Increasing from 20-30 - positive stories? [Archive]

Windywel

31-10-19, 20:43

Hi all I’ve been told not to do this as its not supposed to be helpful for my recovery but feeling really hopeless this morning. 5 weeks tomorrow on cit second time for anxiety. Today is day 18 on 20. I don’t really feel like there has been any improvement and my psych said there should have been some by now. He wants me to keep going for another week and a half or so then evaluate. I don’t think its working this time, I’m still more anxious than I was before I started the meds (they made everything worse because I became really anxious about the meds not working and the side effects) and I don’t understand why when it worked so well last time. I’m feeling a bit desperate as I cant stay like this. I’m supposed to be going to in to work but I’m sitting in the car crying 😔

Windywel

31-10-19, 21:52

Also PDU I was hoping you might be able to advise on propranalol. As you know I’ve been taking it intermittently for the morning anxiety, either 15 or 20mg. It does lower my heart rate, at times down to 59/60. Should I be worried about that? Thanks

panic_down_under

31-10-19, 21:58

Hi all I’ve been told not to do this as its not supposed to be helpful for my recovery but feeling really hopeless this morning. 5 weeks tomorrow on cit second time for anxiety. Today is day 18 on 20. I don’t really feel like there has been any improvement

I would not expect an improvement after only 18 days on the recommended minimum dose. Neurogenesis is not a fast process, it takes about 7 weeks (http://cshperspectives.cshlp.org/content/7/9/a018812.full) for new cells to bud, grow and mature, but improvement in mood may begin earlier, typically from around week 4.

and my psych said there should have been some by now. He wants me to keep going for another week and a half or so then evaluate.

That isn't the experience of most. Yes, some begin feeling great within a few days, the placebo effect is a truly wonderful thing, but it isn't reliable and tends not to last that long.

I don’t think its working this time, I’m still more anxious than I was before I started the meds (they made everything worse because I became really anxious about the meds not working and the side effects)

Which is likely part of the issue, although not the only reason. An anxious mind expecting disaster is very capable of producing the very catastrophe it fears. However, increased anxiety in the early days of taking antidepressants, and especially the SSRIs and SNRIs, is also quite common. It is a consequence of the increased serotonin activity.

There is no way of avoiding either the psychological, or AD induced initial anxiety, but there are ways of minimising it with meds such as the benzodiazepines and sedating antihistamines, etc.

and I don’t understand why when it worked so well last time. I’m feeling a bit desperate as I cant stay like this. I’m supposed to be going to in to work but I’m sitting in the car crying 😔

While I suspect you might be looking at the past through slightly rose tinted glasses, the experience the second time around can be different than the first time, both in terms of the nature of the side-effects and their severity.

Unfortunately, there is currently no quick acting, side-effects free med that can be taken over the long term. However, as per above, there are meds which can help in the short term. Use them. No one is handing out gold stars to those white knuckling through the initial side-effects. It's counterproductive.

Windywel

31-10-19, 22:05

Thanks PDU - but wouldn’t the earlier weeks at 10 and 15mg count? With them in its 5 weeks with only minimal improvement ��

Windywel

31-10-19, 22:54

PDU - do you think I could still be feeling side effects from the dose increase at 18 days? Also I’m due to see the psych in a week and a half and I suspect that if I haven’t seen significant improvement by then he will want to increase the dose as he says he has patients with anxiety on 40mg. Do you think I should consider that or resist for longer? How do you know when to increase?

Windywel

01-11-19, 00:13

By the way I was really worried about what you were saying about benzodiazepines and their effect on antidepressants so I asked my psychiatrist about it. He said “There are rodent studies that look at hippocampal neurogenesis and benzodiazepines and very limited human studies about this. Also, there is no clear clinical significance or relevance of the results of these studies.” So I don’t think you should be saying that to people who have been adviser to use them by their clinicians but then become too scared to.

panic_down_under

01-11-19, 00:20

PDU - do you think I could still be feeling side effects from the dose increase at 18 days?

Yes. Plus, as per my previous reply, at least some of the heightened anxiety may be psychological

Also I’m due to see the psych in a week and a half and I suspect that if I haven’t seen significant improvement by then he will want to increase the dose as he says he has patients with anxiety on 40mg. Do you think I should consider that or resist for longer?

As you've been on citalopram before you may need a higher dose to achieve the same response this time. Whether you'll need to whole 40mg is unknowable. The options are to try 30mg for a while, or go to 40mg until the med is fully effective and then after a while dropping back to 30mg to test its effectiveness.

Personally, I've always need near, at, or above the maximum recommended dose to get a good outcome from ADs so am not stressed by that, but I do understand some prefer to take the minimum amount that does the job.

How do you know when to increase?

When there is still an inadequate response to a dose after a couple of months. Unfortunately, despite much effort, there is still no way of predicting whether an AD will work, much less how much of it will be required to achieve the optimal result. It is all trial and error, seat of the pants stuff.

Windywel

03-11-19, 20:56

keta

03-11-19, 21:23

Hi Windywel
my second time on Citalopram worked out well, I did have heighten anxiety the first few weeks from what I can remember , but eventually it all settled I was on Citalopram for 5 years after that and I wish now i never came off it now.
Stay positive , 18 days on 20 mg is not even 3 weeks , give it more time for your body to adjust. I m sure you will start to feel better soon.

Sparkle1984

04-11-19, 20:21

Hi is there anyone else out there that can provide some reassurance? Now 5 weeks in on citalopram second time (it worked really well the first time) - 3 weeks on 20mg, It has made my anxiety heaps worse and because of that im feeling heaps more depressed as well. i foolishly read several stories on here last week about people trying the same med a second time and it not working and then trying other things and that not working either. Im really worried that im going to end up like that. i guess im just looking for some reassurance from others that have gone back on the meds that it does take longer and is harder the second time but still comes right. i am just feeling really hopeless and scared.

I have been on citalopram 3 times, and it did take longer to work the second and third time. The third time round, I was pretty bad, and I remember how hopeless and bleak I felt in the first couple of months but I still managed to make a full recovery on 20mg. In my opinion, 3 weeks is still too early to think about increasing the dose.

Windywel

04-11-19, 20:41

Thanks Sparkle - did you have awful anxiety? If so how did you manage it during the first few months? How long did it take to see some benefit?

Sparkle1984

04-11-19, 21:57

Yes, I had awful heightened anxiety for the first 2 months. After that, I did start to see some benefit. After 3 months, I'd say I felt about 80% like my usual (non-anxious) self, but it wasn't until 9 months that I felt 100% my usual self. It was the most drawn-out anxiety episode I ever had. I also had CBT, which was very helpful in terms of learning new coping techniques. I found mindfulness meditation very helpful too, in fact I still use it on a daily basis. I use the Calm mobile app for that. :)

Windywel

05-11-19, 02:33

Thanks Sparkle. Was that 2 months from starting on 20mg?

Windywel

05-11-19, 05:24

Is it normal to feel physically horrible as well mentally horrible in the early stages of taking citalopram? My psychiatrist has got me taking lorazepam more regularly but if I don’t take it I just feel horrible. Physically anxious, bit fluey, achy, headachy, just yuck. Assume these are side effects of the meds. Should this still be going on after 5 weeks?

panic_down_under

05-11-19, 09:11

There are rodent studies that look at hippocampal neurogenesis and benzodiazepines and very limited human studies about this.

That is because the living aren't thrilled to have their brain dissected to prove it is just as valid in humans. Go figure. But the latest study I cited, Boldrini M (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374628/), 2014, is based on post mortem examination of human brains.

Also, there is no clear clinical significance or relevance of the results of these studies.”

Says who? Those doing the research must think it important. Does he believe BZDs can cause depression? If yes, what mechanism does he propose to account for this? Could neurogenesis inhibition be it?

So I don’t think you should be saying that to people who have been adviser to use them by their clinicians but then become too scared to.

I have not said to not take BZDs, just cautioned that their use be limited to treating the initial increase in anxiety when first taking ADs and after dose increases and then only for occasional breakthrough anxiety thereafter and cited the reasons why. What you choose to do with this is up to you.

I don't believe in mollycoddling people. Many come here because their experiences with meds is at odds with what their doctors are telling them either out of, imho, misplaced attempts to jolly them along by downplaying what they are going through, or out of ignorance. I'm not about to do the same. The anxious are far more resilient than many doctors credit. They deserve to be told the truth about what they face so they know what is and isn't 'normal', not have their hands patted sympathetically while being told everything is going great when it clearly isn't.

If you find that confronting then I urge you to block me by clicking on panic_down_under at the top left of this post and then View Profile, you should then see a Add to Ignore List link in the left column. This will block my posts from appearing in your feed.

Windywel

05-11-19, 09:23

I don’t want to block you I find your advice very useful - I just think you should be careful about citing studies that are not definitive. Anxious people are anxious and whilst we often look for information from different sources we need to be able to trust the information we get is from credible sources. I’m not sure that limited studies on benzodiazepines in rats counts as a credible source. Perhaps just good to mention that.

panic_down_under

05-11-19, 10:32

I’m not sure that limited studies on benzodiazepines in rats counts as a credible source.

Then you'd have to throw out the bulk of anxiety and depression research. The rat/mice model of anxiety and depression is considered a valid one. Brains, whether in mice or men, respond the same when stressed.

Sparkle1984

05-11-19, 19:28

Thanks Sparkle. Was that 2 months from starting on 20mg?

I started on 10mg then went up to 15mg after a week and finally up to 20mg after 2 weeks. So it was 2 months after starting on the 20mg. My side effects were both physical and psychological. You can see more on my day-to-day diary of restarting the meds at https://www.nomorepanic.co.uk/showthread.php?169765-3rd-time-lucky-!-My-citalopram-diary

Windywel

05-11-19, 20:20

keta

05-11-19, 21:04

Hi Windywel
i m on day 2 10mg so far , so will be interesting to see how I feel as this is my third or even fourth attempt the reading my old messages.
so far just feeling really tired and my stomach is bit off.
Stick with it , it will get better.

Windywel

08-11-19, 01:35

Hi all would be good to hear from others? 6 weeks tomorrow, 25 days on 20mg. Still not feeling great - in fact very depressed today. Just wondering when it’s ever going to kick in ��

Sparkle1984

11-11-19, 07:52

Thanks Sparkle - will have a read. Did you have a whole lot of what if thoughts about the medication not working? It’s really slow this time and I’m really scared it’s not going to work. How did you manage those thoughts? The problem for me is that I was like you and went back on the cit cos I thought I was nipping the depression and anxiety in the bud but instead going back on them has made everything worse cos it ramped the anxiety up, I then get anxious about being anxious and totally focussed on whether the meds would work then all the health anxiety came back, all the negative thoughts and here where are!! I saw my psychiatrist yesterday and he said to stick to the plan as it would be unusual for the cit to not work again but it’s still hard to feel positive when it’s taking so long. Your story is reassuring though as I am only 3 weeks on 20. Hard to imagine another 5 or so weeks of this but I will just have to try and stay strong. I was really hoping to be better by Christmas. Would be awesome if you could keep supporting me - thanks heaps

Yes, I had loads of those "what if the meds don't work this time around?" thoughts. I dealt with those thoughts by reminding myself that there are several medications available other than citalopram, so even if it doesn't work this time, there is bound to be one which does.

It was very tough. However, I think there is a very high probability you'll see an improvement before Christmas. You may not be totally 100% by then, but you will probably feel better than you do now.

Windywel

18-11-19, 01:26

Anyone else on 30mg of citalopram? How do you find it? Did you have side effects going up from 20 to 30? I have been on citalopram before but only ever on 20 but it hasn’t worked that well this time and it looks like I’m going to have to go up which I am very nervous about.
many thanks

Mrsmitchell1984

24-11-19, 07:59

I am no doctor -and you should always speak to them for advice rather than me. But when I went up from 20mg to 40mg on fluoxetine - I had one bad night but otherwise was absolutely fine x

Windywel

24-11-19, 20:32

Thanks Sally - are you on 40 now?

keta

27-11-19, 18:25

panic_down_under

27-11-19, 22:12

I went once to 30mg in the past and have to say it made me so tired that I couldn’t function properly, so lasted only few days, saying that , that was the only side effect from that dose increase I had.

Interesting as insomnia is one of the most common SSRI side-effects. Was it also sedating when you first began taking citalopram?

Windywel

27-11-19, 22:33

I am also still having trouble sleeping after 8 and half weeks, 6 on 20. Wake during the night for short periods then wake at 5.

panic_down_under

27-11-19, 23:09

I am also still having trouble sleeping after 8 and half weeks, 6 on 20. Wake during the night for short periods then wake at 5.

As per my previous post, sleep issues, especially insomnia, are among the more common SSRI/SNRI side-effects, especially at the beginning. They do usually diminish after a while, but can linger in some. The usual treatment is low doses of a sedating antihistamine such as mirtazapine, doxepin, or trazodone taken about an hour before lights out. Melatonin may also work.

If this persists another possibility is switching to escitalopram (Lexapro) instead. Citalopram and escitalopram share the same active chemical, the 'S' isomer of citalopram, aka escitalopram, with citalopram also containing the mostly inactive 'R' mirror image (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC314378/) form which is a poorer fit biologically and so is mostly inactive. While they perform nearly identically in treating anxiety/depression their side-effects can be different. No guarantees, but there is a good chance the sleep issues may diminish with escitalopram. Because they are essentially the same med there should be no traumas when switching overnight, nor should kick-in be affected.

Windywel

28-11-19, 01:06

Thanks PDU. I’m still get the occasional burning sensation anxiety spell thing too. I know it’s a side effect as I didn’t get it before the meds and it was much worse at the beginning. Do you think that is likely to go?

panic_down_under

28-11-19, 09:21

I’m still get the occasional burning sensation anxiety spell thing too. I know it’s a side effect as I didn’t get it before the meds

Burning sensation of the skin? That is a side-effect of most serotonergic ADs. The skin uses about as much serotonin as the brain. It usually does ease after a while, but as with everything about ADs, this isn't a guarantee. The fact it has diminished in recent weeks improves the odds.

One other thing to be aware of is these meds increase skin photo sensitivity so apply sun block to exposed skin if going outdoors for extended periods.

Windywel

28-11-19, 18:51

Thanks PDU that’s really interesting - didn’t know about the photo sensitivity thing. Have you heard about people getting aching legs and burning feet as a side effect? I’ve really noticed it the last few weeks. The burning feet I especially get at night. Notice the legs in the morning (particularly thighs)

Windywel

28-11-19, 19:41

Re the skin thing I do remember having it at the beginning last time too but it did go away so hopefully it will this time. Do the other types of antidepressants not have the same side effects as SSRIs?

keta

28-11-19, 20:27

Interesting as insomnia is one of the most common SSRI side-effects. Was it also sedating when you first began taking citalopram?
It’s funny because it makes you feel tired on the other hand stops you from sleeping , I took my dose at 9am yesterday and slept tiny bit better so will keep taking it in the mornings.
windywel I get restless feet , mainly my right foot , it’s constantly on the move.
I sort of always had it but not as much as this .

panic_down_under

28-11-19, 21:56

Have you heard about people getting aching legs and burning feet as a side effect? I’ve really noticed it the last few weeks. The burning feet I especially get at night. Notice the legs in the morning (particularly thighs)

Aching feet not so much, but burning feet yes. Serotonin is involved in regulating blood vessel tone, constriction and dilation.

Do the other types of antidepressants not have the same side effects as SSRIs?

Depends on the AD. SNRIs have much the same side-effects, as does the TCA clomipramine which is the most potent serotonin and noradrenaline/norepinephrine reuptake inhibitor. The main side-effects of the other TCAs are constipation and dry-mouth.

Windywel

28-11-19, 22:10

Yes it’s the burning feet I have though its only really come on the last few weeks. Does it tend to be temporary or not? Also what about headaches?

panic_down_under

29-11-19, 10:36

Yes it’s the burning feet I have though its only really come on the last few weeks. Does it tend to be temporary or not?

Usually, yes.

Also what about headaches?

Yes, for the same reason as the burning legs, blood vessel tone. Or it might just be a headache.

Windywel

03-12-19, 21:02

Hi all I am 9 weeks on cit for the second time - 7 weeks on 20. Was feeling a bit better and had an ok week last week but having a major blip this week - depression, crying, some anxiety, sleep terrible again and I’m really worried that the meds arent/have stopped working. I’ve been worried all along that they wouldn’t work a second time. Is it usual to have such a major blip or is this a relapse to do with the meds not working - help please! I’m feeling anxious and scared.

panic_down_under

03-12-19, 21:38

Was feeling a bit better and had an ok week last week but having a major blip this week - depression, crying, some anxiety, sleep terrible again and I’m really worried that the meds arent/have stopped working. I’ve been worried all along that they wouldn’t work a second time. Is it usual to have such a major blip or is this a relapse to do with the meds not working

If it worked last week then there is no reason why it isn't this week, however, blips do sometimes occur, especially at the beginning and/or at low doses.

Windywel

03-12-19, 21:45

Do you know why they occur PDU? Shouldn’t the levels be stabilising now?

Sparkle1984

03-12-19, 22:57

Yes, it is normal to have blips during the first few months of taking the medication. I had the same. Hope you feel better soon!

Windywel

04-12-19, 03:09

Thanks Sparkle - Did you have quite major ones that lasted for a few days? Did you think about the increasing? Thanks heaps

panic_down_under

04-12-19, 09:56

Do you know why they occur PDU? Shouldn’t the levels be stabilising now?

Citalopram plasma levels will have stabilised within 7-8 days after the last dose adjustment. But the med has no direct affect on anxiety/depression. ADs are not aspirin, or benzodiazepines. The therapeutic response comes from the new brain cells the meds stimulate into growth and the interconnections they form, and that isn't a linear, or one time process, but goes on continually day after day after day. Not all the cells survive, in fact most die within a few days, nor do all the interconnections and synapses created survive. There is considerable fine tuning by 'pruning' as the cells settle into their tasks. It is an organic, not a chemical process, so can vary from moment to moment influenced by many factors, including your state of mind.

Sparkle1984

05-12-19, 13:48

Thanks Sparkle - Did you have quite major ones that lasted for a few days? Did you think about the increasing? Thanks heaps

Yes I did have some fairly major blips which would sometimes last a few days. I didn't increase though because I really didn't want to go higher than 20mg (which is the dose that had worked for me the previous time).

Windywel

05-12-19, 20:00

That’s the same as me. And did the blips eventually ease off? Were you still getting physical symptoms that were worrying you? That’s my problem and I wonder if I need to increase to stop the worrying which might hopefully stop the symptoms

Windywel

09-12-19, 23:01

Hi all I’m feeling really down and negative today. Had a terrible night with insomnia and now thinking that the meds arent doing anything except giving me side effects (8 weeks on 20 mg citalopram)
im better than i was for the first month but i still think im worse than i was before i started it again. Didnt have this insomnia or breathlessness or crying all the time. i had one bad panic episode related to severe pain from my IBS but otherwise was just a bit down and edgy. i said to my husband this morning i should just come off them but he got angry with me. The doc i saw yesterday has anxiety herself and she has been on meds for 18 years. she said i should probably have tried something different this time as i had been on the cit a while. she also said its a lot harder to treat the second time
I tried not taking the lorazepam yesterday to see how id go without it. i actually surprised myself and wasnt too bad- bit edgy and anxious but ok and i just cracked on with the day but it all went to custard at about 8.30 in the evening when i guess i was tired. Back to being anxious and breathless and tears again. So frustrating as i hadnt cried for a few days and id had a better day up to that point. i know part of the problem is that i keep putting these expectations on myself and get really frustrated when i feel like ive failed. Psych is still really keen for me to go increase as he thinks i will need that to get better but im just so scared of getting the side effects back, particularly increased anxiety and the awful burning sensations i used to get.
just feeling pretty hopeless and dark - really sick of all the crying. Will this get better?

Windywel

09-12-19, 23:42

hi all to recap i have been on cit second time for 10 weeks (8 on 20mg). There has been some improvement but slow and incremental and i am very up and down. My psych wants me to go up to 30 but i am really scared about it as i do not want the side effects back, particularly the increased anxiety and panic and the awful burning sensations. Anyone out there with positive stories about increasing? Many thanks

panic_down_under

10-12-19, 03:39

I tried not taking the lorazepam yesterday to see how id go without it. i actually surprised myself and wasnt too bad- bit edgy and anxious but ok and i just cracked on with the day but it all went to custard at about 8.30 in the evening when i guess i was tired. Back to being anxious and breathless and tears again. So frustrating as i hadnt cried for a few days and id had a better day up to that point.

If you've been taking lorazepam regularly then some of it may also have been from withdrawal.

Psych is still really keen for me to go increase as he thinks i will need that to get better but im just so scared of getting the side effects back, particularly increased anxiety and the awful burning sensations i used to get.

Requiring a higher dose than last time was always likely. Seems to me that there is no point taking a med at an ineffective dose. Yes, raising it may increase side-effects severity for a while, but doing so by only 5mg at a time should limit this.

Will this get better?

Yes, but you will need to help yourself. Procrastination rarely solves anything, ime.

Windywel

10-12-19, 03:46

Thanks PDU - how long do the side effects usually last when increasing? Doc also
suggested possibly adding in quetiapine but not sure about the metabolic side effects -don’t want to put on lots of weight again. I asked about pregabin as someone I know has just started taking it at a low dose and says it made her anxiety go within an hour and is having zero side effects but he didn’t seem to know a lot about it except in patients with chronic pain and GAD who take high doses and he said they find it hard to tolerate the balance and dizziness side effects.

Windywel

10-12-19, 03:48

I have been helping myself - working, counselling, walking, reaching out to friends, meditation - it just seems harder to treat this time and I’m very up and down. I need to get stable for my family.

panic_down_under

10-12-19, 21:39

how long do the side effects usually last when increasing?

Usually not long, a week or two, assuming there are any as it is by no means a certainty. Ramping the dose up in 5mg steps should significantly limit their severity.

Doc also suggested possibly adding in quetiapine but not sure about the metabolic side effects -don’t to put on lots of weight again. I asked about pregabin

I'm not a fan of poly prescribing. It can sometimes be necessary, but I don't see the value in taking multiple meds when one at the right dose may do the trick. Both may themselves trigger side-effects, both initially and ongoing.

I have been helping myself

I meant by increasing the citalopram AD dose.

Windywel

11-12-19, 04:00

Thanks PDU - have taken 25 today - assuming it would make sense to do a week of that and then go to 30? Doc suggested an even slower increase but that feels like it could prolong side effects and delay benefits.

panic_down_under

11-12-19, 04:38

assuming it would make sense to do a week of that and then go to 30? Doc suggested an even slower increase but that feels like it could prolong side effects and delay benefits.

The rule of thumb is to not increase doses before plasma levels of the current one stabilise to a steady-state. This takes up to 5 times the half-life of the med which for citalopram is 36 hours, so no sooner than 7-8 days. Increasing earlier may significantly worsen side-effects, however, delaying it further won't significantly lessen them in response to the next increase no matter how long the delay.