Coming off drugs – does Citalopram help?

I’ve taken Citalopram for the last year and a half.  I’m not sure if it helped or not. I did get better, but I was trying other things too, so it is difficult to know.  I definitely did notice some side-effects: stomach upset when I started the meds and interference with my sex life – which could in itself be depressing – thank goodness I have an understanding husband!

Anyhow, I’ve decided to come off the Citalopram and visited my GP who agreed.  It sounds quite simple.  I’m taking 20 mg daily. I am going to cut this down to 10 mg for a month, then 10 mg every other day for two weeks.  I am also going to keep a daily log of my mood, so that I can see what is ‘normal’ for me and if there are any changes.  That’s it.

Coming off the medication is a bit scary in case I get ill again.  I also made the mistake of looking up the spelling off Citalopram in Google and finding a lot of posts from other blogs about it being difficult to come off.

I also think it will be interesting to see if Citalopram worked or what difference it’s made to me. It is the same family of meds as Prozac (an SSRI) and they are often described as ‘happy pills’.  I didn’t notice any instant happiness, so maybe I’ll just give up and all will be well?

Here’s my first log:  I feel a bit under the weather with a cough and I’m tired because of being ‘entertainment secretary’ for my 4-year-old during our holidays! My happiness/confidence level at 80 percent.  Anxiety at 7 percent.  Mood 90 percent good.  This is using my own subjective HAM index (Happiness, Anxiety, Mood)!  If you’re giving up the meds to do let me know how you’re getting on.

Anxiety reduction success

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I started this website in October 2010 and have beat debilitating worry! I’m now working on maintaining health – an up and down process.  This website is for you if you are looking to beat worry.  There are two ways you can use the information here…

1. Browse for thoughts about conquering worry and anxiety (help yourself).
2. Post some of your ideas about things that help you beat worry.  There are an average of 2000 visitors to this site per month, so if you do post something you will be helping others and that might be a bonus for your self-esteem.

I am hoping to find some guest bloggers, who are experiencing any form of anxiety and would like to write about your experience of recovery.  If you would like to be a guest blogger please contact me.

Keeping up the progress with beating anxiety

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One of the subjects in my last therapy session  was maintaining progress.  As with much CBT there was a form is a form to fill in and I thought it would be good to include it here.  I’ve written in to myself as ‘you’ for future reference, but as ever, nothing I write here is advice, it’s just thoughts that help me.   If you have other things that help you maintain progress do add your thoughts too…

What have you learned?

1. You can tolerate uncertainty (really you can!).
2. Feelings of sadness and fear can be useful.  You can experience these feelings (though may be difficult) and think of them as helping you or alerting you to things you need to know.
3. If strong feelings or uncertainty are whizzing round your mind you can choose a good time to think about things.  It helps to put a time limit on how long you think about contentious issues, then have a cup of tea and chocolate.
4. It is important to notice when you worry, because then you can choose to do something about it.  Two major forms of difficult-to-spot worry are: thinking about anything obsessively and doing lots of things at the same time (which is avoidance too).
5. Confidence is the opposite to worry, and the more you flex your confidence muscle the more it strengths.  This means making decisions yourself and not repeatedly asking for reassurance.
6. For most decision there are more than one solution, so most things are just decisions, neither perfect nor imperfect and that’s OK.
7. For some worries there is no solution, so there is no point analysing it, or thinking about it.
8. There are things called ‘appraisals’ in therapy-language, this means how you assess your situation, or what someone might have said.  If I’m feeling stressed about something it’s a good idea to step back and look at how I am appraising, or interpreting the situation.  Could it be that I’m jumping to conclusions?  Am I being a bit black and white in my thinking?
9. Use a three stage wise mind process when feeling c**p.  Firstly, write down feelings, then write down rational response (beware of ‘appraisals’.  Then think of the wise mind part of you (or ask God) for a kind response to both your feeling and rational self.  This is really good for me if I’m being hard on myself.

What was most useful?

1. Giving and receiving kindness to and from myself.
2. Flexing my confidence muscle.
3. Deciding to stop worrying and knowing I can.

What can I continue to do to prevent a setback? [Note language: prevent ‘setback’ not relapse/meltdown/disaster/collapse/irreversible mistake]

Be conscious that worry is bound to be around sometimes and challenge your behaviour. If you’re starting think in some unhelpful patterns, look after yourself.  Flex your confidence muscle and watch out for asking for excessive reassurance, which erodes confidence.

What are my high risk situations for a setback?

Life changing decisions to do with my daughter, my work or my husbands work, like changing jobs, moving and change in schools. If I have a conversation in which I challenge someone, or the challenge me about something I really care about this can also be a trigger.

What are the signs?

The most obvious behaviour, that I find difficult to believe is when doing it is overworking, or doing lots of things at once for a sustained period of time.  The feelings that are triggers tend to be fear of being threatened/rejected and intense sadness.  The thoughts that are triggers are: ‘You must do x,y,z right now, or else it will never get done.’ ‘See you aren’t really better’,’ You’ll probably always get depression and anxiety’.

What can I do to avoid losing control?

Firstly, to be vigilant for any of the triggers, particularly a feeling of great urgency to do lots of things.  Secondly, to be kind to myself when I’m sad. When I do have some difficult feelings or thoughts, then it’s really important to take the time I need to think and to make sure that I don’t avoid the difficulty.  A further thing I can do is to make sure I have unstructured time to just do what every I fancy, not at job, or an achievement, because my life sometimes gets overrun by striving for achievement.

If I feel sad then it often helps to talk things through, or spend time writing down how I feel.

What could I do if I did loose control?

Tell my husband and/a close friend.  Stop any overwork.  Mistrust any ‘rules’ of things that I ‘must’ or ‘ought’ to do.  Be outside.  Be kind to myself and other people.  Remember that I’ve been low before and come through and I will turn the corner again. Go back to the CBT, check appraisals.

If things were really bad I’d go back to the doctor too.  I am still taking medication too and want to build up a bit more resilience before I come of it.

Leaving therapy; sad, but pleased too

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A simple question, can you really beat anxiety and worry?  For me the answer is yes and no (a true Anglican).  Yes, you can be free from constant worry, but no you can’t be worry free, because that wouldn’t be human. I’ve been reflecting my progress in ‘beating worry’ because I’ve just finished therapy.

I think it’s helpful to acknowledge that leaving therapy can be difficult, personally I feel quite sad about it.  I really liked my therapist and would of been happy popping along to see him on a regular basis just because he is kind. Let’s face it, it’s wonderful to be listened to by a great listener!  I even think this would have been good for me. It felt like a friendship and friendships are good.

Part of my feelings are sadness, others fear: ‘Will I be able to sustain the progress I’ve made? How will I cope if things go pear-shaped and I start worrying my socks off again? Am I better?  What is ‘better’ anyway? Have I really finished therapy? Wouldn’t it be better to polish my psyche a little more?’ It’s all very uncertain, ek, that sounds like worry!

I do also know that it is time to move on from therapy.  There is a bit of me that is triumphant about having embraced the help on offer and having made changes that have really changed my life for the better.  So, I’m pleased to be moving on.  And true to form, the therapist had thought of all this and gave me a chart to fill in, in a rather clinical document called ‘Maintaining Progress‘. I’ll blog about that next…  The point is though, that leaving therapy is a helpful part of the therapy.

How to reduce fear and anxiety

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When I’m anxious it’s usually because I fear that I will be unable to cope with certain situations. It seems reasonable that if things are frightening it is sometimes better not to think about them! For example, I am currently avoiding thinking about my personal email, because I need to make some decisions which may involve saying ‘no’ to people who’ve asked me to help with things that I may not want to do.  I fear their response and my ability to handle the situation diplomatically, so I am avoiding my email.

This kind of avoidance is what my therapist called ‘cognitive avoidance’  Which I translate to mean avoiding thinking about things that cause uncomfortable feelings.  The trouble with avoiding thinking about these emails is that it perpetuates my belief that I can’t decide or handle the decision well.  So one of the challenges for me is to break down decisions into logical steps, take some decisions and learn something from the consequence.

The tricky thing is, that the only way to discover that I can answer my emails and can politely say no, can make mistakes and that’s OK, is to get on and do it.  And every time I just do something that results in difficult feelings and survive my confidence grows.  So bit by bit I am growing in confidence and reducing anxiety.

Incidentally, I started writing this email a couple of days ago. Since then I did indeed say I couldn’t make some things people had asked me to do, without making excuses.  They didn’t mind a bit!

Breaking free from worry

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Worry became a habit, something that I did without thinking and seemed normal.   On the one hand I wanted to be more calm, on the other hand, I was held back by beliefs that most of my worry was actually beneficial.    I thought that if I worried I had the edge at work because I tended to spot problems before the occur and so was more successful than I would otherwise be.  Further more, I believed that worry helped motivate me – that I’d probably just stay in bed all day if I didn’t worry because deep down I was lazy.

The trouble is even if there are some benefits to worry, the downsides of fear, loss of confidence and exhaustion outweigh them.  For example if it is true that worry helps motivate me, then it would follow that the more worry the more motivation!  Yet in practice worry and over analysing led to difficulty with decision-making and decreased my confidence, which often left me less motivated.

So the next stage of therapy was to challenge these so-called ‘positive beliefs about worry’.  It stand to reason that real change can’t occur if deep down we belief that worry is helpful.  Here is one of the beliefs that I challenged:

‘You have to finish all chores before you can relax and enjoy yourself.’ The problem with this belief, was that the chores are never finished.  So I was in a permanent state of exhaustion.  I set up some ‘experiments’ for myself leaving the chores half-done and worked through my beliefs that leaving things half-done would lead to a ‘mountain’ of things to do the next day, that would be insurmountable.  And that I would not be able to cope.

Truth is, of course, that it doesn’t matter if some things aren’t done.  That no disaster did befall me or my family because the washing didn’t get done.  It is now a few months since I did this ‘experiment’ and the house is definitely less tidy, but since I have a three-year-old that’s not surprising.  I’m learning to do the things that matter most and do what I can of the chores round the edges.

I still have to look out for those pesky beliefs that things will be better if I over analyse or worry, but I can honestly say that the worry has subsided.  I now have lots more time on my hands now that I worry less and have started back at dancing lessons and never found them more enjoyable.

Responding to feelings in new ways

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I have real problems with negative feelings, like anger, fear and sadness.  One of the things I found useful has been learning about ‘Emotionally Driven Behaviour’; that is ‘actions we tend to take in response to intense emotions…if we habitually act in ways that ultimately allow us to escape our emotions, these emotionally driven behaviours are not helpful…[and] are emotional avoidance strategies.’ (CBT leaflet, unreferenced).

Here’s  a recent example of a stew I got into: My husband recently changed his job and spends more time away from home, so we will need to make some changes.  My reaction was to plan a new routine for myself, which seems healthy enough. Accept that my ‘routine’ meant that I had no time to myself from dawn to dusk.  Gradually I also gathered some subtle beliefs that I had to do all the washing, ironing, housework, cooking as well as work, before resting. The result: I quickly became exhausted and overworked.

I now conclude that all my busyness, (excessive tidying and organising) is an emotionally driven behaviour; a way of avoiding some of my fear that I might not be able to cope with my husband away more of the time.  The result of this emotionally driven behaviour is that I now am frightened and exhausted.  A better strategy is to ease up on the organisation (live with a bit of mess) face my fear and to spend time on things that sooth me (gardening, jogging, listening to the radio, resting and praying/meditation).

This all sounds easy, but the patterns of worry and avoidance are subtle and almost automatic so it takes perseverance to track them down – it’s going to take some more practice…

Reducing Depression with Kindness

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What do you think is the opposite of depression?  Perhaps happiness or liveliness? Or maybe kindness? I’ve recently found that kindness has really helped to lift my mood. This is probably because I sometimes have thoughts that are quite harsh accusations, for example: ‘I’ll never get better’, or ‘I’m always making mistakes’.  Today I had some pretty depressing thoughts because I was trying to make decisions about my daughters schooling, which is an emotive subject for me.  I was disappointed because despite the medication and treatment I knew I was slipping back into old patterns of over analysing and worrying.  What seemed to help was kindness and an idea from cognitive behavioural therapy about Wise Mind.   The concept seemed a bit corny at first, but the it really helps me.  Here’s the theory…

Wise Mind (Linehan 1993) is the part of our mind where ‘Emotion Mind’ (thoughts based on distressing feelings) and ‘Reasonable Mind’ (rational thoughts) merge together. Wise Mind helps us make sense of our thoughts and feelings, and come up with a balanced and wise response, so that the needs of both Reasonable Mind (what I should do) and Emotion Mind (what I want to do) are met (Yes, Reasonable Mind is right, but Emotional Mind needs to be soothed…). Usually quietly calm, it’s that wise inner part of us that just ‘knows’ what is true or valid. Carol Vivyan 2010

For my own use, I’ve translated it in to Kind Mind, or to use in prayer as listening to God. First, I stopped, got my pen and paper out wrote down my feelings (depressed) and my thoughts (‘I’m worrying just as much as ever, despite all the therapy and over analysing the decision about my daughter’s schooling.’)

I then had a coffee, chocolate and sat in the garden, which is additional to recommendations of the Wise Mind theory, but it works for me!  I then searched for my rational mind which said ‘OK, so you over-analysed.  But it is a difficult decision to make and you still made some progress with the decision.’  Then after more chocolate and some prayer I had a look for my Kind Mind which said, ‘You are still learning to be well and it doesn’t matter if you make mistakes.  Situations about your daughter’s care are those which are most tricky for you, so no wonder you found this difficult.  In your heart you know what you think’s best for her, so trust your instincts.’

And as if by magic the depression lifted – truly.  I have to say though, that it took some discipline and hard work to stop and look after myself. It also seems a bit artificial  and clunky.  But I’m assured by my therapist that with practice thinking in ways to sooth the depression becomes more automatic.

Making an ACE Recovery from Depression

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My treatment switched from anxiety to recovering from depression for a couple of weeks.  One of the things that helped was to complete an activity diary and record my activity in terms of Achievement, Closeness and Enjoyment.  I identified each activity – for example watching telly with my husband whilst having an cuddle and chocolate and scored it our of 10 for achievement (0), closeness (10) and enjoyment (10).  The idea is to appreciate which activities are the most useful and to do more of them.  I made a surprise discovery that one of the things I most enjoyed doing at that time was the aforementioned cuddle watching telly (with chocolate)!  Before this exercise I had thought (rather harshly) that all TV watching was a waste of time because it didn’t achieve anything – how wrong could I be!

Climbing out of depression and darkness

Time for a progress update.  I started learning to beat worry in September 2010 and am writing this in May 2011.  March and April have been  really difficult months for me because I:

• over-did the therapy in effort to get better, and disagreed with my therapist, but wasn’t able to tell him
• was facing my fear of being well, sounds strange doesn’t it that the thing I most want is also that which is most scary.
• was realizing  that cognitive behavioural therapy is a helpful tool, but it is not the thing that will make me better, and that’s OK.

It has been a time of darkness, but things have turned round since then and left me with a backlog of helpful things to write-up, so watch this space!