Anyone else start on 2.5mg?

[maddykip]

Im new here, so I hope you'll all bear with me!
Ive dealt with anxiety my entire life and have handled it well without medication up until about 3 weeks ago.
I had a massive panic attack coupled with a migraine aura that sent me to the ER, and had resulting anxiety that caused me to try Zoloft. The Zoloft gave me bad side effects, made me feel drunk and I couldn't sleep. Getting off the Zoloft caused more anxiety, and I got into an Intensive Outpatient Program for 2 weeks.
This definitely helped, but I was very reluctant to try any more meds. The anxiety caused feelings of fogginess that have been very hard to shake, and the Dr in the program felt that medication would help. Everything Ive read says that once the anxiety passes, the fogginess goes too.

I started on 2.5mg Celexa 3 days ago (small dose due to my sensitivity), and Im so anxious of side effects that I feel like Im in a weird cycle of Anxiety over Anxiety that just perpetuates the cycle.

Has anyone dealt with something similar? How did you break the cycle? Any help is appreciated!

[panic_down_under]

Im new here, so I hope you'll all bear with me!

Welcome to No More Panic,

I started on 2.5mg Celexa 3 days ago (small dose due to my sensitivity), and Im so anxious of side effects that I feel like Im in a weird cycle of Anxiety over Anxiety that just perpetuates the cycle.

Unfortunately, for some, antidepressants can make things much worse before they get better. And the anxiety about this just magnifies the problem. Not all the side-effects will necessarily be being caused by the med. An anxious mind is quite capable of delivering the full gamut even with sugar pills.

Starting on low doses and ramping it up by the same small amount can reduce side-effects severity, though may not eliminate them entirely. However, the trade off is it takes longer to get to a positive outcome because the 3-12 week to kick-in clock only starts running once you're on the minimum therapeutic dose which is usually 20mg for citalopram. You probably would have done no worse starting at 5mg and ramping the dose up in 5mg increments at weekly intervals.

While the side-effects can't always be totally eliminated, most can be successfully treated. The initial spike in anxiety will usually respond well to small doses of one of the benzodiazepines (BZDs), or to hydroxyzine (Vistaril) if your doctor is reluctant to prescribe BZDs. This is an antihistamine with pretty good anti anxiety properties.

As you experienced on Zoloft, SSRI induced insomnia is fairly common at the beginning. Benzodiazepines and hydroxyzine are mildly sedating which should help with that, but if they aren't sedating enough the standard treatment for SSRI induced insomnia is immediate-release trazodone (Desyrel). It may ease some of the other common SSRI side-effects too. Ginger and/or vitamin B6 supplements will usually ease nausea stemming from the heightened anxiety.

The important things to keep reminding yourself is that while antidepressants can trigger some unpleasant side-effects at the beginning and maybe for a short while after dose increases, these are not indicators of harm, and that in most cases the results are worth going through this.

[maddykip]

Thank you so much for the reply Panic_down_under!
Im hesitant to take any benzodiazepines (I was prescribed Ativan for if I have a very bad panic attack), for fear of having a bad reaction and starting back at square 1. When I rent to the ER they gave me Reglan and Diphenhydramine (HUGE doses), and the effects I felt after getting those meds lingered and I feel they helped contribute to putting me into this heightened anxious state.

As for the dosage, Ill talk to my dr and see about increasing to 5mg and so on. I definitely want to get to a therapeutic level, but I also want to go slow. Its hard being afraid of medications when the potential key to managing the anxiety and fogginess IS medication!
Im glad I found this forum though, you all are a fount of information!

[maddykip]

Welcome to No More Panic,




Starting on low doses and ramping it up by the same small amount can reduce side-effects severity, though may not eliminate them entirely. However, the trade off is it takes longer to get to a positive outcome because the 3-12 week to kick-in clock only starts running once you're on the minimum therapeutic dose which is usually 20mg for citalopram. You probably would have done no worse starting at 5mg and ramping the dose up in 5mg increments at weekly intervals.

Ive heard of some people doing well on 10mg, is 20mg truly the lowest therapeutic dose there is?
I emailed my doctor about increasing my dose, but Im not causing any problems starting this low right?

[panic_down_under]

Im hesitant to take any benzodiazepines (I was prescribed Ativan for if I have a very bad panic attack), for fear of having a bad reaction and starting back at square 1.

Benzodiazepines have been in every meal you've ever eaten, including lorazepam. They are found naturally in almost all foods, albeit only in tiny, though not insignificant, amounts which can build to pharmaceutical levels in those with liver disease. They are so ubiquitous in our diets that mammals can no longer survive without them.

When I rent to the ER they gave me Reglan and Diphenhydramine (HUGE doses), and the effects I felt after getting those meds lingered and I feel they helped contribute to putting me into this heightened anxious state.

They treated your panic attack plus migraine with a reflux med and Benadryl?? Sigh I wonder what they use for heart attacks? Bloodletting with leeches?

Its hard being afraid of medications when the potential key to managing the anxiety and fogginess IS medication!

I know. I've needed to be hospitalized to start every antidepressant I've tried, once even to up a dose (I'm okay with other meds). Unfortunately, quite a few of us get med phobia as a freebie with the primary anxiety disorder. I would have preferred the steak knives!!!!

Ive heard of some people doing well on 10mg, is 20mg truly the lowest therapeutic dose there is?

20mg is the recommended minimum citalopram dose even for children and the elderly. If you're a slow metabolizer you might get away with taking only 10mg, but there is no easy way of determining this.

The problem with taking borderline therapeutic doses is neurogenesis may be interrupted whenever plasma levels of the med drop below the amount needed to sustain it which could lead to the second issue, the growing evidence antidepressants become progressively less effective every time they are stopped and restarted. 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). Taking borderline doses may create a similar situation as stopping and restarting the med. While the neurogenesis interruptions may only be of short duration, they will probably occur much more frequently.

[maddykip]

20mg is the recommended minimum citalopram dose even for children and the elderly. If you're a slow metabolizer you might get away with taking only 10mg, but there is no easy way of determining this.

The problem with taking borderline therapeutic doses is neurogenesis may be interrupted whenever plasma levels of the med drop below the amount needed to sustain it which could lead to the second issue, the growing evidence antidepressants become progressively less effective every time they are stopped and restarted. Two studies,

Thanks for such thorough research! SSRIs are so touchy it seems, you can't stop them, they have to build up, you have to wait 6 weeks to even see IF they work... I have never needed any meds before this situation and Im just having such a hard time wanting to commit to this...
Im sure you guys hear this a lot. My fiancé is on Celexa and had no side effects, and took if for a couple weeks and felt better, no issues since. I wish I had his luck....

Is the only way to overcome anxiety with medication? Can I have success against fogginess/derealization without it?

How did you get through being hospitalized? How do you conquer your fear of the medication?

[Vincent Atkins]

Thanks for your posts. I am very sensitive, dealing with ibs, sibo, debilitating pain destroying my body and mind, losing lots of weight, ending up in hospital a lot, considering psychiatric hospital, i am typing in a stupor right now. Just took 2.5mg Citalopram, no idea if it is contributing to how I am feeling right now but no i have been very sensitive to small amounts of anti depessants in the past, immediately. Have put off trying antidepressants for ibs for so long, but can't take pain and what it is doing to my body and mind anymore, it is destroying me. Feel very weak and incapable of doing anything, physically or mentally, and tired of only having few hours of functioning each day. I too wish there was some other way, and don't think drugs are the answer.