Hi, I had posted this info a few years ago on the previous site but can't find that post anymore. I had tried to quit at that point but the side effects made me go back to my previous dose. I also wanted to wait until the warmer weather.

I started taking citalopram around 2011 for GAD. never prescribed for any sort of depression, which I did not and do not have. Maybe 7-8 years ago I tried to quit how my doctor suggested a taper, and had pretty bad SSRI withdrawal syndrome. Extremely dark thoughts. After going back on a higher dosage this resolved quickly. Last year, I tried tapering (starting at my current dose of 20 mg) using liquid and it did not go well. I went back to 20 mg but it took me a few weeks before I felt normal agai. Unfortunately I don't remember the details of the exact taper or schedule.

Unfortunately Outro Health is not available in my state, and I have no idea if it will be soon. I'm interested in trying again and I already downloaded the calculator. Instead of liquid, which I had a very hard time doing with precision (and requires quite a lot of refills), I was wondering about using a pill crusher (already purchased) and a milligram scale (do not have yet). I can't really project with the cutting calculator yet as I don't have the scale to weigh the 20 mg pill, though if anyone knows that value please let me know. Otherwise, would using a milligram scale with the crusher be a good plan? If for example I did a 7.5% reduction, I would get to 1.0 mg at the 40th period, which I could do as 1-2 weeks each.

Oh, the reason I mainly want to stop, besides seeing if I really need the med or not after all this time, is these drugs cause pupil dilation. Since I had LASIK, this results in some visual issues (minor) like starbursts as the larger pupil is hitting the lasik flap more often (learned this from a neuro-ophthalmologist).

Thank you.

Edited May 3May 3 by scj1236
add last paragraph

Hi @scj1236

Welcome to the forum!

 

This is a volunteer-run, community forum aimed at helping those who are tapering and/or experiencing difficulties with psychiatric medications and withdrawl syndrome. We are not medical professionals and cannot offer medical advice. We simply offer support and opinions which you could use as talking points with a medical provider knowledgeable in withdrawing off psychiatric medications.

 

Please familiarise yourself with the forum rules and the disclaimer located here: Guidelines

 

Please make sure your signature is kept up to date with your drug history. This will allow members to see some basic information about your drug history and situation so that they may help you best. Information on how to do this is located in the FAQs section above, but here is a direct link: Update Signature

Once this is done, future posts made by you will have this signature turned on by default. For this reason please keep it clear but condensed as possible.

Please use the format outline here Preferred signature/drug history format

6 hours ago, scj1236 said:

I had posted this info a few years ago on the previous site but can't find that post anymore.

Its great that you found us! You are most welcome here.

 

6 hours ago, scj1236 said:

I started taking citalopram around 2011 for GAD. never prescribed for any sort of depression, which I did not and do not have. Maybe 7-8 years ago I tried to quit how my doctor suggested a taper, and had pretty bad SSRI withdrawal syndrome. Extremely dark thoughts. After going back on a higher dosage this resolved quickly. Last year, I tried tapering (starting at my current dose of 20 mg) using liquid and it did not go well. I went back to 20 mg but it took me a few weeks before I felt normal agai. Unfortunately I don't remember the details of the exact taper or schedule.

Very common, we all have busy lifes, I think this complexity leads to our brains natural flight or fight mechanism being engaged, its very normal in modern life to feel anxious at times. What I and many others have learned, is that there are ways to deal with anxiety and the causes of it, so as to avoid needing drug intervention, which we find often leads to harms far worse than the orginal anxiety itself.

Your first taper was no doubt too fast, doctors often don't know just how slow you need to go, especially after long term use. A failed 'too fast' taper, can bruise the nervous system leaving it more sensitive to further tapering attempts. You say you are not sure what rate your second taper attempt was? I assume is was 10%, as you had found SA? When you said it was a liquid, was it a manufactured liquid? Or was it a liquid you made yourself from your pill? Did you crossover to the liquid first? It is often seen a hard switch from one format to another is itself destabilising.

6 hours ago, scj1236 said:

Unfortunately Outro Health is not available in my state, and I have no idea if it will be soon. I'm interested in trying again and I already downloaded the calculator. Instead of liquid, which I had a very hard time doing with precision (and requires quite a lot of refills), I was wondering about using a pill crusher (already purchased) and a milligram scale (do not have yet). I can't really project with the cutting calculator yet as I don't have the scale to weigh the 20 mg pill, though if anyone knows that value please let me know. Otherwise, would using a milligram scale with the crusher be a good plan? If for example I did a 7.5% reduction, I would get to 1.0 mg at the 40th period, which I could do as 1-2 weeks each.

It is a shame Outro isn't available in your state, however no problems as we can help you here.

There are basically two options with tapering a pill. You can cut it and weigh it on a set of jewelers scales, many use the Gem-20, or you can make your own liquid from your pill and some water.

Either is fine. Liquid is certainly the better route once you get to the lower does. But weighing and cutting your pill is perfectly fine, and many do this for most of their taper. We can help you with either. Just let us know which you would like to do.

Here is our topic on the subject, but if you want help with the process or have questions we are here. Preparing Doses for Tapering - Weighing & DIY Liquids

Once you have decided on a liquid or cutting/weighing route, we can talk about the actual taper itself.

I would personally suggest you micro taper from here. What rate is going to be based on you and how fast or slow you want to go. 10% is the max per month we would suggest of your previous dose, but perhaps you need to go slower 8% or 5% even. A micro taper just means, rather than make that cut at the start of the month and hold it for the next 30 days, you make a small cut each day.

How fast you go depends mainly on you, listening to your body is key, there is no set mathmatical taper schedule that works, people often have to hold and adjust on the way down, depending on how things go for them. Slow and steady is the new fast!

Here are some topics you may like to read to help you make this decision, but again we can help you if you would like, and feel free to ask questions.

Tapering Information

Micro Tapering

In the mean time this is what I would do if I were you:

 

-Stay Hydrated 

 

-Eat a good clean whole food diet, avoiding processed foods and sugars.

 

-Stay away from caffeine, alcohol and antihistamines and any other psychoactive substances.

 

Supplements are to be avoided initially, as they often irritate our nervous systems. Try to get your nutrition through food.

 

Down the line, you may wish to introduce Fish Oil and Magnesium. Those who can tolerate them have found them calming to the nervous system. Be careful try one at a time and start low and see how you get on should you choose to try them.

 

A daily walk is very important as much as you can manage, if you can manage it. Gets you your fresh air and Vitamin D does wonders for your mind!

 

You are very welcome here and I hope you find the site supportive.

Chippy

Welcome to the forum.

@Chippy has already provided you links to various tapering guides to have a read through.

7 hours ago, scj1236 said:

I can't really project with the cutting calculator yet as I don't have the scale to weigh the 20 mg pill, though if anyone knows that value please let me know.

It's going to vary by manufacturer, batch changes and so on. I wouldn't take a provided figure as accurate for this purpose.

I know you don't recall the specifics of your exact tapering schedule and doses from previous attempts, but do the ones described in guides here seem slower? ie. No more than 10% a month, which means smaller and smaller drops moving forward? Or the microtapering approach?

It would be good to think about this just to see if you are going more slowly than previous attempts if you are considering following one.

39 minutes ago, Luke said:

I wouldn't take a provided figure as accurate for this purpose.

@scj1236 I wouldn't worry about the cutting calc yet. We can help you use it should that even be necessary.

Thank you for the helpful replies. The liquid was something prescribed and it came with a dosing cup. I believe I used a combination of a pill plus liquid, i.e. if I wanted 14, half a 20 mg pill and then 4 mg liquid. But again I don't remember the details, except that it made me feel quite "dark" for several weeks. I think since then i've been really paranoid about trying again because of how scary it is. It also makes me want to avoid the liquid form, hence the pill crusher. I'm someone that has complex PTSD, though I've been recovering from that for over a year now and continue to have therapy. I also wanted to wait until the warmer months - I don't have SAD but my mood is still better in the spring vs. winter.

I do not use caffeine or any other drugs. alcohol rarely. I do take vitamin and mineral supplements but that's required for my recovery from a severe B12 deficiency (which I take injections for). From what I remember from the previous forum, once people get below 1 mg they just quit? Perhaps because it's just too hard to be so precise at that point.

I assume this scale would work https://awscales.com/gemini-20-precision-milligram-scale/

2 hours ago, scj1236 said:

Thank you for the helpful replies.

My pleasure

2 hours ago, scj1236 said:

The liquid was something prescribed and it came with a dosing cup. I believe I used a combination of a pill plus liquid, i.e. if I wanted 14, half a 20 mg pill and then 4 mg liquid. But again I don't remember the details, except that it made me feel quite "dark" for several weeks. I think since then i've been really paranoid about trying again because of how scary it is. It also makes me want to avoid the liquid form, hence the pill crusher.

Ok, yes that is a manufactuered liquid. So you did part pill part liquid. Im not sure the liquid was the issue here as you mainly took the pill. I think it more likely the taper was too quick, plus you were cutting the tablet portion without a scale which would have been inaccurate.

2 hours ago, scj1236 said:

But again I don't remember the details, except that it made me feel quite "dark" for several weeks. I think since then i've been really paranoid about trying again because of how scary it is. It also makes me want to avoid the liquid form, hence the pill crusher. I'm someone that has complex PTSD, though I've been recovering from that for over a year now and continue to have therapy. I also wanted to wait until the warmer months - I don't have SAD but my mood is still better in the spring vs. winter.

I understand, it must have been really tough for you. This time we will help you do this more carefully and accurately so you to not have the same issues.

I think we all feel better in the summer months. :)

2 hours ago, scj1236 said:

do not use caffeine or any other drugs. alcohol rarely.

Good, I would not use alcohol at all from now onwards, it is simply just not worth it.

2 hours ago, scj1236 said:

I do take vitamin and mineral supplements but that's required for my recovery from a severe B12 deficiency (which I take injections for).

If you tolerate these ok, then this is fine.

2 hours ago, scj1236 said:

From what I remember from the previous forum, once people get below 1 mg they just quit? Perhaps because it's just too hard to be so precise at that point.

No this is not the case, some do, but that isn't a good move or advised and they often have issues after stopping. The lower we go the more potent the drug is mg for mg and so we must be very careful indeed at that last 1mg, jumping off at this point is NOT advised!

2 hours ago, scj1236 said:

I assume this scale would work https://awscales.com/gemini-20-precision-milligram-scale/

Yes this is the scales, they are what alot of people use. Or if you want we can give you a list of things to get to make up a liquid? It may be easier for you to start on the scales and then switch to liquid when the scales are no longer precise enough.

How are things for you symptoms wise at the moment?

Chippy

yes, it was rx citaloprogram 10 mg / 5 ml liquid

I'm doing fine mentally, but I've been on 20 mg since last fall. When I first tried to quit, I went from 20 to 10, 10 to 5, and at that time did not have any issues (though I know I should not do this). it was really below this where things got problematic. I will update this thread when/if I decide to start the taper. thanks.

10 minutes ago, scj1236 said:

yes, it was rx citaloprogram 10 mg / 5 ml liquid

I'm doing fine mentally, but I've been on 20 mg since last fall. When I first tried to quit, I went from 20 to 10, 10 to 5, and at that time did not have any issues (though I know I should not do this). it was really below this where things got problematic. I will update this thread when/if I decide to start the taper. thanks.

Thanks for the update. It’s really common to have issues on the lower doses due to the hyperbolic relationship the drug has with the effect on the brain. Certainly those last 5mg need to take very cautiously.

We are here if you need us and would be happy to help.

Question about using a crusher to make it into a powder - do you actually have to put this in capsules? can't i just swallow the powder with water, or maybe mix it with water?

6 minutes ago, scj1236 said:

Question about using a crusher to make it into a powder - do you actually have to put this in capsules? can't i just swallow the powder with water, or maybe mix it with water?

You don’t need to crush the tablet. You can just remove enough from the tablet to get it to the correct weight with a file or blade.

If you want to mix it with water this is fine but you should crossover to a water suspension before taking the dose in this way. You would be better off suspending a whole pill in water and making the reduction using a syringe.

I can talk you through either option if you need.

Hi, I have got some razorblades for pill cutting and will receive my milligram scale tomorrow. I will weigh several of the 20 mg pills to get an average weight, then use that to translate to mg equivalent.

I was thinking about starting with 5% reduction each week. Since I'm at 20 mg, this would be

19.0, 18.05, 17.15, 16.29, etc.

I could also try something like 1% per day, i.e. 19.8, 19.602, 19.41, 19.21, 19.02, etc.

Not sure which one would be better. Any thoughts? Right now my goal is just to get to 10 mg.

Edited June 8Jun 8 by scj1236

8 hours ago, scj1236 said:

Hi, I have got some razorblades for pill cutting and will receive my milligram scale tomorrow. I will weigh several of the 20 mg pills to get an average weight, then use that to translate to mg equivalent.

Excellent news.

8 hours ago, scj1236 said:

I was thinking about starting with 5% reduction each week. Since I'm at 20 mg, this would be

Your maths is correct, but 5% every week is too fast. We suggest a max of 10% per month. That is also often a bit quick for those with sensitive nervous systems. Generally as you go lower you need to go slower.

8 hours ago, scj1236 said:

I could also try something like 1% per day, i.e. 19.8, 19.602, 19.41, 19.21, 19.02, etc.

You can cut more regularly but no more than 10% per month and this is as I said above often too quick.

You can do something called a brass monkey slide which is explained in this topic if you want to cut more frequently, or a 1/30 Micro Taper which is also explained in this topic. Micro Tapering

Every Taper technique works on a MAX of 10% per month. Micro tapering is often a good way to go, but it is good to put some holds in here and there to help settle things down once in a while.

8 hours ago, scj1236 said:

Not sure which one would be better. Any thoughts? Right now my goal is just to get to 10 mg.

I think 5% reduction is a reasonable thing to try if you are nice and stable. Why not start with a Brass Monkey Slide after 5%.

1.25% First Week

1.25% Second Week

1.25% Third Week

1.25% Forth Week (Total 5%)

Hold for Two weeks

You can always pause after your first week and see how you feel before moving to week 2.

It is much better to be stable and tapering then in pwd. Don't rush off!

Can I ask you if you have any symptoms at the moment and how you would rate them out of 10, 10 being the worst you could imagine and 1 being mild?

thanks. yes i can try the BM one. that would be for the first four weeks, 19.75 mg, 19.5 mg, 19.25 mg, 19 mg and then hold

i am going to do a bit of traveling in july. the razor blades I have do come in a package but I'm not sure if that's allowed on a plane. so I will cut up the doses in advance and put them in a daily pill container. My main concern is that doing precise cutting off a pill every day for such a long time will drive me insane. Also how can you possibly cut a pill to get a precision of in some cases, 0.0001 grams?

Symptoms I would say mild to none, if by that you mean symptoms I associate with SSRI withdrawal.

Edited June 9Jun 9 by scj1236

14 minutes ago, scj1236 said:

thanks. yes i can try the BM one. that would be for the first four weeks, 19.75 mg, 19.5 mg, 19.25 mg, 19 mg and then hold

Sounds like a good plan.

14 minutes ago, scj1236 said:

My main concern is that doing precise cutting off a pill every day for such a long time will drive me insane.

I think most batch them out to save the tedious job every day!

15 minutes ago, scj1236 said:

Also how can you possibly cut a pill to get a precision of in some cases, 0.0001 grams?

When you get to a certain dose you’ll likely need to switch to a liquid taper. Dry cutting is fine till it becomes too tricky! You’ll know when it’s time.

15 minutes ago, scj1236 said:

Symptoms I would say mild to none, if by that you mean symptoms I associate with SSRI withdrawal.

Perfect.

I have the scale now and calibrated it. after five weighings I have an average of 0.128 g / 20 mg pill. So I can use this to calculate the weight for my exact dosage. I stil lhave some of the liquid as well, and this expires in September so I was going to do a combination of pill + liquid (I felt like switching to just liquid was a bit probelmatic for me when I tried it before). The liquid form I have is 10 mg / 5ml or 0.5 mg / ml. So if for example I start with 10% reduction rate per month, the first day would be 19.9333 mg. This could be 0.1276 grams of the pill, 39.8667 ml of the liquid, or if I want to do half and half (worth trying?), 0.0638 g of the pill and 19.9333 ml of the liquid (which should weigh 0.0638 grams).

Also at what point should the liquid be mixed with water, and is the reason for that to make sure you don't have any residue that sticks to the cup?

Edited June 10Jun 10 by scj1236

oops correction to "19.9333 ml of the liquid (which should weigh 0.0638 grams)."

the liquid comes with a stopper that lets you extract it with a small syringe. the syringe weighs around 4.75 g. After filling up to 5 ml it weighs around 10.62 grams. So 5 mil, which is 2.5 mg of the medication, is 5.87 grams, meaning that 1 mg (2 ml) of liquid medication is around 2.35 grams in weight. So if for example I want 10 mg of liquid medication, the weight of the syringe with the medication inside (after taring off the syringe itself) should be 23.5 grams. sound good? this would also mean that i should wait until I'm at much lower doses to do liquid otherwise I will run out really fast.

Edited June 10Jun 10 by scj1236

last thing i'll add is that even with a 10% reduction over a month, the scale I got does not reach the precision needed.

https://awscales.com/gemini-20-precision-milligram-scale/

It goes out to three digits, but you would need to really go out to four to do the reduction in the taper calculator. the change in dose per day is around 0.0004, i.e. 0.1280, 0.1276, etc. the closest the scale gets is 0.128 then 0.127. and these changes will get even smaller at lower doses.

I tried cutting off the smallest bit i could from the 20 mg pill and the resulting weight was 0.125 g (full pill weight i'm using is 0.128 g). Even if I did have a scale that I went out to more digits, it would be literally impossible for me to cut to such incredible precision.

@scj1236 First things first. I would keep to just the pills if it were me. Mixing is fine but as you have experienced people can react to the switch. I'd make life more simple and just do one format. :)

3 hours ago, scj1236 said:

last thing i'll add is that even with a 10% reduction over a month, the scale I got does not reach the precision needed.

https://awscales.com/gemini-20-precision-milligram-scale/

It goes out to three digits, but you would need to really go out to four to do the reduction in the taper calculator. the change in dose per day is around 0.0004, i.e. 0.1280, 0.1276, etc. the closest the scale gets is 0.128 then 0.127. and these changes will get even smaller at lower doses.

I tried cutting off the smallest bit i could from the 20 mg pill and the resulting weight was 0.125 g (full pill weight i'm using is 0.128 g). Even if I did have a scale that I went out to more digits, it would be literally impossible for me to cut to such incredible precision.

If you want to Micro taper daily and the Pill Weight doesn't allow for that, you just need to work out what reduction is possible to weigh and then perhaps drop every 3 days for example or how ever that works out.

You can also switch to a DIY liquid made from a pill and taper as a liquid. This is a nice solution. You would need to switch over doing the crossover taper suggested in the DIY liquids guide on here first before reducing your dose. It is still good to have scales and shave each pill to the average before making up the solution.

Even if the scale went out that far, I'm honestly curious how anyway could cut a pill to such insane precision. the piece I cut off, which weighed around 0.001 is absolutely microscopic.

6 minutes ago, scj1236 said:

Even if the scale went out that far, I'm honestly curious how anyway could cut a pill to such insane precision. the piece I cut off, which weighed around 0.001 is absolutely microscopic.

All you can do it get a rough size piece that is around the size you need. Weigh it and use a razor blade or file to take a little off and keep weighing it till it’s right. The scales that go to 0.0000 are more used because the third digit after the decimal place is more reliable and flutter less than on the cheaper 0.000 units

who sells those? I thought AWS was a pretty solid brand, but even their most expensive units don't go out that far. I can't find any other brands that go that far either. And again if you have a piece below 0.001 that is absolutely insane in how tiny it is.

22 minutes ago, scj1236 said:

who sells those? I thought AWS was a pretty solid brand, but even their most expensive units don't go out that far. I can't find any other brands that go that far either. And again if you have a piece below 0.001 that is absolutely insane in how tiny it is.

As I said it’s not to measure that small really it’s just scales that go that low measure more accurately to 0.000

You’d be looking at lab grade scales running into the hundreds of dollars/pounds etc.

There is at least one example from memory in our diy cutting guide. Take a look, other wise a Google search but think much more expensive then the gem-20 type scales.

I'm realizing that the fact that my pills vary from maybe 0.124-0.130 means that I'm already used to a small change in actual dosage. I just need to get used to the in amounts. 0.125 to 0.119 seems very small, but that's a dose change of about 19.53 to 18.59 mg.

12 hours ago, scj1236 said:

I'm realizing that the fact that my pills vary from maybe 0.124-0.130 means that I'm already used to a small change in actual dosage.

Exactly, weighing your pill is way more precise than taking a whole pill. It is one of the reasons it is good to have scales even if you switch to a DIY liquid.

reducing by the smallest amount that I can manage to cut is causing my some withdrawal symptoms. it is typically lightheadedness. no idea you can remove such infinitessimal amounts. just removing 0.006 grams (super tiny) is a dose change of around 1 mg. maybe i should try my pill crusher? to get it into powder form.

and if you do have symptoms, do you just add enough to go back the last dose where you didn't?

Edited June 13Jun 13 by scj1236