted 8 months but experienced bad depression over this period, which resulted in me having to reinstate. I guess I'm worried that even with a slow taper, that I may be dependent on antidepressants for the rest of my life.

[Altostrata]

Those researchers have been unable to distinguish "tardive dysphoria" from withdrawal syndrome.

[Emphyrio]

Do you think that 4mg of prozac is probably a better bet? My goal is to be off all meds. I'm thinking that the 5mg has been quite 'activating' so far.

 

If money/time wasn't an issue, I would have stayed on 5mg of citalopram and tapered off that slowly. But it was causing so much cognitive dysfunction/visual side effects that I had to come off it for the sake of finishing my studies. I also have to get a job asap as my money is low.

 

Cognitive dysfunction and visual problems vs anxiety/restlessness? What a choice to have to make. Of course, I could go back to the doc, but I really don't want to have more meds (probably an SNRI this time) thrown at me.

[Altostrata]

You might try 4.5mg so as not to rock the boat too much. Prozac comes in a liquid.

[Nikki]

Hello and welcome....

 

When I first started having panic attacks and major anxiety (and didn't know what it was) I was referred to an infomercial that my mother saw.  It was "Attacking Anxiety and Depression" By Lucinda Bassett.  It is one of the best things I ever did for myself.

 

There is a CD in that program titled "Obsessive and Scary Thoughts."  Harming ourselves or someone else, fear of being around knives, tearing out clothes off and running down the street screaming, etc.  There are so many of these 'scary thoughts'.  When I read the book and listened to the CD I realized what was happening.

 

It is anxiety and it is our minds way of distracting us from what is really bothering us which is anxiety.  Crazy but true.  All made sense and then the obsessive and scary thoughts went away for me.  I remember being home alone and dicing green peppers and being overcome with this fear of having a knife in my hand.  It was awful.  Sheer mental torture.  It is anxiety.

 

When I understood it, it went away.  When I was tapering Lexapro and having a hard time with that, the fear of knives came back because the anxiety from tapering was horrendous and I had an association.  Associations are big with someone who has anxiety.  So are irrational fears.

 

No one really ever acts on these obsessive thoughts, we just drive ourselves into the pits of despair with them.  And believe me I scared myself so badly when that happened and then I would cry because I thought I was losing my mind and became more fearful.

 

You can go onto Amazon.com and look up the material I have referred to.  It would be less money and it was sooooo helpful.

[Emphyrio]

Just an update and some advice needed.

 

Basically, I had switched from 3.75mg of citalopram to 5mg of fluoxetine in September last year. I was experiencing some considerable side effects on the citalopram including cognitive dysfunction, visual snow, pressure in my head, and dizziness. It had done an amazing job at getting rid of my anxiety (possibly withdrawal related - see later) but I was also unable to do my studies. I was staring for hours on end at the computer screen and not registering a thing. 

 

Time was running out regarding my studies. I also knew that I had to find a job in the near future. So rather than continue to taper off the citalopram, I thought I would make the switch to prozac as I hoped that my intrusive thoughts were serotonin related. It didn't go too well. After around 6 weeks or so on the prozac, I experienced a couple of days where I had extreme intrusive thoughts to the extent where I thought I would follow through with them. It was horrible. So I made the decision to see my GP. 

 

I decided that the most important thing I wanted was freedom from the intrusive thoughts - so in early December I started taking 50mg of fluvoxamine. I know there are non-drug ways of dealing with this, but in my case, I believe that the intrusive thoughts were medication/medication withdrawal related. I had a horrible constant feeling of panic too, really on edge, as if I would suddenly lose control and do things that I didn't want to do.

 

I've stayed on the same dosage of fluvoxamine since early December and am not doing too well to be honest. On the one hand, the intrusive thoughts (of a violent nature) are much reduced. On the other hand, I feel really restless - almost like an akathisia like feeling - I want to keep moving, feel my legs bounce around a lot, I'm clenching my jaw a lot, and have a constant feeling of adrenalin/feelings of doom surrounding me.

 

I guess I'm just asking for some advice. I know I should have stuck with the citalopram or fluoxetine and tapered off, but I would have had to suspend or cancel my studies and possibly had to rely on parents to survive (I was not capable of work). But on the other hand, now that I'm on fluvoxamine, I don't feel in a suitable state to work either. Along with the feelings of panic, the 'visual snow' which emerged around May last year (a month of returning to citalopram) has not gone away or reduced in intensity.

 

Could 6 weeks on citalopram 2 years ago really have messed my brain up that much? I'm assuming its some kind of histamine effect rather than serotonin effect, given that the prozac switch didn't work.

 

So I guess these are my options:

1) Stick it out on 50mg of fluvoxamine until I feel better (I've been on it for 2.5 months and still feel adrenaliny)

2) Lower my fluvoxamine dose and see if that helps.

3) Try other medications to attain some form of stability.

4) Go back on 5mg of citalopram and write off the next year/2 years of my life to coming off this slowly (and living with the severe cognitive effects)

[lespaul19]

Your causing your mind and cns chaos by switching around meds so often, you need to pick whatever you like , or hate the least I should say (I suggest staying on the Luvox since you have been on it for 2.5 months) I'm not familliar with Luvox dosages, is 50mg a high dose?

Anyways your body and cns needs stability which will not happen overnight, or week, possibly months, with some new pill, there is no magic bullet to stabilize, it takes consistency with doses and TIME to heal. I would stay on the Luvox for aslong as it takes to feel stable, and then you can start to taper. From what I know this would be your best bet. I hope alto or someone more knowledgeable than me can comment and give some guidance. I do know for sure though that you need to chose one plan and stick to it, no more hopping around!

[Altostrata]

It sounds like that dosage of fluvoxamine is too high for you.

 

To titrate fluvoxamine, see http://survivingantidepressants.org/index.php?/topic/5095-tips-for-tapering-off-luvox-fluvoxamine/

 

Your system may also have been further sensitized by drug switches.

[Emphyrio]

Thanks for the replies.

 

I really do want to get off these meds as (recently) they've done me more harm than good.

 

The thing is, the dilemma I'm in is that I have to be in a suitable position to work. If I have to move back home with my parents - I'll have to move away from my friends and girlfriend and live a couple of years in poverty while I wait for my system to recover.

 

Should I just accept the inevitable and stop trying to find a drug that can solve my issues (or at least get rid of this agitation/restlessness I'm experiencing?) Its really difficult to find 'non drug' ways of dealing with things when my brain is so messed up from SSRI use.

[Altostrata]

It sounds like the agitation and restlessness is caused by the drugs. Many people find antidepressants to be activating.

[Emphyrio]

Here's an update, and it's not great...

 

I should have listened and stopped switching/changing my medications about. IF YOU ARE READING THIS - DON'T KEEP CHOPPING AND CHANGING MEDS LOOKING FOR THE ANSWER - IT DOESN'T WORK!

 

So I was taking 50mg of fluvoxamine - I had a constant internal feeling of panic and anxiety - and I was still getting intrusive thoughts. I tried a low dose of quetiapine (12.5mg and 25mg) for a few nights - it just sedated me and didn't touch the agitation. I was getting frustrated with the fluvoxamine so decided to return to the 5mg of citalopram. I had been on 25mg of fluvoxamine for 1 week, 50mg for 8-9 weeks, then 25mg for a further week.

 

I had a couple of days off the fluvoxamine before I started citalopram - in these two days I actually felt great - the agitation/restlessness was much reduced. I knew however that this feeling wouldn't last, so then started taking 2.5mg citalopram, building up to 5mg after a couple of days.

 

However, the agitation/akathisia was even worse than when I was on fluvoxamine - I believe I may have had some kind of adverse reaction to it. I took it for 5 days, felt absolutely horrible - then decided to stop taking it. I was off it for a week - the akathisia continued, however, and I experienced a few 'brain zaps'. I decided that things may get even worse though if I stayed off it - so decided to start taking it again at 5mg and try to live through the side effects.

 

I started again at the beginning of April - and have taken 5mg since. However, the agitation and panic feelings remain. Around a month ago I experienced a lessening of the agitation/panic, however, it seemed to return fairly abruptly - the only explanation is that it was caused by a changing of the particular brand of citalopram - I have been unable to get my old brand however so cannot confirm this (the pharmacies in the UK have many makes of citalopram which they change from time to time).

 

In desperation I went to see a psychiatrist who suggested that I try pregabalin or 150-200mg of quetiapine a day. He believed that I could simply stop taking the citalopram and that the pregabalin would 'balance things out' - however, I was reluctant to mess around with my citalopram dosage. I have taken pregabalin for a week now (75mg twice a day) but don't think it is doing anything good or bad. I want to be free of all medications - however I felt so bad that I decided that taking something to reduce my horrendous anxiety/akathisia was a necessary evil - and that I could taper off this slowly once stabilised.

 

This is where I need your help - should I continue to take the pregabalin? I can go as high as 600mg a day - could this destabilise me further or could it help with this 24/7 panic/agitation/akathisia?

 

What about the citalopram? Is 5mg too high or too low? Should I try cutting to 4.5mg and therefore initiate a 10% taper?

 

The good things I can report however is that my cognition has returned and my sexual functioning is much improved. I wonder whether this is evidence that my brain has readjusted to the prozac withdrawal induced depression that I experienced in early 2013. There are so many factors involved given all the medications I've tried however part of me wonders whether this is some kind of 'mixed state' that I'm presently experiencing.

 

Any help/suggestings would be much appreciated. And while my goal is to be off all medications, I would take something if it meant I could escape this agitated state that I'm currently in, given that I could always taper off it later...

[Emphyrio]

PS: What happened to my original message? The formatting seems a bit messed up...

[Altostrata]

Fixed the original post.

Emphyrio, it sounds to me like you have been having an adverse reaction to citalopram. If I were you, I'd reduce it by 10% every 2 weeks and see if that helps.

Unknown if pregabalin will help. It could go paradoxical and make you worse. I would not increase it.

[Emphyrio]

Thanks for that Alto. I'll try your suggestion - I thankfully have a jeweller's scale in my possession which I bought last autumn when I thought about tapering off citalopram then. Unfortunately I was too impatient. 

 

You mention that I have had an adverse reaction - how then did I feel a lot better a month ago? I thought it was a sign that I had finally started to stabilise...but obviously not given how I am at present.

 

Would you say that use of propranolol is generally OK (whether prn or every day?) I ask because it does have a slight effect on my restless legs, though I do get cold extremities after taking it. 

 

The positive side of the story though is that I finished my PhD within 4 years - 2 years of which was spent in some kind of nasty withdrawal state. At least now that's out of the way I don't need to worry about any additional stress.

 

Incidentally, the depressed state I was in has completely cleared up. I'm surprised that the psychiatrist did not label me bipolar to be honest! Going by how my brain has adjusted to previous cold turkeys, I suspect I will need 18 months for my brain to readjust to any changes. 

[Altostrata]

This is an indication your current dose of citalopram is too activating for you. The drug changed, and your system was sensitive enough to react to it.

 

I would like to change my suggestion: I would try a 10% reduction for a month, see if it stabilizes.

 

I started again at the beginning of April - and have taken 5mg since. However, the agitation and panic feelings remain. Around a month ago I experienced a lessening of the agitation/panic, however, it seemed to return fairly abruptly - the only explanation is that it was caused by a changing of the particular brand of citalopram - I have been unable to get my old brand however so cannot confirm this (the pharmacies in the UK have many makes of citalopram which they change from time to time).

If the pregabalin isn't helping, I would not increase it.

[Emphyrio]

I dropped the pregabalin after 3 weeks. It was causing numb limbs and was not helping the anxiety at all.

 

I've also completely stopped alcohol as I believe it was causing increased agitation through rebound anxiety. Been feeling quite 'wired' ever since the switch to a different citalopram generic so I'm just waiting to stabilise on that again. Hopefully staying off alcohol - even small amounts - will help, though my sleep has been poor and the intrusive thoughts have come back to some extent.

[Petunia]

Hi Emphyrio,

Did you try a 10% reduction of citalopram as Alto suggested?

 

Its good that you stopped alcohol, it should help, most of us in withdrawal can't tolerate any alcohol at all.  What about caffeine, sugar and processed foods?  What is the rest of your diet like?

 

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/

 

When I'm in a bad wave of symptoms, I suffer with intense, racing thoughts.  I'm not sure if this is the same as 'intrusive thoughts', but I have found that taurine calms these thoughts.  It doesn't work for everyone though.  There are some threads in symptoms and self care about taurine if you are interested.

 

If you start taking supplements, start with a low dose and only one at a time so you will know what effect its having.

 

Petu.

[Emphyrio]

Thanks Petu.

 

No I haven't tried reducing the citalopram yet. I think I should try to let my CNS settle down somewhat. I think that my brain is still somewhat unbalanced from meds/med changes over the past couple of years and probably needs to find stability. I experience violent intrusive thoughts and don't want them to worsen. As long as I don't drink caffeine or alcohol and get enough sleep they are generally under control.

 

While I've tried a number of drugs and supplements (mostly for a few days at a time) I'm guessing that the ones that are still affecting my system are:

 

- prozac - taken at 20mg for a few years until 2011, again in 2012 between June and November (20mg for 3 months of that) then 5mg for 8 weeks last October through December. Prozac is one of those drugs that was anxiety provoking in me, and the times where I've discontinued it I've experienced a drop in anxiety levels. I believe that my brain/body has been gradually recovering from the use of prozac - the recovery is possibly bringing anxiety levels back up.

 

- fluvoxamine at 50mg for 9 weeks until March this year. I never experienced considerable anxiety relief on fluvoxamine at all to be honest - it may even have worsened by restlessness. Though it probably has made changes to my brain that I'm still experiencing today.

 

- citalopram - possible adverse reaction on reinstatement, though anxiety levels are not too unbearable.

 

Given all the changes would you recommend that I still make a 10% cut anyway, or would you hold until my anxiety levels start to decrease? Its like a form of akathisia I'm feeling at present - made worse through alcohol or caffeine use. I could do more to cut my processed sugar intake but I have a sweet tooth.

 

Have any UK members had citalopram compounded either as a liquid or a pill? The liquid in the UK is 40mg per ml and thus rather strong for precise measurements.

 

I'll have to give magnesium and fish oil another try. I attributed the use of fish oil to increased anxiety in the past, though it may have been because of alcohol use a day or two prior to taking it. Now I'm alcohol free I'll try it again. I like eating fish and could easily eat a tin of it a day - mackeral has around 4.3g of omega 3 per tin which is probably a decent amount?

[Rhiannon]

I think I should try to let my CNS settle down somewhat. I think that my brain is still somewhat unbalanced from meds/med changes over the past couple of years and probably needs to find stability. I experience violent intrusive thoughts and don't want them to worsen. As long as I don't drink caffeine or alcohol and get enough sleep they are generally under control.

 

I am inclined to agree with you. If your present state is tolerable for you, given your very chaotic history of as you say "chopping and changing" many times over the past few years, most recently going on and off pregabalin, it might be the kindest thing you could do for your CNS to just chill for a while and let it try to settle into a stable homeostasis.

 

Meanwhile definitely stay off alcohol and caffeine, try to avoid sugar and refined carbohydrates, try to stay to a regular schedule of meals and sleep, and try to get in some gentle exercise (walking is best, and gentle is important) as part of that regular schedule. And keep us posted.

 

If you do end up with a lot of activated type symptoms, like akathisia and insomnia and sensory overstimulation and hypomania, that sort of thing, then you may want to consider doing a 5-10% cut of the citalopram and see if that brings improvement.

 

But if you're feeling your current condition is something you can tolerate, it's my opinion that you'd be best off giving your nervous system some consistency and stability for a change. My guess is that it will probably need to be something like six months, maybe longer depending on how things go. If the only thing you're taking is 5 mg citalopram, if you can stabilize on that even if it takes a year, you'll be in a great position for tapering later, because citalopram is pretty easy to taper (you can get liquid or make your own easily) and you're already at a very moderate dose.

[Emphyrio]

I've made my first cut of citalopram - to 4.5mg, which I'll stay on for 3-4 weeks before revaluating how I feel.

 

If my symptoms were more bearable, I'd stick with the 5mg until things settle down. However, the agitation has returned along with some intrusive thoughts - I'm also extremely jumpy, panicky, and have severe restless legs in bed. I also have muscle pain alongside all these delightful symptoms. I've been taking magnesium (500mg glycinate) at night for several weeks now, but its not had any effect on the agitation so far, Its still good so I'm going to continue taking it, along with twice daily NAC (1300mg) and valerian.

 

Incidentally I feel extremely sharp - I can read things quickly, and if I wasn't so agitated I'd be able to take a lot of information in at once. Its almost like some kind of mania or mixed state.

 

Its pretty horrible living with this constant agitation/restlessness as it means that its hard for me to interact with people, do things etc.

[Emphyrio]

So far the cut has been ok, though its only been 4 days and my system should just be registering it. Generally I do not notice cuts - last year when I dropped from 5 to 3.75 I experienced no side effects - aside from an increased sensitivity to caffeine and maybe some more intrusive thoughts.

 

I think I understand what is going on though, and it largely relates to norepinephrine.

 

Last year, I was several months off stopping fluoxetine. I've come off fluoxetine several times - while it worked well as an antidepressant, it was very activating - and often worsened the intrusive thoughts I experience. I'm guessing this is because it functions as a very slight norepinephrine reuptake inhibitor - also it increased norepinephrine indirectly through 5ht2C antagonism. Every time I've come off this drug I have experienced a considerable worsening of depression and apathy - though levels of agitation/intrusive thoughts have always improved.

 

So this time last year I was also on the 5mg citalopram - the difference between then and now, however, was that last year my brain was still recovering from the fluoxetine withdrawals - hence low norepinephrine/possibly other excitatory neurotransmitters such as glutamate.

 

Since then my receptors may have healed - but may have 'overshot' to some extent - hence the agitation, akathisia, restlessness, intrusive thoughts. Add in a few med changes to cause extra chaos in my brain. I guess in some ways my condition may be akin almost to a medication-induced bipolar (I remain open to the possibility that it may be actual bipolar through I have never been diagnosed with it).

 

I also now recognise that my 'relapse' several months back may not have been so much to do with the change in citalopram brands, but because of the fact that I had recently stopped taking 1300mg NAC daily. Its a powerful supplement that seemed to have benefited my intrusive thoughts. I've been back on it for around 10 days or so and have noticed a decrease in intrusive thoughts whilst taking it.

 

I'm also taking 160mg propranolol daily (80mg slow release morning and night). I have no side effects from this, aside from some increased depression/weepiness. Though to be honest, this is welcome as the citalopram has considerably numbed my emotions. I think its helping the akathisia/restless legs I have, so I plan to stay on this until my citalopram taper has ended. What's the best way to taper off beta-blockers? I understand they need to be tapered but I'm guessing the 10% method is probably too conservative - I've never heard of protracted propranolol withdrawal.

 

My only real dilemma is how quickly to taper the citalopram. Ever since I've been on it I've had a deep sense of panic and restlessness, with few days where I've felt 'normal'. Had a lot of jaw clenching on it as well. I'm not sure whether I should do 10% every 2-3 weeks or every 4-6 weeks. While the latter is the recommended drop, I'm wondering whether I've had an adverse reaction. I've not been sleeping well and have been pretty panicky most days to the extent where its affecting my relationship with others. Any advice would be welcome.

 

Current symptoms:

- insomnia

- jaw clenching

- restless limbs (helped by propranolol)

- panicky feeling

- sensitivity to substances/food. Have noticed increased agitation even after a simple meal like porridge.

- extremely twitchy/jumpy

- desire to remain in safe, familiar environments

- feelings of dread and doom

- feeling like I may lose control

- muscle pain/tension.

 

I'm hopefully going to be starting CBT soon to work on some of my mental issues (intrusive thoughts - which led me to drugs in the first instance).

[Emphyrio]

Also, I seem to be overly sensitive to 'activating' drugs but not 'calming' ones. So things like benzos, propranolol, pregabalin etc - I can seemingly tolerate well at really high dosages, but when it comes to 'activating' ones - caffeine, antidepressants etc, I get hit with agitation/akathisia at a comparatively low dose. Strange that...

[Emphyrio]

Felt like crap these last couple of days. I know it isn't the drop that's doing this as I've been feeling like this for the last couple of months. I feel pretty agitated, restless and panicky - I really don't know why I'm getting worse on the same dose of citalopram

 

Here is my recent drug history:

 

Summer 2011: Was on 20mg prozac for several years; attempted switch to 20mg citalopram (failed due to agitation). I attempted to switch because of increased agitation/restlessness on the prozac which I now believe was the result of prolonged alcohol use.

 

After the failed switch I was off drugs for a few months. Generally felt much better - much less agitated etc, but soon I was hit with crippling depression. In mid December 2011 went onto 10mg citalopram - I felt my depression lift after around 4 weeks, however, I was also hit with a return of the agitation/restlessness/intrusive thoughts. So I stopped C/T after around 6 weeks.

Had a few brain zaps but soon I felt much less agitated and the depression didn't return. However, after around another 6-8 weeks I woke one morning to find myself feeling extremely agitated and panicky. A month or so later I went back onto 20mg fluoxetine - had horrendous start-up effects, agitation, sexual dysfunction etc - some of these side effects went away, but others remained...so I came off this in November 2012 after tapering to 10mg, 6.666mg, 5mg...then off.

 

After coming off fluoxetine the agitation/restlessness largely went away again, though not entirely. But just like the previous occasion, felt crippling depression. So went onto 5mg citalopram in April 2013. Going onto this actually got rid of most of the remaining agitation - I could drink coffee again, eat what I wanted to, etc. However, severe visual and cognitive problems - and some depression remained.

 

Late 2013 - failed switch to fluoxetine 5mg = agitation. December 2013 - went onto 50mg fluvoxamine = but bad restlessness and an internal panicky feeling. Decided to return to 5mg citalopram in April 2014 - had a bit of start-up agitation on this, but after a couple of months felt a bit better (by around June 2014). 

 

Here's the issue - from around June this year my agitation/anxiety/intrusive thoughts has been steadily increasing. This seems to correspond to an improvement in mood/cognitive function/visual problems. My theory is that my already scrambled nervous system is highly sensitive to norepinephrine or glutamate - coming off fluoxetine has led to a lowering of these transmitters in my brain (explaining the decrease in agitation but increase in depression) and that my brain has steadily been attempting to return to equilibrium - however, it may have 'overshot' to some extent - hence the horrendous agitation/akathisia I'm experiencing today. Either that or there is some kind of bipolar type illness here.

 

My question therefore is - should I continue to taper off the citalopram given the increase in anxiety or is it actually protecting me to some extent? 

[bubble]

Hi Emphyrio,

 

I've been reading through your thread and as you yourself say you have done a lot of jumping around. You also understand that this has caused you to feel so bad now. From everything I've been reading, there is no easy way out. Time, patience and above all STABILITY cure. 

 

I couldn't understand from what you wrote what drugs you are taking at the moment and at what dosages. We don't believe in mental "illness" here and bipolar label is particularly problematic. None of that diagnosing helps us to deal with our conditions. Also neurotransmitter theories cannot be tested or proven so I don't bother myself with them.

 

I just know that I wouldn't cut or change the drugs while highly symptomatic. I have found holding and letting my CNS rewire and regrow and find its balance is the best thing that I can do. Gradually the symptoms lessen if we don't react to them with increasing/decreasing medication. Symptoms are a way in which our CNS communicates with us saying that all the changes are displeasing it.

 

So I would hold and look at symptoms and self-care section to look for non-drug ways of alleviating anxiety. are you taking any magnesium? 

 

Hope you feel better soon.

 

best,

Bubble

[Emphyrio]

Hi bubble,

 

I'm taking 4.5mg citalopram (decreased from 5mg a week ago) and 160mg propranolol which I've taken for two weeks in an attempt to halt the akathisia. I don't think it works so I'm going to drop it and see what happens. I would stay on the 5mg citalopram until I stabilise - however, I seem to have worsened in the last couple of months. I believe that may have been my brain rewiring after coming off prozac in November 2012 (I experience a substantial lessening of agitation after stopping prozac). Should I return to 5mg citalopram for now and wait it out?

 

I'm taking 500mg magnesium bisglycinate a day. I've tried fish oil but like a lot of things it overstimulates me...

[Emphyrio]

Had a horrendous last couple of days so I've started taking 5mg citalopram again...I think I need to give things a little longer to settle before tapering. Whether this was a result of the slight drop or whether it was the result of my recent changes - I don't know...

[Emphyrio]

Sleeping poorly too, feel incredibly restless...have done for the past few months, and it seems like things are only getting worse. 

 

I cannot work at the moment or even do voluntary work. I'm really just surviving...its the constant panic and akathisia that's really getting me down, and it affecting my relationships with others. Can hardly sit still to watch a film or write an email to be honest without feeling an overwhelming desire to move.

 

Part of me wonders whether I should try to go back to my original 20mg prozac dose. 

 

Any tips from those who have been crippled by withdrawal? How did you manage to explain the issue to others/loved ones? Some of my close friends keep telling me that I should do more to help myself - but there's only so much I can do when I'm racked with akathisia on a 24/7 basis...

[andy]

Sleeping poorly too, feel incredibly restless...have done for the past few months, and it seems like things are only getting worse. 

 

I cannot work at the moment or even do voluntary work. I'm really just surviving...its the constant panic and akathisia that's really getting me down, and it affecting my relationships with others. Can hardly sit still to watch a film or write an email to be honest without feeling an overwhelming desire to move.

 

Part of me wonders whether I should try to go back to my original 20mg prozac dose. 

 

Any tips from those who have been crippled by withdrawal? How did you manage to explain the issue to others/loved ones? Some of my close friends keep telling me that I should do more to help myself - but there's only so much I can do when I'm racked with akathisia on a 24/7 basis...

sorry to hear your suffering,I took my wife to meet my cpn and counsellor she then got a better understanding of what its like to be going through this

relate can offer counselling for partners and friends of people suffering with mental health problems

[Altostrata]

Withdrawal problems aren't a mental illness problem, they're a drug treatment problem.

 

I have no idea what to suggest, Emphyrio. Your nervous system needs stability, but are you having an adverse reaction to citalopram? I don't know.

 

Keeping notes on paper about your daily symptom pattern relative to when you take your drugs may give some indication.