How the heck can I get off these tablets...anxiety through the roof

[Justanutter]

Been on Sertraline 25mg for 4 weeks and 2 weeks at 50mg...horrendous experience. Stuck with them but am coming off them as no good for me. Don't want anything else. Dr gave me some diazepam to ride out the worst but haven't had them consistently so not done much good. Reduced to 2/3rd of a tablet for a week and now back down to 25mg but side affects are still dreadful. Agitation, worsened anxiety again and low blood sugar episodes. I just want off them asap but there is so much conflicting advice out there and I just don't know what to do apart from sit here and sob. Have tried deep breathing, am doing my CBT and mindfulness but am anxious about the anxiety now. I am back at GP on Monday but terrified I won't be able to have any more diazepam to help as I've had two lots now and I can't do this by myself. Any ideas please. Am terrified these tablets have done me harm.

[Traceypo]

I can't help you as I've never used medication but there may be some useful info in the medication threads or post in there if you don't get the support and advice in here.
Xx

[Justanutter]

Thanks Traceypo....what have you done then as an alternative?

[Traceypo]

CBT, 3 times with large gaps in-between. Learnt to relax more by using mindfulness, researched anxiety to understand the cycles and why I feel the way I do. Talked about it to anyone who will listen to gain other perspectives.
Xx

[Justanutter]

I found CBT no use on the NHS but do have private hypnotherapy but it's costing me a fortune. I do try mindfulness and relaxation but it doesn't help with this agitation from the tablets and makes me even more fearful. I am not taking ADs any more. I used to take Citalopram quite happily for years but had to stop them last year as there were contraindications with my betablockers apparently..sotalol. So now struggling.

[MyNameIsTerry]

Hi JAN,

Here is some advice of Rpsych about withdrawing that may be useful as you haven't been on them long:

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

DURING
•Reduce slowly
•Research suggests:
•if treatment has lasted less than 8 weeks, stopping over 1-2 weeks should be OK
•after 6-8 months treatment, taper off over 6-8 weeks
•if you have been on maintenance treatment, taper more gradually: e.g. reduce the dose by not more than ¼ every 4-6 weeks.

•Stay in touch with your doctor
•Be prepared to stop the reduction or increase your dose again if needed
•Keep a diary of your symptoms and drug doses.

I would be quite annoyed at your GP because I know from checking before that both your old med Citalopram and your current one have the same drug interaction warning against your beta-blocker so your GP had no need to swap you over based on that.

It should take approx. 5 half lives of the drug from the point of the last dose for it to be eliminated to <5% which is classed as clinically insignificant, 7 half lives to reach 0%. This is only using a standard pharmacokinetic calculation, all drugs differ. Sertraline has a half life of 22 hours or 32 hours for women, so it won't be long before it is completely out.

I hope you feel better soon, you've had a really rough time recently and I think your GP needs to learn about med interactions as in my opinion they have caused this situation!

[Justanutter]

Terry, thanks for that. Do you think I should just try every other day now or still take the 25mg and start reducing that? The GP that put me on Sertraline told me that it was fine to take the sert with the sotalol as it was Citalopram that has the problem....that is also what my usual GP also told me and pharmacist also confirmed ok as I checked. My friend is on sert and the cardiologist said it was one of the only ads that is ok for heart probs...bit scared now!!!

[MyNameIsTerry]

If it's based on the need to switch because of an existing heart condition and that's what a cardiologist would do (there are people on here who have taken Sertraline after heart attacks, some still do, so it's safe) then that's ok. but a GP deciding it based purely on drug interaction could be wrong as the same interaction exists against both from what I've seen. Given 2 & a pharmacist have all agreed, it must be fine.

What it may be is that Citalopram hit the news over the Long QT Syndrome issue in recent years. Sertraline has that as a problem too but Citalopram has a slightly harder warning than Sertraline. This may have been the reason why the switch was chosen but it's not a complete no no for Citalopram with that beta blocker. So, the question is whether the risk is worse on Citalopram than Sertraline and whether your doctor can monitor you to be happy with that.

I just question whether this was the right move. If there was another beta blocker, they could have tried that e.g. there is less of an interaction between Propranalol & Citalopram so did you need Sotalol for some reason instead? If so, then I guess it makes more sense but I wonder why you were only them for that time in the first place and all I can think of is the new info about Citalopram and Long QT Syndrome that came out not long ago and wonder whether that has caused GP's to switch patients?

Withdrawal should be ok with being on a short time. You may be able to do both but I feel that alternation means continually peaking back at 20mg every other day whereas reducing slowly and holding the dose makes more sense as your blood-plasma will adjust as per the above calculation stuff. With the latter method it just means more of a downward dip initially but perhaps if you take it slow with small decreases you might not feel it too much?

[Justanutter]

Well GP frightened me to death because she was going to try the Citalopram again but then when she checked it said 'severe' interactions, although very RARE, could result in sudden death!!! so to think I had been on time together for so many years made me terrified so then starting wondering if they had damaged my heart, hence even more anxiety!

Hopefully then I should be off sert in two weeks if I taper each tablet by shaving a bit each day. I wish I could do cold turkey with just some Valium for support as some people have done. I am supposed to be going to Spain in 10 days. It doesn't look like I will be fit to go so really down now.

[MyNameIsTerry]

I think your GP should have been much more careful with that issue, it doesn't even get a mention on the interactions checkers like that but as you say even then it is classified rare. I just wonder why they couldn't switch your beta blocker instead and keep you happy on Citalopram? Drug interaction categories can look scary but a great number of antidepressant switches also carry Major interaction warnings with the rare warnings so it's perhaps more common to be in a situation like that than many of us now but doctors are used to managing it so please don't worry about that. (hearing that would have scared the life out of me too though!)

When I came off Citalopram when I was much better I knew nothing about meds or anxiety still and my GP dropped me in 50%'s. I went 20-10mg for about 15 days and then 10mg-0%. I had been on them about 3 years maybe.

It wasn't that bad at all, nothing like when I went on them.

But it may depend on how bad your anxiety is. It may also be an issue that the Sert is making you feel worse and removing it will help. If it got worse going to 50mg but you weren't too bad on 25mg, as you reduce perhaps you will not feel as bad? It's a minefield of unknowns, isn't it?

It's always a matter of "see how you go" with these things and it's hard to know what to say to people because it's too individual. Could you go to 12.5mg and then come off? Or are you planning cutting down in quarters or something? Please don't feel you have to, you take it as slow as you feel you need to.

I hope you feel better soon and can make it on your holiday. You need some good times, you've had too many bad ones recently with all this!

[Justanutter]

And a lot of my anxiety issues are around trust in the medical profession! I am going to ask that question when I see the GP on Monday as other BBs might not react. I think I will just shave slowly over two weeks and see. I just hope she gives me some more Valium to help.

Thanks for the advice Terry.

[MyNameIsTerry]

Do you know why they put you on this beta blocker? It could be you needed a specific one. It's just all the time you've talked about it I can't remember you saying you needed it for a physical issue so I assumed it was prescribed to control anxiety symptoms? And that's why I wondered why not switch it to Propranalol because there are people on here on that with Cit with no issues and their GP's are happy.

There could be a very good reason your GP chose this beta blocker, I was just hoping before by raising the issue that it might have meant you didn't need it, could switch to Propranolol and head back onto Cit and feel much better like last time.

Propranalol carries a Moderate interaction warning with Citalopram. Both Sertraline and Citalopram carry a Major interaction warning with your current beta blocker BUT like I said, the warning for Citalopram seems a bit harder than the Sertraline one and there must be a good reason for that.

[Justanutter]

Yes, was for anxiety mainly but also palpitations. The other GP did query why I was taking them at all to be honest as I haven't supposedly got an actual heart problem. Something for discussion on Monday also.

[MyNameIsTerry]

Yes, definitely. There could be a solution in here for you. So, whilst it will be frustrating to have gone through something that could have been avoided, if it turns out to be that, it will open a door for you with a solution and a med you know what to expect with.

The other GP was probably not wanting to rock the boat much and Sertraline is one of the favourites. Citalopram isn't licenced for anxiety disorders (it is for panic disorders) but GP's seem to use it quite commonly to treat them, as did mine. Sertraline on the other hand is licenced for panic disorders, OCD, social anxiety disorder and PTSD so it's perhaps seen more as the drug closer related to anxiety treatment and NICE state it should be the first choice for GAD anyway. The 2nd GP was probably thinking it would be just as appropriate?

Palps are a very common anxiety symptom. I'm very sure they would have told you if it was anything more than that so it must be a beta blocker for anxiety symptom management like a lot of people on here use Propranolol for. It thought maybe cost but they are very similar prices on the online pharmacies so that's probably not it?

[Justanutter]

Oh who knows at the end of the day. We are all at the mercy of everything when we are at our weakest. I'll just spend all weekend bloomin worrying about interactions and whatever!

[MyNameIsTerry]

That's true. Well those rare interactions are more about people with a specific heart rhythm issue, a genetic one, so you will be fine. I'm sorry if anything I have said has worried you.

Hopefully the more your dose reduces, the more the agitation will fade. It's a horrible symptom and I remember when I started my current med I resorted to a couple of Diazepam towards the end of it and that respite did help a bit. I resisted the Diazepam before that as used them years before and had found they stopped helping me before going onto Citalopram.

I hope you feel a bit better soon. :hugs::flowers:

[Justanutter]

Thanks again Terry. Have a good weekend. :)

[Mojo61]

I only lasted 3 days on Sertraline, made my anxiety and insomnia 10 times worse. I hope you manage to come off them OK and find a suitable alternative.

[wantpeace]

I'm having a horrendous experience starting antidepressants. Horrendous. So I feel your pain starting the Sertraline. My psychiatrist is convinced my side effects are temporary though. I've managed to get on them eventually in the past. Although it's taken weeks of restlessness, anxiety and agitation to get to a point where I can tolerate and ultimately thrive on them.

The prolonged QT interval/ sudden death drug interaction seems to be a common one with antidepressants and certain other drugs. I'm on a combo which apparently could increase the risk of that, but my psychiatrist says the drugs are commonly put together and the issue is a rare one. I've had a few ECG's and there have been no signs of any issue so far.

It's a real shame you had to come off Citalapram if you were doing so well on it. Is there any point in riding out the Setraline side effects to see if you get improvement? Or alternatively, go to another doctor to see if the risk really is that great between Citalapram and your beta-blocker, or like has been said by Terry if another beta-blocker is possible?

I wish you peace of mind as quickly as possible.

[Justanutter]

Thanks guys. IWP, I don't want to carry on with Sertraline at all. Will be having a good chat with GP on Monday about next steps and also betablockers situation.

[pollynewsome]

Can i just ask. Ive been taking sertraline now for 4 months.. started at 25mg for 2 weeks and then went up to 50mg for 5 weeks.. Then went to 62.5 for a further 2 weeks and then up to 75mg for 17 days which at that point i felt so ill i dropped back to 62.5 for a week then down to 50mg for a week then to 25mg. Went to docs about 2 week ago and she thought i should stay at 50mg for at least 3 weeks to see if i settle.. so i am now 6 days at 50mg and feel dreadful!! could this be side affects or could it be that the drug is not for me? have i gone up and down my body doesnt know whats happeningl?? im back at docs on Thursday and not even sure what to say apart from i feel ill!! thanks in advance)

---------- Post added at 14:39 ---------- Previous post was at 14:27 ----------

P.s i know you are not doctors but any advice would be appreciated:)

[MyNameIsTerry]

have i gone up and down my body doesnt know whats happeningl??

Hi Polly,

That's what I would say. These meds need a certain number of half lives to stabilise and Sertraline is 22 hours or 32 hours for women. If you use the standard pharmacokinetic calculation (which is a standard, it differs per med) then multiply this by 5 and that's when your blood plasma reflects a stable dose.

So, if you are going up and down inside this timeframe, you will be all over the place.

Also, these meds take time to work. Whilst they quickly increase "free" Serotonin between the sending & receiving receptor site (the receiving one then transports it onward for the use it was intended for) there is a longer action where it prevents the sending receptor from reabsorbing it to be sent on again. The latter is the main reason for using the SSRI and this is why your GP is saying to give it some time.

[pollynewsome]

Thankyou for reply.. im now 8 days at 50mg and omg!! i feel absolutely rotten..im at docs tomorrow so will see what she thinks. Head tension is just unbearable and feels like it going to explode and then i am so so cold its ridiculous.. never thought anxiety could make you feel so ill.