Citalopram 10mg > 20mg

[panic_down_under]

We have a plan which does include propranolol and basically putting things in place to give me the chance to get some respite to allow duloxetine to work

Good!

[LilyPad1991]

Good!

Hey Panic Down Under,

I wanted to pop back to send my thanks again and provide a brief update in case anyone in the future sees our chat back and forth and needs some hope.

After about 3 and a half of weeks of really intense side effects from going back up to 60mg of duloxetine, the significant increase in anxiety abated and I am pretty much back to myself now. I can sleep! I can eat! I can drive without panic and walk my dogs without fear and just do normal things again. I ended up taking propranolol for about a week, which provided significant relief from the anxious surges. I was so utterly convinced that I would never be me again and yet here I am. So thank you for your kindness and support. I hope you’re well.

[panic_down_under]

After about 3 and a half of weeks of really intense side effects from going back up to 60mg of duloxetine, the significant increase in anxiety abated and I am pretty much back to myself now.

This is very good news, indeed!!

So thank you for your kindness and support. I hope you're well.

You're most welcome.

I'm doing okay for an old bugger though if I was a horse I'd probably have been sent off the the knackery a long time ago.

[LilyPad1991]

Hi Panic Down Under!

How’re you doing? I hope you’re well.

I’m back again to pick your brain if you have the time so spare. I’ve been doing really well on duloxetine, pretty much back to normal. Lots of the usual life stresses and I’ve been coping well. Last week was especially busy and tiring and then on Friday I started my Masters - I’m doing a 4 year course to qualify as a Psychotherapist here in the UK. I hadn’t really thought much about the first long weekend of training beforehand but it was very intense emotionally and I’ve been feeling quite anxious, with the churning stomach and jittery chest that are so familiar to me as anxiety symptoms. I’m scared I’m going to ‘relapse’ because I’m still on my 60mg but the anxiety is ‘breaking through’. Do you think I’m overthinking it? I’m very aware that I have work to do on exploring my relationship with anxiety but right now I just could do with some wisdom.

One other thing I have thought - I’m currently taking a different duloxetine generic, one that I’ve never been on before. I know that we’re told that one generic is the same as another but that hasn’t always been my experience and I’m wondering if that is potentially contributing to my current experience. What do you know about this?

Thank you so much, as always 😊

[panic_down_under]

How're you doing? I hope you're well.

I'm doing okay. Thanks for asking. We've had a long dark, cold winter down in my part of Oz which was starting to get me down, but spring has finally put in an appearance.

I'm back again to pick your brain if you have the time so spare.

Time I have to spare, brain not so much.

I'm doing a 4 year course to qualify as a Psychotherapist here in the UK.

Ah, physician heal thyself.

I hadn't really thought much about the first long weekend of training beforehand but it was very intense emotionally and I've been feeling quite anxious, with the churning stomach and jittery chest that are so familiar to me as anxiety symptoms. I'm scared I'm going to 'relapse' because I'm still on my 60mg but the anxiety is 'breaking through'. Do you think I'm overthinking it?

Possibly. ADs can't protect us from all the stresses of life, or at least they shouldn't. We still need to laugh and cry. The stress should begin to ease as you adapt to the new experiences. If it does get overwhelming then you may need a dose increase, but I'd hold off for a week or two to see if things calm down. It would take some weeks for the higher dose to begin making a difference anyway by which time you're likely to be past the initial stresses. The important think is to accept that this is coming from the life changes and not that the old foe is dragging you back.

I'm very aware that I have work to do on exploring my relationship with anxiety but right now I just could do with some wisdom.

Oh, I could use some of that myself. It seems to be a very rare commodity in this crazy world we're living in these days.

I know that we're told that one generic is the same as another but that hasn't always been my experience and I'm wondering if that is potentially contributing to my current experience. What do you know about this?

It doesn't happen as often as it is claimed, but it does happen. If there were no other changes in your life it would be a hypothesis definitely worth considering. However, I think the extra stress you're currently under is the more likely explanation.

[LilyPad1991]

Thank you so much for getting back to me 😊

I'm doing okay. Thanks for asking. We've had a long dark, cold winter down in my part of Oz which was starting to get me down, but spring has finally put in an appearance.

Those long, dark days can be quite miserable can’t they! We’re heading into Autumn now and it’s suddenly got quite cold.

Possibly. ADs can't protect us from all the stresses of life, or at least they shouldn't. We still need to laugh and cry. The stress should begin to ease as you adapt to the new experiences. If it does get overwhelming then you may need a dose increase, but I'd hold off for a week or two to see if things calm down. It would take some weeks for the higher dose to begin making a difference anyway by which time you're likely to be past the initial stresses. The important think is to accept that this is coming from the life changes and not that the old foe is dragging you back.

I just wasn’t expecting to have such a reaction, so it came as quite a surprise. I’ve been so well and it’s scared me a bit to be reminded of those physical symptoms of anxiety. I’m also worried by the prospect of a potential dose increase, since going back up to 60mg caused such havoc. I have in the past occasionally gone up to 80 or 90mg with success but I’m more cautious now after the experiences of earlier in the year. I did speak to my GP, who is brilliant, and she said the same as you really, about taking some time to level out after a busy time and some intense experiences. I am just worried, which is hardly surprising 😂 The GP did remind me that I have 10mg propranolol tablets to help with the physical symptoms, if I want to use them again whilst I get through this ‘blip’. I know it’s silly but to me, that’s like accepting I’m not 100% and I don’t want to be unwell again. Anxiety really is awful.


I have been able to soothe myself by walking outside and doing yoga but I just so don’t want these physical symptoms of anxiety at all, ever. Can I ask, do you ever still get ‘flare ups’ of anxiety symptoms? I seem to recall you’ve been on your medication for a long time.

It doesn't happen as often as it is claimed, but it does happen. If there were no other changes in your life it would be a hypothesis definitely worth considering. However, I think the extra stress you're currently under is the more likely explanation.

This is interesting, thank you. I have my next prescription now and it’s a brand I’ve used before so it’s not really a concern now anyway. And as you said, the extra stress is a more likely culprit.


Thank you again for your reply. It is so helpful having the insight and knowledge of someone who knows what this is like!

[panic_down_under]

I'm also worried by the prospect of a potential dose increase, since going back up to 60mg caused such havoc. I have in the past occasionally gone up to 80 or 90mg with success

Of citalopram? The maximum recommended dose is 40mg/day and while most without cardiovascular problems could probably take the original recommended maximum 60mg without significant issues 80-90mg is well into the red zone.

The GP did remind me that I have 10mg propranolol tablets to help with the physical symptoms, if I want to use them again whilst I get through this 'blip'. I know it's silly but to me, that's like accepting I'm not 100% and I don't want to be unwell again. Anxiety really is awful.

Anxiety and depression are the emotional manifestations of a physical brain dysfunction caused by high stress hormone levels atrophying parts of the two hippocampal regions. It is essentially a type of auto-immune disorder which is why they often worsen when the immune system is in overdrive fighting an infection. If you had say rheumatoid arthritis and it flared up would you have the same feelings?

Can I ask, do you ever still get 'flare ups' of anxiety symptoms? I seem to recall you've been on your medication for a long time.

I haven't had a full blown panic attack in many years, possibly not this century. But I do occasionally have lesser episodes, racing heart, vertigo, sudden dry mouth, etc. Fortunately, these don't last long, maybe a minute or so and I rarely get more than 3-4 a year. I've looked for a pattern, but if there is one it's alluded me.

[LilyPad1991]

Of citalopram?

No, sorry, I’m on duloxetine. I think our conversation started on someone else’s thread that was originally about citalopram.

Anxiety and depression are the emotional manifestations of a physical brain dysfunction caused by high stress hormone levels atrophying parts of the two hippocampal regions. It is essentially a type of auto-immune disorder which is why they often worsen when the immune system is in overdrive fighting an infection. If you had say rheumatoid arthritis and it flared up would you have the same feelings?

I wouldn’t. I do also have endometriosis, which no one fully understands yet but is potentially a kind of auto-immune disorder, and I feel far more comfortable taking any necessary medications for that. What I’m struggling to wrangle with is why did this anxiety come on so suddenly, triggered by what seems to have been, tiredness, stress and then the intense emotional experience of my first training weekend? On Thursday I was fine. On Friday, I gradually seemed to slide downhill. I know there is something to be said of becoming hyper aware of physical anxiety symptoms, which I know I do, as much as I try to divert and deflect away from them.

I haven't had a full blown panic attack in many years, possibly not this century. But I do occasionally have lesser episodes, racing heart, vertigo, sudden dry mouth, etc. Fortunately, these don't last long, maybe a minute or so and I rarely get more than 3-4 a year. I've looked for a pattern, but if there is one it's alluded me.

That’s impressive! 😍

[panic_down_under]

What I'm struggling to wrangle with is why did this anxiety come on so suddenly, triggered by what seems to have been, tiredness, stress and then the intense emotional experience of my first training weekend? On Thursday I was fine. On Friday, I gradually seemed to slide downhill.

I'd have been surprised if you hadn't had a reaction. You were already tired and stressed before you got hit with intense emotions. That would also have triggered a reaction in the others on the course who don't have an anxiety disorder. The difference is they would have accepted the symptoms were a natural reaction to the stress they were under and not become fixated on them, or doubted their ability to cope and rebound. They would have seen it as a normal response, you perceived it as abnormal. How we frame such experiences matters.

I know there is something to be said of becoming hyper aware of physical anxiety symptoms, which I know I do, as much as I try to divert and deflect away from them.

The propranolol may damp down some of the physical effects.

[LilyPad1991]

I'd have been surprised if you hadn't had a reaction. You were already tired and stressed before you got hit with intense emotions. That would also have triggered a reaction in the others on the course who don't have an anxiety disorder. The difference is they would have accepted the symptoms were a natural reaction to the stress they were under and not become fixated on them, or doubted their ability to cope and rebound. They would have seen it as a normal response, you perceived it as abnormal. How we frame such experiences matters.

My therapist said exactly this today too, thank you for your wisdom! It's a really interesting concept, that I perceived the symptoms as abnormal. That is absolutely 100% what happened. I am just impatient to be back to my equilibrium though and I also feel impatient with all the various pieces of teaching that talks about 'acknowledging your anxiety and doing stuff anyway'. I understand it but the other side of my brain is saying, 'but I don't bl**dy want anxiety at all! I just want to be normal!'

The propranolol may damp down some of the physical effects.

I shall keep the propranolol for if I feel I really need it. I just feel generally quite sensitised after the emotional onslaught but I can soothe myself with breathing, yoga, dog cuddles etc etc. And I really, really appreciate your kindness, once again