Restarting Citalopram after a few years....new side effects

[Justanutter]

Hi. Ive successfully taken Citalopram on and off over the last 25 years but now haven’t been on them for the last 3. Felt the need to go reluctantly go back on them after an extremely stressful year and ongoing issues but having some awful side effects this time. Never had any before. Nausea, lack of appetite, bit faintly feeling of a morning, can’t sleep and worst of all, a weird sensation in the upper abdomen region which is horrible and keeps me awake, the strangely disperses in the morning. Getting bad low blood sugar episodes too.

Anyone know why I am experiencing startup symptoms this time around?? I’m taking 10mg and am on day 9. I just generally feel unwell. Don’t want to do anything or move from sofa.

[panic_down_under]

Hi. Ive successfully taken Citalopram on and off over the last 25 years but now haven’t been on them for the last 3. Felt the need to go reluctantly go back on them after an extremely stressful year and ongoing issues but having some awful side effects this time. Never had any before.

You've been lucky. Unfortunately, there is growing evidence antidepressants, especially the SSRIs, may become progressively less effective every time they are stopped and restarted, often requiring higher doses to achieve the previous level of control, or not working at all. They may also produce progressively more severe, and/or different, initial side-effects each time too. Two studies, Amsterdam JD (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5123793/), 2016 and Amsterdam JD (http://www.karger.com/Article/FullText/226611), 2009, found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Bosman RC (https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/30041180/), 2018; Amsterdam JD (http://www.ncbi.nlm.nih.gov/pubmed/18694599), 2009; Leykin Y (http://www.ncbi.nlm.nih.gov/pubmed/17469884), 2007; Paholpak S (https://www.ncbi.nlm.nih.gov/pubmed/12501907), 2002).

The above makes a compelling argument for remaining permanently medicated, imho. Something perhaps to discuss with your GP, or psychiatrist.


Nausea, lack of appetite, bit faintly feeling of a morning, can’t sleep and worst of all, a weird sensation in the upper abdomen region which is horrible and keeps me awake, the strangely disperses in the morning. Getting bad low blood sugar episodes too.

Not sure about the blood sugar levels, but for the others, the most serotonergic organ of the body isn't the brain but the gut which makes about 50 times more serotonin than the brain. The gut from the gullet to the anus is controlled by its own mini brain, the enteric nervous system (http://www.scientificamerican.com/article/gut-second-brain) (ENS) and it may be more affected initially by SSRIs than the brain is. The body usually soon responds by down-regulating serotonin synthesis and expression with most of the side-effects then beginning to diminish.

Ginger and/or vitamin B6 supplements are often effective for nausea.


I’m taking 10mg and am on day 9. I just generally feel unwell. Don’t want to do anything or move from sofa.

This is fairly typical. :sad: There isn't really anything that can be done to speed things up. ADs work by stimulating the growth (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC60045/) of new brain cells (neurogenesis) in the twin hippocampal regions of the brain and they provide the therapeutic response. The entire process from cell budding to maturity takes about 7 weeks (http://cshperspectives.cshlp.org/content/7/9/a018812.full), however, some improvement may begin 2-3 weeks before full maturity

[Justanutter]

Thanks for your detailed response. I feared that might be the case. On top of this dr would prefer me to try a different AD, as Citalopram at high doses has contraindications with Sotalol, the BB I take, not that I take the problem dose. However, after a dreadful experience with Sertraline and Prozac in the past, I won’t be doing that so looks like I’ll have to ditch the ADs and suffer on.

[panic_down_under]

On top of this dr would prefer me to try a different AD, as Citalopram at high doses has contraindications with Sotalol, the BB I take, not that I take the problem dose.

Unless you have Congenital Long QT syndrome (https://en.wikipedia.org/wiki/Long_QT_syndrome) (LQTS) the risk from taking both citalopram and sotalol is very low. I've been on a potentially much more cardio toxic AD, dosulepin, at above the recommended maximum dose for decades and more recently switched to solalol from another BP med and there has been no prolongation in QT interval (https://www.nps.org.au/australian-prescriber/articles/drugs-and-the-qtc-interval) prolongation in the two ECGs (EKGs) I've had since the switch. Many meds may affect the QT interval, the CredibleMeds website (https://crediblemeds.org/) which maintains a data base of these meds on behalf of the FDA list over 300 medications. There are quite a few cardiovascular drugs on the list, including solalol.


However, after a dreadful experience with Sertraline and Prozac in the past, I won’t be doing that so looks like I’ll have to ditch the ADs and suffer on.

SSRIs and SNRIs are not the only ADs, nor, arguably are they even the most effective. There main claim to fame is being safer in overdose and this isn't true of all of them. Tricyclic class ADs (TCAs) are often more effective and the 3 most prescribed TCAs, amitriptyline (Elavil), clomipramine (Anafranil) and imipramine (Tofranil) are rated as having lower potential impact on QT than citalopram/escitalopram and sertraline. Fluoxetine has the same lower risk as the TCAs.