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Citalopram.

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13:45 / 20.12.02

(I'm putting this here for attention but can move it to lab if necessary).

I've been prescribed this and now have a box of the stuff sitting at home. Am apprehensive - GP (temporary one, not my normal one, as I'm a transfer patient because my main residence is apparently University) was pretty useless and blunt, didn't really see where I was trying to lead her and wasn't going to ask stupid questions.

So I've been given a box of ADs. And I'm apparently looking at a six month course of the damn things. Final half of University. Whilst I know I need to do something about what I've got, I'm apprehensive as to whether this is the right thing. Perhaps I'll think differently when they've had some effect. But at the moment... not looking forward to six months off alcohol. According to the box I should not drink "too much" alcohol, but most sites on the web suggest "none" as a better precaution. I cannot do none. Maybe most days, but not by the end of final term, and not by New Year. This is not me being weak or anti-social. This is me wanting a drink. I drink less than I used to, thank fuck, and can probably cut it further... but to nothing? No way. Not with all the willpower and happy-juice in the world.

So basically: I wanted people's advice; has anyone taken this stuff before? Am I being stupid with my drink-problem? Should I investigate stuff like cognitive therapy (which I am interested in) myself if my GP doesn't mention it - I mentioned I'd been in counselling, so she assumed it wasn't worth another try. I explained that by "counselling", the Counselling Service thought people saying nice things but not actually getting their hands dirty and working with me would do. And it was for a specific complaint.

Basically, I'm scared, but I was scared of what I've got, scared how I am when it really kicks in, and now I'm scared of the cure. And it's shitty. And I thought it might be worth asking for help.

13:57 / 20.12.02

Paleface should take the ADs, says I! I don't have experience of those particular ones, but they probably will make you feel a bit wierd for 10 days/a fortnight, before they start working properly, but I'd say to give em a try. As for alcohol - you have to be realistic. Alcohol's not brilliant for anyone, really, so I hope I'm not being really stupid here by saying it's better to drink a little on the pills than not take them.

And some kind of counselling or therapy is also needed, I would think. ADs are a helping hand, not a cure in themselves. Tell your GP what you think you need, if you can.

And try and take it easy. The whole concept of being prescribed ADs can be daunting/depressing in itself, but try and think of it in the same way as you'd think of medication given you for a physical illness.

Tryphena Absent

14:32 / 20.12.02

Well here's an alternative but it costs money (they tend to means-test you). The Foundation for Psychotherapy and Counselling Nationwide Referral Service lives at 020 7721 7661, you can also email referrals@psychotherapy-counselling.org and the website, if you want to know more about them, is here.

As for GP's, a lot of them are useless and blunt, people tend to be useless and blunt back and then nothing gets acheived. That doesn't mean they don't know what they're doing (except for the Welsh female bitch who treated me two years ago) actually it often means they do it all the time. As for the pills, I wouldn't take them but I had a problem taking the pill, drugs make me feel ill and there's nothing I can do about that, it colours my view towards everyone else shoving the things in to their bodies.

One more thing, six months is a long time and Doctors are often very mad about giving people long courses of pills, there's an important practical question that you haven't asked - how is it coming off this stuff? You don't want to end up in massive miserable withdrawal and right back where you started and feeding your body full of brain altering chemicals for the rest of your life.

15:48 / 20.12.02

There's research showing citalopram lowers one's desire for alcohol.
It also reduces the effects of Ecstasy.

Apparently the side effects tend to go away after three weeks, and citalopram tends to have fewer than other anti-depressants, acting directly on the serotonin system and not (directly) affecting much else.

This site indicates that citalopram doesn't potentiate alcohol in humans (which is the problem with lots of similar drugs), but that it's probably a bad idea to drink too much while on it anyway. (This seems like scientistese for "well, it oughtta make you drunker, but it don't, so stay away just in case.")

I'd also avoid ayahuasca experiments while on this drug; MAOIs don't mix well with it.

----

On a less researchy note, it's hard to give advice without knowing the problem, which you may or may not want to divulge in a public forum. There's absolutely nothing wrong with getting a second opinion from a professional, and I'm generally a big supporter of seeking therapy over medication. But therapy takes time, and if whatever's bugging you is interefering with your final semester, you might need a quick solution to the problem first to get through the school year.
So definitely seek out other professional advice, and always do your own investigating. But don't discount the doctor out of hand.

16:02 / 20.12.02

A good person to ask about interactions is a pharmacist.

I asked mine about the "alcohol" thing when I first took A-Ds (not citalopram, but an SSRI, and they're all similar) and she told me that they really just advised it because it can make some of the side effects worse, dizziness, nausea etc, but it wouldn't actually do you any real harm.

If you couldn't drink on A-Ds about three people would have taken them ever. I found that booze really didn't help, though - it seemed to cut the effect, so when I was pissed I was as bad as I would have been without the pills.

Cognitive therapy is very good IME, but there's a huge waiting list. You should ask your GP to refer you to a psychiatrist, too, since most GPs are not very good with dealing with these things.

Suedey! SHOT FOR MEAT!

17:39 / 20.12.02

mmmm. ok, personally I wouldn't take them. I had them before, and they really spun me out.

They made me feel really really weird, far too much, for far too long.

I did drink while I was taking them, and it was not good. Really not good. As in, would lose massive chunks of memory, wake up in strange places, do things I definitely would not normally do, no matter how drunk and be sick very very easily (which in addition to the lost memory, and being sick all over peoples stairs, is not good). I'm not normally sick when I drink, either.

So, if you must take them , I really must advise you do not drink.

They did not help me at all, in any way, they just made me feel a whole lot stranger. All the doctors did was increase my dose when I told them... and eventually gave me something else, which was even strogner (EFFEXOR, or something, it says on the box. It says that on the box, and I never really took them, I just eased off them... I actually feel a whole lot better now...)

So, without knowing the problem, I'd say try and work it out with a counseller or just by talking... sorry, got very blunt here, but I must go. I will add more later.

18:05 / 20.12.02

All the doctors did was increase my dose when I told them... and eventually gave me something else, which was even stronger

A little thread rotty of me, but in response to the above can I just say how terrifyingly easy it is to get hold of some of these drugs. I went to my GP about a fortnight ago as my sleep patterns were pretty irregular and my sporadic insomnia was returning. I'd barely finished my explanation of my symptoms before he was pushing a prescription for Diazepam and Prothiaden into my hand and ushering me to the door. It seems many GPs consider a prescription - regardless of whether you need it or not - to be the panacea of all ills...

18:17 / 20.12.02

Suedehead - were you taking citalopram?
It's actually a bit different from other SSRI drugs, because most of them interfere with other neurotransmitters besides serotonin -- which could easily give you some strange reactions to alcohol, as well as some other side effects.

18:22 / 20.12.02

I was on citalopram for a while. I found it to be side-effect free, but then I've never had any major probs with ADs that weren't sexual or tiredness-related. Citalopram didn't do much for me, and I am now on two other ADs that seem to help. Withdrawal shouldn't be a problem - they tend to take you off all ADs gently, otherwise you might feel a bit weird for a few days, but that's about it (I've come off several anti-depressants abruptly, and never felt worse than a bit weird). Six months isn't really that long - I finally got diagnosed with bipolar 2 disorder, and am likely to be on anti-depressants for quite a while longer than that.

Generally good to pair anti-depressants with counselling - as you are a student, there may well be free counselling organisations (outside of college) that your doctor will be able to recommend - mine did. You need to *tell* the dr what you want. Anti-depressants can be really helpful, I speak from experience. Ultimately it's up to you whether you take them or not, and up to you what other measures you take...but I think you should give it serious consideration.

18:25 / 20.12.02

I should also mention that I don't drink. But I think, from what you've said, it's probably worth trying these pills out for a while, seeing how they effect you, and perhaps cutting down on the drink to allow these tablets to work. Alcohol is also a depressant - not the best drug if you're already depressed.

20:27 / 20.12.02

Thanks all.

This thread has buoyed me somewhat. I'm going to take them, I've decided. I knew I ought to, but am now convinced it's workable. The drink-thing was getting to me a surprising amount - I've cut down a fair bit this year from some of the headier moments of my first year (and to explain: I do not binge drink. I do not spend two weeks in a library and then get legless and turn into an obnoxious dick who can't remember anything. I just drank a fair amount relatively regularly. And it probably wasn't so healthy). I think it's entirely workable to go slower, drink less, especially if I feel the need to drink less - I don't drink to drown my sorrows, but I'm sociable with similarly heavy drinkers and the speed I dispense a pint in normally must be dealt with. Basically: I'm cutting back for the sake of the pills. Cutting back I could do. Stopping terrified me.

And it really has got to the point at home where something has to change. And I've been given this, and I at least ought to give it a go. I'll keep you posted on how things go, obviously. But now I've reached a decision and been told it isn't so scary really... I feel a lot better. Thanks, folks.

23:48 / 20.12.02

It seems many GPs consider a prescription - regardless of whether you need it or not - to be the panacea of all ills...

Really, I think that GPs, with a few exceptions, really aren't capable of dealing with psychiatric illness. I've dealt with quite a few myself and had a lot of feedback from other people. A few know what they're doing. The majority will stick you on pills. If you don't get better, they stick you on more pills. If that doesn't work, they stick you on different pills.

That's okay if it's a short-term situational thing, and all you need is something to get you through a bad patch. But I advise anyone with deeper problems to insist on referral to a psychiatrist.

00:29 / 21.12.02

Hmm. It's a little while since we've had an antidepressants question, eh?

Citalopram is a selective serotonin reuptake inhibitor - and rather more specific, neurophysiologically speaking, than other drygs from the same class (fluoxetine, paroxetine, etc.), which is a Good Thing in terms of side-effects. All SSRIs flag up a big 'With Caution' where alcohol is concerned; this is mainly because alcohol can potentiate some of the side-effects as well as tending to counteract the antidepressant effect (alcohol being a depressant).

'Counselling' is a catch-all term covering a multitude of sins, anything from properly structured cognitive-behavioural stuff to relatively unstructured 'tea and sympathy'. Much depends on the counsellor-client relationship, and it's always a two-way process, not a passive 'cure me' situation - so disappointment is likely to result from poorly-compatible personalities rather than any more general unwillingness on the part of the counsellor to 'get his hands dirty'. The responsibility to engage with the process is a shared one.

Cognitive therapy is worthwhile but time-consuming, so the waiting list is likely to be long. It's also worth noting that, where depression is concerned (and I'm assuming this is the problem, Paleface, although you don't explicitly say) cognitive therapy is comparable in effect to antidepressant drugs but generally slower in terms of onset.

Finally, I think it's important to point out, in defence of general practitioners, that they are typically faced with inexhaustible demand, unrealistic expectations, inadequate training and laughable resources. They have an average of six minutes in which to assess and tackle your problem, however complex. On a daily basis, they are expected somehow to 'treat' unhappinesses, injustices and social ills that may have little or nothing to do with 'illness' per se. Generally speaking, they're not legalised 'drug dealers' with some sort of sinister agenda of prescribing a pharmacological "panacea" to all and sundry; it's just that, presented with the unceasing demand that they 'do something', they resort to what little arsenal they do possess. How would you suggest they help you?

Suedey! SHOT FOR MEAT!

17:33 / 21.12.02

Grant: Suedehead - were you taking citalopram?

Yes, I most assuredly was. They really didn't work for me, but I guess they just didn't fit with my lifestyle at the time. I found that it was easier to work through any problems I had when not taking them, they just didn't seem to help. But that's just me, personally.

What I'd urge Paleface to do if he takes them, is really be careful with alcohol. I mean, really. You may well find you get very very drunk, far too easily, and your memory just slips out of your head. It's not nice.

But, they could be right for you, I dunno. For me, I felt like I wasn't in control, and couldn't feel any real emotion, which I found horrible. And that's without going in to how it effects the sexual side of things... ergh. I forgot about that.

(Basically, the most commonly known side effect I know of - and I know a few people who've taken citalopram - is that it makes it extremely hard to come. Like a real chore. And it doesn't feel *right* somehow... it's very odd, and very very annoying. I mean, really. That's just gonna piss you off.*)

*Although, noted, other parties may enjoy this "prolonged life".**

**Until they're too sore to carry on.

*Ahem* I think I'll leave it now.

17:58 / 21.12.02

It's called "retarded ejaculation", v common with SSRIs. I'm told there's an equivalent female symptom.

18:04 / 21.12.02

One of my friends was on prozac for a while. At first the drug worked really well, she could get on with her life without unbearable stress, anxiety and suicidal tendencies. About six months later, she was 'flattened' (just like Suedehead described), the good effects of the drug had worn off and what was left didn't help push her forward.

Now she is off the drugs, going through cognitive therapy and slowly sorting her life out. It helped when someone pointed out that it isn't bad that stuff can make you miserable, otherwise how would you know what you needed to change? Being unhappy about something can give you a big push. Often the most optomistic points in my life have been when I've decided that I've had enough, whatever situation is awful and I must do something about it. Generally these points are when I finally twig what has been bugging me for so long and can start to work out a solution.

If you are going to take a-ds, then you should really make an effort elsewhere in your life as well. Investigate the therapy thing, work out what is of worth to you in your life (goals and things you have now) and go and enjoy it. Some people never get a 'flattening' effect from an anti-depressant, but just in case I suggest you view this as an opportunity to sort yourself out, not a cure.

19:05 / 21.12.02

Hmn.

I'm aware of the whole feeling-real/not-feeling-real thing, and that could be a problem. I feel quite enough as it is; at the same time, my irritability, anger, frustration, and the way I get neurotic about little things is, to my best guess, all I part of this (which is depression; I didn't realise it wasn't obvious). I haven't quite been me for over two years now. So I'm not sure that if my emotions change a bit on these things, I'll remember what it's like. When I was in a good way I was what, sixteen-seventeen? It's a while ago.

Hmn. Retarded ejaculation. Somehow I get the feeling that that's only going to be a problem for me. We'll see what happens.

harmony: to be honest, I have been making an effort elsewhere in my life. Not in therapy, but in working out what needs doing, what sets it off, what my limits are and what makes me happy through this. Actually working out what I want half the time is very difficult, not just because I'm indecisive, but because I feel so vacant and hollow. If these pills make me feel anything, I think that would at least give me oomph and motivation that's so lacking.

And you mentioned optimistic moments: one of the most optimistic moments was yesterday afternoon, when I read the posts people had put here, and said to myself: "I'm doing this." Around last weekend, I realised quite how much I'd sunk and how unreal the world felt, and I also realised how little I could put up with this. The resolve made me feel good; but that feeling doesn't last. I now need to start working on results.

And, of course, it's not just being abjectly miserable. It's also concentration, excessive need-for-sleep, motivation. I need them far more than I need to be happy. If I had them, my workpatterns were good and I could cope on less sleep than the ridiculous amount I like now, I'd not be half as bothered. But there are so many things, almost certainly related to my depression , that need sorting, that the buck stopped.

Tryphena Absent

23:15 / 21.12.02

Well said you and I hope it works hyper-effectively!

Goodness Gracious Meme

21:25 / 22.12.02

properly structured cognitive-behavioural stuff to relatively unstructured 'tea and sympathy'.

*will* be back to this more relevantly, but is there a bit of a crappy judgement call going on here, re to one of these being 'proper'?

Good *counselling* (ie work with a qualified counsellor) is very rarely 'just' 'tea and sympathy' (that'd be a drop-in situation, more likely) ... and there are good and bad practioners in every discipline...

22:53 / 22.12.02

No, I used the 'tea and sympathy' thing to illustrate the continuum in terms of 'structuredness' rather than effectiveness. The single biggest factor in the effectiveness of 'talking treatments' is the client-therapist relationship - so the variety of approaches under the catch-all 'counselling' label are very much on a par with (if not better than) more structured therapies, contingent on the therapist's degree of empathy...

Tryphena Absent

23:47 / 22.12.02

This is completely off-topic but I'll just elaborate on Ganesh a little here:

The thing about counselling is that there are so many different types, off the top of my head here's a vague list: psychotherapy, psychodynamic, psychoanalysis, psychiatry, straight counselling, voluntary counselling (Samaritans etc.). Counselling is an incredibly vast topic and the kind of therapist you are really depends on where you train and the kind of path you follow. In Britain the main training centres that I know of to become a qualified counsellor around London (that's an analyst, therapist or someone who follows a dynamic method) are the WPF, LCP and the Tavistock. The WPF really leans towards psychodynamic counselling and teaches both the intellectual (Freudian) methods and the more instinctive (Jungian) ones. The LCP is much more intellectual and the Tavistock is more instinctive in its approach.

The more effective therapy rarely depends on the personality of the therapist but actually on the type of counsellor that person is, for instance a young girl is probably not going to respond well to a counsellor who follows only Freudian intellectual theory and lies her down on a couch.

You probably already know all of this...

The Return Of Rothkoid

22:00 / 05.01.03

It's called "retarded ejaculation", v common with SSRIs. I'm told there's an equivalent female symptom.

A friend of mine was on Zoloft - the doctor I saw said that it and Citalopram were virtually interchangeable - and she said that yes, it made it impossible to orgasm. But the second time she was on them, no worries, apparently. Is this common? I mean, side-effects changing with each iteration of the drug you take?

17:24 / 11.01.03

I wanted to give everybody an update.

Friday I went to see my doctor for the followup. And I had good news to tell her. The tablets basically kicked in after about four-five days on a half dose with noticable improvements all around; less neurotic, little problems and things that work me up not getting out of hand, no shouting at my mother. Mother immediately noticed change, as did several others - commenting that I'd returned to being pretty much as I was about three years ago, before this phase of life kicked in.

I'm now on a full dose and have had no unpleasant side-effects bar one incidence of anxiety and a bit of queasiness. Things are genuinely looking managable; there's still long-term things to work on, like concentration, etc, but they're things that will take longer (and more than just pills) to cure.

But I wanted to thank you all for your help and support. The hardest thing I had to do was decide to take the damn things. The arguments I had over that were... unpleasant. And now I wouldn't go back for the world. I'll keep everyone posted, obviously, but I basically wanted to let you know it's all good around here.

The Return Of Rothkoid

00:58 / 12.01.03

Did you find it made you sleepy? I've heard that's fairly common...

Tryphena Absent

01:03 / 12.01.03

Erm, I don't have anything to say here except

Suedey! SHOT FOR MEAT!

11:47 / 31.01.03

Just a quick query. If someone were to take a couple of these, and it made them feel all funny, is there any way they could counter those effects? Or do they just have to wait until it goes away... ?

18:05 / 31.01.03

Depends on the particular variety of "funny" but essentially no, the market isn't exactly awash with anti-antidepressants.

18:54 / 31.01.03

Well, there's alway Ingmar Bergman movies...

The Return Of Rothkoid

23:26 / 31.01.03

I stopped taking them, presumably because of the funniness you mean. I didn't like the fact that I tended to lose feeling in my fingertipe (like when one is drunk), as well as some other side-effects. I may go back, but I don't know - I felt distinctly at sea with them. Maybe it's about breaking through that wall, but... I don't know.

Maybe I'll just stick to my Bergmans.

23:36 / 31.01.03

How long did you take them for, Rothkoid?

01:46 / 01.02.03

I drink with my ad's and have always felt guilty, but it doesn't seem to really bother me at all, and am glad to have this thread's clarification. Paleface--I have anxiety attacks when I'm very stressed, and have used in addition to normal ad prescription (paxil for me) verrry sparingly, lorazepam, which is in the valium family. A cousin or something. (A good old family with nice connections to people in the suburbs.) Anyway, I like Lorazepam for occasional insomnia and panic--great for nights when brain won't shut off and the world grows large and menacing around me.

but it's addictive, so must be used with care. I used to like having a bottle in the cabinet--was like having access to a light-switch for my brain. I'm pretty much insomnia free now . . . haven't used any for a long while.

and love my tea and sympathy feeling therapist--she's a PsyD and well trained, but the best part was she's got an BFA in painting so she had me draw pictures for several weeks, which was great because I'm too tricksy and hidey with language, having a phd in literature. no one else seemed to figure out that just talking to me and getting me to talk simply wasn't going to get me to go into the messy regions--I was too good at intellectualizing, with language.

alas.

The Return Of Rothkoid

12:15 / 03.02.03

G: a bit over three weeks.

12:44 / 03.02.03

Rothkoid - there are other ADs that might be of more use to you - it took ages for my drs to find a combination that worked. It is worth trying and trying again until you find something that helps - my drs have admitted that it's pretty much a case of trial and error. I'd really strongly consider talking to 'em again, seeing if they can try you on something different. I never used to be a believer - seemed like everyone else had pills that worked but me - I went through 4 or 5 anti-depressants before they found a combination of two that made a difference. Now, with pills that do help - everything seem a lot more manageable. I'd almost certainly have taken an overdose sooner or later if this combination hadn't come along. I'm bloody grateful for my meds now...

It also sometimes takes the first few weeks for the side effects to fade...

Sorry I've not PMd you for a while - will write soon, I promise.

15:06 / 03.02.03

Mmm. Not sure three weeks is really long enough to tell whether or not they'll help: depending on your metabolism, it can take up to four, five weeks for side-effects to diminish and beneficial effects to manifest themselves.

Like Cholister, I'd say it's worth persevering with antidepressants - as long as they're not all one's depending on to help one's situation...

Goodness Gracious Meme

15:29 / 03.02.03

I'd third that. I've used mine as a crutch to get me into other stuff. And I'm not ashamed of that. You'd use a physical crutch to support a broken leg while you were learning to walk on it/strengthen it again, wouldn't you?

and defintely want to repeat G's point about anti-deps to be used *in conjunction* with other treatment/work... they don't attack the causes... in my case, I view it as the antideps give me a little extra push to do the things taht I want to do: counnselling, study (eg I know that two years ago, i wouldn't have got through the door of any college class without them, and becasue of taking them, managed to start a counselling class that changed my life.), social stuff, circus... etc...

and a couple of years down the track there are big changes going on, which are exhiliarting but scary. and the antideps give me a little extra support to cope with this, and with a difficult few months...

Oh, and Paleface, that's wonderful. Well done you.

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