Catch 22 with SSRI

[Stickworm]

I’ve been on citalopram on and off since 2010. It really worked wonders for me for many years but the first 2-3 months taking them were hell - I couldn’t sleep, eat or work. Just unable to function at all. Once they did work it was like a cloud over my entire (anxious!) life lifted. However I reduced to the lowest dose when I became pregnant with my first child 6 years ago and have been on it ever since (now have 2 children). I’m on 10mg which isn’t even a therapeutic dose but when I try to come off it (I’ve tried for 6+ months before) the withdrawals are horrendous.

I’ve wanted to increase the dose for a long time to get back to feeling really good again (I’ve mostly been coasting for a few years) but when I try to increase, even by 5mg at a time, again the side effects are so bad I can’t function - it’s just not possible with small children and a full time job. As you can see I feel stuck not being able to come off them OR increase!

My question: is it worth trying to swap to a new SSRI that is more ‘sedative’ such as mirtazapine? Citalopram side effects had me pretty much fully awake for 2 weeks.

To note - I’ve had various different types of therapy over the years, it has helped a little but not fully.

IMO I'd try to find a way to address the side effects.
Reason - best advice is to use an anti-depressant that has worked well for you in the past. You've had good results from citalopram and are likely to get that again, and you're already halfway there as it were being on the 10mg.
Could you take some zopiclone for a short time to help with sleep and anxiety increase after citalopram dose increase?
Could you look into exercise etc to help burn the dose increase jitters etc?
My opinion is withdrawing from one you know works for you to start another will be more trouble and give you more side effects than increasing on you're on that you know works. Also the sedating ADs tend to have a much bigger knock on people's ability to work/function etc and for a longer time in my experience.
I think it's going to be addressing the SE of the citalopram dose increase that aren't tolerable to you that is the better course rather than switching all together. Worth a planned discussion with GP and maybe a very slow increase - 20mg a couple of times a week/every other day - slowly building it up possibly.
Good luck.

That is a really tough situation to be in. I think @Tooforsicksohjuan is spot on though. Coming off the one that has worked for you to then start on something new is just going to prolong the tough spell of side effects etc.

I am about two weeks in to a dose increase and am functioning much better the last few days. I have had a hellish 2 weeks, but starting to see the other side.

In my case though I had completely crashed into unable to function anyway, so the side effects from the dose increase were swallowed up in the general nightmare my life was anyway. So I appreciate you are struggling with the decision to put yourself through that if you are managing to struggle along as you are.

How old are your kids?

If you do decide to increase I would agree to speaking to you doctor about a more gradual increase as pp said.

Also agree with having strategy for the side effects like Zopiclone to get you somensleep. I have also had positive experience of diazapam and propranolol to help me just to basically function for the worst few.

My other suggestion would be to plan a time when you could have 2 weeks to just bite the bullet and go to 20mg, getting it over and done with. Arrange whatever would make it easier for you. A week or 2 weeks off work? Kids staying with grandparents for a few days? Partner (?) taking time off with work to pick up the slack?