Help please! Withdrawal/side effects question

[anxiousjomo]

So...will try to explain as simply as I can. This forum has been such a help to me over the last few months I decided to join and start taking part. But I am hoping you can help me too.

I was on Prozac for about 6 years for depression and GAD and came off it last summer. Seemed fine. Then had crazy panic attacks and other fun and games in feb and march this year. Doc put me back on Prozac but I had a horrific side-effect related reaction to it (which was weird as had no side effects at all previously). Was taken off it after 3 weeks and put on Citalopram. Initially at 10mg for 6 weeks, then up to 20mg for 5 weeks. Unfortunately my side effects on Cit never went away, and just got worse. Mainly 5am wake ups with crazy anxiety, upset stomach, sweating, shivering etc (things I never had before starting the meds). Then would feel awful until later in the afternoon when I would start to feel a little better. So tired by the end of the day i pass out at night, but just wake up at 4 or 5am the next day for the whole cycle to start again. This is making me really really depressed. Doc and I decided I was worse on than off, and that I should stop taking them and give my body some time to settle before having a re-think.

Went to 15mg for two weeks, then 10 for two weeks and now going to 7.5 for a few days and then to 5mg for a couple of weeks or so. Then either down to 2.5 for a bit or just stop.

The issue is this - I still feel exactly as terrible as I did on 20mg (and the 10mg) with the added slight dizziness and headaches from withdrawal. Plus every day I am still taking the pills makes me feel like I am just extending the period of suffering.

So - do I go faster and just get the horrible things out of my system, as I am feeling terrible anyway, or do I just try and keep fighting through and go slowly? Is dropping down by 5mg every two weeks after only having been on for about 4 months ok?

When I read other people's post about withdrawal, they go slowly because they want to maintain the good feeling they get from the drug. But for me, the drug makes me feel awful, so the slower I go, the more I am prolonging the unpleasantness. But if I stop too quickly, I could add a whole lot of new problems on top! Or I might be absolutely fine...

Any ideas or suggestions??? And how do I keep going through these mornings without feeling suicidally depressed about the endless cycle of feeling horrible??

[panic_down_under]

Doc put me back on Prozac but I had a horrific side-effect related reaction to it (which was weird as had no side effects at all previously).

This is not unusual. For some reason the side-effects tend to become progressively more severe each time an antidepressant is stopped and restarted. They may be different than before too. Two studies, Amsterdam JD, 2016 and Amsterdam, 2009 also found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Amsterdam JD, 2009; Leykin Y, 2007).

So - do I go faster and just get the horrible things out of my system, as I am feeling terrible anyway, or do I just try and keep fighting through and go slowly? Is dropping down by 5mg every two weeks after only having been on for about 4 months ok?

You probably could have been dropping the dose at weekly intervals without significantly increasing side-effects severity. The rule of thumb is to allow plasma levels to stabilize to a steady-state after a dose reduction before cutting it again. Citalopram usually settles to a steady-state within 7 days in reasonably healthy adults (takes longer in the elderly and those with liver impairment). Given you weren't on meds for long and seem to be having only minor withdrawal symptoms, 10mg cuts may not have been any worse either.

When I read other people's post about withdrawal, they go slowly because they want to maintain the good feeling they get from the drug. But for me, the drug makes me feel awful, so the slower I go, the more I am prolonging the unpleasantness. But if I stop too quickly, I could add a whole lot of new problems on top! Or I might be absolutely fine...

I think you would be fine. I also think not all of the problems you're having are down to the med. I think at least some of the symptoms are psychological. An anxious mind can produce our worst nightmares for us given half a chance. So getting the med completely out of your system, which will happen within 7 days of the last dose, may not stop all the symptoms.

[anxiousjomo]

Thanks for responding.

Last night was brutal sadly - only about an hours sleep - just wired and anxious and shaky and sweating etc. This was my first day at 5mg so it may be that.

Doctor gave me a 28 pack of 2mg diazepam which I am concerned about taking due to all the issues with those drugs, but it may be I need to use it to help me get through the next week or two. Maybe one before bed will help me at least to get some rest.

Certainly I have GAD issues underlying everything, and have since I was little, but before I went on this drug I have never had that much problem sleeping, only had panic attacks maybe once or twice a year and found everything pretty manageable. With regular exercise, CBT etc I am hopeful I will be ok without meds.

It is just right now is so awful. I guess I am finding it hard to keep going every day.

[panic_down_under]

Doctor gave me a 28 pack of 2mg diazepam which I am concerned about taking due to all the issues with those drugs, but it may be I need to use it to help me get through the next week or two. Maybe one before bed will help me at least to get some rest.

Dependence would only be an issue if you were to take diazepam daily for a month, or so.

BTW-you're already have a diazepam dependency as it is the main natural benzodiazepine (BZD) found in all foods, albeit only in small, though not insignificant, quantities. BZDs were probably originally plant poisons used to discourage foraging animals, but most life forms, including humans, have become so adapted to them that it can no longer function without them. If you could eat a BZD free diet you would soon begin having uncontrollable seizures.

[anxiousjomo]

Thank you very much indeed - always helpful to hear from someone who actually seems to know what they are talking about (unlike my GP who seems to think throwing drugs at me without any warning, and then pulling me off them cold turkey is a good idea!)

I know I just have to keep fighting my way through the next few weeks, and then hopefully things will start to improve. Or, if they don't, I will know it is not the meds but me and then can be proactive to do something about it!

Right now I actually find the purely physiological aspects of these side-effects/withdrawal symptoms fascinating (and deeply unpleasant to experience) - like have the physical symptoms of being anxious rushing up through body in waves from my gut to the top of my head, without actually being anxious about anything....

Certainly the effect of these drugs on my stomach has been very dramatic, and clearly evidences how key serotonin is down there in the gurgley bits.

And thanks for the reassurance about Valium. If I still feel awful tonight I will take one and see if it helps me get some sleep (which makes a massive difference to how able I am to cope with the symptoms the next day!)

[panic_down_under]

like have the physical symptoms of being anxious rushing up through body in waves from my gut to the top of my head, without actually being anxious about anything....

But you probably were anxious, it just isn't getting to conscious awareness. Our emotions are the product of the non conscious brain regions collectively known as the Limbic system. Stress diminishes the links between the frontal lobes of the prefrontal cortex which facilitate consciousness perception and the Limbic reducing emotional awareness. Antidepressants help strengthen these links.

The Limbic system is directly linked to the adrenal glands which initiates the adrenaline surges you're experiencing.

Certainly the effect of these drugs on my stomach has been very dramatic, and clearly evidences how key serotonin is down there in the gurgley bits.

The "gurgly bits" or at least the enteric nervous system, the mini brain which controls them, is by far the most serotonergic organ of the body making and using about 50 times more serotonin than the brain so can be far more affected by SSRIs.

[anxiousjomo]

Thanks.

I ended up having to take 2 tabs of the 2mg Diazepam last night, as one did not work and my anxiety was through the roof. I managed to sleep a bit, but am very very depressed today. I guess they are depressants, so that should be expected!

Annoyingly after months of having horrible mornings in particular on the citalopram, I am now starting to get anxious in the evenings in anticipation!

I am on day two of 5mg now and am certainly having increased anxiety during the day. Hopefully after a week or so my body will adapt.

I guess if, after I finally get off Citalopram, I am still having these issues with anxiety maybe I will have to try something else. My doctor suggested considering amitriptyline, partly because I have IBS issues too. My mother-in-law has been on a low dose of Trazadone for years which she says helps massively with her anxiety and insomnia. But I guess the problem is I have no idea what will work until I try, and that process can be bloody horrible!

Prozac used to work well for me, but now doesnt. Citalopram at 20mg gave me insomnia, increased anxiety (after 3 and a half months it was getting worse), morning diarrhea etc...there are so many alternatives out there but I feel like my GP has no better idea than me what to try!

Any suggestions?

Or should I just try CBT, regular exercise etc and see if that can get me to a better place instead?

[panic_down_under]

My mother-in-law has been on a low dose of Trazadone for years which she says helps massively with her anxiety and insomnia. But I guess the problem is I have no idea what will work until I try, and that process can be bloody horrible!

Although it isn't one, at low doses trazodone acts only as very sedating antihistamine, basically just as a sedative and this takes almost immediate effect. For those with mild to moderate anxiety this can be enough to make a big difference. It only begins to behave as an antidepressant at doses of around 150-225mg and above with the sweet spot being 300mg/day for most. As with all antidepressants it then usually takes 3-12 weeks to kick-in.

Any suggestions?

I think your GP is on the right track suggesting a TCA instead of another SSRI as you don't seem to be reacting well to the latter anymore. TCAs have long been used to treat IBS. If diarrhoea is an issue then amitriptyline would be a good choice, but desipramine might be the better option if constipation is the predominant problem as it has low constipation triggering acetylcholine muscarinic and antihistamine activity (the SNRI duloxetine might also be a good fit).

Or should I just try CBT, regular exercise

A big YES to both even if you decide to try meds again!!!

[anxiousjomo]

Thanks man, I really appreciate you taking the time to respond. It is very kind of you.

Have been going to gym 3 or 4 times a week for the last couple of months and it really does make a massive difference. I hate that all those smug people that say how important exercise it were actually right ;-)

[anxiousjomo]

Interestingly I have got down to 2.5mg now, and have been on that for 6 days. I was intending tomorrow to be my last day and to then just stop, but yesterday and today I have suddenly got weirdly increased anxiety - feels like tingly rushes up through my body and then into my head, along with an anxious feeling up in my chest. This is after having a few really good days in a row. Also groggy and fuzzy head and that weird thing where, if you move your head quickly from side to side it feels like there is a lag. Like water sloshing in a bowl.

What is so difficult about this whole process is it is impossible to know if this is: (1) withdrawal symptoms; (2) part of the on-going side effects I have been having from the drug; (3) my own anxiety; or (4) all of the above...

I guess the only thing I can do is stick to the timeline I committed to and take my last pill tomorrow. Worst case scenario is I feel awful in few days and then either go back on 2.5 for a bit, or just get through it. I just want to get the point this stuff is out of my system so I can try and work out what is actually going on with me and what I need to do about it.