You spin me right round baby right round like an anxiety disorder right round round round

April 15, 2008 8:14 PM

You're not my psychiatrist, and I'm not your patient. But I need some help evaluating my feelings and setting my dosage within the limits my psychiatrist has prescribed.

I'm on Citalopram (generic of Celexa, predecessor to Lexapro) and have been for well over a year. Recently, I've been feeling great, but have been having some sexual side effects and general 'laziness'. I haven't been exercising, so I've gotten fat. I've got about 100 hours of consulting work to do in the next few weeks plus my day job, and I need a little bit more nervous energy and 'edge' to get myself back in the gym and doing the work I need to do. I asked my psychiatrist during my last appointment if I could reduce the dose just a tad, and she wrote the prescription to allow for between 30mg and 40mg. I began the new dose on Saturday night.

Now, I realize that this is a midrange dose, and since the half-life is 36 hours, it's not completely settled down to my new dosage yet. Additionally, it should take a little longer for me to see the effect.

But back on the other hand, I've been beyond jittery and stuck on fast forward all day today. I've been focused and mission-oriented, and I've gotten TONS done, but ... sheesh! My girlfriend asked me at dinner tonight if I had been smoking crack, so it's an obvious behviour change to others. Back on the bright side, the sexual side effects (inability to ejaculate) are already gone.

I'm trying to make sure these aren't withdrawal symptoms and I'll settle back out if I just give it another week. But I'm "spinning" -- that's the word I use to describe when my anxiety disorder blows things out of proportions and leads the monkey on my back to jump to hasty conclusions. A good example: My GF isn't online, which must mean that she was put off by my hyperactivity at dinner, and is going to dump me. Illogical -- I know. But that ol' monkey's whispering it in my ear...

My main worry over the next week is showing signs of 'instability' to coworkers and consulting clients. My life has been stellar since I went on the drugs... the drugs let me channel a little bit of the 'zen' I've been seeking my entire life. Not so much that I act like a pot smoker, but enough that I'm able to let life flow around me and dip into precisely the parts I want to. I'm mostly anxious (go figure) about the effects an increase in hyperactivity will have on my work and love relationships.

So. Grit my teeth and stick it out at the lower dosage and just work myself to exhaustion the next few nights till things settle back out ... or go back on the safety blanket dosage that I'm comfortable with?

I'll obviously call my psychiatrist tomorrow, but I'm interested in the hive mind's opinion in the meantime.

posted by anonymous to health & fitness (5 comments total)

Oh. I recommend the safety blanket.

Here's why: you are teetering on the edge right now (I know this because I've stood alongside you there at one point). I don't even know you and I can tell from your writing that you're teetering. And you're going to crash and doing so is going to undo all the progress you've made/will make.

I make the following statements based on the idea that you have a boatload of work ahead of you and your time is critical at this juncture; that is, you don't have time to waffle and play with meds until finding the perfect dosage.

The safety net dosage has a number of benefits: you already know what it feels like so you know how to work around its side effects. This is evident because you mention that you are aware of its sexual and laziness-related side effects. Contrast that awareness to the nebulous world you'd be entering with the newer, reduced dosage. There are way too many variables there that are gonna screw you over at a time when you can't afford to be screwed over, IMHO. Better the devil you know, etc.

Additionally, since you are familiar with the safety blanket, you probably know how to overcome the laziness aspect: will caffeine help? A Coke? Some forced exercise? More/less sleep?

Also, some balance: what's better here? "My life has been stellar since I went on the drugs" or "my anxiety blows things out of proportions and leads the monkey on my back to hasty conclusions?" I really think the stellar is better than the monkey, even if it means you're moving a bit slower than you'd like. So your work approach would have to be slow and steady as opposed to the WHAM that you're trying to achieve.

So use your current edginess to write a letter to your more slothlike self: PROMISE yourself that you're going back on the safety dosage with the understanding that you have to force yourself to exercise, work an extra hour, or whatever to achieve the same results at a slow and steady pace that you'd achieve if you were wired.

As for the sexual stuff, Girlfriend is going to have to be patient and understanding right now. Besides, you're going to be working a whole lot in the upcoming timeframe, so...perhaps it would be a quiet season anyway. It sounds like she's aware of the problem anyway. You might want to let her know that once this work crunch is over, you're going to dedicate more time to addressing the negative sexual aspects of your safety dosage.

And do that: once this work crunch is over, jostle the meds around to see if you can find a happy medium.
posted by December at 8:35 PM on April 15, 2008

I agree. I don't know thing one about your particular meds, but I think that crunch time is not the time to experiment. If you want to get back to the gym? It can wait until the next few weeks of extra consulting are over. One thing at a time. Work's the priority now, and then once things settle back to normal, you can follow the plan you and your doctor worked out to try to bring that more intense energy into your life.
posted by moxiedoll at 8:41 PM on April 15, 2008

I'm on a fairly low dose of Celexa, 20 mg per day. One time I waited too long in between appointments and had to half my dosage for a week. That entire week I was more irritable and jumpy than I have ever been in my entire life. All I did was snap at my housemates and friends. I understand the jitters, too, because any time I'm even late for a dose I start to get shaky and off-balance.

While I also often feel lazy and unmotivated, if I were you I'd go back to the full dosage if you're looking at some upcoming stressful events. It's easier to power through the inertia than it is to try and pick up the pieces if things go haywire.
posted by riane at 10:38 PM on April 15, 2008

I've worked through similar things, and I found it helpful to find benchmarks for myself. When I start feeling mushy and lazy, time to titrate down. When I start "spinning", time to titrate up. Natural systems work like this, and things are rarely static, so it makes sense to have a system for dosage adjustment.

Another option might be to have your doctor recommend a different drug or dose timing. I'm no pharmacist, but the 36 hour half life leads me to believe that dosing changes would take a long time to "settle out" and what feels right today will be a lagging indicator.

Maybe 30 one day, 40 the next?
posted by gjc at 8:37 AM on April 16, 2008

The different between 30 and 40 is a lot. Why not try 35? I take Celexa, and I can notice a difference between 30 and 27.5. Maybe you're similarly sensitive.

I've heard of people doing what gjc suggests -- with a drug that has a long half-life, it can work.
posted by wryly at 2:52 PM on April 16, 2008