Coping with Early Stages of Citalopram

[keithwms]

Greetings. I just joined this site after reading some helpful tips here. It is my goal to find my way back to "normal" and eventually help others.

First off, I have read Psycho Poets citalopram guide to survival here, and it is quite helpful. I don't aim to compete with that glorious epistle! Rather, I thought I'd chronicle my experiences with citalopram, pose some questions, and offer suggestions / help whenever I can.

Quick background on me: I have had a lot of stress / anxiety /depression lately, and for good reason. After setting up my whole life to be a university professor and doing that, I reached a brick wall in my career. Okay, I didn't just reach it, I went head-first into it. I don't really want to go through the details, but let's just say that some very rough things happened to me around 4 years ago, things that shouldn't happen to anybody. I was happily installed as a professor, doing research and teaching at a fine school. I graduated two PhDs and many undergraduates, was productive, loved my students etc. And then some nasty departmental politics...

I was completely defenseless. I'd spent my whole life, literally form age 7 or so, building up the way I valued myself and preparing myself for that one career plan. then, after spending ~25 years going down that career path and doing really, really well, suddenly I felt casually cast aside. I was completely devastated, like life wasn't worth living any more. Not a good thing for an energetic young fella in his thirties.

What happened next was something rather miraculous; I still don't know exactly how it happened but I suppose an angel was on my shoulder. I got my bad news four years ago and somehow found the fortitude to prepare a resume. Within three days I was on a totally new path, a rather exciting one. I won't go through all those details just now except to say that a lot of people think I should be happy. But the reason I am not is that I miss my students so desperately. I am, to the depths of my soul, a teacher; the "kids" are like children to me and that bond is something I miss so very much. And they miss me too, so it's just very, very rough.

Recently my moods started taking a dip again, and I sought help. I had some treatment before, which kind of / sort of helped for a year or so, but I admit that I didn't really commit as I should have to that process. Now I am committed. Really. I hope!

So that's the intro; I hope it wasn't too long and boring. Now I'll describe where I am with citalopram and describe things as I go. Please feel free to comment, offer advice (please!) ask questions, get to know me, and let me know if I can help you.

---------- Post added at 10:29 ---------- Previous post was at 09:57 ----------

I began citalopram 12 days ago and it's been... rough.

First off, before starting, I told my doc that I seem to have pretty big responses to such meds; I've been given SSRIs on a couple occasions before and always felt very jittery and anxious. So we agreed to go with 10 mg daily at least for a few weeks, to see how it goes.

So... as expected... my first two weeks have been very difficult. I have had gastric upset, mostly due to the pangs of anxiety, I believe. My sleep is not good; I'm probably down to a few hours of quality (?) sleep per night. I typically wake up with the racing mind, just fixated on something which then causes more anxiety. Some general descriptions of what I am experiencing:

Wired/tired feeling: feeling very tired (probably due to lack of REM sleep) but at the same time unable to sleep. This is a bit like those times in college when I had to do a long assignment and caffeinated myself to get it done... and didn't sleep for a day or two. It's very unnerving not to be able to just close the eyes and doze- even brief recovery naps are difficult. I don't know any remedy for this but perhaps beta blockers might help. If I don't feel some relief soon, I'll ask my doc.

Racing thoughts: the mind wanders to all manner of subjects, and seems to be selecting those topics that will cause the most anxiety It's as if there is a catalogue of everything that can upset me and the mind just keeps running through it, back and forth. It takes real concentration to stop this; you have to figure out how to nip it in the bud and interrupt it with something that requires some thorough concentration. I find walking, driving, and diving into work to be helpful.

Fixation: this conspires with the racing thoughts to leave me feeling really unpleasant. What happens is that the mind races to some subject that really causes anxiety, and then I get stuck in a rut thinking about that one thing. Again, the best remedy I've found is to find something that requires concentration. For me, when I'm not exercising or working, that's playing piano and chess. Cannot let the mind go where it wants to!

Desperation: an example would be when I visited family and told them I needed to take a nap. I went in my room, shut the door, and attempted to nap.. but couldn't. Soon I found myself crying and wishing there were some alcohol or something so that people wouldn't see me this way. This gets really rough at times and again it's important to know what to expect, and to have a strategy including a support system.

My basic strategy for coping is as follows. First of all, I think it is imperative to have full disclosure about what you're going through with at least a few friends and family members. This is not something to be ashamed of; just put it out there and let them know that you may need their help and patience, and remember that most people like to feel helpful. So let them know how they can help, and trust...

In case it helps, here is a paraphrase of what I told some of my family:

"My doc and I discussed my mood swings and we think it's a good idea to try some meds. I've researched the meds and I expect to be feeling pretty rough for several weeks. I will have ups and downs before I start feeling better. It'd be really helpful to me if you'd check in, be patient with my moods, and don't freak out if I get weepy or anxious or just generally weird; a lot of people go through that in the beginning. Just please try to be encouraging to me and bear with me while I work through this."

And, so far, my family and friends have understood and are standing by me. This means so much to me.

Apart from the family/friend network, I do think it's important to have regular contact with a therapist. I began weekly visit with a therapist from 2 weeks before I began citalopram, so that is helpful. She can chronicle my progress and provide encouragement... and spot any major issues, I hope. Plus, the goal is for her to help me start to tackle the deeper issues, once I'm in a good enough place to start that process. Not yet. So far she thinks (and I probably agree) that I have PTSD issues due to the experience described above, and we expect it to take several months before we can really tackle that.

[Geoff78]

Hi Keithwms

Interesting post. I can relate to all of those symptoms and Iv'e not even started to take my Citalopram. I can't muster up the courage to start after scaring myself reading these boards. I kinda wish I just not looked online at what the side effects were.

Having said that, after reading your post I kinda figure that if I'm feeling like that without anyway how much worse can it be if I take them!

I shall follow your progress with interest. All the best.

[keithwms]

Geoff, I totally understand your fear about starting. A few years ago, I had a prescription for another med*** and actually got the bottle and it sat on my shelf for several months before I finally gave in. I was depressed about being depressed! And there were horror stories online... it took along time to sort through it all.

Without knowing your circumstances etc, I certainly wouldn't aim to coerce you into starting. But I'll say this: don't be afraid of the known, temporary side effects. There are several known things that'll happen and that's just your body responding to a new sheriff in town, acting to regulate the serotonin. As long as you know what to expect and prepare accordingly, you'll very probably be just fine and start seeing benefit soon. There are many excellent tips for coping with the starting symptoms.

Another way to think of it, perhaps set a goal for where you want to be at the end of summer. Or by the Christmas holidays. Think longer term, not how you're going to feel for a week or two or three. This is about long-term wellness.

The known, temporary side-effects can be dealt with, and there are good strategies. I am happy to share mine if you wish. The really bad side effects are very rare, and we all have to watch out for them. But if you have the right support network, you'll be able to separate the temporary stuff out and deal with it.



***Venlafaxine, which I have to say is a very different kettle of fish.

[Geoff78]

Thanks Keithwms - I certainly am depressed about being depressed and I know that acceptance is where I need to get too. I just keep thinking "how have I ended up feeling like this"

The point you make about looking at it from a long term perspective is something I have not thought about before. I keep coming up with reasons for not starting but I'm just not getting any better so I have booked an appointment back at my doctors tomorrow to discuss. I have been taking Zimovane to help me sleep and I want to know if I can continue to take as Insomnia seems to be one of the main side effects talked about.

Have you taken citalopram before? I'm just wondering if there is anything else out there that is worth asking to try before citalopram. The posts on the Mirtazapine forum seem ti suggest it has far less side effects so I'm tempted to ask if I can try that first.

Good luck for tonight and thanks for the kind words of support.

[keithwms]

This is my first tour with citalopram. Another similar med that I considered with my doc is lexapro, but we thought we'd try the citalopram.

Past experience: way back in grad school I got depressed due to a really crazy work schedule and had difficulty with anxiety etc; my doc put me on prozac. That was not good; I felt very jittery and never reached anywhere I wanted to be and quit after a few months. Then I had disorienting brain zaps for months, which was fairly terrifying.

A few years ago, I followed some rather poor advice from an inexperienced doc and tried venlafaxine. That is something I would definitely not recommend unless it is absolutely necessary. I had rather difficult time settling into it, but finally I got up to a low dose and stayed there for a half year. I had decent benefits during that period. But I did a fair amount of research and learned of the problems people have coming off it, so then wanted to get off it ASAP, because the discontinuation issues appear to be much more extreme if you stay on it a longer time or go to a higher dose. So then I stopped after a brief taper, and it was just horrendous, even thought I was coming off the very lowest dose available. I could write pages about how hard that was! Hence it was very important to me that citalopram discontinuation isn't that bad, and that the half life is high enough that I won't get thwacked if I do miss a dose by chance.

So... of the meds out there, my doc and I landed on citalopram and decided that'd make sense. We talked statistics for my age group and symptoms, side effects, typical discontinuation experiences, the half life issue etc. The only other one that came close for me was lexapro.

My understanding is that there's really no question that citalopram will mess with your sleep for a while. You might be able to take something else to help cope with that, but it's something to expect and strategize around. With me it gets better each day. But if you can, I would think about cutting back on critical work for that second week or so... anything you can do to take a little pressure off.

Have a good visit with your doc, get it all out there on the table and ... don't be afraid!

[Geoff78]

Hi keith,

Just to let you know I went to see my doctor this afternoon and she has prescribed me Amitiripyline. They sound a lot easier on the SE's than Citalopram and also help with sleep so I'm going to give them a go. Not sure if you have any experience with this medication?

I will still follow your progress with interest.

All the best.

[keithwms]

Glad to hear you got a good consultation, Geoff. I am not familiar with that med but just read a bit and I'll be curious to hear how it goes for you. Best of luck with it!

[Sparkle1984]

Keith - I just re-started cit 6 days ago and I can relate to the side effects you mentioned in your first post. I've started my own diary thread on here to keep track of my day to day symptoms.

Geoff - I'm not familiar with Amitriptyline but there is a separate sub-forum for it on here: http://www.nomorepanic.co.uk/forumdisplay.php?f=91

[keithwms]

Appetite back!

It might seem like a small thing, but my stomach upset has finally abated enough that I can enjoy eating most of my meals. The urge to eat came back quite spontaneously... suddenly I just felt hungry and raided the fridge. And there was no guilt or nausea! Good thing, too... I am down around 5 lbs since starting citaloparam.

I do still have some general stomach upset in the morning which makes breakfast difficult. And know that I really need to eat before I take the citalopram. Thus I have been downing a portion of a protein bar just so I have something in the stomach when I take the pill.

My sleep patterns are still not normal, though I have apparently regained my ability to nap, which is helpful. For the last few days, with the wired/tired feeling, I couldn't nap at all- I'd just lie there with conflicting urges to go to sleep or get up and do something.

The quality of my regular nighttime sleep is still soso. I seem to be able to fall asleep alright, thank goodness. But then I wake up very early, usually with a discomforting thought in my head. So the mental fight begins bright and early So... I try to give myself something to look forward to... a nice bath. And I had an epiphany in the bathtub this morning! Namely, that this process of developing strategies to cut short my negative thoughts right when they start may actually be a major benefit of this treatment. Yes, I am saying that the bad stuff associated with starting the med may actually contribute to the good effects in the long term. I think I'll stick with that theory...!

So... perhaps I am rounding a corner, entering week 3. We'll see. I have rebounded quite well from a few dips, so I hope I am gathering some forward momentum.

I am a bit worried about increasing my dosage; I started at 10, and my doc thought I should probably dial that up to the normal 20 in another week or so, but I am reluctant. Maybe I'll just stay put for a while and see what happens.

[blairwaldorf]

Keith, just wanted to thank you for your advice about having a network. I decided to tell my good friends what I was going through and asked them to be my buddies for the times when I feel extra anxious or panicky in public.

It feels great to know I have people watching out for me and if I have to leave a situation early or go get some air, I know they will be by my side.

Thanks again, and I hope your 10 mg continues to stabilize!