Friends and regular readers of my website may remember my recent post, openly sharing the issues that I am currently having with panic attacks. The associated response from my social media contacts was fantastic, and so many people, many of whom I only know online, came forward to share stories with me. It was very humbling to have all that support out there.
I wrote the post primarily as a no-nonsense and non-clinical report for those in a similar situation who may come to find it in via Google in later months and years, and, a few weeks on from that, I wanted to do the same with regards to the medication that I am currently taking – Citalopram (20mg), which generally has a pretty bad side-effect rap sheet, many of which I’ve endured many of these over the past two weeks.
I have just completed my first two weeks on Citalopram (20mg), and the word ‘adventure’ definitely springs to mind.
Initially, I was pretty worried and hesitant to take the tablet, having done my research online and after looking at the accompanying safety leaflet. The number of icky side effects that are listed under “very common” (more than 1 in 10) or “common” (more than 1 in 100) are very off-putting, but it is important to know that these are in line with most SSRIs. Everyone will react differently to different medications in the SSRI class (as it alters the serotonin levels in your brain), but generally, Citalopram is held to be one of the more ‘stable’ options available, and the one that works best for most people.
On the first day, after a lot of umm-ing and ahh-ing, I finally took the plunge (it feels really weird waking up on a gorgeous sunny day and knowing that you are about to take a tablet that could end up making you feel so lousy). I felt pretty much ‘normal’ for the first four hours or so, as it takes this long to get in to your system. However, whilst out shopping, I was suddenly hit by the most intense wave of nausea that I have ever experienced, it was pretty ghastly. Fortunately, we were by a pharmacy, and so, after getting a knowing look from the pharmacist, was sold something called Motillium 10 (Domperidone), over the counter to help settle my stomach. Whether it was partly placebo effect, or not, I’ll not know, however within twenty minutes or so of taking it, I immediately felt so much more settled, which was very much welcome. Assuming these random bouts of nausea were going to be the ‘norm’, I continued to take Motillium 10 alongside my Citalopram and ‘sucked it up’.
Over the next few days, I continued to take the Motillium 10 throughout the day, as the dosage recommends, to try to help settle the random bouts of nausea. On the pack it does say as a disclaimer not to take for more than 48 hours, before consulting a doctor. I did this via telephone, and didn’t really get a straight answer. He didn’t seem too concerned with my specific symptoms, and instead went out of his way to reassure me that everything was ‘normal’, which I already knew, having done a lot of homework on Citalopram before hand. Nevertheless, I took the sign that he didn’t shout ‘no, stop!’ to be encouraging and continued with it.
However, I was totally unprepared for Day 6, thinking that I’d already experienced the worst of the side effects. I woke up and could immediately tell that something was different – I felt so nauseous upon waking. Looking back, Day 6 must have been when I reached the ‘normal’ resident dosage in my system. The worst thing about the nausea is that generally, you don’t vomit, and so there is no ‘relief’ to be had from it. Arguably, it is made slightly worse as you know that it is medically induced, and so there’s nothing really ‘wrong’, and no real known time frame for when sickness will work out of the system, as it’s owing to something that you’re constantly putting in. The Motillium 10 didn’t seem to have much effect, and I ended up having one of my panic attacks, something which I’ve not had at home before. It was genuinely awful, I thought I was going to keel over right there and then with just my cat to slowly eat me to death – even though I am sure my other half would have been home well before Fudge got THAT hungry! 😉
I spent 5 days on the couch, and could barely move. Appetite went, I didn’t/couldn’t leave the apartment, I felt really depressed and anxious and experienced a whole range of other symptoms. For me, I found that I developed morning sickness – in that I would feel absolutely shocking for the first 6 hours of my day, between say 10am and 4pm, and in the evenings, I would just feel worn out, but not anywhere near as nauseous as during day light hours. I had bad insomnia too, so I was often up in the living room until 3am, or so, before lying in bed for an hour. On balance, I had 6 hours of crap, 12 hours of ‘I feel a little more OK’ – but it’s hard to see the perspective at the time. Additionally, I was lucky, in that I was still getting 6-8 hours of solid sleep a night, just unfortunately it was coming at a rather skewed time frame.
As soon as I was strong enough to leave the apartment, I went to see my Doctor in person to discuss the nausea, and again was reassured that it was completely normal. What he did offer to do, however, was to prescribe me a stronger anti-nausea tablet for me, called Cyclizine (which they often give to pregnant women to settle nausea). This stuff has proven fantastic, and whilst it does knock you out for the first day or so (along with a nice warm fuzzy feeling), after the third day of taking it, for me, the drowsiness stopped, and it became just another pill.
Now, upon entering the third week of the Citalopram, I am thrilled to find that almost as quickly as the second wave of side-effects initially hit me, they’ve started to subside. At present, I am on my second day without taking anything for the nausea. I get the odd bout, but it’s nothing I feel that I want to medicate for at this time. I have some energy back, and have since been able to leave the apartment and do little things again like going shopping, or meeting Max from work – all the small things I missed so much when I was laid up. My sleeping is becoming better, and I now tend to retire around midnight-1am, and only lie awake for half an hour, which is a decent compromise.
I have yet to feel any benefits of the Citalopram itself (which I am primarily taking for my anxiety, along with some cognitive behaviour therapy sessions), and am weary about any increase in dosage, as I don’t really want to ever experience these side effects again, but I also know that it can take 4-6 weeks for the benefits to show, and I am still only on the start of week 3. I remain very optimistic about the Citalopram, and would also very much like to thank everyone online (especially twitter) for all the interest, words of encouragement and the advice.
As I said earlier, I am posting this post mainly as a reference point for people who are perhaps starting to take Citalopram who, like me, spent an obsessive amount of time trawling the internet, and reading about other people’s symptoms. My honest opinion on this is that whilst it may help to calm you and rationalise the side-effects, it is very important to realise that no two people have the same reactions to these tablets, so don’t get too hung up on it.
Also, it is worth remembering that your Doctor cannot predict which of the dozens of side effects (if any, many people seem to manage without them, believe it or not!!) you will have, and so do not feel afraid to go back to see him/her a few days after starting with Citalopram to report the side effects and seek complimentary medications for the specific side effects that you are encountering. One of my biggest mistakes was perhaps relying on an over-the-counter tablet once I got the more intense bout of nausea, instead of pressing my Doctor further. As is evident, I made my way through it, and whilst it felt like forever, it was just five days and was fairly routine (in that you knew exactly when you were going to feel crap and roughly when you’d start to feel more human).
My top tips for surviving Citalopram side effects:
- Remember that people do not take to the internet to post positive reviews – there is a lot of support out there, and by all means the various anxiety and depression forums are great, but just be aware that, generally, people will only post the bad, and, when they do, they may even exaggerate it slightly either for bragging rights or to make whatever the previous poster has been discussing seem milder in comparison, so as not to worry them. My post above is, I feel, an honest account of my experience, however, if you had encountered exactly what I did, perhaps you would have been a better patient (I am a total wuss!) and reacted differently – don’t rely on others to tell you exactly how to feel, but feel comforted that you are not alone.
- Citalopram side effects genuinely do not last forever – as hard as that is to believe. I felt that, with my symptoms, there was no way that I would start to feel ‘well’ again after the second week, but yet here I am – the difference can, honestly, be as quick as a day between feeling like a sack of spuds and not. Keep positive, and totally make the most of someone taking care of you (I have never drank so much tea in all my life!!).
- Get in to a routine with taking your Citalopram. Your body is far less likely to throw a wobbly after the initial side effects if you can keep the dosage ‘constant’ – speaking of dosage, please do not alter the dosage of your medication without first speaking to a Doctor! I have seen some people self medicate themselves at 10mg for the first week (splitting the butterfly tablet in half), and then upping themselves to 20mg in the second week. I’d imagine that would then put additional strain on your body (as you will be stepping up the amount twice in a short space of time, not once), and should only be done with the advice of a Doctor.
- Do not stop taking it suddenly! Whilst I was having my panic attack on Day 6 and feeling like I was about to die, I absolutely was ready to ring my Doctor up to tell him where he could stick his Citalopram, and that he would have needed more than just a pen-light to find it! Whilst the on boarding effects are dire, going cold-turkey is apparently so so much worse. Sure, you may feel fine for three days owing to the half-life of the tablet, but it seems that almost without fail, you’re going to crash in to a wall, and feel much much worse than pushing through. Even if you’ve only taken the one tablet (and that first one psychologically is always the worst), you really don’t want to screw up your brain!
- Take Citalopram just after food! It says on the label that they don’t have a preference as to when you take it, and that it can be with or without food. As I discovered, this just means that the drug absorption rate is neither hindered or helped by the digestive process – it’s nothing at all to do with what is best for your stomach. Taking my Citalopram after a piece of toast in the morning helped bring about perhaps the biggest change in my nausea. It was still rough, but taking the tablet on an empty stomach is definitely a lot more brutal! If you can stomach a cup of tea over a glass of water, with your breakfast, that also helped me.
- Following on from my last point – NEVER take a tablet with a cup of tea. It is MINGING and causes the tablet to dissolve in your mouth, and the chemical taste is abhorrent! Always use a water/cordial based drink 😉
- As soon as you feel able to, it’s great to have a friend come over and have a good DVD night in or similar. That way, you have an incentive to get up and about and do things, at a gentle pace, and a distraction, plus you also get the chance to reconnect with a friend and the outside world. It’s very easy, especially if you end up as rough as I was, to wallow around feeling terrible, which is perfectly fine when it’s really bad, but the longer you do this the harder it will feel to get back in to it. Having a friend over really helped to motivate me out of that spiral and to battle on through.
- Please, please, please – for the love of every God under the sun, avoid alcohol! I was shocked to find several people on an online forum bitching about their Citalopram usage, with many mentioning that they were still drinking, and experiencing some pretty horrific side effects because of it. Some people refused the medication flat-out because they weren’t able to have a glass of wine in the evening. How anyone can value a glass of wine over their mental wellbeing absolutely staggers me! In this area, I am aware that alcohol can play a major role in how someone has previously been ‘dealing’ with their situation, however it scares me that there are people who would not see this as the wake up call that they need to seek further help. The people who I saw bitching about this online were not on a dedicated alcohol forum, and cannot all have had a substance misuse problem. I absolutely hate that I cannot have a drink until the summer (at least) – made totally ridiculous as I barely even drank at all previously (maybe as little as one glass of wine a month max!) – but I’ll soldier through it (and count down the days, ha!). Sorry, tough love there, but please, seek help!
- This drug is sold with a black label warning on it, as it can increase the feelings of suicide in the first few weeks (go figure!!). If this happens, PLEASE go and see the GP, or speak to NHS Direct or the Samaritans etc. Don’t be worried that they’re going to bang you up and put you in a straight jacket etc, that very rarely (if ever) happens any more – more likely, they will be able to adjust your medication and offer further support to you from dedicated wellbeing crisis teams in your area. Do not suffer in silence! I made the mistake of opening up a forum thread online late one night where someone was discussing wanting to overdose on their Citalopram (please, never, never do this – it will really really fuck you up and it won’t work!) and it was absolutely horrible to read it, but on balance, it was good that he had at least reached out. In the end, over a couple of days, the forum members managed to convince the chap to get to his GP and crisis team, and as far as I know, he didn’t take his own life – but it was an incredibly close call, reading the first few pages of the forum, he was pretty much poised to do it there and then – it was a last-ditch cry for help. Absolutely harrowing, it made me cry, and I could not bring myself to talk about Citalopram without acknowledging this dark side to anxiety, depression and also the magnified feelings of both (and suicide) that may arise from the initial use of SSRIs.
- Above all, if you feel confident enough to, I’d say to be very open with those around you. I’ve been very vocal about my current situation, and how I’ve been feeling. I’ve not been aware of any negative comments, and people will either just ignore what you’re putting out there, or else they’ll really step up as friends and support you so fantastically, that you’ll feel a lot closer to them afterwards. In my opinion, the more taboo this sort of thing is, the more that it starts to win – you’ll often find people very sympathetic to your situation, and the more awkward you are about it, the more awkward it may be for them too. I was lucky enough to be able to joke around about it, generally how I deal with most things in life, and it really helped to keep me upbeat and approachable.
It goes without saying that I am always happy to discuss my Citalopram experience further, especially as I continue to take it – I really would just like to try to normalise this as much as possible. I don’t expect that I’ll have much cause for a follow-up post on my website, as these tablets will either settle and help me out, or they won’t and I’ll either get an increased dosage or a new one to try – but folk reading this should know that Citalopram is well worth a go, and if it proves not to be sitting quite right, your GP can switch you over to something else, until you both find the right SSRI for you. Something like 50-80% of people find the right SSRI first time around, and so totally do stick with it and hopefully you’ll feel more positive soon! 🙂
UPDATE 29 Dec 2014
Still on the Citalopram, now at 40mg, very proud at how well this post has taken off and how many people stop by to say that they’ve found it useful. I just wanted to post the monthly stats up for this one post alone on this one simple site to hopefully illustrate that you’re not out there on your own – plenty of others doing the exact same thing as you are. Hopefully that knowledge helps too 🙂
UPDATE 20 Feb 2016
I continue to feel pleasantly overwhelmed as to the number of people who are contacting me and saying that they have found this post in some way helpful. I’ve had people I know in real life approach me as well as made hundreds of contacts via the site (both email and in the amazing contacts section below).
I posted some numbers in the 2014 update, and I’m SO proud to share that this figure is just going up and up, month-on-month – the grand total is currently around 70,000!
I’m still on my 40mg and hoping to bring that dosage down soon – it’s primarily been delayed two years by my having had a brain tumour (I’m alright now!) and we all agreed that it was best not to meddle at such a delicate time.
3 and a half years on, this post continues to inspire me and long may it continue to be of use to others! Always remember, you guys are not ‘mental’, you’re gladiators! x