Starting Citalopram Tomorrow After Severe Relapse - Advice Needed Please

[shoegal]

Hello folks,

I am crying as I write this so please bear with me.

A quick History - I have suffered from Agoraphobia on and off for 6 years but was able to go out with a safe person and could walk my dog by myself. In January I had a relapse and started to have panic attacks when walking my dog. This got progressively worse until I was unable to leave the house without having a severe panic attack. This led to severe panic attacks at home as well which I didn't suffer from before.

In the past 6 weeks I have suffered from severe anxiety day and night with occasional 12 hour panic attacks that keep me awake all night in a complete state of panic and despair. When I panic I feel like I will faint or collapse, my heart races, I have a tightness in my chest that makes me feel like I can't breath, I shake from head to toe, I retch and am sometimes sick, I have blurred vision, my mouth gets dry... you name it I've got the symptom.

After a particularly bad attack on Wednesday night my sister came to stay with me and I told her I wanted to kill myself. I don't want to kill myself, but I WANT THE PANIC ATTACKS TO STOP as I am no longer able to function. I cannot eat properly, I cannot sleep, I can barely look after myself and I fear that I will become too unwell to look after my dog.

This all led to me being referred the the Mental Health Crisis Team who came to my house to assess me. They have put me on Diazepam for a week and on Monday (tomorrow) I have to start taking Citalopram. I am terrified of taking this drug as I cannot imagine my anxiety being any worse and I am scared of what I might do if my attacks get any worse.

Originally I was told to take 5mg of Citalopram and to increase the dose to 10mg when I felt ready. I was also told to take them at night. I did as advised and within an hour of taking the Citalopram I was violently sick and couldn't stop shivering. This went on all night and I was in such a state of panic even my boyfriend thought I was much worse when on them so I stopped taking them.

My Psychiatric nurse has told me I have to take the Citalopram again only this time I have to take 10mg and I have to take it in the morning. Having looked at my prescription, the Dr has said I should take the Citalopram at night, so I'm now confused about when I should take it? Why have two different Drs told me to take it at night when the nurse has told me to take it in the morning? And why have two Drs told me to start on 5mg and increase the dose slowly when the nurse has told me to start on 10mg?

I am so scared. I am alone, in a state of constant panic and absolutely dreading the side effects of the Citalopram.

I would really appreciate some support/advice/guidance from anybody who has been through the same thing please.

How bad are the side effects going to be? Will my panic attacks get wose (I really don't think I could bear them to be any worse than they are)? Will the sickness pass? Please don't tell me any horror stories as I'm frightened enough as it is (understatement)!

I am genuinely scared that I will never get better and that my panic attacks will never stop. I feel like I am in hell. Please help.

*Just thought I would add that I've been crying almost non stop for 4 days now and I've been told I have depression. I have never suffered from depression before and generally have a cheerful and positive outlook despite the agoraphobia. I think if I am depressed it is because the anxiety has got out of control and I feel so helpless.

[KK77]

I'm sorry you've been having such an abjectly horrid time.

Re dose, it's difficult because your doc wants you to get better ASAP and therefore reach the optimum level quickly. This obviously has to be balanced against initial side effects and worsening of your condition, so perhaps it would be wise to take your doc's advice - go with 5mg and increase slowly. I know you probably don't want to be a burden on others but I feel you should stay with someone who could monitor you. At the very least, let family, friends etc know you're starting on a med that could potentially make you feel worse before it kicks in. I'm sure your MHT will also be supportive.

Re timing, citalopram can be taken morning or night but taken at night could interfere with sleep, although it has the opposite effect in some people. I would, again, follow your doc's advice here: take it at night and see how you go. It's trial and error sometimes.

I think it's pretty normal to feel a degree of depression when anxiety symptoms persist but I think treating your immediate anxiety is essential and I hope the antidepressant along with support from friends, family, bf, MHT and NMP help you to get through this terrible time.

[LauraSmith27]

Hi Shoegal

I'm sorry to hear you've been having such a bad time. It sounds like you've reached rock bottom just as I did two months ago. I'm glad to hear though that you're going to give the citalopram another go.

Why have two different Drs told me to take it at night when the nurse has told me to take it in the morning? And why have two Drs told me to start on 5mg and increase the dose slowly when the nurse has told me to start on 10mg?

I think this is all just a case of different people having different opinions. I would try not to worry too much about it. I had one GP tell me to start on 10mg and another said 20mg. One also said morning and the other said night. I think you just have to do what you feel most comfortable with. If you want to start very slowly with 5mg, then do so. The nurse probably thinks a dose of below 10mg will barely do anything so is advising you to start off higher, but if it makes you feel better to start on 5mg, then go with that. As for the time of day, that is also up to you. I find taking my cit at night is better, but this varies from person to person. Again, I would try not to worry too much about it, just go with what you feel.

How bad are the side effects going to be? Will my panic attacks get worse (I really don't think I could bear them to be any worse than they are)? Will the sickness pass? Please don't tell me any horror stories as I'm frightened enough as it is (understatement)!

You won't know how bad the side effects will be until you start taking it. They usually pass within a couple of weeks. I had tiredness and headaches to start with, but this quickly got better. I didn't experience a worsening of my panic attacks at all, maybe you won't either. I think I mentioned taking anti-sickness tablets to you before if you are worried about being sick. I don't know if you could ask your GP about these. I've found them very useful in the past.

I really wish you the best of luck with restarting the citalopram. I know how it feels to be scared and alone. I was terrified of starting this drug too, but it has helped me loads. No matter how hopeless everything feels, don't give up. It won't be easy, but you can most definitely beat the panic attacks.

Best wishes,

Laura x

[shoegal]

Thank you for you advice. The Psychiatric nurse said she was going to be strict with me and is coming to see me in the morning to check if I took my Citalopram. Personally I want to start on 5mg because last time when I took that much I felt worse than ever and I can't imagine what 10mg would do to me! My panic attacks are severe and if they get worse I'm concerned I will be tipped over the edge! I definitely don't have anyone who can be with me which doesn't help wth my fears about how I will cope with the side effects so I really think I should start on 5mg. But if I don't do what the nurse tells me I feel like I'm being naughty and will get into trouble! It's easy for them to dish out orders when they are not living in this hell isn't it?!!

I have just had another severe panic attack and the Diazepam has barely done anything. My sister phoned and heard the state I was in so she told me to ring the Crisis Team. She said they need to hear what I'm like when I'm not coping. This whole thing is so degrading. I'm begining to think that I will never recover from this nightmare. I just don't know what to do anymore. I have not eaten today because I have no energy, feel sick and can't stop crying with anxiety and panic attacks on top of that. WTF is happening to me?

UPDATE: The Crisis Team have just called me back and I told them I felt panicky and I was worried about starting my Citalopram tomorrow. My Psychiatric nurse has said I MUST take 10mg and I must take it in the morning. She said they are only prescribing Diazepam for me to help me cope with the 10mg dose of Citalopram. So in other words they are blackmailing me, and would withhold the Diazepam (the only relief I've had in months from my panic attacks) if I don't do what they tell me. I feel scared and a bit like I'm being bullied into this! I've also been told I 'have' to take it in the morning even though two different Drs told me to take it at night. I am fed up and confused.

[blueangel]

First of all, I'm really sorry to hear that you're having such an awful time at the moment. I know from my own experiences that anxiety can be crippling, although I'm lucky to never have had real problems with agoraphobia (other than finding crowds hard work sometimes).

I can understand that you're feeling worried about taking the Citalopram - BUT don't forget that not every body has problems with side effects. A lot of people take it with no problems at all, or ones that ease off after a week or two. I've actually taken Citalopram three times now, and each time I've started them I've had different side effects. Only one time out of the three has it made me feel more agitated, but it wasn't the same as panic symptoms; I felt restless and twitchy, but it didn't translate itself into panic in the way that I'd normally describe it. I started with 10 mg and to be honest, I didn't feel much effect from it at all - it was only when I stepped up to 20 mg that I could feel that I was taking any medication.

I agree with the others that you need some urgent help, and at least the Crisis Team are very experienced at dealing with this sort of thing.

I can also understand how you're feeling at being told what to do, and I can see how you feel that you're being blackmailed. However, there are times when all of us need a bit of "tough love" (I know as I've been there myself) and we have to accept that maybe we need to take advice for our own good, even though it might not feel like it at the time.

Good luck, and keep us posted.

[LauraSmith27]

Hi Shoegal,

How did things go with your psychiatric nurse this morning? Hope you're ok.

Laura x

[shoegal]

Hello people,

Well... I took my 10mg of Citalopram this morning along with 4mg of Diazepam as recommended by my Psychiatric nurse. Then I went back to bed because I didn't want to think about things. Within half an hour I had to run to the loo because I had the runs (TMI) and then went back to bed and fell asleep. I woke up at noon and had to run to the loo again! I've just had some Weetabix and again I have an urge to run to the loo. I've not had an upset tummy at all even when I had severe anxiety so could this be a side effect of the meds? Other than feeling slightly more anxious than usual I can't say I've noticed any other side effects... YET! However it's early days and I don't mind admitting I'm scared.

[KK77]

Hello people,

Well... I took my 10mg of Citalopram this morning along with 4mg of Diazepam as recommended by my Psychiatric nurse. Then I went back to bed because I didn't want to think about things. Within half an hour I had to run to the loo because I had the runs (TMI) and then went back to bed and fell asleep. I woke up at noon and had to run to the loo again! I've just had some Weetabix and again I have an urge to run to the loo. I've not had an upset tummy at all even when I had severe anxiety so could this be a side effect of the meds? Other than feeling slightly more anxious than usual I can't say I've noticed any other side effects... YET! However it's early days and I don't mind admitting I'm scared.

Yes, I'd say it was a side effect of cit, Shoegal. Don't worry as it's transient. Drink plenty of water as you're likely to be dehydrated and take it easy. I don't think milk will help. Try eating some plain toast if you can stomach it...

Keep us updated and stay strong.

[Eternity]

Hi Shoegal
I'm so sorry that you're going through this, it sounds awful and you have always been so supportive and kind to everyone else on here. I take citalopram, I've been on it for over two years, and am on the highest dose 60mg. I was recently changed to vensir which didn't work and am now back on citalopram. i remember starting them and as I was starting to feel so low and anxious, I also worried about the increased anxiety and possible suicidal thoughts. But to be honest it wasn't that bad, I felt nauseous for a few days and a bit anxious (but I think that was more to do with panicking in case they didn't work!!). But it really wasn't too bad. I also take mine in the morning and have never had any problems. Please take care and let us know how you are getting on.
Lots of love
Tina xx

[JT69]

Hi Shoegal,

Firstly so sorry that you are having such an awful time.

I have taken citalopram in the past and it did cause stomach upset (runs) when I first took it so it is a side effect of the medication. I found I just drank lots of water and ate dry toast or munched on a dry cream cracker. It will pass once your body gets used to the meds. I always started on 10mg when starting out before slowly increasing when I felt ready.

I hope that you feel better soon. You have a lot of support here.

TC
Jo.xx