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Thread: Starting Citalopram

  1. #31

    Re: Starting Citalopram

    Day 34 and this week is a little more challenging with some big work projects going on, visitors in the house and knowing I have the house to myself for a couple of days. Yesterday on a site visit whilst waiting for a meeting the panic started to climb and I was hot and feeling sick, but started chatting to someone next to me and sipping water and got it back under control and had a good meeting on the end.

    Am very tired and the weather is dark and rainy and miserable so I know I am facing a lot, but I do know that I am dealing a lot better with things in general and holding onto that. Good times are coming back soon

  2. #32
    Join Date
    May 2014
    Posts
    5,986

    Re: Starting Citalopram

    Of course you are going to feel a bit nervy, even without anxiety. The good thing is from this point it will improve as you've got over the first and hardest hurdle already. x

  3. #33
    Join Date
    Jan 2012
    Posts
    596

    Re: Starting Citalopram

    Hi,
    I just wanted to pop on on say I think you are doing great. Your posts reminded me a bit when I started out on CIT. Although I was off work and barely living so I think you are amazing for how well you are coping with it all. Well done you. I'm having a blip at the moment but I am no where near the starting out process and reading through your thread has reminded me of that. So we'll done you you are doing great xx

  4. #34

    Re: Starting Citalopram

    Thanks guys for the comments and support. I think the hardest thing at times is to acknowledge that anxiety/stress/nervousness are all part of life and are actually there to protect us and it is only when it gets out of control that we have problems. I suspect like most I was looking to feel nothing in the way of 'bad' emotions when I started the meds as I was so tired of feeling anxious all the time, but need to come around a little more now to see that if I get rid of those I am just aiming at being numb to happiness and all the other 'good' emotions.

    It isn't always easy to see and it is very tiring, but I am moving towards a balance and trying to re-learn that I am made up of all emotions and will feel them all.

    So onto day 39 - have had the in-laws now for 5 days, they head home tomorrow and had a couple of days without anyone at home. Met up with a friend each day to do something and was at work and mostly was fine. Couple of flashes, but not much more.

    Have noticed that I have trouble sleeping on a Sunday night and always some anxiety Monday morning when it is time to get up and go into work, but I was reminded that I have never been a Monday person anyway - a lot of my nervy periods are around transitioning from one place or routine to another. Work to home, home to work, home to holiday etc.

    I do have some peace of mind now to be able to see some of the specific things that cause me anxiety and the next step for me now is to reinstate and practice some long term CBT, Mindfulness and Meditation techniques back into my life.

    Wishing you all a positive day!

  5. #35
    Join Date
    Sep 2019
    Posts
    136

    Re: Starting Citalopram

    Hi all I am new to this forum and would really appreciate some support and reassurance. I have just restarted citalopram after 6 months off due to a relapse of anxiety and depression. I was on it for 4 years and it did help a lot. I decided to come off it as I was feeling better. It has been 5 days now - I took 5 mg for the first 2 days and then 10 mg for the last three. My anxiety has gotten much worse with panic attacks now too and an unusual sensation of burning on the arms and chest when really anxious. I remember that from the first time but not feeling much more anxious. Though I was already really bad before I went on the citalopram the first time so might not have noticed much difference. Is it normal to have a marked increase in anxiety at the beginning and should I just try and ride it out? Or should I talk the doctor about changing to another medication? It definitely did end up working for me last time - I just remember that the anxiety did take a while to go away. Iím feeling really panicky about the medication not working and being stuck with this awful anxious panicky feeling. I canít relax or sleep or even sit still for long and I canít eat anything!How long does it take to go away? Please just supportive positive replies right now - I just need to hear about peopleís good experiences going back on medication. Surely because it worked last time itís more likely than not to provide some benefit even if it doesnít take it away entirely?
    Thanks so much - really looking forward to your replies

  6. #36
    Join Date
    Jan 2017
    Posts
    1,711

    Re: Starting Citalopram

    Quote Originally Posted by Windywel View Post
    Hi all I am new to this forum and would really appreciate some support and reassurance.
    to No More Panic,


    Is it normal to have a marked increase in anxiety at the beginning and should I just try and ride it out? Or should I talk the doctor about changing to another medication?
    Yes, it is a common initial side-effect of most serotonergic antidepressants (ADs), caused by the increased serotonin activity. The brain will respond after a while by downregulating serotonin synthesis and expression, but the heightned anxiety may return for a while after dose increases.

    Iím feeling really panicky about the medication not working and being stuck with this awful anxious panicky feeling. I canít relax or sleep or even sit still for long and I canít eat anything!How long does it take to go away?
    If citalopram worked before then there is a good chance it will again. Talk to your GP or psychiatrist about the side-effects as there is no need to suffer. Small doses of one of the benzodiazepines (BZDs) - diazepam (Valium), etc - should help, but they can interfere with the mechanism by which ADs work, so maybe try *hydroxyzine first. It is a prescription antihistamine with good anti anxiety properties, not quite as potent as the BZDs, but often potent enough. It is also mildly sedating which may help you sleep, however, be aware of this if driving, or engaging in any other potentially hazardous activity.

    *Hydroxyzine comes in two forms, hydroxyzine pamoate (Vistaril) and hydroxyzine hydrochloride (Atarax). Anecdotally, the pamoate form is claimed to be the more effective anxiolytic, but just how true this is remains a matter of debate in forums

    I just need to hear about peopleís good experiences going back on medication. Surely because it worked last time itís more likely than not to provide some benefit even if it doesnít take it away entirely?
    It is likely to work as well as before, but some find the initial side-effects are different than the first time.

  7. #37
    Join Date
    Sep 2019
    Posts
    136

    Re: Starting Citalopram

    Thanks so much for your reply panicdownunder. I am also down under in NZ. How long until the heightened anxiety starts to wear off? I went to the doctor this afternoon and now have some propranolol and some lorazepam but Iím too scared to take either of them. She didnít suggest the antihistamine unfortunately. Do the benzos stop the citalopram from working properly? She also suggested that I try escitalopram as she reckoned it was more calming and worked faster so I got a script for that but Iím thinking I will persist with the cit for a bit longer as it did work last time. I can also switch to that next week if no improvement.

  8. #38
    Join Date
    Jan 2017
    Posts
    1,711

    Re: Starting Citalopram

    Quote Originally Posted by Windywel View Post
    How long until the heightened anxiety starts to wear off?
    That's one of those 'how long is a piece of string' questions which can only be answered with, 'it depends'. It all comes down to how the med meshes with your individual biology. Anything from a few days to a few weeks, plus there should be a dose increase to 20mg at some point which will extend the time. There are no quick solutions, unfortunately.

    I went to the doctor this afternoon and now have some propranolol and some lorazepam but Iím too scared to take either of them.
    Propranolol is a beta-blocker which works by inhibiting the symptoms of the adrenaline surge which often accompanies anxiety/panic attacks, but it doesn't have a direct affect on anxiety itself. However, if those surges are the main problem it can be a useful med. They main problem with it usually is that it can be fatiguing.

    Lorazepam is arguably the best BZD to use in this situation thanks to its moderate half-life. It is one of the naturally occurring BZDs found in most foods so your brain is well used to dealing with it. So much so that it couldn't function without it and the other BZDs in your diet.

    Do the benzos stop the citalopram from working properly?
    They can slow down the onset of the therapeutic response. However, this doesn't mean they shouldn't be used if needed. It's better to delay the response for a little while than stop taking the AD because the anxiety is too unbearable and this never get a response at all.

    ADs work by stimulating the growth of new brain cells (neurogenesis) in the twin hippocampal regions of the brain to replace cells killed, or prevented from growing by high brain stress hormone levels. The therapeutic response is produced by these new cells and the stronger interconnections they forge, not the meds directly (see also: How antidepressant drugs act).

    There is now good evidence BZDs (also alcohol) can block hippocampal neurogenesis (see: Boldrini M, 2014; Nochi R, 2013; Sun Y, 2013; Song J, 2012; Wu X, 2009; Stefovska VG, 2008).

    In light of this BZDs use should probably be limited to a couple of weeks when first taking ADs just to ease the initial increase in anxiety levels, for a while after AD dose increases for the same reason and thereafter only for occasional breakthrough anxiety.

    She also suggested that I try escitalopram as she reckoned it was more calming and worked faster so I got a script for that but Iím thinking I will persist with the cit for a bit longer as it did work last time. I can also switch to that next week if no improvement.
    Citalopram is made up of two isomers, the 'S' form which is the active component, and a 'R' mirror image form which is a poorer fit biologically and so is mostly inactive. Escitalopram is more refined and only contains the 'S' isomer which is why the doses are half that of citalopram. I'm not convinced there is really that much difference between them. Their side-effects can be subtly different, however, so if there is an ongoing SE with one which is bothersome then switching to the other med might solve the issue, but if one doesn't work the other probably won't either.

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