7 Weeks in...relapse?! Can somebody help please I'm so low :(

Treatment and medication
1

Hi everyone,

I have posted in here before and found everyone to be so helpful and amazing.

I had my citalopram dose upped from 20mg to 30mg on 21st December, I had a good few side effects at first and then they seemed to settle down and I felt like I was managing OK, not 100%, but just OK. Better than I was, which was the main thing for me.

My initial side effects were enlarged pupils, no appetite, nausea, fatigue coupled with insomnia, that citalopram headache that hits right across the eyes! I also felt woozy.

When I first started the tablets, I was taking 1.5 20mg of the Teva brand to make 30mg, then I got 10mg of one brand and 20mg in the Accord. This past week I have had bouts of nausea - mainly after I eat, around an hour later, which is pretty much what I was like when I initially upped the dose. Also had woozy spells, but i know that at certain points in your cycle, you can have the wooziness and dizziness heightened due to hormone changes.

I’ve had pancreatic cancer 4 years ago, so anything stomach related really kicks me off anxiety wise and luckily, I have an amazing nurse who is now my friend and he basically lets me have any test that I want if it offers me reassurance. So, due to the nausea I asked if I could have my bloods checked and thankfully, they are all completely normal and my tumour marker is normal. But the nausea was still there and giving me major anxiety! It lasted for around 4 days, then eased and I was eating whatever I wanted again with no nausea, then it’s returned and has kicked off my anxiety yet again and I’m messaging my nurse asking if I have stomach cancer - that’s where my mind takes me, it’s really awful. I’ve also noticed I feel woozy again. Is it normal for these side effects to come and go? I do know that these can be side effects of anxiety, too - it’s a total mind game working out what is what.

I worked in pharmacy as a technician for 7 years and the usual line you are told to tell the patients is that brands don’t make a difference, and we are trained that 20mg of a drug is the same across all brands, but even though I’ve had this training, I’m not convinced at all. My friend who is a pharmacist said the active ingredient is the same but the fillers can be different which can alter things and try to stick to one brand if possible. Has anyone else noticed this across brands?

I’m scheduled in for a call with my GP tomorrow and was going to ask if I needed to up my dose due to the mood drop, but I also don’t want to rush in too soon if this is quite normal.

Thanks everyone for the support - you’re all amazing and when I’m having my low days I come on here to read your stories and they give me so much hope :slight_smile:

2

Spoke to my GP who told me that the daffodils will come out again and the sun will shine again…seriously!

3

Hi amybelle

Not sure how long you’ve been on Citalopram, but just to say they take a very long time to work. Months - took me 6 months. During this time, you’ll probably have many flare ups of anxiety and it seems this is how the meds work, or recovery anyhow.

You won’t just start feeling a bit better and then improve from there, but instead anxiety will come back time after time (setbacks), even after you’ve had good days or even weeks. This will though eventually even out over a long time.

Meds - every time you increase your dose you will probably experience side effects again. This is normal, and it doesn’t mean you’ve started from the beginning, but just that your body is trying to adjust.

Brands - yes I’ve read this all too often on this forum that people experience side effects / a setback when they’ve had a different brand issued. So what I’ve read is that though the active ingredient remains the same, its often the inactive ingredients (the shell / coating) that can differ. Does that affect people? Somethings seems to anyway.

Trouble is with anxiety, when side effects start, this alarms people and then sets off a series of worry and fear about these sensations which then causes more anxiety. Anxiety is a cycle of fear / anxiety / fear - each feeding each other.

So maybe increasing AND changing brands causes similar side effects and maybe its just a case of waiting for your body to acclimitise to the changes.

Maybe these side effects will settle down in time, but it wouldn’t hurt to ask your doctor for only the brand you’re used to and visit another pharmacy for that particular brand.

But yes - this is a common problem with brand changes.

K :heart:

4

Hi Kate,

Thanks so much for getting back to me - I really appreciate it as I’ve had a really rotten time anxiety wise the last few days. I feel like I’m speaking to somebody famous! Ha!

I am on 30mg citalopram since Dec 21, having previously been on 20mg for the last 3.5 years. I felt the efficacy wasn’t quite hitting what it used to and my health anxiety and intrusive thoughts made a big comeback. I started taking the extra ten, by splitting one of my tablets in half and taking 1.5 at a time, had all the usual side effects, but they tapered off. I literally cannot remember how I was when I started the 20mg, I remember starting on 10, feeling a boost and moving up to 20, but I was diagnosed 2 weeks later and straight into chemotherapy so I had a lot of other meds to deal with and nausea etc. so couldn’t differentiate the two.

My nausea has lifted today and I’ve eaten more, but the same thing happened last week and then I dipped again so I’m treading carefully. I’ve also noticed things like dry mouth again, dry eyes, I had sinus issues last week, that citalopram headache is saying hello - I seem to be looping the symptoms again and it’s only happened since this brand change. My mood has also dipped but my anxiety peaks in response to physical symptoms so I thought it was that, but looking back over the last couple of weeks, it’s massively dipped.

So, my job before I was ill was a journalist and I’m naturally inclined to research, and the whole brand change thing was really wigging me. I moved onto this specific brand in the summer and started with heart palpitations, had an ECG - all normal, but heart palpitations just aren’t something I’ve ever really dealt with apart from when my iron levels dip, and they came out of nowhere. I changed brands, they tapered off, I started taking magnesium and just sort of forgot about them.

What I’ve found about brand differences, particularly in antidepressants like Citalopram and in Citalopram in particular, is that brand changes can be extremely detrimental to patients and cause relapses in symptoms and original illness. This obviously isn’t something that happens to everyone, but it’s relatively common. As you said, the other ingredients used as excipients and coatings can be whatever the company chooses as long as they are safe, but they have free reign to choose their quantities in order to create the tablet - this will have an effect on how fast or slow the tablet metabolises in the stomach and gets into the bloodstream, which, when varied from brand to brand, can be a problem for many, especially those with sensitive stomachs (or half a stomach like me!). However, the thing that interested me the most is the fact that whilst the active ingredient, in this case the citalopram, has to be the same as the original patent, so Celexa in this case, the FDA stipulates that the bioequivalence is actually between 80% and 125% of the original. Meaning, some tablets can be produced with 80% potency of the original, or up to 125% of the original, and that’s fine to vary that from brand to brand - completely legal! So, when symptoms relapse, in theory, patients could be given a more potent tablet that is essentially kicking off all of the side effects again, or losing potency. Considering 95% of serotonin is made in the gut, then I think this makes sense especially when it comes to those who suffer with nausea/indigestion/heartburn from Citalopram.

Twenty patients were blind tested and had their brand citalopram switched to generic and all reported relapses - this has been found to happen in generic switches, too. Many psychiatrists actually acknowledge that patients who did well on 20mg of celexa may indeed need a different strength in the generic.

My old boss, who is a pharmacist, also clarified that the difference in excipients and coatings could also kick off side effects again.

I know that this can be disputed, but considering what I’ve read from patients on here, as well as when I worked in pharmacy, I think there is a lot more to the “it’s all the same drug just a different brand” spiel I was trained to deliver.

Sorry that was a big long, Kate! I thought you may be interested in my findings :slight_smile:

Thank you so much for replying - it’s nice to see a reply at a time when sometimes you feel like you’re completely alone xxx

5

just come across your messages and it feels so good that someone else has discovered the truth about generic antidepressants. I’m actually taking Fluvoxamine now,because I will not take generic Citalopram because of all the things you’ve correctly discovered,and the detrimental effects it has when taking generics. I started taking SSRI’s 30 yrs ago when Sertraline was first introduced,then went to Paroxetine,Prozac and Citalopram. All were the branded medications due to still being in patent. In all those years I never experienced a problem after the initial few months of recovery and side effects,until they started giving me generic brands of Citalopram. All the things you described,I experienced. Two years ago I went back on Citalopram with the understanding with my Dr. I would only be given the branded citalopram,Ciprimil. After a couple of months this was either accidentally or purposely swapped to generic. Within days of taking the generic my anxiety came back with a vengeance. I had to phone my Dr. to explain and he actually apologized and altered it back to Ciprimil. The problem occurs,not from taking one generic brand,but from swapping from branded citalopram to generic or from one generic brand to another. As I live in the UK,the NHS is constantly swapping between generic brands to save money and there are many,many different brands of citalopram. Dr.s and pharmacies will blatantly lie to your face that this problem does not exist simply because to save money. If the truth as you’ve discovered yourself was admitted, it would cause untold expense. I was lucky enough to be given Fluvoxamine before my Dr. retired,even though it is generic it is very rarely prescribed and then for OCD. Why,I can’t find out because it is an SSRI and I’m taking it for anxiety/depression. Because it is so rare,so far I’ve been able to keep to the same brand, otherwise I don’t know what I would do. I actually had an argument with a Dr. over the phone who insisted that generics were “exactly the same as branded”. Either she was lieing or incompetent. Either way,these are serious medications that enter your brain and can influence your whole life for the better or worse and the generic problem needs to be exposed..