Antidepressants: friend or foe?

I have a little friend called Citalopram. We have a strange friendship. We have had our ups and downs, and on occasions I’ve doubted whether I need him in my life. Not only that, I hope we’re not going to be friends forever. I’d rather we remain friends for the next few months and then, when spring arrives, we might be able to go our separate ways and bid each other an amicable farewell.

The problem is, it’s hard to say goodbye to Citalopram. After a couple of attempts, I’ve had to concede that actually I do need him. He’s just a tiny, white, oval-shaped tablet – considerably smaller than Paracetamol – but he is a powerful little chap.

Now that he and I are friends, I find it hard to admit to him that once I had quite a prejudice against him, and others like him. Antidepressants. Ugh.

In early 2010, I had to face up to what was happening to me. I’d been getting headaches every day for two or three months and was getting struck down by minor ailments on a regular basis. I was clearly stressed out and had lost my perspective. I wasn’t looking forward to anything and was experiencing some horribly dark moods. The only thing was, I was afraid of going to see the doctor about it, because he might ‘put me on tablets‘.

I don’t know why I didn’t trust these ‘tablets’. I didn’t even know what they were, but presumably they were going to alter my mind, and that just didn’t sound right to me. The irony was that I was having to take Paracetamol at least once – often twice – a day for my headaches. I had no problem taking on a headache with medication, but this was different.

It’s obvious now that my mind needed altering, because my nemesis and shadowy alter-ego, Paul Brookes, had crept into my brain, staged a hostile takeover and needed sorting out. When I did go to see the doctor, he confirmed what I’d suspected but hadn’t really wanted to accept. I had depression.

One of the standard ways of treating depression is with antidepressants, like Citalopram, which is what I was prescribed. You can take it in various doses. I started off on 20mg, a fairly low dose.

“What’s happening to me?”

The first night I took Citalopram, something scary happened. I got up to go to the toilet in the middle of the night. The next thing I knew I was lying face down on the bathroom floor, feeling very strange and extremely queasy. I hadn’t a clue what was going on. I managed to crawl to the bedroom, where my wife found me. She realised I had fainted and luckily for me she was very calm and knew what to do.

I still felt unwell the next day, and had to make two phone calls:

  1. to my doctor: he said the fainting episode might not be related to the antidepressants. It’s apparently not uncommon for men to get up during the night to go to the toilet and then faint, because their blood pressure suddenly drops. That’s how I remember the explanation, anyway. The drop in blood pressure might have been a result of taking antidepressants, but might have been nothing to do with it. Whatever the case, it has not happened since, which is quite a relief.
  2. to my manager at work: this was more than the average “I’m ill and not coming to work” phone call – it was a revelation that I was mentally ill, and one of the first times I’d had to discuss it with anyone outside my family. Fortunately for me, she was very understanding and supportive. I had to take two days off, but was back doing my job just as well as usual the following week.

Since then, I’ve had a rollercoaster relationship with Citalopram. The 20mg dose didn’t seem to work, so my doctor upped it to 30mg – one 10mg tablet and one 20mg. There was an improvement and the headaches gradually disappeared, but although we were treating the symptoms, only counselling could get to the heart of the causes and help me to deal with them.

Early in 2011, I was feeling good. By the time I’d finished my course of counselling, I was feeling ready to reduce my dose of Citalopram. You can’t just stop taking it by going ‘cold turkey’, I’ve been told. The consequences do not sound attractive. So I dropped it to 20mg after talking to my doctor.

It was at this point I learned how big a difference antidepressants can actually make, because I soon found my mood darkening again, just by dropping 10mg of Citalopram. Within a week, I’d gone back up to 30mg. Once things had settled down again, and I’d been feeling great for a few weeks, I tried 20mg again.

Victory?

This time, there was no backlash from Paul Brookes. I was fine on 20mg – yippee! I could sing Jimmy Cliff’s ‘I can see clearly now’ loudly and confidently in the car, knowing I was at last on the way to getting myself off my medication. I started dreaming of cold beer, a cheeky whisky, or maybe a glass of wine one evening. Citalopram and alcohol don’t mix well, I understand, so I have been teetotal since the day I took my first pill.

As summer 2011 neared its end, I dropped my dose again, down to 10mg. Was the end of my Citalopram odyssey in sight?

Alas no. I’d dropped my dose as a particularly busy and stressful season kicked off at work, and I needed my little friend to help me fight the re-emergence of Brookes. My doctor said I should stay on 20mg as my stable dose through the winter, which I was happy to agree with.

This time, though, my little sidekick was no match for the sinister powers of Brookes, who rose from the shadows and gave me a good beating, this time resulting in three weeks off work and a return to 30mg of Citalopram.

I’ve learned a few things from this unfortunate adventure:

  • Depression is an illness, which you can treat with drugs, just as you would with any other illness. And, like other illnesses, people recover and no longer need those drugs. The same will happen for me – just not quite yet.
  • Citalopram is a powerful drug. You might think it’s not doing anything, but it is. I only really recognised this when I tried to come off it. It needs careful management and close consultation with your GP.
  • I need Citalopram at the moment, and don’t see this as failure or weakness. It is a necessity, and the alternative is much more damaging.
  • Antidepressants are my allies. Citalopram has complemented my counselling, curbed my anxiety, banished my headaches and cured my insomnia.

So I have accepted Citalopram as my friend. I’ll be glad when he’s gone, but only because that will be a clear sign to me that I am better. In the meantime, he’s my companion on the road to that promised land.

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23 Comments on “Antidepressants: friend or foe?”

  1. longtimelurker says:

    Hi paul,

    I’ve been following your posts with interest. It’s my feeling and I think worth noting that SSRIs are not a cure, they give you some mental breathing room to address the things in your life that are causing you to be depressed. Unless you’re depression is clinical and not so connected to circumstance when I think a higher level of insight is required.

    Thanks

    • paulbrook76 says:

      Yes, that’s a very good point. I have found myself that medication alone will not solve the problem. In my case, counselling has been the answer, but I have needed the medication to address some of my symptoms.
      Thanks

  2. David says:

    It is a brave step to start this journey – it took me years to have the courage to ask for help. I started on fluoxetine (Prozac). But then because I thought they were the magic pill didn’t say anything when they didn’t work – and it tooka crisis situation for me to admit it and I was changed to mirtazapine, and another major crisis when I was changed to venlafaxine. Still good days and bad days, but I’m beginning to know to work with my psychiatrists to keep me level. Now waiting for my psychogy referral to come through to work on the underlying issues.

  3. Janine Pickering says:

    I’ve recently started anti depressants after almost 9mths resisting them. I was critically ill last Xmas after the birth of my son & was in a coma for 17 days. After being separated from my son for his first 3 & half weeks, followed by no time to recover, caring for a newborn, I think it was inevitable I was going to become depressed.

    I felt a little perkier after 4wks of taking 20mg of fluoxetine but they seem to have a levelled out now & I’m feeling down again. I’m going to discuss my dosage when i see my GP next.

    I think it’s so important to raise awareness of depression. I feel most people don’t understand and think I should just pull myself together. Wish I could.

    • paulbrook76 says:

      That really sounds horrific, Janine. Don’t put pressure on yourself to get better, because, like I have done myself, you end up feeling you have failed, which then makes you feel worse. Have you tried counselling? It has been enormously helpful to me.
      You’ve done well to get where you are, by the sounds of things. Good luck with your recovery and take it as slowly as you need to.

      • Janine Pickering says:

        I had one lot of counselling, which did help. I’m now waiting for more. I’ll keep going, as I want to feel better for my son’s sake especially. Good to know your not alone : )

  4. Similar story to my own, I spent years dealing with my depression on my own, unwilling to take meds for it after hearing the scare stories about benzos back in the 90’s. It was only at the start of 2010 when I was hit by a bad case of anxiety that I sought help and started taking Citalopram.

    I too thought I was well enough to stop taking them around December and spent a few weeks reducing the dose until I stopped but later I realised that I’d stopped too soon and my anxiety returned in March of this year. I subsequently went back onto the Citalopram and right now I’m happy taking it until I feel that I’m ready to think about stopping, which won’t be any time just yet, perhaps next year, but I’ll deal with that when I get there.

    This is a good article for anyone dealing with depression, whether first hand or by knowing someone who is going through it. The meds brought me back to a level ground where I could deal with the things I needed to, they didn’t turn me into a zombie like some of the old stories tell you, they just help reduce the anxiety and depression to a level where it doesn’t rule your thoughts and you can get on with the things that need doing, in my case job hunting.

  5. Tracie says:

    I have a friend it isn’t my best friend but without it life would be harder and less interesting. It doesn’t fill me with glee as I thought it might! It just makes me feel like me. I have known it for 12 years and hope it stays because without it I am ill not dramatically just enough to notice. Life’s too short to worry about a friend leaving or to be ashamed of having it. In fact too short to call it a friend! My anti depressant is fluoxetine 20mg I am not ashamed and I am a fully functioning, fantastic mum, friend, wife and teacher because of it.

  6. Thanks for writing this, I can relate to much of what you wrote. I’ve been off citalopram for a while now but I probably should have gone back on them for the last month or so because I’ve had lots of dark days. The reason I didn’t was because I saw it as a weakness but I won’t make that mistake again after reading your article.

    • paulbrook76 says:

      Hi James. Very glad I could help. It really isn’t a weakness, although it has taken me a while to realise that. Braver, I think, to admit to yourself you need that extra help at the moment. All the best, Paul.

  7. Marylin says:

    Citalopram is my best friend! (well, in medical terms, at least)
    I’ve been on it for over 5 years now, other than coming off while being pregnant.
    I’m on the 30mg dosage too, and I will stay on it for as long as is necessary.
    I was rather lucky, really.
    I happened to be a pharmacology student at the time, and the day after I was prescribed my Citalopram, I had a 2 hour lecture about SSRI’s, of which our good friend is one of.
    Honestly, it made so much more sense to me. I think everyone should have a lesson on exactly what their medication does when they’re first given it.
    It’s the odd time my prescription runs out and I’ve forgotten to fill it, that I occasionally forget for a few days. Only two or three.
    Then I realise I’m being very edgy and snappy with the smalls.
    Not to mention feeling exhausted all of a sudden.
    It’s hard to remember sometimes, as Youngest has autism, doesn’t sleep well, and is difficult in general, so it can take a while for me to realise that I’m not just in a grump.
    I start to feel like I’m not coping. Not fun!
    It’s amazing what a tiny little pill can do…
    The doctors will have to fight me to take my Citalopram away from me, that’s for sure!

  8. Ruth Kirk says:

    Oh, Paul, what a helpful article. I’ve been on Citalopram for seven years, since developing chronic fatigue. I have long-term chronic depression anyway, punctuated over the years by three or four very bad bouts of acute depression. It’s been really helpful, especially with my mood and sleep. Last February my neurologist asked me to reduce it slowly and come off it, in case it was contributing to my migraines and headaches. So I did, very slowly. Two months ago I reached 3mg every fourth day, but my mood was dropping ever lower and lower. I was having unbidden suicidal thoughts and laying awake for hours every night. So I put it up to 5mg per day, and definitely felt a bit better for a while. Even so, feeling that my life is pointless and laying awake at nights can still be a problem, so I’m currently wondering whether to go to 10mg daily. I know that 20mg is very helpful, but I put on a lot of weight at that dose, and it’s pretty well impossible to lose it unless I reduce the dose. Its a very delicate balancing act. Anyway, sorry to bang on, but I did so value reading your story, and I will TRY to see my doses as a blessing, rather than a failure. Very best wishes to you, from Ruth XXXXX

    • paulbrook76 says:

      Thanks Ruth.
      It’s a difficult balance isn’t it? You want to feel you can do without it, but those little tablets are much more powerful than we give them credit for. I’m really interested in – and reassured by – what you said about gaining weight, as that has also happened to me. I reckon I am more or less a stone heavier than I used to be. It’s not all down to the Citalopram (could also be my sweet tooth and love of curry) but I think it’s at least partly to blame.
      Much as I want to come off the medication, mainly for the sense of victory over the illness, I have tried reducing my dose before and got the timing wrong. It’s much more important to feel well and stable, so I will stick with it for as long as necessary.
      I’m sure it works differently for everyone so am in no position to advise, but I’m glad the blog helped.
      All the best to you and thanks very much for your support on here and on Twitter :)
      Paul

      • Ruth Kirk says:

        Dear Paul, thanks so much for taking the time and trouble to reply to me personally. That was very kind of you. With regard to the weight issue, Citalopram doesn’t itself make you put on weight, but it does increase appetite, which makes it very difficult not to to eat more, and thus pile on the pounds. I don’t know how well or fit you are, but my solution is to wear the simplest SILVA step-counter, and to aim to do 10,000 paces almost ever day. This makes a huge difference. I’ve heard others report that if you do 12-14,000 per day, it’s pretty well impossible to gain weight, unless you eat very self-indulgently! Have also given up bread at lunchtimes. Instead I have a big bowl of chopped fruits, 2 dessert spoons of home-made yoghurt, and two dessert spoons of coarse porridge oats, all moistened with milk. It keeps me going sufficently to do my main walk In the afternoon, and avoids the fattening butter, meat, cheese, mayonnaise etc that normally make up sandwiches.

        I can help to support you in any way, I’d be glad to.

        All best wishes from Ruth XXXXX

      • paulbrook76 says:

        Thank you Ruth. You are supporting me by leaving nice comments and chatting on Twitter – so thank you!

  9. […] me. I’d say “I’ve come off my antidepressants!” Those are the magic words I’ve wanted to say for three-and-a-half years. Now, at last, I can […]

  10. Adam B says:

    Hi Paul
    I read your blog with great interest and it has made me look at things in a different light. I have been taking citalopram for six years now and really would love to move forward on the road to recovery by leaving the little friend behind. It’s true..you don’t realise how powerful the tablets are until you change the dosage and open pandoras box!..I have gained some fantastic advice from you. Thank you so much and good luck.

    • paulbrook76 says:

      Hi Adam
      Thanks – glad you found the blog helpful. I stopped taking my tablets about 11 months ago. Sometimes it has been tough without them but I’ve managed it so far. I’ve definitely needed to take care of myself more and get as much support and help as I can when I go through dips.
      Good luck with your recovery – there’s no rush!
      All the best
      Paul


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