Starting again, early days do suck

[EdnaLegume]

since this is my third, and final trip down cit lane, I think it’s best I document things more completely than I did the first go round years ago. That way when I get a bee in my bonnet to come off cit again, I will revisit these posts to remind myself that’s not an option.

I’ve been reading and reading this forum for days. I’ve re-read my own posts from when I first started cit in 2013. This board was such a huge comfort for me then. And here I am again seeking reassurances and comfort.

I was on cit for almost 8 years. I never liked the fact I had to take meds and constantly felt there must be something I can fix in order to be “healthy”. (I have a huge case of health anxiety). So last summer I decided to wean off the cit. very, very slowly. I did well and was going along swimmingly off the meds for just a few months until sept 2021 when my husband had a huge health crisis and my anxiety went off the deep end again. I honestly cannot remember what the startup was like when I went back on them. It must not have been very noteworthy unless my concern over my husband was just far greater.

so back on cit until this summer. Again, slowly weaned off again and I think I came off around July. All was fine. Until it wasn’t. I don’t really know what set it off but it was bad. I did discover I have an iron deficiency but I’m fairly certain I’ve had that to some degree for years. My health anxiety insisted that I figure out what was going on. The more I tried to “fix” my anxiety, the worse it got. We went on a family trip to a lakeside home for a few days 2 weeks ago. The altitude was slightly higher than home. It was freezing cold and we couldn’t get the house temp up past 62 degrees f. I spent half the time up all night with diarrhea, full body shakes and no sleep and the other half putting on a happy face so I didn’t ruin the trip for my family. We came home on Friday and by Sunday I’d felt so bad I nearly had my husband run me to the emergency room.

instead I grabbed my cit and took 10mg. My very first time on cit I started at 20mg and woah Nelly that was a wicked first 2 weeks. I don’t remember what I started with last year after husbands health crisis. I figured I’d start with 10mg this time since the side effects were so awful the first time. Well…. They’re awful this time too lol.

increased anxiety being the main shenanigans. Today is day 10 at 10mg. After reading posts for the past several days, I think I’m better off upping to 20mg tomorrow. (When I started the first time, I started on 20mg for a short while and increased to 30mg which I stayed at.). I know I need to be at therapeutic level for best results. I’m not looking forward to potentially more side effects but I’m already here in side effect land, oh well.

I have to say, after the morning anxiety simmers a bit, my days haven’t been too terrible, and evenings aren’t bad with just a mild uptick in anxiety. Today was an exception and I partly think my trip to a mall an hour away with my daughter set todays nonsense in motion. The other part being that I have been up since 330 am with that maddening morning anxiety. The drive to the mall was fine, but the minute I got out of the car and headed into the mall my condition went south. My head felt heavy, I got the tingling in my neck, shoulders and arms. My legs felt like lead. But I pushed on. We were there less than 2 hours but we did have a good time. But I knew I’d reached my limit and needed to go home. The anxiety eased a lot as soon as we were home. I spent the next 4 hours resting, then put up a few more Christmas decorations and just took it easy. Then the evening anxiety started but has been a bit more pronounced. I’ve been having a relatively ok time falling to sleep lately so I’m praying tonight gives me at least that much and if I can get 5 hours of sleep I’ll consider myself lucky. I don’t plan to go anywhere for the next couple of days so if I can get rest during the day, I’ll take that too.

I KNOW I’m going to get better. I KNOW I’m not dying. But holy cow what evil is this health anxiety when it gets going. I’ve spent many moments just today reminding myself that no, I’m not going to feel this way forever. I also tell myself that I’m far more likely to have equal success this time around as I did previously. I know the chances do decrease the more you start and stop, but I’m being positive. I have to. I take comfort in reading my old posts and see that by the 3rd week I was doing pretty well, considering. So, knowing I’m likely going to have a slightly harder go this time, maybe by week 4 I’ll be feeling that same upswing. That things are finally heading in the right direction.

it’s so much easier to focus on the bad but I do see the good, the small successes. I could just kick myself to the moon and back for coming off the meds in the first place.

I did make a doctor appointment but the soonest is 2 weeks away. I am on a wait list if a spot opens sooner. I may ask about klonopin to help buffer the worst of it as that’s what I did the first go round and needed only a bit of help for a few sleepless nights. Otherwise I’m stuck with the grin and bear it approach. I don’t work so I can tolerate the daytime. The early mornings are still just awful for a few hours. This morning was quite impressive with how bad it was. I found it interesting to see I had an extra rough day around the same 9 or 10 days in on the first go round when I was re-reading my old posts. In old posts in this forum I saw a few others struggling more on this 10 day spot.

there’s just a great deal of comfort in simply knowing you’re not alone.

[EdnaLegume]

Took 15mg this morning even though I was scared to do so. I slept horribly last night and ended up talking half of a Benadryl around 2am. I managed about 2 hours of sleep after that so I may throw caution to the wind next time and take the whole tablet if needed.

today I felt less of the anxiety symptoms but was quite a bit more tired. The restless nights are definitely taking their toll. I got a few things done early on and spent the afternoon relaxing and dozing when I could.

Anxiety symptoms are creeping in again this evening. I even told myself out loud “that’s fine just let it do what it does”. I think it’s mostly my apprehension over another rough night of sleep. Either way I know it’s just part of the journey.

I’ll pop up to 20mg after a week at 15 and settle there for the duration. Likely I’ll end up at 30 as that was my dose previously but I’ll play it by ear.

after a rough day yesterday and night last night I was happy to have a mild day today. I know it’s just the new dose but it was welcomed nonetheless. Who knows, perhaps I’m on the upswing now! Trying to stay positive and not let the lows freak me out.

I did have a bit more of a headache today, which seems mostly in my face. Now either my sinuses are getting annoyed (possible this time of year) or I’m really grinding my jaws. Which I had an issue with for years. I know I’m clamping my jaws together frequently throughout the day. It was a side effect previously as well. I may resort to wearing my night guard during the day if it gets worse. Thankfully last time it did let up and settled at my normal nighttime clenching.

otherwise I’m 11 days in, it’s been a roller coaster, but I’m hanging in there.

[panic_down_under]

I may ask about klonopin to help buffer the worst of it as that’s what I did the first go round and needed only a bit of help for a few sleepless nights.

Clonazepam (Klonopin) and the other benzodiazepines (BZDs) are okay if you only need them occasionally, but they are not great if needed daily for a while as they inhibit the growth of new brain cells in the two hippocampal regions of the brain (neurogenesis). It is these new cells and the interconnections they form which provide the therapeutic response.

The antihistamine hydroxyzine may be a better choice. It has fairly potent anti anxiety properties, not quite as potent as the BZDs, but often potent enough and it is usually also mildly sedating which may help with the insomnia. Hydroxyzine comes in two forms, hydroxyzine pamoate (Vistaril) and hydroxyzine hydrochloride (Atarax). Anecdotally, the pamoate form is claimed to be the more effective anxiolytic.

I’ll pop up to 20mg after a week at 15 and settle there for the duration. Likely I’ll end up at 30 as that was my dose previously but I’ll play it by ear.

Given this isn't your first time on citalopram you will likely need to take at least 30mg. For reasons which aren't really understood antidepressants lose a little effectiveness each time they are discontinued and restarted. Their initial side-effects can also be more severe and/or different too.

I did have a bit more of a headache today, which seems mostly in my face. Now either my sinuses are getting annoyed (possible this time of year) or I’m really grinding my jaws. Which I had an issue with for years. I know I’m clamping my jaws together frequently throughout the day.

Sounds like the most probable explanation, but serotonin has many roles in the body including in the regulation of blood vessel tone, constriction and dilation, and ADs can affect this which may trigger headaches.

otherwise I’m 11 days in, it’s been a roller coaster, but I’m hanging in there.

About all you can do is to hunker down and wait for the med to begin weaving its 'magic.' Unfortunately, there is no way of speeding up the process.

[EdnaLegume]

Panic down under, So happy you’ve replied. Your posts are such a tremendous help.

I slept much better last night, waking only a few times but managing to get back to sleep. in light of what you said about the klonopin inhibiting the growth, and thereby stalling the recovery process, I’d definitely keep them on an emergency basis. If the Benadryl helps do you think it’s an acceptable “once in a while” helper for getting some sleep?

I’m fine going back to 30mg. I just figure it was better to get on the therapeutic dose and let my body settle there for a bit?? Or should I just get up to 30 as it’s more likely the dose I need and the dose I was on for many years? I really wish I could get in with my dr sooner. Not that I think she’ll know much. I may need to find a proper psychiatrist who is much more trained in meds than my regular nurse practitioner.

[panic_down_under]

in light of what you said about the klonopin inhibiting the growth, and thereby stalling the recovery process, I’d definitely keep them on an emergency basis.

Definitely, take the clonazepam if you need to, but resist the temptation to take it 'just in case'. The occasional dose probably won't affect neurogenesis to any significant degree, but taking it daily for weeks is likely too.

If the Benadryl helps do you think it’s an acceptable “once in a while” helper for getting some sleep?

Benadryl containing diphenhydramine as the active ingredient (not all formulations do) has long been used to ease anxiety through sedation. It seems to be relatively benign if not abused, however, caution is advised in potentially hazardous situations, including driving, as the sedation can impair concentration and reaction times and taking it with citalopram may exacerbate these side-effects. Alcohol should be avoided for the same reason (alcohol also has the same negative effect on hippocampal neurons as BZDs so is contraindicated anyway).

Or should I just get up to 30 as it’s more likely the dose I need and the dose I was on for many years?

I suspect you will likely need to go back onto 30mg, possibly more, at some point, but whether you will need to immediately I can't say.

[EdnaLegume]

Thank you! Very much appreciate your input.

[mct]

My apologies for butting in.
As someone who is not seeing a benefit from the similar drug escitalopram, I am now wondering about the negative effect of alcohol (one small glass of wine per day!). I had naively assumed that the advice to avoid alcohol was just the universal caution that drug companies put on all their meds.
PDU, would you be kind enough to provide a reference? Many thanks.

[panic_down_under]

PDU, would you be kind enough to provide a reference?

Alcohol has the same affect on hippocampal neurogenesis as cortisol (among other deleterious effects on anxiety centres of the brain). Even moderate drinking can result in significant hippocampal atrophy (Topiwala A, 2017) - see also: Geil CR, 2020; Anderson ML, 2012; Morris SA, 2010; Crews FT, 2003.

Another issue is that ADs can increase alcohol's effects in unpredictable ways. Some days you might be able to drink a herd of alcoholic elephants under the table without raising a sweat, on others a small *shandy may turn legs to rubber. Don't drink and drive while on ADs!

* 50/50 mix of beer and lemonade for the uninitiated

[mct]

PDU, thank you for your help once again. Having read the references, I am convinced and will now abstain completely. It makes me wonder how much even modest alcohol intake might be contributing to antidepressant drug failure.

[panic_down_under]

It makes me wonder how much even modest alcohol intake might be contributing to antidepressant drug failure.

I'm unaware of any studies into it. Most GPs ,and possibly some psychiatrists, are probably unaware that alcohol can inhibit hippocampal neurogenesis even though this was first reported in 1980.

Alcohol is by far the most (self-)prescribed anti-anxiety/depression 'med' with few realising it just steepens the downward spiral. Incidentally, the second most self-prescribed 'med', nicotine has much the same effect.