Medication Advice

[WorryBNot]

I'll try to keep this brief.

Early last year i stopped taking citalopram, without asking the doctor. i'd been on it for many years. i was sick of everything, tiredness, lack of sleep, it not helping me overcome anxiety and probably many other things that might not have even been down to citalopram.

For the first few months i felt good, then had a crisis. i told my doctor the pills hadn't been working hoping he'd prescribe something else. he up'd citalopram from 20mg to 30mg. i didn't tell him i had stopped taking it.

I started myself back on 10mg and just got on with life. every week or two i'd feel down and my rumination/chatterbox/constant thinking happened everyday. i didn't increase to 20 or 30.

This year. still on 10mg. still constant thinking every day but not hugely anxious or depressed, just the feeling down (feeling everything turns bad etc) once in awhile. then i decided to up to 20mg and my head just went crazy, i just couldn't control my thoughts, feeling panicky etc. thinking stupid things, being hugely melodramatic etc i stopped taking it altogether the next day i felt normal again. still with chatterbox but i didn't feel everything was turning to crap.

2 weeks on and i'm not sure what to do. put myself back on citalopram at 10mg, 20mg 30mg? try and just get on with life and try and cope with chatterbox (which really gets me down some days) or confess to the doctor and see what he says?

Thanks for any advice.

[panic_down_under]

I started myself back on 10mg and just got on with life. every week or two i'd feel down and my rumination/chatterbox/constant thinking happened everyday. i didn't increase to 20 or 30.

Remaining on only 10mg may have been a bad move.

Antidepressants 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 this requires a certain level of the med in the system to initiate and sustain.

The problem with taking borderline therapeutic doses is neurogenesis may be interrupted whenever plasma levels drop below the neurogenesis sustaining threshold which leads to the second issue, the growing evidence that antidepressants become progressively less effective every time they are stopped and restarted, often requiring higher doses to achieve the previous level of control. They may also produce more severe, and/or different, initial side-effects. Two studies, Amsterdam JD, 2016 and Amsterdam, 2009 found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Amsterdam JD, 2009; Leykin Y, 2007). This applies whether returning to a previously taken antidepressant or a different one. By taking a low citalopram dose for an extended period you may have been effectively creating a similar situation as stopping and restarting it. While the interruptions to neurogenesis may have only been of short duration, they will probably have occurred much more frequently.

2 weeks on and i'm not sure what to do. put myself back on citalopram at 10mg, 20mg 30mg? try and just get on with life and try and cope with chatterbox (which really gets me down some days) or confess to the doctor and see what he says?

Imho, the only viable option is the last, coming clean with your GP. As per my above, side-effects can be different and/or more severe each time antidepressants are restarted. A small dose of diazepam (Valium) for a week or two would help you cope better with the side-effects you experienced.

Also ask your GP about cognitive behavioural therapy (CBT). I understand most NHS trusts will pay for some therapy sessions. CBT therapists can teach you techniques for controlling the "chatter".

[WorryBNot]

Thanks for the advice, a lot more detail than i was expecting. much appreciated

[WorryBNot]

I talked to my doctor which in the end made me feel completely hopeless about my future.

She said i could go back on citalopram and build it up or pick another one. left me to choose, i had no idea what to do. in the end i chose to try another. she prescribed sertraline and is referring me for online CBT therapy.

I'm now scared of the side affects and whether i should even be taking sertraline at all. i've read people with manic depression shouldn't take it, i don't know if i have manic depression i've never been told what i have.

Depression wise i'm not as bad as i was, it's more bouts of anxiety and my major problem is the ruminating. is this just text book anxiety? i'm feeling very lost. i don't ever feel suicidal or get these (what sound) very bad panic attacks that people on the forum get. i suffer from low self esteem and probably body dysmorphic disorder and don't leave the house. this has been a problem since 2002. i left the house in 2009 a couple of times and in 2015 left multiple times but had to. i *think* i can beat the not going out of the house but have little motivation to do so.

I'm even thinking on not taking the medication, going cold turkey and just try and cope and see how the therapy goes.

Sorry for the ramble. if anyone has any advice it would be much appreciated. Thanks

[panic_down_under]

I talked to my doctor which in the end made me feel completely hopeless about my future.

Sigh! Look for another GP, or ask to be referred to a psychiatrist.

she prescribed sertraline and is referring me for online CBT therapy.

Good

I'm now scared of the side affects and whether i should even be taking sertraline at all. i've read people with manic depression shouldn't take it, i don't know if i have manic depression i've never been told what i have.

If you had manic depression citalopram would also have triggered mania.

Depression wise i'm not as bad as i was, it's more bouts of anxiety and my major problem is the ruminating. is this just text book anxiety?

It is typical of generalised anxiety with depression, possibly with a touch of OCD.

i'm feeling very lost. i don't ever feel suicidal or get these (what sound) very bad panic attacks that people on the forum get. i suffer from low self esteem and probably body dysmorphic disorder and don't leave the house. this has been a problem since 2002. i left the house in 2009 a couple of times and in 2015 left multiple times but had to. i *think* i can beat the not going out of the house but have little motivation to do so.

It seems your past treatments haven't actually been effective, either for anxiety, or depression. I think you need to see a psychiatrist asap. At the very least take the sertraline and be prepared to go up to the recommended maximum 200mg if necessary.

I'm even thinking on not taking the medication, going cold turkey and just try and cope and see how the therapy goes.

I think quitting would be a bad idea. Antidepressants and CBT individually can be very effective, but combined they offer the best chance for a good result.

[WorryBNot]

If you had manic depression citalopram would also have triggered mania.

I've had a long talk with family tonight to try to decide what is the best thing for me to do and came to the conclusion that i need to find out what exactly is wrong with me but also go back on citalopram (better the devil you know etc) until i find out.

I have worried that i might have manic depression in the past but on reading up on it dismissed it as i don't feel i get the huge lows and the extreme highs people say they get but i do have mood swings. i can be down for a few days and then wake up one morning fine as if nothing has happened, i've also had problems getting to sleep at night as i'm giddy and have plans going on in my head for what i'm going to be doing in the morning. just lying there for hours not being able to fall asleep. at times i can feel i'm talking very fast and i'm getting so excited i can barely get my words out to the point i'm start to bug the people i'm talking to.

Possible bipolar or am i just over thinking it?

edit



1. not over long stretches of time. a day or 2 at the most
2. yes sometimes
3. yes
4. restless yes, impulsive no i overthink everything
5. not sure
6. a little
7. no



1. not over long stretches of time. a day or 2 at the most
2. withdrawal no/activites yes
3. no. i eat too much
4. yes but my sleep pattern is all over the place and i get no exercise
5. when i'm down yes
6. massively
7. no suicide/ preoccupation with death i'd say yes but worry for family members

Apologies for this long post detailed post, it's just nice to hear from someone that clearly knows what they're talking about.

[panic_down_under]

Possible bipolar or am i just over thinking it?

I think you are over thinking it. Both anxiety disorders and depression wax and wane, but this isn't necessarily a sign of bipolar. I doubt you are bipolar, but a mood stabilizer may help anyway.

I think you need to see a psychiatrist, both to get a definitive diagnosis and a treatment plan. Rarely being able to leave the house for 15 years is no way to live. I found being housebound by agoraphobia for just a couple of months intolerable.

[WorryBNot]

thank you for your advice. it means a lot

[MyNameIsTerry]

Manic Depression is what they used to call bipolar. I've been down this route myself because of my cyclical anxiety & depression issues but in end, with the help of fellow SNRI experienced folk on here, I worked out it all started when I went on a med.

But I also learned that what we assume is bipolar can be a range of hard to diagnose mood disorders that are lesser known. In these the intense spikes to mania & depression are not experienced.

I'm not saying you have such a disorder, because I agree with Ian about the waxing & waiting issue, but I'm mentioning so you don't worry about bipolar which is more complex when there are lesser forms that are less worrying.

[Bike Rider]

Hi Worry. I am not in the same league as Ian or Terry and I do believe they give excellent advice, but you sound a little bit like me, especially the mood swings which in my case can alter in 15 mins, plus the sleep pattern too.

Fluoxetine has done a good job for me and I have just had 7 weeks of feeling normal. Ok anxiety has come back the last 2 weeks but nowhere near as strong as it use to be.

My counselor has told me that I am trying to prove things to my mind, that cannot be proved, so going round in circles up a blind alley and my GP often speaks of my irrational overwhelming my rational thoughts, same thing I think.

So it does improve, take heart from this and make your plan. It will get better.