DOSE:

10 - 20 mg

oral

Pharms - Citalopram

(daily)

BODY WEIGHT:

154 lb

Citalopram was the first drug I was prescribed for my anxiety and depression. I’d gone to my general practitioner (GP) in a desperate state. I told him I’d been suffering with a bout of insomnia – not my first – which had ruined a recent holiday but that I had been anxious and depressed for many years. This was the first time I’d sought help for my mental health problems. My GP told me he would prescribe me Citalopram, which he said should help me. He started me on one 10mg tablet per day, and after a few weeks advised me to increase the dosage to one 20mg tablet per day. I was first prescribed Citalopram in 2004, one month before I turned 24, and I took it consistently until 2011. It wasn’t until 2012 that I realised the cause of my anxiety and depression was obsessive compulsive disorder (OCD), which when left untreated frequently causes anxiety and depression. I had been suffering with OCD since I was 14-years-old so the anxiety and depression I reported to the doctor in his office that afternoon were by-products of OCD, but I didn’t know this at the time.

I’ll start by saying that nine years have passed since I last took Citalopram. As such, my memory of the experience has slightly faded. However, considering I took the drug consistently for seven years, I think I still remember sufficient information to make a report about my experience of Citalopram useful. As mentioned, my GP started me on a low dose of 10mg daily. I think I took this for two or three weeks to ascertain that I was able to tolerate the drug, then my GP increased the dose to 20mg daily, which is an average dose. My doctor warned me that when I first started taking Citalopram, and again when I increased the dose, that my depression may get worse, but to persevere with it because this would level-off. However, I didn’t notice any worsening of my depression on either occasion. When I first started taking Citalopram, I think I perhaps expected there to be a marked lift in my mood where I would be able to pinpoint the day where I changed from being a depressed person to a happy person, and all of my doubts, fears and anxieties would suddenly vanish. I suspect this is something that a lot of people who are naïve about antidepressants believe when they begin a course of treatment, however it doesn’t work like this. From my experience, if the drug is working, your bouts of depression will become less frequent and less intense, but you’ll still suffer with them from time to time. I became able to function better and became more resilient to being buffeted by life’s problems. Antidepressants don’t magically transform me into a happy person. I describe them as helping to keep me on an even keel.

My introduction to Citalopram coincided with my return to college and that year I studied an adult education course to enable me to go to university. I was thrilled to be learning again and loved every minute of this course. I had not taken my studies seriously when I was at school so I relished getting another chance to work hard and prove what I could do. I had a good group of friends at college and I looked forward to going to university the following year. This year was a good one for me so this definitely helped improve my mood as well. For this reason, it’s difficult to say how much of my good mood was due to the Citalopram and how much was due to me being in a good place in my life at that time, however I do think the drug was having a positive effect. Luckily, I didn’t experience any side effects while taking Citalopram, which can include decreased appetite and erectile dysfunction, and I didn’t notice any side effects when drinking alcohol either. I was taking Citalopram while I was a student at university, where I guzzled more than my fair share of beer, but I didn’t notice any interactions with alcohol, for example it didn’t make me feel sleepy when drinking and it didn’t make my hangovers any worse the next day.

Citalopram kept me on an even keel for most of the seven years that I took it. However, it didn’t stop me from having obsessive intrusive thoughts and I had two very bad episodes of OCD during this time. Both times I suffered with severe acute insomnia and both made me very anxious and depressed, which caused me to resign from the job I was doing during each period. The first episode took place during the summer of 2006 and the second episode lasted from December 2009 to December 2011. In 2006, I was plagued with obsessive thoughts about three scars that I have on my arm, which was a new obsessional topic at the time. In 2009-11, I was haunted by a long-standing obsessional fear of developing incestuous feelings for my mother, which grew to also include obsessional thinking about the university where I was studying at the time. (Yes, my friends, OCD is strange.) The 2006 episode lasted about three or four months and was bad enough to make me quit my summer job because I felt couldn’t cope with it anymore. However, a new adventure as an exchange student in Germany starting that October jolted me out of this episode. On the other hand, the 2009-11 episode was extremely persistent and lasted for two years. Both times I felt awful and the winter of 2011 is the lowest I have ever felt in my life. Citalopram could not protect me against either of these bouts of depression so I either wasn’t taking a high enough dose, there is a limit to its usefulness, or perhaps it was just not the optimal antidepressant for me. You may be reading this and thinking to yourself, “But maybe the antidepressant on its own wasn’t enough and you needed therapy.” In fact, I had just finished my first course of cognitive behavioural therapy (CBT) shortly before the 2006 episode began and I had a course of talking therapy in 2011 during the height of that episode. Neither course was very helpful because neither therapist had been able to identify that I was suffering with OCD so during these times I felt let down by my therapists and by Citalopram.

The 2009-11 episode lasted for so long that I became convinced that the Citalopram wasn’t working at all anymore so in the summer of 2011, I made the decision to ween myself off it. I didn’t discuss this with my doctor and in retrospect I can see this was a foolish thing to do because things got much worse after this, spiralling downwards until I reached the nadir in December. During this time, I completed the Master’s degree I was studying and took a job at the same university shortly afterwards but I was in such a bad state by then that I quit my job after only three weeks and finally broke down in my mother’s arms one cold December afternoon.

While I was weening myself off Citalopram I experienced what are colloquially known as “brain zaps”. These are a commonly reported withdrawal symptom of SSRI antidepressants and I had actually experienced them before, usually if there’d been a delay in getting my new prescription and I hadn’t been able to take my usual dose for two or three days. I didn’t think it was wise to go cold turkey so I decided to taper down my use by reducing my dose from 20mg to 10mg. I did this by breaking the 20mg tablet in two. I can’t remember exactly in what fashion I began tapering down but I think I might have reduced to 10mg daily at first, and then reduced the dose again by taking 10mg every other day until I eventually stopped taking the tablets completely. Even with this tapering down of the dose, I experienced quite frequent brain zaps during the few months that it took to complete my withdrawal. The feeling is hard to describe but it is something like an electric pulse or current passing through my brain for a second or two. This caused me to feel giddy and sometimes slightly off balance for a moment. I have read other people describe brain zaps as feeling unpleasant but I never found them to be painful or uncomfortable; actually, to be honest, I found them quite pleasurable. As mentioned, a few months after I’d completely withdrawn from Citalopram, things got much worse and I soon reached my lowest point. I think the darkest months I experienced were due to the fact that I wasn’t taking any antidepressant medication at all and because I’d started to experience severe insomnia again. I returned to my GP in December 2011 (the same doctor who’d prescribed me Citalopram seven years ago), explained my problems and he prescribed me with an alternative antidepressant with a sedative effect, which I still take to this day.

So, did Citalopram help me? I think it did in that it helped to keep me on an even keel for most of the seven years I took it. There were two very difficult periods during this time, detailed above, but apart from these and some minor episodes along the way, I enjoyed long stretches of good times, too. So I think it can be an effective antidepressant. I guess the biggest drawback of Citalopram for me personally is that it doesn’t have a sedative effect. During my worst flare-ups of OCD, the usual anxiety and depression are accompanied by insomnia as well. However, Citalopram couldn’t help me sleep so I had to rely on sleeping pills during these times, which are not an effective or healthy solution beyond one or two weeks’ use. Citalopram and other SSRI antidepressants are the first line of pharmaceutical therapy against OCD and perhaps they can fight OCD well because during my good times I think I was fairly untroubled by obsessional intrusive thoughts. They were a quiet background noise to my other normal thoughts. However, Citalopram failed to help me during my severe flare-ups of OCD. This might have been because my dose wasn’t high enough to contend with the intensity of my OCD and depression during these episodes and in retrospect perhaps I should’ve asked my doctor for a higher dose. However, I was so distressed during these times it didn’t even occur to me to ask. Another problem was that I didn’t have a diagnosis of OCD at the time so I was not getting any cognitive behavioural therapy specifically for OCD, which I found to be extremely beneficial when I finally did get this a few years later. One thing I’m sure of now is that no drug is capable of beating OCD on its own. Therapy is also needed to help you to identify and change distorted thought patterns and unhelpful behaviours, and to develop a repertoire of coping strategies to give yourself the best chance of keeping OCD at bay.

Exp Year: 2004-2011	ExpID: 114560
Gender: Male
Age at time of experience: 30
Published: Jul 16, 2020	Views: 1,660
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Pharms - Citalopram (227) : Retrospective / Summary (11), Depression (15), Medical Use (47), Not Applicable (38)