Citalopram - help and advise PLEASE!!!

[Spot-the-frog]

I just don't know where I am with Citalopram anymore!

I think the medication/dosage as advised by my doctor over the past 8 weeks has been changeable to say the least.

8 weeks ago I was prescribed 20mg fluoxetine which I took for just under 3 weeks and I felt no different, still very depressed and extremely anxious so my GP changed me over to Citalopram 20mg. I took these for 2 weeks, went back to my GP and he told me to up them to 40mg as I was still struggling badly in the mornings. I decided that I would take 30mg for 2 weeks before going up to 40mg. After a couple of days on 30mg things really looked up and I began to see the light at the end of the tunnel, the second week on 30mg and I began to feel almost normal and I started doing things and going out and then out of the blue at the end of the second week on 30mg I had a massive panic attack that lasted ages and totally freaked me out. I was back to almost square one and spent the next 3 days in bed feeling depressed, panicky and having dark thoughts. I then decided to take 40mg (as advised by my GP) and am now on the second week of 40mg. Well, I don't feel good, I feel anxious (especially in the morning), I have an upset stomach, hot flushes and headaches and my mind is racing. I can't believe that I seem to have gone backwards and I am so down and scared about this.

I don't know what to do now. Shall I stick with 40mg for another week and give it a go? Should I go back down to 30mg? I am going back to work week after next so I need to get this right, I have had so much time off already and this is playing on my mind.

Any advise, help, thoughts will be so greatly appreciated!!!!!!

Thanks
Kx

[NoPoet]

Hi, this is all normal. Medication tends to make people feel worse at first but if they endure and are on the right dose, they start noticing their symptoms improve within a few weeks. This part is a beginner's trap, since people think that they are recovering just because they feel some relief from their symptoms. When their symptoms come back, which they are bound to do out of habit more than anything else, the person despairs and feels that the medication isn't working. The doctors, possibly sympathetic but probably unprepared to deal with anxiety or depression in a patient, increase the dose or change the meds. The whole cycle repeats and the sufferer learns to believe that there is no hope for them.

As I said, this is just a trap for beginners. As you get more experience, you learn to realise how your illness works, and that the eventual cure for it comes from a changing of your beliefs, attitude and behaviour. The medication is just a crutch - they're like the bodyguard that leaps to muzzle your attacker, but the attacker is stronger and more determined, so in the end you will have to face it yourself.

Read my citalopram survival guide (link in my sig) and you will find a lot of stuff in there that seems familiar, but shows you a new way of thinking about them.

[chicaplatense1]

Hi Spot,
I think that when you had the Panic attack coming back it was just a blip and you were on your way to getting better. I think I did exactly that. I was beggining to feel better on 20mg at 5 weeks, side effects were wearing up. I rememberI was beggining to get excited about life and then I had a massive Panic Attack at week 5 after a nap. I then convinced myself (with my doctor's help) that 20mg wasn't working and I increased the dose at 7 weeks but then I started to feel worse after the dose increase, probably due to the return of side effects.

I probably would have been ok if I had just taken a Klonopin on those days instead of increasing. I went back down to 20mg. My new philosophy is stay on the lowest dose possible and if you start to get Anxiety again give it time to get better on its own instead of increasing right away. If necessary take some Anti-Anxiety medication for a few days and see if that helps get you out of the dark thoughts.

You will feel better! I know it! If I start feeling bad again I am prepared now to just ride it out and I know that if I do this the bad patch will be just that, "a patch" and then it will get better again.... It will be the same for you. Don't believe the lies of Anxiety. :-)

[flori]

Aw Spot the frog
I hope you feel better soon

[keithwms]

Spot, I am sorry to hear about this, it sounds like your dosing and planning is all over the place.

I think you really need to settle on one dose and adhere to it until the primary side-effects have faded enough to judge if there is real benefit. As you'll find in so many other testimonials here, changes of dose -up or down- are almost always accompanied by all manner of unpleasant (but temporary, thank goodness) side effects).

Roughly speaking, it seems that the absolute earliest that most people start to see benefit is ~2 weeks in, with many people not really feeling the love 'til something like 2 months.

One observation I have made is that some assume higher dose equals better results more quickly. I don't see evidence for that; it seems most of us feel pretty anxious and uncertain of benefit after any dose change for several weeks. I got past the primary side effects (nausea, loss of appetite, inability to sleep) in week two and now, in week 3, I have quite a lot of anxiety to work through. But I do seem to be gradually developing some distance between myself and the emotions, by which I mean I can talk about it and recognize when some way of thinking is taking me down the wrong path. So that's progress. Only after I stabilize some more will I consider a dose change... otherwise I'd worry that I could lose my investment thus far. Maybe that is a helpful way to think of the starting symptoms, as an investment.

I certainly hope you start to stabilize and feel some benefit soon. And I hope you have a support network there- people with whom you can disclose how you feel and get some feedback.

Best wishes.

[Spot-the-frog]

Yes I think I do need to stick to one dose but I am not sure which one now! I am so confused as to what is the right thing to do. Currently I have been on 40mg for 2 weeks and still feeling rotten. Do you think I should stick with the 40mg? I was ok for about a week but now feel dreadful so am thinking should I go back down to 30mg? I really need to sort this out! Help!

[keithwms]

Yes if I were you I think I would stick with 40 well past two weeks. It's all individual and hard to say exactly what you should do... but it seems that for many of us, the period of real improvement after any dose change starts around 2 weeks later and reaches really noticeable returns around the 8 week mark. Thus I am concerned that you're just feeling starting/stopping issues and haven't gotten into any sort of rhythm yet.

Now, I have to say, I can't tell what 'dreadful' means in terms of effect on your life right now, so please speak with your doc and preferably also therapist about that and decide whether it is something that you can soldier through for a few more weeks or not. If you can identify specific problems e.g. anxiety attacks then they may have some temporary relief for you e.g. with beta blockers. But the main thing is you need to talk with them about specific things your experiencing. I.e. see if you can break 'dreadful' into specific things. Maybe if you tell us about that then we can be more helpful

My experience (now at the end of my 3rd week at 10mg) is that the side-effects are still there for two weeks at least.

I just now started to feel well enough to go to my recommended dose of 20... just started that today, fingers crossed! My decision was based on (1) side effects now manageable and I'm not terrified to try higher; and (2) I got a brief glimpse of good benefits but that faded, as might be expected for insufficient dosage; and (3) my doc and I researched and concluded that 20 is my likeliest solution.

I would *not* go back down if I were you. Your body needs to equilibrate with the dose for at least a month, otherwise you're just fighting through side effects. And there side effects for going up or down in dose seem to be fairly similar for many people.

As always, please discuss these things with your doc and therapist and make a plan, get it on the calendar, and stick to it! Don't ask yourself how you feel every minute or every hour, that's not productive. Think in terms of where you want to be in two months. Please try to develop a longer-term goal and perspective; we all need to get past the fear of every step...

I'm here with you and want you to recover with me! So... keep the communications flowing!

[Spot-the-frog]

Thanks Keith. I really wish I had read more about Citalopram and the effects before I chopped and changed the dosage. With hindsight I would of stayed on 20mg for much longer, but you know how it is, you speak to your doctor, you trust him and I just followed his advise. I have decided to stick to the 40mg for now, I will give it another 2 weeks (that will mean I will have been on it for a month).

I started counselling last week and have my second session tomorrow, when we are going to put a plan into place. Last week was mostly taken up with the counselor getting to know all about me and my anxiety and depression. The company I work for are paying for these 6 sessions, and I have also been referred for 1-2-1 CBT therapy with the NHS (unfortunately there is a 12 week waiting list).

I am trying to be more positive, to change the way I think but I am finding this very difficult. I am worrying about the amount of time I have had off work and worrying about going back which maybe triggering the anxiety.

Thanks for your help.
Karen x

Face the fear and do it anyway!!!!

[keithwms]

I'm glad to hear that you have a structured plan, Karen. I find that thinking longer-term e.g. expecting to be stabilized and happier in two months is very helpful to my overall outlook.

Like most people, I find that the quality of mental health advice from GPs can be pretty variable. I worry that one GP may not have much experience with citalopram and thus may not be able to give good counsel on how long to try a particular dose. But we are all very, very fortunate to have internet resources such as this forum where we can double and triple check things, and talk through our concerns.

I t may well be that 40 isn't right for you, but look at it this way, if you do the different doses in a methodical way then you should have it sorted in a few months and then be converging toward a good result. Again, we all have to try to think about the longer term result.