Citalopram withdrawal - 9 weeks stopped completely

[felix324]

Hello. The doctor (note, I don't say "my" doctor - the rare times I actually go to the surgery, I never see the same one twice) told me in October 2016, when I asked for advice about coming off citalopram, that I had been on this drug for 6 years along with propranolol 40mg for even longer. He told me because I was 'only' on 10mg that I could quit cold turkey. Given that missing a dose for 2 days gives me awful side effects, I decided to taper both tablets' dosage. Half tablets every day for 2 weeks then half tablets alternating each day. I stopped completely on 19 December 2016.

In hindsight, I think this was too soon, but I had no tapering advice from the doctor to follow.

9 weeks on, I am still suffering from headaches on waking - always on the right temple side - and cannot drink alcohol. Even one drink gives me a headache the next day.

This is getting me down so much, I relented and started to take 40mg propranolol this week - I reckon these tablets get into your system quickly and I hope they may help in the short term. 5 days later I still am having the headaches. Can anyone advise? I would be grateful for any advice.

I withdrew from Seroxat many years ago by using a syringe which measured out small doses over a long period. Perhaps this is a better solution?

I am seeing the/a doctor (not the same one who advised cold turkey!) on Monday 20 February, a 2 week wait for an appointment, and I am told the appointment duration will be 10 minutes.

[panic_down_under]

hello

Hi, welcome to No More Panic :welcome:


I asked for advice about coming off citalopram, that I had been on this drug for 6 years along with propranolol 40mg for even longer.

What was the propranolol for? If anxiety, why wasn't it discontinued when you were stabilized on citalopram?


He told me because I was 'only' on 10mg that I could quit cold turkey.

Firstly, taking sub therapeutic antidepressant doses is a bad idea on several levels. Antidepressants have no direct effect on anxiety, or depression in the way say aspirin has on a headache. They work by stimulating the growth of new brain cells (http://www.americanscientist.org/issues/feature/depression-and-the-birth-and-death-of-brain-cells/99999) (neurogenesis) to replace cells killed, or prevented from growing by high brain stress hormone levels. The therapeutic response is produced by these new cells and the stronger interconnections they forge. While a borderline sub therapeutic doses might just be enough to initiate and sustain neurogenesis much of the time anything which affects plasma levels of the drug, and this coul be something as simple as a minor infection, or having a drink risks the neurogenesis process being interrupted, which leads into the second issue...

There is growing evidence that antidepressants become progressively less effective every time they are stopped and restarted, often requiring higher doses to achieve the previous level of control. Two studies, Amsterdam JD (https://www.ncbi.nlm.nih.gov/pubmed/27805299), 2016 and Amsterdam, 2009 (http://www.karger.com/Article/FullText/226611) found the likelihood of antidepressants working after each restart drops by 19-25% (see also: Amsterdam JD (http://www.ncbi.nlm.nih.gov/pubmed/18694599), 2009; Leykin Y (http://www.ncbi.nlm.nih.gov/pubmed/17469884), 2007). Taking sub therapeutic doses risks triggering the same stop/start problem.


Given that missing a dose for 2 days gives me awful side effects, I decided to taper both tablets' dosage.

Missing doses will trigger withdrawal effects. Can't really blame the medication for that. And tapering off two meds at once is unwise as it can be impossible to determine which is creating any problems that arise.


In hindsight, I think this was too soon, but I had no tapering advice from the doctor to follow.

I'm not convinced weaning off them over many months/years is either necessary, or produces better outcomes. The brain adapts to changes fairly quickly. In most cases they can be weaned off at about the same rate as they were initially tapered onto.

The problem is withdrawal is not simply a matter of chemistry and biology, psychology is at least as important, especially in anxiety disorders and anxious depression.


9 weeks on, I am still suffering from headaches on waking - always on the right temple side - and cannot drink alcohol. Even one drink gives me a headache the next day.

Headaches are normally caused by either constricted, or dilated blood vessels. Serotonin is a signaling protein in the regulation of blood vessel tone so SSRIs can affect constriction and dilation while they are being taken, but it would be hard to come up with a mechanism to account for this to continue for 9 weeks after the last dose.

Your reaction to the alcohol also suggests there may be more to this than withdrawal. BTW-alcohol and anxiety are not a good mix. They tend to feed off each other. It also blocks neurogenesis.


This is getting me down so much, I relented and started to take 40mg propranolol this week - I reckon these tablets get into your system quickly and I hope they may help in the short term. 5 days later I still am having the headaches.

Then stopping the propranolol probably isn't the cause of the headache, nor probably is high blood pressure which was my first thought until I read the above, but still have it checked by the GP.


I withdrew from Seroxat many years ago by using a syringe which measured out small doses over a long period. Perhaps this is a better solution?

Paroxetine is notoriously difficult to discontinue because of its short half-life and lack of an active metabolite. The better way to discontinue would have been to switch to fluoxetine (Prozac) and once stabilized on an equivalent dose begin weaning off.

But citalopram is a different kettle of fish to paroxetine as it has a half-life second only to fluoxetine and an active metabolite to extend its activity further.


Can anyone advise? I would be grateful for any advice.

I think you need to ask about other potential causes for the headache as it alone is not usually a SSRI or propranolol withdrawal symptom. Nor do withdrawal symptoms usually only occur at a specific time of the day. It is possible either citalopram, or propranolol were masking something, or that something else has cropped up coincidentally. Given the headache is present only when awakening, it could be as simple to fix as a change in pillows.

If nothing else is found the bottom line is that there is not much you can do except treat the symptom. Have you taken otc painkillers for the headache? If so, which one and is it effective?