Reducing citralopram 40mg to 20mg

[shelley1813]

I'm hoping for some advice. I've been on 40mg of citralopram for nearly 5years and am pregnant. Been on 20mg for just over 2 weeks now n the dizziness and nausea is awful. Is this normal

---------- Post added at 16:27 ---------- Previous post was at 16:26 ----------

I'm now 11 weeks pregnant and I'm worried. Doc said withdrawal is normal but would it last this long???

[MrAndy]

you have dropped by 50% so would expect some withdrawal symptoms ,the recommended drop in dosage is usually 10% every month
Things should settle after 3-4 weeks you just have to hang in there

[shelley1813]

It was doctors decision to reduce to 20mg. Another doctor wanted me to go cold turkey

[nicola1980]

Firstly congratulations on your pregnancy :D This makes me so mad about doctors and pregnancy...they just completely freak and take you off your meds when infact you can still carry on taking some of them in pregnancy, ask your gp or midwife to refer you to the perinatal team, they specialise in women taking AD's in pregnancy, my sister was referred to them in her pregnancy and they changed her AD to what they deemed a pregnancy safe med, you really shouldn't have to suffer like this especially when the first few months of pregnancy are tough anyway xx

[shelley1813]

Thank you Nicola. I agree think doctors don't think u have to go to wrk n I have young children at home. Feeling as I do is really tough. I didn't think it was going to last this long though so I'm panicking a little, it's not all day the sickness and dizziness/lightheaded comes and goes xx

[nicola1980]

well you've dropped 50% like MrAndy said and that def isn't recommended, I would certainly speak to your midwife before you drop anymore xx

[shelley1813]

Couldn't drop anymore yet don't think id do too well. At hospital next week so il mention it to them. Thank u again for ur advice xx

[MrAndy]

It was doctors decision to reduce to 20mg. Another doctor wanted me to go cold turkey
doctors are quite ignorant to coming off meds,the only way to avoid withdrawal is reduce very slowly.Nicola has given you some great advice I would follow what she says

[MyNameIsTerry]

The interesting thing is The UK Teratology Information Service (UKTIS), who NICE state all doctors should contact for advice on antidepressant use when pregnant, have reviewed the findings of the studies that suggested problems could be caused by their use and found that the studies were conflicting thus do not constitute as evidence.

Like Nicola said, they freak. GP's don't have a clue and they know that antidepressants are not licenced for use in pregnancy so I think they base their decision to withdraw more out of protection of their practices than out of concern for the patient. I think they seize the opportunity that being 'off label' presents them. NICE have produced guidance about this and the patient should be very involved in making this decision based on information about the risks and the fact that nobody really understands this area. Personally, I don't think GP's know much about antidepressants anyway.

NICE have a detailed set of recommendations for this and I would normally post some of the key facts and a link but I am mindful of the board this is on and the article talks about the unproven risks to babies and I don't want to post any of that unless you are sure it will not be a trigger for you.

On a practical note, I've seen the 10% reduction mentioned loads on this forum by a few members such as MrAndy and I would interested to know more because when I came off Citalopram I went 20-10mg then 10-0mg. It was ok really but I have more of a concern about this next time as my current one, Duloxetine, was a lot worse to get onto so I'm thinking it will be more magnified coming off it when compared to Citalopram. I think this will help the OP too because I don't know how you can do this because some of these medications come on very limited mg formulations and some are in capsules.

How is it supposed to be done? The OP's will be in powdered tablet form so it is a matter of cutting them up?

[MrAndy]

Mind have a good article on reducing or stopping meds ,I also took advice from the surviving antidepresants website but I must warn you the site contains many triggers.
I cut my tablets up to reduce as close as I could to 10% and held each dose for a month
Duloxetine has a short half life so a slow reduction would be advised,some people switch or bridge to prozac as it has a very long half life and is supposed to be easier to get off
http://www.mind.org.uk/information-support/drugs-and-treatments/medication-stopping-or-coming-off/planning-withdrawal/#.VPWBI_msWWU

[MyNameIsTerry]

Cheers MrAndy.

There is a useful one here as well from the the RCPSTCH:

http://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/antidepressants/comingoffantidepressants.aspx

Its strange how all the advice is out there yet GP's still go the old fashioned route.

Duloxetine is about half a day, which is strange when I take 1 dose a day. I know some people take 30mg am and pm but I was told there was no need. I only came across the half life later and its made me wonder whether this is the right way.

I guess with Duloxetine, it will be a matter for some very accurate scales. Do people who do that have to come off Duloxetine completely first or just cross taper?

[MrAndy]

Cheers MrAndy.

There is a useful one here as well from the the RCPSTCH:

http://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/antidepressants/comingoffantidepressants.aspx

Its strange how all the advice is out there yet GP's still go the old fashioned route.

Duloxetine is about half a day, which is strange when I take 1 dose a day. I know some people take 30mg am and pm but I was told there was no need. I only came across the half life later and its made me wonder whether this is the right way.

I guess with Duloxetine, it will be a matter for some very accurate scales. Do people who do that have to come off Duloxetine completely first or just cross taper?
I have read that you cross taper with prozac (bridge) as the half life of prozac is days not hours.The pain with reducing 10% is as you have pointed out how do you cut or reduce tablets.Some people dissolve them in water and use a syringe.Some people ask the doctor for a liquid formula,its all a bit sketchy isnt it.I do know stopping cold turkey is asking for trouble and slow reduction is the best way.Benzos have a very short half life and thats why many people run into trouble using them
http://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/antidepressants/comingoffantidepressants.aspx Thats a very good article with some solid information ,interesting it mentions Duloxetine

[MyNameIsTerry]

I have read that you cross taper with prozac (bridge) as the half life of prozac is days not hours.The pain with reducing 10% is as you have pointed out how do you cut or reduce tablets.Some people dissolve them in water and use a syringe.Some people ask the doctor for a liquid formula,its all a bit sketchy isnt it.I do know stopping cold turkey is asking for trouble and slow reduction is the best way.Benzos have a very short half life and thats why many people run into trouble using them
http://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/antidepressants/comingoffantidepressants.aspx Thats a very good article with some solid information ,interesting it mentions Duloxetine

Yeah, I was happy to read that withdrawal was low in terms of anxiety. I expected the opposite on this as the anxiety was terrible going up to the standard dose. Pure hell! but at least only brief at 8-10 days.

There is no way I would cold turkey, its just not worth it unless the medication is having a bad adverse effect. I'm not a fan of switching if I can avoid it as I really suffer going on but for a taper off it should be easier as a at least your anxiety is much lower due to recovery and decided to come off altogether. I really feel for people who have to experiment and go through withdrawal just to swap to another when they are at their worst.

Crikey, I'll remember not to use the words 'dissolve', 'syringe' and 'dragon' all in the same sentence if the plods are walking past me at the time! :winks::D

[MrAndy]

how good would you have to feel to come off them ? I wish I could get through this without meds but at the moment I dont think its possible for me.Some days I almost get a craving for an AD when I am having a hard time but then I remember some of the side effects.Olanzapine for me has been very neutral in terms of side effects,it works almost instantly and you dont get the ramp up of side effects when starting it like an AD

[MyNameIsTerry]

I believe I would need to not be restricted by symptoms or have the negative thinking. Any confidence & self esteem issues need to be resolved too. Otherwise, its only going to be a later relapse again provided the right trigger come along and for me, stress is one of the biggies as it sets off the obsessional side.

I don't think it will be for quite a while for me, I want to get as much resolved as possible.

[MrAndy]

I believe I would need to not be restricted by symptoms or have the negative thinking. Any confidence & self esteem issues need to be resolved too. Otherwise, its only going to be a later relapse again provided the right trigger come along and for me, stress is one of the biggies as it sets of the obsessional side.

I don't think it will be quite a while for me, I want to get as much resolved as possible.
good plan,there is no need to rush these things and time is also a great healer
To many people who come on here want a quick fix either from tablets or therapy.When I was in hospital they would never talk about timescales for recovery and always told you to take each day at a time.Looking back although a cliche it was good advice

[MyNameIsTerry]

Yeah, I agree with that. It took time to retrain your subconscious to work like this so its going to be the same to retrain it again, although this time it's going to be fighting you all the way.

I think its only natural to want a quick fix, no one wants to suffer but we have to apply the same logic as to a physical illness eg a cold is quick, recovering from a serious illness can take all year.