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(If you missed the first half of this story, catch up here.)
I had just reduced my Celexa dosage from 20 mg to 15 mg per day, and there I was doing something completely routine: driving across the bridge from my town to pick up a crate of veggies.
My adrenal glands, however, disagreed that my task was routine. The adrenaline grew from a twinge in my gut as I drove over an unremarkable concrete bridge that crosses the equally-unremarkable Susquehanna River.
One minute from my destination, I hit a red light.
The twinge of fear grew larger.
Thirty seconds from my destination, I started sweating.
The twinge of fear grew even larger, bubbling up from my gut into my chest cavity, and stretching out to my limbs in the form of pins and needles.
I pulled up to the parking lot where the CSA crates were stacked and ready for pickup. Mine was loaded with tomatoes, zucchini, spring mix, and string beans.
KEEP CALM AND CARRY VEGETABLES
I lifted up the crate and tried, with shaky arms, to focus on the red and the orange and the yellow cherry tomatoes instead of the disturbingly fast rhythm of my racing heart.
Pretty colors. Yeah, focus on those, Summer. Not the adrenaline.
Oh, beans. I’ve got beans. Focus on those, Summer. Not the palpitations.
Fresh, garden-y scent. Focus. Focus on the geosmin and not the shaking.
Feel the beets. Ignore the heartbeat.
Heartbeat. Heartbeat. Lots of heartbeats. And they’re speeding up.
Why are they speeding up? What’s wrong with me? Something is wrong. Something is terribly, terribly wrong.
“Normal bodily reactions to stress”? Screw you, CBT. That’s such bullshit. I’m clearly dying. This isn’t normal. This is wrong and dangerous and I NEED TO GET OUT OF HERE RIGHT NOW.
Cue one of the worst panic attacks of my life — surely a Top 10, if not a Top 5.
I won’t go into detail for fear of seeding a new attack (in me or in you, reader). But rest assured that it was horrifying, and each time I had to pull my car over to the side of the road (4, in my short 1.5-mile drive back to my house), I was 100% convinced that my current breath — shallow and irregular as it was — would be my last.
COMMISSION VS. OMISSION?
While it’s nearly impossible to pinpoint the exact cause of any panic attack — especially given that each attack is probably borne out of a multitude of precipitating factors — I questioned my recent Celexa dosage cut. Was a 5 mg cut too much? Was this attack, at least in part, a result of cutting down from 20 mg to 15 mg?
Can panic actually be a result of SSRI withdrawal and not necessarily a flare-up of my original condition?
From Psychology Today’s blog, “Side Effects”, by Christopher Lane, PhD:
Jerrold Rosenbaum and Maurizio Fava, researchers at Massachusetts General Hospital, found that among people getting off antidepressants, anywhere from 20 percent to 80 percent (depending on the drug) suffered what was being called antidepressant withdrawal (but which, after the symposium, was renamed ‘discontinuation syndrome’).”
…”The symptoms of discontinuation syndrome could be fierce,” [Bruce] Stutz added, as he recounted in considerable detail, at varying doses, his own harassing problems with “brain zaps,” panic attacks, insomnia, and despair on lower and lower doses of Effexor.
Fierce. I love that word. It’s perfect.
Anyway, the piece goes on:
Fava, he noted, went on to publish in 2006 a paper citing further withdrawal symptoms, such as “agitation, anxiety, akathesia, panic attacks, irritability, aggressiveness, worsening of mood, dysphoria, crying spells or mood lability, overactivity or hyperactivity, depersonalization, decreased concentration, slowed thinking, confusion and memory/concentration difficulties.”
To the authors, these symptoms and their widespread recurrence looked increasingly like a drug-related syndrome.
Isn’t that just fantastic? SSRI withdrawal in and of itself is known for causing panic attacks. My “original condition” (panic, obviously) is virtually indistinguishable from one of the defining features of SSRI withdrawal itself.
And with that, I called my psychiatrist to ask for some liquid Celexa so I could return to my safe haven of 20 mg, and then make smaller and more precise dosage adjustments based upon what felt comfortable for me.
No more taking the easy road — no more calculating my dosage cuts based upon the splittability of a pill (or the lack thereof).
It’s time to throw back some shots of carefully-measured and foul-tasting liquid Celexa.
Cheers.