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Energy and Citalopram SSRI dilemma

Discussion in 'Post-Exertional Malaise, Fatigue, and Crashes' started by Singout, Jul 19, 2014.

  1. Singout

    Singout

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    Hi, everyone,

    I've had M.E. since Sept 2008, with the first five years being relatively mild (70% then 90% functioning).

    Last summer, after moving to a new city for a new job the previous fall, I developed a severe depression due to isolation, and somewhat reluctantly, on the advice of a good friend went to a walk-in clinic for an anti-depressant dx to get me over the hump so I could make better decisions about my future.

    I got put on 10 mg of citalopram at the end of July, and asked to follow up with a psychiatrist a month later. I was feeling pretty good by the time I saw him (I'd had bad anxiety side effects that were wearing off), but went up to 20 on his advice, had a bad reaction (my lifelong epilepsy went haywire), and went back down to 10. Decided to quit the job and move back to my home city (Toronto) in November, and was ready to come off the meds in Sept but wanted to wait till I'd moved.

    Then in late Sept I had a really bad relapse from all the stress, and have been down to about 30%, housebound and in bed a lot, a complete change from before. However, by about Feb (after the move) my mood had stabilized, and in early June I started to taper off the citalopram. My energy improved considerably between mid-May and late June--I could go to the store across the street, stay out of bed a bit longer (5 hours total), do the laundry without it feeling like an ordeal, etc. I had a crash at the end of June that brought me back to my April levels.

    THEN I realized that I had accidentally gone up to 20 mg from 10 in mid-April, bc my pharm had got the psych's dx somehow. So now I'm wondering if that improvement I was so happy about was not due to meds I'm on for OI, rest, supplements, summer weather, etc. but just to the increase in the drug I'd like to get off! I'm now down to 7.5 and also sometimes feeling a bit more depressed.

    I'd be interested in anything folks know about:
    • Whether that energy boost could be due to increased cit, and if it's "good" energy or if it's "fake" energy (like caffeine) that will just lead to me PEMing myself more. I've been seeing the cit as just about mood, but maybe it helps in other ways.
    • Experiences coming off this or a similar drug--do you go through a low period but then recover when it's out of your system?
    • Could the new OI I developed in the fall (I'm on Florinef and am going to start midodrine in a few weeks) be related at all to being on an SSRI? Will having the SSRI out of my system help with those meds?
    Thanks and sorry this is so long!
     
  2. minkeygirl

    minkeygirl Narcissism = lack of self awareness

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    I'm just wondering if a med is helping you, why go off it? Our lives are miserable enough so why not feel good if you can?
     
    barbc56, zzz and catly like this.
  3. Singout

    Singout

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    initially I didn't know if it was still helping me or not, because the depressing circumstances have changed.

    I like the idea of being on as few meds possible: I'm now on 2 for epilepsy, soon 2 for OI, 2 for sleep, plus supplements. Also cost as I have no insurance or income.

    I don't know how this medicine might be interfering with other things.

    I guess there's an ego factor involved in wanting to the able to manage my emotional issues without drugs. I was seeing this drug as strictly being for emotional stuff but now I'm not sure.

    I don't know what happens longer I stay on it.
     
  4. minkeygirl

    minkeygirl Narcissism = lack of self awareness

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    I get about not wanting to be on a ton of meds but each one has it's own purpose. And at some point you just have to say I need this.

    This disease totally screws up our brains so trying to "tough" emotional stuff just may not be possible. And so what if you need it for emotional stuff. Being chronically ill is a hugely emotional situation.

    I recently got some Lyrica I wanted to try for sleep. It helped my brain so much! It took the edge off my anger, that was huge. If it wasn't for the weight gain (I eat nonstop when I'm on it) I would take it all the time but when I start to feel my brain spinning out of control I take it. The same for Seroquel. I got some for sleep but it really helps my brain.

    There are plenty of smart people here who can tell you if the drugs have interactions so someone will chime in.
     
    catly and Singout like this.
  5. Gingergrrl

    Gingergrrl Community Support Volunteer

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    @Singout I am not sure where you live but if you are in LA I could give you the name of a great integrative psychiatrist who is fully knowledgeable in both psychotropic meds and supplements.

    I would also check with your neurologist to make sure the Celexa dose is safe for someone with epilepsy (as you mentioned when you first increased the dose your epilepsy worsened.)

    It's a complex scenario but if the Celexa is helping and safe w/your other meds and safe w/your epilepsy then I would find a local psychiatrist to monitor and ideally someone with an integrative background.
     
    Singout likes this.
  6. Singout

    Singout

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    Thanks, everyone, that's helpful.

    You're right about the risks of being tough about it.

    I was approached by a cool psychiatrist at the sleep clinic a few months back about her pilot program-- I'm too tired for the group sleep program but maybe she sees individuals about other things.

    (And I'm in Toronto Canada, far far away from LA but thanks!)
     
  7. minkeygirl

    minkeygirl Narcissism = lack of self awareness

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    Who said come to LA? I won't even go to LA.
     
  8. zzz

    zzz Senior Member

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    Celexa is a rather clean SSRI, so its main effects are due to the increased serotonin levels. Just as depression by itself can leave you feeling low-energy, taking an antidepressant can make you feel like you have more energy. This is a very real type of energy, as you're basically correcting an imbalance of too little serotonin in your brain. As long as you feel normal, just with a bit more energy, that's fine. You shouldn't overdo it, of course, but it's normal for a depressed person to be able to do more when taking an effective antidepressant. To avoid PEM, just increase activities slowly; if you hit the point where you're getting even a little PEM, back off a bit.

    On the other hand, if it feels like you have too much energy, and you feel too good, and start feeling like doing risky things, this may mean that you have hypomania, which means you're taking too much of the drug. But this is fairly uncommon, or often transient when it happens, and what you described doesn't sound like this.
    Here's what the prescribing information for Celexa says about discontinuation. Note that these symptoms don't happen to most people, and they generally go away by themselves. They can generally be avoided completely if you taper off Celexa gradually.
    Also notice the following from the prescribing information:
    Many people with depression have to take these drugs long term. From what you said, your original psychiatrist's recommendation of a 20mg dose makes sense. As all the SSRIs have a small risk of causing seizures, especially when increasing the dose, it's easy to see why the first time you went up to 20 mg, you had a lot of problems with your epilepsy. But the second time you didn't; by then, you were more acclimated to the Celexa. Furthermore, this study found that a dose of 20 mg/day of Celexa actually reduced the frequency of seizures in epileptic patients.
    The one thing that may be relevant here is that Celexa can cause hyponatremia (low sodium levels). This is undesirable in people with ME, as it can aggravate low blood volume, which can possibly contribute to OI. Fortunately, there should be a simple solution, which would be to eat more salt. Many people with ME find this helpful in general; it should be combined with drinking lots of water. I use SaltStick capsules; you can find them on Amazon, among other places. You should check with your doctor to have your sodium levels tested, and see what he recommends for salt supplementation. You should be sure to tell him that because you have ME, you need more salt than healthy people.

    Generally, depression that is strong enough to require medication is not due to circumstances, so I would think that the drug was helping, especially in light of your later experience.
    From reading the prescribing information, it doesn't sound like it should be interfering with the other meds you're taking.
    Although depression almost always has an emotional component, there's a biological basis to it, which is why these drugs work. Just as you wouldn't expect to be able to cure your ME just by thinking it away, you shouldn't feel bad if you can't get rid of your depression just by thinking it away. The fact that the depression went away completely with the Celexa seems to say that this is a fundamentally biological disorder, and you are fortunate enough to have an effective treatment for it.
     
    Last edited: Jul 20, 2014
    barbc56 and Singout like this.
  9. Singout

    Singout

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    Thanks! Very helpful advice.
     
  10. Singout

    Singout

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    So, I've decided to talk to my GP tomorrow about gradually going up to 20. Also e-mailed the cool sleep psych about a consultation or referral. Thanks again @zzz for the info about serotonin, epilepsy, and sodium (already on high sodium for OI. I do think this depression wouldn't have happened if I hadn't moved, but I also have an underlying tendency toward depression. At least if I can get that small boost back again I'll be able to work more on that and other health issues, which is hard to do when I'm so tired!
     
  11. heapsreal

    heapsreal iherb 10% discount code OPA989,

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    if you dont want to take an antidepressant, supplements of 5htp can help mood, can be a matter of adjusting doses too. I find 100mg works well, some use more and some less or take it twice a day. I guess less drug interactions with 5htp but they can happen if your still on an antidepressant or tramadol?
     
  12. Singout

    Singout

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    Thanks, Heaps, I guess I think my mood is Ok (maybe a little down) so what I'm looking at is increasing my energy that lets me do things back to where it was last month.

    It's looking like that energy increase might have been due to an SSRI, which I had thought was just about feeling happy or sad.
    So I'd only be interested in 5htp if my physical energy improved to doing what my positive mental state wants to do.
     
  13. heapsreal

    heapsreal iherb 10% discount code OPA989,

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    OK, misread your thread. Could try acetyl tyrosine .

    A few of is here of late have used q10 and acetyl carnitine in higher dose similar to doses used in mitochondrial disorders with some success, but increases doses slowly. Q10 400mg upto 1000mg, carnitine 1000mg to 2000mg worth experimenting with.
     
    Singout likes this.
  14. adreno

    adreno 3% neanderthal

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    Right, never combine 5-HTP with an antidepressant.
     
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  15. zzz

    zzz Senior Member

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    Exactly - because 5-HTP is an antidepressant. Specifically, it's a serotonin precursor; serotonin is also known by the name 5-HT. Also, 5-HTP is used by the body to produce melatonin; tryptophan is used in both of these reactions.

    You need to be very careful when taking supplements or herbs with SSRIs in that you should generally avoid taking ones with antidepressant properties along with prescription antidepressants. (For example, one of the effects of St. John's wort is to raise serotonin levels.) If you raise serotonin levels too much, you run the risk of developing serotonin syndrome, which can be serious.
     
    Last edited: Jul 22, 2014
  16. Singout

    Singout

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    Really good to know! Hoping to find an integrative doctor who might be familiar with this.
     
  17. belize44

    belize44 Senior Member

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    Is it safe to take 5htp with Zanax?
     
  18. adreno

    adreno 3% neanderthal

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    Yes.
     
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  19. belize44

    belize44 Senior Member

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    Thank you! I have been afraid to try it because of not understanding how 5htp works with it.
     
  20. adreno

    adreno 3% neanderthal

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    Xanax works on GABA receptors, not serotonin.
     

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