Panicking!

[Poppyeyebright]

Please help me. My gp has prescribed setraline as my citalopram is no longer beneficial for me. My concern is he has just told me to stop taking the citalopram for two days and then to start the setraline! I'm concerned this isn't correct. My counsellor is thinking that I may be bipolar so I'm waiting on a referral to community mental health team. I'm frightened as to how this will affect me. Does anyone have any experience regarding this. Many thanks Becca.

[MyNameIsTerry]

Hi and welcome to NMP

If you look at page 14 of this NHS local trust guidance from late 2014 http://www.sussexpartnership.nhs.uk/...s_-_oct_14.pdf it shows that when moving from "SSRI's (except fluoxetine)" to "Other SSRI" they should "Withdraw, then start new drug".

Citalopram has a half life of 35 hours. So, your GP is allowing for it largely be excreted by the time you start your new one, but not a complete withdrawal which I'm guessing limits the withdrawal symptoms that could be experienced.

This NHS document is a good guide to the various strategies and it looks like your GP is using the Immediate Switch option so its worth reading this and also there is a table at the bottom.

http://www.medicinesresources.nhs.uk...?pageId=504038

Withdrawal & start up effects are a possibility. From the document, these may be minimised by using this method but these meds affect us all different so I doubt anyone can say for sure and you will just have to monitor the situation.

Hopefully, some people who have done this will be able to comment further as I've only ever started them from nothing so far.

[little scientist]

Hello Poppy. I am in the same boat as you. My 40mg citalopram just stopped working, and the GP has switched me to sertraline (50mg). Because they are in the same group (ssris) I was told to simply take sertraline straight away (ie an immediate switch) no tapering off. Some documents, like the one Terry has found suggest tapering, but I also found one that said it may not be necessary. My doctor said side effects may be minimal because I already have the Sri of citalopram in my system, and being in the same group, it's not like starting up again.

I have had no bad effects from the switch, had heart burn one day but that was it. AND, I think they are beginning to show signs of working already, and I am only on day 4! I was at rock bottom on Tuesday unable to eat a bite of food. I am sat here having just eaten breakfast and drinking a brew.

Hope that helps and reassures

[MyNameIsTerry]

I have had no bad effects from the switch, had heart burn one day but that was it. AND, I think they are beginning to show signs of working already, and I am only on day 4! I was at rock bottom on Tuesday unable to eat a bite of food. I am sat here having just eaten breakfast and drinking a brew.

Thats good to hear!

I remember starting Citalopram and having real difficulty with hunger yet being unable to eat anything and it just makes you feel rougher.

[little scientist]

It's early days (day 4!) , but I am so glad not to be feeling the way I did. I had been feeling progressively worse in recent months, and it's only now that I realise just how long ago citalopram started to not work - back as far as last June. Given how great I am feeling right now, I am prepared for a fall but here's hoping there might not be one!

[MyNameIsTerry]

It could just be that you have dropped on the med that works for you so no uphill slog past the side effects and a quick reaction in helping you.

Its sounds very promising.

I think if these meds are going to hit you, its going to be pretty quick. They say it takes 5 half lives for a drug to reach steady state and yours has a mean of 26 hours so its reaching steady state now. It can also see effects in the first 7 days although requires longer to judge its true impact.

So, based on that and how you are feeling, it sounds like a very good sign!

[little scientist]

Yep it does look good

Last week I couldn't have foreseen a return to work anytime soon, but today I am thinking a return in Wednesday when my self certification runs out, might just be possible without getting signed off, or I may request a part time return for a while so that I don't overdo it. We'll see

[MyNameIsTerry]

Good luck with it!

The quicker you can get yourself as much normality as possible, the better you will likely feel but a phased return it often a very good way to test the waters. I don't think we realise how much these disorders affect us sometimes and returning to work can be very tiring until you get used to it again. Its amazing how being at home with all this seems to affect energy levels.

[Poppyeyebright]

Thanks for the reassurance. I've only gone one day without anything. Feels like I'm waiting for the side effects to come along!

I've been given 2 weeks sick cert to see how I get on with side effects. Also have occ health appt on Monday for work. Too much going on!

[little scientist]

Don't worry about the occ health - they are there to support you and see if any adjustments need to be made to help you in your job

I've levelled out a bit more since I had my "great" feeling day, kind of come back down to earth a bit, but still better than I was when I presented at the doctors.

Keep us posted with how you get on!