antidepressant side effects help

July 22, 2012 11:24 AM

Unbearable side effects of starting Citalopram. Should I stick this out or take a chance with an alternative?

I've struggled with depression and anxiety off and on for my whole life, and after the birth of my baby things have been steadily declining again. Although I started therapy again a couple months ago, I've been having problems with participation and lack of focus and follow through. After talking it over with my therapist and doctor I have decided to go back on medication as least in the short term.

I have been on wellbutrin in the past and found the side effects terrible, although it was probably 10 years ago and I can't "remember" exactly; I do remember describing it to people as feeling as though my skeleton was trying to escape the confines of my body. I was on lexapro for a while after that and remember that I tolerated it much better than the wellbutrin, but again, I don't remember specifics.

I told my doctor that the lexapro worked well for me last time (same prescribing physician), and she said that citalopram was chemically very similar and much less expensive, so suggested I try that. I started 5mg on monday, and she said to increase to 10mg after a few days.

I have not been able to increase the dose all week for fear of worsening side effects. I actually did not take the pill this morning, as I can't bear the feeling any more. I have already made the decision to call my doctor tomorrow morning and let her know what's happening, but I'm worried now that the side effects will be the same on another medication and I don't know if I want to do this again, and I can't trust myself to carefully weigh the benefits of medication.

Side effects include:
* jittery anxious writhing feeling through my whole body; uncontrollable muscle twitches (expected this short term, but not this intensity, nor for this long on a half dose)
* loss of appetite (expected)
* nausea (expected)
* poor concentration (expected, but not to this degree, I will get lost in the middle of doing something, lose my train of thought in mid sentence. This has been awful to deal with at work)
* insomnia

weirder side effects:
* visual disturbance (black streaks that fly across my field of view, glistening lights, constantly seeing movement in my periphery)
* loss of my social filter (told a woman at work i "didn't fucking care" about whatever thing she was telling me, didn't even realize this was inappropriate until hours later)
* problems modulating the volume of my voice
* i can't taste anything; food tastes like dust in my mouth

Re-reading this it doesn't sounds that bad or unusual I guess but I literally feel like I am going crazy, which is much worse than being disengaged and crying all the time.

I guess my questions are these (yes not my doctor, etc; I'm looking for personal experiences):
How typical is this?
Am I not giving it enough time to even out?
What are the chances that another drug is going to have the same effect?
Am I misremembering my experiences with lexapro? maybe it was this bad and I don't remember?
Should I take my 5mg dose today? I am loathe to do this; right now I'm jittery and spacey still but no hallucinations and can actually eat.

Also I don't know if this is a question but I'm terrified to try another drug as I don't know if I can afford to "lose" another week the way this one went. But I also realize I can't assess the benefits of medication realistically right now I don't think... so I guess... "help"?

posted by lilnublet to health & fitness (8 answers total)

I can't tell you whether or not to keep taking it, but I can tell you that Lexapro (escitalopram) recently became available in generic form in the US and thus might be more affordable than your doctor knows (or more affordable than their price checkers show.) You might try calling Costco pharmacy to find out prices--you can use their pharmacy without being a member an they tend to have good prices.

Also, Lexapro/escitalopram was designed to be like citalopram but have fewer side effects--basically, citalopram is a mixture of two molecules where escitalopram is just one of those...the one thought to be responsible for the desired effect rather than the unwanted side effects.
posted by needs more cowbell at 11:35 AM on July 22, 2012 [1 favorite]

No one can promise you it will pass however--it will very very likely pass and you will start feeling better. Most of these are typical side effects which, as you know, usually pass in 10-14 days. It is unfortunate they have these side effects but such is the nature of tweaking levels of neurotransmitters to help them return to a more appropriate level.. The following may sound trite and easy for another to say but here goes: no matter how bad you feel you will feel better: you will not die, you will not be fall apart: this will pass: and if all else fails you can stop taking them (always tomorrow). You only have to stand them one day at a time. I have seen all to many persons get derailed during the first 14 days only to return to chronic anxiety/depression that gnaws away for a lot longer than 14 days. And, if they do not start working in 21-30 days you may have to try another drug--and you should. Your life and experiences are to important to get set aside for what is almost always transient discomfort/unease/fear/anxiety. Wishing the best for you
posted by rmhsinc at 12:04 PM on July 22, 2012 [1 favorite]

There are many different drugs now that work for depression and anxiety. If you are experiencing both, you may also find relief from mood stabilizers in addition to the more traditional class of antidepressants. Find a doctor who will work aggressively with you to find the right drug(s) for you - the side effects vary widely with the different kinds of drugs, and ideally you'll find one that both treats the underlying disease and causes minimal disruption in your life. Don't settle for less, and remember that your body/hormonal chemistry has likely changed since you were last on meds, especially with the baby, so you may just need to try a few new options. Odds are very good that you'll feel much better in a few short weeks once you find the right treatment. Best of luck.
posted by judith at 12:31 PM on July 22, 2012 [1 favorite]

The side effects you are reporting are very common.

I have to ask this question. Why citalopram? My reason for asking is simple...

...when Prozac (fluoxetine) was new, all the psychs were prescribing it. Then came sertraline, paroxetine... and so on.

Then came fluvoxamine, and venlafaxine, bupropion, citalopram (Celexa).

Celexa was popular for a while. When patent protection was about to expire, Forest Pharma tweaked the manufacture so that only one enantiomer ended up in the final product, and boom, escitalopram (Lexapro) was born!

I am deeply suspicious for the simple reason that, if the existing drugs worked in the first place, they didn't stop working just becase some new patent medicine came along. And honestly -- the side effect profiles of the newer drugs aren't any better, and in a lot of cases, worse. The visual disturbances and parasthesias are a real issue with citalopram.

My point: have you tried fluoxetine? Radical idea, I know. But there is a reason there are dozens of generic formulations of it on the market: it still works very well, and the side effect profile is pretty good. It has a long half life, so it's much easier to taper or fine tune the dose.

And it has another benefit... it's even less expensive than citalopram.

All of these drugs have an adjustment phase when treatment starts. It can last from three to eight weeks. But experience suggests that if you're having this much trouble tolerating it at the beginning, it's not likely to work for you.

Talk to your doc... and be suspicious if he wants to push only new stuff on you. Ask him or her about a trial of fluoxetine.

Finally... meds have their place, and if you are really stuck, don't be afraid to use them (especially if they have worked in the past). That said, if you're willing to consider a more sustainable approach, have a look at Emily Deans' excellent blog.
posted by rhombus at 3:36 PM on July 22, 2012

I was on Citalopram for several years and had a lot of visual disturbance and lightheadeness/nausea, especially when moving my head rapidly at night. I also had some physical problems (enlarged prostate). Switching to Lexapro got me over those bumps. If you are having those side effects, and you're on such a low dose (5-10mg is really a low dose; I was on 30 or 40mg if I remember correctly), then I would call your doctor tomorrow and describe the side effects and ask to switch tos something else.

My family does NOT tolerate wellbutrin well. I tried it and immediately wished I had not. It was ... rather extreme.

Keep in mind that everyone is different, and doctors may prescribe the older drug first, but there is a generic of Lexapro out (escalitopram I think) and it works very well. Prozac would work as well, but has it's own realm of side effects. The trick is to find the drug that works best for you and then to get the dosage worked out so that your symptoms decline to a manageable point and have bearable side effects.
posted by SpecialK at 7:30 PM on July 22, 2012

I have gone on and off the same drug as you a few times over the last few years, and am very in touch with how my body reacts to it.

I believe that the symptoms you describe are mostly withdrawal symptoms, not acclimatization symptoms. Here's the thing: the half-life of citalopram is little more than a day, therefore if you are taking a very low dose once daily, the amount of it that is in your system is drops to very, very low in the hours before you take your next dose. During those hours is when I would feel the symptoms, and taking the next dose made them go away.

I found that when I started taking slightly more (i.e. 10mg daily), not less, that the side effects went away. Bear in mind too that 10mg daily is still considered a "low" dose -- 5mg daily is considered "very low".

Of course, everyone is different, and maybe my experience is too anecdotal to be considered scientific. Bottom line is that you should just give it a couple more weeks, and of course maintain a good dialogue with your doctor.
posted by wutangclan at 7:47 PM on July 22, 2012

Nthing asking about escitalopram. I'm really surprised your physician didn't just put you back on this as it worked in the past and had manageable side effects. It just went generic, so they might not have known.

Your side effects don't sound that abnormal, fwiw, and you can expect side effects like the ones you list for a few weeks, really, but if you think you'd be better on the Lexapro, I would ask to switch, especially before the citalopram really gets going. Both take at least 3 weeks to really start showing any benefit, so keep that in mind.
posted by Lutoslawski at 1:02 PM on July 23, 2012

You should give it more time before giving up. I'm on my fifth week of Citalopram and experienced similar side effects as you in the first 1-2 weeks. Everything got a lot better after two weeks and at threeish weeks I didn't have any negative side effects that were noticeable. I started out taking 10mg for eight days and then upped it to 20mg after that.

You really have to wait through at least the first six weeks to see if the side effects let up. The positive effects came in around the second week and I can see it definitely works for me. I didn't like Lexapro, but I know it's a YMMV thing.
posted by side effect at 3:09 PM on July 26, 2012