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Old 06-04-09, 00:38
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Citalopram survival guide

PsychoPoet Research Initiative
Aut viam inveniam aut faciam


Fasten your seatbelts. Recovery is a bumpy ride.

"In the face of this abomination that would take our hearts, we will stand firm, unmoveable, resolute! Defiant to the last warrior! There can be no mercy, no surrender! No forgiveness of those who have betrayed us! No regret that it has come to this!

And we do not despair even now! We remain undaunted by the hounds of hell that snap at our heels and the butcher who demands his due. We must not lose sight of the golden thread of hope which will guide us through the darkness. We must grasp it, for it is the truth which taunts us from the limit of our reach, knowing that only by striving and suffering through this night can we move into a new day."

- The Terran Emperor, "The Last Day"

THE CITALOPRAM SURVIVAL GUIDE

Your guide to recovering from anxiety and depression, forever

> When fear rises and confidence falls, hope survives.

In a time when people don't believe anxiety and depression will ever be beaten, I am certain they will.

Anxiety and depression disorders, referred to hereafter as anxious illness, are an increasing scourge on modern society. There are many given reasons for this. Most of these reasons are debatable. There is a lot we don't know, and many supposed experts do not seem to have either enough facts, or a workable plan to fight against anxious illness.

It seems that some of our GPs are clueless or uninformed about anxious illness. Appropriate treatments are not always (or even usually) prescribed; it seems that many people are simply prescribed antidepressants, in some cases the cheapest type rather than the most effective, and sent on their way. It's up to the patient to learn about medication side effects - usually the hard way - and it seems common for there to be no further support from the GP.

Those who are provided access to therapy can find themselves at the end of a huge waiting list. When the therapy starts they may only have a set number of sessions, frequently with a trainee therapist as opposed to someone with experience.

The lucky few who are referred to a psychologist generally believe they are being sent to a "mad house", and that psychologists only deal with people who are seriously ill or psychotic. It is never explained that a psychologist is quite simply a doctor of the mind and is the right person to consult you if you are suffering from anxious illness, just as a proctologist is the right person to consult if you're an unnamed Hollywood star who "accidentally sat on a hamster, I didn't put him up there because it seemed like a good idea after snorting a yard of Bisto".(*)

This approach to anxious illness is totally inadequate and can leave people worse off. A quick trawl of relevant forums or blogs will confirm this. People simply don't have the support they need to get better, and they are rarely put in touch with people who understand.

Quite simply, anxious illness has been kicking our collective arse. I say it's time we kicked back.

About this Guide

This guide was started in 2009. I have learned a great deal since. I am currently working on a heavily revised self-help guide which will be published as an Amazon Kindle book at some point in 2015.

This Guide is written in an informal and often bizarrely rambling style designed to be light-hearted and entertaining. There are very few pieces of literature out there that consider the feelings of a person suffering from anxious illness. This is one of those few.

You will not find anything in this Guide that will shock you, frighten you, dissuade you or otherwise give you cause for concern. Instead, you will find hope, a quirky sense of fun and constant reassurance mixed with facts and research.

This Guide and its author take the view that anxiety and depression can be beaten, no matter how far you have fallen.

Whether you've suffered from anxiety and/or depression for a day or a lifetime, whatever the cause, whatever your present circumstances, even if you've already tried every medication and self-help book under the sun, you will find in this Guide a constant and total faith that you can get better.

You probably don't believe that yet. Okay, that's normal. You probably feel that you don't believe in anything much; but you somehow still manage to believe that you are seriously ill, or beyond help, or that you'll never get better. So you can believe in something. You just need to believe in the right things. Don't worry, you will learn how, and there are no weird gimmicks involved.

Believe that you will get better


Part of the problem may be your lack of belief or confidence in yourself. Some people, rarely, tell me that they feel very confident about themselves. So they feel totally confident apart from that pesky anxiety disorder that's destroying their lives. I'm not quite sure how a person can be confident and anxious at the same time since there is a degree of mutual exclusivity here... which leads us to our first diversion.

When things are mutually exclusive, it means there can normally only be one of them existing in the same place at the same time. So if you are aware that you are highly self-confident in social situations and do not experience any particular fears about dealing with people, it's unlikely you would be diagnosed with severe social anxiety!

NEW: When two mutually exclusive things try to exist together, they create cognitive dissonance. This is the confusing and almost painful experience where you believe one thing, but are being told another which contradicts it. For example, when you believe the England football team are a bunch of over-paid and over-sexed alcoholics who will never achieve anything, and the press call them heroes who could win tournaments if the manager gets his face out of the players' wives' cleavage.

When contrasting mental health conditions exist together, such as anxiety and depression, people can experience mixed states where their mood seems to be a jumble of symptoms. This can cause you to feel very confused, and make you wonder what's really wrong with you.

For example, "atypical depression" is where people are still able to feel joy and hope when good things happen, despite generally suffering from depression.

Cyclothymia
is a condition where your moods fluctuate rapidly, eg from anxious, to recovering, to depressed, to anxious, etc. (This isn't the same as being bipolar.)

Even if you are confident in some ways, you may be so overwhelmed by what you're going through, or so afraid after a lifetime of constant "defeats", or simply so exhausted after months of worrying about vague (or perfectly clear) "threats", that your self-confidence needs to be bolstered.

This isn't just a Citalopram Survival Guide any more. I spent almost 3 years thinking that medication was the most important part of suffering from anxiety. In fact, that's a load of horse poo fresh from the underside of John Wayne's cowboy boots. Medication is simply a useful and valuable tool to aid your body's natural recovery; it will never be any more or less than this.

While the Guide still gives Citalopram a starring role and some parts are Citalopram-specific, the basic information within will help anyone.

* I sought advice from the RSPCA before including that bit.(**)

** No I didn't.


THYMIAS
Some terms you'll hear me use:

Euthymia: A euthymic mood is the default human mood. It's a state of neutral or no emotion, with an outlook that is biased towards being positive. It is also used to describe someone who is in a generally good state of mind. Emotions use up a lot of energy, and I believe euthymia helps you to conserve this energy.

Dysthymia: A kind of low-grade, negative bias, similar to depression but not actually diagnosable as depression. You are likely to be capable of living a full and interesting life, but your thoughts and feelings have a negative, gloomy bias. Anyone who says "I'm not supposed to feel happy" but does not consider themselves depressed might be dysthymic. You can suffer from diagnosable depression alongside dysthymia, which is referred to by the Americans as "double depression".

Cyclothymia: As described above, this is the rapid cycling of moods, where your outlook, thoughts and feelings alter drastically the instant something good or bad happens, or in response to your thoughts, etc. This is really common in the world of mental health and typically is not a sign of impending doom!

ABOUT THE INFORMATION WITHIN THIS GUIDE

1. This Guide used to be about the SSRI medication called citalopram. It has now become more of a general guide to anxious illness and medications.2. Please bear in mind that some sections of the Guide are citalopram-specific. Information about dose strength, side effects and such may vary for different medications. Please speak to a pharmacist or medical professional if you are taking a different medication, even if it is from the SSRI class.

3. Citalopram and escitalopram are not the same thing. This is not a guide for taking escitalopram. However these two medications are related and many of the side effects are the same.

4.
The guide is useful for people taking any dose of citalopram for any reason. It will also help people who are experiencing panic attacks, panic disorder, anxiety, depression, feelings of fear of distress and upsetting negative thoughts, even if they are not taking citalopram.

5.
I am not a doctor. This free guide is written by a sufferer, for sufferers. This guide is merely a self-help tool and should not replace the advice or instructions of a doctor or medical professional. If you are worried by your symptoms or you wish to begin or stop taking medication or any kind of supplement, talk to your doctor or pharmacist first.

6. All views and opinions expressed in this guide are purely my own unless otherwise indicated.

7. I welcome any and all feedback about the guide.

8. What smashing blouses you're all wearing.

--

Guide Layout: Your Guide to the Guide

30/10/12 NOTE: THIS GUIDE IS UNDERGOING REVISIONS AND THE INFORMATION BELOW IS SUBJECT TO CHANGE

INTRO
Purpose of the Guide //
About the author // Are anxiety and depression caused by a chemical imbalance?

- PART ONE: ABOUT CITALOPRAM -

ABOUT CITALOPRAM: THE BASICS
What is citalopram used for? // How effective are SSRIs? // Can citalopram cure anxiety and depression? // Citalopram half-life // Before taking citalopram

CITALOPRAM SIDE EFFECTS

CITALOPRAM DISCONTINUATION SYMPTOMS
Discontinuation facts // Effects of citalopram discontinuation

ANXIETY AND DEPRESSION BLIPS AND SETBACKS
Blips // The difference between a blip and a relapse

CITALOPRAM AND SUICIDE

HOPE AND FEAR - CITALOPRAM FAQ

YOUR CITALOPRAM DOSE
Dose strength // Changing your dose // Missing a dose // Citalopram half-life // The best time of day to take citalopram // What happens if your dose doesn't work

COMBINING CITALOPRAM WITH OTHER SUBSTANCES - FAQ
Painkillers // Antidepressants // Anxiolytics (anxiety relief) // Caffeine // Sugar // Alcohol // "Recreational" drugs // Vitamins and supplements

INOSITOL - FAQ

MEDICAL RESEARCH AND NEW TREATMENTS FOR DEPRESSION AND ANXIETY

- PART TWO: THE JOURNEY OF RECOVERY -

COGNITIVE IMPAIRMENT
Physical effects of anxiety and depression // Staying sharp

FIGHTING BACK AGAINST ANXIETY AND DEPRESSION

The chatterbox // Staying social // Distraction // Positive thinking

LIVING A NORMAL LIFE
Work // Maintaining a sense of positivity // Mood swings


- PART THREE: RECOVERY COMPLETE -

FINISHING TREATMENT
How do I know when it's time to come off citalopram? // Relapse discussion // Avoiding a relapse

FURTHER SUPPORT AND GUIDANCE
Therapies // Support agencies // Internet support groups



My Story

Hi all,

I have always been an anxious type of person. This manifested early: as a baby, my mum simply could not put me down, or I'd scream for hours. (What a pain in the arse that must have been!)

Starting school came as a horrible shock as it presented me with a bunch of rules and people I didn't understand and didn't want to be around. I've had so many mental and emotional problems that it's amazing I am sane.

I've been diagnosed with various things: generalised anxiety disorder (GAD) with a score of 20 out of 21 on the GAD scale in 2012; depression with a ph9 score of 20 out of 27 in May 2009; dysthymia; obsessive compulsive disorder (OCD).

Nothing I did ever seemed to change anything for long. Therapy did not help at all until I met my CBT therapist, Dr Taylor-Kerr, via Anxiety UK.

The National Health Service has been little short of counter-productive and their unprofessionalism and mistakes made it nearly impossible to get the correct treatment or diagnoses; my battle with the NHS is continuing as of 25th June 2016 and has gone to the Health Ombudsman and my Member of Parliament (who I didn't vote for, whoops).

It wasn't until 2014 - after an unbelievable 34 years of struggling and suffering - that I was finally diagnosed with Asperger syndrome, which is an autistic spectrum disorder, and attention deficit hyperactivity disorder (ADHD). As of June 2016, I also believe I have undiagnosed Pathological Demand Avoidance, which is so bound up in Asperger syndrome that there's no point trying for a diagnosis; and some kind of attachment disorder.

I started taking strattera (atomoxetine) for these conditions in May 2015. Receiving the correct medication after struggling for years on the wrong stuff effectively "dropped the hammer" on my mental health problems. My recovery is ongoing, but for the first time ever, I made drastic strides in a short space of time.

Finally, at my own effort, and through immeasurable personal and financial loss, I can look my problems in the eye and tell them that I am going to kick their arse for all time.

I aim to help as many people as possible recover, so that they don't have to suffer alone like I did.

Adam

[Last updated
25/06/15]

NOTE: Guide updated occasionally -- please check back. All dates given are in UK format (DD/MM/YY and DD/MM/YYYY).



The Purpose of this Guide

* To take a lighthearted look at life with citalopram;
* To provide relief to those who have been frightened by everything they have read and heard about citalopram and depression and anxiety;
* To be an honest and frank source of information written by a sufferer for fellow sufferers;
* To provide first-hand proof that citalopram can help with anxiety and depression;
* To provide ideas for other types of support, assistance and therapy that you should take advantage of alongside medication;
* To be a light when all other lights have gone out.

Welcome to the citalopram bandwagon

Hello there and welcome to the Groovy Gang! You're just setting out on your grand citalopram adventure, or maybe you're a veteran who just wanted some further info. Or maybe you're just nosey and want to see what this is all about.

I'm sorry you've reached the point where you need medical backup to recover... but recover you will, and this guide will be your companion for your journey. There are ups and downs in store, but the ups just keep on coming... and that's life, anyway

I'm PsychoPoet. Most people call me Poet. I'm not actually a psycho. I'm not a poet either when I come to think of it. I don't really like it when people call me Psycho, just so you know.

I've had depression and anxiety on and off for my whole life. I never really shrugged them off cos I am a lazy sod and I stopped making the effort as soon as I feel better. (Story of my life.) That's why the feelings kept coming back.

This time is going to be the last. This time is when I bin my depression and anxiety off... once and for all.

I want you to know that depression and anxiety can be beaten. People who are very ill with them may not believe this to be the case. To that opinion, with the greatest respect, I hereby say: "Cakapoopoo." Sometimes things simply are right, sometimes they simply are wrong.

Sometimes, if their underlying causes are not resolved, anxiety and depression come back; for some of us, like the Huge Materia in Final Fantasy VII, once they're gone, they are gone for good.

What is citalopram used for?

Citalopram is an SSRI (selective serotonin reuptake inhibitor) which is used to treat depression. It is sometimes, and increasingly, used to treat anxiety disorders. Sometimes it is prescribed for obsessive compulsive disorder since it can treat some of the agitation which causes of worsens this condition.

It should not be used for bipolar disorder since it may trigger mood swings in these people.

Citalopram is thought to work by preventing immediate re-absorption of serotonin in the brain. Serotonin is a "happy chemical" which is deficient in many people who suffer from depression.

This deficiency is thought to be caused by a chemical imbalance in the brain in which case you do not always produce enough serotonin, and/or the brain re-absorbing (re-uptaking) serotonin too quickly. Re-uptaking serotonin too quickly could leave you with insufficient amounts to boost your mood.

SSRI medication forces your body to keep its serotonin reserves active for longer. This means you should find that your mood improves, you experience fewer negative thoughts, the impact of negative thoughts which do slip the net are reduced, anxiety recedes into the background and any suicidal thoughts you may have are blocked or seem unreasonable, which is the way it should be.

This is an entirely natural process, so SSRIs are not simply masking your bad feelings, they are attempting to return a balance that should be there by default: God or mother nature or whoever/whatever else you believe in therefore, unquestionably, DID NOT design you to be permanently miserable.

They designed you to be able to feel joy and other positive emotions, and these positive emotions are DESIGNED to be the way you feel by default.

If you believe that you are specifically being punished, or are supposed to feel depressed etc, then you are wrong.

Not everyone needs to take medication to help them deal with anxiety or depression. In fact, nearly everyone is believed to suffer from some form of depression at some point in their lives, although many people will simply never realise it before they recover naturally.

Most people who suffer from depressive or anxious episodes are therefore likely to recover. This is not a guarantee, and it is not an argument against seeking medical treatment, it is just some reassurance that depression is not the all-conquering monster you probably believe it to be.

Some (but not all) in the medical profession believe that anti-depressants are most helpful to those suffering from severe depression. It is believed that people with mild to moderate depression may benefit more from talking therapies such as counselling and congnitive behavioural therapies as their first line of treatment.

However, anyone who is depressed or anxious may benefit from taking citalopram.

If you find your symptoms are getting worse and/or they are interfering with your life in any way, you are advised to speak to your doctor as soon as possible.

It is possible in some cases for untreated anxiety and depression to become serious, although this is not always the case and would probably be obvious.

The sooner you ask for help the better it will be for you in the long run. Trust me on this.

You do not want to allow anxiety and/or depression to take hold of you. They can be difficult to shift once they become a habit.

A new variant of citalopram, called escitalopram, is also available and is thought to cause fewer side effects than citalopram. This survival guide does not specifically cover escitalopram as I have no experience with or knowledge of that medication.

How effective are SSRIs?

Current research indicates that between 30 and 70 per cent of people suffering from anxiety and depression respond to the first antidepressant they try. This does not just include SSRIs - it means all of the various types.

This means that if you are prescribed citalopram, it is fairly likely to help suppress the symptoms of anxiety and/or depression.

However, what does not seem to be commonly known, is that of the people who do not get any benefit from the first medication they try, the majority (up to approximately 70%) will find benefits from the second or third antidepressant they try.

SSRIs are considered to be among the most effective medical treatments for depression. Work is constantly continuing on new SSRIs and, in the long term, a new generation of medication which may eventually replace SSRIs.

SSRIs and other types of antidepressant are not generally prescribed to under-18s, probably due to the developing mix of chemicals and hormones in their bodies.

For those of us over 18, citalopram is generally regarded as safe, with fewer side effects and a longer half-life than some other SSRIs (more on this later). It would take an extremely high dose of citalopram to cause damage to your body.

A lot of people say antidepressants don't work for them, or make them feel worse. I'm willing to bet that these people gave up on medication because of the side effects, or only tried one or two different medications. You must not be dissuaded by these peoples' experiences.

The truth is that SOME people WILL feel worse when they begin taking citalopram, or any other type of medication. Virtually every medicine in existence (including natural remedies) may have side effects.

The human body is immensely tough but it's still a system which will suffer if its balance is altered. You're not a car, you can't be made more powerful or any smarter by tweaking your basic settings, unless perhaps you are Stephen Hawkings with all that fancy computer stuff around his head.

SSRIs and other medication may cause serious negative side effects such as suicidality, very bad moods, violent outbursts and so on, although there is no guarantee the medication will do any of this. If a person becomes noticeably worse while taking citalopram, it might be worth switching to a different type of medication; if you develop severe depression and suicidal thoughts, consider switching from SSRI medication altogether. (See the "Citalopram and Suicide" section later.)


Side effects are one of the most important things you need to understand about antidepressants
and are discussed in depth later on.

Whatever you are taking citalopram for, medical trials show that all types of anti-depressant medication work better when you are also receiving other forms of treatment such as counselling. Medication alone is not an effective "cure" for depression or anxiety. It is designed to control the symptoms so that you can deal with the cause.

Medical understanding of depression and its treatments are improving year on year. It is likely that very highly effective medications will be available at some point in the future. Until then we have to make the best use of what we've got, and what we've got can be pretty good.

Do any anti-anxiety medications work quickly?

Yes, a lot of anxiolytics work very quickly. Unfortunately they are for short term or emergency use only, since many of them are highly addictive and present severe withdrawal symptoms. It is possible to take certain anti-anxiety medications and feel relief within hours.

You CAN take some anti-anxiety drugs alongside citalopram but you'll need medical advice.
Antidepressants tend to have positive effects in the treatment of anxiety disorders and are suitable for long-term treatment. This is why antidepressants are often prescribed for anxiety sufferers.

Do any antidepressants work quickly?

Our current antidepressants can take weeks or months to start working properly. If you are taking antidepressants, you are in for the long haul. Accept this now, don't fight it or rail against it. Start taking your tablets at the prescribed dose (or a lower dose if you are getting side effects) at a time of day that suits you. Start them now; otherwise you are wasting time.

This is due to their complicated (and sometimes uncertain) mechanisms of action. While the documentation that comes in packs of citalopram states that antidepressant effects may become apparent after 1-2 weeks it is not common for them to have much effect in such a short space of time. So if you're going onto medication, you may need extra support until the antidepressant effect kicks in.

It is strongly recommended that you ask for counselling, CBT, hypnotherapy or anything else that may help you. Remember you also have the Samaritans and any other support agencies that might be in your area. Do not waste time waiting to see if the medication kicks in. Book therapy as soon as you feel you need it.

The newest generation of antidepressants are called SNRIs. These are suppoesdly easier to tolerate than SSRIs such as citalopram. This means that the side effects may be more limited in severity and fewer in number.

Scientists are currently researching ketamine for its "miraculous" antidepressant properties. Ketamine offers relief from the most severe depression in just a single dose and can last for days. Unfortunately ketamine is very dangerous if used without close supervision.
Therefore we are still a while away from "miracle" depression drugs which are safe to use.

There are new medications being developed all the time so there is every chance that the biological effects of depression will be cracked - it seems to be a question of when rather than if.

SSRI and SNRI antidepressants, along with many older types of antidepressant, are not thought to be addictive despite having potentially nasty withdrawal effects if you stop taking them "cold turkey". This makes them suitable for long-term treatment.

Note that there are usually underlying reasons for depression. Depression may have come about after suffering from prolonged anxiety, stress and physical or mental illness. Medication will not undo any damage you believe has been done to your life. Therapy and self-help are ways to repair this damage, not medication. Medication simply eases the symptoms of depression.

Can I permanently recover from anxiety and depression?

Yes. You can recover from anxiety and depression and never suffer episodes of them again.

This involves building coping strategies and learning to accept what you have been through.

It also involves knowing triggers and being able to identify warning signs - your body will let you know when enough is enough.

If you do have episodes later in life, this does NOT mean you have failed or you are weak, and it does NOT mean that you are doomed or cursed to suffer forever. It does, however, mean that you need to keep practicing your coping strategies and maybe evolve new ones.


You cannot recover until you lose your fear of what you're going through. Acceptance and understanding are required. It's a bit like the Ancients from Stargate SG-1: you need to achieve a kind of spiritual peace and acceptance, which can be obtained by anyone over time, in order to "ascend" into a better state of being.

Citalopram half-life

You'll often hear people referring to the "half-life" of citalopram. I'm quite certain that, like myself, people tend to use this term without understanding what it really means. Well a quick bit of research reveals the following:

A medication's half-life is the time it takes for HALF of the CURRENT AMOUNT of medication in your system, to LEAVE your system.

Citalopram has a half-life of 36 hours. This means that after 36 hours of taking a dose, only half of that dose is still in your body, since your body will fight it off like any invading element.

Of the amount that remains, after another 36 hours, half of that amount will be gone from your system. And so on until there's nothing left.

That's why radioactive elements with half-lives of 500 or 5000 years are such a problem: a half-life of 500 years DOES NOT mean a full life of 1,000 years. It would still be present in some amount for a couple of millennia.

That's a very simplified way of putting it and it may be slightly flawed, but I'm not exactly a top scientist, despite the fact that I usually understand what's going on in Star Trek Voyager.

Can citalopram cure depression or anxiety?

SSRIs are not a "cure" for depression or anxiety. They are designed to help you feel better by reducing the symptoms. The theory is, if you feel better for long enough, you will recover naturally thanks to your body's in-built defences, and you will seek therapy and self-help. In cases where the anxiety and depression seem to come from nowhere, you will definitely need to seek a doctor's advice as you do need to find out what is causing them and the doctor can refer you on for appropriate help.

Medication is like covering a wound with antiseptic gel and a sterile pad: it provides protection while your body heals itself naturally.

So although antidepressants are not a "cure" as such, they can help you to make a complete recovery by making you feel better for extended periods of time. If you wish to stay in a recovered state, you should consider self-help and therapy.
MEDICATION IS JUST ONE METHOD YOU MUST CONSIDER ON YOUR ROAD TO RECOVERY. MEDICATION IS NOT TO BE CONSIDERED AS THE ONLY AVENUE TO EXPLORE.

Note that finding the right dose is one of the most important aspects of using antidepressant medication. If you are on the wrong dose, it will not help you with your problem: too low a dose may present the usual side effects but will not be fully effective at suppressing your symptoms; too high a dose may make you unable to function by reducing your energy and motivation.

Any antidepressant is only truly effective once you have found the right dose for you!

What are your "natural defences"?

Often throughout the guide you'll see references to "natural defences" or "mental defences". Basically, in all living creatures there is an in-built survival mechanism which prevents us from putting ourselves in harmful situations, or from undue suffering caused by negative thoughts or feelings. In the most extreme case, this manifests as health anxiety. Health anxiety always relates to the fear of death, though this can sometimes manifest as a fear of being permanently debilitated by illness or injury, which represents the end of your current and accepted way of life. Therefore, if you suffer from health anxiety, the underlying problem is either a fear that things will change for the worse, or a fear of dying.

Sentience versus Sapience

Humans are the first species known to have evolved with our level of intelligence. In every case throughout the history of earth, the first of a new breed of species act almost like a "testbed" which is refined over the course of thousands of years. It is my opinion that the human brain is currently imperfect. Consider our brains and our level of intelligence to work with the operating system "Sapience 1.0".

Sapience, in case you were wondering, basically means "intelligence of human level". This is wrongly called sentience in science fiction. Sentience essentially means a living being of any level of intelligence. This means all animals are essentially sentient, even my mate's dog Betty.

JANEWAY: "Ensign Kim, run a scan for sentient life."
TUVOK: "Captain, our scans would undoubtedly detect sentient life, since we already know a variety of animal species exist on the planet's surface. Perhaps you intended Mr Kim to search for sapient life, in which case we would know whether or not our enemies were waiting in ambush."
JANEWAY: "Security, please escort Mr Tuvok to the brig. Harry, just look for the f*****g Borg."

Flaws in the running of our brains can lead to mental disorders, emotional problems, self-destructive behaviour, depression and so on. (Just because it CAN, doesn't mean it WILL.) According to the laws of evolution, as the human race continues to evolve, our brains will become more sophisticated and should eventually start to "work better".

In theory, mental illness could be something that we will eventually "out-evolve" and leave behind.

Sounds far-fetched? Well, I read somewhere that the average child of today would have been considered a genius sixty years ago. The IQ test is constantly being adjusted so that the average human IQ rating is around 100. Otherwise, the average IQ would probably be much higher by now.

I also read that if the Western world had not suffered several hundred years of "dark ages", where technology and progress were shunned in favour of fear and superstition, we would have been colonising the galaxy by now.

So it is clear that over time, the human species can make leaps of intellect and technology that make a mockery of previously held beliefs.

Our reaction to depressive or anxious thoughts is the same as our reaction to a "real", physical threat. In most cases people recoil from negative or hurtful thoughts and will attempt to block them out or deal with whatever caused them.

A human's mood generally returns to a neutral or positive state after the person has rested or has not experienced negative stress for a short time. The company of other people tends to have the same uplifting effect.

Also, the balance of hormones and chemicals in the brain will attempt to return to "normal" at every opportunity. So someone who becomes depressed after, say, losing a loved one or experiencing a relationship break-up, will find that over a period of time their despair will no longer sink so deep and that they will naturally be able to cope with their grief, even if the grief never really goes away.

Is depression caused by a chemical imbalance in the brain?

Last updated October 2012.

Depression has many causes. A "chemical imbalance" is the cliched and commonly accepted explanation for depression. Some research has shown that depression sufferers have a chemical imbalance - usually a lack of serotonin. SSRIs prevent the brain from re-absorbing serotonin too quickly, thereby forcing the brain to maintain the correct, or nearly correct, serotonin balance. However, other types of antidepressant, such as agomelatine, work on other chemicals instead.

A very large amount of research that has gone into answering the question of the chemical imbalance. It is starting to become the consensus that a chemical imbalance in the brain is not that cause of depression, but may simply be a result of depression. So when you begin to suffer from depression it throws your brain chemicals out of sync as a side effect.

However, people do not usually become depressed without an outside cause. Therapists believe depression is linked to loss, like the death of a loved one, the end of a relationship, the loss of a job, major changes to your lifestyle and so forth. This may explain why antidepressants can mask or reverse the effects of depression, but do not "cure" it: by restoring the chemical imbalance, your mood improves to the point where you are able to identify and resolve the problems which actually cause your depression. THAT is the cure for depression. Medication is simply a useful and effective tool to help you while you recover your strength and start to work things out.


This contradicts the popular theory that people who suffer from depression do so because they already have a chemical imbalance. This would mean that depression is a side effect of the chemical imbalance. It doesn't explain why people who don't have chemical imbalances can become depressed.

Dr Claire Weekes stated categorically that depression was caused by a chemical imbalance, but she was writing in the 1970s, when depression's mode of action was barely understood. Dr Weekes then repeatedly refers to depression as "depletion" when it appears alongside an anxiety condition such as generalised anxiety disorder. While depletion is an excellent word to describe anxiety-related depression, it does not explain depression which is related to death or the end of a way of life. When I lost my job to redundancy, I did not become "depleted".

So, some people believe depression is caused by a chemical imbalance in the brain; others think the chemical imbalance is simply a side effect of depression. Probably both theories have merit.

Everybody is different. It's highly unlikely that depression has only one specific biological cause. Some people will have "flaws" in their brain chemistry either due to a minor defect or a brain injury. Others will find themselves suffering from depression simply because their life has become very tough, or they are on medication or suffering another illness whose side effects include depression.

CBT, Depression and How We Interpret the World

CBT (cognitive behavioural therapy) teaches us that the real cause of depression is actually something we learned - or more often, didn't learn.

Anxiety and depression are very strong indicators that something is wrong either with our life or ourselves. Sometimes these things really ARE in the outside world - abusive partner, crap job, etc. Generally, depression and anxiety are created and reinforced by the way WE interpret things.

Say you're walking down the street and a gang of kids shout something insulting at you. Do you shrug this off and think, "Who do they think they are, the bunch of scrubbers?", or do you internalise their insults and scurry away, vowing never to be seen in public again? An average person would lean more towards shrugging it off. An anxious or depressed person would not be able to let it go.

Coping with life is like playing tennis. When life hits the ball to you, you need to learn to hit it back. Otherwise the ball is going to smack you in the face. Then there'll be another ball, then another. And it's always life's turn to serve.

A lot of the time, depression is caused by the way you react to changing circumstances in your life. It is not the world, or life events, that make you depressed - it is the way you respond to them. If the war on terror makes you terribly afraid and upset, for example, then your real problem could be that your sense of security is being challenged, and you do not yet have a coping mechanism to deal with the problem, or your coping mechanism is no longer adequate.

Avoidance is a very common defensive mechanism. It is ultimately self-defeating because you will eventually have nowhere left to run. You CANNOT hide from anxious illness and especially depression. There is something causing the illness, something you may be afraid to admit even to yourself. THE ONLY WAY TO CURE YOURSELF IS TO FACE THE FEARS THAT ARE CAUSING YOU TO BE ILL.

Also, if you are under stress for a prolonged period, depression and/or anxiety may result. This can happen even if you DO have effective coping mechanisms. In this case, the illness is a warning that you are in a situation that must be changed. Generally, the change needs to come from within you - you should think, really THINK, about what you're going through and how you have responded to it. If someone else was going through the same thing, how would you expect them to feel? What would be your advice to them?

Having said that, sometimes people may seem to be depressed for no reason at all.

No matter what caused your depression, no matter how bad your depression can be, there are treatments available and a full recovery can be made. Millions of people recover from depression, many of them without medical intervention, although if the depression is affecting your life you should get it seen to as soon as possible; the sooner you start, the sooner you're going to feel better. You should strongly consider CBT as the fist-line treatment for depression.

Before taking citalopram

Do not start taking citalopram, or any other type of antidepressant medication, if you are not prepared to put up with it for AT LEAST TWO MONTHS.

It can take this long before the antidepressant effects become obvious. There are no immediate benefits from taking antidepressant medication.

However, side effects can become obvious straight away. Some NMP members, including myself, have experienced effects within one to two hours of taking our daily citalopram dose. Doctors claim it takes 3-4 hours for citalopram to enter the blood and this is when side effects should begin. I believe these doctors are wrong. They have never taken citalopram. How would they know our feelings better than we do?

It is common for the first dose of any SSRI to come as a shock if they cause unusual side effects. Higher strength doses may cause more pronounced side effects, so it is usually better to start on a lower dose and gradually increase the dose over a period of weeks.

Not everyone experiences side effects. Some people also find that the SSRIs will start to improve their mood within 2 weeks to 1 month. If it takes longer than that for you, this is normal and does not mean that the medication isn't working.

If you stop taking your medication before, say, 2 months, you may not have given the medication enough time to start working. This means you might have taken the medication for nothing. If after 6-8 weeks there is clearly no benefit, you should talk to your doctor since it may be that your dose is too low - in the first instance you should discuss increasing the dose slightly, NOT coming off the medication.

If you want to quit a medication after a short time and your doctor agrees, they might not be doing you any favours. They may THINK that they are helping you, but they might be taking you off your medication too quickly, before it has a chance to help you. Of course, if the medication really is making you ill then that's different - see below.

If you feel that you have tried many medications and none of them helped you - but you did not stick with any of these medications for at least 2 months - YOU HAVE NOT STUCK WITH ANY MEDICATION LONG ENOUGH FOR THEM TO HELP YOU.

If this is the case, your condition is NOT treatment-resistant, and the medication has NOT failed to help you. YOU have failed to stay the course, so your best course of action will be to STICK WITH A MEDICATION FOR AT LEAST 2 MONTHS.

SPECIAL NOTE: If you find you become depressed, or if your existing depression becomes worse, and/or you develop suicidal thoughts, you should speak to your doctor as soon as possible about changing your medication.

SSRI Discontinuation Syndrome

There is a single rule about abruptly stopping a course of SSRIs:

Don't do it.

If you are ever in doubt, refer to the rule.

All SSRIs are known for "discontinuation syndrome". This is usually, and perhaps incorrectly, known as "withdrawal syndrome."

"Discontinuation syndrome" is something that may occur when you reduce or stop your dose of SSRIs, due to your body trying to adapt to life without the medication's effects.

"Withdrawal syndrome" is when you experience negative effects because your body has become dependent on a substance which is then reduced or stopped altogether.

The difference is, the human body is not thought to be dependent on SSRIs, and they are therefore not classed as addictive. In practice the difference may be meaningless. If you abruptly reduce or stop your dose you can still experience unpleasant side effects.

You should NEVER abruptly stop taking any SSRI without a doctor's advice. I did, but my doctor is quite frankly an idiot, and to be honest so am I. I paid for it horrendously, and I would not wish that on anyone, not even Davros. Unless a medical professional tells you to, or if you are CERTAIN that the medication is actually making things worse, stay on your course of medication.

Listen, it's your life, you are free to think you know better than me, probably you do know better than me, and you are welcome to make your own decisions and make your own mistakes. If you want to go against the advice of someone who has done what you want to do, you are welcome to do so, I respect that it's your choice.

But if you want to go cold turkey from an SSRI, you're a fething muppet.

Note that running out of medication can put you at risk of discontinuation effects. There were occasions where I tried to see if I could do without the medication. (Ah, those naive days!) The longest I went without nasty discontinuation effects was 5 days; by the 6th day I was quite ill. Do not ever allow yourself to run out of medication.

You are still at risk from discontinuation effects even if you are actually recovering from anxiety or depression. When I decided to go "cold turkey" I was completely, 100% sure I didn't need the medication any more. Unfortunately I was wrong. I was well enough to lead a fairly normal life but there were plenty of warning signs that I was still depressed and I ignored them out of fear.

Experiencing discontinuation effects does not necessarily mean you are relapsing. They are basically negative side effects. They do not indicate that your mental health is worsening or that your anxiety or depression have not been successfully treated. On the other hand, they may indicate that you are NOT ready to come off the medication yet, so you should reduce your dose very slowly. If you're coming down from higher doses you're looking at months, not days or weeks.

My Experience with Citalopram Discontinuation

This section is quite long and is very personal. I have been through as much of a journey in the last 2 months as I have in the last 2 years, all because I decided to bin the citalopram altogether. I hope that my experiences give other people comfort and hope - and I am willing to bet that a lot of you will recognise yourselves in my thoughts and feelings.

I took citalopram for nearly two years with only the occasional lapse. On the two or so occasions that I didn't take citalopram for 5-6 days I started to feel highly agitated, with a building tension headache that felt like my head was caught in Ghazghkull Thraka's power claw.

When I went back onto my full dose of cit I found myself already heading into blip territory. It wasn't pretty. The first time this happened it took about TWO WEEKS for me to start feeling better again - that was not nice at all. To be honest I can't believe I have made it through this many blips with my sanity (such as it is) intact.
I think we should all clap ourselves for being blip survivors.

About six-seven weeks ago at the time of writing this, I felt in every molecule of my body and soul that it was time for me to take the plunge and come off citalopram.

At first it was actually quite beautiful. Emotions that I had forgotten, unknowingly suppressed or otherwise thought long-lost started to come back within a week.

I remember coming out of work one evening and seeing an absolutely magnificent sunset. It was a Friday evening, I had the weekend off, nothing bad was happening in my life, and my God I felt like I had found myself again. I got a sense of mystery, some deep connection to the world, a huge turnaround from the early days of my depression/anxiety when I felt like the world was made of cardboard and there was nothing beyond the horizon.

In fact, if you stop to think about it, there are certain things that trigger our innate mysticism: a beautiful sunset, driving around a corner onto a hill that descends into a huge valley, laughing at something until we nearly cry; these things strip away our cynicism, they obliterate our dependence on concrete and technology, and they plant us right back into the circle of life that connects us, all of us, everything that has ever lived or died, to the world we live in. If you can still feel like this, even for a moment, then all is not lost. If you can't - you will. Believe in that. Everything has its season. So do depression and anxiety.

There are two things that stopped this from being a complete recovery. I wasn't fixed, and I came off my tablets cold turkey.

I became the biggest plonker in Rotherham.

I'm NOT saying that reducing the dose gradually would have been any easier -- there are as many horror stories about slow reduction as there are about going cold turkey -- and, after carefully considering all the shit I've had thrown at me over the last few weeks, combined with my own innate sense of negativity, it was INEVITABLE that I would experience a blip or two.

What I can say with complete certainty is, my stress response became very poor within 2 weeks of coming off the citalopram and I developed a very hot temper which led to some unpleasant incidents that made me feel ashamed of myself. Don't worry, I didn't thump anybody, even though I wanted to. Anger makes you feel strong. Unfortunately it places a great strain on you emotionally and it WILL end badly.

Over the following weeks I found myself feeling increasingly negative, which culminated in a dark mood one Friday. That night I had a horrible night's sleep. I was sweating, shaking, felt like throwing up, my dreams were disturbed, I woke up about 3 or 4 times and on Saturday I felt a total wreck. It was the kind of anxiety attack that legends are made of. It was my first attack of that ferocity in nearly 2 years.

For the next weeks, every time I thought about anything I felt trapped, like I was running from bad topic to bad topic in my brain. This is how I used to feel in the early days of my illness - that I was screaming in my head which had become my prison.

When I think about this calmly and rationally, which is quite hard because it is such a painful topic, I realise a few things. My life is not at a point where I can face the world without support. I am still too negative, too needy, and basically I have few coping mechanisms that work in the real world. I am depressed and the medication did not cure it; I hid from that truth, so my depression basically went untreated throughout my two years of medication.

It's not all doom and gloom. I now accept that I am depressed. As hard as it is, I can face up to that ultimate fear. While I generally feel terrible with alternating anxiety and depression, I have been through too much to simply give in.

The sense of "screaming in my head", rather than a terrifying harbinger of doom, is a NORMAL, COMPLETELY UNDERSTANDABLE reaction to feeling trapped by unhappiness. Feelings of depression are BOUND to follow if you stay like that for long enough. Depression is an urgent warning that your life needs to change, that YOU need to change. That may be simplistic and some people will find it offensive I suppose but that's how it is for me and many of the people I speak to.

I accept my illness, I accept that it will be a long time before I'm back up to par. The main thing is I BELIEVE, no matter how much my bad feelings tear my heart out and stamp on it, that there WILL come a day when I WILL feel better. I believe this because I've been through anxiety and depression a number of times in my life. I have felt even WORSE than I do now and somehow I made it through. My depression tells me it won't happen, I'll always be like this, but the truth is I want to be better and I respond well to treatment, so I will put up with hell because I have faith in myself.

Try making a list of everything you've got going on now. It doesn't matter how long or short the list is, it doesn't matter how major or minor your problems are, just DO IT. Then try and find the reasons why you feel that way. I'm willing to bet all or most of it overlaps. It doesn't matter whether or not everything does link in; all that matters is that you know HOW you feel, and you investigate WHY you feel that way. You don't have to be Sherlock Holmes. Just spend a few minutes on it. If this task distresses you, either wait til you feel stronger or have some relaxing music playing while you do it.

I think my old fears - about death, that I'll go mad or become suicidal - are still here and haven't been properly resolved yet. So there is still plenty of work to do.

Discontinuation Facts

1. Between 33% and 80% of people who abruptly discontinue use of SSRIs (in other words go "cold turkey") may experience some degree of SSRI discontinuation syndrome.

2. You are NOT guaranteed to suffer from any discontinuation effects.

3. Everyone who experiences discontinuation effects will experience them in their own way. There is usually some commonality between peoples' experiences but don't be freaked out if your symptoms were different from other people's.

4. Discontinuation effects normally last between 1 to 7 weeks; in RARE cases, they can go on for months.

5. Discontinuation effects can range from mild to severe, but not everyone gets them.

6. If you reduce your dose by more than 5mg in two weeks, you may be at risk from withdrawal effects. Therefore to safely reduce your dose to zero, you must decrease it by NO MORE than 5mg every 2 weeks. Some people will find it takes MUCH longer to successfully come off SSRIs. There is nothing wrong with you if this is the case!

7. Your doctor could prescribe another type of medication to help reduce severe discontinuation effects, but then you run the risk of having to wean yourself off that one day as well.

8. Discontinuation effects range from tolerable to severe; however, even the distressing effects are not physically harmful.

9. If you are suffering very badly, your doctor can temporarily increase your dose, or if you have come off altogether they may prescribe you a low dose to take for a few weeks, and then wean you off much more slowly. You are not trapped on SSRIs, it just requires a delicate touch to get them out of your body.

10. If you don't think medication is for you, or you don't think you will be able to stick with medication, DO NOT TAKE MEDICATION. Try an alternative such as inositol and make sure you have other forms of therapy such as counselling,
hypnotherapy, CBT and so on.

11. Some people find that hypnotherapy, CBT, counselling and so on can help them to reduce and/or manage withdrawal effects. I would strongly recommend that you get help when coming off the medication, even if you otherwise feel ok.

12. The majority of discontinuation symptoms appear to be physical rather than emotional. I personally suffered emotionally as well as physically.

Citalopram Discontinuation Symptoms

These are similar to the symptoms of a "blip" or relapse, but do not indicate that you are experiencing a relapse. They range from mild to very distressing. However none of them are actually a threat to your health.

Discontinuation symptoms last between 1-7 weeks but can last much longer.

Increasing your dose (under a doctor's guidance) can alleviate discontinuation symptoms.

The most often reported symptoms of abrupt citalopram discontinuation seem to be physical in nature e.g. headaches, dizziness, nausea, problems sleeping. You can also experience heightened anxiety and a recurrence of your depression, if any.

The more unusual or outlandish side effects are discussed here:

Brain Zaps

Brain zaps seem to be most often reported as a discontinuation effect of taking SSRIs. However, I have experienced them immediately before or during a major anxiety attack, but I've only had them since I started taking SSRIs. I've had less than ten in the last year, two on the same day and related to citalopram discontinuation.

There seems to be some variation in what people report as brain zaps. Some people may feel like their head just exploded ("exploding head syndrome") or they received an electric jolt. I personally experience a tingling feeling, almost like pins and needles, which works its way around my temples and across the front of my head.

Whatever the actual cause, brain zaps range from mild to highly noticeable, and they may cause a great deal of distress due to their bizarre and unexpected nature.

However, like all side effects of medication, brain zaps are harmless and do not indicate there is anything physically wrong with you.

Mood Changes

Your mood may become flat or low, or may swing between happiness and sadness or depression. You may notice an increase in symptoms of anxiety. If your depression or anxiety become very bad, you should seek medical advice. Most doctors will have seen this before.

Blips

A blip, often called a "setback", is defined in this survival guide as a temporary increase in the symptoms of your illness which can occur for any number of reasons, such as life events, stress, emotional trauma, remembering past suffering and any change in your medication. Discontinuation symptoms can also trigger a blip.

Blips can be very frightening and distressing to someone who is new to them or has not developed coping skills. It is very common to confuse a blip with a relapse and experience despair about ever getting better, but a blip is not the same as a relapse.

Blips vary in strength depending on their cause or causes. There will often be more than one cause for a blip. I recently had a blip and counted ten causative factors.

Blips can be severe even for those who are almost recovered. A blip will not respect your experience or mental strength; the only thing that can reduce their severity is for you to develop coping skills. You need to essentially de-sensitise yourself to them. Part of this comes from discovering and eliminating the thoughts and beliefs which cause them to happen. The other part is by refusing to succumb to "second fear".

When a blip strikes, it is normal to feel intense fear, despair or discomfort, along with physical symptoms like nausea, headache and other unusual sensations. This is "first fear" - the trigger. "Second fear" is your response, which is likely to be panic, shock and distress, creating a negative spiral that leads you to believe you have relapsed into illness once more. It is very common at this point for people to think they are becoming psychotic, but this is just another baseless fear.

While a blip always has a logical cause, the blip will make you think and feel in ways which do not rely on logic or reality. (In fact, reality is poisonous to a blip.) You will exaggerate and distort things in your mind and this will make you miserable because you'll believe it. You don't realise that thinking during a blip is like looking at the world through a glass of water: you'll see a mess which you can't understand and will therefore interpret wrongly.

A blip is pure fear. This is why you don't feel like doing anything during a blip. Your natural instinct is to protectively curl up and defend yourself against the perceived threat. Your hobbies will seem like a bad joke, and you may find that the thought of doing anything fills you with dread or sadness. You can start to associate blips with doing things, which is really the worst-case scenario.

Remember at all times that you do not feel bad because of what you're doing. You feel bad because that's what happens when you're in a blip. It's the illness which is making you believe your hobbies are harmful or the world is dangerous.

If you have come to associate certain things with a blip - for example, going into certain rooms in your house, or going to work, or painting, or watching a certain TV programme - you can break the negative association. This takes some guts, but it can be done surprisingly quickly, especially if it's something you used to love doing.

Of course, sometimes things put us in a blip because we genuinely hate them. If the idea of going to work makes you sick with anxiety, it's time to think about whether that particular job is the one for you. If the idea of any job makes you ill, the problem lies within you and must be addressed. If you would actually like another job but still feel ill at the thought of going to the one you've got, you need to work out what it is about your current job that bothers you then try to fix things... or go to the Job Centre if the problems can't be fixed.

Virtually everyone will experience blips on the road to recovery. Let's get this cleared up now: you will probably experience a lot of them, maybe hundreds, especially if you have been very ill or do not know how to motivate, encourage or reassure yourself.

Accept this now and don't waste time worrying about it or counting the number of blips you have. When it happens, you'll know about it and you'll deal with it, because that's what we do.

No matter how many blips you experience and how severe they are, they are totally normal and do not cause any type of damage to your mind or body. You must keep this in mind at all times because it is often hard to think rationally or calmly while you experience a blip.

Blips can last from as little as a few minutes to a week or more, possibly a lot longer. When I first started getting better I would have a good day followed by several bad days. Gradually, with guided self-help and with the benefit of citalopram, I began to experience a weird balance between good days and bad days: one good week followed by one to two bad weeks. Eventually I was having two good weeks followed by a couple of bad days. I've gone from having blips that lasted two weeks to some that have lasted half an hour and I've fought some off before they even took hold.

Whatever the frequency of your blips, other people have been through the same number and have recovered from each one.

A blip can be a treasure-trove of information. Each blip has a cause or causes. People don't just "have a blip", there is always a cause. Were there warning signs that you were heading into a blip? Early warning signs are extremely important as they can save you a lot of suffering.

If there were no warning signs, either you didn't recognise them or you had an unconscious thought which triggered the blip. I've woken up loads of times shaking with anxiety because of bad dreams which I couldn't even remember.

If you can highlight possible or probable causes, it can eliminate a great deal of the fear, confusion and mystery that are common to episodes of anxious illness.

A blip will go away eventually. The duration of a blip will be tremendously shortened once you learn to recognise them and become able to trust and reassure yourself.

A blip is not the same as a relapse.

By contrast, a relapse is when your recovery completely reverses, or when your illness returns after a period of apparent recovery. Like a blip, a relapse DOES NOT mean that you are doomed to a permanent state of illness. It is possible to permanently recover from a relapse.

If you are experiencing a blip, it does not mean that your illness is actually getting worse - it just means you feel worse NOW.

Once you start to recover from a blip you may feel physically and emotionally fragile and/or exhausted. Negative thoughts may be especially painful and you may recoil from certain life situations. During this time you should avoid high levels of stress and try to spend more time doing things to keep yourself occupied.

Your feelings are very normal. Trust yourself.

A mild feeling of euphoria seems to accompany the end of a blip. This is a very pleasant feeling and comes from pure relief that your symptoms have either reduced or returned to normal. Enjoy it!

Hope and Fear

"When I dare to be powerful, to use my strength in the service of my vision, then it becomes less and less important whether I am afraid."
- Audre Lorde

Q. Why does everyone hate citalopram?

A. In the last few months people's attidues towards citalopram have improved on No More Panic. Many of the long-standing members who I have known (including myself) are finding that citalopram is helping them to get their lives back. This took time and effort.

Always remember that people don't make the effort to join a website like No More Panic to sing the praises of their medication. They come here for help and support.

You are a million times more likely to see "I hate citalopram" than "OMG I want to marry citalopram and have its babies". This is the way the world works; why would someone log on to a citalopram forum if they are not having problems with it?

Besides, who loves the flu jab?

Q. I'm scared to start taking citalopram.


A. Just because some people have a rough time of it doesn't mean you will. Everyone is scared to start on citalopram: it's a momentous decision to take an antidepressant. Not only that, it can be a bit overwhelming when you read about the potential side effects, and the length of treatment can seem scary as well!

I was in a shocking state before I started taking citalopram and to be honest, if I look back fairly over the first couple of weeks of treatment, a lot of the things I thought were side effects were already happening. I wasn't sleeping properly, I was waking early with panic attacks, I felt anxious all the time.

All right, the medication did magnify certain problems for a while but I've been on this stuff for only 3 weeks and I am already getting some of the old swagger back. Stop worrying and get it down you

Q. I'm ashamed or frightened by the fact that I've got to take medication.

A. No need to be. You don't get ashamed at having to take headache tablets or vitamin pills, do you? Ironically my last two girlfriends both hated taking medicine and would suffer with headache all day rather than swallow paracetamol, and no offence but it was really annoying!

Medicine is there to help you if you need it. You're taking a course of treatment, that's all. There is little point hiding from this or denying it. You will only cause yourself a backlog of anxiety and bitterness. You need to be honest with yourself from the start: you needed something to give you a boost so that you could recover. What is wrong with that?
And look at it this way: some z-list celebrities (in the UK, that's anyone who has ever been on the telly for more than a few minutes) enjoy regular trips to the beauty clinics to have their colons irrigated. If the wretched Paris Hilton enjoys a hosepipe up her bum now and then, surely you can take real medication to treat a real problem.

Q. Is citalopram "safe"?

A. Citalopram is considered to be safe, in other words it is not considered toxic and there are no known long-term health problems caused by citalopram. There are no food interactions with citalopram, but there may be reactions with other types of medication including natural remedies; see later in this Guide, or ask your doctor or pharmacist.

It is possible, but very difficult, to overdose on citalopram; extraordinary overdose levels may result in death (800mg to 2000mg has proven fatal in some cases) and it is possible for citalopram to cause coma or unconsciousness if taken in abnormally large amounts. However, people have survived vast doses without permanent damage.

As the usual dose is between 20mg and 60mg, death or serious damage caused by overdose is incredibly unlikely and is not something you need to worry about.

It is likely that a person who takes too much citalopram will feel very unwell until their body can fight the medication down to acceptable levels. If you kick a cat up the bum it cannot be blamed for scratching your shin. Citalopram is the cat and your brain is the shin. Show respect.

Q. Does citalopram actually work?

A. Once I found the right dose of citalopram, the medicine was extremely effective. I struggled by on 20mg for 9 months before asking, then finally demanding, that my doctor increase the dose.

He prescribed 40mg. Knowing that you should not make large changes to your dose in one go, I went up to 30mg and stayed there for 4 weeks. My mood was transformed within a week and I became able to enjoy life to the full without feelings of lurking fear.

In January 2010 I went up to the full 40mg. Unfortunately I became lazy and exhausted, with no additional benefits. So after a month, when it was apparent that 40mg was too much, I dropped down to 30mg again and gradually got most of my energy back.

30mg of citalopram has proven particularly effective against general anxiety, health anxiety and negative thoughts.

Citalopram is more effective when combined with other treatment such as counselling, cognitive behavioural therapy (CBT), hypnotherapy, yoga and/or self-treatment such as relaxation, stress management and positive thinking.

Medication alone is not usually the best way to tackle anxiety or depression. You should definitely request some other form of treatment such as counselling at the same time as you request your antidepressants. Do not rely on citalopram without taking any other steps to recover. Recovery from anxiety and depression is supposed to be hard work.
You will increase your chances of recovery even further by indulging in hobbies and maintaining your social life. This becomes a lot easier as your treatment begins to take effect.

Q. How long does citalopram take to work?


A. Usually the positive effects of citalopram become noticeable within a month. Although the instructions which come with citalopram state that the antidepressant effects become noticeable within 1-2 weeks, it seems very rare for any medication to produce its full benefits that quickly.

If you have to increase your dose for any reason, you may not see the benefits of the increased dose for 1-2 weeks or more.

If you do not notice any benefits after 2 months, talk to your doctor, as you might need to try a higher dose or even a different medication.

Q. How do I know when citalopram is starting to work?

A. Trust me, you will definitely know, and so will the people around you.

Your feelings of anxiety and depression may lessen gradually, making it feel like you are coming out from under a cloud. You may find yourself able to concentrate and enjoy yourself more, and your motivation may increase, making you want to do more things with your day.

One of the more noticeable effects may the reduction of "mind chatter" which can bring a tremendous feeling of relief and make you able to relax more easily.

Note that in the early stages of recovery you may feel mentally and emotionally fragile and/or otherwise exhausted. This is totally normal. You must avoid high stress and situations that trigger your anxiety or depression until you are well enough to start dealing with them.

Q. Does citalopram work for anxiety as well as depression?

A.Citalopram can be used to treat panic disorders and anxiety as well as depression. It is designed as an anti-depressant and may take a while to work against anxiety. Some people do not find citalopram effective against anxiety. Many people do. I did, once I was on the right dose.

Any SSRI medication may increase your anxiety or depression when you first start taking it. This is simply a side effect, it does not mean that your condition is actually worsening, and although unpleasant it usually dies down after a few weeks.

Q. I hear that in medical trials, placebos are more effective than citalopram. Is this true?

A. Placebos are "fake" medication such as sugar pills which are given to people during medical trials. Half the people in the trial will be given real antidepressants, the rest will be given placebos, and none of the people will know who has been given what.

Large numbers of people who take placebos tend to feel better. In some studies, the placebos seem equally (or more) effective than actual antidepressants, although there are plenty of studies available which show SSRIs including citalopram to be greatly superior to placebo in the long run.

You will naturally start to worry that this means antidepressants don't work. Think about it from a positive perspective: placebos demonstrate the tremendous power of positive thinking! The people who are taking them BELIEVE they are going to get better and lo and behold, many of them do!

Antidepressants DO work for many people; think how effective antidepressants could be if the people taking them strongly believed in their own recovery!

Q. Do you believe that citalopram works?

A. Citalopram has made a big difference for me. It was tough to stick with at first as my body didn't tolerate the citalopram particularly well. (That's an understatement by the way.) I toughed it out and here I am, recovering a little bit more every day.

People told me that I started to resemble my old self after about 3-4 weeks. One friend told me that by the sixth week I seemed to be my normal self again. By week eight I was beginning to feel like I was almost recovered.

Even if the medication is working you may experience "blips". These are temporary worsening of your symptoms, and are a normal part of the whole experience. Blips can occur without triggers, especially if your anxiety or depression are cyclical, but in my experience there is often a trigger factor such as a stressful event.

Recovery is a fragile process. You might start to feel better after, say, 3 weeks, but you may still feel "up and down" for a while. The one day you'll wake up and you suddenly realise that you are getting your life back. It's weird but it feels wonderful.

Bear in mind citalopram on its own won't do much -- you need to combine it with positive thinking and other techniques that will be discussed later. All types of medication work best when combined with other types of treatment.

Q. Will I feel like a new person?

A. No. Even better than that. You will start to get back to your old self -- the person you were before anxiety/depression took over; the person you were always meant to be.

I cannot tell you how terrified I was that I would be a zombie on citalopram, I could not imagine going back to being my old self. Anxiety is what made me a new person. Citalopram helped me to get back to being me.

This is probably the best thing about medication. It is like a gift. Remember the lessons you learn during your battle with anxiety/depression and incorporate your hard-won wisdom into yourself. You will emerge from the storm hopefully feeling tougher and more experienced.

Citalopram Side Effects

"
Any change, even a change for the better, is always accompanied by drawbacks and discomforts."
- Arnold Bennett

Q. Why does citalopram cause side effects?

A. Antidepressants cause side effects due to the way the medication goes to work. Medical science does not have a complete understanding about the biological processes of depression. Therefore, our current medication does not have an accurate guide, so we don't know quite where to strike.

So we target a point of the whole process and we have to wait until the medication finally reaches its destination. It's like trying to deploy troops by helicopter: when the helicopters reach a tangled one hundred thousand year old jungle, the copters have to land and the troops get out and march into the jungle on foot.

We do not have the technology or the scientific understanding to be able to deploy our troops exactly where they need to be because the obstacles in our way are insurmountable at this moment in time.

Incidentally, this is also why some people find their depression or anxiety gets worse after they start taking SSRIs. The medication has to make its way through a long and convoluted route to find where it needs to be. During this time the medication is not having its intended effect. So while all this is going on, you're still suffering from depression or whatever, and your symptoms are naturally getting worse.

Finally, and perhaps just as relevant, citalopram is very cheap compared to similar medication. It stands to reason that a cheaper SSRI will have a downside compared to something like Sertraline, which is well-known for being easy to tolerate.

Q. What are the side effects of citalopram?

A. Mood swings, dizziness, tiredness and headaches are very frequently reported side effects of taking SSRIs.

Insomnia, weight fluctuations (up and/or down) and anorgasmia (problems or inability to reach orgasm) are also common.

One side effect which worries people is the risk of gaining weight. There is no way to know whether this will happen to you. You should bear in mind that SSRIs are not steroids so you are unlikely to bloat. Weight gains may be temporary and can be countered by increased exercise and healthy eating. In rare cases people can lose weight, in which case eating regular healthy meals should help.

Some people experience nausea or vomiting. It is fairly common for people to feel more depressed and/or more anxious in the first few weeks of taking citalopram or SSRIs.

It is possible to experience suicidal thoughts while taking SSRIs. This is fairly rare.

Initially you may experience panic attacks, strange thoughts or sensations and visual disturbances such as hallucinations or apparent movements or shapes in your peripheral vision. These are all normal and they are certainly not an indication of paranoia, brain damage or psychosis. Citalopram does not cause psychosis.

Side effects vary in severity and duration. They may start to reduce after 1-2 weeks but it may take longer than this.

Note that side effects are basically harmless. If they are interfering with your life or are otherwise intolerable, speak to your doctor.

Q. How do I know if I will suffer side effects?

As with nearly any medication, you might feel worse when you start taking citalopram. This depends entirely on how your body reacts to the medication. Some of us react badly to it at first; most of the people who do will find they are able to tolerate citalopram after a while. Side effects may also be suffered (or made worse) if a person abruptly discontinues taking citalopram. It can take weeks to taper off a course of citalopram in order to avoid this "discontinuation syndrome". Discontinuation syndrome can vary from mild to extremely unpleasant, and generally it will cease after a month or so of discontinuation. Plenty of people suffer no side effects at all -- clinical trials suggest 90% of people do not suffer side effects, which anyone who has ever taken citalopram may find hard to believe.

Q. How long do citalopram side effects last?

A. Your citalopram leaflet may state that the side effects "generally resolve themselves in one to two weeks". In many cases, people find they are still suffering side effects (usually in a reduced form) for a number of weeks, even months, if their bodies do not tolerate the medication very well. It seems to be quite rare for people to get over their citalopram side effects as quickly as the citalopram leaflets say, so there is nothing wrong with you if you still get side effects
.

On the other hand if you are still suffering from a rainbow of side effects after 2 months your present dose may be too strong or you may need to try a different type of medication. Consult your doctor.

Q. Will citalopram make me gain weight?

A. Weight gain seems to be a more common side effects than weight loss, but it doesn't happen to everyone. It seems to be more common for women to notice weight gain than men, but then again the demands of society probably mean that women pay more careful attention to their weight than men do (pardon the generalisation), and I also know about 100 times more women than I do men, so this is probably not a reliable observation.

There is no way to predict whether you will gain or lose weight, and if you do, how much your weight will change or for how long.

If you weren't eating properly beforehand then when the SSRIs start to work and you start to feel better, you may find - as I did - that your thirst and appetite return with a serious vengeance. This is normal; your body has been burning so much energy for so long, with so little extra fuel to work with, that it will grab the first opportunity to pile food and drink down the little red lane.

When you're anxious, it is your brain that isn't hungry, not your body!

Q. Why does it take so long for citalopram to work?

A. NEW INFORMATION: Today's generation of antidepressants, the SSRIs, have to take a long and indirect route to achieve their objectives. Imagine if, during the Cold War, American marines had to launch an assault on Siberia by travelling across the North Pole. This is the sort of pointless and over-long task facing today's medicines. That's why it can take weeks for antidepressants to start having any effects. Medical researchers know this, and they are currently researching the way that ketamine (used as a tranquiliser for animals) works.

Ketamine has significant antidepressant effects which occur within hours of taking a dose (rather than weeks) because it takes direct action against the biological causes of depression. However, ketamine is never going to be used in the treatment of depression because it has horrendous side effects which render it completely unsuitable for this purpose.

Researchers are trying to find a way to duplicate ketamine's rapid and direct relief of depression so they can produce a new generation of fast-acting antidepressants.

Q. I'm struggling with the side effects.


A. Citalopram is strong, so it is completely normal to feel side effects for a long time. Side effects cannot hurt you. Headaches? Pah! My great grandma used to live with migraines before they had decent painkillers. Horrid panic attack feelings? How many people died of panic attacks? Er, no-one. Ever. Trembling? Nobody has ever been crippled by a slight shivering in the limbs!
Clenching jaw? Don't worry, that's a reaction to your heightened anxiety and it will stop eventually. Waking up at night? That's a bugger actually, but it won't happen forever!

Q. What happens if I can't bear the side effects? What's wrong with me?

A. Nothing is wrong with you. Not everyone finds citalopram suitable. If you are suffering to the point where you feel you cannot continue with citalopram then it may be worth asking if you can switch medication.

It is worth bearing in mind that a lot of people find the side effects are surprisingly strong in the first week or two but the majority of people will find their side effects gradually diminish over time. Eventually you will start to settle down and even the worst side effects should subside.

Q. If I decide to switch due to intolerable side effects, what else can I try?

It's worth considering Sertraline, which is another SSRI and is well-known for having a limited side-effect profile, but there's no guarantee this medication will not produce similar side effects if you are sensitive to SSRIs.

You could try a left-fielder like Mirtazapine. Mirt is a NaSSA (noradrenergic and specific serotogenic antidepressant)
which is greatly superior to Citalopram for treating inner restlessness and sleep problems. You will definitely sleep better on mirt - your first night's sleep after the initial dose can seem to undo weeks of anxiety-related insomnia.

Clinical trials indicate that mirtazapine offers superior antidepressant effects to many other types of medication.

Mirtazapine does not seem to be very well-known and is considered a second-line treatment after SSRIs and SNRIs have failed, due to strong sedative effects. You will DEFINITELY gain weight on mirtazapine - I've gained about two stone in a year. Food will taste absolutely amazing. You will be hungry all the time and since anxiety affects appetite, your body will start making up for lost time straight away.

I'm pretty fond of lasagne. One week, while suffering on cit (it turns out I just can't tolerate it), I couldn't eat a quarter of the serving. The very next week, after about 2 days on mirt, I had the same serving again (which was a "serves 2"). I demolished it within five minutes and only realised it was all gone when my spoon banged against the side of the empty bowl.

Apart from a pronounced sense of tiredness in the morning, and that fact that a dose will knock you out within half an hour to an hour (you must be VERY careful not to take your dose unless you're going to bed straight after as you WILL NOT be capable of doing anything else), there really aren't any other side effects to mirt. It doesn't interact with food or most types of medication (eg ibuprofen, which can react with citalopram).

Q. What happens if the side effects don't go away?


A. Some people will suffer side effects longer than others. Just because some people stop having side effects after two weeks doesn't mean anything is wrong with you if you still wake with sweaty pits after week six.
If the side effects continue at full strength for more than six weeks, or you simply cannot tolerate the side effects, it might be worth talking to your doctor about reducing the dose. The normal starting dose is between 10 and 20 mg although the starting dose can be higher if you are suffering with a very high level of anxiety or depression. If citalopram simply isn't for you there is a wide range of other stuff you can try. Talk to your doctor.

Q. I'm having all the "very rare" (less than 1 in 100,000 people suffering them) side effects and none of the "very common" (more than 1 in 10) side effects... what the hell's wrong with me??

A. Nothing; this, again, seems to be fairly normal.

The figures given in the citalopram leaflet seem to have been chosen by someone throwing darts at a dart board. I've had more "very rare" side effects than Captain Kirk has had hot alien babes. They started on day one. Nearly everyone who has ever posted about citalopram on the No More Panic forum has also suffered these "very rare" effects.

Methinks the citalopram PR people are slightly biased when they write their little leaflets. After all, they're trying to sell their product, and they never had to take it.

There is nothing wrong if you are suffering the so-called "very rare" side effects. You are going where thousands of us have gone before. The side effects will fade over time.

Q. Is it possible to reduce the side effects?

A. There are a few things you can try which might help:

Take inositol - While this will not stop you from experiencing side effects, inositol can be highly effective at controlling emotional problems (see later in this Guide) and, in theory, could make the difference between suffering and sailing through your early weeks on citalopram.

Ask your doctor about taking ginkgo biloba -
This herb appears to be effective at reducing the sexual side effects of citalopram, for example altered sex drive and possibly orgasm problems (anorgasmia). Check with your doctor or pharmacist if it is ok for you to take gingko, do not combine it with an SSRI without medical advice. Gingko is available in tablets of varying strength and liquid drops of very high strength. The liquid drops may be more desirable. Gingko Biloba can be fairly expensive. It is available at Holland & Barretts. Ginkgo Biloba does not have any antidepressant or anti-anxiety properties.

Take B-vitamins -
These are well known to benefit those who suffer from depression. B-vitamins can provide a natural energy boost which may help those who are low on energy or motivation. B-vitamins are safe in large doses as your body simply urinates any excess out. This may mean your urine appears neon orange depending on the amount of B-vitamins you take.

Remember the side effects don't last forever -
You may experience them for a few weeks, gradually reducing in strength as your body adapts to the medicine and you naturally evolve new and improved coping methods.

Stay hydrated -
If you find yourself sweating or urinating too much and/or suffering headaches and/or suffering diarreah* due to nerves, drink plenty of water.

If you can't eat -
This is usually due to nothing more serious than anxiety but nausea and reduced appetite are normal side effects of SSRIs during the early days.

If you can't eat, drink soup. Eat healthy food such as fruit. You might find your appetite comes back during moments when your anxiety has faded. Make sure you eat decent food during this time. Take advantage of your opportunities!

Take your tablet at the same time each day -
You need to establish a routine straight away so your body learns to cope with the medication.

Go to bed at the same time each night
- Get into a night-time routine to "train" your body so that it knows when to sleep.

Don't isolate yourself -- integrate! -
If you are very anxious make sure to be around other people. Stay social, stay connected to the real world, KEEP TALKING.

Hypnotherapy -
Hypnotherapy and self-help hypnosis CDs can help to ease your suffering. Hypnotherapy is mostly useful for teaching you to relax. While you are very relaxed, positive suggestions can, over a period of time, improve your mental attitude and treat a wide variety of emotional problems. It may not prevent you from having side effects but it can certainly help you to deal with them.

Panic attacks can't hurt you -
Remember that even the most horrendous panic attack is ultimately harmless -- you will recover from it without harm. It is totally normal to feel your heart racing and your breathing go all weird. Your heart will not stop beating or suffer cardiac arrest! You will not suddenly stop breathing or develop asthma. A panic attack is like a bad storm. You may feel like it's blasting you around but in the end it will lose its strength and you will still be there, the same person you were before, fully intact and utterly unharmed.

Ask your doctor or pharmacist about anxiety relief -
This is addressed later in the guide. NOT ALL ANXIETY RELIEF CAN BE TAKEN WITH SSRIS.

Get therapy! -
I will be repeating this throughout the guide: if you ask your doctor for antidepressants, ask for therapy at the same time! Note that counselling WILL NOT be effective against an anxiety disorder. This contradicts my original advice. Counselling is designed to help you cope with difficult life events. CBT is the only type of therapy which is recognised as an effective treatment of anxiety-based disorders. For example, there is no evidence whatsoever that counselling can help you to defeat health anxiety, but there is strong evidence that CBT can help.

Talk about it! -
Talk to friends and family to take your mind off things, or to offload when you need to vent.

Speak to Samaritans or MIND (more on these later) if you need support or reassurance. MIND in particular will be very familiar with medication side effects. The Samaritans are available all the time and they offer a chance to vent your feelings which can be very helpful.

You can also look up Anxiety UK, which is a much smaller organisation than Samaritans, but is staffed by people who have been suffered anxiety themselves.

Speak to your doctor if you are finding the side effects hard to deal with.

Cut down on caffeine -
Don't suddenly cut it out altogether or you may get withdrawal effects. Try to cut down on how much caffeine you drink. AVOID energy drinks.

Avoid drugs and alcohol -
These will almost certainly make the anxiety worse.

* How the hell do you spell it??


Q. I get scared at night-time.


A. Technically this isn't a side-effect of citalopram. You're probably worried about being alone with your chatterbox, or scared of having a bad night's sleep. There is nothing to fear. You will either have a good night's sleep or you won't. There is always tomorrow night. Your ability to enjoy a good night's sleep will return in time.

Make sure that you watch a comedy or read a happy, uplifting book before bedtime. Chat on the phone to a friend, spend time with family members, engage in a hobby, have a relaxing hot bath.

When you are going to sleep imagine the best case scenario: think happy thoughts. Turn negative thoughts into positive ones. It's likely that you tend to focus on thoughts that make you unhappy. Forget past grudges or betrayal. Focus on the positive things that have happened and the good things yet to come. If you think of something negative, twist it around and try to think of a positive outcome - this is challenging at first but you may be surprised how easy it becomes with practice.

Going to sleep in a positive frame of mind will help your recovery enormously. You can, over time, change from a sombre and mistrustful person into someone who is hopeful and less stressed.

Self-hypnosis mp3s - these are pretty useful if you listen to them at night before bed and ESPECIALLY if you wake early feeling anxious. Not only do you get a soothing, relaxing voice telling you pleasant things, you learn to relax and you can also make numerous self-improvements. If you fall asleep while listening to them, your unconscious mind will keep listening.

NOTE THAT MOST SELF-HELP MP3s ARE AIMED AT PEOPLE WHO DO NOT SUFFER FROM ANXIOUS ILLNESS. Relaxation is a skill you probably don't have. It can be frustrating at first, but you will get better with practice. Self-hypnosis and hypnotherapy are only effective if you can get yourself into a relaxed state. This will not happen in fifteen minutes, it can take WEEKS. This is why any decent self-help mp3 will require you to listen to it every day for a month before you start seeing the benefits.

Q. I feel like I'm having a brain tumour.

A. I've read comments like this so many times it even made me paranoid!! If you have this fear, try to take comfort from knowing that almost EVERYONE who is worried about their health will get round to fretting about brain tumours at some point!

Citalopram can cause headaches which do not necessarily feel like "normal" headaches. I find I can usually tolerate them without having to take paracetamol. Some people can't because they get really bad headaches.

You should also remember why you are taking citalopram: chances are you are under a great deal of strain and this will cause tension headaches, which again do not feel like "normal" headaches as they are persistent, resistant to painkillers and can be quite severe.

It is highly likely that mosty people who have permanent, painful headaches are having tension headaches.

Lack of sleep and waking up in the middle of the night cause persistent headaches and sore eyes. So do stress and anxiety.

I experienced strange physical feelings in my brain for several weeks while taking citalopram. It felt like an invisible hand was rearranging my brain. This stopped after about 5 weeks. It was the medication going to work, and was not a headache or migraine or brain tumour.

Citalopram and other SSRIs are known to make people feel slightly "hungover" in the mornings. This is normal and is nothing to worry about. Some days you'll feel fine, others you'll feel like you fell off John Wayne's horse.

If you are worried about a brain tumour see your doctor and also get your eyes tested. An eye test can indicate if you have anything to worry about. A doctor's formal diagnosis will be required if the optician finds anything.

The chances of your suddenly having a brain tumour are not high.
It is more likely a combination of health anxiety, stress level and perhaps your body's reaction to citalopram.

You could even be suffering from withdrawal symptoms if you have abruptly stopped using caffeine, alcohol or drugs.

Citalopram and Suicide

Let's get this out of the way. Don't see this as a triggering or fearsome part of the document, it's something we all need to know and I will try to make it as non-threatening as possible.

A minority of people who take citalopram (or other SSRIs) report suicidal thoughts or urges ("suicidal ideation") at some point after starting the medication. This seems to be most common in younger people (younger than 18). Not every younger person who takes SSRIs will experience this, it's just that their age group seems to be at higher risk.

Note that people who feel or think suicidally while taking an SSRI often feel this way before taking the medication.

Suicidal ideation, if experienced, is a symptom of an illness and/or a side effect of the medication. It CAN be treated and it will NOT define you if you don't let it. Suicidal people have lost all hope, but they do not realise that this is simply due to the illness or the effects of medication. In a sense, suicidal people are living in a false reality with no apparent exits except the ultimate one. This is why the world seems to be made of cardboard, or that there's nothing beyond the horizon - the illness tells you this is so, but you know it isn't really true, and this generates conflict in your mind. (The other reason you might feel like this is because the way you see the world has changed and you haven't realised it or come to terms with it yet. You're seeing the world with new eyes.)

The truth is that hope exists for everyone and it cannot be destroyed; it is beyond your power to change or obliterate and it exists whether you choose to see it or not, regardless of how you feel at this point in time.

Why can citalopram cause or worsen suicidal ideation?

This could be due to any number of things. Research is still ongoing. In the case of adolescents it seems likely that the mix of chemicals and hormones raging in their bodies are delicate enough without having something else thrown into the mix.

Developing, or experiencing, suicidal ideation does NOT mean you will try to commit suicide, and it does NOT mean that you are beyond hope or treatment. You CAN recover, as millions of people have done and continue to do. You need support to help you through this difficult time. help is available.

As the initial side effects wear off over a period of 1-6 weeks or more and your body stabilises on the medication, it is likely that the suicidal ideation will go away. However, if you continue to get worse you need to speak to your doctor and get support straight away.

Therefore, if you find that taking citalopram or any SSRI makes you feel more depressed or even suicidal, you should strongly consider consulting a pharmacist for advice about another medication, and contacting your doctor to arrange a switch to another class of medication. For example, Mirtazaprine is used as a kind of mood stabiliser and might be more appropriate since it is not an SSRI and apparently offers side effects that are fewer in number and less in severity than other drugs.

Most people who contemplate suicide do not act on it, and many people who do act on it are unsuccessful. The human body is designed to survive anything except old age. Suicide attempts are sometimes thought of as a "cry for help".

A vast range of support is available for those who experience suicidal thoughts or urges; call your doctor immediately or go to a hospital. You can also talk to the Samaritans, and a few minutes' research on the internet will give you plenty of contact numbers for organisations dedicated to helping people overcome suicidal impulses.

It is very possible to recover from feeling suicidal. People who recover from suicidal urges can live long and happy lives without the urge ever returning. Feeling suicidal, or fearing becoming suicidal, are not a sign of weakness or shame.

There is no point avoiding taking medication just because you are afraid you may feel suicidal. SSRIs can and do help many people who were genuinely suicidal before they started taking the medication.

Ironically, some research shows that it may be the very benefits of SSRIs which can lead to some suicide attempts. Someone in the depths of depression may contemplate suicide but not have the energy or motivation to attempt it. When the SSRI starts to improve their mood, their energy and motivation naturally increase as well. This could mean that people who previously wanted to kill themselves but couldn't basically be bothered, now have the strength to have a go.

The same research shows this risk mostly occurs during the early days; as time goes by and a person's mood continues to lift, thoughts of suicide become less relevant and are gradually left in the past. Cognitive behavioural therapy can teach you to cope with and eventually refute fears of suicide or actual suicidal thoughts, so you don't have to wait for them to go away, you can resolve them so that they cannot ever affect you the same way again.

I'm scared I might become suicidal - is this the same as BEING suicidal?


Being afraid you will commit suicide one day, maybe as a result of going mad or becoming overwhelmed by depression, is not the same as being suicidal. This is a natural and common fear which can be very debilitating. I have personal experience of this.

This situation falls under the umbrella term of health anxiety. Health anxiety is always, ultimately, a fear of death. You are expressing a fear of "mental dissolution" - losing your mind - which, when thought about logically and realistically, is not going to happen. Other factors include a fear of uncertainty. If you show lots of little coping habits, like following a routine, counting words or numbers, that kind of thing, you are doing these things to create a sense of control by cataloguing the world. This is strong evidence that you fear a loss of control and have difficulty coping with change or uncertainty.

You can seek help to overcome these distressing fears.


Citalopram and Bipolar Disorder


Bipolar disorder used to be called manic depression. Nobody who works in mental health uses the name "manic depression" any more, or at least they shouldn't, as it is not accurate enough and emphasises depression as the cause of the condition. Actually, bipolar disorder is a seperate condition to depressive disorder even though they share some of the same symptoms.

There are two main types of bipolar disorder. The third type can only be created by administering the wrong type of medication and it is rare. Bipolar is characterised by dramatic mood swings from the depths of depression to a "manic" phase in which the person doesn't need to sleep and is bursting with enthusiasm, vitality and ideas. Their behaviour is strange and their ideas far outstrip their ability to make them become reality.

Mood swings are relatively common and it is easy for someone with no experience of bipolar disorder to believe they may have it. It may be obvious to a medical profession whether someone is suffering from bipolar or not and, depending on your behaviour, it may be obvious to other people too.

Am I bipolar?

You need to be officially diagnosed with bipolar, so your starting point is your GP. Bipolar disorder is treated and handled differently to depression or anxiety, even though depression and anxiety will be present. You will need to learn to manage all of the symptoms.

If you are NOT diagnosed as suffering from bipolar, you may be on the "bipolar spectrum". This means that you are not currently diagnosable as bipolar, but have characteristics that might put you at risk of developing it
if you do not modify your beliefs and behaviour, learn to spot triggers and learn to cope with the "shock" of a mood change. Alternatively, you may have some symptoms of bipolar disorder but they are not pronounced enough or numerous enough, or you are not vulnerable enough to them, to ever progress towards developing a disorder.

Bipolar Type I:
In brief, this is where you experience very noticeable mood swings, which provoke extremely noticeable behaviour. The high, or "manic" phases (to use an old term), can involve a person feeling supremely confident, highly motivated, exciteable, uncontrollable, intelligent, witty, sharp and over-enthusiastic. They may feel extremely wired and suffer from pressured speech or thinking, or both (they speak and think at an uncontrollably rapid rate). A lot of anxiety sufferers may now be pooing their pants as they recognise these symptoms and will now fear they are bipolar. Well, other indications of a bipolar sufferer in a high phase is going for days without sleep and not feeling tired, and highly abnormal behaviour that "seemed like a good idea at the time" such as running down the street wearing only a top hate "for a laugh". By contrast, the depressive phases may leave the sufferer unable to motivate themselves or get out of bed. They lose hope, they cannot bear to work on the hundreds of things they started while in the high phase and in bad cases they may feel suicidal.

Bipolar Type II: In brief, this is similar to type I but is less understood and is harder to recognise. It's often mistaken for depressive disorder or ADHD. This can be a very bad thing as the treatments for depression and ADHD can make bipolar symptoms worse.

Bipolar type III: In rare cases, there may be the possibility of developing bipolar III, which is a form of bipolar disorder caused by administering the incorrect type of antidepressant. Therefore you can only experience bipolar III under very specific circumstances. This is usually seen in people who are already on the bipolar spectrum - in other words, they display some of the traits of bipolar disorder and are vulnerable to developing it, but have not developed it yet.

Can I recover from being bipolar?

Yes, people can recover from bipolar disorder. This means they go into a permanent remission, either by chance, by medical intervention or, most likely, by becoming experts at spotting triggers and modifying their beliefs, thoughts and behaviour. It is definitely possible to manage mood swings and carry on with their lives even if they still experience some symptoms.

Can I take SSRIs to treat the depressive phase of bipolar disorder?

SSRIs are not a useful treatment for bipolar disorder types I *or* II and can make things worse by triggering mood swings. The Italian psychiatric expert Franco Benazzi, MD, PhD, believes that treating bipolar type II with SSRIs can lead to suicidal feelings and acts, or at least can increase the occurrence of bipolar mood swings by around 10 times.

In the long term, a person who either has bipolar disorder, or who is on the bipolar spectrum would benefit greatly from seeking medical advice as there are mood stabilisers such as lithium and in some cases antipsychotics which are far more effective at controlling bipolar disorder and will offer significant relief compared to SSRIs.

Citalopram and Anger

Some people find that their mood changes for the worse while taking citalopram. I found that I got bad road rage at first, and I can occasionally fly off the handle more now that I'm on citalopram. This is a normal side effect of the treatment and does not affect everyone; in fact I don't really know anyone who got like this while taking citalopram.

In my own case, it's likely that my improved confidence made me more likely to want to retaliate when pushed. I also suffer from a low tolerance to stress and stress definitely turns me into a monster. I do have a lot of buried resentment which needs to be dealt with rather than released in a fit of temper.

If you find yourself having temper problems, consider the actual reasons behind them. If you are sure it's the medication, or the anger is becoming disruptive, talk to your doctor - maybe you can try a different dose or try another medication, or maybe anger/stress management therapies are what you need.

Treatment Duration

"Courage, it would seem, is nothing less than the power to overcome danger, misfortune, fear, injustice, while continuing to affirm inwardly that life with all its sorrows is good; that everything is meaningful even if in a sense beyond our understanding; and that there is always tomorrow."
- Dorothy Thompson

Q. How long will I have to take it for?


A. Doctors usually put you on it for six months MINIMUM. This does NOT include the time it takes you to come off citalopram, which can add weeks or months to your treatment plan.

This is to make sure you have recovered from your depression/anxiety before they stop medicating you for it. Due to the time it can take citalopram to work, and the distressed state people are in when they begin treatment, there is little point prescribing citalopram for shorter periods than six months.

Usually your doctor will not want to reduce or discontinue treatment until you have been free of anxiety and/or depression for 6 months. This doesn't mean you aren't allowed to have bad days, it simply means that you (and they) must be convinced you have made a full recovery before you can start reducing your dose.

You should continue your entire course of treatment even if you start feeling better after just 2 weeks - in fact you should continue treatment ESPECIALLY when you are feeling better - this is the period you are most at risk of exposing yourself to unnecessary stress, and forgetting to get a new prescription!

Q. I'm scared I'll be on it forever.

A. You won't. But you'd better learn to accept that you will probably be on it for a year or more; believe me, once you start feeling better, the idea of being on medication long-term will not seem so bad!

The more you do to make yourself better, the quicker you will be able to come off citalopram.

You must attempt to deal with the issues in your life. You must make strenuous efforts to beat your fears and phobias. It's harsh, but that's life. They are never going to invent a pill that can make life easy. Your destiny will not fulfil itself.

Q. I'll never get back to my old self.

A. Of course you will! You just can't see it yet. It's called "not seeing the wood for the trees".

When you're in the grip of anxiety and depression it is very difficult to get a realistic view of the bigger picture. Stress, negative thinking, bad memories, all of this conspired to keep you trapped in a state of fear. If you weren't afraid, you would start getting well again, and if that happens the anxiety and depression will die. So they do everything in their power to make you bloody miserable!

You are you -- there is a personality, a set of behaviours and a way of thinking that you will recognise as being consistently yours. Anxiety and depression may de-rail you for a while but you can and will get back on track. Stop worrying about it and start working at it! The less time you spend allowing fear to paralyse you and distract you, the sooner you can get back to being you!

Q. How will I know when it is working?

A. Trust me, you will definitely know. The people around you will be able to tell the difference as well. You may notice your inner chatterbox is quieter or can be ignored more easily. You will feel like your anxiety is being smothered with a blanket or recedes quietly into the background. Your anxiety may start to change to a feeling of anticipation or excitement.

It is normal if you sometimes still feel anxious or depressed; it may seem hard to deal with when you go from being happy to sad over and over again, but it means your body is trying to find a balance between your depression and the medication. Things should settle down if you keep going. You will stay the same person you have always been; it's now time to work on self-improvement and mental toughness.

Q. When will I feel better?

A. This largely depends on you. If you are suffering badly before you take citalopram, it can take a while for the medication to loosen the grip of your depression/anxiety.

The usual guideline is 2 weeks before you start to feel better. This is approximately how long it took before I was sure citalopram was starting to work for me. Note that I said startingto work for me. It took six weeks before I was certain that the citalopram, along with my other methods of controlling anxiety and depression, were starting to get up to full strength.

In the meantime I had to kick myself up the bum every time I felt anxious or unhappy. This was not easy and it was not pleasant.

The average time for citalopram to start reducing anxiety and depression is reported by No More Panic members as 3 to 4 weeks. It often takes longer for anxiety to be reduced than depression.

Note that side effects can continue to occur during this time. You will not be magically fixed overnight.

Depression and anxiety take a long time to do their damage, and therefore citalopram is also going to need a while before it can start to make repairs.

Q. Is citalopram addictive?

A. No. But as discussed earlier, abrupt discontinuation of citalopram brings with it an insane risk of discontinuation symptoms, which are not exactly the same with withdrawal symptoms.

People sometimes feel that if they ever stop taking medication, their symptoms will return. This is a common fear and is not particularly realistic; if you stay with citalopram for the full course of treatment then gradually wean yourself off them following your doctor's advice, you will probably find that your symptoms do not return, or are of a manageable level which do not interfere with you enjoying your everyday life.

Remember that it is normal to feel some fear and anxiety at some points in your life. Everyone has bad days or bad weeks. Having a bad day does not mean you are relapsing or you need to go back onto the medication.

If you have made a concerted attempt to deal with your problems then you will most likely be able to enjoy a perfectly normal life. You will be weaned off the treatment gradually in order to avoid withdrawal side effects which can be very severe if you suddenly stop taking your medication.

Dose Strength and When to Take It

"There is suffering in life, and there are defeats. No one can avoid them. But it's better to lose some of the battles in the struggles for your dreams than to be defeated without ever knowing what you're fighting for."
- Paulo Coelho

Dose strength


Your medication will not work effectively unless you have found the correct dose. Your doctor will probably start you off on the lowest dose possible unless they think you are suffering badly.

Do not keep adjusting the strength of your dose unless you are acting on your doctor's advice.

Do not
suddenly stop taking it altogether as you could suffer severe discontinuation effects.

Q. Can I increase my own dose?


A. It is possible for your dose to be increased if your doctor says it is ok. Don't increase the strength of your dose without a doctor's advice. You will not make citalopram work faster by taking more of it, and you may increase the risk of experiencing side effects.

If you ever miss a dose, do not take a double-dose to make up for it.

Never take more than the maximum dose of 60mg.

Q. Can I reduce my own dose?

A. Again, you should not do this without medical advice or you will definitely run the risk of discontinuation effects.


You would normally want to reduce your dose if you are suffering from severe side effects or if you are trying to get used to the medication slowly or if your doctor agrees it is time to stop taking citalopram.

You can cut your tablet in half, or just cut a bit off the top. I and many members of NMP have done this for extended periods of time with no adverse effects. However, since we do not carry medical tricorders, we do not offer any guarantees about this.

Bear in mind that reducing the dose may reduce the side effects, but it will also reduce the beneficial effects of the medication.

Talk to your doctor if you feel your medication is too strong, or if you want to come off it, or if you feel it just isn't working.

Q. What happens if I change my dose?


A. You may experience temporary side effects. It is better to alter your dose by no more than 5mg in a 2-week period.

I successfully increased from 20mg to 30mg in one go with an increased feeling of tiredness as the only side effect. I noticed vastly greater benefits from the higher dose.

I then increased from 30mg to 40mg for one month. There were no additional benefits at this dose and I became drained of energy and emotion.

I dropped back to 30mg with no negative effects. The extreme tiredness and deadened emotions wore off.

Finally, I tried dropping down to 20mg for a week but suffered brain zaps, distressing dreams, low moods and very hightened anxiety.
Q. When is it best to take citalopram? Morning or night?

A. This is the eternal question. It is probably best to take it in the morning, as it can interfere with your sleep. If you find citalopram increases your anxiety or induces panic attacks, which I really struggled with in the first week, they will occur during daylight hours when you can keep busy and surround yourself with people.

Be advised that if you take it during the day you may notice your side effects more so don't panic if you feel tired or spaced out. These effects should subside over time as citalopram is not especially regarded as a drug that "zombifies" people.

If you do not have side effects, or if the citalopram makes you tired, take them in the evening or just before bed.

I initially took my dose at night but experienced panic attacks, so I switched to mornings. After my side effects started to subside I went back to taking the dose before bed and experienced no further problems.

Q. What happens if I miss a dose?

A. Don't worry about it. A missed dose here and there is not the end of the world as long as you don't keep doing it. Citalopram has a resonably long half-life (for an antidepressant) so you have a short period where withdrawal symptoms will not kick in.

Take your dose as soon as you remember. If it's getting towards the time for your next dose, just wait until it is time for the next dose. Do not take a double dose.

Q. How can I increase the effectiveness of my medication?

A.If you are on the correct dose, and if citalopram is the right drug for you, you should eventually find the citalopram effective at suppressing negative thoughts and feelings. Taking the correct dose at the same time each day or night is the best way to ensure the medication takes its full effect.

Everyone finds their medication starts to work at different rates because everyone has their own distinct biology and everyone's personal circumstances are different.
Get yourself trained up - Take your dose at the same time each day. This will allow your body to get into a routine which may make the whole process easier for you.
Get further help - Citalopram, along with all other forms of antidepressant medication, is most effective when combined with other treatment such as positive thinking, relaxtion, counselling and regular exercise.If you truly want to recover, you MUST seek further help.

Take with food
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Taking citalopram with food is recommended, as with many medicines and all vitamin/mineral supplements, but it is not a requirement. Avoid eating or drinking a lot in the last couple of hours before you go to bed if you take your tablet at night.

Don't change the dose without medical advice
-
Talk to your doctor if you believe you need a stronger or weaker dose. Do not alter the dose without speaking to a professional. Members of NMP do not count as professionals. You are always free to ask our advice, but consult a doctor before following it.

We are what we eat - A healthy and balanced diet will always help your mental, emotional and physical well-being. Omega-3 (found in fish oil) is almost mythic for its beneficial effect on the human brain. This may include a significant boost to the effectiveness of antidepressant medication. Fish oil is well known to help alleviate the symptoms of depression. In the United Kingdom, the dedicated mental health charity MIND strongly recommends that depressed people include oily fish as part of their diet. You can also try Inositol, also (rarely) known as vitamin B-8, which if taken in large doses may have significant impact on the symptoms of depression, even the equivalent of modern day SSRIs, with few or no side effects. (More on these later.)

Q. What happens if it doesn't take all of the anxiety or depression away?

A. Citalopram is not a cure-all; the factors that cause you to feel low will still be there. That's why you need to combine citalopram with self-help and other forms of therapy.

If your citalopram is not making enough of a dent in your anxiety or depression you may need to try a higher dose. This is what happened to me, and increasing from 20mg to 30mg made a massive difference.

Citalopram can take weeks to have any positive effects. You should not consider increasing your dose until you have given your current dose a chance; speak to your doctor if you want to increase the dose.

In the worst case scenario there are plenty of other medications you can try. Speak to your doctor if citalopram is not effective for you.

Recovering from Anxiety and Depression

"Through all the chaos that is our history, though all of the wrongs and the discord, through all of the pain and suffering, through all of our times, there is one thing that has nourished our souls and elevated our species above its origin; and that is our courage."
- President's speech, Armageddon


Can citalopram cure depression or anxiety?
No. But anxiety and depression can be permanently cured once you know what is causing them. Citalopram is designed to alleviate your symptoms. When citalopram starts to clear the clouds, you can come out into the sun where it's warm. You'll find yourself with some breathing room and eventually you should be able to start tackling the reasons you are depressed and/or anxious. You can beat depression. You can beat anxiety. No matter what you might feel, you can recover from depression and anxiety. Millions of people have.

What happens if I am anxious or depressed for no reason?
Generalised anxiety and depression are tougher to beat but they can still be beaten! Millions of people have lived long and happy lives after overcoming their problems. You might never be totally free of worry, but you're a human being. Worrying is part of our nature and is not to be feared or despised, no matter how much of a pain in the bum it is. Citalopram could make more of a difference to people suffering from generalised anxiety or depression, as by alleviating your suffering, you can get on with living a normal life. The more time you spend free of symptoms, the more likely you are to make a good recovery. You can overcome depression and anxiety.

What is the Cycle of Worry?
This is one of the main reasons people feel so bad when they are depressed or anxious. It is possible to get trapped in a "loop" that reinforces itself, making you feel more stressed and upset. Your brain constantly searches for something to be scared of and you spend more and more time dwelling on your problems, finding worse "threats" and potential difficulties all the time.

Can the Cycle of Worry be broken?
Yes. It's likely that by the time you are trapped by the Cycle of Worry, worrying has become a habit. Bad habits can be changed! You have taken on the "role" of a worrier or a victim. Relaxation and distraction are the best methods of breaking the Cycle. If you can break it even for a moment, you have proven that you can be permanently free! Another very effective method is to follow a worry through to its conclusion: "How bad would it be if this really happened?" "How likely is it to actually happen?" Bear in mind that worrying is not a bad thing as long as it doesn't get out of control -- a small amount of worrying is normal and even healthy. It shows you care.

Is it possible to be permanently free of anxiety and depression?
Yes! You can be cured of anxiety and depression. It involves mental discipline on your part - you are the cure. You can recover from depression and never suffer depression again. It's possible to have bad days, of course, everyone has them. You will always feel some fear while you are growing as a person. Growing involves removing yourself from your comfort zone. That is always scary. You can handle it.

Why can't they invent a medication that will cure depression?
* They probably will in the next decade or two. Medical trials are constantly underway. New medications and techniques are still under review.
* Some upcoming medications may be effective within days rather than weeks, and may have few or no side effects.
* Some alternative remedies for depression and anxiety, such as kanna and inositol, are not going to make drug companies any money as these are naturally occurring substances which can be bought at any high street health shop. Kanna and inositol are proving as effective as modern day SSRIs in medical trials without the side effects, yet research into these natural remedies has been limited to say the least.
* The problem with depression is that people don't think they can beat it and they don't take enough action to try to get rid of it. Many people just rely on pills and expect medication to get rid of the depression. Depression doesn't work like that.
* Depression is treatable like any other illness. It isn't easy for everyone, some people suffer much worse than others, yet the truth is that depression can be cured or permanently held at bay. It requires mental discipline... but mental discipline is a massively useful skill that, if perfected, will give you an enormous advantage in life. It's a tough world -- be tougher.

Will citalopram stop me sleeping?
SSRIs such as citalopram may interfere with your sleeping patterns until your body gets used to the medication. This can be the toughest of the initial side effects, but it does pass.
If you find that you have disturbed sleep, for example you either can't get to sleep or you wake up early or you keep waking through the night, take citalopram in the morning or afternoon. Don't take it at night. I found my ability to sleep started to return after 10 days on citalopram. I still changed to taking it in the morning to avoid night-time panic attacks.

I hear that people have very vivid dreams on citalopram and that worries me.

What's wrong with vivid dreams? Why have vivid dreams got to be a bad thing? A "vivid dream" is a dream that you experience and remember more intensely than usual because it is weirder or more important to you than the rest -- but people have vivid dreams all the time without the aid of medication. I've had hundreds of bizarre dreams over my 29 years of life, yet since taking citalopram I have only had one -- and I don't blame citalopram for that, I blame too many episodes of Voyager.

My first experience with citalopram was horrible and I'm not taking it again.
Everyone remembers the first time they took citalopram. Don't let it scare you. Citalopram does take a while to get used to.
This period of adjustment can be damaging to your self-confidence. If people search their souls while suffering from anxiety and depression they may find that a very large number of their problems stem from poor self confidence and a lack of self-esteem. Remember that citalopram is not your enemy. It is not a poison! It is trying to protect you. However it takes a while to get going ("medicine lag?"), and you will need to get used to it. If you suffer very severely then speak to your doctor about changing medication. But don't give up on it straight away. You're in a battle against depression/anxiety, there is little room for victory if you are gonna raise the white flag on day two.

Citalopram makes me feel psychotic.
You are not psychotic. Citalopram will not make you psychotic. You are suffering from one of citalopram's most frightening (and common!) initial side effects. This feeling will pass.
Visions, hallucinations, disturbing thoughts, altered perceptions and so on are caused by the weird sensation of citalopram going to work. You will be fine.
I had this side effect for two nights. This side effect has never come back since. If you worry about it coming back, you are worrying for nothing.

Citalopram has caused me breathing difficulties.
If you can draw in a full breath without obstruction or agonising pain, you are not having breathing difficulties. You are either suffering from a bout of anxiety or hyperventilation. Your chest will not collapse, your lungs will be fine. You are perfectly safe. Regulate your breathing, keep telling yourself you are simply having a panic attack. Your breathing will get back to normal. Feeling some tension in your chest afterwards is normal. Your breathing will return to normal once you get used to the panic attacks and/or your body starts to tolerate the medication. If you are genuinely worried, see your doctor for your own peace of mind.

Citalopram is making me tired.
* A very common complaint, especially when you are new to citalopram or when you are taking high doses, even though medical documents tend to say that SSRIs do not usually make people tired. In practice, starting out on citalopram can seem to drain your energy. This tends to fade as you get used to the medication.
* Stress and anxiety can very quickly drain your energy reserves. It is likely these are the main cause of your tiredness.
* Depression can cause demotivation which makes people want to stay in bed all day or stay asleep so they don't have to face their problems. If this is the case, citalopram could be very helpful in the long run by restoring some of your va-va-voom, so stick with it. Citalopram seems to be much more effective against depression than anxiety (in my experience).
* Make sure you are eating a healthy, varied diet. Stay hydrated - drink plenty of water.
* Consider taking vitamin supplements. B-vitamins are good for providing a natural energy boost and they are known to help alleviate symptoms of depression.
* Practice good sleep hygeine -- go to bed at the same time every night and don't stay up til the early hours.

Citalopram is causing me problems of a sexual nature.
*
Sometimes people find it hard to get sexually aroused or to reach climax while taking citalopram. Were you having these problems before you started taking citalopram? If you've always had sexual problems of some kind then they are a separate issue which need to be dealt with.
* If you don't usually have problems in the sex department, remember that anxiety is a total passion killer. As your mood improves and/or as your body begins to tolerate the medication, your mojo should start to return.
* Gingko is believed to be effective at reducing sexual side effects of citalopram. It's available from Holland & Barretts and can be ordered online, just like any of their products.
* Once your sex drive comes back it may be more intense. Again this is normal.

Citalopram makes me feel like I'm not real, or the world is not real, or like someone else is controlling my body.


* You are unlucky enough to be experiencing the weird and rather unpleasant effects known as derealisation (you feel that you are not real or the world is not real in some way) and depersonalisation (you feel that you are not in control of yourself, or you feel detached from your body).

* Before you start freaking out, both of these states of mind are well known and you haven't got anything to be afraid of. Millions of people get these conditions and everyone comes out of them naturally, over a period of time which varies from minutes to months depending on how much attention you pay to them.

* Both of these conditions are usually caused by stress, anxiety and medication side effects, but could also be caused by tiredness or exhaustion.
Believe it or not you can even get them if you have a bad migraineor are recovering from an illness.

*
Feeling depersonalised or derealised does not indicate that anything is seriously wrong with you!

* They are not designed to be warnings of impending doom. They are defensive reactions, which means they are designed to PROTECT you. While it's understandable to fear them at first, if you have read this and you are still afraid of derealisation and depersonalisation, you are wasting time and energy that should be spent reassuring yourself.

* What they usually indicate is that your brain has become exhausted for one reason or another -- usually if you have been constantly worrying about something over a period of time -- and it is retreating to a safe distance to give itself a break so it can rest and recover! They have therefore put you in a kind of "safe zone" to protect you from overload.

* If medication, tiredness or stress have caused these feelings, they are simply a type of disorientation and are natural and harmless. Of course, you should always tell your doctor if you are concerned.

* Almost everyone will experience these conditions at some point -- most won't feel them long enough to realise, or simply won't pay much attention to them. It's really only people who are prone to anxiety who will really notice and care about the symptoms.

* The chances are you will return to your normal state of mind fairly quickly, for example once the current bout of anxiety or stress has ended, or when you've had sufficient rest, or when your body starts to tolerate the medication (if medication is the cause).


I am finding that I can't bear to be alone any more!

* Fear of being alone is probably a side effect of your anxiety and panic attacks. Remember that anxiety may be increased for several days or weeks when you start taking SSRI medication. This increase, for the unfortunate (including me), can seem to magnify your anxiety 10,000%, which leads to strange thoughts and behaviour patterns which you may not normally experience.

* You are probably in a negative train of thinking with your inner "chatterbox" constantly telling you frightening things. Your chatterbox is wrong. Your chatterbox is a liar. Your chatterbox represents all your worst fears and is presenting them to you in a way that is undermining your sense of well-being. It's trying to look out for you, but it is going about it totally the wrong way and is having a damaging effect on your confidence.

* Severe panic attacks are very damaging to your self-confidence. It's no wonder that you are frightened to be alone with your thoughts and symptoms.

* Your mind can "associate" panic attacks with whatever you are doing when the panic attacks occur. So if you're alone watching Diagnosis Murder in your living room during one or more panic attacks, your mind automatically assumes that 1: being alone and 2: being in your living room and 3: watching Diagnosis Murder will make you feel bad.
(Bear in mind that these things probably did not cause the panic attacks, you had them simply because you are prone to panic attacks - maybe something jogged a hidden, unpleasant memory, which kicked off with a new panic attack.) You see how easily negative associations can form? This probably has a direct bearing on why you became anxious or depressed in the first place. You subconsciously created a complex web of things to avoid and eventually became trapped.

* This kind of generalisation is supposed to protect you (eg "burning your hand is painful and can cause permanent damage - don't do it"). Your subconscious is vastly powerful and has the power to make you ill then make you well again. However, it does not understand complex issues. It doesn't understand that
being alone, being in your living room and watching Diagnosis Murder have got nothing to do with your panic attacks. All it knows is that you had a panic attack while you were under those conditions. There is a major difference.

* Make sure that you spend time around people and try to keep your mind busy with things that are important. Worrying about your symptoms is not important. Forget them for a while, even just a few minutes. Why would you want to constantly bear the burden of anxiety? Drop it while you do something more interesting. This can be very hard to do but will represent a significant step towards recovery when you manage it. Remember - baby steps, you will not be good at this straight away. We learn through hard work and mistakes.

* Once you start feeling better, gradually get used to being alone again. Face the panic attacks and anxiety this brings and deal with them calmly, one by one. Once you get used to being alone and even better, once you are able to enjoy being alone, half the battle is won! It is not a bad thing to spend some time alone; it's healthy and often relaxing!

TIP: If you associate things with anixety or depression, but realise they really do not have anything to do with the illness, try doing them again but with a happy, optimistic mindset. So in the previous example, think "I love Diagnosis Murder" and think of a few reasons why. You don't have to spend hours over this, just think about how fun and intriguing it is. Think like this for a while while you're doing other things so your subconscious has had time to start learning it - it will take a while to over-write its anxious programming and may cause you a few blips along the way. When you sit down to watch the next episode, sit down with a sigh of relaxation and smile while you do it. Get a cup of tea and some biscuits or something (if you're on mirtazapine, don't eat the entire pack, I know it's tempting!), something you enjoy, and when the familiar creeping anxiety crawls up your spine, deliberately try to relax your body and smile, thinking "It's just the old associations again - well it's my body, it's my life, I'm making some new, happy rules!" This takes practice, so get to it!

Citalopram isn't making me feel better.

It's not a cure for anxiety or depression. It's there to help you ride out the storm by relieving the worst symptoms. An umbrella can keep your head dry, but it won't stop the rain.

Citalopram's effects depend on the dose, on the nature of your problems, whether or not your body tolerates it, whether you believe it can help you or not and how healthy your thought process is. (See the bit about negative associations just above this part.)

The cure comes from within you. If you are agoraphobic, you must deal with your agoraphobia. Pills will NOT make this simply "go away". If you suffer social anxiety, you must get out into the world and get used to being around people. Anxiety MUST be confronted - you will only beat it by getting through the absolute WORST of it, with a confident and positive thought process which tells you that you can make it, no matter how tough it can be!

If you're depressed, you must surround yourself with the people you love and do things you enjoy. You do NOT face depression head-on. You cannot beat it by summoning feelings of depression and talking yourself through them. Doing so can be problematic since it is addictive and feeds from itself. Depression is like quicksand - you don't walk over quicksand, you find a road instead. This means the treatment for depression and anxiety are DIFFERENT is this basic sense. With depression, you need to find the CAUSE and fight THAT. There are usually negative schemas (thought patterns) which create depression. Remember, thoughts create feelings. Depression is caused by thoughts.

To make things more complicated, you need to bear in mind a lot of your problems are probably hidden. You have an unhelpful, counter-productive thought process happening in your subconscious. You can learn to identify when this process is happening and once you do that you can start "catching" thoughts as they happen. Catching hidden thoughts provides you with a way into the basic workings of your illness. Not only can this provide surprising and amazing insights into yourself, they offer you the chance to start rebuilding the way you think (and therefore behave and therefore feel), which is where recovery becomes inevitable for those with the guts and determination - for those who, in the words of Muse, "choose to strive".

I realise all of this is a lot easier said than done. However the simple, and painful, truth is this: You must make some kind of effort to recover -- you can't just leave it to the medication. You will need to take responsibility for your own recovery. This means claiming ownership of everything you think, do and feel.

Nobody recovers from anxiety or depression if they allow the illness to take over. It's your mind, you are the driving force. And none of this bullshit about being beyond help please - you are either saying that to punish yourself, or you can't be arsed to put in the hard work. This is totally understandable, but you either show some pride in yourself and strive to get better, or stay as you are now. What choice will you make?

Citalopram is making me feel worse.

This is probably going to happen in the first week or two. Maybe even longer. Accept this and try it anyway! What have you got to lose?

If everyone who felt bad on citalopram gave up taking it, citalopram would never help anybody. You need to ride out the first few weeks. This is where friends and family (and counselling and CBT if necesary) come in.

Some people never have any problems with citalopram. Maybe you'll be one of those people. Stay cool, don't fret, don't feel bad that you have to take tablets. You won't be on them forever. There's no shame in needing them.

However, if you are really feeling much worse, you should speak to your doctor and see what they think. Citalopram doesn't suit everyone; it's impossible to make a medicine that everyone can tolerate. If you can't tolerate citalopram, there are plenty of other medications to try.

Ask your doctor to refer you for counselling or, preferably, congnitive behavioural therapy (CBT). These can be tremendously helpful if you are willing and able to look for the causes of your problems and solutions to those problems. They can also give your self-confidence a boost. The NHS is currently focusing on CBT and is trying to improve access to mental health support. You can also consider contacting an anxiety charity or support group and asking for their advice on what to do next.

I don't need to take citalopram any more. I am feeling much better now.

Stay the course! Keep taking your medication until you have reached the end of your treatment period and your doctor has advised you to come off it. Always follow a doctor's advice. Don't come off cold turkey unless there is literally no other option. You can do a lot of things with your life, you're in the driving seat, but if you come off medication cold turkey you are showing all the wit and cunning of a meat and potato pie. You can commemorate this action by buying a green three-pointed hat with bells hanging off it, and learning to play the lute to entertain a king.

DON'T come off medication cold turkey or you almost certainly WILL go back to square one, unless you have developed extraordinary coping skills. ANY doctor will tell you this. Fair enough, many doctors are arrogant ******s with their thumbs permanently fused into their rectum, but even the biggest-foreheaded among them know you don't come off antidepressants without a bloody good plan.

Most people who have suffered from anxiety or depression for years will have not fully develop these skills in less than a couple of YEARS - it is ridiculous to think that someone will suddenly recover from GAD in six CBT sessions, for example.

Citalopram is helping to control your depression/anxiety, but you may still have some work to do before you are fully recovered. If you fully believe your problems are resolved and you don't need to keep going with the tablets, talk to your doctor - do not discontinue treatment until your doctor agrees you are ready.

There will be a huge difference in yourself when you are genuinely ready to come off medication, compared to when you THINK you are ready. It's like a steadiness, a resolution. You have rebuilt yourself from the ground up; at your centre is an iron core of willpower and self-belief which is flexible enough to take a hammering without breaking or suffering long-term upset. This is totally different to someone who has been on pills for six months and thinks they've won some endurance award. When you no longer see the length of your recovery as important, when you are okay to remain on pills while you keep working and keep improving yourself, THAT's the right kind of mindset and you will probably "know" when you are better. (Usually you have to be symptom-free for 3 months before you are classed as recovered, but a genuine, relapse-free recovery comes when you have mastered your problems and rebuilt yourself.)

My chatterbox is coming back.


Your chatterbox is the nattering fear that constantly tells you that you are doomed! The chatterbox represents the sum of all your fears and anxieties. You can probably guess that your chatterbox is biased towards the gloomy side of life. It will always look for the worst. It is mistrustful. Citalopram helps to shut the chatterbox up but if you are stressed or tired or anxious or ill or your defences are otherwise down, the chatterbox can wake up and start again. Demoralising... but normal, and not something to waste too much effort worrying about. The chatterbox is only trying to look out for you. It's simply going about it wrong. The best thing you can do is remember that the chatterbox is always wrong. Counter every negative thought with a positive one. Don't sit there listening to it, but don't deny its existence; it is a normal part of you just like it is a part of every human being. Respect the fact that you have fears while knowing that those fears are exaggerated and unrealistic.

Why does my anxiety keep coming back differently?
Sometimes it's possible to stop yourself feeling anxious about something, but the anxiety comes straight back in a slightly different form. For example, I suffered quite badly with health anxiety while my symotoms and side effects were at their worst, but after the side effects started to relent and I had spoken to my doctor, I didn't suffer any health anxiety for several days. Then I started to worry about the health of my family members. It was the same anxiety, it just found a new target. Anxiety is a clever little sod. It will know when it is beaten and it will break off its attack. You will have a short rest from it, then it will find another vulnerability to exploit. The anxiety knows how to adapt to your defences and find a way around them. (Thanks to Danny_Dingle for this)

How am I supposed to beat something that can changes and comes back?

This is not the problem you might think it is. As you get better at fighting anxiety your mental defences will naturally become tougher.
Anxiety has to work harder once it has been defeated. Anxiety is just like you: it can change its behaviour to some extent but it cannot change its own nature. It is what it is. You will learn to recognise the traits common to all forms of anxiety. If you have beaten it once you can beat it again and again.

I was feeling really good but now I've had a relapse... I'll never get better.
This seems to be a very common feeling for people who are taking any medication, not just citalopram. Everyone has bad days. You will too, you're part of the world, you're a human being. You will always feel some fear as long as you continue to grow as a person. There are bound to be days when you feel like crap. Maybe this will be due to the medication, maybe it won't. It might be that your medication has not yet started to have its full effect. Maybe you simply had a bad panic attack which has made you think the bad old days are back. You wouldn't be reading this guide if your problems weren't tough, so is it really a surprise that you are still experiencing vestiges of the old fear? Tomorrow will be a better day so what does it matter if today is a blip? Remember the good days because they are your armour against the bad days. Citalopram is not a panacea for all the world's ills. There is no such thing as a cure-all for anything. Anxiety and depression require a lot of mental effort to defeat, even if you are on the highest dose of citalopram. You must believe you will get better -- how do you expect to recover if you are always telling yourself you can't? Positive thinking! Optimism! They are your friends, they are just waiting to get to know you. Trust me, once you become familiar with them, you will like them a lot. They will help you to recover -- and stay that way!

Why did I have a "blip" or temporary relapse?
You are human, that's the main reason If we were perfect, we wouldn't be human, we'd be Hayden Panettiere. If you've been feeling good for a while then a recurrence of anxiety, fear, panic or depression may seem severe. But if you think about it, you don't feel any worse than you did before. It's just that you have forgotten what it was like to be that way. "Blips" also occur while getting used to the medication. While they are nasty, they shouldn't last forever and they are not an indication that the medicine isn't working. Most people are going to experience blips. You might as well stop worrying about it; worrying won't change anything and it won't help with your recovery. If a blip happens, you will handle it.

How long can a "blip" or relapse last?
This depends on your circumstances, so there is no average time. Don't fret, if you have felt good before you can and will feel good again. People can have bad days or bad weeks. Experiencing a "blip" or relapse does not mean your problems are coming back or your treatment is not working.

What do I do if I am having a "blip"?

* Continue taking your medication at the dose recommended by your doctor.
* Remember that having a bad day or bad week is completely normal.
* If you are finding that your anxiety or depression are starting to get worse, you will need to raise your game: try new coping techniques, phone Samaritans to offload your feelings, spend more time with family or friends. Anxiety and depression don't just sit there and allow you to beat them. You may need to evolve new coping strategies. This is completely normal and it does not mean that you won't prevail.

Negative Thoughts and the Chatterbox

The "Chatterbox" is the anxious person's worst enemy. It can lead you through distressing and very tiresome debates with yourself in which you are usually exposed to your own darkest fears. Needless to say this is counter-productive and can be mentally and emotionally exhausting.

The Chatterbox is the unrelenting voice (or voices) in your head that are constantly asking you worried questions, giving you bad advice and generally making a nuisance of itself. Depressed people in particular may hear lots of noise like different radio sets all playing at the same time: speech, music, it's a regular disco in there.

It is entirely normal to hear music or speech or both. It is normal to hear many different "channels" all playing together in a discordant concert. You do not have to be depressed to hear all of this and you do not need to be suffering with psychosis or a disorder of any kind.

The difference between the Chatterbox and "hearing voices" in the psychotic sense is distinct. The Chatterbox may be annoying, distracting or upsetting, but you KNOW it's all coming from within you. Much of the time, you won't consciously hear what they're saying, it's playing out in your unconscious. Your unconscious mind IS listening to them, and if they're negative, this is when you become agitated and distressed.

People who are "hearing voices" in the stereotypical sense - for example, people with schizophrenia - DO NOT realise these voices are their own. These voices seem to be from other people, or perhaps ghosts or spirits, and may seem beyond the person's control. People suffering from psychosis CAN recover from hearing voices as they gradually learn to listen to the encouraging ones and stop reacting to the bad ones. So as this Guide is trying to prove, there IS hope for everyone.

As you begin to recover, the chatterbox may become noticeably more quiet. You may feel tense at first, thinking the silence is just a trap for fools and the Chatterbox is lurking to ambush you. While it's true the chatterbox does tend to switch itself on and off a lot during the early stages of recovery you will gradually get used to this and you will be able to identify "triggers".

If the Chatterbox has been very prevalent in your life, you may feel weird or empty without it at first. You may need to learn how to cope without it. The Chatterbox can be a proper pain in the arse, but it provides you with comfort in a monstrous and distorted way. You cannot suddenly adapt to the silence when it's gone. Imagine having the radio playing in an empty house, then switching it off. That's the effect of cancelling the Chatterbox. You can learn to live without it, just understand that you will need to learn to adapt.

Here are a few of the more prevalent types of negative thought.

"I'm scared I will go mad and/or kill myself"
Anxiety UK report this to be a very common fear. Unless you understand how anxiety works, this problem is one of the hardest to deal with. Once you have an active grasp of your situation and the mechanism of defeatist thinking which anxiety and depression use, you can permanently break this fear and you'll wonder why it ever bothered you so much.

If you're scared of this, your fear almost certainly won't come true. It's no different to any other fear.

Anxiety and depression are based on a series of untrue and hevaily biased thoughts and interpretations. You cannot make terrible things happen just by willing them to. This is called magical thinking. It's a throwback to ancient times where people genuinely thought thunder was God dropping his Commodore 16 down the stairs. If you allow these primitive fears to hold you back you are denying several hundred years of progress.

Fear of suicide may relate to a fear of losing control of yourself and it definitely relates to a fear of death. Perhaps you are aware there are no external threats, so you instead believe that you will somehow become the threat instead. If you think about this you can unravel your fears of suicide fairly quickly, though as with any deeply-held fear, it may hold you in its shadow for some time.

Ask yourself this: how many people do you know who suddenly went mad? Or committed suicide for no reason? Instances of "spontaneous" suicide or apparent insanity are actually the result of someone having long-standing problems which they weren't able to deal with and which eventually took them over. These people were probably very good at concealing it - "My makeup may be flaking but my smile stays on."

If they were half as good at confronting their problems as hiding from them, they would be formidable.

Things like this do not happen overnight. You don't just wake up and think "Oh dear, I've lost my marbles." It simply does not work like that.

"I'm scared I'll need to go to hospital"
Extremes of stress, anxiety and depression - usually over prolonged periods of time - can result in an emotional or nervous breakdown. In the worst case, a person who has suffered a breakdown may need to be hospitalised. This is not common considering the sheer number of people who suffer from nervous illness and it is highly likely that you will never see the inside of such a hospital... unless you work there, obviously.

A hospital is not a place you go to live for the rest of your life. The focus is on treating patients and getting them well again so they can go home and start rebuilding their lives. You will be allowed to return to the world when you are judged to no longer be a threat to yourself and you are able to cope with your life once again. You will be required to co-operate and work towards your recovery. However your early days in the hospital will be focused on cooling things down and working out an effective treatment plan. You won't need to push yourself straight away.

The point is, even if you have a breakdown, you can recover. It may take weeks or months, but if you do recover, the timescale doesn't really matter. All that DOES matter is you follow your doctor's advice, use what support you can find and concentrate on getting well.

Mental problems such as psychosis CAN, in some cases, develop through use of mind-altering substances (basically, illegal drugs) or physical injury to the brain. Unless you are born with a vulnerability to mental disorders, these are the only ways a person can become psychotic. You don't just suddenly "go mad", there needs to be a physical factor involved.

If there is a history of mental illness in your family you may be more at risk. Long-term use, particularly heavy use, carries greater risks.

If anyone tells you cannabis is harmless, they are an idiot who needs to take the spliff out of their mouth and their thumb out of their arse, and get back to junior school for some learning. Cannabis and other mind-altering substances CAN cause mental illness in previously healthy people - there is a reason this stuff is illegal!

Readers of H P Lovecraft will now say "Yeah, but people go insane every time they see a monster!" Well Lovecraft was a fiction writer and he was writing about monsters that exist outside of the laws of our reality, so unless humans come into contact with phenomena that our brains are literally not designed to cope with like Lovercraft's characters, you can scratch this one out.

Equally, suicide is relatively rare in society. People don't simply wake up and think "I know! I've been depressed for ages, I think I'll top myself."

As discussed earlier, many people who attempt suicide either fail (they might want to die at that exact moment, but their body sure as hell doesn't), or are simply doing it as the "cry for help" we hear about so often.

This doesn't mean that suicide attempts should be ignored or aren't serious. A person in that much distress needs help. Help is available. Again, as stated before, it is entirely possible to recover from suicidal thoughts (whether or not you actually act on them, and most won't act on them) and you can live a life free of suicidal urges.

Do not panic or freak out if it happens to you; seek help. No-one has to go through this alone.
"I'll never get better"
This is a load of crap. Your body is designed to recover from anything. If you catch flu, you don't have flu for eighteen years. If you break your leg, your body will attempt to heal the bone and tissue damage so you can walk again. This is the most common type of negative thought, it is often the most distressing, and it's a common symptom of depression.

"There's no point to anything"
Another very common falsehood, and a hugely common symptom of depression. If there was no point to life, we wouldn't exist. I can't tell you what the point of life is. So what, that means there IS no point? Am I God? Are you? I'm willing to bet you're not God, otherwise you wouldn't need to read this since you already know what it says. (If you actually are God can I just apologise for what I said on the 15th of September 2009. It was said in the heat of the moment.)

Some people say we are here by some random accident. Stop and have a look around - I mean really look. Can all of this really be a cosmic cock-up? If everything happens by random chance, how is it that human beings can understand the way the universe appears to work - how can our maths and our science make any sense of anything? Why are the galaxies around us laid out like a chequerboard pattern?

How can our world be so pleasant and and beautiful to us? Is that all an accident as well? Why do we feel love and happiness? Why can animals feel it too - how come humans can co-exist with dogs, cats, horses, pigs, cows, even dolphins? If this was all an accident, wouldn't we still be a glowing green slime lying in a rock pool somewhere? How could we evolve from that slime to what we are today? Why would we need to?

"The universe is horrifyingly big... I feel small and pointless"
Why does being small make you pointless? Really consider that question. Spiders are smaller than we are, yet they set up camp in our homes and help to keep them free of pests, and are capable of incredible artistry with their webs. Elements that make up spider silk are being investigated for use in advanced military body armour. Do they give a damn about being small? They just get on with being awesome.

Ants are tireless working machines who can survive being stepped on, who build and construct and thrive and even fight as an intelligent, co-operating swarm. They're pretty amazing.

Dolphins are tiny compared to whales, yet dolphins are intelligent, loving and often very friendly towards humans, despite dolphins possessing only a fraction of our intelligence.

So being small isn't necessarily a bad thing!

"What if the world ends in a nuclear holocaust?"
Every major military power in the world knows what will happen if a nuke gets launched. Nobody is stupid enough to do this. Nobody wins if the world becomes a poisonous wasteland - nobody wants to live in a cave for the next 200 years.

Nobody is stupid enough to supply terror groups with nuclear technology, and if a terror cell did manage to deploy a nuke in a major city, their country would be utterly destroyed in retaliation. The gloves would come off: countries harbouring terrorists would be seriously sanctioned using military force, the group responsible for the attack would be hunted down and destroyed to the last member and terrorists would immediately find themselves facing secret executions without trial.

"What happens if aliens invade?"
Doomsday scenarios are often unrealistic or pointless, like this one. Why would aliens attack Earth when there are possibly thousands or millions of other planets out there? Why would they even go near us when we are an aggressive, hostile, warlike species with the capability to irradiate our entire planet rather than hand it over to conquerors from space?

Half the world united to fight Hitler 70 years ago -- imagine what would happen if a new enemy arrived who hated every human on earth equally -- it would most probably cause the whole planet to join forces, which in the long run might actually be the best thing for our species.

Oh, and if they're here for our resources, you're telling me they can travel the gulf between solar systems but they can't get their own water? Why do you even think they need water or oxygen or human embryos? Don't they know about cloning, or have an advanced understanding of genetics, despite having technology hundreds or thousands of years more advanced than ours?

"If aliens exist, God does not."
While we're on the extreme topics, allow me to vent about this load of old moo-cow. Some people think that if an alien civilisation is discovered, religions on Earth would collapse and there would be riots and mass suicides etc.

Maybe there would be - but only if religious people are prats!

Does God not believe in diversity? If he made humans in his image and all else is evil, why are insects and dinosaurs and mammals and stuff OK but aliens aren't? Why are aliens the same as demons? Sounds a bit racist to me! Reminds me of what the European colonists felt about the natives when they discovered America, and we all know how that turned out...


I personally think that if aliens are discovered, life on Earth for Joe Public will return to normal within a few weeks. After all, Kim Cardashian (whoever she is) will still need to walk down the street, Prince Harry will still need his privacy invading and a national debate on whether he's allowed to have a penis, Hollywood will still release insipid and uninspired drivel about "a group of friends going to [insert random backwater location] and unleashing an evil [insert enemy name here]". And we'll all have to go to work on Monday morning.

What medication is safe alongside citalopram?

Can I take it with painkillers?
Some. See the list below:

Paracetamol
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Yes, it is safe to take the normal stated dose of paracetamol alongside citalopram. Some people may find paracetamol to be weak as a painkiller, but those people have probably taken it all their lives and developed a tolerance to it. Paracetamol is available with or without caffeine. Paracetamol is very cheap, particularly if you buy it without the caffeine ingredient. If you find caffeine stresses you out, buy it without caffeine.
Caffeine is thought to be effective in reducing the severity of headaches. Personally if I drink coffee I get headaches, so who knows.
Side effects: Normally none, but you might feel spaced out or disorientated the first couple of times, particularly if your body is still adjusting to the medication.

Aspirin
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(E.g. Anadin Extra) No, you should avoid aspiring while taking citalopram.

Ibuprofen
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Yes, you can take citalopram with ibuprofen, but you must avoid taking ibuprofen all the time due to an increased risk of stomach bleeding. Ibuprofen itself is notorious for causing side effects (not related to taking them with SSRIs) and not everyone can take it. Even those who can safely take ibuprofen should not do so for extended periods.
Check with a doctor if you are not sure.

Migraleve
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No, the anti-nausea ingredients of Migraleve *may* react with the citalopram -- I have not been able to confirm this though -- my pharmacist advised me to stick with paracetamol rather than risk Migraleve.

Can I drink caffeine while taking citalopram?
* It is safe to drink caffeine and energy drinks while taking citalopram, but it is not a good idea to drink a lot of caffeine if you are already suffering from anxiety.
* Caffeine is known to increase anxiety and stress in some people. The more you drink, the worse these side effects become.
* It is easily possible to overdose on caffeine by drinking lots of it in one day, which will greatly exaggerate the side effects of caffeine, although you should not be otherwise harmed. You will probably need the toilet though. And you might find it hard to sleep.
* You find the most caffeine in coffee, cola, some energy drinks (like Red Bull) and tea. There is not as much caffeine in tea as the other drinks.
* The most caffeine is in energy drinks - the equivalent of several cups of coffee. Some energy drinks do not contain any caffeine.
* Some people are sensitive to caffeine and will feel stressed if they have even one cup of tea. Others, like myself, are not affected until they have drunk several cups, and even then all it does is make them a bit twitchy.
* The best thing to do is try to drink less caffeine to see if it makes any difference. Do not suddenly stop taking it altogether.
* Many people are addicted to caffeine. While this addiction is relatively harmless compared to, say, smoking or an alcohol addiction (both of these - especially smoking - can be tremendously harmful), cutting your supply of caffeine off is the same as going "cold turkey" and you may suffer side effects such as headaches, twitchiness and anxiety until your body flushes the last of the caffeine out. Cut down gradually.
* Caffeine withdrawal lasts for up to 9 days (but may be longer) and is usually at its most severe in the first week. The most common withdrawal effect is a severe headache. Depression and other symptoms may be present.
* After 9 days without caffeine, the human body is no longer classed as addicted and side effects should cease. This will not be the case for everybody - however if you are still having side effects after 9 days, get yourself checked out by a doctor just in case.
The odd cup of tea or coffee -
Do not be afraid of caffeine. Small amounts of it might not have much impact on your anxiety, but it is something to be aware of.
Lots of tea or coffee - Avoid drinking a lot of caffeine if it tends to make you stressed, twitchy or anxious. I sometimes suffer "caffeine burnout" after a long, tough day drinking lots of tea or coffee, which makes me tired, headachey and prone to stress.
Energy drinks containing caffeine - Eg Red Bull. Avoid at all costs as one can of Red Bull is supposedly equivalent to four cups of coffee.
Energy drinks which do not contain caffeine - Eg Lucozade. These should be fine. Watch your sugar intake though as that can also cause wild behaviour in very large quantities.
If you cannot function without caffeine of any kind, there are serious changes which need to be made to your lifestyle!


Does too much sugar provoke anxiety?

A small amount of sugar in your diet is not really harmful. A very large amount has been known to promote aggressive behaviour, especially in children, presumably due to the short-term energy boost it provides. "Sugar rushes" caused by bingeing on sweets can leave you feeling shaky and exhausted hours later which will certainly not help you if you are depressed. You can still have sugar in your diet, just stick within recommended guidelines, and try to cut down if you can.

What effect does gluten have on my behaviour?

Gluten is found in many processed foods but primarily in wheat and dairy products like milk and processed cheese. It can cause intestinal problems, and since the intenstines and brains are thought to be connected somehow ("gut instincts" do exist), these can manifest in behavioural problems.

Gluten is a total no-no if you suffer from aspergers syndrome and other autism-spectrum conditions. A proper gluten-free diet is a pain in the arse to follow and costs more money, and you also need to cut "casein" out as well if you are trying to combat the downsides of autism such as aggression, tantrums, anxiety, depression, social issues and restlessness.

Autistic people, particularly aspergers, can benefit amazingly from getting rid of gluten, to the point where they are capable of living their lives with only minor difficulties. Anyone who is gluten and casein intolerant can find their physical and mental health improves almost overnight by eliminating gluten, and within a year at most if eliminating casein.

Can I drink alcohol while taking citalopram?

Alcohol does not have much reactive effect with citalopram, so in theory it should be fine to drink alcohol while taking citalopram. The question remains why you would want to introduce alcohol into your body when you are depressed or anxious. Alcohol is legendarily depressive when drunk in large quantities.
If you really must drink booze, use your common sense. Don't drink too much, don't chuck it down your neck and don't drink spirits.
Alcopops, low strength booze - Alcohol might not physically interact with citalopram but it may drastically reduce its effectiveness. The odd glass of wine or a bottle of Bud here or there probably won't hurt too much.
Spirits, binge drinking
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Avoid spirits and drinking large amounts of any type of alcohol. Stronger alcohol such as spirits are far more likely to put you in a low mood, especially if you have a bad hangover. Spirits are renowned for causing severe hangovers. Binge drinking may indicate a problem with your lifestyle: going out and getting paralytic is, without meaning to be judgemental, a silly thing to do. What's the point in having a night out which you won't remember?

Can I take anxiety relief medication alongside citalopram?
There are certain things you can take to relieve the anxiety that citalopram can provoke. The list which follows is not exhaustive and does not include anxiolytic (anti-anxiety) medication. You should speak to your doctor or ask a pharmacist before taking any additional medication or supplements alongside citalopram. This guide does not intend or imply replacement of medical advice from a qualified person or agency.

"Citalopram safe" shows whether or not research indicates you can take these supplements alongside citalopram. Please note that the information below is compiled through exhaustive research and personal experience -- not everyone will be safe to try the anxiety relief listed below.

Kalms
- Used to lessen mild to moderate stress and anxiety. Available from supermarkets and pharmacists.
Some No More Panic users have reported that Kalms (which contain valerian) are effective against anxiety when taken at HALF the stated dose, but taking Kalms is not recommended if you are also using citalopram. Kalms contain a small amount of valerian extract. See valerian extract below.
Side effects:
See valerian extract below.
Citalopram safe: No - see valerian extract below.

Valerian extract
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Used to relieve anxiety. Valerian extract is found in Kalms but possibly in lower amounts. Available from Holland & Barratts.
Side effects: Warning - may increase depression if taken alongside citalopram.
Citalopram safe: No, due to adverse interaction between the two substances.

Valium - Used to relieve moderate to severe anxiety. Available on prescription. Sometimes prescribed with citalopram when side effects of citalopram are severe, but doctors do not like to prescribe it due to its addictiveness. Best taken as and when needed e.g. only when anxiety is unmanageable without it.
Side effects:
Increased tiredness, also presumably the usual valium side effects which I am not familiar with as I have never taken it.
Citalopram safe: Yes.

Anxiolytics - Anti-anxiety medication. Some types are very addictive and are only prescribed over the very short-term. Modern anxiolytics are less addictive and possibly more effective than previous generations. You must speak to your doctor if you want additional anxiety relief to be prescribed alongside your citalopram. Anxiolytics are beyond the scope of this guide.
Side effects: Depends on medication.
Citalopram safe: Depends on medication.

Cannabis - Psychoactive drug with a number of very useful medical applications. Cannabis is also used recreationally to induce a state of relaxation and well-being. Although many recreational users do not believe there is anything wrong with using cannabis, this substance is banned in many countries due to its dangerous effects on human mental health. Contrary to popular opinion, regular cannabis use has damaging effects and should be avoided. It is a MYTH that cannabis is harmless; arguments that cannabis is harmless have NO basis in scientific fact.
If you disagree with this, as is your right, you are welcome to provide your medical credentials and show me which studies prove your argument, and it would be handy if you could also get a retraction from at least one major drug charity/organisation apologising for bad-mouthing cannabis for decades.Although some people argue that alcohol is more damaging to society - and due to the number of people who drink compared to the number who use cannabis, they are right - the fact remains that cannabis should be avoided by anxiety and depression sufferers, particularly if you are already suffering from other mental health issues. The UK drugs charity "Talk to Frank" says of cannabis: People who say cannabis is harmless don't know what they are talking about.
Side effects: Mood swings, personality change, paranoia, depression, anxiety, serious mental health issues including psychosis. People with a history of mental illness in their family, or who are already at risk of mental illness, may find the risks of mental illness are significantly higher. Mental health issues and personality changes may be permanent.
Citalopram safe: No.

Kava Kava - Used in the successful treatment of anxiety, but reacts with citalopram and must never be combined with an SSRI.
Side effects: Unknown.
Citalopram safe: No.

Ketamine
- Used as a tranquiliser for animals. Unsafe for recreational or self-prescribed consumption due to significant and disturbing side effects which commonly include hallucinations. Current research indicates that ketamine has antidepressant qualities which are highly noticeable noticeable within hours of taking a dose (often just 1 hour but normally about 7).
A single dose of ketamine when delievered at the correct dose (which is currently unknown to those outside the trials) and when supervised by a medical professional can relieve the symptoms of serious depression for up to two weeks.
During medical trials, ketamine successfully and noticeably relieved symptoms of depression in people whose depression was "very treatment-resistant" (had not responded to between 2 and 6 different types of treatment). Therefore, there is hope that a depression-busting drug can be synthesised once ketamine's antidepressant effect is understood. This might take several years before larger trials with a synthesised medication.
Ketamine is currently under investigation to help researchers develop a new generation of antidepressant medication.
Side effects: Significant, dangerous and frightening side effects from ketamine abuse include anaesthesia, muscular relaxation (including the lungs!), human consciousness being drawn within itself (a sense of falling into a hole - known as the "K-hole"), temporarily forgetting who or what you are (inability to function as a human being!), temporary inability to recognise yourself or other people and impairment of all five senses. Although ketamine is used illegally for recreational purposes, to do so is stupidly dangerous. Needless to say I don't know of another substance with such a fearsome list of side effects!
Citalopram safe: No, not even if you're the ghost of Mr Ed!

Can I take another antidepressant alongside citalopram?
You CAN, under a doctor's supervision, combine certain antidepressant medications. In fact, some medical researchers think doctors need to be far more aggressive at tackling depression and in some cases a combination of two antidepressants may be recommended, for example in treatment-resistant cases.
Great care needs to be taken so it must be done through your doctor. Combining two different SSRIs, or combining an SSRI with certain other medications or substances like St John's Wort, may cause something called serotonin syndrome. Good luck finding a clear definition of serotonin syndrome. It can be very serious, as in life-threatening.

NOTE: Originally I said you couldn't take other antidepressants with SSRIs. This was not correct.

What vitamins and minerals can I take with citalopram?
There are a number of things that are thought to be effective at controlling the symptoms of depression. It is possible these might also help relieve anxiety and stress. Note that none of these supplements can cure depression or anxiety on their own -- you still need to do the donkey work unfortunately!
Some of these substances occur naturally within the body or are found in a healthy and balanced diet so there should be little reason to fear taking them alongside citalopram. Make sure you don't exceed any stated or agreed doses. Take them during or after eating to get the maximum benefit. "Citalopram safe" shows whether or not research indicates you can take these supplements alongside citalopram.
Note that you are better off simply eating a more balanced and healthy diet. Vitamins found in food are vastly superior to those found in supplements. Also, a healthy diet will help to improve many aspects of your physical and mental health.

Caution! You should not take more than the recommended daily dose of vitamins A and E as your body cannot dispose of these substances. It is possible that high levels of these vitamins can cause damage to your body, although they would have to be stupidly high.

Omega-3 fatty acids
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Found in fish, fish oil supplements and flax seed capsules. Medical studies consistently show that omega-3 has been effective at relieving the symptoms of depression. It has numerous other health and behavioural benefits including improved memory function. Autism-spectrum people such as aspergers can benefit greatly from Omega-3 supplements and increased Omega-3 in the diet. Fish oil is your friend!

Some studies have even shown that taking omega-3 alongside antidepressant medication can significantly increase the effectiveness of the medication. The medical profession is hesitant to state this as a proven fact as more research needs to be done.

The benefits of regular omega-3 supplementation are most noticeable over a period of 12 months, so if you plan to take omega-3, you will need to take it for at least a year. (This does not mean you won't get any benefits if you take it for shorter periods.) Supplements may be as effective as omega-3 found in your food, which is not always the case with supplements.

Take with food and drink. Do not exceed the stated dose if your omega-3 supplement contains vitamin E, as it is possible to harm your system with high doses of vitamin E.

Side effects: None.
Citalopram safe: Yes.

Ginkgo Biloba
- There is medical evidence to suggest that gingko biloba reduces the sexual side effects of citalopram (e.g. changes to libido, difficulty achieving orgasm etc). This supplement is strongly recommended to anyone who is suffering adverse effects from citalopram. Speak to your doctor or pharmacist to see if it's ok for you to take this supplement. Gingko does not have an antidepressant effect, it simply makes things easier for you while you adjust to the citalopram. Do not take it if you are pregnant. Do not combine with an SSRI without seeking a doctor's advice. Do not combine with anticoagulants such as ibuprofen and aspirin.
Side effects: Vomiting, bleeding, headaches, dizziness. Stop using the product immediately if side effects appear.
Citalopram safe: Seek a doctor's advice.

Chromium picolinate
-
Studies have indicated that supplements of this substance, which can also be found naturally in a healthy or balanced diet, may help relieve the symptoms of "atypical depression" (which accounts for 40% of all reported depression).
Atypical depression means your depression is mood-reactive -- in other words if something good happens, you experience positive emotions despite generally being depressed. This can get you into the minefield of bizarre- or frightening-sounding, but ultimately unthreatening medical terms such as euthymia, "mixed state" and so forth. Don't worry about these things, they are simply medical explanations of what could be happening to you and they are nowhere near as scary as you think. You may need to learn more about them if you want to know how your illness actually works and a talented, professional CBT therapist will be able to walk you through them. Avoid researching them on Google or Wikipedia - ask someone who actually works with this stuff, they'll explain it in terms that are far less frightening than Dr Google will.
"Melancholic" depression, which is what most people mean when they talk about depression, often prevents the sufferer from feeling good during happy events.
The UK health authorities have declared chromium picolinate safe as it shows no indication of causing serious harm or long-term damage, and the human body can tolerate very high levels meaning it is difficult to overdose. The United States recommends doses between 0.05 and 0.2 milligrams per day for adults. The United Kingdom also advises people to avoid taking more than 10mg per day.
Note that not all experts agree that chromium picolinate makes any difference at all to depression.
Take with food and water.
Side effects: May impair your body's metabolism of iron and may hinder its attempts to store iron. Do not exceed the agreed dose as there is a slender chance of blood-related side effects, particularly for very high doses.
Citalopram safe: Not confirmed, but presumably safe as this substance occurs naturally in the human body.

B-Vitamins - Medical evidence suggests B-vitamins are effective at alleviating the symptoms of depression, and may give you a mild, natural energy boost. Vitamin B-complex supplements contain a variety of ingredients, usually in super-strength doses. Your body naturally disposes of unused B-vitamins in the urine so there is no risk associated with super-strength doses. Do not exceed the daily dose stated on the label.
Side effects: Unused B-vitamins are naturally flushed out of your body in your urine, which can lead to your urine coming out in some very alarming colours. This can be anything from neon yellow to radioactive orange. This is normal and nothing to worry about. Do not confuse this with symptoms of dehydration, which colours the urine dark yellow or dark orange.
Citalopram safe: Yes.

Choline - I heard anecdotal (rumoured) evidence that choline supplements can help to relieve the symptoms of either anxiety or depression. Very little medical research seems to have been done on this, and I do not know anyone who has tried taking choline for anxiety or depression. Choline deficiency is very rare: during one medical trial, the researchers had to induce choline deficiency in the patients, in order to find out what problems and benefits are associated with choline supplements.
Side effects: High doses (9g per day) may provoke or increase feelings of depression, making this one supplement to avoid if you are already depressed or in a low mood.
Citalopram safe: Unknown, but no evidence to indicate that combining choline and inositol is harmful.

Inositol - Inositol is usually found in the spinal fluid. People suffering from depression tend to have reduced amounts of inositol in their spinal fluid. Increasing the amount of inositol in the human body seems to be very effective against a wide range of mental problems. Further tests are needed but the initial results are very encouraging.
I rate inositol more highly than citalopram due to its gentle influence and lack of side effects, and I would encourage anyone who does not suffer from mood swings to try it (provided they are able to take it).
* Available in tablet and powder form. Powder form is usually stronger and may be preferable because of this. High doses (12-18g per day) may be effective in treating depression, anxiety, obsessive compulsive disorder, bulimia, panic disorder, panic attacks and bipolar disorder, with no negative impact on health.

* However, inositol is expensive, especially in powder form, and taking 12g per day is not only unrealistic, it will prove beyond most peoples' financial means. (An Ł8 tub of inositol pills would last 4 days. That's 24 tablets per day.) You will almost certainly need to take a lower dose. I find 3.4g (6 pills per day) to be effective.
* Inositol is believed to be very effective in silencing the "chatterbox" and has been known to improve the duration and quality of sleep for people suffering from depression.
* In small-scale trials, inositol has proven more effective than some SSRis but without any side effects. This offers considerable hope to those who want to fight depression using natural remedies.
* Inositol out-performs some SSRIs at reducing the frequency and severity of panic attacks. Inositol may become effective against panic attacks in less than a week.
* Inositol does NOT seem to be effective against problems that do not respond to SSRIs. If you have tried several SSRIs and none of them have worked, there may not be any benefit in taking inositol, although anything is worth a try.
* Inositol is believed to start having its maximum effect after three weeks. Medical trials strongly suggest that small doses of inositol ARE effective and inositol CAN start working very quickly (i.e. a lot less than three weeks).
Side effects:
The side effects of inositol are comparatively minor, making it a highly desirable alternative to SSRI medication. Some people have posted on self-help websites that inositol increased the frequency and violence of their mood swings; these people were taking a medley of anti-depressants and anti-psychotics at the time, and medical studies do not completely back their claims up. It is possible that high doses of inositol can make you feel drowsy or sleepy. You may find an increased need to use the toilet.
Citalopram safe:
Yes, according to the preliminary research. However it is currently thought that inositol and SSRIs do not "combine their strengths" to fight depression (it is not currently known why they don't), which suggests that there is no medical benefit to taking them alongside one another. In my experience, there is an advantage in taking inositol alongside citalopram.
NOTE: I strongly recommend you try inositol if it is safe for you to do so (ask your doctor or pharmacist about contra-indications). I found it immensely helpful and it started to improve my quality of sleep after just 3-4 days of taking 3g per day.

Kanna - Scientific name "scelentium tortuosum". Kanna has been used to relieve symptoms of anxiety and depression for centuries, and if you are not currently taking medication you may find Kanna to be effective and easy to live with. Medical trials on rats show significant antidepressant effects. Kanna may be on a par with anxiolytics (anti-anxiety medication) for the relief of anxiety. It is believed Kanna works similarly to SSRI medication with very few side effects. Kanna can relieve anxiety in very low doses, but it should never be combined with alcohol, cannabis, SSRI or MAOI medication due to adverse reactions.
Side effects: Higher doses may cause headaches, nausea and anxiety. May cause insomnia or tiredness. Kanna may increase blood pressure. There have been no reported harmful effects from sensible use of Kanna. Very high doses can lead to a sedative effect.
Citalopram safe: No. Do not combine Kanna with SSRI or MAOI medication. It is possible Kanna may help those who cannot tolerate citalopram side effects or who do not want to try medication.

Zinc - Found naturally in the diet. Can be taken in supplements. Thought to be helpful in controlling depression.
Side effects: None.
Citalopram safe: Yes.

Magnesium - Found naturally in the diet. Can be taken in supplements. Magnesium deficiency is known to cause or increase the effects of depression and it is very important that you maintain a good balance of magnesium in your diet.
Side effects: None.
Citalopram safe: Yes.

Flax seed - Supposedly helps to relieve the symptoms of depression.
Side effects: None known.
Citalopram safe: Yes.

St John's Wort - Believed to be a potent natural anti-depressant which may also help with stress and anxiety, but many people report severe side effects. Medical trials have been inconclusive overall. It appears that St John's Wort may not help those suffering from dysthymia (a chronic but less severe form of depression which saps motivation and puts the sufferer into a negative frame of mind).
Side effects: May increase feelings of depression. Can cause dizziness, tiredness, gastrointestinal symptoms and in rare cases may cause sensitivity to sunlight.
Citalopram safe: No. Taking this supplement alongside many types of medication including SSRIs can cause adverse reactions which ultimately put you at risk of serotonin syndrome which can, in extreme cases, be fatal.

My experience of St John's Wort (SJW)
I have tried St John's Wort in the past to help me with stress problems. Within a couple of days my mood had turned black. I felt the beginnings of very severe depression. It scared me so much I chucked the tub of SJW in the bin and I have never even looked at this stuff since. My mood returned to normal within a day or two.
It is possible that this depression would have lifted if I'd stuck with the SJW. I was too scared to do so.
If you really do not want to try citalopram, look at Kanna instead. If you are already taking citalopram, I strongly recommend you try inositol supplements.

Gluten and Casein: As previously mentioned, these need to be ELIMINATED from your diet if you are intolerant to them. They MUST be eliminated from your diet if you are autistic, as you may see considerable benefits from doing so, and some people report the benefits of removing gluten can be felt within days. These products are mainly found in processed food and dairy products.
Diets free of these substances are annoying and expensive, and you should seek medical advice before going ahead, but the benefits will probably be worth it for most people. (You need to seek medical advice as your diet will be limited if you are removing gluten and casein.)
Side effects: These substances may cause irritation of the digestive system and are linked to depression, anxiety, irritability, aggression, tantrums, antisocial behaviour or difficulty interacting with others, and social anxiety. Ladies and gentlement, I give you the wonders of modern, processed food! It is thought that gluten and casein affect autistic people, very noticeably aspergers, considerably more than they affect non-autistic people.
Citalopram safe: Yes.

Inositol: Humanity's doomsday weapon against depression and anxiety?

"There couldn't be more excitement here if Elvis walked in and asked for a chip sandwich."
-Sid Waddell's football commentary

There is one thing that I have found more useful than practically ANYTHING else in the war against anxiety. It's called inositol, and I have been preaching about it on the forum for months.

Whether or not you believe this stuff works, I have found on a consistent basis that when I start taking 3-4g per day of inositol, my mood and ability to sleep improve sharply. If I stop taking inositol, I find that over a period of days or weeks my anxiety begins to climb and negative thoughts seem more frightening.

Inositol DOES make a BIG difference to my feelings of well-being, and I do not think I would be so far along the road to recovery without it.

People suffering from depression tend to have reduced amounts of inositol in their spinal fluid. Nobody currently knows whether a lack of inositol causes the depression or vice versa.

Increasing the amount of inositol in the human body seems to be very effective against a wide range of mental problems. Further tests are needed but the initial results are very encouraging.

Fun Facts

* Available in tablet and powder form. Powder form is usually stronger and may be preferable because of this, but it is very expensive.

* High doses (12-18g per day) may be effective in treating depression, anxiety, obsessive compulsive disorder, bulimia, panic disorder, panic and attacks.

* OCD requires a higher dose (18g) than anxiety and depression (12g).

* Inositol is significantly more effective than placebo and may, for some people, be more effective than antidepressants.

* Much lower doses are thought to be effective, so you don't need to take massive amounts of inositol to see any benefits.

* A course of inositol takes an average of 3 weeks to show its maximum benefit but, during medical trials, inositol was found to work within days for many people.

* Proven to reduce panic attacks more quickly than some SSRIs.


* Believed to be very effective in silencing the "chatterbox", bringing very effective relief from anxiety and negative thoughts.

* Inositol has been known to improve the duration and quality of sleep for people suffering from depression.

* Side effects are minimal and easily tolerated; this offers considerable hope to those who want to fight depression using natural remedies.

* Since inositol is a naturally occurring substance within the human body, high doses are not thought to be damaging, and medical studies show that high use of inositol does not cause physical damage or changes within the kidneys, liver or blood.

* Powder inositol is superior to tablet form as it lasts far longer and is only a quid more expensive to buy.


* Inositol does NOT seem to be effective against problems that do not respond to SSRIs. If you have tried several SSRIs and none of them have worked, there may not be any benefit in taking inositol, although some experts still insist that it might be worth a try.

* According to the manufacturer of Pot Noodles, Mauna Kea is actually the world's biggest mountain, overtopping the legendary Mount Everest. (Well this section is called Fun Facts)

Side effects: Possible agitation or mania in bilopar sufferers;
some people suffering from psychosis and bipolar believe inositol increased the frequency and violence of their mood swings; mild nausea or need to use the toilet; drowsiness or sleepiness; very long-term effects of heavy inositol use are unknown.

Citalopram safe:
Yes.

Random Stuff

Dad: "Chuff me! It's lucky they're playing worse than us!"
Me: "Look at him with that beard! He looks like a devil worshipper."
Dad: "He plays like one an' all."
- Me and Dad watching football

Should I tell my prospective employer (when I'm going for an interview) that I'm on citalopram or suffering from anxiety/depression?
NO! You should NOT disclose anything that is not immediately obvious! I don't condone lying, but we are not living in the Federation here. Honesty is best served in small doses.

The person who goes into an interview and is completely honest will probably not get the job unless they are totally awesome. Successful applicants are probably lying through their teeth! Their CVs are probably the greatest work of fiction since Jack Butler's Nightshade. Nightshade might be weird sci-fi, but it's probably got more reality in it than the average CV, and this book has vampires and people with robot brains!

You don't have to *lie* in an interview but you should not hurt your own chances of getting a job. For all you know your problems might be resolved in the next few weeks!

What about if I'm already employed? Should I tell my boss?
You don't need to tell your employer unless you are really struggling and need support. If your work is being affected, you may need to come clean. Remember, if they tell you that you should have disclosed this earlier, you were NOT deliberately withholding vital information! You had a private matter going on in your own private life, which is just now becoming something for your employer to know about. Unless you are unable to perform in your role any more, your personal issues are not your colleagues' business.

How do I know if I am paranoid?
Most people think they are paranoid when really they are either low on confidence, find it hard to trust people, or suffer from unreasonable fears or phobias. There is a major difference between someone who is clinically paranoid and someone who isn't.

The difference between paranoia and anxiety - the thing that makes the distance between the two an unbridgable gulf - is that a paranoid person will never question their negative belief. They do not realise it is irrational or made up. They believe it is an empirical fact, just as you believe that a grey cloud means rain. If you try to convince a paranoid person that they actually are paranoid, they will think you are lying to them in order to mess with their head - or worse, they may think you are allied to whatever they are afraid of. They may be incapable of seeing their thoughts and/or behaviour as paranoid.

How is it possible to maintain a sense of humour when I feel so bad?
It's difficult, I kid you not! It is hard to smile and joke when you are anxious or depressed. The important thing is that you try. Don't give up. keep going. Smiling really does convince your brain that you are happy. Even if it only makes a 5% difference to your mood, that is 5% that you want and need! It's easier to maintain a sense of humour if you are a natural joker, a cheeky so-and-so, or you tend to have a cavalier attitude (e.g. you like to bravely charge in without worrying about the odds).

What would happen if you ever spoke to the people who invented citalopram?
Citalopram people: "We're sorry you have suffered so many rare side effects while taking our product. We hope there are no hard feelings."
Me: "There are lots of hard feelings, and I'd like to send you a photocopy of my backside. The only thing stopping me is my newfound sense of maturity."

How to live a normal life while adjusting to citalopram

"There are as many nights as days, and the one is just as long as the other in the year's course. Even a happy life cannot be without a measure of darkness, and the word 'happy' would lose its meaning if it were not balanced by sadness."
- Carl Jung

* Don't be afraid. Citalopram is not out to hurt you. It just comes as a bit of a shock to your brain, that's all. You have not been poisoned. It gets easier as you get used to the medicine.

* If you're suffering with side effects, think of it as an exercise in character building. This is a good way to find some value in your suffering. People can tolerate nearly anything if it is worthwhile to do so. Do not allow your health anxiety to take over. The side effects won't always be so bad and they should wear off over time.

* You might feel more depressed or anxious for a while. This is an unpleasant truth of medication. One day they'll invent something that doesn't have side effects but we are living in the here and now. Remember that you are taking a medicine that is supposed to reduce depression and anxiety -- once your brain is used to it, the citalopram should hopefully clear them up for you. In the meantime you will have to tough it out.

* Just because some people don't like it, or because it didn't work for them, does not mean it won't work for you. Believe that the medication will help you. Trust it. Forget what other people say about it. Believing it will work will make a difference in the end.

* If you suffer from interrupted sleep, take your meds in the morning. Not being able to sleep is a crap experience but your sleeping patterns will eventually settle down and return to normal or near-normal.

* You will probably suffer from occasional spaced-out feelings and maybe headaches as well. If you are really worried or suffering badly, you should see your doctor for your own peace of mind then get your eyes checked at an optician's. Remember that these are quite common side effects and almost certainly do not indicate failing health.

* You could find yourself suffering from "ups and downs" even when you've been taking the medication for weeks. This is normal. You are still going through a difficult time -- you wouldn't need medication in the first place if things were okay. Stick with the medication. Hopefully things will settle down. If you genuinely feel it is not working, speak to a doctor. Make sure you don't rely on medication as your only treatment for anxiety or depression.

* Do not just stop taking your medication. It doesn't matter how much better you feel. Stay the course. Also, if you're running low, make sure you get a repeat prescription in time so that you don't have to go for a few days without medication!

Medical Science and the fight against mental illness

Is there any procedure which can permanently cure mental illness?
At this time, curing depression, bipolar disorder and so forth with medicine is beyond our technology. This will not always be the case. Research is constantly ongoing. New generations of medicine and physical surgery are under investigation even now. Brain implants and other radical treatments are also being looked into.

Note that it is still possible for today's treatments to help people permanently recover, they just don't work for everyone.

How far away are we from curing mental illness?
According to a recent (2009) article in the British media, British medical science is "a long way" from being able to permanently cure mental illness such as schizophrenia and depression. However, the fight goes on, and recent breakthroughs (such as identifying previously unknown relationships between bipolar disorder and schizophrenia) could be significant in the treatment of many conditions.

Why is depression apparently on the increase?
Although today's world is a difficult and stressful place to live, it is likely that more people are aware of depression, anxiety and stress, and are more likely to approach their doctors for help instead of suffering in silence. Doctors are also more likely to diagnose these conditions as they are gain more experience of them and learn to recognise the symptoms.

How to fight back against anxiety and depression

"...we shall defend our Island, whatever the cost may be. We shall fight on the beaches, we shall fight on the landing grounds, we shall fight in the fields and in the streets, we shall fight in the hills; we shall never surrender."
- Winston Churchill

Recovery is possible

* Remember that many, many people can and do recover from depression and anxiety. You can make a complete, lifelong recovery.

* It is also possible to recover from bipolar disorder and schizophrenia.

* Take responsibility for your own recovery -- medication is an aid, not a cure. Medication will not help on its own unless you make some attempt to toughen yourself mentally and resolve your problems.

Don't be ashamed

* Whether or not you are mentally ill, YOU HAVE DONE NOTHING WRONG. You are NOT weak, you are NOT some kind of mutant, you are NOT a bad person and GOD IS NOT PUNISHING YOU. You didn't sin in a former life; you have not been selected by some cosmic lottery. What is happening to you is ENTIRELY NATURAL and happens to a very, very large number of people across the world.

* In my experience, people suffering from anxiety and depression tend to be a remarkable bunch, full of interesting and painful stories to share, with unique insights into themselves and the nature of existence.

* Winston Churchill kept the British Empire fighting when all hope was extinguished and Europe had fallen; Winston Churchill defied perhaps the most powerful tyrant the world has ever known; Winston Churchill was dogged by depression. Depression does NOT mean that you will be unable to have an interesting and event-filled life!

The chatterbox is wrong

* Depression and anxiety will try to convince you that your situation is hopeless. This is a lie. There is always hope, even when it's hard to see it, even if you are tied to a chair balanced on a tightrope above a crocodile pit with a tarantula on your head and a lit stick of dynamite jammed up your bum cleft. I'm willing to bet your situation is not quite so desperate. Depression and anxiety are liars. They want you to stay scared so they can continue to exist. If you stop being afraid, they cease to be. Anxiety and depression want to survive. You should disregard what they tell you because they are always wrong.

* Your subconscious is always listening. Make sure that you are sending it constant positive encouragement. Don't let the chatterbox get there first. Reassure yourself that you are a good person, you are worth getting to know, you haven't made any more mistakes than anyone else, you like yourself and enjoy your own company. Your higher self is listening and will believe you. After all, you're telling it the truth!

Be a part of the world

* Stay social! Spend time with loved ones and your closest friends. The more time you spend having fun with your mates, the less time you're feeling sorry for yourself. Staying in touch with friends can and will help to reduce anxiety, agoraphobia and depression. Have fun, laugh and joke, act like nothing's wrong. It will help you in the long run.

* Save the world. Join up to the World Community Grid and devote your computer's spare processing power to fighting against cancer, HIV and tropical disease. Other projects available are researching clean energy resources, finding ways to provide food for the starving and even scanning deep space signals for signs of alien communication. This will not cost anything to join and will not interfere with your computer's day to day running but it may slightly increase energy bills and laptops in particular *may* get hot as all of your computer's processing capacity will be used. You can literally make a difference to the world by joining up. (Click the link above to join - download options are on the home page)

* Stop researching your medication, symptoms and side effects. You are taking a serious step backwards whenever you do this -- especially if it makes you feel bad! The internet will only ever tell you the worst case scenario. Chances are you are NOWHERE NEAR the worst case scenario. If you are worried about the way you feel, tell it to a doctor. Do not consult Google or any other search engines. Do not rely on medical dramas or television documentaries.

Exercise and a diet that's wise

* Regular exercise is looking to be one of the best ways to control stress, anxiety and depression. Exercise is legendarily good at defusing tension in the body and mind. I worked for more than two years for the most stressful and small-minded company and not once did I feel anxious or depressed about it. I went for a walk round the block with a family member nearly every night of the week. Not only did this keep me fit, active and at the correct weight, it gave me a chance to burn off some of the stress and I got to vent my frustration by talking to my family member.

* Exercise should be at undertaken at least 3 days per week. You should exercise for at least 30 minutes and it should leave you slightly breathless. If it doesn't meet at least one of these criteria it doesn't count as exercise!

* Exercise releases feel-good hormones into your brain, and with good reason: you are burning off unwanted calories and you are physically improving the condition of your body and mind. Exercise is tremendously good for you and you have every right to feel pleased with yourself.

* Stay hydrated. This is especially important if you aren't currently eating or drinking much. Drink plenty of water. Make especially sure that you are hydrating yourself if you have nervous diaorreah. Drinking plenty of water can help with headaches and migraines and will help to keep your body in decent working order.

* Try to avoid eating too much crap. This is your chance to eat lots of fruit. Fruit is good for you and eating a lot of it can make you feel good!

* IMPORTANT NOTE: On higher doses of medication you may not have the energy or motivation to exercise. You should take note of what your body is telling you, and stick within your limits. A person on 60mg of citalopram is not going to be running any marathons for a while.

The world is the world; it's how you see it that matters

* Contrary to popular opinion, the world is NOT a terrible place. The world is the world and it makes no apologies for that. It's one world among unnumbered billions. Yet it's the only one currently known to harbour life. It's the only one we know of that humans can survive on unsupported. The world was set up specifically so that life could thrive, and thrive it does! Why do you think humans were born with the ability to appreciate beauty?
In spite of its flaws and the actions of a few deluded prats, the world is and always will be a wonderful, amazing place.

* If you feel threatened for a prolonged period for any reason whatsoever, the world can seem a brutal and dangerous place. This is an especially popular world view among sufferers of depression, or by those who have experienced some kind of violence, or who read and believe everything they see in the papers. The fact is that brutality and acts of horror are committed only by the few. The majority of people are at least ordinary, hard-working people who are making something of themselves just by the act of living their lives. Every day brings them fresh challenges and fresh hopes, and, yes, fresh disappointments in some cases. When you are able to become a part of the world again, you will be just like those people. You will make a life for yourself. You will be too busy dealing with everyday problems and enjoying everyday treats to worry too much about "the big picture". There's no reason to worry anyway. The world will keep turning and your recovery is coming closer with every day.

* The world will not end overnight. There will be no nuclear war. If anybody wanted to start firing nukes, it would have happened decades ago before people realised the true effects of nuclear weapons. It would have happened during the Cold War, where the world was brought to the brink of armageddon. But you know something? The Russian fleet decided that they didn't want to start a nuclear war. They knew how bad it could get. In the end they had the courage to turn their ships towards home and say to the Americans "You know what, we don't want this war any more than you do."

* If any militant organisation detonated a nuclear or biological weapon in a major city of any nation on Earth, the militant organisation would find holy hell unleashed upon it by the Western powers. They would be hunted to the ends of the earth, their supporters would be rounded up and their assets would be captured by the Western alliance. Militant organisations across the world would live in terror and presumably many would be disbanded or cease operations for a long time to come. The militant organisations know this. They know that using such devastating weapons (if they can even get them) would mean certain death for themselves and their cause.

* The world is not simply going to "end" any time soon. It has existed for billions of years facing one catastrophe after another and always, always emerging stronger. Apocalyptic science fiction is just that: science fiction. Take it for what it is - a natural attempt to satisfy human curiosity by asking that most crucial of all questions - "What if?"

* The human species has evolved from cave-dwelling apes through to a species which can cure the black death with a simple course of pills and then send people to Mars. We have been around in one form or another for thousands of years. We haven't even been around long enough for the cosmos to know we are here. We will continue to endure because we are the most intelligent and the bravest life forms known to exist. The human race is here to stay.

* One day we will be able to cure flu, cancer, depression, alzheimer's, stress, AIDS and so on. Once the cure is invented a total eradication should not be far behind. We have come a long way. Science continues to advance every year. A cure is coming. But you can cure anxiety and depression yourself. Concentrate on your own well being. Trust the scientists and researchers to continue their fight for the future of mankind. Your own battle is your business.

* Every attempt you make to improve yourself and escape your depression or anxiety is a worthwhile use of your life and forms part of your contribution to the betterment of the human race! When you recover you can stand as an example to those who are still suffering. You can provide hope and inspiration to others. They in turn might provide hope to the people who know them. It's a ripple effect which can spread out and affect dozens or hundreds of people -- maybe more. And you will have started it.

* Try doing things for other people. Hold doors open, let people out at junctions, apologise if you bump into someone. If you catch someone's eye nod politely and say hello. When you phone a call centre, don't unleash hell on the person who is trying to help you. Try to spread a bit of good cheer; try to set an example to people with your own thoughtfulness.

Build your self-confidence

* Your self-confidence has probably taken a hammering. Remember at all times that the way you feel is being made worse because of low confidence and self-esteem. Once your confidence and self-esteem begin to improve, you may find that a lot of your other issues become easier to handle.

* Confidence and self-esteem can be improved by actually living life rather than challenging it or hiding from it. Learn to forgive old grudges, ignore and forget insults. It doesn't matter what other people think or feel. The only thing that matters is how you feel. Respect yourself. You are not a bad person no matter how unfairly you judge yourself. If you respect yourself, you will naturally show more respect and consideration for others. This begins a positive cycle which feeds itself, strengthening your bond with others and making everyone's life more pleasant.

* A phobia involves a lack of confidence. Phobias are deep-rooted fears which are more severe than usual. You might otherwise be a happy and intelligent person, but a phobia -- such as health anxiety or agoraphobia -- can turn you into a quivering wreck. While exposed to the trigger for your phobia, your ability to trust yourself becomes zero and you feel unable to cope with the situation. You need to be your own best friend. Even if you hate yourself now, believe me, one day you will come round to this way of thinking: you are a good and decent person, worth as much as anybody else. If you are able to trust your own judgement and believe the positive things you tell yourself, you can deal with fears and phobias. It is not easy so prepare for a gradual and sometimes painful process. Hey, you can cope with it. Go as slowly as you need to. You will always feel some fear while you are growing as a person! That's the way we are -- there is no gain without pain!

Take the bad with the good

* Don't feel bad for the times when you are happy! There is nothing wrong with smiling or laughing even if you feel like your world has broken down. Good humour and the ability to let go of problems are essential life skills. You will need to develop them both.

* If you've had a good day, try to hang on to the good feeling for as long as you can.
If you can feel good even for a minute you have proven that it is possible to be free of anxiety and depression. Remember this feeling if you have a bad day. It's your hope, your shield and your encouragement. You have felt good before. You will feel it again. The only question is when.

* If you have negative thoughts or a panic attack, instead of wasting time wondering if you're having a relapse, sieze on this opportunity to practice positive thinking in a "live fire" environment. It's good to practice positive thinking when you feel safe and happy, it's entirely another to put it into practice when you feel under threat. You will make the biggest improvements in confidence and positivity when you put yourself to the test. Don't fear it -- sieze it. Grab it by the throat and don't let go until it puts its hands in the air and admits that it is your bitch.

* Don't waste time worrying about the days when you felt bad! That was then, this is now. It doesnt matter how horrendous you felt a week ago on Thursday. You survived. You carried on going. You showed guts and determination. You have moved on from then. Today is a different day. You are more experienced now. Look forward to the days ahead when you will feel better. Enjoy today because it only happens once. Each day is an opportunity to improve yourself, a chance to loosen the grip of fear. Every moment you spend having bad memories is a moment you could have spent looking ahead with excitement! Let go of your bad memories. They can't help you. They don't serve a purpose. They qualify as baggage. Let go of the pain. Learn to forgive yourself: you have come through a rough patch, that's all. There is no point thinking about what might have happened. There is only what is happening now. You are building a future of success and happiness -- and it all starts here!

Do something with your day

* If you wake up early, make sure you have a fully charged mp3 player with gentle, reassuring music to listen to. It beats listening to your inner chatterbox.

* Don't stay in bed all day. Get up and talk to your family, phone a friend, arrange to do stuff during the daytime. Keep active. Night-time is for sleeping.

* It's ok to sleep in the daytime if you are exhausted. Fifteen minutes' sleep in the afternoon can recharge your adrenal gland, giving you some extra oomph to face the day. Exhaustion during the day is often caused by a lack of adrenaline; you've literally spent your strength through worry and stress. Try to sleep in the day only if you really need to as it can interfere with sleeping at night.

Side effects are caused by anxiety or reaction to medication and are not to be feared

* Most or all of your side effects will start to reduce over time. They may well disappear altogether. They will trouble you less as you get used to them. Remember most other people in your situation will have experienced the same things and some people will have had them worse than you ever will.

* Treat headaches with paracetamol only. At least paracetamol can take the edge off your pain. You are not suffering a brain tumour.

* Derealisation and depersonalisation are NOTHING to be afraid of. I have suffered both of these conditions due to anxiety and migraines, and while I fully sympathise with someone who is experiencing them for the first time, you will eventually realise that you can and will recover from these bouts of weird feelings. They are not capable of causing any kind of harm (apart from giving you a scare if you've never experienced them before). You might never suffer from them again, you might get it again tomorrow: either way you should not be afraid because they do NOT indicate there is anything wrong with you other than anxiety or depression, and anxiety and depression can be treated and recovered from.

Get your act together


* Be prepared at all times. Keep the phone number for Samaritans, MIND, your doctor and any other support organisations to hand in case you need them.

* Get into a routine for taking your medication: take them at the same time every day. Keep a drink in your room so you can take the tablet when you wake up or before you go to bed.

* Get into a routine for going to bed. Watch something relaxing or funny, or read a book, before going to bed. Try to go to bed around the same time each night so your body gets into a habit which will help you sleep.

* If you're having anxiety attacks during the night it can help to have some music to listen to and a drink of water on your bedside table. Make sure your music player is fully charged if it runs on any kind of battery. Check it before bed and also make sure you have a fresh drink just in case you need it.

Positivity : Be the best you can be

* Go one step at a time. It is not possible to effect large-scale changes overnight. If you try, you may find the efforts of maintaining such changes are beyond you and you could slip back into old habits. It's far better to move gradually. Start by trying to change the way you think when you go to bed at night. Focus on good things; look for the good points in your friends and family. Reflect on what you've learned this week. Repeat short, positive phrases to yourself: "I am a good and loving person", "I am looking forward to my future". Small scale changes are much easier to maintain. Eventually they become part of who you are.

* Say hello to people and ask them how they are. Get to know people gradually. They will appreciate your interest and you can make friends this way.

* Forget about assigning blame for anything; the world is the way the world is. It doesn't matter who did what to whom. Just get on with your life without shouting the odds. If you attempt to blame someone for something, if you complain about circumstances that you cannot change, you are giving away responsibility for your life and you become the victim. Try to go a week without complaining about anything. Some people will find they don't speak much during that week.

* Rather than looking back over a painful past, it might help if you concentrate on how you are feeling at this moment in time. You cannot predict the future so you cannot say for certain that you will always be in pain. Looking back on the past is often hard to handle as we tend to look at our mistakes. So live for now. As you recover, you can start making preparations for a future free of depression and anxiety.

Cognitive Impairment: The physical effects of anxiety and depression

The term "cognitive" refers to the process of thinking. As you will probably know, "impairment" in the medical sense means that you have lost the full ability to do something. Taken together, "cognitive impairment" means that you have difficulties of some kind with your thought process.

People who are depressed, anxious or otherwise on medication may be familiar with the "brain fog" phenomena. This is when your thinking feels vague and fuzzy, like your head is full of mist or cotton wool.

Your mental reactions start to slow down, rendering it difficult for you to answer questions without hesitation (while your brain tries to access and relay the information). You may feel like you're slightly behind other people, and sometimes other people might notice it too. Taken to extremes, you may feel like there is something physically wrong with you, like you're suffering from dementia.

The truth is, you are not losing your mind and you are not suffering from dementia. Current research indicates that long-standing bouts of depression and mania can actually cause minor damage to certain areas of the brain. This damage can be coped with and apparently either slowed or reversed. (Remember brain cells, like skin cells, are constantly dying and being created - the brain DOES have some capacity to heal.)

So the next time you find yourself trying to think through a wall of cotton, try a few of the following things to strengthen your brain and improve your memory.

Mental exercise: Quiz games, memory exercises, reading, keeping a diary, interacting with people. All of these can get the mind going and can be quite pleasurable, unless the person you choose to spend time with is my best mate who is, let's face it, a trog.

Physical exercise: Possibly the number one cure-all for diseases of the body and mind. This gets the blood pumping and induces pleasure-causing chemicals. Maybe this is nature's way of keeping us active? There is significant evidence that exercise relieves stress and helps people to cope with depression and anxiety.

Healthy diet: Another major contributor to your well-being. A healthy diet helps you recover from all types of illness, reduces or prevents emotional problems, stops you turning into Fern Britton and definitely, definitely helps your mind to work quicker. Two weeks eating fruit and drinking water can make a significant change to the way you feel.

Vitamins C and E: These are thought to slow down memory loss and may even prevent Alzheimer's (although the whole Alzheimer's thing doesn't really apply to us). They should be taken together. Multivitamin form may not provide the same, or any, benefit in improving cognitive function.

Lower doses of medication: Obviously this is not something you want to contemplate if you are still ill with anxiety or depression. Once you have been feeling noticeably better for a while (like several months), it might be time to consider taking a small step down? You can always go back up again if you need to.

Reducing stress: This is where physical and mental exercise, combined with a sensible eating and drinking regime, can really pay dividends. Make sure you get enough sleep - not too little, not too much. Set some time aside EVERY DAY to relax. Cut down on caffeine and alcohol.

Avoid recreational drugs: My opinion of a person who would use this stuff while depressed is not to be repeated here - but I must say that I understand people seeking comfort wherever they can find it. Whatever your reasons for using this stuff, please, please find another way.

You should find that if you do some or all of this stuff, you become sharper and more alert. Your mind WILL degrade if not used and you will then need to re-train it, a process that is annoying and sometimes frustrating. Memories actually decay as neural pathways start to break down. This is normal and does not indicate brain damage. You can stop this from happening just by using your brain and improving your ability to remember stuff.

Mission Complete: Coming off citalopram

"My list of ingredients for success is divided into four basic groups: Inward, Outward, Upward and Onward."
- David Thomas

Q. How do I know when I'm ready to stop taking citalopram?

A. So, you are very far along the road to recovery and you feel it's time to face the world without citalopram. Good show, you should be really proud of yourself. You have come a long, long way.

Normally you are supposed to continue taking citalopram for at least 4 months after you stop feeling depressed.
This means that you should still have been taking citalopram even when you felt better.

This is purely a "cover your back" measure in case the anxiety/depression were subdued but not completely beaten; if you have gone for weeks or months without feeling anxious or depressed then you are likely to have beaten them altogether. Your doctor will discuss this with you.

If you're receiving talking therapy you can also discuss it with your counsellor. It's likely that your therapist will have signed you off long before you are due to stop taking citalopram.

This is a very positive time and you should definitely allow yourself to enjoy it! You have achieved something that you once thought impossible! Nothing is impossible if you believe in it!

Q. Is it possible to relapse into anxiety/depression?


A. Anything is possible on this wacky ball of soil, water and religious intolerance we call Earth. It's natural to feel a bit worried about stopping your medication. Don't waste time thinking about it; you are going to be fine. Remember that when life presents you with a challenge it is totally normal to be upset or stressed; if bad things happen you can naturally feel down without becoming clinically depressed! Life is tough but you have proven that you are tougher! You are allowed to feel upset or scared sometimes without it being a major issue! If you are worried you may be relapsing, you can always start taking citalopram again. A pain in the bum, I know, but look at it this way: you have come this far, you've just got a bit further to go, that's all!

Q. Can I come off citalopram straight away once I am recovered?

A. No. Never. You need to "taper" your treatment off. This is a process that takes several weeks or even months.

You need to give your body time to get used to the lack of citalopram. If you don't you can suffer discontinuation side effects. These are basically the same as the side effects you got when you first started taking citalopram.

Q. Will I get discontinuation side effects?

A. Not necessarily. You might not get any side effects at all. If you do, remember that SSRis are known for this. It is not considered a danger to your health.

The discontinuation effects tend to fade within a few weeks, probably more quickly than the initial side effects faded when you first started taking citalopram.

A. Are discontinuation effects harmful in any way?


Q. No, they are not going to cause you any permanent or long term damage. SSRi discontinuation syndrome is very well known and I have not read anything to make me worry about them. If I'm not worried, you should be fully confident, cos I'm an utter chicken when it comes to side effects.

Q. Are the discontinuation side effects as bad as I've heard?

A. Sometimes: usually if you suddenly stop taking citalopram altogether, which is the worst-case scenario, but also if you drop your dose in large amounts.

Remember that not everyone gets discontinuation side effects. Not everyone who gets them has many problems with them.

Q. What can I do to reduce discontinuation side effects?

A. See the answer to the next couple of questions.

Q. Can the discontinuation side effects make me have a relapse?

A. Probably not, as having discontinuation effects is not the same as having a relapse. If you are certain you are relapsing then speak to your doctor. It is more likely that you're just stressing out about your side effects, or your body is having a hard time adapting to life without its daily dose of SSRi. Things do improve. Your body has got some housekeeping to do, it might just find it a bit strenuous. It's nothing your system can't handle.

Q. I am having withdrawal effects and they are a nightmare!

A. If you are unfortunate enough to be suffering bad discontinuation effects, you can temporarily increase your dose to its normal level and try to reduce the dose again at a later date. This can alleviate the side effects partly or completely. Speak to your doctor about this!!

If you have gone "cold turkey", you should consider taking your normal dose again and reducing it slowly over a period of time. Speak to your doctor!!

It's not wise to mess about with dosages unless you are doing it under medical supervision (in other words a doctor has told you to). Remember the discontinuation effects will fade gradually, usually over a period of 2-4 weeks.

How to avoid a relapse

Once your treatment is over, it is likely that you will be able to live a normal life without suffering from clinical depression or uncomfortable levels of anxiety.

Not everyone is able to permanently "cure" their tendencies towards depression or anxiety; part of your recovery involves accepting who you are and what personality traits you have. In this case, you will learn how to manage your depressive or anxious tendencies so that you can avoid or remove triggers and you will recognise when you are slipping into a bad frame of mind. You'll be able to do something about it before it becomes a problem. This is called prevention, and as the saying goes, prevention is better than cure!

If you do experience the occasional downer or moment of panic you have nothing to worry about. Of course, it's only natural to worry that the way you feel now is the way you will always feel. Don't even waste your time with that one. You are not a robot programmed to be exactly the same for your whole life. Your moods are like gas bills: they can go up as well as down

Exercise

Exercise seems to be one of the BEST ways to stay in remission. 30 minutes of exercise that leaves you breathless at leats 3 times a week is the minimum you should do. The benefits of exercise are incalculable. Exercise will improve everything about you.

Talking therapies

Counselling and cognitive behavioural therapy are more likely than medication to prevent a future relapse. Usually, this may be due to you having worked the probelms out for yourself. You may have learned a new way of thinking which makes you mentally resilient compared to how you were before. You have upgraded your shields. However if you have learned something you MUST put it into practice to the point where it becomes a habit. CBT won't help you much if you aren't prepared to follow its guidelines.

Life experience

Your experiences may have caused you to develop a mental and emotional toughness which will make it difficult for anxious or depressive thoughts to trouble you. You have literally been there and bought the t-shirt, you recognise the signs and you know how it all works. You have proven to yourself that such problems can be overcome and they will not seem quite so scary any more. You have built a suit of armour.

Positive Thinking

"Positive thinking" is the reason why placebos can help people to recover from illnesses, or why people with terminal illnesses sometimes recover beyond all medical expectation. My cousin survived a metastasised cancer that should have killed her; there is no medical explanation as to why she has been in remission for 10 years, from a virulent cancer that had spread through her torso. The doctors said it can only be explained as a miracle.

Positive thinking helps you to acknowledge that life is good despite its occasional hardships. It projects an aura of confidence and maturity and generally helps you to enjoy yourself. It makes you more attractive as a person; being a miserable git is a turn-off. Why would you want to be miserable? The alternative is to be a positive thinker!

Pot Noodles

Technically these will make no difference to a relapse or a blip, but in my mind there is always room for a Bombay Bad Boy of the king-sized variety. You might want to bear this in mind when you need an unhealthy snack.

Further Support and Guidance is available

"Hope is that thing inside us that insists, despite all the evidence to the contrary, that something better awaitsus if we have the courage to reach for it, and to work for it, and to fight for it."
- Barack Obama

* Asking for support can be scary. That's a natural feeling. If you need help, you need to ask for it. You'll find that once the wheels have been set in motion, things are not quite as frightening as you thought they might be.

* Most forms of therapy will make you feel worse before they make you feel better.
Confronting your problems is not always easy! As you get used to confronting fears and difficulties, things gradually become easier. You may find yourself feeling considerably better once you are starting to receive support.


* Don't keep it bottled up; if you need to talk to someone, talk to someone! People are more likely to recover if they receive love and support. Try to remain positive, don't get lost in misery, focus on your recovery: "I'm feeling anxious at the moment but I know it won't last forever". You may feel a lot better if you communicate your feelings rather than isolate yourself.

* If you feel like there is no-one you can talk to, speak with your doctor. If you don't like your doctor, change your doctor. Doctors are there to help you. If your doctor can't do this, bin them off and get one who can.

* If you feel you need medication, ask for counselling or cognitive behavioural therapy at the same time. This is the most important thing you can do! You shouldn't rely on one strategy alone! You need to get yourself onto the waiting list as soon as you realise you've got a problem!

* Talking therapies help a lot of people. They don't work for everyone because everyone is different and we all have our own needs and requirements. It also depends on what is actually making you feel depressed or anxious.

* The sooner you start a talking therapy, the more likely they are to help you recover quickly. However they can still help even if you have been suffering for months and years.

* It is normal to worry that talking about your problems may make them worse. Yes, you might feel upset when you start to discuss them -- who doesn't? You can't confront something painful without feeling any pain. In many cases it is better to face that pain and share a problem or vent your feelings. It's like the old saying, "better out than in", which nowadays tends to be used only by people who fart loudly.

* If you genuinely believe that discussing something will make it worse, save it for when you are ready to share it. It's not a race. Sometimes things are so hurtful that they do more damage than good if we talk or think about them. Some medical experts believe that discussing past events may be harmful rather than therapeutic in some cases; some people may find it more helpful to forget past events and concentrate on the present and future instead.

* If you are prepared to look for solutions and actively try to resolve your problems you may find counselling and CBT make a big difference to your confidence and understanding of your issues.

NOTE: THE FOLLOWING LIST OF THERAPIES AND SUPPORT GROUPS IS NOT EXHAUSTIVE!


NOTE ALSO: It is likely that some sessions of your therapy may leave you feeling confused, distressed, upset or otherwise worse off than before you went in. This is NOT a sign the therapy isn't working: it's actually a clear sign that you have been discussing things which are central to your condition. You've been hitting the nail on the head, so to speak, and this can be very painful. You should make sure you have access to support outside of therapy sessions: a local support group, No More Panic, the Samaritans, Mind, Anxiety UK etc. You can seek further support directly after a therapy session if you need it. Rest assured that there will come a day when you don't need someone else to support you after a therapy session: you will gradually become confident enough to stand on your own two feet. This takes time, so please don't feel like a wimp if you need help and reassurance. Humans were made to need one another.

Counselling

* Counselling is useful for people who need to talk, or to be heard, or both. It is helpful for those who feel better by getting things off their chest. It it an opportunity to vent in a constructive and supportive environment. It is most effective for dealing with emotional problems such as grief, bullying and so on.

* Counselling provides a point of human contact which is reassuring in an environment that is safe. It's your chance to talk about your problems and to get your negative feelings out of your head! A counsellor is someone who has dedicated their life to being there for people in your situation. They are there to help you!

* If you aren't going to work at your problems and just want to bitch and vent, counselling can make you feel better in the short term but will not help your recovery. You must try to work your way out of your problems. this is your responsibility, not the counsellor's. The counsellor is there to listen and provide support and guidance -- they are not there to live your life!

* Some organisations believe that counselling isn't the best treatment for depression, as counselling often focuses on resolving your feelings towards traumatic incidents in your life. It's becoming a popular theory that while this is useful for some life problems, reliving the past in this way does not help with depression and can make it even worse.

* Cognitive behavioural therapy will probably be more useful than counselling for people who are depressed or who suffer from generalised anxiety disorder (GAD). This doesn't mean counselling cannot help you - it may work like a dream, especially if your problems are not deeply rooted or you have not been suffering for very long.

* Counselling seems to be very effective alongside medication, although in some cases it may eliminate the need for medication altogether. (Not everyone who is anxious or depressed needs medication, although some people do.)

* Successful counselling (with or without meds, depending on the severity of the problem) is proven in studies to be better at preventing relapse into anxiety and depression than antidepressant medication alone.

* Studies also show that counselling and other therapy has a massively improved effect and very low relapse rates when combined with Mindfulness and/or interpersonal skills - improving how you relate to yourself, other people and the wider world.

* Make sure that you get everything off your chest during counselling. Make a list of things you want to talk about if necessary.

* You may feel worse when you have counselling. This is totally normal and does not mean the counselling is not going to work. You are directly accessing thoughts and feelings which are painful to you. Recovery is not easy but it is always worthwhile. This is true of any type of therapy including antidepressants -- think of it as character building.

* If you don't feel counselling is working you should consider cognitive behavioural therapy (CBT). If counselling turns out to be a dead end, even if it was helping you initially, it is likely that counselling is not sufficient to help you recover from the problem. In this case you should definitely consider CBT.

Cognitive Behavioural Therapy (CBT)

* CBT is a type of therapy which focuses on achieving goals and working systematically to change the way you think and behave. This is very difficult to do but the benefits can be substantial, and can lead to permanent recover from depression, post-traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD) and GAD.

* If you are suffering very badly, for example to the point where you are unable to function in everyday life, and/or your problems are long-term and apparently resistant to treatments such as counselling, self-help and medication, you should definitely try CBT.

* CBT is effective for people who want to learn about why they feel the way they do, and want to try to improve themselves or change the way they think and/or deal with life's challenges. CBT is therefore a tool for self-improvement, and can help you adjust to living in the "real" world, no matter how much you feel you won't be able to do that.

* Current research shows that of everyone who uses CBT, 33% will not benefit much or at all; 33% will find the treatment helpful or very helpful; 33% will find the treatment significantly helpful. CBT courses seem to have have low drop-out rates, which may mean less people give up on CBT than on other types of treatment. Relapse rates following CBT treatment tend to be low to medium, but relapse rates drop significantly when combined with life skills (see next point).

* New research indicates that CBT combined with Mindfulness and/or inter-personal skills has a success rate of 80% and a very low relapse rate. This indicates that many, many people suffering from nervous illness of all types seem to have issues in how they deal with other people and interact with the world.

* Make a list of everything you want to deal with during CBT.

* CBT is supposed to be hard work. You will need to spend your own time putting your CBT into practice by actually using the techniques you will learn and doing your CBT homework, if the therapist gives you any. This can take some effort until it becomes second nature to you. Putting your CBT homework off til the last second is counterproductive and can delay your treatment, by denying you access to insights and learning about your condition.

* You may feel worse when your CBT begins. Alternatively, as in my case, CBT may make you feel better at first and then much worse later on. It all depends on many factors, including which problems you deal with. This is totally normal. This is true of any type of therapy including antidepressants -- think of it as character building. CBT can be very demanding. Work at it!

* If you find a particular topic very painful to discuss and examine, it may mean you have found one of your "core" problems, which is usually a very threatening and unpleasant negative belief which you hold to be true, but is actually exaggerated and unrealistic. The core problems may take weeks to resolve, but beating these will clear up some of your other symptoms remarkably quickly.

* There is a question of how many CBT sessions is "normal". Well I'm here to tell you now that there is no "normal". The NHS usually prescibes something like 6, 8, 9 or 12 sessions, but may stretch to 20 in some cases. GAD sufferers may require extensive support as their illness can mimic so many different problems and disorders. People who have suffered for many years are also likely to need a high number of sessions. A Samaritan told me recently, "I've heard that for anxiety, you need one session for each year you've been alive." So a 21-year-old who has suffered with anxiety-related problems most of their life could need around 20-21 sessions.

* A person who suffers from a phobia of bees (for example) could be cured in a relatively small number of sessions. It may seem obvious that someone with GAD, which manifests as bouts of depression, health anxiety, fear of death etc, will require much more treatment. If you are unable to get more than 6-8 sessions but feel you require more, you should consider paying for therapy. If you do this, contact Anxiety UK, or your country's equivalent if you live outside the UK.

* A talented therapist can cut months off your recovery. If you do not have any insight into yourself or your condition, you should work with your therapist until you do. Having insight into how you think and feel will also cut months off your recovery.

* Visit http://www.livinglifetothefull.com and sign up to their free online cognitive behavioural therapy programme. If you're already having counselling this could be an extra boost to your recovery.

* If CBT does not seem to bring you results, there are a number of other therapies to try, so don't fret.

Eye Movement Desensitisation and Reprocessing (EMDR)

* A slightly controversial technique which has proven effective at reducing or completely eliminating the distress associated with negative thoughts and memories.

* EMDR is recognised by British medical authorities as a way of treating or curing post traumatic stress disorder, and is likely to be prescribed to sufferers.

* It may also be effective against grief, anxiety, depression and other problems which are related to upsetting memories.

* EMDR therapy assumes that the brain has been so traumatised by an event or series of events that its coping mechanisms were temporarily overwhelmed and the brain has stored the memories of these events incorrectly. Because these memories are stored in the wrong place they can be "triggered" to cause the same level of distress or disturbance that was experienced when the event(s) originally occurred.

* A person undergoing EMDR will be asked to relive their distressing memories while their therapist conducts an unknown procedure (need someone's help with this as there isn't much available on the net to explain what they do).

* The procedure teaches a person's mind to disassociate their negative feelings from their memories, and instead links the memories to more realistic thoughts from other areas of the brain. This stops the memories from triggering negative emotions, effectively ending the patient's suffering

* In some cases, a person can be healed in just 1-3 sessions of treatment. This is substantially lower than the number of counselling, CBT or hypnotherapy sessions many people would otherwise require. If a person is suffering badly the number of sessions may be higher.

* Although some critics claim that EMDR is not as effective as standard types of therapy, and others claim that it is too experimental or "not scientific enough", medical trials consistently show that EMDR does seem to work.

* Further research may be required into EMDR to understand exactly why it works. The fact remains that it does appear to work and has helped many people recover from traumatic experiences. and allowing them to move on.

Hypnotherapy

* Out of all the therapies I have tried, hypnotherapy has had the biggest impact not just on my depression and anxiety, but on myself as a person.

* Hypnotherapy is an extremely positive form of therapy in which the subject is placed into a state of deep relaxation. This clears the mind of its everyday "clutter" so the hypnotherapist is able to place helpful and positive suggestions into your subconscious.

* Over a period of time, these suggestions can help you to recover from emotional problems and can even cure phobias.

* It doesn't usually matter if your attention wanders off or you fall asleep during hypnotherapy. Your subconscious mind will still be listening.

* Contrary to old wives' tales, hypnotherapy IS effective against depression and will not make depression worse. Hypnotherapy is not known to trigger or create mental problems of any kind. In fact, hypnotherapy is starting to be looked at as an alternative or supplementary treatment for depression.

* Your innate mental defences mean that your subconscious mind is not capable of accepting negative suggestions. Only the positives will sink in during a state of hypnosis. Everyone has these defences.

* Hypnotherapy is recognised as an effective form of treatment by the British Medical Council.

* It can take days or weeks for the suggestions implanted during hypnotherapy to become effective. Multiple sessions may be required. It is not an immediate cure for long-term emotional problems.

* Self-help hypnosis and relaxation mp3s can be useful as they provide comfort and reassurance. However, self-hypnosis mp3s may require a month before their effects start to show. You should try to listen to them once a day for 2-4 weeks.

* You can listen to them more than once per day; you can listen to several different mp3s in one day. It is best to listen to them when you can sit back and relax, or before you go to sleep or get up in the morning.

* You will not go into a "trance". All you need to do is relax. This may take several sessions before you have trained yourself to do it.

* The state of relaxation can be very deep (but doesn't necessarily have to be) and if you are not used to relaxation exercises, it can feel quite startling the first few times until you get used to the pleasant sensation.

* Hypnotherapy and self-hypnosis are completely different from stage hypnosis, in which the participants fall asleep at the click of a magician's fingers then run around acting like Ghostbusters.

Alternative therapies

* Some people find hypnosis or other non-standard treatments such as acupuncture and massage therapy can help. These therapies can certainly relieve stress, which may reduce the impact of depression and anxiety.

Samaritans
http://www.samaritans.org
08457 909090 (national number - note your local branch will have its own phone number)

* The Samaritans are an organisation set up to provide a point of contact from anyone who is suffering from any kind of distress, no matter how big or small. They realise that human beings need to connect with others, and that problems only go away once they have been brought out into the open where they can be dealt with. So they will listen to you as you talk about whatever's on your mind.

* They are open 24/7. The Samaritans have branches in most towns and cities, so there will probably be one in your local area.

* You do not have to be seriously ill or suicidal to contact the Samaritans! This is a common mistake people (including me) have made. The Samaritans are ready and willing to speak to anyone. Please call them if you need to talk about any problems.

* Samaritans units are staffed by volunteers.
They are good and honest people who are giving up their time to be there for you if you need them. The Samaritans provide a friendly shoulder to cry on and are available at any time.

* Calling the Samaritans is not a sign of weakness. It does not mean you are facing overwhelming problems. Your problems will not become more "real" or more intense just because you are talking about them. You may feel worse when you first start to discuss your problems, which is normal -- but as you start to examine your thoughts and feelings, and as you get used to using the Samaritans service, you may find that you start to feel considerably better.

* Samaritans are there to listen. Don't expect them to try to "fix" your problems.
They may provide encouragement and the occasional suggestion, but they are not counsellors. They will listen to you as you talk about what is troubling you. They want you to share your feelings with them. The point is for you to get distressing thoughts and feelings out of your head and into the open where you can examine them and hopefully move on from them.

* Some Samaritans units operate a drop-in centre. Phone your local branch for information.

MIND
http://www.mind.org.uk

Note: Mind are available in England and Wales. There is a Scottish equivalent, but they are not called MIND.

* MIND is a support organisation for anyone who is suffering any kind of mental illness, right the way from panic attacks to severe schizophrenia. It has paid staff and operates a drop-in centre along with numerous events throughout the week. It is currently available in England and Wales.

* MIND is sort of a halfway measure between the Samaritans and counselling. Some MIND units are lucky enough to have qualified counsellors. The vast majority of MIND staff are simply people who have recovered from or learned to cope with depression, anxiety and other mental illnesses, and who wish to share their knowledge with fellow sufferers.

* All MIND staff receive some training with regard to counselling and medication therapies, so they will know what you are talking about. Just as importantly, they will know what they are talking about.

* "Consultations" with MIND staff are simply informal meetings in a large common room. Other people will be present in the room either taking part in activities, speaking to staff or simply enjoying having company.

* MIND is friendly and informal. It seeks to bring you gently into the real world by providing guidance, reassurance and human contact. Their service is face to face rather than over the telephone. This takes some getting used to but once you do get used to it you may find it incredibly therapeutic, especially if you are not used to being around other people.

* Finding counselling tough? Drop in to MIND after your counselling sessions and speak to the staff. They'll make you a cup of tea (so bring 30p!) and help you to make sense of those roiling emotions. It's better than going home and stewing about what was said during counselling!

* There is no fee for visiting MIND or using its services. If you want to take part in activities, there may be a small charge for each activity. MIND branches regularly run activities such as music groups, art, poetry, video nights and takeaway nights.

* MIND have plenty of free booklets available for you to take home and read. You can also read text-only versions of all their booklets online.

* Most of the MIND staff have survived anxiety, depression and any number of other problems. They have escaped from hell, and they went back in to drag other people out. I cannot think of a more noble thing to do. You might want to make small donations to MIND when you visit to help keep this organisation running. I usually give them a quid for a cup of tea every time I drop in.

Using The Internet

There are a wide range of support websites for every conceivable illness or medication. You may find it beneficial to join more than one of these websites. However, you should always keep in mind that the internet cannot replace the real world -- your objective should always be to recover to the point where you can take your place in the world!

The internet will usually provide you with scaremongering or inappropriate information: for example, researching chest pains (which are likely to be caused by a pulled muscle, hernia or indigestion) will provide you with detailed information about heart attacks and very little information about anything else.

Avoid researching your own ailments (or perceived ailments) online. If you need more information, ask a qualified medical professional, preferably your doctor, or ring NHS Direct on 0845 4647.

Your best course of action is to see your doctor if you have concerns about your health. This is ALWAYS preferable to other sources of information.

* Online cognitive behavioural therapy is available for FREE at http://www.livinglifetothefull.com. However you should be aware that this is like a proper course of CBT and you must work hard at it!

* Log on to No More Panic and ask for help if you're scared or suffering. There will always be someone online to answer your questions. Please be patient though, your threads will not always receive immediate replies
, especially if:
- You use very flowery language which no-one will understand.
- Your grammar and/or spelling are very poor.
- You use L33T or text speak which insults the intelligence of everyone reading it.
- Your text appears in an odd colour that is difficult to see.
- You make very long posts that appear as a solid block with no paragraphs (this type of post is the worst offender).

Remember that fewer people use No More Panic at the weekends so your thread may receive fewer replies then.





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Citalopram Survival Guide
Inositol Survival Guide

What would you do if you weren't afraid?

I drew the line between hope and despair, and the line will hold.

"Forth now, and fear no darkness!"

Last edited by NoPoet; 25-06-16 at 21:00.
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  #2  
Old 06-04-09, 00:48
danj danj is offline
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Re: Citalopram survival guide

Great post PsychoPoet!
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  #3  
Old 06-04-09, 12:14
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Asha1979 Asha1979 is offline
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Posts: 266
Re: Citalopram survival guide

What a brilliant post! At last somebody who has positive things to say about citalopram I thought I was the only one here! I would change the part where it says - can I increase my dose? to 'yes' but only with advice from your doctor. - its just a bit more positive for people who are increasing their dose. x
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  #4  
Old 06-04-09, 12:57
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Marc EH Marc EH is offline
 
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Re: Citalopram survival guide

What a great post PsychoPoet! This is really going to help me over the next few days/weeks!
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  #5  
Old 06-04-09, 13:48
STEPHYUNO STEPHYUNO is offline
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Posts: 106
Re: Citalopram survival guide

Thanks so much for that post, you clearly spent much time on it and you are correct that citalopram can help and does for many. Over the years I have had various SSRIs and the last few months I,m back on just 10 ml of Citalopram per day, which helps to stabalise me, also and importantly I do this in combination with things like excercise, motivational cds, hot baths, anything really that helps lift your mood, but doesn't harm you. One final thing that has helped me is keeping a diary, for the last few years I have done this, it gives me a focus and stops me becoming that horrible hazy indescive way, it also encourages you to take one day or one week at a time.
All the best guys, Stephen x
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Old 07-04-09, 19:05
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NoPoet NoPoet is offline
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Posts: 3,680
Re: Citalopram survival guide

Thanks all

I have been updating it with bits and bobs.

I'm following my own advice (for once) and although my problems are not fixed and I still have moments where I am down or anxious, I literally drag myself through it.
__________________
Citalopram Survival Guide
Inositol Survival Guide

What would you do if you weren't afraid?

I drew the line between hope and despair, and the line will hold.

"Forth now, and fear no darkness!"
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  #7  
Old 07-04-09, 21:10
strawberry1756 strawberry1756 is offline
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Posts: 72
Re: Citalopram survival guide

Thanks for the brilliant advice, I am going to print this off so I can look over it when Im feeling bad. xx
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  #8  
Old 09-04-09, 17:07
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Danny_dingle Danny_dingle is offline
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Posts: 180
Re: Citalopram survival guide

Psychopoet, you are a LEGEND!

Best post I've seen on here!

Danny xxx
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‎"I am an optimist. It does not seem too much use being anything else." - Winston Churchill
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Old 09-04-09, 17:59
syers38 syers38 is offline
 
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Thumbs up Re: Citalopram survival guide

excellent

Last edited by nomorepanic; 20-04-09 at 18:44.
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  #10  
Old 09-04-09, 18:00
syers38 syers38 is offline
 
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Re: Citalopram survival guide

Excellent so well written love it ..............................
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