Increased anxiety 10 days after reducing from 10 to 5mg, and heavy cold

[panic_down_under]

Due to my weight, I probably would avoid mirtazapine as I've heard some people on that feel hungry most of the time!

True, mirtazapine can cause powerful carb craving to the point some will eat sugar from the bag, however, you should be okay taking a small dose only when you can't sleep.

I am taking one 10mg citalopram tablet one day, then nothing the next. Maybe this is making me feel more unsettled, so I might try getting a pill cutter and taking 5mg a day, depending on the advice I get.

I'm not a fan of tapering by skipping doses as it can produce a yoyo effect, especially when on very low doses, however, citalopram has a longish half-life of about 35 hours which may dampen this effect.

She also has issues with anxiety and depression and is on escitalopram.

Citalopram and escitalopram are nearly the same med sharing the same active ingredient, the 'S' isomer of citalopram, aka escitalopram. The difference is citalopram also contains the mirror image 'R' isomer which is a poorer fit biologically and so is much less active.

[Sparkle1984]

Yesterday I got a pill cutter so I can take 5mg a day. I also started taking Sudafed decongestant tablets on my sister's advice. Last night, although my left ear is still blocked, the whining noise seemed slightly less loud and distracting, and I got a better night's sleep. I still feel a bit anxious today, though. I am looking forward to my first Christmas party tonight. I'm also counting down the days to my microsuction treatment - it's now 8 days to go.

As of yesterday morning, the Otex Express eardrops started to feel a little bit irritating inside my ear, so I've decided to give it a rest for a couple of days and start using olive oil drops instead from tomorrow, in preparation for my microsuction appointment.

[Sparkle1984]

It has now been exactly 2 weeks since I reduced my dose. Unfortunately I am still experiencing heightened anxiety today. I feel like my body is full of adrenaline and nervous energy. I feel more fidgety than normal. In the last 10 days, I haven't experienced much in the way of depression symptoms; it's nearly all been anxiety.

I was hoping the Christmas quiz tonight would take my mind off the anxiety, but unfortunately I felt anxious all the way through and I just couldn't forget the anxiety was there. I wasn't anxious about the event itself, it was more like free-floating general anxiety.

As well as the physical symptoms, these are the intrusive thoughts I've been getting:
What if this is a relapse and not withdrawal symptoms?
What if the anxiety doesn't go away once my ear is sorted out?
What if I just can't cope without the medication after all?
Why do I feel so anxious when I have no serious, long-term problems in my life? (I consider the ear problem a temporary problem, as I'm pretty sure the feeling of fullness will go and the whining sound will die down once the wax is removed next Saturday). I have a loving family and a secure job, so there is no real reason for me to feel so anxious.

[panic_down_under]

As well as the physical symptoms, these are the intrusive thoughts I've been getting:
What if this is a relapse and not withdrawal symptoms?
What if the anxiety doesn't go away once my ear is sorted out?

It is possible you've relapsed. There's no way of knowing beyond waiting to see if the anxiety diminishes.

What if I just can't cope without the medication after all?

Then you go back on it and continue with life.

Why do I feel so anxious when I have no serious, long-term problems in my life? (I consider the ear problem a temporary problem, as I'm pretty sure the feeling of fullness will go and the whining sound will die down once the wax is removed next Saturday). I have a loving family and a secure job, so there is no real reason for me to feel so anxious.

While many cases begin due to stress after significant life changes there are lots of people who develop these disorders out of the blue with no obvious triggers. Anxiety and depression are the symptoms of atrophy of parts of the two hippocampal regions of the brain caused by high stress hormones killing nerve cells and inhibiting the growth of replacements. It is a type of auto-immune reaction (alcohol, benzodiazepines and some illicit drugs including cannabis can also cause hippocampi atrophy). Both ADs and CBT/REBT/etc therapies work by stimulating the growth of new neurons. They and the connections they form create the therapeutic response, not the meds or therapy directly.

[Sparkle1984]

In the end, I decided to contact my doctor this morning and I went back on 10mg as of tonight. In recent days, my ear blockage has improved just from using olive oil ear drops and although it's still not back to normal, the whining sound and the feeling of fullness is less noticeable than it was a week ago. I remember sitting in the office last week and I could hear the whining noise in my ear over the top of the hum of the heating system. This week, I only really noticed the whining noise during the day if I was focusing on it.

Despite that, the anxiety is only a little bit better than it was last week. I feel a bit of hopelessness and less enthusiastic about things I would normally enjoy, and I'm not even looking forward to Christmas much this year, even though it's usually one of my favourite times of the year. In early January next year, I have a trip away with work, and I want to feel better by then. So I thought it would be best to go back up to 10mg, at least for the time being. I'm never going to reduce my dose in winter again!

[panic_down_under]

So I thought it would be best to go back up to 10mg, at least for the time being.

Are you planning to increase the dose to the recommended minimum 20mg/day? Remaining on 10mg, which is a sub therapeutic dose for most, for long periods may increase the risk of the AD pooping-out.

[Sparkle1984]

Are you planning to increase the dose to the recommended minimum 20mg/day? Remaining on 10mg, which is a sub therapeutic dose for most, for long periods may increase the risk of the AD pooping-out.

It depends how I feel. The doctor's surgery said to contact them in 2 weeks to see how I'm getting on. Although 20mg is the highest dose I've been on in the past, there have been long periods where I've found 10mg sufficient. For example, I cut down to 10mg in May and I was OK until I came down to 5mg in mid-November. Also, the last time I was on citalopram from 2015 to 2019, I managed fine on 10mg from 2017 onwards, then came off completely in July 2019 after weaning down from 10mg for several months.

[Sparkle1984]

Today is day 7 of my citalopram increase to 10mg. Today I've felt so awful that I've had to take the day off work sick! I think I only managed to sleep for 4 hours last night, although I did manage to catch up a bit in the morning after contacting work. I woke up feeling panicky after a nightmare. I feel low, with a lot of intrusive thoughts.

[Sparkle1984]

I was hoping that as I was only on the 5mg dose for just under 3 weeks in total, it wouldn't take too long for the 10mg dose to kick back in, and that the side effects would be less compared to starting from nothing?

[panic_down_under]

I was hoping that as I was only on the 5mg dose for just under 3 weeks in total, it wouldn't take too long for the 10mg dose to kick back in, and that the side effects would be less compared to starting from nothing?

They may be less than they would have been if starting from scratch. The rule of thumb is that increasing a med dose sooner than 5 times its half-life may trigger more severe side-effects than if the increase occurs after 5x the half-life. But delaying the dose increase for longer usually does reduce the side-effects no matter how long the delay.

However, things are less clear cut when increasing the dose after a temporary decrease. I suspect that psychology may be contributing to the severity of the side-effects you're experiencing. An anxious mind is very capable of generating or adding to the symptoms.

The likely better news is that it takes about 7 days for citalopram plasma levels to stabilize to a steady state and this is often when side-effects begin to ease. So you've probably just reached peak side-effects severity and are on the home stretch.