Is It Withdrawals or MAYBE something else?

[EhBien]

About a month ago my psychiatrist moved me from Citalopram to Escitalopram. I've taken Citalopram on and off-- about 10-5mg-- since I was 19 (I'm 33 now). For some reason the Citalopram just stopped working for my anxiety and the brain foggy side effects and tiredness were worsening. The psychiatrist suggested Escitalopram as the better fit.

After giving 5mg (I'm pretty sensitive to medicines) of Escitalopram a honest try for 3 and half + weeks.. it just didn't sit so well with me. One thing that was rather hard to push through was an increase in blurred vision. The psychiatrist suggested that since I was only taking 5mg I could just stop taking the Escitalopram cold turkey and we would attempt a different plan of action at our next appointment.

Since I've taken Citalopram for so long, I'm very familiar of what it feels like to miss a dose or have the withdrawal symptoms from coming off of the medicine. Stoping 5mg of Escitalopram cold turkey felt JUST like that. I phoned the psychiatrist again and let her know... she suggested I'd take 2.5mg for 5 days and then stop completely. That eventually helped the withdrawal symptoms I was feeling from coming to a halt on the 5mg of Escitalopram. Tuesday was my 5th day on the 2.5mg of Escitalopram and on Thursday I started to feel what feels like withdrawal symptoms again; "Brain Zaps" when I turn my head, an overall nausea and unwell feeling that comes over me in waves, and the feeling of a nervousness on the inside... like my bones are shaking.

Is it possible that my body is still enduring withdrawals from the Escitalopram... or is this just me and my anxiety? My fiancee seems to think that its just "me" and its hard to decipher if this will pass... or its something I should get checked out.

Thank you for any feedback or suggestions

[panic_down_under]

I've taken Citalopram on and off-- about 10-5mg-- since I was 19 (I'm 33 now).

If you meant 10-15mg, then you have never been on the minimum therapeutic dose. Which may have increased the risk of the med quitting, if indeed it actually did.

For some reason the Citalopram just stopped working for my anxiety and the brain foggy side effects and tiredness were worsening. The psychiatrist suggested Escitalopram as the better fit.

Was any thought given to just raising the citalopram dose onto the usual therapeutic 20-40mg dose range?

I don't understand the rationale in switching from citalopram to escitalopram as they are essentially the same med, sharing the same active chemical. The difference is citalopram also contains a mostly inactive isomer of it. This can produce some small differences in effectiveness and side-effects, but if one doesn't work then the other almost certainly won't either.

The psychiatrist suggested that since I was only taking 5mg I could just stop taking the Escitalopram cold turkey and we would attempt a different plan of action at our next appointment.

I think it would have been better to decide on the different "plan of action" before weaning off escitalopram. I assume that will entail another med and with the exception of the old MAOIs, which are an unlikely alternative at this stage, it is possible to switch to most other antidepressants either overnight if to another SSRI, or via a short cross-taper if to a SNRI, or TCA, thus avoiding the potential traumas of withdrawal.

Imho, your personal plan of action should include considering finding a new psychiatrist.

Is it possible that my body is still enduring withdrawals from the Escitalopram... or is this just me and my anxiety?

It's probably a combination of both. The symptoms are typical of withdrawal, especially the 'brain zaps' but they may be being exaggerated by anxiety. Withdrawal isn't just about chemistry and biology, psychology is at least as important a factor, especially when an anxious mind is involved.

[EhBien]

Thank you so much for your reply, Panic!

Historically, I've always been sensitive to medicines and tend to lean to the more lower doses of things. Its something my doctors have often worked with me on. The reason why the switch happened to escitalopram was because of how the side effects of citalopram were effecting me, whilst the medication over time showing that it was no longer helping as it typically did. Trying a similar medication with less side effects... she thought would be helpful and MAYBE changing to something slightly different could've also been helpful since the citalopram worked for so long. I think we have to admit, finding the right medicine for us is ALL trial and error... we're all different.

Our next plan of action will be to see what I metabolize best since I've had so many problems with different medications in the past. I think like the meds and the battles we've all had with anxiety, I think I'll give my psychiatrist one more try!

[panic_down_under]

Historically, I've always been sensitive to medicines and tend to lean to the more lower doses of things.

While sensitivity to some meds is common, sensitivity to all of them is unlikely because there are so many different ways meds are metabolized, so I believe blanket sensitivity is driven more by anxiety than physiology.

The particular issue with antidepressants is they have no direct effect on anxiety, or depression in the way say aspirin has on a headache. They work by stimulating the growth of new brain cells (*neurogenesis) to replace cells killed, or prevented from growing by high brain stress hormone levels. The therapeutic response is produced by these new cells and the stronger interconnections they forge, not the meds directly, and it is important that enough of a med is taken to activate and sustain neurogenesis.

* for a more detailed explanation see: How antidepressant drugs act.

[EhBien]

Thank you for this, Panic! I really appreciate this information!


And what can I say, I'm a delicate flower when it comes to meds ! And you're absolutely right... It could totally be my anxiety as well!

I'll report back about it once the pharmacogenetics testing results are in!

[panic_down_under]

I'll report back about it once the pharmacogenetics testing results are in!

Genetic testing may prove useful in the future for guiding selection of the most effective antidepressants with the lowest side-effects for a patient, but atm they seem to be of limited usefulness. Currently, the may benefit of these tests may be in building gene data bases which can be used in the future to design better predictive models.

See: Pharmacogenetics of Antidepressant Drugs in Depression particularly page 5 (Medscape article, free registration required to view); Kang HJ, 2016; Dubovsky SL, 2016; de Leon J, 2015; Biernacka JM, 2015; Howland RH, 2014; Crawford AA, 2013; Are genetic mental health tests causing more harm than good?