View Full Version : Anyone else had terrible increased anxiety for 2 or 3 weeks after starting citalopram
Hi all I am day 7 on 10mg after restarting citalopram. Been off it for 6 months after 4 years on it for anxiety and depression. Anxiety has gone through the roof since starting it. Much worse than it was was before. I thought it might be easing off by now but no sign. Almost constant intense anxiety with lots of mini panic attacks as well. Anyone else had this for a couple of weeks before it started easing? Had another bad night last night (Im in NZ so it’s morning here) Thanks heaps
panic_down_under
04-10-19, 00:38
Hi all I am day 7 on 10mg after restarting citalopram. Anxiety has gone through the roof since starting it. Much worse than it was was before.
The initial side-effects may be more severe, and/or different, than the first time, but hindsight is also often viewed through rose tinted glasses.
I thought it might be easing off by now but no sign. Almost constant intense anxiety with lots of mini panic attacks as well.
It can take several weeks for the side-effects to diminish. Citalopram plasma levels typically stabilize to a steady-state within 7-8 days after which the side-effects usually begin to ease. They may return for a while after the increase to the recommended minimum 20mg dose, though the intensity tends not to be as severe as at the beginning.
Taking the propranolol and/or lorazepam you've been prescribed would help. White knuckling your way through this can be counterproductive by reinforcing the anxiety.
Thank you so much for replying! I’ve moved doctors and saw someone on Monday who isn’t the one I will be seeing going forward. I emailed the surgery yesterday to ask for some reassurance about the anxiety and when I should move up to 20mg abs they rang back this morning to say that I should stop the citalopram until I have seen the doctor next week - apparently this was a message from the doctor I saw on Monday! This seems very confusing to me and my husband is saying just to ignore it and to push through. If I still have the intense anxiety next week does that mean it’s not or won’t work? Could it still work after 2 or 3 weeks? And could it still work a little bit even if it doesn’t work quite as well as before? I don’t need the anxiety to go away completely just not be as bad as it is right now as it’s hard to function. Thanks so much!
Also I’m guessing that I won’t get much benefit until I go up to 20mg so when would be the best time to start doing that? My husband thinks I should do it now as I’m already having such bad side effects but I wonder if I should wait a bit longer- your advice would be much appreciated
Just seen all the posts about how often ADs don’t work second and subsequent times. Now I just feel absolutely dreadful. I’ll go through all this and then have to do it again on another drug and another and maybe none of them will work ��
panic_down_under
04-10-19, 06:27
Thank you so much for replying! I’ve moved doctors and saw someone on Monday who isn’t the one I will be seeing going forward. I emailed the surgery yesterday to ask for some reassurance about the anxiety and when I should move up to 20mg abs they rang back this morning to say that I should stop the citalopram until I have seen the doctor next week - apparently this was a message from the doctor I saw on Monday! This seems very confusing to me and my husband is saying just to ignore it and to push through.
I agree with your husband. All antidepressants will likely trigger heightened anxiety at the beginning so stopping and then starting another med is probably not going to help much, plus even if you do need to switch it is better to do so from one med to another rather than stopping for a week and then starting again. The time you've been on citalopram will still count.
If I still have the intense anxiety next week does that mean it’s not or won’t work?
It doesn't indicate anything either way. SSRIs and other serotonergic antidepressants (ADs) trigger an increase in brain serotonin levels within about an hour of the first dose. This is what is triggering the anxiety. Despite the popular myth, anxiety and depression are not caused by low brain serotonin levels and ADs do not work by increasing serotonin although this is the first thing they do, nor is it a 'feel good' neurotransmitter, as you're discovering. In response to this initial increase in serotonin activity the brain (and other affected organs) will respond by downregulating synthesis and expression (http://www.nomorepanic.co.uk/showthread.php?t=193671), in some brain areas to well below baseline, and the heightened anxiety and other side-effects should then begin to ease. Unfortunately, this may take several weeks and may reoccur for a while after dose increases. There is no way of speeding this up, but the lorazepam and propranolol can make a significant difference during the wait.
Could it still work after 2 or 3 weeks?
ADs typically take 4-12 weeks to kick-in. They work by stimulating the growth of new brain cells (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC60045/) (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, not the meds directly, and they take time to bud, grow and mature. The entire process takes about 7 weeks (http://cshperspectives.cshlp.org/content/7/9/a018812.full), however, some improvement may begin several weeks earlier. For a more detailed explanation see: How antidepressant drugs act (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025168/).
And could it still work a little bit even if it doesn’t work quite as well as before? I don’t need the anxiety to go away completely just not be as bad as it is right now as it’s hard to function.
There is a very good chance that citalopram will work as well as before and if it doesn't a small dose increase will usually cover any deficiency.
Also I’m guessing that I won’t get much benefit until I go up to 20mg so when would be the best time to start doing that? My husband thinks I should do it now as I’m already having such bad side effects but I wonder if I should wait a bit longer- your advice would be much appreciated
The rule of thumb is to time dose increases to no earlier than 5 times the half-life of the med, which for citalopram is about 35 hours, so 7-8 days. Upping the dose earlier may significantly increase side-effects severity, but delaying it won't significantly reduce them no matter how long the delay. You could still be an anxiety spike for a day, or two, however, so use the lorazepam and/or propranolol. No one is handing out gold stars for white knuckling through anxiety. It is also counterproductive.
Just seen all the posts about how often ADs don’t work second and subsequent times. Now I just feel absolutely dreadful. I’ll go through all this and then have to do it again on another drug and another and maybe none of them will work
While there is an increased risk of an AD not working the second time around, it is a long way short of 100%. There may also be a way of reinvigorating a med should this become necessary using the GAD specific med buspirone. And if the worst happens then switching to another AD will almost always solve the problem with only a minimum loss of time. You are wasting a lot of nervous energy catastrophising about chickens which are very unlikely to hatch.
Thank you so much this help an awful lot!
Thanks Ian. It was really useful - just had the weirdest experience though - it was like I had a panic attack physically without having the mental aspect. Was feeling a bit better so my husband convinced me to go out and get something to eat and he got me a white wine spritzer when we arrived (a few hours ago now. We had some Japanese and I was ok until near the end and then had this awful thing. Like burning down my arms, across my shoulders and chest and down my back. And now my legs are all shaky. This is clearly a medication side effect as I wasn’t having this before I started them and I wasn’t thinking anxious thoughts when it started. It’s now been about half an hour. Which would be better to stop this - the propoponal or the lorazepam?
panic_down_under
04-10-19, 10:40
then had this awful thing. Like burning down my arms, across my shoulders and chest and down my back. And now my legs are all shaky. This is clearly a medication side effect as I wasn’t having this before I started them and I wasn’t thinking anxious thoughts when it started. It’s now been about half an hour.
It could be adrenaline which can lead the triggering anxiety, or it might be the med. Hard to say, though my money would be on adrenaline.
Serotonin isn't only a brain neurotransmitter, in fact the brain is a minor player using less than 2% of the serotonin made. The skin and its blood vessels use about as much and skin irritations and other effects are fairly common when first taking a serotonergic AD. Most are innocuous. However, one ongoing side-effect to be aware of is skin photo sensitivity may be increased so protect the skin if outdoors for more than a few minutes at a time, especially in light of the ozone layer hole above you.
Which would be better to stop this - the propoponal or the lorazepam?
If it is adrenaline then propranolol should stop it cold by blocking beta-adrenergic receptors, though it might take 20-60 minutes to act by which time the surge may be over anyway. But your anxiety level have probably risen as a result of all this and beta blockers don't really do much for them so you might need a small amount of lorazepam too. Note, both can be sedating so be careful if doing anything potentially hazardous until you can gauge how you're affected. Given the hour you will likely get a good night's sleep.
Thanks again Ian - just another pesky side effect then? Nothing to worry about? Can you take the two together then?
And if it is the med and not adrenalin will the lorazepam work for that?
I’m a bit nervous about taking the propranalol because it can make you feel sick I think and I don’t need when trying to get some desperately needed sleep.
I've been on and off propranolol for ages; worst it's ever given me is cold hands.
Thanks BlueIris - does it work for you and do you think it will work in this situation?
I don't take it any more, but it was really great for dealing with headaches and palpitations.
So you didn’t take it for anxiety?
Yes, I did - it reduced the physical symptoms rather than the mental ones.
Do you mean that you didn’t feel the physical anxiety in your body but still had the worrying thoughts?
Pretty much, yes, but they were easier to manage without the physical discomfort.
Mrsmitchell1984
05-10-19, 16:20
Hey, how are you doing today? X
Mrsmitchell1984
05-10-19, 16:43
Just to provide you with a bit of reassurance. I have been on fluoxetine on 3 previous occasions and it worked every time. I also know of a lady who has been on fluoxetine 10-15 times- and it worked every time. I also have a friend who has stopped and started citalopram 3 times and it worked each time.
However, if FLU works this time- I will not be coming off again.
I think we need a bit of hope that it will work- it’s bad enough going through all this hell without the worry that it may not work. Having said that, even if they don’t work- the chances are something else will work and there is always Lithium and ECT 🙈
Thanks for thinking of me. Saw that you are feeling a little better. I’m much the same - do have small periods of not feeling quite so anxious but then it all comes back. Still no appetite but am forcing myself to eat I’m losing too much weight. It’s morning here and the morning anxiety is always so bad. I feel really tearful then too. It doesn’t really seem to be getting any better but I just keep telling myself it is only day 8 (haven’t taken today’s dose yet) and the intensified anxiety usually lasts around 2 weeks they say. Feel so much pressure to get better as we are supposed to be going on a family holiday for a week in 2 weeks and I can’t imagine how I’m going to do it if I’m still in this state. I’m really worried that if the anxiety doesn’t get better they’ll have to put on some awful sedative drug and then I’ll be zombie ��
panic_down_under
05-10-19, 23:26
I’m really worried that if the anxiety doesn’t get better they’ll have to put on some awful sedative drug and then I’ll be zombie ��
Benzodiazepines (BZDs) do not usually turn people into zombies, although they can be a little sedating for the first few days. Our brains are so adapted to the BZDs ocurring naturally in all foods, including *lorazepam, that it can no longer function without them. I urge you to trial the lorazepam you've been prescribed before you go on holiday so you see how it affects you.
* Ativan (lorazepam) has been isolated in the blood of lab rats that haven't been exposed to the pharmaceutical drug (Wildman J (http://www.ncbi.nlm.nih.gov/pubmed/3172979). (1988)). Lorazepam, delorazepam, and many other benzodiazepine compounds, have been found in wheat and potatoes (Wildmann J (http://www.ncbi.nlm.nih.gov/pubmed/3178869) et al, 1988). Delorazepam - C15H10Cl2N2O2 - is chemically almost identical to lorazepam - C15H10Cl2N2O, having just an extra oxygen molecule. It is marketed in Italy as a longer acting version of lorazepam under the trade name Dadumir.
Thanks Ian - I wasn’t thinking so much of the benzos I was thinking about the hardcore long term sedative antidepressants and antipsychotics. I have had Xanax before for flying and I know it works well for me but we can’t get it in NZ before. Had lorazepam once for flying and i remember thinking it didn’t work so well. I’m scared that if it works I will want to take it all the time so I don’t feel like this and if it doesn’t work I will get really panicky as I will think there is nothing to take the anxiety away
Also PDU - how addictive really is lorazepam? If I need to take it for 2 or 3 weeks to get through this first stage will I be able to come off it ok?
PS feel a bit better after getting up and getting g busy. Husband made me eat some food too. TIP - do not stay in bed and nope and ruminate even you think you are resting - just makes things heaps worse!
panic_down_under
06-10-19, 01:44
I was thinking about the hardcore long term sedative antidepressants and antipsychotics
I doubt it will be necessary, but the most likely sedative antidepressant you'd be prescribed will be mirtazapine which is more antihistamine that antidepressant, and as for antipsychotics it would probably be quetiapine which is pretty much mirtazapine with slightly more dopamine activity. Both can be sedating at low doses, much less so at the high end of their dose range.
if it doesn’t work I will get really panicky as I will think there is nothing to take the anxiety away
Which is why I suggest you try it now so that if it isn't effective you get a more effective med before you leave.
PS:
Also PDU - how addictive really is lorazepam? If I need to take it for 2 or 3 weeks to get through this first stage will I be able to come off it ok?
If you take it every day for 2-3 weeks you may develop a, usually mild, dependency - which is not addiction, but you shouldn't need to take it every day. You could also ask your doctor to prescribe *hydroxyzine, an antihistamine with good anti anxiety properties. It's not quite as potent as the BZDs, but is often potent enough and you can keep the lorazepam for the extra anxious days.
*hydroxyzine comes in two forms, hydroxyzine pamoate (Vistaril) and hydroxyzine hydrochloride (Atarax). Anecdotally, the pamoate form is claimed to be the more effective anxiolytic, but just how true this is remains a matter of debate in forums
Yes I was going to try it this afternoon. Did you see my question about depevdance and coming off if it dies work and I need to take it for 2 or 3 weeks? Also would the mirtazapine turn me into a zombie? Do you mean I would get that as well as the citalopram or instead of?
panic_down_under
06-10-19, 01:58
Yes I was going to try it this afternoon. Did you see my question about depevdance and coming off if it dies work and I need to take it for 2 or 3 weeks?
I just added it as a PS to my previous post
Also would the mirtazapine turn me into a zombie? Do you mean I would get that as well as the citalopram or instead of?
It would probably be added to the citalopram. It is often prescribed as a sleep aid for those with SSRI induced insomnia. While it is sometimes prescribed on its own as an antidepressant it doesn't have a great record.
Mrsmitchell1984
06-10-19, 07:41
Wow Windywel- you have a lot of uncertainty at the moment about the meds- which hasn’t been helped by the doctors. No wonder you are feeling bad. Thank goodness we have panic down under to help us.
How have you been for most of the day?
I have a family holiday coming up in 2 weeks too and I am worried just like you that I won’t be better in time and ruin it for everyone 😥
Mrsmitchell1984
06-10-19, 07:49
Which dose are you on now? X
Still on 10. Was feeling a bit better this afternoon but now I’m freaking out about serotonin syndrome as I have some of the symptoms - restlessness/agitation, anxiety and some muscle twitching ( though that has been fairly minimal today) - have you ever heard of anyone getting it from low dose of one SSRI? I really don’t need to be worrying about that along with everything else ��
Are you feeling any better?
Mrsmitchell1984
06-10-19, 08:12
Hi Windywel- that’s the problem with serotonin syndrome as it has the same symptoms as the side effects of the antidepressant.
What is your temperature like as that is usually an indication?
However, it is hugely unlikely that you will get SS on such a low dose of citalopram.
SS usually occurs if you overdose on an antidepressant or if you take something else with the antidepressant. If you read my thread on the fluoxetine - coming off of St Johns wort - which is a herbal remedy you will see that even with that I didn’t get SS. There was a real chance of me getting SS when I had taken a herbal remedy which increases your serotonin too- so I had to take a 7 day gap between the two.
Mrsmitchell1984
06-10-19, 08:15
I am better than yesterday as yesterday I spent most of the day in bed and that was completely counter productive- even though to my body it felt like the right thing to do.
It a Sunday so I am up and I have just plonked my son in front of the tv (bad mummy) but my husband worked last night so is in bed. I will probably try to go to Church today as it gets us out.
Only thing is half the Church has been praying so hard for me and so they are all going to be all over me today asking how I am. Unfortunately - I only have news that I feel the same. I know praying helps but I am still waiting for the miracle xxxx
panic_down_under
06-10-19, 09:48
I’m freaking out about serotonin syndrome as I have some of the symptoms - restlessness/agitation, anxiety and some muscle twitching ( though that has been fairly minimal today) - have you ever heard of anyone getting it from low dose of one SSRI?
You cannot develop serotonin syndrome from 10mg citalopram. Even massive SSRI overdoses are very rarely fatal because of the syndrome unless there is also another serotonergic agent. Almost all fatal cases have involved MAOI class antidepressants plus another serotonin inhibitor or releaser. 99.9% of the online 'information' is male bovine manure, and medical journals are not much better. One of the two blokes that knows most about it, Ken Gillman (http://scholar.google.com.au/citations?user=ea6KeD0AAAAJ&hl=en), used to spend much of his semi retirement writing letters to the medical journals correcting the nonsense being peddled. You can read his frustration here (https://psychotropical.com/st-case-reports-update-old/).
[I really don’t need to be worrying about that along with everything else ��
Then please fire Dr Google as your consultant. His "advice" is not doing you any favours.
Totally agree Ian - your frustration is also shared very strongly by my husband! Have been trying to be disciplined but sometimes I give in - this was a bad slip up. Thanks for all your wise and sensible advice - it really is helping me get through this.
Mrsmitchell1984
06-10-19, 13:26
Yaaay we both worried about serotonin syndrome and neither of us got it. Let this be a way of us to see how our mind plays tricks on us.
You are through another day! Getting through each day- it’s a HUGE challenge- so well done you l! Xxxxx
Early morning here. Had a bad night with little sleep. Had a panic attack just as I was about to go to sleep. Managed to get go sleep but have woken several times and now been awake since 4.30. Had a better afternoon so was thinking the intense anxiety was wearing off but no such luck! I am day 10 so feeling pretty dispirited. Shouldn’t the panic attacks be going away by now? I didn’t have these out of the blue attacks before I started the medication. PDU is this still normal after 9/10 days? Sorry still haven’t taken the Lorax as felt I didn’t need yesterday afternoon but should have as I definitely needed something overnight.
Mrsmitchell1984
06-10-19, 18:36
Aw Windywel-sorry to hear you had a bad night - but that doesn’t mean it has to be a bad day.
I am wondering if your dose may be a bit low- what do you think PDU?
Sending you lots of hugs and hoping you have a normalish day. Also don’t be too dispirited- a panic attack doesn’t mean it has erased the progress that you have made. They will still come for a bit - but gradually go with time. One day you will look back and think - wow they have gone xxxxx
Thanks Sally - hope you don’t mind me calling you that. Hope you have a good day too. It’s all about baby steps right? It’s just hard when it’s making me feel so much worse than I did before I started the meds.
Im feeling really down about the fact that I am 10 days in and not really noticing any change in the heightened anxiety yet. Also I have IBS which is one of the reasons why the anxiety got so bad again and I have an upset tummy this morning which is making me feel even more anxious. I’m also just so tired as the nights are pretty bad yet the anxiety makes me feel wired so I can’t sleep ��
panic_down_under
06-10-19, 22:22
Shouldn’t the panic attacks be going away by now? I didn’t have these out of the blue attacks before I started the medication. PDU is this still normal after 9/10 days?
Unfortunately, it can take up to 12 weeks for ADs to kick-in from when a therapeutic dose is first taken, although most begin to see some improvement at around 6 weeks. Did your doctor suggest a dose increase to 20mg after a week or two at 10mg?
Hi PDU - I haven’t seen the doctor again after the other stupid one said I should stop taking the citalopram. I have been emailing the psychiatrist though who I am going to see in November (he couldn’t get me in any sooner). He said I should work with the GP to get up to the therapeutic dose that worked last time which was 20mg. I’m scared to go up to that though in case the side effects get worse. Can the extra anxiety and panic attacks last for 2 months or should it have started to go away by now? It’s definately a side effect as nowhere near this bad before I started meds. I’m sure if I go to the GP she will say that I should change to something else and I’m not sure that this the right thing. The other one tried to get me to change to escitalopram as she said it was more calming and worked faster. Have you heard that? That’s the other issue with going up to 20 - wouldn’t that make it harder to switch to another drug if I needed to?
panic_down_under
06-10-19, 22:49
Also I have IBS which is one of the reasons why the anxiety got so bad again and I have an upset tummy this morning which is making me feel even more anxious.
Citalopram may help with IBS too if it isn't accompanied by diarrhoea. The brain isn't the most serotonergic organ of the body, it makes and uses less than 2% of the total. The enteric nervous system (http://www.nytimes.com/2005/08/23/health/the-other-brain-also-deals-with-many-woes.html) (ENS), the mini brain which controls the gut makes about 50 times as much serotonin and the downregulation of its synthesis, expression and receptors density by SSRIs can also have a positive affect (https://www.healio.com/gastroenterology/curbside-consultation/%7B14477a97-aec3-41f6-8515-c7a0ed098293%7D/what-is-the-role-of-ssri) on the gut, though initially it can make things worse for a while.
BTW-while it is much smaller, the ENS seems to be the dominant partner with most of the data exchange going from it to the brain. The two are linked by the vagus nerves which also connect to the heart and lungs and though those connections the ENS can trigger some of the more common anxiety symptoms. Electronic vagus nerve stimulators which affect the ability of the gut to communicate with the brain have proven to be an effective for treatment resistant depression, though not for anxiety disorders. In turn, the ENS is greatly affected (https://pdfs.semanticscholar.org/c8fa/d0ba164b8cc0ba181fdf690db5c919235391.pdf) by the gut flora. It could be argued that the flora is in charge and we are merely their life support system so it pays to treat them with respect.
panic_down_under
06-10-19, 23:13
He said I should work with the GP to get up to the therapeutic dose that worked last time which was 20mg. I’m scared to go up to that though in case the side effects get worse.
The rule of thumb is to not increase the dose any sooner than 5 times the half-life of the med which for citalopram is ~36 hours, so 7-8 days. Upping the dose before this can significantly increase side-effects severity, but delaying it for longer won't significantly increase them no matter how long the wait. You could try increasing to only 15mg for a few days.
Can the extra anxiety and panic attacks last for 2 months or should it have started to go away by now? It’s definately a side effect as nowhere near this bad before I started meds.
Side-effects tend to diminish to some degree once plasma levels stabilize to a steady-state which usually occurs at 5 times the half-life, hence the suggested dose increase/decrease timing. However, bad days may still occur.
The other one tried to get me to change to escitalopram as she said it was more calming and worked faster. Have you heard that?
It is something claimed by the pharmaceutical company, but the evidence is sparse. They are essentially the same med. Citalopram is made up of two isomers, the 'S' form which is the active component, and a 'R' mirror image (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC314378/) form which is a poorer fit biologically and so is mostly inactive. Lexapro (escitalopram) is more refined and only contains the 'S' isomer. My observation is that in practice the main difference between them is some subtle differences in their side-effects. If there is an annoying ongoing side-effect then switching to the other med may help, but if one doesn't work then the other almost certainly won't.
That’s the other issue with going up to 20 - wouldn’t that make it harder to switch to another drug if I needed to?
With the exception of switching to a MAOI class AD, which is, possibly unfortunately, very unlikely, it won't make much difference. An overnight switch directly to an equivalent dose of another SSRIs is usually straight forward with cross tapering to a TCA the better option.
So 10mg isn’t actually enough to get any benefits - you just get the side effects?
panic_down_under
07-10-19, 00:18
So 10mg isn’t actually enough to get any benefits - you just get the side effects?
It is probably borderline. The minimum recommended dose is 20mg, even for the elderly who typically metabolise ADs more slowly. Because of the way ADs work low doses are problematic, imho.
Thanks I’ve taken 15 today - will do that tomorrow too then go to 20
PDU - can you take hydroxyzine as well as lorazepam? And I’ve read that some people have also used Phenergan? Finally I’ve also read that on a data information sheet that you’re not supposed to take hydroxyzine with citalopram - do you know why that is?
So emailed GP to ask for script for hydroxyzine and she wants me to come in tomorrow for a full clinical review! (It’s a new doctor)My husband thinks that’s crazy and that I should never have changed GPs while going through this. He thinks I should change back to the other one because she knows my history. I have a feeling that if I went tomorrow she would try and get me to change medications because of the intense anxiety which doesn’t seem to make much sense to me as I’m only just over a week in. Advice anyone?
panic_down_under
07-10-19, 05:05
PDU - can you take hydroxyzine as well as lorazepam?
You could, but I don't see the point of doing so. I was suggesting hydroxyzine as a break between taking lorazepam to reduce the dependency risk.
And I’ve read that some people have also used Phenergan?
Promethazine can also work. It relies more on sedation whereas hydroxyzine has anti anxiety properties distinct from sedation despite also being an antihistamine. Mirtazapine is another possibility. However, weight gain is more likely with promethazine and, especially, mirtazapine than hydroxyzine.
Finally I’ve also read that on a data information sheet that you’re not supposed to take hydroxyzine with citalopram - do you know why that is?
It and citalopram may cause prolongation of the heart's QTc interval (https://www.nps.org.au/australian-prescriber/articles/drugs-and-the-qtc-interval). Which isn't as scary as it sounds. There is a known (though disputed) risk from citalopram, and a conditional risk from hydroxyzine under some circumstances. Many drugs have this potential affect on the heart, including, ironically, several medications for controlling heart rhythm. A large part of doctoring is balancing such risks. Unless you have other cardiovascular risk factors, particularly Congenital Long QT Syndrome, this is unlikely to be an issue.
Fwiw, the TCA I take is highly cardio toxic, so much so that it has now been removed from the British National Formulary (https://en.wikipedia.org/wiki/British_National_Formulary) and the UK drug regulator has recommended (http://webarchive.nationalarchives.gov.uk/+/http:/www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON084687) only psychiatrists and other special-care doctors be allowed to prescribe it to new patients (not that long ago it was the UK's most popular AD with nearly 75% of the market). Despite having been on the maximum recommended dose for about 25 years and my ancient heart being under significant strain due to a lung lobectomy, its QTc interval is still in the normal range.
panic_down_under
07-10-19, 05:12
I have a feeling that if I went tomorrow she would try and get me to change medications because of the intense anxiety which doesn’t seem to make much sense to me as I’m only just over a week in. Advice anyone?
Another AD will likely produce much the same intensity of side-effects. If there was one that didn't it would be the first one prescribed.
So you think best to wait it out and see if if it starts to work in another couple of weeks?
panic_down_under
07-10-19, 06:12
There doesn't seem to be any reason atm to make a change.
I’m having issues with GPs as you know and I foolishly asked my parents in law for advice. My father-in-law is a retired hospital pharmacologist. They are making me feel like I am really really ill and have a serious problem. They are saying I need to go back to the old gp and see her ASAP and take my husband and tell her how bad I am so she can get me in to see a psychiatrist. And he thinks I should be feeling better than I am after 10 days. So now I’m freaking out and thinking I’m going to end up being hospitalised or something!
Hi Sally it’s been a difficult day. Thought I’d be better going to work but not so. And I’m having issues with GPs as you know and I foolishly asked my parents in law for advice. My father-in-law is a retired hospital pharmacologist. They are making me feel like I am really really ill and have a serious problem. They are saying I need to go back to the old gp and see her ASAP and take my husband and tell her how bad I am so she can get me in to see a psychiatrist. And he thinks I should be feeling better than I am after 10 days. So now I’m freaking out and thinking I’m going to end up being hospitalised or something! I feel really alone in all this.
Mrsmitchell1984
07-10-19, 07:27
Awww windywel- I think your anxiety is high as you don’t know what to do and you are scared that GPS are going to just guess what to do- which doesn’t give you much confidence.
I am having a really bad day too- I have just upped to the therapeutic dose of FLU and the anxiety is really high already- but I am going to ride it out as I really want to see the benefits sooner rather than later.
Your last GP recommended stopping the medication - but did they recommend anything else?
I know you are feeling pretty desperate at the moment - but with every day it’s going to get better- we are going to get each other through this xxxxx
Mrsmitchell1984
07-10-19, 07:29
I would go and see this new GP and see what she recommends.
I am too scared that I am going to be hopsitalised too- but I think this is only if you are suicidal or a harm to others.
I was thinking last night - I would love it if they could just put me in a coma and keep giving me the fluoxetine and then give me a test to see when it is working and then wake me up again.
Gosh the burning sensations up and down my arms today?!
Hi Sally thanks for coming back to me! Yes that burning is awful isn’t it! I’ve gone up 5mgs today too which could be making the anxiety worse I guess. The thing I find so hard is that I feel so much worse than I did before starting the damn things! It’s so hard to see how they can be good for you when they make you feel this bad! My Hubble and parents in law both think I should go back to the other gp as they think I need someone who knows my history so I think I will do that. She is good she just rushed me all the time. I just really didn’t need them making me feel like I was a having a major mental crisis. I mean I know I’m not good but I didn’t think I was that bad! What are we going to do about our bloody family holidays??! My two youngest kids came back from a week with my mum yesterday. So hard to put on a brave face for them and just makes me feel so far away from where I was 6 months ago or even 3 months ago!
Mrsmitchell1984
07-10-19, 07:47
Aw I know exactly how you feel. They do make us feel much worse and so it feels strange carrying on with it when it makes you feel so bad.
On top of that you are having to make decisions about your treatment and doctors. It’s a bit much - perhaps your husband should be making the decisions and take the strain off of you a bit.
How old are your children?
I have a four year old son and I have to take him to school in a bit and it’s taking me all the strength in the world to do it whilst shaking like mad.
Mrsmitchell1984
07-10-19, 07:47
My biggest challenge is that time seems to be going so slow- I just want to be at the stage when the kick in-at the same time we both have holidays coming up and that is putting pressure on us too.
I know - the holiday thing does feel like huge pressure. My kids are 16,13 and 8 so a bit older than yours. Old to enough to understand that things aren’t right with me. Did you have this every time you’ve been on the FLU? Do you think going up 5 mg could make the anxiety peak again? I was feeling a bit better yesterday afternoon until the serotonin syndrome thing. I really appreciate you making such an effort to make me feel better when you are feeling so bad
Mrsmitchell1984
07-10-19, 08:03
I am happy to help- it makes me feel less alone when I know there is someone else thinking and feeling the same.
I wish someone would read this though and give us some inspiration. Like there is light at the end of the tunnel and it will get better.
How are your kids handling it? I guess at least you can explain it to them x
Mrsmitchell1984
07-10-19, 08:03
Are you feeling a bit better this afternoon x
Mrsmitchell1984
07-10-19, 08:06
I have felt bad the last 2 occasions I want on FLU. This is my 4th time - so there is a huge chance it may not even work the time which is making me feel very bad. It reduces by 25% each time- so 25% x 4 is likely it will not work. PDU- that is what you said wasn’t it?
I do know some people that have been on FLU lots of times though and it has worked for them every time. So I am holding on to that.
Mrsmitchell1984
07-10-19, 08:08
However, I think PDU has been on a medication 4 times and it has worked each time. Maybe at a slightly higher dosage or it took longer each time x
Mrsmitchell1984
07-10-19, 08:09
But you are in a better position Windywel as you have only taken it once before so it should work for you this time.
How did you feel on the Citalopram last time? X
Hi sorry had to go to the shops to get dog food. The cit helped so much last time once it kicked in and I can’t really remember the beginning. I was so bad before I started it last time that we might not have noticed much difference. I do remember it was pretty hard though and I was so pleased when it finally started working. I’m sure it will work for you. Someone else posted somewhere that they knew someone who had been on flu heaps of times and it had always worked and as PDU said there are lots of other options. We need to stay positive and remember it’s two weeks from the therapeutic side before it starts working properly xx
Mrsmitchell1984
07-10-19, 09:40
Wow you went out and got some dog food- I wouldn’t not have just been able to go out and do that- well done you.
Have you decided what you are going to do about the docs? X
My husband was out and the kids were back so no choice but to cook dinner and take my daughter to the supermarket. Sometimes those things actually help I find as they normalise things a bit - otherwise I just feel really strange like this big thing is happening just to me while everything else goes on as normal. I try to put a brave face on with the kids as the two younger ones always worry a lot when I’m sick. I think it’s all just wearing me down as I’m not sleeping or eating properly. Have cancelled the doc appointment tomorrow and will try and go back to the old GP. Can’t bear to go through all my history again at the moment with someone new. I can always change once things are under control. Is your husband worried? I find it hard when I know he is worrying about me.
Mrsmitchell1984
07-10-19, 10:32
Hey Yes it is good to do things. I have a day off of work today and I am just feeling like the time is dragging- I am wondering how much longer I can cope feeling like this.
I have to work tomorrow and I am really worried about going in.
How are you feeling? Has the evening made you feel a bit better?
When are you seeing your old doctor?
X
Mrsmitchell1984
07-10-19, 10:33
I’m not eating properly either.
How are things sleep wise with you? I think the anti histamine is helping me sleep x
Hi sleep is terrible last two nights. I’m so tired but I can’t sleep and now I’m having a panic attack about not being able to sleep. They can always give you something to sleep can’t they? You can’t survive without sleep so I won’t be able to keep going this
Are you there? Any advice to help calm me down? It’s an awful feeling - being so so tired but just not actually being able to sleep. I’ll have to go to the doctor tomorrow to try and get sons sleeping tablets
Mrsmitchell1984
07-10-19, 13:48
Hi Windywel- I am so sorry I worried you about the sleep. Were you able to sleep? Yes they can give you an antihistamine with drowsy side effects to help you sleep. Also, the citalopram should eventually work on the sleep problem - even though it tends to give people insomnia at first 🙈
Hi Sally it’s 2am and haven’t been to sleep yet. Have taken .5 of lorazepam and will see what that dies. Do feel a little calmer but not sure whether it will be enough to put me into dreamland. At least I’ve stopped trembling like I was before. How is your day going?
Insomnia another one of those pesky side effects I didn’t have before! Even though I was anxious and a bit down before the meds I was sleeping pretty well. Why are we putting ourselves through this? Do they really make Ilya feel better or just better then the first few weeks of being on them
Mrsmitchell1984
07-10-19, 14:02
That’s what I wonder sometimes- why are we doing it to ourselves and will it be worth it?
With you I can almost certainly say it will as you have only been on these tablets once - so the probability is still quite good for you - but I do think you should ask about going up to the therapeutic dose. Xxxx
Mrsmitchell1984
07-10-19, 14:16
I was reading suemarieeee’s diary of citalopram and it seems she was on her third time- and she has really good results x
Did she have this awful intense anxiety at the start though? At the moment it’s so hard to imagine it going away - it’s auch a physical response. Well the loraz managed to work a bit. It just gently made me feel a bit calmer and finally managed to get to sleep about 2 so would have had almost 5 hours sleep. Better than nothing! Still woke up feeling just as anxious though so it didn’t last long. Might have to ask for something that lasts a bit longer. It’s so crazy but I have a job interview today! Have no idea how im going to get through that! How was your day Sally? Are you feeling any better?
Mrsmitchell1984
07-10-19, 20:47
Wow- I hope your job interview goes well! The good thing about anxiety is that it’ll make you super prepared for the interview. Go knock them dead xxxx
Thanks - can’t imagine how I’m going to get through it at this stage. Last night was too tired and anxious to concentrate so haven’t done any preparation.
PDU - could going from 10-15mg cause another spike in anxiety? Felt like I was a little better on Sunday afternoon but all back to square one now. It feels like it’s getting better not worse. Really panicking that the fact the anxiety isn’t easing at all means that I’m not going to be able to keep taking the drug as it’s increasing my anxiety instead of easing it. Can you have the awful heightened anxiety for 2 or 3 weeks before it eases, instead of just one?
panic_down_under
07-10-19, 22:30
PDU - could going from 10-15mg cause another spike in anxiety?
Unfortunately, yes. But it tends to be less severe that at the beginning and not continue for as long.
Should it stick at 15 for a while or go up to 20 today since I already feel so bad
hi all
i am on day 11 today (yesterday and today 15mgs, rest 10) and I still have terrible increased anxiety - much worse than before I started - and now insomnia as well. This is my second time on it and I don’t remember it being like this last time. Im really worried that the fact that it isn’t easing at all means that the meds are just not going to work this time. Just need some good news stories from people where the first few weeks were really bad and then things got better. Thanks heaps.
Mrsmitchell1984
08-10-19, 06:53
It does tend to be worse the second time around - I remember the first time I had fluoxetine and it worked pretty much straight away but the second time I had to take a week off of work for the first week x
Mrsmitchell1984
08-10-19, 06:54
But after that it got better.
When are you seeing you doctor and how did the interview go? X
panic_down_under
08-10-19, 07:09
Im really worried that the fact that it isn’t easing at all means that the meds are just not going to work this time.
The severity of side-effects, or the lack thereof indicate nothing about the likely effectiveness of the med as most are generated by other organs of the body, not the brain.
Hi
This is just a courtesy reply to let you know that your thread was merged with another of your threads.
Please when posting on similar topics add it onto your previous post rather than starting a new one.
It is nothing personal it is just to make it easier for people to follow your story and to give you advice as a whole.
Elen
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