Citalopram diary - Day 1

[humanagain]

Hey all,

Second round of Citalapram after a 15 year stretch of only background anxiety. 3 weeks ago I Suffered a mild concussion/head trauma and now found myself in a position where I'm very anxious/depressed and getting very little sleep, due to misdiagnosing it, and the whole scenario being mega stressful. I'm off work to recover which isn't helping, as I'm the support for the family.

Thought i'd do a diary, as it seems to help:

Day 1
Zero sleep
Took first 10mg at around 1pm. Also on propanalol. Spoke to doc, and he prescribed zopiclone as I've not slept for 3 days due to horrific night panic/jumps as I drift off to sleep, with no restbit at all.

Day 2
Zero sleep
Took cit and propanalol first thing. Noticed prefused sweating, was concerned it was Seritnonin overload. Also pupils are large. Unsure if source of anxiety is from lack of sleep.
Waves of high anxiety today, dark thoughts. Sitting and starring alot, mixed with being very wrestless and doing random tasks. Crying the gP's office over sleep is another low point to add to this life.

Let's hope I can sleep tonight with some assistance...

[humanagain]

Oh one thing to add, GP mention possibly switching to another AD beginning with 'M'...he said it was more sedating which may help. We'll see what next week brings. I've used cit before, and remember the initial 'process'.

[panic_down_under]

Day 1
Zero sleep
Took first 10mg at around 1pm. Also on propanalol. Spoke to doc, and he prescribed zopiclone as I've not slept for 3 days due to horrific night panic/jumps as I drift off to sleep, with no restbit at all.

So you're taking only 10mg citalopram initially and zopiclone didn't help?

Day 2
Zero sleep
Took cit and propanalol first thing. Noticed prefused sweating, was concerned it was Seritnonin overload.

Maybe try taking the citalopram just before bed. All SSRIs initially increase serotonin synthesis and expression, but so does anxiety and depression. Despite the claims, serotonin is not a "feel good" neurotransmitter. Just the opposite. But after a few weeks biofeedback mechanisms kick in and serotonin levels in areas of the brain which manifest anxiety drop to well below baseline.

Also pupils are large.

This is quite common. Often both pupils are enlarged, sometimes only one.

Unsure if source of anxiety is from lack of sleep.

It could well be.

Waves of high anxiety today, dark thoughts. Sitting and starring alot, mixed with being very wrestless and doing random tasks. Crying the gP's office over sleep is another low point to add to this life.

Unfortunately, antidepressants often make things worse at the beginning. The fact this is not the first time you've taken an SSRI may be adding to the discomfort. The initial side-effects may be different than the first time too.

GP mention possibly switching to another AD beginning with 'M'...he said it was more sedating which may help.

Probably mirtazapine which is more a very sedating antihistamine, not a true AD. It can actually be taken with SSRIs as a sleep med in small doses (it becomes less sedating as the dose increases), however, your GP's drug interaction data will, incorrectly, say that there is a risk of serotonin syndrome. There is about as much chance of serotonin syndrome/toxicity (SS/ST) as there is of you flying to the Moon by flapping your arms because mirtazapine is only an extremely weak serotonin reuptake inhibitor. Not my opinion, but that of arguably the world's leading SS/ST expert, Dr Ken Gillman:

As I have pointed out before, drugs like bupropion and mirtazapine, that have no significant serotonergic activity, are no more likely to cause ST than is vitamin C. This scenario has already been enacted, over a decade, with the antidepressant mirtazapine, which was claimed, erroneously, to have serotonergic activity. Many poor quality case reports of ST with mirtazapine were published. This probably led to misdirected treatment of overdoses, some of which may have caused morbidity. It took several reviews to correct this error and establish that mirtazapine cannot cause ST

PK Gillman, 2010 PDF. See also: A systematic review of the serotonergic effects of mirtazapine in humans

Moreover, mirtazapine is a serotonin 5-HT2a receptor antagonist (blocker) which can prevent the body temperature spike which does the damage in SS/ST although in humans the recommended treatments are the more potent 5-HT2a antagonists cyproheptadine and chlorpromazine.

And lest there still be doubt, the other leading expert, Ian M. Whyte, whose team at the Hunter Toxicology group devised the SS/ST diagnostic criteria now used world wide to diagnose SS/ST, agrees (note: 5-HT=serotonin):

In some cases this has led to reports of serotonin toxicity for drugs that, from well-defined receptor binding studies, are unlikely to cause increased levels of CNS 5-HT. Important examples include the 5-HT2A receptor antagonist olanzapine and the 5-HT receptor antagonist mirtazapine.

Dunkley EJC, et al, (2003), The Hunter Serotonin Toxicity Criteria, QJM, Sept, vol 96(9):635-642

[humanagain]

Thank you so much panic_down_under. I've noticed your comments are always filled with so much useful information.

Only 10mg this week, then probably upping it to 20mg. Unless the doc decides I'm better on mirtazapine?

I'm curious. If the anxiety I am feeling is a chemical imbalance from knocking my pituatary/hypothalamus, then will these meds work? I'm having tests done to establish thyroid function, etc.

I do suspect the concussion has brought around some strange chemical imbalance from my pituatary, either that or in a bruised brain stem. Either way it seems that I've been in fight or flight mode since the symptoms came on (and got misdiagnosed as vestibular issues, then I thought I was diabetic) Symptoms being: over thirst and urination, blurred vision up close, occsional nystagmus, hot flashes, cold sensitivity, balance issues etc.

Unsure if it's purely from my TBI, or the anxiety is due to the stress of it all. Or likely a bit of both...

So...once i put 2 and 2 together and realised it was all due to the mild concussion (no loss of conciousness but a big enough smack at the back of the head to see stars), I needed to recover. I was initally prescribed OTC cocodomal, propanalol, and 3 x 3.5mg zopiclone. Which helped for 2.5 nights.

The panick, anxiety was growing and filled me through and through, after that I was awake for 4 days unable to drift off to sleep, having those hypnic jerks, and a panic attack as I feel to sleep.

I broke down to the GP's, and he prescribed me the 7.5mg zopliclone. Which i where I am now. I slept last night, but could feel anxious before sleep. My chest felt tight after taking the zopliclone, which was one of the warning signs, so that induced panic, before I drifted off.

I'm taking propanalol as and when I need it.

Oh I wish things where normal...thanks for listening.

[humanagain]

Day 3 10mg Citalopram - Noticed blurred vision, waves of anxiety through the day. Sweating alot, but nothing to heavy. Took a propronal in the afternoon and felt some heart palpitations as i kicked in.

Sticking to the routine.

Zopiclone full tab helped me sleep from 10.30 till 3:45. Not the best, but better than nothing. Cannot drift off unaided. Tried during the day, and felt waves of anxiety.

[panic_down_under]

I'm curious. If the anxiety I am feeling is a chemical imbalance from knocking my pituatary/hypothalamus, then will these meds work? I'm having tests done to establish thyroid function, etc.

"Chemical imbalance" is a myth. It doesn't cause either anxiety, or depression (see my Serotonin - The 'chemical imbalance' myth, nor do antidepressants work by correcting any imbalance. I posted a full explanation about the underlying biology and other info which may be of interest here .

Either way it seems that I've been in fight or flight mode since the symptoms came on (and got misdiagnosed as vestibular issues, then I thought I was diabetic) Symptoms being: over thirst and urination, blurred vision up close, occsional nystagmus, hot flashes, cold sensitivity, balance issues etc.

Unsure if it's purely from my TBI, or the anxiety is due to the stress of it all. Or likely a bit of both...

I suspect these are mostly driven by your reaction to the knock on the head than any physical damage from it. What was your anxiety state leading up to it?

My chest felt tight after taking the zopliclone, which was one of the warning signs, so that induced panic, before I drifted off.

Imo, the chest tightness was more likely anxiety than the med.

Day 3 10mg Citalopram - Noticed blurred vision, waves of anxiety through the day. Sweating alot, but nothing to heavy. Took a propronal in the afternoon and felt some heart palpitations as i kicked in.

All of these are fairly typical side-effects of these meds.

Sticking to the routine.

GOOD!!!!

After 5 years of keeping the 21st Century plague, aka Covid, at bay I've finally slipped up somewhere and succumbed so if I'm slow answering questions it isn't because I'm ignoring you, just not up to it.