Tapering off SSRI

So, as a brief backstory, I have been afflicted by panic attacks for most of my adult life, and when I had a stroke, I had hoped that these pernicious yet physically benign interruptions might have been zapped by the strike and that I would, instead, have gained the skill of a polyglot. Alas, the panic attacks endured and I have a long way to go before I can utter a sentence in any of the Proto-Indo-European languages. A panic attack is like a threat of death with all the trimmings yet, in theory, there’s probably a more real and present danger of choking on the silver sixpence in your slice of Christmas pudding. With all the brain fog, disorientation, fatigue, fear, psychical and mental malaise associated with having a stroke, I just couldn’t face adding panic attacks to the mix. I opted for long-term medication, I already used short-term medication if a really nasty panic should arise, and the Mental Health GP dished out some Prozac which knocked me about silly, and was the same medication I suspected might have kicked off all these panics in the first place, but that is another story. I did a small amount of research and came across Citalopram which is used to treat panic attacks and panic disorder, besides also being an antidepressant. In the same way that the anti-depressant, Amitriptyline, is also used for a number of other conditions, including insomnia.

I have been taking 20mg of Citalopram for three years now, since having had the stroke. The first four weeks of taking the medication made me feel like I was cast into Dante’s Purgatorio. Everything got worse before the medication settled, and then only after six months was I, at last, able to come up for air. It did work. It did the trick. It suppressed the panic attacks. On another positive note, SSRIs help neurogenesis (especially the hippocampus) and neuroplasticity, so as someone who, after stroke, really could do with some push on these things, I was not reluctant to take them. Yet, after three years, I feel my brain is stable enough now to proceed tapering off this medication, and plucky enough to tackle the potential attack of panic with all the useful Mindfulness techniques and other ways of being I have adopted subsequent to having my brain smote.

To taper off this medication, I have reduced my quantity by half. That’s 10mg per day. My aim is to stay on 10mg for about six months. So far, it has been two weeks. Already some unpleasant feelings have arisen, mainly feelings of anxiety, hot flushes, and an impending feeling of doom. I have been prepared for this and have, so far, contended with those feelings quite confidently. I have used the Mindfulness technique of observing the negative sensations and letting them pass. I have also practiced a bit of exposure therapy and allowed myself to press on despite wanting to run away and worry. The latter does not feel good but coming out the other side, knowing that I made it, gives me that extra boost of confidence for when it next occurs. It also compels the brain to make new pathways it might otherwise retreat from because I have retreated. A case in point, I recently had an argument with my brother-in-law, it was a colourful one. I was very much in the moment. There was lots of finger pointing, knitted brows, and exclamations of exasperation. I eventually walked away to cool down. I felt mentally exhausted for two days but then something twigged. It was if I had exerted some neurones to the point of making a connection or two. Now, I am not saying, go out and have a quarrel with someone, but my point is that often as stroke survivors we get to a point in our rehabilitation where we just stop short of the mark for a myriad of reasons, be they fear, fatigue, disillusionment, disheartenment, failure, or the task is frustratingly put in the too hard basket. That’s when a neurone that might have made a connection backs off as well.

I suspect these feelings associated with tapering off will continue for about six weeks. I plan to add to this post until the edit-by-date, and describe as best I can my experience and coping strategies.

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Morning @Rups. Just wanted to wish you strength and fortitude in your quest as someone who has struggled with this issue pre and post stroke. It sounds like you’ve researched and prepared, and will give it your best, informed, chance to find the right things for you, thank you for sharing, Julia x

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@Rups best wishes and big hugs , you’ve got a strong character and personality to assist you along the way, you’ve prepared and researched so know what to expect. All the ground work is in place, you’ve got this, it’s in the bag👍

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Nice piece of writing and relevant subject matter for us in this forum .

Thanks for taking the time to share

:slight_smile:

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Bore da,

@JuliaH, diolch yn fawr, I imagine that I’ve got at least six weeks of adjustment before the reduced amount of Citalopram settles. I have friends who have stopped SSRI medication suddenly and the result has been they resumed promptly after because the rapid decrease in dose creates havoc for the brain, and anxiety gets a lot worse.

@Mahoney, diolch yn fawr, and hopefully the bag has some kind of zip or fastener that keeps it there. :smile:

@SimonInEdinburgh, diolch yn fawr, it was somewhat startling when I first thought to review my medication and realised I had been taking it now for three years. One of my bugbears with Citalopram is that one of the side effects is dizziness, and of course one of the symptoms of cerebellar stroke is dizziness, so this can add disquiet to any introduction to the medication or tapering. It’s a battle of wills.

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I can’t remember the pill my hubby was on for stress and insomnia but when he weened himself of it, he used to just halve and quarter the pill. So he started off taking ¾ of a pill, gradually reducing to ½ then ¼ 'til eventually he was just taking slivers which were more for the placebo effect than anything :smile: Can’t remember exactly how long he was on each reduction but I think it took him a year before he came off them. But he still uses a couple of slivers now and again when he’s having trouble sleeping. I suppose it’s the fear of regressing but his doctor is happy to keep it that way as seems to be working for him.

I love your post, and we all appreciate reading peoples progressions, it gives us all hope for our own futures on this new path we find ourselves on. I wish you every success getting yourself off this tablet. Tread carefully and go up to 15mg if need be and stay there for a while…if you can divide the tablet, my hubby used a nail clipper to cut his up.

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@Rups good luck with this journey. Sounds like you are fully prepared for it & are strong enough to deal with the downs along the way.

I agee with @EmeraldEyes re taking 15mg for a while if necessary.

Look forward to hearing how you get on.

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@Rups Croeso
yes the oh god is it happening again feeling is always troubling even when dispassionately we know that we felt that way before for what is no good reason
Caio
Simon

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Diolch, @EmeraldEyes, progression is the word. I have also followed some of your wisdom with exercise and diet, we are mapping our way through all this, and hopefully it is a useful map for others who might join us on this unfortunate but insightful journey. I did consider a quarter of a pill but the manufacturer of the particular tablet I am supplied with have made it almost unbreakable, even when splitting in two. I have had half a tablet fly across the room a few times, or just fall apart in fragmentary pieces. However, when considering my tapered dosage, I took into consideration its half-life which is thirty-five hours and the dosage of 20mg, if I were taking the maximum dosage of 40mg, I wouldn’t dare go down by a half.

Diolch @Mrs5K, in times of distress, I remind myself that I have survived a stroke, and if I can survive a stroke and carry on, I can handle, albeit with a bit of bumbling, almost anything.

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If the are so hard to split, maybe have a word with your chemist and see if you can get the same in 10mg tablet as they might be easier to split. Chemists also sell little pill cutters which may also make it easier.

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Or grind them in a pestle mortar possibly with a little sugar or something to bulk out the powder that’s created and then divide that up to halves of quarters or fifths?

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Update on tapering off Citalopram. It is now twenty-five days since I have been on a half tablet. It generally takes about ten days for the body to feel the effects of reducing the dose of an SSRI. After two weeks things got a little harder. I have had a few days of unnerving anxiety. This has caused my stroke symptoms to increase because my brain is managing the anxiety, and the result has been anything but pleasant.

The other day, I was out metal detecting with an archeology friend, we were sweeping a field for potential iron-age relics. I felt awful, had to lie down in the grass and practice some Mindfulness, I called out to Molly and encouraged her to sit with me as I entertained the feeling of impending doom. I thought about returning home but fought it by picking at grass and talking to my dog. I then did some breathing exercises and observed what was happening to me. I was experiencing detachment and heating up physically. It did, however, pass and I was able to detect for another good hour, and then have a pint in a quiet farmer’s pub afterwards, but it was touch and go at one point.

I’ve noticed the anxiety can erupt at anytime, I can be relatively okay and then start to feel detached and doomed. Tonight, while watching the jolly, fun film Dungeons and Dragons: Honour Among Thieves, anxiety swilled up, I closed my eyes for about thirty seconds and let it flow over me, go on, do your thing so I can resume watching the film

The main effects of the anxiety are hot flushes, detachment, impending doom, tingly feelings in my hands, and disorientation. During one episode, I genuinely expected another stroke but none of the symptoms were there, so I was jumping at shadows. A bit like Arthur Dent expressing “So this is it. We’re going to die”.

Okay, so the short and curly of the whole matter is that if you are tapering off SSRI medication, you may feel side-effects appearing after about ten or so days, just when you thought everything was under control with the reduced dose. Assess the situation, don’t backtrack if you are determined to taper off. I will check in again when there is further development, hopefully, a better change will prompt another update.

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@Rups sounds a frightening experience, though I’m pleased to hear you’ve managed to find a coping mechanism that’s helping.

Best wishes

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Frightening and alarming, indeed, but I try and replace such words with words like boring, tiresome, bothersome … :laughing: The interesting thing about Citalopram, is that it doesn’t eradicate a panic attack, it merely inhibits it. So, as far as I can see, the panic is still occurring but I don’t feel it. So, when dropping the dosage, I’m not experiencing a full blown panic but it is a little more intense than if I were on 20mg. So, beginning from two weeks after having dropped to 10mg, I expect at least four to six weeks of this feeling before my brain gets to grips with the adjusted level of serotonin.

I know of someone who came off Citalopram cold turkey. She was okay for about half a week but went straight back on it when the side-effects became worse. And it will be worse. It will be amplified, so I have observed other people’s experiences enough to know that mine are not out of the ordinary per se.

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Hi Rups
Just to pose the question, are there long term effects of taking that medication?
If there are not, such as side effects and it was giving you some benefit, why not stay at the original dose ?

The pharmacist who was helping me suggested as a guide, minimum dose for maximum benefit.

Do you find much when out metal detecting ? I guess there was an explosion of interest when the detectorist series was on and aquachigger on you tube. Always surprised he maintains so much enthusiasm for funding yet another bullet. :grin:

Cheers
Nige

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Rups that’s another standout post :slight_smile:

Assume you’ve seen the physical effects of anxiety graphic that ive posted before? You’ve added an extra visceral dimension or a dimension of viscerality - If that’s word!

Ciao
Simon

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Shwmae @Nigelglos, there are a few benefits to taking SSRI, mainly for a stroke survivors, neurogenesis and neuroplasticity, and managing depression and anxiety. However, I didn’t need them before stroke, and feel that it is time to at least reduce the amount. I worked very hard all my adult life to manage panic attacks, and would like to benefit from that effort again. I agree completely with your pharmacist, minimum dose for maximum benefit. If 10mg works for me, I will stay on this for an appropriate amount of time.

I find lots when metal detecting … fence staples, barbed wire, hand-forged nails and axe heads, lead, gate pins and hinges, occasional coins (nothing too old), parts of agricultural machinery. No Holy Grails or Excaliburs, but am currently sweeping an area that has been recently listed as an iron-age settlement. As with with foraging for mushrooms, I enjoy the day out, mucking about outdoors without any particular aim than the potential reward of a find.

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Diolch Simon, let us say it is a word as you have used a logical combining form, even the word English is made from a combining form - Angle and ish, which makes creating additional words good funment.

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An update on tapering off Citalopram, it has been thirty-five days (five weeks). The third week was rather ruthless, with increased irritability and at times a tender hook temper, the anxiety levels got close to a panic attack a few times, but didn’t follow through, and I had to use a lot of meditative techniques to get through the day. By the fourth week, it all calmed. it was almost as if I could feel my brain adjusting to the new dosage. I imagine that the drop in serotonin must be unnerving for the nervous system (no pun intended).

So, after the sixth week, I will finalise this little journey and write up some of my coping strategies.

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Well done Rups the struggle will yield dividends, best wishes

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