Citalopram (Celexa) and tremors....need advice



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Horus
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13 Aug 2010, 3:15 pm

I am currently taking 60mg of Celexa for depression. I take a divided dose of 40mg when I wake up and 20mg about five hours later. Thus far, I personally haven't noticed ANY effects from this medication. This is hardly unusual for me since i've tried dozens of anti-depressants and NONE of them seem to have any effects either positive or negative.


My mother has said that i've been shaking/trembling more than usual however and I just haven't noticed this. According to the clinical trials i've read about Celexa, 8% of Celexa-treated patients reported tremors as oppsed to 6% of placebo control group. I have been shaking and trembling to some degree all my life as it is. Especially when i'm socially interacting with people or otherwise engaged in something which is stressful for me. I wonder if this medication has simply exacerbated my trembling and shaking. If so....is there any reason I should be concerned about this aside from a worsening in my trembling and shaking itself?

Other people noticed this too....but they also often tell me i'm "shaking like a leaf" when i'm NOT on any medication. It seems to be worse when I haven't eaten anything all day, but i'm not Hypoglycemic either. I recently had an A1C test and my average blood sugar level for the past two/three months was 5.5. New guidelines from the American Diabetes Association state that an A1C level of 5.7-6.4 indicate blood glucose levels in the prediabetic range. So I actually have to be careful about my sugar intake.


While blood glucose levels can fluctuate on a daily basis, i'm just not sure if my tremors/shaking has anything to do with that. Sometimes I don't eat anything for several hours after I wake up. I am always more depressed in the daytime hours and therefore find it difficult to muster a desire to eat anything during the day.


I always feel I have to make excuses for my tremors/shaking too. The whole reason I decided to post this is because some stranger just commented about them a few minutes ago. I was at Walgreen's picking up a few things and some older guy rode up to me on a bicycle asking me for change. He immediately noticed I was trembling because he said, "are you alright?....you're shaking like a leaf"! !! I told him I was fine and that I just haven't eaten anything all day. He then started to give me the usual hard-luck story panhandlers often give when asking for change and stuff. I just wanted him to go away and leave me alone so I quickly handed him a couple coins. He got back on his bike and again asked me if I was "sure I was alright". I said I was fine, wished him luck and he said "thanks alot, sorry to bother you" and rode away. I am not going to tell complete strangers that I have a neurological disorder known as Asperger's/NVLD and that this has much, if not everything, to do with the reason i'm shaking.


I can't stand shaking/trembling like this in public because it's the one thing that draws attention to me. While I don't make much eye contact or reciprocate smiles, those things aren't THAT uncommon even for NT's. Especially when you live in one of the largest metropolitan areas in the country (Miami/Ft Lauderdale.) People just aren't as friendly and open with strangers around here as they are in smaller towns. Nobody trusts one another down here (not entirely without reason either considering we don't exactly have the lowest crime rates in the country), so people just generally go about their business.

Panhandlers always make me nervous though. Enough of them are ex-cons (and even sex offenders 8O ) who can't find work, housing, etc...Therefore you never know what they're capable of and I always try to get them out of my presence ASAP. Even though I live in a pretty affluent neighborhood, there's tons of panhandlers around here and I get accosted by at least one nearly everytime I leave the house. For one thing, I live on the beach and panhandlers seem to be common in beach areas. For another....there's alot homeless people in South Florida in general since it's comparatively more pleasant to be homeless in place where the temperature rarely falls below 40 degrees fahrenheit.

Anyway.....i'm just wondering if this medication has excerbated my tremors/shaking or if has something to do with the fact that I often don't eat anything in the day. Maybe it's a combination of both, but all I can say is that I personally haven't noticed any increase in my shaking/trembling. It's something i've dealt with all my life, I can't remember a time when I didn't shake and tremble at all. I really don't want to shake/tremble more than I already do because again, it would be the only thing which would draw attention to me around here. I prefer being as "invisible" as possible in public and in general. Other people, including my mother, seem to be commenting on it alot more lately (even since i've been on Celexa), but I just can't be sure if Celexa truly has anything to do with it. My mother, at least, knows that i'm on this medication and therefore might EXPECT certain side effects like an increase in tremors. Considering i've been shaking all my life, maybe this is just her perception and it has nothing to do with the medication.



If any of you have taken Celexa...have you experienced tremors while on this medication? If you already shake/tremble often, did you or anyone else notice an increase in your tremors while taking Celexa?

If you are Dx-ed with Asperger's (and/or told you exhibit the common symptoms associated with the NLD syndrome) do you have problems with shaking/trembling?



nemorosa
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13 Aug 2010, 3:57 pm

Wow, 60mg sounds like a lot. I've been on 20mg of Citalopram for about 4 months now without any perceptible benefit. I did initially have some side effects but thankfully those have now ceased.

As to the shaking, I do have a slight trembling in my hands occasionally during social occasions, but more often than not this is due to tiredness or not eating enough, and then this then makes my whole body rather weak and shaky and I have to sit down for a few minutes to recover. I've not noticed any of this to be any worse whilst taking Citalopram.

I am self diagnosed with Aspergers and taking the Citalopram for depression.



Horus
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13 Aug 2010, 4:21 pm

nemorosa wrote:
Wow, 60mg sounds like a lot. I've been on 20mg of Citalopram for about 4 months now without any perceptible benefit. I did initially have some side effects but thankfully those have now ceased.

As to the shaking, I do have a slight trembling in my hands occasionally during social occasions, but more often than not this is due to tiredness or not eating enough, and then this then makes my whole body rather weak and shaky and I have to sit down for a few minutes to recover. I've not noticed any of this to be any worse whilst taking Citalopram.

I am self diagnosed with Aspergers and taking the Citalopram for depression.




AFAIK....60mg is the maximum dose. 60mg is not usually recommend, but some patients may require it. I have also heard 80mg is the maximum dose from some sources, but i'm not sure if they're reliable. I don't believe anyone else has noticed an increase in my trembling when I was on any other anti-depressant. I suppose i'll stay on this med for another month or so and if I notice no perceptible benefit (and/or if I experience any significant side effects) I will gradually go off it. I have tried so many anti-depressants at this point, I wouldn't even know what else to take.

My depression seems pretty treatment-resistant no matter what. Nothing seems to help, neither exercise, sunlight, nor medication at least. Alternative treatments like ECT and deep brain stimulation are currently beyond my means and of questionable efficacy anyway.



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13 Aug 2010, 4:22 pm

I've been taking citalopram (40 mg) for a couple of months now and I have also noticed in myself short bursts of trembling/shakiness which are uncharacteristic for me. They are very short lived bursts of trembling in my case.

I never before thought it could be the citalopram, I'll have to pay more attention to the phenomenon.


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Assembly
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13 Aug 2010, 4:58 pm

10 mg citalopram for 2 months, I'd benefit more from a higher dose as I still feel somewhat depressed but I've had side effects like tension and cramp in my legs,increased blood pressure and heart rythm as well as head aches.



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13 Aug 2010, 5:09 pm

I used to take 30 mg of Celexa, but when my doctor switched me from abilify to seroquel xr, he moved it down to 10 mg. I never have really had that many side effects with celexa, but I have a bunch of side effects with seroquel. That med makes me so tired.


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AardvarkGoodSwimmer
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13 Aug 2010, 5:12 pm

Horus wrote:
. . . I suppose i'll stay on this med for another month or so and if I notice no perceptible benefit (and/or if I experience any significant side effects) I will gradually go off it. . .

Good, good, I have heard that anti-depressants can have a rebound effect and it's important to come off them slowly. Now, it's always preferable to have a doctor you can at least halfway talk with, but sometimes in our current system, that ends up being kind of a luxury (when of course, it really shouldn't!). Sometimes a person ends up kind of stuck with a doctor who is mediocre at least, and might be just a terrible listener. Sometimes writing something on half a piece of paper and handing it to the doctor works, but sometimes even that doesn't work! I certainly am not a doctor myself, but it kind of seems to me that you could phase down to two-thirds a dose for a couple of days, watching your body and mood along the way, and if that works, phase down to a third of a dose for another couple of days, again watching your body and mood along the way, not obsessing about it, but just watching with easy confidence. That's certainly better than a person simply getting frustrated and stopping cold turkey, and for that reason, a phase down should probably be part of the conversation.

I struggle with depression on and off (probably not to the same extent you do, and I realize that). One thing, I have noticed and realized, I can be tired, cranky, need an afternoon nap, but I take it and wake up, or just half wake up, and it's brutal. I'm really depressed.

And sometimes I don't eat for several hours after waking up, too! Now, that one, sometimes kind of works.



Horus
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13 Aug 2010, 5:50 pm

Assembly wrote:
10 mg citalopram for 2 months, I'd benefit more from a higher dose as I still feel somewhat depressed but I've had side effects like tension and cramp in my legs,increased blood pressure and heart rythm as well as head aches.




Wow....that's a low dose. My psychiatrist started me out on 20mg after an unsuccessful (as usual ) trial with Cymbalta. I have noticed no other SE's aside from the increase in shaking/trembling which OTHER PEOPLE claim to noticed. Namely only my mother and this panhandler today. I don't have too much contact with other people right now beyond my mother and the public, who, aside from panhandlers, usually leaves me alone. Others have often commented on my shaking/trembling long before I was on any medication. I think much of it has to do with my Asperger's/NLD and possibly because I often don't eat anything until the early evening hours. The former I probably can do nothing about ofcourse and the latter is a bad habit I need to break. It's really hard to say it this medication has increased my trembling/shaking, but it's obviously possible that it has.



Horus
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13 Aug 2010, 6:01 pm

AardvarkGoodSwimmer wrote:
Horus wrote:
. . . I suppose i'll stay on this med for another month or so and if I notice no perceptible benefit (and/or if I experience any significant side effects) I will gradually go off it. . .

Good, good, I have heard that anti-depressants can have a rebound effect and it's important to come off them slowly. Now, it's always preferable to have a doctor you can at least halfway talk with, but sometimes in our current system, that ends up being kind of a luxury (when of course, it really shouldn't!). Sometimes a person ends up kind of stuck with a doctor who is mediocre at least, and might be just a terrible listener. Sometimes writing something on half a piece of paper and handing it to the doctor works, but sometimes even that doesn't work! I certainly am not a doctor myself, but it kind of seems to me that you could phase down to two-thirds a dose for a couple of days, watching your body and mood along the way, and if that works, phase down to a third of a dose for another couple of days, again watching your body and mood along the way, not obsessing about it, but just watching with easy confidence. That's certainly better than a person simply getting frustrated and stopping cold turkey, and for that reason, a phase down should probably be part of the conversation.

I struggle with depression on and off (probably not to the same extent you do, ad I realize that). One thing, I have noticed and realized, I can be tired, cranky, need an afternoon nap, but I take it and wake up, or just half wake up, and it's brutal. I'm really depressed.


And sometimes I don't eat for several hours after waking up, too! Now, that one, sometimes kind of works.




Yes...this is exactly what my psychiatrist told me to do if I don't wish to take the medication any more. I try to be very thorough with all this, even to the point of the ridiculous I suppose. I even asked him if there would be any problems taking Celexa while participating in the autism research study i've been accepted into in September. The researchers wanted to know all the medications I was currently taking and at the time they asked me, I was on Cymbalta. I haven't told them i've recently switched to Celexa and my psychiatrist told me it wouldn't be necessary to tell them.

I have noticed no changes in my mood at all since i've been on this medication and I can't say i've personally noticed any changes in my body either. Irrespective of whether Celexa really has increased my tremors or not, it is painfully obvious to me that there's no reason to stay on it if I see no appreaciable benefits from it. The mornings have always been the worst for me when i'm depressed and I feel RELATIVELY better as the day progresses. For this reason, I often don't even get out of bed (even i'm not sleeping) until later in the afternoon.



Horus
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13 Aug 2010, 6:40 pm

Another thing with me and Rx meds I need to take on a daily basis is that I often forget whether I took them or not. I KNOW I took the 40mg dose of Celexa when I woke up today, but I swear I don't remember if I took the 20mg dose just a few minutes ago. 8O Now i'm not going to take the chance of taking 80mg just in case I did take the 20mg. I need to develope a mnemonic device in order to be sure i've taken the correct amount for the day. I'm not used to taking Rx meds as I haven't been on any anti-depressants for years until very recently. I've just been assuming i'd remember taking the correct amount for the day, but often, I just don't.


I'm supposed to have a pretty good short-term/working memory too, so I don't know why I can't keep track of this. :?



DW
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14 Aug 2010, 4:33 am

Trembling is a fairly common symptom of citalopram and should not be considered too serious. It's up there with other common symptoms such as nausea, dry mouth and drowsiness. If you were to develop rather rare symptoms such as convulsions, severe anxiety, uncontrollable vomiting, hallucinations, etc, than you should be taken off of the medication. Symptoms such as drowsiness, dry mouth, nausea, yawning will eventually dissipate as occurs with almost all SSRI class medications. Also, I know this sounds strange, but the fact that you are experiencing side effects shows that your body is responding to the medication, and if all goes well, the net benefit of the medication will be positive. If you have negative results, than obviously you should taper off the citalopram and maybe try another SSRI. Theoretically speaking, citalopram can initially worsen trembling, but this trembling will eventually taper off.

By the way, trembling when you have not eaten is very common. Also, almost all individuals who fall into the autism spectrum will tremble prior to entering a social situation, along with other physical symptoms, this is attributable to the social anxiety aspect of Asperger's Syndrome.

Shortly put, so far everything in your case is fairly normal and you should not worry too much about it. Also, remember that the citalopram may lessen social anxiety in the long run, so the net result may be even less trembling. I hope this helps, I wish you the best with your current treatment approaches.



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14 Aug 2010, 12:39 pm

DW~


Thank you very much for your advice. I was fairly certain none of this was unusual or serious, but I was a bit concerned nonetheless. Again, i'm not even sure if my trembling is any worse than it is any other time. Only my mother has observed this and that just might be faulty perception on her part. While this panhandler also noticed it the other day, strangers have been commenting about my trembling all my life. At any rate.....even if my trembling has increased and it's because of the Celexa, i'm not experiencing any of the other common side effects.



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14 Aug 2010, 3:13 pm

I have a good short-term memory, too. However, I used to manage a small university copy center. Usually, it was just me and one employee, and maybe for that reason it was excellent, excellent business experience. Anyway, after I gave my two weeks notice and was turning it over to the new manager he said, "I need a list for what I'm doing right now," and he was so right! Someone calls for an estimate, okay, no problem, then a university department calls to have a job picked up, a student has trouble making transparency copies, etc, etc. Oops, and I completely forgot about the estimate!

(It very much is a commodity business, price rules. Interestingly, people think of most of the cost of a copy as the paper, and not the toner, developer, and wear and tear on the machine. Instead of being happy that they could get a $10 course packet instead of a $30 book, students rather view it as an additional, extra purchase, and an additional, extra chore and hassle at the beginning of the semester, and I kind of understand that. All in all, Interesting business!)



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