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

[Sparkle1984]

I've been having a difficult few days. About 10 days ago I developed a heavy cold, which unfortunately coincided with me reducing my citalopram dose from 10mg to 5mg a day. I started on 20mg in July 2020, and cut down to 10mg in May this year. My anxiety had been better in recent months, so I felt ready to reduce.

On Wednesday night as I was lying in bed, I noticed a rumbling sound in my left ear. I feel like this is a repeat of the scenario I faced nearly 6 months ago in June - shortly after having a cold in late April/early May, my left ear became so full of wax that I could no longer hear properly, my ear felt full and I heard a rumbling sound. I tried using ear drops for several days but it didn't solve the issue, so I had to have my ears professionally microsuctioned. The audiologist said my left ear was completely full of wax, but my right ear didn't have much wax at all. After it was removed, the rumbling noise in my left ear went away and I could hear normally again.

So I might have to have my ears microsuctioned again (if using Otex ear drops doesn't work), but the earliest weekend appointment is 7th December.

I find the rumbling noise rather distracting, and it feels like the wax is leaning against my ear drum. I keep listening out for the noise to see whether I can hear it over whatever I'm doing at the time, and it makes me particularly anxious at night when I'm trying to sleep.

I've been feeling rather anxious and a bit low. My thighs often feel tensed up. I'm thinking it's probably a combination of the citalopram withdrawal and my ear blockage. The cold itself is almost gone now, and I'm gradually getting back into my usual routine. When will the negative effects of the dose reduction start to die down?

[panic_down_under]

I started on 20mg in July 2020, and cut down to 10mg in May this year

Are you tapering down on your GP's recommended schedule, or following your own?

I'm thinking it's probably a combination of the citalopram withdrawal and my ear blockage. The cold itself is almost gone now

I suspect it is a combination of your ruminating about the ear rumblings, maybe withdrawal symptom although they typically begin earlier than 10 days and the cold. The underlying brain dysfunction which creates the anxiety and/or depression symptoms is produced by a type of auto-immune reaction and these disorders can become more severe when the immune system ramps up fighting an infection.

[Sparkle1984]

Thanks, I am following my doctor's advice for the reduction in dose. I first started feeling this heightened anxiety about 5 days after dropping down to 5mg. When will it improve?

[panic_down_under]

I first started feeling this heightened anxiety about 5 days after dropping down to 5mg. When will it improve?

Unfortunately, that's a how long is a piece of string question which can only be answered with "it depends". Anywhere from tomorrow to some weeks.

Try to keep busy so you don't have time to ruminate about how you're feeling and then launching into catastrophizing.

[Sparkle1984]

Thank you. I am trying to keep myself busy both with work and by going out for walks during my lunch breaks. I've also got several events planned for the next few days, such as an early Christmas quiz and chips night with my work colleagues on Friday, and going to the cinema and maybe out for a meal on Saturday.

[Sparkle1984]

In the last couple of days or so, I've experienced some loss of appetite, difficulty sleeping, queasiness and jitteriness as well as muscle tension. Could the withdrawal symptoms be worse this time around because I've been on citalopram for over 4 years? Would they be milder in someone who had only been on it for a few months?

[panic_down_under]

In the last couple of days or so, I've experienced some loss of appetite, difficulty sleeping, queasiness and jitteriness as well as muscle tension.

Talk to your GP is the symptoms become too hard to handle as there are ways of minimizing them.

Could the withdrawal symptoms be worse this time around because I've been on citalopram for over 4 years? Would they be milder in someone who had only been on it for a few months?

Nope. Most of the brain changes ADs initiate occur within 2-3 months, plus many withdrawal symptoms originate in other organs. For example the loss of appetite and queasiness are probably reactions from the enteric nervous system (ENS) the mini brain which controls the gut and also seems to have considerable influence over the brain between the ears (in turn the gut microbiome seems to have considerable control over the ENS and as the microbes also have serotonergic binding sites so are also affected by ADs).

[Sparkle1984]

Thank you - just out of interest, what options do doctors have available for minimising the withdrawal symptoms?

[panic_down_under]

Thank you - just out of interest, what options do doctors have available for minimising the withdrawal symptoms?

The meds typically prescribed for each symptom, such as pregabalin or a benzodiazepine for the heightened anxiety, low dose mirtazapine for insomnia, plus it would likely solve the lack of interest in food too, maybe an antiemetic for nausea, but try ginger and/or vitamin B6 supplements first as they can be very effective.

[Sparkle1984]

Thank you. Thankfully the muscle tension has mostly gone away in the last couple of days. My appetite hasn't been too bad since yesterday - I can still manage all my main meals, it's just that I get fewer hunger pangs between meals so I don't snack so much. Maybe it's just as well, as my weight has increased quite a bit since 2020 - I was previously slim after completing a weight loss programme, but since the pandemic/lockdowns and starting citalopram on summer 2020, I have put the weight back on and I am above what I should be for my height. It seems weird because I bought some of my favourite chocolates on Sunday but I've hardly had the urge to eat any! Usually they would be mostly gone by now, but I've only been eating a couple a day, if it all. Due to my weight, I probably would avoid mirtazapine as I've heard some people on that feel hungry most of the time!

I spoke to my sister who works in healthcare and she said she would ask a pharmacist colleague for advice on my behalf. Currently, 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.

My main problem at the moment is getting to sleep and staying asleep, and the ear problem For example, this morning I woke at 6am and kept thinking "oh no, I have to be up for work at 7am!" and then felt so anxious I couldn't get back to sleep properly.

I spoke to my sister for an hour on the phone yesterday and this has helped reassure me somewhat. She also has issues with anxiety and depression and is on escitalopram.