Day 16 of re-starting citalopram, anxiety is sky-high

[Sparkle1984]

I'm on day 16 of my second time on citalopram due to a relapse and I still don't feel any better. In fact, for the last 24 hours in particular, my anxiety has been sky-high and I'm still suffering low mood. I did have some side effects for the first few days, but since then it has honestly felt like I haven't been taking anything at all. It definitely feels like my own anxiety - in fact today has been my worst day since August last year (which was actually before I started cit for the first time). It feels like I've gone back to square one, considering I'm feeling as bad today as I did last summer.

This is how bad it's been for me - I've felt extra anxious since yesterday afternoon, even though I wasn't doing anything particularly stressful at work. This carried on all the way through the evening, even when I was at home. When I went to bed, I fell asleep fairly quickly, but then I woke up just after 2am feeling really panicky with intrusive thoughts about death and dying and I couldn't get back to sleep. I also kept getting weird scary thoughts about the "infinity of nothingness" that atheists believe happens after death. Without wanting to get into a debate about religion, I don't really believe in that theory but nevertheless it scares me when I'm feeling extra anxious.

This probably sounds ridiculous for a 29 year old (please don't laugh ), but I felt so bad I had to get in bed with one of my parents for a sense of security. Even then, I still didn't sleep very well, but I felt a little bit more secure. I kept having weird nightmares in which I either ended up going insane or dying!

I had to go to work today, and I felt awful as I couldn't have had much more than 4 hours sleep. I felt very on edge all day, as if I was going to have a full-blown panic attack at any moment. I found it hard to concentrate on my work, but I did my best and I managed to do what I wanted to do today. I had a hairdressing appointment and I felt panicky then, and for the rest of afternoon at work I continued to feel panicky. I felt constantly on edge, as if something bad was going to happen.

By the end of the working day, I felt exhausted. As I was waiting for the bus home, I suddenly felt an overwhelming urge to cry, which made me feel even more self-conscious in the middle of a busy city.

Is it usual to experience such heightened anxiety and depression 16 days in? It feels like I'm getting worse, not better. The first time I was on cit (last summer) I began to improve after just 5 days. Is there still a chance that I will improve, or is it not going to work this time around? When would I have to consider asking to increase the dose? (I'm on 10mg just like last year, and I never needed anything higher than that before). If I still don't feel better after increasing the dose, then I guess the next step would be to request a different medication? My usual doctor has just gone on maternity leave, and even though I'm supposed to have a review once I've been on cit for 3 weeks, when we called the surgery today they said there are no appointments available until 22nd June or something ridiculous like that! So if I'm still feeling really bad next week, I'd have to ask for an emergency appointment in order to make sure I can be seen before I go on holiday in 2 weeks time. I don't think I could bear to feel as bad as this on holiday, when I'll be hundreds of miles away from home.

If you've read my diary thread, you'll see that I have had some days where I've felt better than others, but I had that even before I went back on cit. This is what makes me concerned that it's not working. Please can someone reassure me?

Sorry for the long post.

[keithwms]

Unfortunately, yes, this kind of anxiety is similar to what I have also experienced, off and on. I gather we can expect these sorts of dips almost any time over the first two months, though they tend to rectify in a few weeks. Seems to me they usually have some catalyst, e.g. a piece of bad news or such, but it's hard for me to sort exactly where they start.

This isn't much of a medical explanation, but I think of this as a battle going on: the body is really fighting against the new substance. In that sense, the very things that the med attempts to address will tend to be more acute in the short term, because the body is wired to preserve the status quo. You have to be faithful that you and the med will win in the longer term.

Let me ask, are you doing other things to help deal with the anxiety? Have you considered requesting beta blockers or some other aids from your doc? It might be a good idea to request a small number of pills for a panic attack, should it happen; simply having them might be enough to make you feel more confident. And have you considered meditation or some other kind of routine exercise? Breathing exercises... anything that focuses you on something positive.

I have been able to channel some of my anxiety towards exercise, which has been helpful. What I do is get on an elliptical machine for a half hour or so a few times per week, which seems to be a good way to dump some nervous energy.

Sorry to read that you're having this setback, but... it's not unusual. As long as it isn't doing real physical harm to you, you should see some improvement soon. Maybe try to think of it as progress toward eventual resolution.

[Sparkle1984]

Thanks Keith. I am trying other things to help deal with the anxiety - for example, every night before I go to bed I listen to a relaxation/meditation MP3. I also still read through the CBT booklets I got when I went through my main anxiety episode last year. However, when I'm feeling really anxious/depressed/panicky I find it hard to stay focused on these self-help methods. For example, when I woke up at 2am last night in a panic, I don't think the relaxation MP3s would have helped me much. I've tried using them before when I'm really anxious and they don't seem to have much effect. I will persevere though.

So you don't think I need to ask to increase the dose yet?

I've never actually had beta blockers, but when I first went on cit last year the doctor gave me diazepam but I never used it. I still have it, but I don't know if it's actually able to reduce negative thoughts? Or does it just reduce the physical symptoms of anxiety?

I don't feel quite as bad as I did earlier today. I think I feel more relaxed because I know I've got a 3-day weekend ahead of me.

Another thing - when I was prescribed citalopram 16 days ago, the pharmacy gave me a brand I'd never had before (Mylan). I was wondering if maybe these aren't as effective for me as other brands I've had in the past. I still have some old tablets left over from the first time I was on cit - these were of the Aurobindo Pharma brand. I know those ones worked well for me at the time (January/February this year). So I decided to take one of those ones this evening instead of the Mylan ones. It will be interesting to see if they work better. I know that although the active ingredient is the same, some people on here have said they're sensitive to tablets from different manufacturers.

[keithwms]

I've never actually had beta blockers, but when I first went on cit last year the doctor gave me diazepam but I never used it. I still have it, but I don't know if it's actually able to reduce negative thoughts? Or does it just reduce the physical symptoms of anxiety?

I think the question is whether the anxiety and thoughts you feel might perchance be catalyzed by some residual physical side-effects. For me, if I get sweaty palms or a bit dizzy or the stomach cramps then my brain tends to turn that into even more anxiety. That's where beta blockers might really help break the cycle.

Even with meds to help, I think you'd still need to find new ways to prevail in the mental fight. For me, right now, rearrangement seems to be the theme. I cleaned the house and rearranged some things, just to try to get myself out of old habits. I've been focusing a lot on doing anything to cut the negative thoughts short... even if that means literally doing jumping jacks or dancing to some music. Anything! I also find that texting or emailing a friend... just to check in, helps me out.

Can you try to identify at what times the anxiety comes, e.g. is it right after or before meals, at particular times of day, and can you identify any catalyst? That might help you figure out how to tackle it. One time when I had a lot of anxiety, a doc made me write out my daily schedule for a whole week, and we discovered that... there was no schedule.. no rhythm. That was the main contributor to my anxiety. So I worked on more consistent meal and sleep times, and introduced some habits like reading an engaging (but not too serious!) book etc. Rhythm is very important to our moods, and I have to tell you, the SSRIs do eff up the rhythm for quite a while, this is well known.

I would definitely have a further discussion about beta blockers or other acute anxiety meds with your doc, there's no reason to suffer, it its really causing you problems. But try to go to him/her with some more specifics about catalysts or triggers, because there are many different meds out there and there may be no reason to go beyond the basic beta blockers like inderal. Inderal works wonders for performance musicians (as I learned myself back in school) because it wipes out the sweaty palms, and thus breaks the anxiety cycle.

And yes, you might be due for am SSRI dose change or supplement; I did my switch from 10 to 20 mg right around 2-3 weeks, but only after the primary side-effects subsided. I needed that confidence that whatever the higher dose would bring, I could handle.

I am afraid I know nothing of the different brands of citalopram, I am just aiming to stay on the same brand. If you do switch dose, you might want to check that the new pills are the same brand.

[UrbanMark]

Sparkle

I'm going through the exact same stuff as yourself. Last week was terrible - as though I had never ever taken medication before, anxiety, stress, palpitations, feeling like I was going to black out - but I didn't. The important thing that I tell myself to remember is - I've been through this before and managed, so I can do it again.

Today and yesterday things started to improve a little, and I understand that it will take some more time to level out. But I'll get there in the end.

Do you keep fit at all? It's just that whenever I completed some exercising, Football, running, cycling, boxing or similar, I always had a great nights sleep.
A punchbag is THE ultimate de-stressing tool.

Keep on going Sparkle, it won't be long until you feel much better.

[Sparkle1984]

Thanks for the advice. I'm sorry to hear you're going through the same thing, Mark.

Thankfully, today has been better (I've updated my diary thread with so I won't repeat myself here).

I haven't done any exercise (other than walking) for a few weeks, as I haven't had the energy or motivation. I think I will have to make more of an effort with this, as I have heard it can be helpful for people with anxiety. Even when I'm not going through an anxiety episode, I have trouble motivating myself to do exercise.

[keithwms]

I haven't done any exercise (other than walking) for a few weeks, as I haven't had the energy or motivation.

I know it's hard to do but I think you must force yourself to get some exercise, as it will really help. Please try. It worked wonders for me. Physical exercise has a lot of association with serotonin, and it might help you find equilibrium more quickly. Besides that, exercises that require some concentration / coordination can engage your mind and give you something to feel positive about when you're done. I don't do anything heroic... I just hop on an elliptical for 20 mins 3x per week... but I definitely feel the benefit.

[MarkUk]

Thanks for the advice. I'm sorry to hear you're going through the same thing, Mark.

Thankfully, today has been better (I've updated my diary thread with so I won't repeat myself here).

I haven't done any exercise (other than walking) for a few weeks, as I haven't had the energy or motivation. I think I will have to make more of an effort with this, as I have heard it can be helpful for people with anxiety. Even when I'm not going through an anxiety episode, I have trouble motivating myself to do exercise.

As said above, I find walking a great way of clearing my mind of chatter the fact that your moving along looking where your going makes the mind focus abit more also after 20 mins or so your body will start to pump some feel good chemicals around your body so by the end of a long walk I can feel much better.

[karennn]

Sparkle,

Hope you are feeling better now. I have experienced the same exact thing when I relapsed and had to go back to my meds! It's your brain chemicals trying to balance itself out again so I would assume that this is normal. Try and go out for a walk/jog so that you can release some serotonin in your body. I know that it is hard because I experienced days in just mourning in bed for no reason.