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Thread: Anyone else had terrible increased anxiety for 2 or 3 weeks after starting citalopram

  1. #1
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    Need some reassurance please!

    Hi all I am day 7 on 10mg after restarting citalopram. Been off it for 6 months after 4 years on it for anxiety and depression. Anxiety has gone through the roof since starting it. Much worse than it was was before. I thought it might be easing off by now but no sign. Almost constant intense anxiety with lots of mini panic attacks as well. Anyone else had this for a couple of weeks before it started easing? Had another bad night last night (Im in NZ so itís morning here) Thanks heaps

  2. #2
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    Re: Need some reassurance please!

    Quote Originally Posted by Windywel View Post
    Hi all I am day 7 on 10mg after restarting citalopram. Anxiety has gone through the roof since starting it. Much worse than it was was before.
    The initial side-effects may be more severe, and/or different, than the first time, but hindsight is also often viewed through rose tinted glasses.

    I thought it might be easing off by now but no sign. Almost constant intense anxiety with lots of mini panic attacks as well.
    It can take several weeks for the side-effects to diminish. Citalopram plasma levels typically stabilize to a steady-state within 7-8 days after which the side-effects usually begin to ease. They may return for a while after the increase to the recommended minimum 20mg dose, though the intensity tends not to be as severe as at the beginning.

    Taking the propranolol and/or lorazepam you've been prescribed would help. White knuckling your way through this can be counterproductive by reinforcing the anxiety.

  3. #3
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    Re: Need some reassurance please!

    Thank you so much for replying! I’ve moved doctors and saw someone on Monday who isn’t the one I will be seeing going forward. I emailed the surgery yesterday to ask for some reassurance about the anxiety and when I should move up to 20mg abs they rang back this morning to say that I should stop the citalopram until I have seen the doctor next week - apparently this was a message from the doctor I saw on Monday! This seems very confusing to me and my husband is saying just to ignore it and to push through. If I still have the intense anxiety next week does that mean it’s not or won’t work? Could it still work after 2 or 3 weeks? And could it still work a little bit even if it doesn’t work quite as well as before? I don’t need the anxiety to go away completely just not be as bad as it is right now as it’s hard to function. Thanks so much!

  4. #4
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    Re: Need some reassurance please!

    Also I’m guessing that I won’t get much benefit until I go up to 20mg so when would be the best time to start doing that? My husband thinks I should do it now as I’m already having such bad side effects but I wonder if I should wait a bit longer- your advice would be much appreciated

  5. #5
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    Re: Need some reassurance please!

    Just seen all the posts about how often ADs don’t work second and subsequent times. Now I just feel absolutely dreadful. I’ll go through all this and then have to do it again on another drug and another and maybe none of them will work ��

  6. #6
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    Re: Need some reassurance please!

    Quote Originally Posted by Windywel View Post
    Thank you so much for replying! Iíve moved doctors and saw someone on Monday who isnít the one I will be seeing going forward. I emailed the surgery yesterday to ask for some reassurance about the anxiety and when I should move up to 20mg abs they rang back this morning to say that I should stop the citalopram until I have seen the doctor next week - apparently this was a message from the doctor I saw on Monday! This seems very confusing to me and my husband is saying just to ignore it and to push through.
    I agree with your husband. All antidepressants will likely trigger heightened anxiety at the beginning so stopping and then starting another med is probably not going to help much, plus even if you do need to switch it is better to do so from one med to another rather than stopping for a week and then starting again. The time you've been on citalopram will still count.

    If I still have the intense anxiety next week does that mean itís not or wonít work?
    It doesn't indicate anything either way. SSRIs and other serotonergic antidepressants (ADs) trigger an increase in brain serotonin levels within about an hour of the first dose. This is what is triggering the anxiety. Despite the popular myth, anxiety and depression are not caused by low brain serotonin levels and ADs do not work by increasing serotonin although this is the first thing they do, nor is it a 'feel good' neurotransmitter, as you're discovering. In response to this initial increase in serotonin activity the brain (and other affected organs) will respond by downregulating synthesis and expression, in some brain areas to well below baseline, and the heightened anxiety and other side-effects should then begin to ease. Unfortunately, this may take several weeks and may reoccur for a while after dose increases. There is no way of speeding this up, but the lorazepam and propranolol can make a significant difference during the wait.

    Could it still work after 2 or 3 weeks?
    ADs typically take 4-12 weeks to kick-in. They work by stimulating the growth of new brain cells (neurogenesis) 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, and they take time to bud, grow and mature. The entire process takes about 7 weeks, however, some improvement may begin several weeks earlier. For a more detailed explanation see: How antidepressant drugs act.

    And could it still work a little bit even if it doesnít work quite as well as before? I donít need the anxiety to go away completely just not be as bad as it is right now as itís hard to function.
    There is a very good chance that citalopram will work as well as before and if it doesn't a small dose increase will usually cover any deficiency.

    Also Iím guessing that I wonít get much benefit until I go up to 20mg so when would be the best time to start doing that? My husband thinks I should do it now as Iím already having such bad side effects but I wonder if I should wait a bit longer- your advice would be much appreciated
    The rule of thumb is to time dose increases to no earlier than 5 times the half-life of the med, which for citalopram is about 35 hours, so 7-8 days. Upping the dose earlier may significantly increase side-effects severity, but delaying it won't significantly reduce them no matter how long the delay. You could still be an anxiety spike for a day, or two, however, so use the lorazepam and/or propranolol. No one is handing out gold stars for white knuckling through anxiety. It is also counterproductive.

    Just seen all the posts about how often ADs donít work second and subsequent times. Now I just feel absolutely dreadful. Iíll go through all this and then have to do it again on another drug and another and maybe none of them will work
    While there is an increased risk of an AD not working the second time around, it is a long way short of 100%. There may also be a way of reinvigorating a med should this become necessary using the GAD specific med buspirone. And if the worst happens then switching to another AD will almost always solve the problem with only a minimum loss of time. You are wasting a lot of nervous energy catastrophising about chickens which are very unlikely to hatch.

  7. #7
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    Re: Need some reassurance please!

    Thank you so much this help an awful lot!

  8. #8
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    Re: Need some reassurance please!

    Thanks Ian. It was really useful - just had the weirdest experience though - it was like I had a panic attack physically without having the mental aspect. Was feeling a bit better so my husband convinced me to go out and get something to eat and he got me a white wine spritzer when we arrived (a few hours ago now. We had some Japanese and I was ok until near the end and then had this awful thing. Like burning down my arms, across my shoulders and chest and down my back. And now my legs are all shaky. This is clearly a medication side effect as I wasn’t having this before I started them and I wasn’t thinking anxious thoughts when it started. It’s now been about half an hour. Which would be better to stop this - the propoponal or the lorazepam?

  9. #9
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    Re: Need some reassurance please!

    Quote Originally Posted by Windywel View Post
    then had this awful thing. Like burning down my arms, across my shoulders and chest and down my back. And now my legs are all shaky. This is clearly a medication side effect as I wasnít having this before I started them and I wasnít thinking anxious thoughts when it started. Itís now been about half an hour.
    It could be adrenaline which can lead the triggering anxiety, or it might be the med. Hard to say, though my money would be on adrenaline.

    Serotonin isn't only a brain neurotransmitter, in fact the brain is a minor player using less than 2% of the serotonin made. The skin and its blood vessels use about as much and skin irritations and other effects are fairly common when first taking a serotonergic AD. Most are innocuous. However, one ongoing side-effect to be aware of is skin photo sensitivity may be increased so protect the skin if outdoors for more than a few minutes at a time, especially in light of the ozone layer hole above you.

    Which would be better to stop this - the propoponal or the lorazepam?
    If it is adrenaline then propranolol should stop it cold by blocking beta-adrenergic receptors, though it might take 20-60 minutes to act by which time the surge may be over anyway. But your anxiety level have probably risen as a result of all this and beta blockers don't really do much for them so you might need a small amount of lorazepam too. Note, both can be sedating so be careful if doing anything potentially hazardous until you can gauge how you're affected. Given the hour you will likely get a good night's sleep.

  10. #10
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    Re: Need some reassurance please!

    Thanks again Ian - just another pesky side effect then? Nothing to worry about? Can you take the two together then?

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