View Full Version : Do the same SSRI's work second time round?
My concern comes from being 11 years successfully on Citalopram. Coming off because I felt fine... biggest mistake of my life.
Lasted three months off it. Came back on at the start of Jan this year. Tried for 2 and a half months and it hasn't worked.
Switched to Escitalopram and I'm 40 days in and still climbing the walls with anxiety.
I don't know why these drugs aren't working a second time round. I also don't know how much longer I should keep on my current med before switching again.
Also... I don't know what to switch to! I'm scared to go on some medications such as seroxat and I don't think SNRI's are overly suitable for anxiety. Plus I'm very ANTI medication as it is and believe that 11 years and ruining my serotonin neurotransmitters and I don't want my noreadrenalin messed about with either.
I really don't know what to do.
ElizabethJane
23-04-13, 18:49
It would seem that the answer to your question is no they do not. I don't know why this is so but others have reported this also. I also don't know whether ssris interfere with the brain chemicals permanently? I am aware that the medication that I take can interfere with the workings of my brain but it is a risk that I am prepared to take. I have regular blood tests to check the effect of lithium on my thyroid, liver and kidneys. I also saw my psychiatrist today who said that I needed medication in order to stay well - indefinitely. I feel 90% well.if you have found something that works for you then stick with it. EJ
Yeah I wish I stuck with Citalopram. I went against the old 'If It AINT broke DONT fix it' rule.
But that's hindsight now. And now my life is a wreck. I've had to move back in with my dad. I've been massively anxious and agoraphobic and terribly depressed and suicidal for 4 whole months, worse than I've ever been in my 23 year history of anxiety.
I don't know what to do.
I'm really scared about this. I know that once I get back to 'normal', I will bloody well stay there this time! But for now, I just don't know what I can do.
Does anyone else have experiences with coming off and back on an SSRI?
Also, what other medication should I consider taking next?
Steve
Have you tried a Tricyclic or Tetracyclic? I take Amitriptyline and Mirtazapine respectively and they work for me. I took Citalopram for 10 years and had a severe reaction the second time around - sheer hell.
Hope you find something to tide you over until you are back to your old self again.
bernie1977
23-04-13, 20:06
Hi Steve,
I had a similar situation to you. I was on Citalopram, stopped taking it then tried numerous other medications which all made my condition worse due to the side effects. After a break from Citalopram I was put on Venlafaxine, this wasn't effective and was hell to get off. I then went on Mirtazipine and it did not nothing to help with my depression and anxiety and I gained nearly 2 stone in weight, this came off as soon as I stopped this med. I was then put on Duloxetine which gave me awful side effects. By this time I'd had enough and went med free for a few months. I was no worse but no better. My psychiatrist managed to talk me into giving Trazodone a go. This medication was very good to me in the start up period the only thing to report was a very lethargic feeling that lasted most of the day. I also suffer with Chronic Fatigue Syndrome so hard to know if it was the meds or CFS what was causing the tiredness.
I'm still doing ok on trazodone, I'm getting help from a support worker and CPN before I couldn't let them in the house as my anxiety was so bad.
It's impossible to tell someone what to do with medication as our bodies all react differently. I do know that I will never take a SSRI or SNRI ever again as I genuinely fear for my mental health and well being when taking those as they me feel so low and ill.
A good psychiatrist is your best bet but unfortunately a lot don't seem to understand or appreciate what we describe about SSRIs
Best wishes Steve
Thanks for the replies guys.
I've seen 2 consult psychiatrists in the last 4 months due to this.
The first told me to increase my Citalopram and also start Pregabalin. The increase in the Citalopram gave me side effects, and the Pregabalin made me feel sky high. I did tell him that my main issue was depersonalisation and feelings of unreality but he failed to notice that the main side effect of Pregabalin was that.
The last p'doc I saw a couple of weeks ago wanted to switch me to seroxat and also put me on an anti psychotic, Quetiapine. I obviously had massive concerns about going on Seroxat so I declined that, and the quetiapine I didn't see as a long term solution. I felt that was wallpapering over cracks. Also, I am concerned about the sedative side effects. I was told that would I rather feel anxious or sedated, I still would rather feel like me and be able to function whether it gives me anxiety or not. I've spent 27 years of my life not having to be sedated to live a non anxious life.
Bobbydog, what was your experience second time round on Citalopram and how long did you stick it out for?
I basically want a medication with no sedation side effects. I just want to be back on my feet. I can't believe I'm still here nearly 4 months on of hell EACH day.
I'm also still popping 4mg Diaz a day too. 2mg am and 2mg PM. I tried to ween myself off and got into a panic.
I appreciate everyones input. I understand no one is able to recommend me a medication etc. Just interested to hear your own stories. Just want to know if it really is true that Citalopram won't work 2nd time round and seeming as Escitalopram is so similar, I doubt that's going to do much either.
I'm going to try 20 more days of Escitalopram which would of been 60 days in total, to make a proper opinion.
Then I',m worried it's going to be months and months and months of trial and error on other meds!!
I'm so so scared. I'm unfortunately very vulnerable to self harm during long acute periods of anxiety and unfortunately have made a couple of silly 'life ending' attempts over these last few months. I'm scared that if this carries on or gets worse, I'm worried about what I'll do.
No professional is willing to help me with this either despite 2 trips to A and E for 'life ending' attempts. The p'doc discharged me from the CMHT because I refused Seroxat and Quetiapine. And because I'm not trying to kill myself daily, the crisis team no longer come round. The CPN I had would come round once every 3 weeks for about 10 mins to ask how I was, take notes, then leave.
I just don't know what to do anymore.
Hi Steven,
You know my experience but just to remind you, I've been in venlafaxine 3 times over the course of 10 years and it's worked really well for me each time. It's been my urge to go med free that's caused my problems.
My opinion is that the mind plays a big role in how meds work and leads the way in believing that the medication will work - part of a placebo effect. This doesn't explain your experience with citalopram though. The moral of that story is that we're all different and the effects are hard to predict.
You're right to give your current meds a bit longer. If you do swap, all I'd say is not to rule out anything. You say that SNRIs are not particularly effective for anxiety but, in my case, they are. Others find tricyclics work well and others, anti-psychotics. Your inquisitive mind doesn't help you in this as you, like me, want all the info before embarking on something new and that's not always helpful. We can be our own worst enemy sometimes.
Take care
Pip xx
Hi Steve,
I took Escitalopram for 5 years with no probs and recently tried to go back on it but gave up after 3 weeks as the increase in anxiety was just too much for me to cope with...I was only taking 5 mg a day! I know 3 weeks isn't really long enough, but it didn't affect me like that first time around. I think there's a lot to be said for your state of mind at the time you start the medication.
Originally went on it for depression and the anxiety wasn't really an issue. However, this time around it was predominantly anxiety that I was suffering from.
Snoodlester
23-04-13, 22:14
Hi Steveo
I can't remember when I started on Cit, but it was at least a couple of years ago. I was on about 10mg a day for probably 6 months, and I felt really well. I came off the tablets, but all too quickly the anxiety came back worse. Not really bad, but bad enough for me to go back onto Cit and that's what I was on before I had my 'crises' this year. My doctor reluctantly switched me from cit to Mirtazapine - she said that where Cit works on one part of the brain Mirt works on 2. I went immediately from one to the other overnight and I went through hell the first few weeks. After 2 weeks my doctor said I should increase the dose to 30mg. My second 'crisis' happened, and she then has upped the dose to 45mg and also Zopiclone for my sleeping problems. I don't think Mirtazapime is wholly effective - it's helped with some aspects of my life but not the main problem. My doc says to just carry on and wait for CBT.
Sorry you're still going through 'hell', I really do hope things pick up for you soon.
I've been given a book to read by a friend who had difficulties a decade a go - 'Coping Successfully with Panic Attacks' by Shirley Trickett, she said she got it from Llloyds the chemist. I'm going to start reading it tonight, so I'll see what it's like.
Sue x
Thanks for the further replies.
Violet12 - Are you on any other medication now?
Problem with medication and GPs and p'docs, is that its all subjective. What one p'doc says and prescribes, another might be totally against.
I really don't know what to do.
nicola1980
24-04-13, 02:45
Hi Steve I've been on and off cit since i was 18 and its always worked brilliantly for me but this time around it was absolute hell, the side effects were unbearable but i stuck it out for 4 months before admitting defeat, my psychiatrist said its common for ADs not to work as well or at all second or third time around as your body gets sort of immune to that certain AD, i then tried mirt which sent me a suicidal mess andso was quickly changed to venlafaxine which Im still struggling to get the dosage right, all i can say is don't struggle on for months like i did hoping the cit will kick in cause those months were the worst of my life so i understand exactly what your going through now x x
Well I just don't know what to do then.
The cit didn't work. The Escitalopram doesn't seem to be working.
Which means my next step is to either up my dose or to gamble with trial and error on some other med that initially is a dead cert to make me feel absolute HELL for at LEAST 2-3 weeks all over again.
I can't keep doing this.
bernie1977
24-04-13, 13:47
It's an awful and daunting place to be. Going through the hell of the start up process on numerous AD has led to me becoming really anxious about taking any meds now, I'm sure this is a common occurrence.
I've been where you are now are its awful, I really feel for you. The only thing I can think of is to maybe give one of the tricyclics a try. A few are being prescribed now off label for anxiety.
Good luck Steveo and I'm sorry I can't be of more help x
Hi Steve
It's a horrible decision to have to make, and one that's not easy especially when you get no help from the ad with your symptoms.
I agree with both points that Nicola and Bernie say, but only you can make that decision Steve. Even when the gp or psych make a suggestion we still go through this turmoil, do I change do I stay it's a nightmare and your not alone in thinking like you do.
Are you on 10mg of cipralex? How about upping it to say 15mg see how that goes it can't be as bad as going onto another ad. I think that's probably what a go would suggest.
Cipralex at 20mg stopped working for me after few years on it, hence going on venlafaxine.
Take care x
My next step will be to try upping to 15mg Cipralex before I change. But thats another month at least of just waiting.
I'm in a hellish situation which is adding so much stress and fear on my already stressed and feared condition.
Can't even get out of bed as my knees buckle from panic. If I'm not in absolute tears and panic, im terribly depersonalised and numb and can't connect with the world around me and can't believe I'm really here. It's like this is a dream world.
nicola1980
24-04-13, 18:01
Steve i really feel for you, i have been exactly where you are now and its horrific but i promise you you will get better, i know it doesn't feel like that at the min but you will, take your diazepam to help you through, thinking of you x x
I don't know what else I can do. I'm spending most of my days curled up in a ball rocking.
Steve,
Just another thought
I know you don't really like taking the diazepam but! 3what about upping them to give you some restbite from the way you feel. It won't be the diazepam doing things to your body as they give you the calming feeling. And the way your feeling right now 4mg a day might not even be touching your system.
Just think about it, just a suggestion as I was on more than that at the beginning of my episode.. You need just a good day to get you back up there like a few weeks back.
Perhaps have a word with your gp, you must be feeling your own your own through this nightmare now.
Yeah I might up my diazepam but that's just wallpapering over cracks for now. 40 days into Escitalopram and I'm in hell. I don't think another week or 2 will really make a big difference. Im going to have to up my diazepam if I up or change meds.
I'm just so so scared of doing it
Steven,
I think I've said before but beta blockers can be a life saver for the physical symptoms. They work a treat for me and really helped with the AD start-up effects. A GP wanted to prescribe diazepam for me but I wouldn't take it so I got beta blockers instead. They're not addictive at all and just slow the heart rate, stop the shakes and palpitations, and make you feel calmer.
It just depends if it's physical symptoms giving you grief.
Pip x
Btw, it was the wallpapering over the cracks issue that stopped me wanting diazepam - I always like to think I can find a longer-term solution.
Unfortunately 95% of my panic symptoms are 'mental' rather than physical. My heart is normally very low as it is and I don't tend to shake that much. Right now for instance I am absolutely filled with panic but my heart rate is a steady 60bmp. Only during the height of the worse panic attack ever does it start thudding etc.
For most of my life I've been on fluoxetine - I even stopped it for 8 months in 2008 and recommenced taking it at 20mg with no problems. Then last year I quit it, tried citalopram in the meantime, came off that and had really bad anxiety for a few months (with intrusive thoughts). I then took fluoxetine and it was hellish...sexual side effects, shaking, lost a stone in weight, etc etc. Even on 5mg I still had sexual side effects.
I think that something changed in my body which made me hypersensitive to meds/caffeine etc between giving up fluoxetine and reinstating it. I think maybe it would have happened without these changes however - I came off fluoxetine because I experienced a worsening of intrusive thoughts whilst on it (incidentally, those times when I've been off it have been the best periods as far as anxiety/depression go).
Just had to stop sertraline because of blurry vision and the general zombified feeling it gave me. Back to square one...
Hi Stephen, I was just reading your forum post and really empathise with your situation. I was wondering how you are feeling now? x
Hi, for what it's worth at this point, you can always just try them again. Sometimes people find the same medication won't work a second time or creates side effects they didn't have before, but the internet is full of horror stories because people don't seek help when things are going right, so the internet is biased.
Remember, if the same med doesn't help a second time, it might just need to take a while, but you can always try a different one.
Hi there. I have exactly the same problem. i was on citalopram successfully for 6 yrs. but went turkey and after 3 months started to feel worse ever. before i quit, i was on maintenance dose of 10ml quite perfectly. but after stopping all i remember is nightmare and regret. now it has been nearly 7 months with the last 2 months on 40 ml but have made little improvement. not feeling the same as before. still feel depressed and have less motivation to do things. I do not know what to do and i wish i hadn't stopped.
Hi, same here. 7 great years on 50mg of Sertraline, didn't even know I could feel that good. About two years ago I decided to taper down with my doctor, all went great, but after two months without it I suddenly felt way worst than I had ever felt... with syntoms I had never had...
We decided to go back to Sertraline, but it didn't work. In the next two years I:
Upped the dose from 50, to 150. No improvement.
Lowered it back to 50 and added Lexapro, gradually, up to 15. Made no difference.
Tappered completely of lexapro and keep on 50 Sertraline. Made no difference
Now I'm thinking about ading Prozac. I'll do it the same way I did it with Lexapro, keeping my 50mg of sertraline (not droping it again until I really start feeling better)
Right now I'm better than I was those first months, which makes me think that it was withdrawl... At this point I feel as I use to feel just before taking my first med... which is way better than after the big post tapper crash but worse than those 7 years on 50 zoloft...
I've come to the conclusion that the 50 zoloft isn't doing the same as it used to and that the big meltdown I felt after I tappered of it two years ago was probably withdrawl that has taken my brain a long time to come back from...
Now what?
whatisthis
03-11-16, 15:24
For most of my life I've been on fluoxetine - I even stopped it for 8 months in 2008 and recommenced taking it at 20mg with no problems. Then last year I quit it, tried citalopram in the meantime, came off that and had really bad anxiety for a few months (with intrusive thoughts). I then took fluoxetine and it was hellish...sexual side effects, shaking, lost a stone in weight, etc etc. Even on 5mg I still had sexual side effects.
I think that something changed in my body which made me hypersensitive to meds/caffeine etc between giving up fluoxetine and reinstating it. I think maybe it would have happened without these changes however - I came off fluoxetine because I experienced a worsening of intrusive thoughts whilst on it (incidentally, those times when I've been off it have been the best periods as far as anxiety/depression go).
Just had to stop sertraline because of blurry vision and the general zombified feeling it gave me. Back to square one...
After Paroxetine I'm hypersensitive to everything now. Caffeine, nicotine, alcohol, meds. I've improved with nearly coming off paroxetine with a withdrawal from 20mg in 2011.
If it does not help ,you need to read metacognitive therapy, it is freely downloadable on a search on google.
You also need to use both thought field therapy and EFT to remove negative emotion ,these simple technique are also available on Google and YouTube. AND THESE WORKS!!!
panic_down_under
09-05-17, 23:42
Now I'm thinking about ading Prozac. I'll do it the same way I did it with Lexapro, keeping my 50mg of sertraline (not droping it again until I really start feeling better)
I think a non SSRI would be your best option as you seem to be no longer responding to them. Creating what is essentially a bespoke SNRI by adding the noradrenaline/norepinephrine reuptake inhibitor nortriptyline (Pamelor) to the sertraline is likely to be more effective than adding fluoxetine. This combination was often prescribed in the past for treatment-resistant depression.
I've come to the conclusion that the 50 zoloft isn't doing the same as it used to and that the big meltdown I felt after I tappered of it two years ago was probably withdrawl
It almost certainly wasn't withdrawal if it only began 2 months after you stopped taking sertraline. The med would have been completely out of your system within 7 days. However, the brain changes which create the antidepressant therapeutic response could unravel within 2 months producing a relapse.
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