Jump to content
CrazyBoards.org

Celexa lethargy? Sloth inertia...


Recommended Posts

I just started up on Celexa again for the 2nd time (was off all meds for a year). It's only been 3 days and I feel overwhelmingly lethargic & apathetic all of the sudden. Up until now, my energy has been normal/decent and the last 2 days, all I can do at around 1pm-2pm is go back to bed and lay there for 2-3 hours. I am not sedated and i do not sleep - it's like my body is a bowling ball and I get caught into an incredible vortex of inertia and i cannot get up!! I'm a total sloth.

I am only on 20mg (but now I'm on Lamictal also). Previously, I had gone up to 40mg on Celexa then 60mg and felt this way, but I don't recall feeling this way at only 20mg. Will this go away? I know it's due to the med, because I'm also getting the yawning & dry mouth/throat side effect that is typical with SSRI's.

How long should I give it, before I scratch this medication? The apathy is a main feature of depression that I am trying to overcome.

Edited by cloudmonger
Link to comment
Share on other sites

Yes, apathy can be an effect of Celexa. But once it starts working for you, you'll feel good enough that you won't care that you are apathetic. I've always said that Celexa has made me apathetic about being apathetic. In my experience, this side effect does not go away. I would advise sticking with it, though, until it starts to work to see if things don't improve.

Link to comment
Share on other sites

33 minutes ago, jt07 said:

Celexa has made me apathetic about being apathetic. In my experience, this side effect does not go away.

oh my...that sounds like a bit of an oxymoron. I can see how this would be favorable if someone is really wired with restless anxiety....but I don't have this problem. I might need something more activating? I have things to do and cannot be dazed & bedridden 2-3 hours per day :-( I don't think i can concentrate on anything...feel sort of spacey.

Not sure how long to give it before deciding - 1 month? 2 months?

Edited by cloudmonger
Link to comment
Share on other sites

If I were you, I'd give it six weeks at your highest dose. The apathy might go away for you. 

I know you want something more activating, but I didn't find Celexa sedating at all. It just has that apathy side effect. I must admit, though, that adding Abilify to it really helped. 

Link to comment
Share on other sites

4 minutes ago, jt07 said:

If I were you, I'd give it six weeks at your highest dose. The apathy might go away for you. 

 I didn't find Celexa sedating at all. It just has that apathy side effect. I must admit, though, that adding Abilify to it really helped. 

I'll consider this and talk to my pdoc. I do recall when I was on it previously, the apathy was worse when I went to 40mg and above. I went down to 20mg and my pdoc put me on Ritalin which really helped give me a boost, then I ended up tapering off the Celexa completely which wasn't a problem.

I agree, the Celexa doesn't really feel "sedating" it's like this extreme lethargy, apathy (which I hate) BLAH and fuzzy haze. A bit flattened. Like nothing will move me. I lay down in bed and stare at the wall for hours - it's terrible. On the other hand, could be good for times I get irritated (sometimes) we shall see. i guess being in an I-don't-care-daze is better than crying everyday and ruminating with worrisome thoughts!

Link to comment
Share on other sites

I believe citalopram has the highest affinity for the H1 histamine receptors of all the SSRIs, and does bind to the muscarinic acetylcholine receptors (so may produce some antihistamine and anticholinergic effects).

If you decide to give another SSRI a try, a more stimulating one would be fluoxetine or sertraline would be better. An alternative would be an SNRI would be better, like venlafaxine ER, Pristiq, Fetzima (is that available where you live?), or duloxetine.

Link to comment
Share on other sites

4 hours ago, mikrw33 said:

I believe citalopram has the highest affinity for the H1 histamine receptors of all the SSRIs, and does bind to the muscarinic acetylcholine receptors (so may produce some antihistamine and anticholinergic effects).

If you decide to give another SSRI a try, a more stimulating one would be fluoxetine or sertraline would be better. An alternative would be an SNRI would be better, like venlafaxine ER, Pristiq, Fetzima (is that available where you live?), or duloxetine.

It's strange because when I was on Celexa a year ago, 20mg didn't make me feel this bad.....Plus, despite the lethargy/apathy all day, I am now unable to sleep soundly at night (not good!) I'm going to reduce the dose to 10mg and see if that helps. If not, I do not want to risk my amazing deep sleep that I've worked hard to achieve for a long time to go on a crappy SSRI again :-(

I've been on Zoloft (made me crazy psychotic insomniac within 3 days), Prozac/Fluoxetine (made me completely numb, an unemotional zombie), Cymbalta was ok for awhile and then it began to make me very agitated/angry and grind my teeth down every night - when I tried to go of I had a Hellish withdrawal), I don't even want to try Effexor again due to the short-half life and nightmare withdrawal syndrome.

I'm thinking SSRI's are really not for me....I don't  know if I can handle another go-around when I've already tried these years ago...I'm stable on the Lamictal, just need some sort of antidepressant action....Maybe I will continue to ask to be put  back on Ritalin, I was on that with no ill effects.

Edited by cloudmonger
Link to comment
Share on other sites

7 hours ago, cloudmonger said:

It's strange because when I was on Celexa a year ago, 20mg didn't make me feel this bad.....Plus, despite the lethargy/apathy all day, I am now unable to sleep soundly at night (not good!) I'm going to reduce the dose to 10mg and see if that helps. If not, I do not want to risk my amazing deep sleep that I've worked hard to achieve for a long time to go on a crappy SSRI again :-(

I've been on Zoloft (made me crazy psychotic insomniac within 3 days), Prozac/Fluoxetine (made me completely numb, an unemotional zombie), Cymbalta was ok for awhile and then it began to make me very agitated/angry and grind my teeth down every night - when I tried to go of I had a Hellish withdrawal), I don't even want to try Effexor again due to the short-half life and nightmare withdrawal syndrome.

I'm thinking SSRI's are really not for me....I don't  know if I can handle another go-around when I've already tried these years ago...I'm stable on the Lamictal, just need some sort of antidepressant action....Maybe I will continue to ask to be put  back on Ritalin, I was on that with no ill effects.

 

That's strange... 10 mg is too low of a dose to be pharmacologically active for citalopram due to the (R)-(+) enantiomer having actions that cancel out the SSRI actions of the (S)-(+) enantiomer (escitalopram).

Oh ok. Well, have you given thought to trying a tricyclic antidepressant (TCA)? Some of them can be actually somewhat stimulating (the secondary amines, mainly, like desipramine, protriptyline, and nortriptyline, especially in higher doses).

Link to comment
Share on other sites

33 minutes ago, mikrw33 said:

That's strange... 10 mg is too low of a dose to be pharmacologically active for citalopram due to the (R)-(+) enantiomer having actions that cancel out the SSRI actions of the (S)-(+) enantiomer (escitalopram).

Oh ok. Well, have you given thought to trying a tricyclic antidepressant (TCA)? Some of them can be actually somewhat stimulating (the secondary amines, mainly, like desipramine, protriptyline, and nortriptyline, especially in higher doses).

That is bizarre...So this means that the 10mg dose will probably do nothing?

I have tried 1 TCA (Pamelor, which I think is nortriptyline...)it was a long time ago and I really don't recall what kind of effect it had (if any)...Would you recommend trying another TCA before moving onto an MAOI? I think i read the old TCA's have a lot of heavier side effects...as far as sedation, weight gain etc

Link to comment
Share on other sites

7 hours ago, cloudmonger said:

That is bizarre...So this means that the 10mg dose will probably do nothing?

I have tried 1 TCA (Pamelor, which I think is nortriptyline...)it was a long time ago and I really don't recall what kind of effect it had (if any)...Would you recommend trying another TCA before moving onto an MAOI? I think i read the old TCA's have a lot of heavier side effects...as far as sedation, weight gain etc

 

Maybe... If not for the (R)-enantiomer canceling the effects of the (S)-enantiomer, then at least for the fact that at 10 mg, 65% of SERTs (serotonin transporters) are inhibited, and it's theorized that at least 80% inhibition is needed in order to be effective. At 20 mg, 70% of SERTs are inhibited. Citalopram has a relatively flat dose response curve, so 40 mg doesn't yield that much more SERT inhibition, nor does 60 mg—just side effects.

Yep, Pamelor = nortriptyline. Well, you could try another TCA. You don't have to follow any dietary restrictions, then again if I'm not mistaken, moclobemide is available where you live, which would be relatively easier to take than the irreversible MAOIs. Generally with the TCA's blood levels need to be checked to establish a therapeutic dose.

Drug - therapeutic range 
Amitriptyline (Elavil) - aim for 100-200 ng/mL but exact range poorly defined
Clomipramine (Anafranil) - range not yet defined
Desipramine (Norpramin) - aim for 50-150 ng/mL but exact range poorly defined
Doxepin (Sinequan) - range not yet defined
Imipramine (Tofranil) - aim for 150-300 ng/mL but exact range poorly defined
Maprotiline (Ludiomil) (tetracyclic) - range not yet defined
Nortriptyline (Pamelor) - aim for 50-150 ng/mL; well defined and accepted
Protriptyline (Vivactil) - (189-270 ng/mL?)
Trimipramine (Surmontil) - range not yet defined

Yes, some of the older ones are more sedating, that is the tertiary amines (amitriptyline, clomipramine, doxepin, imipramine, trimipramine), but trimipramine was actually one of the newer ones, and actually acts more like an antipsychotic than an antidepressant. The secondary amines (desipramine, nortriptyline, protriptyline) tend to be more stimulating to more people (but still may be somewhat sedating to some, not as much as the tertiary amines...). In fact, they may be stimulating so much so that they are used for ADHD and narcolepsy (mostly to eliminate cataplexy, though).

Receptor affinities that may moderate sedation as a side effect are H1 histamine, α1 adrenergic, and M1 muscarinic acetylcholine, for which they all antagonize these receptors. SERT and NET affinity (serotonin and norepinephrine transporters, respectively) may cancel out some sedation.
Ki values for the following receptors (the lower the number the tighter the binding to the receptor):
Drug: H1 histamine / α1 adrenergic / M1 muscarinic acetylcholine / SERT / NET
Amitriptyline: 1.1 nM / 24 nM / 12.9 nM / 3.13 nM / 22.4 nM (metabolie is nortriptyline)
Amoxapine (tetracyclic): 25 nM / 50 nM / 1000 nM / 58 nM / 16 nM
Clomipramine: 31.2 nM / 39 nM / 37 nM / 0.21 nM / 45.9 nM (metabolite is potent inhibitor of NET)
Desipramine: 100 nM / 110 nM / 196 nM / 17.6 nM / 0.83 nM
Doxepin: 0.24 nM / 23.5 nM / 38 nM / 68 nM / 29.5 nM
Imipramine: 37 nM / 32 nM / 46 nM / 1.4 nM / 37 nM (metabolite is desipramine)
Maprotiline: 1.7 nM / 91 nM / 560 nM / 5800 nM / 11.1 nM
Protriptyline: 60 nM / 130 nM / 25 nM / 19.6 nM / 1.41 nM
Trimipramine: 1.4 nM / 24 nM / 59 nM / 149 nM / 2450 nM
So you can tell that doxepin has the strongest antihistaminergic effects (sedation, weight gain), along with α1 antiadrenergic effects (orthostatic hypotension, sedation, weigh gain); amitriptyline has the strongest anticholinergic effecs (dry mouth, constipation, sedation); clomipramine has the strongest serotonin reuptake inhibition; and desipramine has the strongest norepinephrine reuptake inhibition.

Link to comment
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

 Share

×
×
  • Create New...