Consequences of coming off anti-depressants
May 30, 2013 10:24 AM   Subscribe

I've been on 40mg of Citalopram for over a year, I'm also on medication to reduce my blood pressure. About a week or so ago I stopped taking them, initially I just forgot for a day or two, but I now feel like I want to stay off them. Am I making a really bad decision here?

I know you are not my doctors, and I will go see a doctor if absolutely necessary, but tbh I am sick of doctors. About a year ago I my father died. I was very depressed and had suicidal urges. I was put on Citalopram and at the time was glad. I haven't has suicidal urges since. On the other hand I have spent most of the last year lying on the couch doing nothing, with very little will to actually do anything to improve my mood.

Whether connected or not, I have at least in the last few days felt a little more energy. I have cleaned my flat for the first time in months. Last night I had a few drinks and while watching a film started weeping. This has happened before, but not for a long time long before the citalopram. My feeling about it was 'wow, an emotion!'. I haven't had any physical side effects.

With the blood pressure pills, well I was diagnosed at the same time last year and put on a pill. Dosages and pills have increased and continue to increase. Last time I saw the doc he wanted to put me on a 3rd pill, and maybe one for cholesterol as well.

I am not surprised, I am a 48 year old male, overweight and unfit who drinks and smokes heavily. I just hate being on pills. I want to treat my blood pressure more naturally, get fit, eat well, drink less. I've done it before. Only a few years ago I transformed my life from fat couch potato to thin and fit hillwalker and mountain biker. I relapsed, but I think I can do it again. That is, if I can get off the couch I've been lying on for the past year. I'm willing to go back on those meds if necessary, but I want some time out, if I see a doctor they will just pressure me to go on the pills, which is what they have done when I discussed this with them before.

So, the question. Mainly re the citalopram. Am I making a huge mistake stopping so abruptly? Is a week too short a time to tell if I will get worse symptoms? If I need to taper it, should I start back on the 40mg, or try half a pill a day for a while?

Further info: I am in the UK so can see doctors for free anytime, but access to therapy or counselling is harder and I haven't the money to go private. I had some cbt several years ago, I'm not sure it helped much. I also own a copy of Feeling Good by David Burns :)
posted by zingzangzung to Health & Fitness (25 answers total) 3 users marked this as a favorite
We'll wait while you Google "SSRI discontinuation syndrome."

I can't speak to the blood pressure meds, but if you want to be done with this stuff and you really, really can't phone your MD to discuss discontinuing, for the love of god get a pill-splitter from the corner drugstore and taper yourself off.
posted by trunk muffins at 10:27 AM on May 30, 2013 [15 favorites]

Do you really expect people on the internet to reassure you that coming off a medication unsupervised that was intended to keep you from killing yourself is a good idea? Call your doctor.
posted by something something at 10:29 AM on May 30, 2013 [7 favorites]

I am not a doctor, okay? But it seems to me that if you were taking the Citalopram for situational depression, that situation has passed and you're not having adverse effects from discontinuing it and have no suicidal urges then it's fine.

That's entirely different from being an unfit overweight smoker and drinker who stops taking your blood pressure medication. If you want to get fit, good on you, but there is no reason you can't do that whilst on the blood pressure meds. And in fact, untreated high blood pressure and intense exercise seem like a combination putting you at risk for stroke or heart failure. This seems like a really bad idea to me. With the Citalopram, there is at least logic behind discontinuation; with the BP meds, there's nothing beyond "I don't like pills" and that's just childish.
posted by DarlingBri at 10:35 AM on May 30, 2013 [1 favorite]

I can't speak to the blood pressure issues but I stopped Citalopram cold turkey a few years ago. I experienced some very nasty discontinuation side effects and like you, the positive effects of going off the drug were apparent right away. Ultimately, although I was disabled by withdrawal effects for a few months, that all went away eventually and going off psych meds remains one of the best decisions I've ever made. I totally understand how the experience of being in a patient role and being pressured to take drugs can be more than you want to deal with right now. To be honest, at least here in the U.S., lots of doctors don't know all that much about discontinuing psych drugs anyways - it just isn't in the drug companies interest to fund extensive research about that. I will say that in my experience getting off these drugs and the experiences of many friends, slower is always better and I do think you should get a pill splitter and try to taper. Good luck!
posted by horizons at 10:40 AM on May 30, 2013

I'm on Citalopram for anxiety and my doctor thinks that the benefits outweigh the drawbacks, and I agree. I've asked to see if I can reduce the dosage, but I have to admit, I don't miss my anxiety and panic attacks one little bit.

I too have high blood pressure. That's a thing that requires treatment, probably forever. If you can reduce your weights, quit smoking and exercise more, once you've been successful, re-visit with your doctor. But for now, you really shouldn't stop.

Talk to your doctor and work together to find solutions that work for you.
posted by Ruthless Bunny at 10:45 AM on May 30, 2013

The problem with blood pressure issues is the you're likely not to have any symptoms, even when your blood pressure can be sky high. I'd get back on that med ASAP. Then, start exercising, lose weight, etc and see if you can bring it down naturally. Then, go off the meds once you're at a good level.

Your doc giving you BP meds isn't a big pharma conspiracy. It's an attempt to lower your blood pressure.
posted by BlahLaLa at 10:48 AM on May 30, 2013 [1 favorite]

IANAD, this is not medical advice, but what I would do:

1) Go back on your Citalopram and then contact your doctor for a plan to ease yourself off it. Suddenly going off a medication like that can lead to adverse reactions. I would not attempt to change the dose myself, as you are suggesting. I know you're sick of doctors, but this is an important thing to contact your doctor about.

2) My grandmother has high blood pressure and takes two medications for it on a daily basis. We've seen her when she's forgotten to take her pills and she gets dizzy, confused and may have had a small stroke, leading her to breaking her hip. So unless you want to invite a stroke into your life, I would continue with the blood pressure meds while attempting to get back into shape. There's nothing that says you have to stop your blood pressure meds while you get back into shape. As you lose weight and feel healthier, check in with your doctor (I know, I know) to see how your blood pressure is now and again so that, if recommended, you can wean yourself off those.

TL;DR: Check with your doctor before stopping any medications. Period.
posted by juliebug at 10:50 AM on May 30, 2013 [1 favorite]

I am not a doctor, okay? But it seems to me that if you were taking the Citalopram for situational depression, that situation has passed and you're not having adverse effects from discontinuing it and have no suicidal urges then it's fine.

The OP has only been off the Citalopram for a week.

I'm also not a doctor, but I can imagine that the negative effects of discontinuing the Citalopram could take more than a week to manifest.

OP, please speak to a doctor about this.
posted by alms at 10:57 AM on May 30, 2013 [2 favorites]

Wanting to go off your meds is at this point may in fact be a good thing for you. Going off your medication cold turkey unsupervised is not. When I went off my medication last year my doctor (who was supportive of my decision) tapered me off my medication over 4 months to avoid withdrawal symptoms. My advice? Go back on your medication. Go find get another opinion from another doctor or psychiatrist if your doctor is not listening to your concerns about your medication.
posted by snowysoul at 11:14 AM on May 30, 2013 [2 favorites]

You have been off the Citalopram for a week. I am not a doctor. I merely have experience with SSRIs. I agree that negative effects of the discontinuation could definitely take more than a week to be felt. I do a lot of my own meds management (slightly raising or lowering dosages), but I never do anything as drastic as this without talking to my doctor. That said, since you have been off the 40mg for a week, if I were you (caveat: I'm not you), I would go back onto something like 20mg and talk to your doctor about slowly tapering off. The side effects of going off can be minimally unpleasant, or horrible. An example is what they call 'brain zaps'. You want to minimize that. You also don't want to go back into full blown depression, or suicial thinking. It is better and safer to taper off 1) to minimize discontinuation side effects, and 2) to make sure that you are truly ready to go off. If you start becoming depressed, you will know that you need a higher dosage. Anecdotal: everytime I make a meds change, whether up or down, I feel great for 3 days to two weeks, and then the 'true' effects reveal themselves.

If you don't want to or can't see your doctor right away, call your pharmacist. Pharmacists are very knowledgable about these things and can be very helpful. That is their job. And I'm willing to bet it's much more interesting and gratifying to answer questions than count pills and ring sales through.
posted by kitcat at 11:16 AM on May 30, 2013

Talk to your provider about going off the Celexa. I couldn't afford my Lexapro (similiar drug) for about a month and it was terrible, terrible, terrible.
posted by thylacine at 11:32 AM on May 30, 2013 [1 favorite]

Nthing "talk to your doctor about weaning off the Celexa".
Barring that, sometimes taking St. John's Wort helps with the withdrawals.

But really, talk to your doctor!
posted by luckynerd at 12:28 PM on May 30, 2013

re the blood pressure medication: can you get a home BP monitor? You could check your BP daily or weekly, and then you'd have much better information about whether or not you need that particular drug.
posted by Corvid at 1:16 PM on May 30, 2013

You're not looking for advice; you're looking for the internet to tell you you're right to do what you did and it's OK.

If you were looking for advice you'd have called someone with expertise in medical advice, like (at least) the medical information line at your local hospital, or (ideally) an actual doctor a/o psychiatrist.

Of course, you already know what they'd say: don't just go off-med because you want to, that is often the path to disaster. Instead, they'll want to understand where you are right now, and put you on a carefully monitored tapering off (or try to convince you to stay on them, if you are fooling yourself about upbeat and in-control your emotions are now).

Advice about self-monitoring your results to see if it's OK to go off-meds is frankly stupid when the meds are for psychological symptoms that no one can objectively measure in themselves.
posted by IAmBroom at 1:25 PM on May 30, 2013 [1 favorite]

I'll go against the grain here. I did what you're doing now. Same med, same dose, same cold-turkey stop. I didn't feel wonderful but it was not painful. "Brain shivers" is what it I've heard discontinuation syndrome called, and that's a pretty good descriptor. I just told one person to check in with me because I was quitting the medicine, and looked in myself for the same symptoms that caused me to originally ask for the medicine. I felt like this was completely safe for me because:
- I'd originally recognized symptoms that led to me asking for meds, so I knew what to look for.
- I was actively looking for those signs, unlike before
- I'd asked a friend to check in with me, unlike before
- Since I'd then felt both ways (before meds and after) I was able to recognized that the feelings of depression were chemical

Maybe not the best way to approach things, but lots of people have done it. Just keep an eye out on your mood. Every day just take a quick mental inventory, and don't be discouraged if you're struggling and you must return to the meds.

Don't take St John's wort, tryptophan or 5-HTP while the antidepressant is in your body because this might cause serotinin syndrome (you don't want that).

The antidepressant might be lowering your blood pressure, in addition to your meds for that. At least, that was true for me.
posted by Houstonian at 1:58 PM on May 30, 2013

Eh, I disagree with everyone here about the citalopram. I took it for a while, it did nothing for me, so I just stopped taking it. Nothing happened, nothing at all. Furthermore, I think if you were going to have issues coming off it you would notice after a week.

Please DON'T just stop taking your blood pressure meds, though. Feeling tired is a really common side-effect of BP-lowering drugs, and if that's happening to you they should try you on a different medication. I know it's not always easy to switch GPs in the UK but it sounds like you need to do that if they're not willing to find a drug that works for you without knocking you out. You certainly might be able to get your BP down with exercise and diet enough to stop taking drugs eventually (my dad did) but you should be at least be checking it in the meantime.
posted by Violet Hour at 2:10 PM on May 30, 2013

Response by poster: Thankyou to all who answered. One of the more useful answers was to google SSRI discontinuation syndrome, which led me to find out about ssri half life. This answered my quesion about whether a week was long enough to get over it, the answer is no.

I took a 40mg Citalopram about 2 hours ago. I will be tapering off from now on. I'll probably go back on the blood pressure meds too, but one thing at a time. Porbably go see the doc in a week or so.

I see a couple of people assuming that I was looking for the internet to justify me, well I've been online long enough to know that you guys will make those kind of comments whatever. Sorry to disappoint you, but I was looking for info I did not know, I have been supplied with the info, and I have acted on it.

I appreciate the anecdotal stuff from those who cold turkeyed without consequence, but I read enough about brain zaps and other side effects to make me want to avoid them.

Even asking this question was more than I have done in over a year, I am going to come off the meds sensibly, but I think that my experience in the last week has been a breakthrough, and I feel that most of the responses here will help me to deal with this in a positive way.

I haven't marked any best answers because they are all good.
posted by zingzangzung at 2:37 PM on May 30, 2013 [2 favorites]

May I gently suggest that you not drink while you are tapering? Alcohol is a depressant and may make the transition more difficult. Good wishes to you.
posted by michellenoel at 3:51 PM on May 30, 2013

What DarlingBri said above about situational depression rang very true with my experiences. A few years ago, I went to my GP and eventually to a psychiatrist because I was depressed about my job, girlfriend, politics, etc. and was just sort of breaking down and getting stagnant in general. Over the next year and a half I must have tried at least ten different meds for depression or bipolar. We kept experimenting to see if anything worked. Nothing really did, and I still felt crappy. At the end of it, I was taking lithium and bupropion (Wellbutrin) and just kind of forgot them for a few days and then never got back on. I didn't have any discernible side effects from quitting. (Btw, bupropion, as a dopamine reuptake inhibitor does not cause sexual side effects, so any of you taking SSRIs may want to talk to your doctor about that, though they would obviously know best whether it's a viable alternative for you.)

My point is not to anecdotally suggest that stopping your meds is acceptable but to point out that meds may not work if your depression stems from something more situational than inherent. Counseling is often coupled with medication, which is what I was doing for some of that time. My problems were things that needed to be talked out, so I could develop effective strategies to cope with them. I can't say that the counseling in my particular case was super effective, but it was at least something I could control and direct the way I needed it. I could address specifically how I felt week to week. With the meds, I was just waiting for something to happen; I didn't know what it would be or if it WAS happening or how much it would help, so it was just a waiting and med-adjustment game.

I'd suggest going back on your meds per doctor's orders (especially the BP meds since that directly affects your physical health), then going to your doctor and being completely honest that you're not feeling anything significant from the citalopram and that you'd be interested in getting off of it. At the same time, ask if they have any counselor or psychologist recommendations. If they don't, find one on the internet. Try going to a few sessions while still on your meds, and see if you feel better talking with someone about the specific things making you depressed. If that seems like it's helping, then report that back to your doctor, and see if you can transition from meds to therapy for your depression. I think it's important to run everything by your doctor, because your reaction to meds or the lack thereof could be different from someone else's.
posted by KinoAndHermes at 4:03 PM on May 30, 2013

Going off the meds sensibly requires talking to your doctor. Period.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 5:30 PM on May 30, 2013 [1 favorite]

Glad you have decided to taper. I have no advice re the blood pressure meds as I know nothing about them. I agree that the best thing with coming off meds is to do it after consultation with your doctor, sounds like perhaps you need to find a new doctor if you're not happy with the doctor(s) you've been seeing. I do understand getting fed up with having to have every single health decision okayed, but with something like psych meds I do think it's important.

Anyway, more anecdotal evidence: I am currently on 20mg citalopram and that's okay with me right now. However, a few years ago I was on that dose and was doing well, decided that it was time to come off, talked to the doc and my psych who both agreed, began tapering. My memory as to how long I stayed on each reduced dose is a bit sketchy, but think it was about a month for each stage. First down to 10mg, then 5mg, then 5mg every other day, then off. It seemed to work pretty well, the only side effects I noticed were an increased tendency towards nausea which went away after I was off them completely.

Given the meds usually take about a month to stabilise when you first start taking them, it makes sense that you don't know how a particular dose is going to work out for you unless you give it at least a month. Good luck!
posted by Athanassiel at 7:21 PM on May 30, 2013

I'm glad you have decided to taper. I took myself off an anti-depressant a few years ago, and the brain zaps haunted me for 3 years. For the first few months, it would happen every time I turned my head around, which sucked while driving because every time I backed up or turned to look as I changed lanes, it would happen. They slowly went away but I hated dealing with it for so long.

I really hope you reconsider not adding the blood pressure meds. Please read the responses again. It is very serious and can lead to a stroke or other nasty things. It's not worth your life, to avoid swallowing a pill.
posted by veerat at 7:37 PM on May 30, 2013

1- Stay on the blood pressure medication.

2- Everyone's experience is different with SSRIs. Zoloft worked fine for me, but the discontinuation syndrome was unpleasant. No amount of tapering made it better. It just made it last longer. So the last time I went off of it, I just went cold turkey. It was no worse, and it lasted a lot shorter of a time. The fact that you feel dull while taking it and better when not taking it indicates to me that it's time to come off. That's how I determine for myself.

As far as i know, discontinuation syndrome is not harmful. Just weird. If you go off of it and start feeling more depressed and/or anxious (angry, short tempered, miserable), then I would get back on ASAP. But if you don't, I wouldn't worry too much. But that's just me.
posted by gjc at 7:40 PM on May 30, 2013

I see a couple of people assuming that I was looking for the internet to justify me, well I've been online long enough to know that you guys will make those kind of comments whatever. Sorry to disappoint you, but I was looking for info I did not know, I have been supplied with the info, and I have acted on it.
Happy to hear it. You must also have enough experience here to realize that a significant number of people are looking for peers to back up their unwise behaviors.

Best of luck with all of this. Be safe.
posted by IAmBroom at 9:55 AM on May 31, 2013 [1 favorite]

Everyone's been mainly focusing on the antidepressants here, but I just wanted to say DO NOT go off of your blood pressure medication.

My mom did that, because she's young (she is younger than you are), she doesn't smoke, she doesn't drink, she thought she didn't really need it, etc.. She actually felt okay for a while, I think she was off the medication for a few months, went to the doctor for a completely unrelated ailment, who immediately sent her to the ER because her blood pressure was sky-high, and she had no idea anything was wrong.

You're looking at it backwards. You don't stop taking the necessary medication before you attempt to get fit and healthy, you get fit and healthy so you can stop taking medication when it is no longer medically necessary.
posted by inertia at 12:22 PM on May 31, 2013 [3 favorites]

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