Day 5 on Citalopram and struggling with nausea

[Cherry79]

Can anybody offer any advise with nausea please? I'm really struggling. I feel nauseous almost all day long and am struggling to eat. I'm barely leaving my house as I just feel so awful all the time.

My Dr gave me Buccastem but I read online that you shouldnt use it if you're at risk of stroke (which I am) so I'm too scared to take it.

Is there anything else I can take?

I'm taking:

10mg Citalipram
40mg propranolol (x3 a day)
20mg omeprazole
2mg diazepam (only when desperate)

[Cherry79]

Now on day 8 and still struggling.

The weight is dropping off me rapidly as I'm hardly eating.

Please does anyone have any advice??? 😢

[RobTheRobot]

Don't be afraid to use the Diazepam. You are in the early phases and I feel so bad for you.. it can be a living nightmare. I was worried about the diazepam but when the city kicked in I didn't think about it again. Speak to your doctor if the diazepam helps significantly. I was allowed up to 6mg a day.

[Cherry79]

Don't be afraid to use the Diazepam. You are in the early phases and I feel so bad for you.. it can be a living nightmare. I was worried about the diazepam but when the city kicked in I didn't think about it again. Speak to your doctor if the diazepam helps significantly. I was allowed up to 6mg a day.

Thank you so much.

My husband ending up calling the out of hours dr as he is struggling to see me in such a bad way. Dr recommended taking 3 lots of 2mg diazepam a day whist the side affects are so bad. So I'm going to take them and try not to worry too much about the addictive side of things. They do take the edge off a little.

You're right, it is a living nightmare! Thankfully I'm signed off of work at the moment but I have 2 young kids and it's so hard trying to do everything for them. I really hope this gets easier soon.

[RobTheRobot]

I was in the exact same position as yourself. I also had to take time off work as the side effects knocked me out.

I was really worried about becoming addicted to diazepam also.. to the point I went against my doctors advice and was stupid. I started breaking tablets in half so I was only taking 1mg and getting no benefit and, generally, acting a bit crazy about the whole thing!
I confessed to my doctor I was worried sick about becoming addicted to diazepam on top of the horrible anxiety I had. He was quite stern in telling me that I would not become addicted, and the tablets are prescribed because I needed them for their purpose. I felt better after this and took 4mg - 6mg a day.
It really helped me relax and I could go about daily tasks. The anxiety was still there but the edge was gone.
One more bit of advice... please stick to the citalopram. It took a lot longer to work for me but when it did I felt my old self again. It was a few months before it worked though but everyone is different, I was just unlucky. Don't give up on it. I'm currently still on 40mg but I feel really good. My anxiety was a pure 10 / 10 but now I feel it at 2/10. Stick to it.. don't be afraid of going back to work and always talk to people you trust regarding what you are going through :)

If you need any help or support feel free to send a PM.

[Cherry79]

Thank you so much Rob. I really appreciate your support and it helps knowing you have been through the same and come out the other side.

I am determined to stick with the Citalopram. Blimey it's so hard though. The nausea over the past day or 2 is easing a little bit but the lack of sleep is a killer. I've always been a really good sleeper and never had any issues so this is really alien to me! I tend to fall asleep at midnight, sleep for an hour or 2 and then I'm pretty much awake for the rest of the night, maybe dozing for 10 mins here and there. It's pure hell! And I'm sure that's what makes me feel so bloody awful in the mornings. I find mornings so difficult. Then by lunchtime I start to feel a little better. I take my Citalopram at around 8am, not sure if that makes any difference.

I'm getting great support from my mum and my husband. I just hope I can start to feel a little better soon. I've got a gp appointment on Friday and I'm considering asking for something to help me sleep, but I already feel like I'm taking so many different medications I'm a bit scared to add another!
I wonder if my gp will advise upping the Citalopram to 20mg as I'm only on 10, but I'm worried the side effects will ramp up again.

So many worries I know!! I sometimes wish I'd never started this medication! ��

[RobTheRobot]

Yeah the Nausea can be horrific.. especially in the mornings. I didn't suffer too much from insomnia though so I can't really relate there. First few nights were bad but it quickly sorted itself out in regards to sleep. I lost my appetite too and dropped a considerable amount of weight, but the appetite comes back before your anxiety goes away.

Stick to it though. It's a long road ahead but it does get better :) Try to relax and take your mind off it.

[panic_down_under]

Can anybody offer any advise with nausea please?

Is there anything else I can take?

Ginger is usually beneficial, and vit B6 supplements are often recommended for morning sickness in pregnancy so may also help.

The reason for the nausea is the effects of the med on the enteric nervous system (http://www.nytimes.com/2005/08/23/health/23gut.html) (ENS), the mini brain which controls the gut (and the brain, heart and lungs to some extent). It is by far the most serotonergic organ of the body making and using around 95% of all the serotonin produces. The brain accounts for only a little less than 2%. So the immediate increase in serotonin activity can affect it more than it does the brain. However, after a couple of weeks the body (and brain) responds by down-regulating serotonin synthesis and expression and things usually settle down, but such side-effects can return for a short while after dose increases.


I take my Citalopram at around 8am, not sure if that makes any difference.

It shouldn't do. Citalopram has the second longest half-life of all the antidepressants, around 35 hours, so levels don't change much, plus after about 7 days plasma levels stabilize to a steady-state of around 2-2.5 times the peak level from a single dose and then don't vary much across 24 hours.

BTW-I see you're taking omeprazole to reduce stomach acid production. You may not need it if the citalopram calms the ENS as well as the brain.


So I'm going to take them and try not to worry too much about the addictive side of things.

You won't become addicted to diazepam, but you may become dependent on it's taken regularly for more than a month, or two and will then need to wean off it rather that quitting it cold-turkey. You will also develop a dependency to citalopram, btw.

The main drawback to taking BZDs is that they can delay antidepressant kick-in to some extent by blocking the formation of new brain cells which is what produces the therapeutic response of antidepressants. But it is still better to take BZDs when needed rather than quitting the antidepressant.

Incidentally, you already are dependent on diazepam as it is one of the naturally occurring benzodiazepines (BZDs) found in all foods (potatoes and wheat sprouts are particularly rich sources) to which we have become so adapted to that we can no longer function without them. If you were to eat a BZD free diet you would soon begin having uncontrollable seizures. Fortunately, this is probably impossible. See:


Muceniece R, Saleniece K, Krigere L, et al. (2008)
Potato (Solanum tuberosum) juice exerts an anticonvulsant effect in mice through binding to GABA receptors.
Planta Med. 2008 Apr;74(5):491-6. (Abstract (http://dx.doi.org/10.1055/s-2008-1074495))

Kavvadias D, Abou-Mandour AA, Czygan FC, et al (2000)
Identification of benzodiazepines in Artemisia dracunculus and Solanum tuberosum rationalizing their endogenous formation in plant tissue.
Biochem Biophys Res Commun Mar 5;269(1):290-5 (Abstract (http://www.ncbi.nlm.nih.gov/pubmed/10694515))

Sand P, Kavvadias D, Feineis D, et al. (2000)
Naturally occurring benzodiazepines: current status of research and clinical implications.
Eur Arch Psychiatry Clin Neurosci vol 250(4): p 194-202 (Abstract (http://www.ncbi.nlm.nih.gov/pubmed/11009072))

Kotz U, (1991)
Occurrence of "natural" benzodiazepines.
Life Sci;48(3):209-15 (Abstract (http://www.ncbi.nlm.nih.gov/pubmed/1992279))

Unseld E, Krishna Dr Fischer C, et al (1989)
Detection of desmethyldiazepam and diazepam in brain of different species and plants.
Biochem Pharmacol Aug 1;38(15):2473-8 (Abstract (http://www.ncbi.nlm.nih.gov/pubmed/2502983))

Wildman J, Ranalder U. (1988)
Presence of lorazepam in the blood plasma of drug free rats.
Life Sci. 43(15):1257-60. (Abstract (http://www.ncbi.nlm.nih.gov/pubmed/3172979))

Wildmann J. (1988)
Increase of natural benzodiazepines in wheat and potato during germination.
Biochem Biophys Res Commun. Dec 30;157(3):1436-43. (Abstract (http://www.ncbi.nlm.nih.gov/pubmed/2849941))

Wildmann J, Vetter W, Ranalder UB, et al (1988)
Occurrence of pharmacologically active benzodiazepines in trace amounts in wheat and potato.
Biochem Pharmacol. Oct 1;37(19):3549-59. (Abstract (http://www.ncbi.nlm.nih.gov/pubmed/3178869))

Sangameswaran L, Fales HM, Friedrich P, De Blas AL. (1986)
Purification of a benzodiazepine from bovine brain and detection of benzodiazepine-like immunoreactivity in human brain
Proc Natl Acad Sci U S A. 1986 Dec;83(23):9236-40. (Abstract (http://www.ncbi.nlm.nih.gov/pubmed/3024172) | Full text - PDF (http://www.pnas.org/content/83/23/9236.full.pdf))

[Cherry79]

Thank you for your replies and very useful information.

I'm now on day 12 and the side effects are definitely wearing off a bit. The nausea isn't gone but is more manageable. The last 2 nights I've slept a little bit better too, thank goodness.

Still not feeling any benefit but I know this can take some time. So I've got to be patient.

[Cherry79]

Now on day 14. Very pleased I've managed to make it through the 2 weeks as I know these are probably the hardest. Things are definitely getting easier. I'm now sleeping pretty well and the nausea has eased a lot!
I'm managing to eat now. In fact we went over my mums last night and all shared a Chinese take away which I was surprised I actually enjoyed.

I still have headaches and have developed an annoying eye twitch (I guess from the stress levels and lack of sleep).

The anxiety is a little better but I'm not sure the Citalopram is having any real affect yet, I just think I'm probably relieved that the worst is over.

I'm still only on 10mg and will be for another 2 weeks. I think at my next gp appointment she might suggest increasing to 20mg but I'm so scared of going through the hideous side effects again. I may actually suggest going to 15mg for a couple of weeks and then 20mg.

[panic_down_under]

Now on day 14. Very pleased I've managed to make it through the 2 weeks as I know these are probably the hardest. Things are definitely getting easier. I'm now sleeping pretty well and the nausea has eased a lot!
I'm managing to eat now. In fact we went over my mums last night and all shared a Chinese take away which I was surprised I actually enjoyed.

This is all looking very promising. :)


I'm still only on 10mg and will be for another 2 weeks. I think at my next gp appointment she might suggest increasing to 20mg but I'm so scared of going through the hideous side effects again.

You should be aiming to take at least 20mg as this is usually the minimum effective dose. The side-effects are usually less severe as the percentage increase is less.


I may actually suggest going to 15mg for a couple of weeks and then 20mg.

An intermediate jump to 15mg is a good idea, but there is no advantage to delaying the subsequent increase to 20mg by more than a week.

It takes 4-5 times the half-life of a drug for plasma levels to stabilize to a steady-state after a dose increase (or decrease). For citalopram this is within 5 x 35 hours, so 175 h/7 days. Upping the dose sooner may increase side-effects severity, but delaying it won't reduce them no matter how long the delay.

[Cherry79]

I've posted a new thread and would really appreciate any advice. X