10 months off - now back on day 2

[Overwhelmed]

I have been on & off Citalopram since the age of 21 (10 years). It has always greatly bothered me that I "need" them & that I wasn't taught coping mechanisms for my anxiety back in the beginning. I was also never really reviewed, so just kept going on & off them for years not realising that's not what I should be doing until finally I started experiencing panic attacks/racing thoughts & couldn't quite manage without them! That's when I realised I had to stay on them for a long time before weaning myself off. They always work brilliantly for me, too brilliantly really, as they eliminate my racing thoughts, panic attacks and the feelings of absolute sadness.

Anyway, this time around I was on the meds for about 2 years before I decided to wean off them, of which I did over the course of 1 year (mostly just taking half of a 10mg tablet- which suited me fine).

I was determined to stay off them & have now been off for 10 months exactly. I was excited to come off them to start a family with my fiancé which, when on the meds, seemed like an exciting & feasible prospect. My partner & I were in a good position - recently engaged & I was very content with life.

Well, what a shit show these last 10 months have been. In hindsight, it probably wasn't the best time for me to come off them, but hindsight is the most wonderful thing, ey?

Things that have happened since coming off the meds:
- 1 year anniversary of my grandmother's death
- great Aunt passed away
- another Aunt passed away very suddenly at a young age after only being diagnosed 12 weeks prior (cue crippling health/existential anxiety)
- stepchildren moved away to Australia after only being told last minute
- car problems (might seem a small thing to some but when you're already in a panic state, an engine failure light coming on whilst driving is enough to tip you over the edge!)
- fiancé took a new job & had to work away a lot for training, something that is new to me
- booked wedding for 2 year's time - realised how expensive everything is
- own health issues - having abdominal scans at hospital
- Uncle passed away
- Autistic brother tried to run away/threaten to commit s**cide whilst I was staying down my mums

How my anxiety presents itself:
- health anxiety - about my own health & others'.
- relationship anxiety (my hardest one to deal with). Am I in the right relationship? Is he the cause of my anxiety? Or is my anxiety causing me to feel this way? I do not question this at all when I'm on meds. I think I am anxiously attached. He is easy going/stubborn/doesn't understand mental health & I'm anxious and want constant reassurance/attention - not the easiest combo. I seem to only focus on the negatives of our relationship when I'm off meds & then I have panic attacks about it. But he is a lovely man who I have been with for over 8 years & I don't want to give up yet. It is worth noting that I moved away to be with him, I have no family or close friends here, so I do rely on him for my happiness which I know is an unhealthy idea.
- racing heart daily
- regular panic attacks
- constantly questioning if I feel right, or if I'm acting right, or if I should be feeling happier
- absolute emotional overwhelm - I seem to react much more & feel much more than anybody else. I have feelings of complete sadness & overwhelm on a regular basis.
- I'm petrified of getting pregnant. When I'm anxious, I never feel like it will be the "right time". I'm not sure I'll ever feel ready (although when I was on meds, I did).
- I struggle to feel happy. I cry regularly.
- I feel bitter & sad that I suffer with anxiety
- I feel like I've lost myself. I do not know what is me or what is anxiety anymore. I sometimes feel like it would be easier if I wasn't in anybodys lives & that I should just run away from it all.

Positive things I have noticed in the last 10 months -
- My IBS has improved significantly since being off meds
- Less headaches since being off the meds
- My sex drive is starting to improve
- I've managed to "accept" my racing thoughts enough so that I no longer have regular panic attacks, I've been doing yoga weekly, which I love & am proud of how far I've come.
- I've tried all sorts of things to help - acceptance, yoga, acupuncture, cbd, vitamins, hypnotherapy, meditation etc. These can help with the panic side of things.

Why I'm going back on meds:
Apart from the few positives above, the last 10 months have been miserable. Worse than miserable really - it's just been one big struggle to keep on going. I've had very few days where I've felt comfortable & I'm so, so tired. I think I am a little messed up inside & don't want to do anything irrational (I.e. ruin my relationship) without at least seeing if I can settle my brain first. I just can't bare another 40+ years of my life (if I'm lucky) with this mental torment. I just want to feel at peace again.

I am currently seeing a psychotherapist who believes I just need to be on the meds for life as a maintenance dose. I struggle with this concept but am slowly starting to accept it. I am also waiting to be assessed for ADHD as I fit a lot of the criteria. I have just taken my second QUARTER of a 10mg citalopram tablet this morning (I have to start very low as I react badly to starting meds - I will up it in about a week). I hope I can get back to myself soon. The bad dreams & increased anxiety have already started!

Thank you if you have managed to read this far. X

[panic_down_under]

to NMP,

I have been on & off Citalopram since the age of 21 (10 years). It has always greatly bothered me that I "need" them

Would you feel this way if you had to take medication for type 1 diabetes, arthritis, or another autoimmune disease? Anxiety and depression are the emotional manifestations of an underlying physical brain malfunction, atrophy of the twin hippocampal regions of the brain caused by high brain stress hormone levels, particularly of cortisol, killing brain cells and inhibiting the growth of replacements. It is essentially a type of auto-immune disease. So much so that these disorders often flare when the immune system goes into overdrive when fighting off an infection. See also: Depression and the Birth and Death of Brain Cells (PDF). Both therapy and antidepressants work by stimulating the growth of new hippocampal brain cells. The cells produce the therapeutic effect, not the treatments directly.

& that I wasn't taught coping mechanisms for my anxiety back in the beginning.

It is never too late. The cognitive, behavioural (CBT, REBT, etc) and mindfulness therapies can teach you coping skills and are often very effective. As per above, they create the same physical changes as antidepressants (ADs).

They always work brilliantly for me, too brilliantly really, as they eliminate my racing thoughts, panic attacks and the feelings of absolute sadness.

And this is bad, how?

Anyway, this time around I was on the meds for about 2 years before I decided to wean off them, of which I did over the course of 1 year (mostly just taking half of a 10mg tablet- which suited me fine).

Such a long wean off period is not usually necessary and there are risks of the AD no longer working by taking sub therapeutic doses for long periods of time.

I was determined to stay off them & have now been off for 10 months exactly. I was excited to come off them to start a family with my fiance which, when on the meds, seemed like an exciting & feasible prospect. My partner & I were in a good position - recently engaged & I was very content with life.

You probably wouldn't need to come off citalopram to have a baby. With the exception of paroxetine (Paxil) it is unclear that SSRIs significantly increase the odds of birth defects or complications. Studies have reported higher incidents of defects, but there doesn't seem to be a common pattern to them which may indicate the studies aren't showing a real issue, but just reporting statistical noise. The problem is that the number of patients in each study tends to be low, the defects tend to be mostly the rare ones and the increases they report are often small. To complicate matters, there is evidence that maternal anxiety (and/or depression) can adversely affect the fetus, both immediately, and later in life. Unfortunately, antidepressants and pregnancy is an issue where there are no clear cut 'right' answers. I suggest you discuss this thoroughly with your family doctor and obstetrician and/or gynecologist well before becoming pregnant and follow their recommendations.

If planning to breastfeeding then sertraline (Zoloft) may be the better SSRI as very little, if any sertraline is expressed in the milk (Pinheiro E, 2015). However, there is no guarantee that it will work as well for you as the med you're on, plus see below about its possible effect on IBS.

Things that have happened since coming off the meds:
- 1 year anniversary of my grandmother's death
- great Aunt passed away
- another Aunt passed away very suddenly at a young age after only being diagnosed 12 weeks prior (cue crippling health/existential anxiety)
- stepchildren moved away to Australia after only being told last minute
- car problems (might seem a small thing to some but when you're already in a panic state, an engine failure light coming on whilst driving is enough to tip you over the edge!)
- fiance took a new job & had to work away a lot for training, something that is new to me
- booked wedding for 2 year's time - realised how expensive everything is
- own health issues - having abdominal scans at hospital
- Uncle passed away
- Autistic brother tried to run away/threaten to commit s**cide whilst I was staying down my mums

These disorders often begin, or become more severe in the months after just one major life event and most of these qualify.

- My IBS has improved significantly since being off meds

Then sertraline probably wouldn't be the best SSRI to be on as it tends to be the hardest on the GI tract. The brain isn't the most serotonergic organ of the body. It makes and uses less than 2% of the serotonin made in the body. The gut and the enteric nervous system (ENS), the mini brain which controls it make about 50 times as much so can be far more affected by SSRIs and other serotonergic ADs. The ENS also has considerable influence over the brain between our ears.

I am currently seeing a psychotherapist who believes I just need to be on the meds for life as a maintenance dose. I struggle with this concept but am slowly starting to accept it.

Given your history I think your psychologist is probably right. There is also a risk in coming on and off ADs for there is growing evidence antidepressants, especially the SSRIs, may become progressively less effective every time they are stopped and restarted, often requiring higher doses to achieve the previous level of control, or not working at all. They may also produce more severe, and/or different, initial side-effects. Two studies, Amsterdam JD, 2016 and Amsterdam JD, 2009, found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Bosman RC, 2018; Amsterdam JD, 2009; Leykin Y, 2007; Paholpak S, 2002).

I am also waiting to be assessed for ADHD as I fit a lot of the criteria. I have just taken my second QUARTER of a 10mg citalopram tablet this morning (I have to start very low as I react badly to starting meds - I will up it in about a week).

Cool! The rule of thumb on this is to start on a low dose, especially if you've been on an AD before and to ramp up the dose by the same amount at intervals of not less than 5 times the meds half-life which for citalopram is about 35 hours, so no earlier than 7 days after the last increase (or decrease if weaning off). Raising the dose earlier may increase the severity of any side-effects, but delaying it doesn't usually reduce their severity no matter how long it's delayed.

I hope I can get back to myself soon. The bad dreams & increased anxiety have already started!

Fingers crossed!

[Overwhelmed]

Thank you for your reply panic_down_under. I have seen your replies quite a few times on this forum & you seem to be very well researched on the topic.

No, I would not feel the same about taking other medication. I think I've read too many things about the long-term use of antidepressants and I had convinced myself that there must be another way.. that maybe I didn't try hard enough in the past. Like you said, CBT can have the same affect & I'm also exercising more, doing EFT, meditation, practicing acceptance etc.. there are "ok" days but unfortunately the lows are just too low for me.

I have talked to my GP about the pregnancy side of things & she has said she would rather my mental health be stable and that she has dealt with hundreds of women who have been on meds during pregnancy & everything has been fine. At the moment pregnancy is off the cards for me anyway - my partner isn't too bothered either way.

I have taken day 3 of a quarter tablet this morning. Boy, I forget how much it ramps up your anxiety. The morning is the worst - racing heart, shaking, panic, keep thinking "I can't do this". I just want to hide away at the moment.

I'm back to work today after a week's holiday, I'm hoping it will keep me adequately busy so I don't have the time to think about it.

[panic_down_under]

I think I've read too many things about the long-term use of antidepressants

I've been on them almost continually since early 1987. My brain hasn't dissolved yet.

I have taken day 3 of a quarter tablet this morning. Boy, I forget how much it ramps up your anxiety. The morning is the worst - racing heart, shaking, panic, keep thinking "I can't do this". I just want to hide away at the moment.

Let your GP know as most of these side-effects can be diminished, for example with a small dose of a beta-blocker for the racing heart which may then also ease the shaking and perhaps even the panic. Consider benzodiazepines too if it means you stay on the citalopram.

I'm back to work today after a week's holiday, I'm hoping it will keep me adequately busy so I don't have the time to think about it.

Keeping busy will certainly help. Not all initial side-effects are necessarily caused directly by the med. Anxious minds can cause havoc too.

[Overwhelmed]

Thank you for your reply panic_down_under, apologies for not replying sooner. I managed to get through those first few weeks relatively unscathed, apart from the first week. It honestly wasn't as bad as I'd prepared myself for. Maybe because I'm just so used to dealing with it now.

I can't believe its been over 2 months since going back on Citalopram already. 10 months off them felt like a lifetime whereas these 2 months have flown by.

My thoughts have mostly settled now and its so refreshing to have space for "normal thoughts" or dare I say it.. silence! Ahh.

Still getting a few small niggles of anxiety but nothing I can't cope with. The relationship/health anxiety has passed and the only thing I tend to latch on to now is worrying that a message or call from my family will be bad news (Mum has had some health concerns lately). I do need to work on this.

I've signed up to do yoga teacher training, which my lack of decision making/fear of making the wrong decision would never have allowed me to do before. I'm really excited. 🤗

The only downsides of being back on meds:
- I'm tired ALL the time. Sleep seems to be my no.1 priority in life.
- I have NO sex drive again. Like absolutely no desire whatsoever. 🙄
- Definitely getting more headaches again.

All in all, I'm down okay. I'm glad I went back on them.

[panic_down_under]

I managed to get through those first few weeks relatively unscathed, apart from the first week.

This is very good news!!

The only downsides of being back on meds:
- I'm tired ALL the time. Sleep seems to be my no.1 priority in life.

Most get insomnia as a side-effect which can be harder to deal with. It will likely ease after a while, though, as with everything about ADs, there are no guarantees.

- I have NO sex drive again. Like absolutely no desire whatsoever.

Unfortunately, most ADs may nuke the libido and the ones which don't tend not to be great for anxiety disorders, trazadone being the exception. I've listed a few things which may help here: Libido ...loss of, but it was originally written for a Nth American audience and some of the suggestions are not available from the NHS.

- Definitely getting more headaches again.

Pretty much all you can do is take paracetamol, aka acetaminophen. The NSAIDs, aspirin, ibuprofen, etc, work well too, however, paracetamol should be the first choice as SSRIs are mild anticoagulants as are the NSAIDs and taking them together can be risky for some. A couple of tablets now and then probably won't do any harm, but definitely avoid taking them multiple times a day for extended periods.

Final thought on all the side-effects. Escitalopram (Lexapro) is almost the same as citalopram sharing the same active chemical. The difference is citalopram made up of two isomers, the 'S' form of citalopram, i.e. escitalopram, which is the active component, and a 'R' mirror image form which is a poorer fit biologically and so is mostly inactive. Lexapro (escitalopram) is more refined and only contains the 'S' isomer. While that small chemical difference doesn't usually impact effectiveness it can cause differences in the side-effects each produces and there is a chance that switching to escitalopram will ease, or eliminate the side-effects you're experiencing. But it could make them worse, or produce other side-effects which are even more of a pain in the posterior. The only way to know is to try it. Fortunately, as they are so close chemically switching between them rarely causes any issues. Something to consider if the side-effects become too overbearing.

[Overwhelmed]

My anxiety/panic seems to have taken a turn for the worst again. This scares me as it's never really happened whilst on meds so now my brain is naturally thinking "I'm beyond hope". Panic setting in further and all I want to do is hide away.

I think I might get in touch with the doctor about going up to 20mg. 10mg has always worked very well for me in the past but maybe my brain just needs more this time. Very scared that nothing will work. 😔

[panic_down_under]

now my brain is naturally thinking "I'm beyond hope".

That's the anxiety 'talking'. You're a long way from having to worry about that.

I think I might get in touch with the doctor about going up to 20mg. 10mg has always worked very well for me in the past but maybe my brain just needs more this time.

It is not rare to need a higher dose after stopping and restarting an AD. Plus, 10mg is a sub therapeutic dose for most so you really should be on at least 20mg anyway.

Very scared that nothing will work.

While there is a chance that citalopram may not be effective this time another SSRI is likely to work, plus the SSRIs (and SNRIs) are not the only ADs, nor, arguably, are they the most effective. They are the ADs of choice these days because they are perceived to be safer in overdose than the older TCAs and MAOIs, which isn't actually true of all of them including citalopram, not because they are more effective. So you would have many options should a med change be needed.

[Overwhelmed]

Thank you Panic_down_under. x

[Overwhelmed]

Gosh this wave of panic has really knocked me back so unexpectedly this time around. When it happened when I was off meds, I could almost accept it & work through it, but now that I'm back on meds I almost convinced myself that I was invincible whilst taking them.

Now having panic about panic about panic.. you all know the drill. My thoughts aren't really my own at the moment. I'm waking up with my heart racing again & can't even think about planning for the future (aka wedding).

Please no talk of the medication pooping out as I can't face the thought right now. Just taking things very slowly & quietly until this episode (hopefully) passes. I hate anxiety.