Side effects of citalopram

Contents

What Are the Long-Term Effects of Citalopram?

Citalopram (Celexa) is an antidepressant in the selective serotonin reuptake inhibitor (SSRI) class. Prescribed under the brand name Celexa, citalopram is used to treat depression and sometimes prescribed for alcoholism, panic disorder, premenstrual dysphoric disorder, social phobia, or eating disorders.1,2

SSRI antidepressants like citalopram adjust the levels of serotonin in the brain, keeping them stable. SSRIs take between 1 and 4 weeks to become fully effective.2

Although there are some people who struggle with prescription drug abuse and abuse citalopram, abuse is rare because these medications do not cause euphoria like other drugs of abuse.

However, even people who take citalopram as prescribed may experience short- and long-term side effects.

Citalopram Side Effects

Short-term side effects of citalopram can include:2

  • Dry mouth.
  • Nausea.
  • Appetite loss.
  • Drowsiness.
  • Joint pain.
  • Constipation.
  • Stomach pain.
  • Heartburn.
  • Frequent urination.
  • Changes in libido.
  • Yawning.
  • Sweating.

Citalopram can also cause a condition called serotonin syndrome, particularly if it is combined with tricyclic antidepressants, fentanyl, lithium, tramadol, trytophan, buspirone, amphetamines, or St. John’s wort. This condition requires emergency medical attention, so call 911 if symptoms arise. Serotonin syndrome can be deadly. Symptoms include:1

  • Fast heartbeat.
  • Delirium.
  • Hallucinations.
  • Severe dizziness.
  • Nausea or vomiting.
  • Diarrhea.
  • Loss of physical coordination.
  • Agitation.
  • Restlessness.
  • Muscle twitches or rigidity.
  • Seizures.

Citalopram’s Long-Term Effects

Most people take citalopram for 6 months. But in some instances, a doctor may prescribe this substance for 9 months. 3

Long-term use of antidepressants may put people at risk for type 2 diabetes, and SSRIs may cause heart rhythm abnormalities at higher doses. A European study linked citalopram with increased electrical abnormalities of the heart and that these abnormalities became worse with increasing doses. Those with pre-existing heart conditions should speak with their doctor before taking citalopram, even as prescribed.4,5

Some people who take SSRIs may problems with blood clotting because of decreased serotonin in blood platelets. People who take the drugs are at increased risk for stomach bleeding or bleeding in the uterus. Combining SSRIs and NSAIDs (aspirin, ibuprofen) increases this risk.6

As mentioned above, citalopram may also lead to lowered sexual interest or poorer performance in both men and women. Patients can try lowering the dose or switch to Wellbutrin, which does not generally cause sexual side effects.6

Rarely, elderly patients who take citalopram may develop tics, muscle spasms, dyskinesia, parkinsonism, and akathisia, which may occur with anxiety. These symptoms can be treated with anti-anxiety drugs, beta-blockers, and antiparkinsonian drugs or by switching to a different antidepressant.6

Elderly people who take citalopram may also have a severe fall in sodium levels known as hyponatremia. This may lead to a build-up of fluid inside the body’s cells, which can cause someone to stop breathing and go into a coma. Symptoms of hyponatremia include feeling sick, headache, muscle pain, reduced appetite, and confusion. More serious symptoms include tiredness, disorientation, agitation, psychosis, and seizures.7

Long-Term Psychological Changes from Citalopram Abuse

Some people may experience “Prozac poop-out,” a condition that occurs when an SSRI like citalopram suddenly becomes less effective after months or years. A person may take Celexa every day, as prescribed, and respond well until suddenly one day, they do not, leading to a relapse in depression symptoms. People who experience this phenomenon can increase the dose or switch to another antidepressant with a different mechanism of action.6

In addition, some people have suicidal thoughts when they take SSRIs. People under 25 are particularly at risk. These could be due to an underlying illness such as bipolar disorder. People taking citalopram should regularly check in with their doctor and let them know if they do not feel better or develop suicidal thinking.6,7

Mixing Citalopram with Alcohol

Although citalopram does not increase the effects of alcohol, drinking while taking prescription drugs is likely to make any side effects of the medication worse. In medical trials, some users experienced alcohol intolerance, or immediate unpleasant reactions after drinking such as stuffy nose and skin flushing.1,2

In general, alcohol can make depression worse and drinking while taking antidepressants is not recommended.1

Withdrawal from Citalopram

Patients should not stop taking citalopram suddenly, as this can lead to withdrawal symptoms—some of which can be serious. Signs of withdrawal may include:2,7

  • Anxiety.
  • Confusion.
  • Agitation.
  • Mood swings.
  • Nausea.
  • Fatigue.
  • Dizziness.
  • Sensations that feel like electric shock.
  • Seizures.
  • Sweating.
  • Insomnia and other sleep trouble.

When a person wants to stop taking citalopram, their doctor will work with them to safely taper off the drug.

If you believe you are going through depression, or you know someone who is, speak to your doctor or a mental health professional about the possibility of using Celexa or a different antidepressant. Keep in mind that antidepressants tend to be most effective when combined with some form of talk therapy with a counselor or psychologist.

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Sources

What is Celexa?

Celexa is a medication known as a selective serotonin reuptake inhibitor. The mediation is approved to treat major depressive disorder, but it is sometimes prescribed to treat other conditions.

When did the U.S. Food and Drug Administration (FDA) approve the medication?

Celexa was first approved by the FDA in 1998.

Is there a generic version of Celexa?

Yes, the generic version of Celexa is known as citalopram and is sold in the U.S.

Are there any major differences between Celexa and other mental health medications?

Celexa is a selective serotonin reuptake inhibitor (SSRI). The drug is sold in tablet and oral solution form. SSRIs are the most commonly prescribed type of antidepressants, and they work by increasing levels of serotonin in the brain. If you have bipolar disorder and take an SSRI, you may be at risk for triggering a manic episode if you are not also taking a mood stabilizer. Talk to your doctor about your specific symptoms, other health concerns, and other medications you take so they can make the best recommendation for your condition and symptoms.

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Can children take Celexa?

Celexa has not been approved for use in pediatric patients.

Are there potential interaction issues for people taking Celexa and any other drugs?

There are hundreds of drugs which are known to interact with Celexa in major, moderate, or mild ways, so let your doctor know what other medications (both prescription and over-the-counter), vitamins, and supplements you are taking before you begin taking the medication. Be sure to tell your doctor if you take or have taken an MAO inhibitor or escitalopram (Lexapro).

Are there any other medical conditions that would make someone ineligible for Celexa therapy?

Talk to your doctor about other medical conditions before you take Celexa, such as long QT syndrome, slow or irregular heartbeat, low levels of magnesium or potassium, high blood pressure, stroke, bleeding problems, heart attack, other heart conditions, kidney disease, or liver disease.

What is the typical dose that would be prescribed to someone taking Celexa?

Dosage will vary but is recommended not to exceed 40 mg per day.

What do I do if I miss a dose?

Take the dose of Celexa when you remember, but skip the missed dose if it’s almost time for your next dose. You should never take extra doses of the medication to make up for missed doses.

How long does it take for Celexa to reach full efficacy?

It may take several weeks or longer for the medication to be fully effective and for initial side effects to decrease.

What side effects can Celexa cause?

Common side effects can include:

  • nausea
  • headache
  • sweating
  • dry mouth
  • diarrhea
  • nervousness
  • fatigue
  • sleep problems
  • sexual side effects

It also is recommended that you wait to drive or operate machinery until you know how the medication affects you. It is also recommended that people avoid alcohol and illegal drugs while on the medication, as they can worsen adverse effects. Report side effects to your doctor immediately. Serious side effects can include irregular heartbeat, dizziness, confusion, chest pain, fainting, loss of coordination, rash, hives, itching, difficulty breathing or swallowing, bleeding or bruising, swelling, memory problems, seizures, hallucinating, and coma. You can also report side effects to the FDA at 1-800-FDA-1088 or online.

What are the potential psychological side effects of taking Celexa?

A small percentage of teens and young adults who take antidepressants experience an increase in suicidal thoughts and behavior. Seek medical help if you experience these thoughts or other changes in behavior or mood.

What are the potential long-term effects of taking Celexa?

Celexa can cause angle-closure glaucoma, so talk to your doctor about the risks.

Is it safe for a woman who is pregnant, about to become pregnant, or nursing to take Celexa?

There is limited research on Celexa and pregnancy, but animal studies show adverse effects on fetal development. The drug is excreted in breast milk. Therefore, talk to your doctor about the risks and benefits if you are pregnant, planning to become pregnant, or are nursing before you take Celexa.

Can symptoms occur if Celexa is discontinued?

It’s important not to discontinue use of the drug before talking with your doctor. Withdrawal symptoms of Celexa can include irritability, headache, vomiting, nausea, dizziness, nightmares, or tingling sensation on the skin.

What should I do if I overdose on Celexa?

An overdose of Celexa could be fatal, so seek immediate help or call the Poison Help Line at 1-800-222-1222 if you overdose. Overdose symptoms can include nausea, vomiting, drowsiness, dizziness, uncontrollable shaking, sweating, confusion, irregular heartbeat, fast breathing, blue color on mouth or fingers, confusion, muscle pain, dark-colored urine, and coma.

Is Celexa habit-forming?

Celexa is not habit-forming, but it is not recommended that you discontinue use of the drug before talking with your doctor, as withdrawal symptoms can occur.

How much does Celexa cost?

According to goodrx.com, 30 tablets of 20 mg generic citalopram cost approximately $22. 30 tablets of 20 mg Celexa cost approximately $268.

Are there any disadvantages to Celexa?

The biggest disadvantages of Celexa are the potential side effects. Talk to your doctor about what medication is best for you.

DISCLAIMER: The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other healthcare providers. This article mentions drugs that were FDA-approved and available at the time of publication and may not include all possible drug interactions or all FDA warnings or alerts. The author of this page explicitly does not endorse this drug or any specific treatment method. If you have health questions or concerns about interactions, please check with your physician or go to the FDA site for a comprehensive list of warnings.

Article Sources Last Updated: Jan 13, 2020

In the U.S., around 40 million people have anxiety, but many don’t get treatment. If you have anxiety, there are several ways to get help. One option is Celexa, an antidepressant medication. Let’s talk about what you should know about Celexa if your provider prescribes it for anxiety.*

What is Celexa?

Celexa (citalopram) is a selective serotonin reuptake inhibitor (SSRI). Other SSRIs include:

  • Paxil (paroxetine)
  • Prozac (fluoxetine)
  • Lexapro (escitalopram)
  • Zoloft (sertraline)

SSRIs are primarily used to treat depression, but they are used to treat anxiety disorders as well as irritable bowel syndrome, bulimia, and other conditions.

When a provider prescribes you Celexa for anxiety, it is known as “off-label” use. This means the medication is prescribed for a condition other than what it was originally approved to treat by the FDA. Even though Celexa is not FDA-approved for anxiety, the American Psychiatric Association recommends it for panic disorder in its clinical guidelines. Studies have also found that it may improve symptoms of generalized anxiety disorder.

How will it help my anxiety?

Celexa works by increasing the amount of serotonin in your brain, which is a natural chemical found in your body that helps to regulate mood. It does this by blocking the reuptake, or reabsorption, of serotonin into nerve cells, which makes more serotonin available in your brain. Improving serotonin levels has been found to help people with anxiety and depression feel better.

Your provider might recommend that you see a therapist in addition to taking Celexa. Many people find the combination helpful, and the most common therapy for anxiety, cognitive-behavioral therapy, has been found to be effective for a variety of anxiety disorders, including generalized anxiety disorder, panic disorder, social anxiety, and obsessive-compulsive disorder.

How do I take it?

You take Celexa once daily by mouth, in the morning or evening, with or without food. Typical doses range from 10 mg to 40 mg.

Be sure to keep taking Celexa unless your doctor tells you to stop taking it—even if you feel better. If you suddenly stop taking Celexa, you could experience withdrawal symptoms, which include:

  • Headache
  • Nausea
  • Diarrhea
  • Abdominal cramping
  • Insomnia
  • Dizziness
  • Blurred vision
  • Anxiety
  • Irritability

These symptoms are usually mild and last about 1 to 2 weeks. You are more likely to have symptoms if you have been taking Celexa for at least 6 weeks.

When you and your provider agree that you can stop taking the medication, your provider will gradually lower your dose over a period of few weeks to reduce the risk of withdrawal symptoms.

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How long does Celexa take to work?

It may take about 2 to 6 weeks for you to experience the full benefit of Celexa. Everyone is different, though, so you might see an improvement in your symptoms faster or slower than that.

It often takes longer for Celexa to start working for anxiety than it does for depression because most people start at a lower dose, and increase the dose more slowly, when taking it for anxiety than for depression.

If your anxiety doesn’t improve after several weeks, talk to your provider about adjusting the dose or switching to a different medication.

Will it make my anxiety worse when I first start taking it?

Unfortunately, some people do experience more anxiety when they first start taking Celexa. This effect usually lasts about 2 weeks, and one way to prevent it or reduce it is to start on a low dose and go up slowly, allowing your body time to get used to the medication.

How long do I need to be on it?

You and your provider can work together to determine how long you should be on Celexa, but many people safely take it for a long time. If it is helping you and you aren’t having bothersome side effects, your provider might recommend that you keep taking it so your anxiety doesn’t come back.

What side effects does Celexa have?

SSRIs generally have fewer side effects than other types of antidepressants. However, you may still experience some side effects while taking it.

The most common side effects of Celexa are:

  • Headache
  • Feeling tired
  • Insomnia
  • Nausea
  • Dry mouth
  • Constipation
  • Sweating
  • Loss of appetite
  • Diarrhea

Other important side effects to know about include:

  • Sexual dysfunction. Some people, especially men, have had sexual problems while taking Celexa. Problems include a low sex drive or taking longer to achieve an orgasm. Rarely, people have experienced priapism, which is a prolonged erection. If you think you are experiencing priapism, call 9-1-1 or go to the nearest emergency room immediately.
  • Hyponatremia. This is a condition where there is not enough sodium in your blood. Symptoms may include weakness, feeling unsteady, or confusion. While hyponatremia is also rare, it is a medical emergency. You should call 9-1-1 or go to the nearest emergency room if you think you are experiencing it.

Overall, the side effects of Celexa are usually mild and most should get better over time. But some of them, particularly sexual side effects, may continue for as long as you take Celexa.

If you’re pregnant or planning on becoming pregnant and think you may be dealing with anxiety, talk to your provider before using Celexa. The medication is thought to be fairly safe to use during pregnancy, but there are still risks, such as heart defects and losing the pregnancy.

What drug interactions does it have?

The following medications can interact with Celexa (this is not an all-inclusive list):

  • Blood thinners. Serotonin plays a role in blood clotting. Because of this, SSRIs may increase your risk for dangerous bleeding, particularly stomach bleeding. This risk is higher if you are already on blood thinners such as warfarin (Coumadin).
  • Non-steroidal anti-inflammatory drugs (NSAIDs). These medications are used to treat pain, inflammation, and arthritis and include ibuprofen, naproxen, and meloxicam. NSAIDs can also put you at a higher risk for bleeding if you take them while you are taking Celexa.
  • Other drugs that affect serotonin. Taking Celexa with other drugs that affect the serotonin in your body (such as other antidepressants and migraine medications like sumatriptan or eletriptan) can increase the risk of a condition called serotonin syndrome. Symptoms include sweating and/or a fever, nausea, vomiting, diarrhea, a rapid heart rate, and tremor or muscle spasms. While also very rare, it too is a medical emergency, and you should call 9-1-1 or go to your nearest emergency room if you experience symptoms.

Despite these interactions, many people do take Celexa with these medications. Be sure to talk to your provider about any medications you are taking before starting Celexa.

Additionally, alcohol can make you more drowsy and impaired while you are taking Celexa. It may also make Celexa less effective. If you are concerned about drinking alcohol while taking Celexa, talk to your provider.

How much does it cost?

Celexa is an inexpensive medication. The current lowest GoodRx price for thirty 20 mg tablets is $4. You might be able to save more by using a mail-order pharmacy or purchasing a 90-day supply. The lowest price for ninety 20 mg tablets, by comparison, is $9.40.

What are some alternatives to Celexa?

If you and your provider decide Celexa is not right for you, there are several other medications available to treat anxiety, including:

  • Other SSRIs. These medications work similarly to Celexa and include sertraline (Zoloft), paroxetine (Paxil), and fluoxetine (Prozac). If you didn’t get the benefit you were hoping for while taking Celexa, you might want to try switching to another SSRI.
  • Hydroxyzine. Hydroxyzine (Vistaril), an antihistamine, can be helpful for immediate relief of anxiety symptoms. You might also benefit from taking hydroxyzine at the same time as other anxiety medications, like Celexa.
  • Benzodiazepines. These include medications such as alprazolam (Xanax), lorazepam (Ativan), and clonazepam (Klonopin). Like hydroxyzine, benzodiazepines can be helpful for immediate relief of anxiety symptoms, and you may benefit from combining benzodiazepines with other medications like Celexa.
  • SNRIs. These are another type of antidepressant medication that includes venlafaxine (Effexor) and duloxetine (Cymbalta). While you wouldn’t usually take these medications at the same time as Celexa, they might be a good alternative.

The bottom line

Celexa is an inexpensive antidepressant medication used to treat anxiety. While it can help with your anxiety, it may take a few weeks for your symptoms to get better, so try to be patient.

You may have some side effects while taking Celexa, but these are generally mild. Once you start taking the medication, do not stop without talking to your provider first. Quitting it cold turkey can cause withdrawal symptoms.

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  • The U.S. Food and Drug Administration (FDA) is clarifying dosing and warning recommendations for the drug Celexa (citalopram hydrobromide). There is the possibility that high doses of the antidepressant can cause dangerous abnormalities in the electrical activity of the heart.

    The drug label has been changed to describe the caution that needs to be taken when citalopram is used in patients with certain underlying heart conditions, and those who are predisposed to having low levels of potassium and magnesium in the blood. The revised drug label also describes lower doses that should be used in patients over the age of 60.

    Changes in the electrical activity of the heart can lead to the risk of fatal abnormal heart rhythm; because of this risk in certain circumstances (described below), health care providers may need to regularly monitor the heart – or check blood levels of potassium and magnesium — in patients that must use Celexa. The maximum recommended dose of Celexa is 20 mg per day for patients older than 60 years of age.

    Additional Information for Patients

    • Do not stop taking Celexa or change your dose without talking to your healthcare professional. Stopping Celexa suddenly can cause withdrawal effects.
    • If you are currently taking a Celexa dose greater than 40 mg per day, talk to your healthcare professional.
    • Seek immediate care if you experience an irregular heartbeat, shortness of breath, dizziness, or fainting while taking Celexa.
    • If you are taking Celexa, your healthcare professional may occasionally order an electrocardiogram (ECG, EKG) to monitor your heart rate and rhythm.
    • Your healthcare professional may also order tests to check levels of potassium and magnesium in your blood.
    • Read the Medication Guide for Celexa carefully and discuss any questions you have with your healthcare professional.
    • Report any side effects you experience to the FDA MedWatch program using the information in the “Contact FDA” box at the bottom of the page.

    Additional Information for Healthcare Professionals

    • Celexa causes dose-dependent QT interval prolongation, which can cause Torsades de Pointes, ventricular tachycardia, and sudden death.
    • Celexa is not recommended for use at doses greater than 40 mg per day because such doses cause too large an effect on the QT interval and confer no additional benefit.
    • Celexa is not recommended for use in patients with congenital long QT syndrome, bradycardia, hypokalemia, or hypomagnesemia, recent acute myocardial infarction, or uncompensated heart failure. Celexa use is also not recommended in patients who are taking other drugs that prolong the QT interval.
    • The maximum recommended dose of Celexa is 20 mg per day for patients with hepatic impairment, patients who are older than 60 years of age, patients who are CYP 2C19 poor metabolizers, or patients who are taking concomitant cimetidine (Tagamet®) or another CYP2C19 inhibitor, because these factors lead to increased blood levels of Celexa, increasing the risk of QT interval prolongation and Torsade de Pointes.
    • Electrolyte and/or ECG monitoring is recommended in certain circumstances
      • Consider more frequent ECG monitoring in patients for whom Celexa use is not recommended, but is, nevertheless, considered essential.
      • Patients at risk for significant electrolyte disturbances should have baseline serum potassium and magnesium measurement, with periodic monitoring. Hypokalemia and/or hypomagnesemia may increase the risk of QTc prolongation and arrhythmia and should be corrected prior to initiation of treatment with periodic monitoring.
    • Celexa should be discontinued in patients found to have persistent QTc measurements greater than 500 ms.
    • Advise patients on Celexa to contact a healthcare professional immediately if they experience signs and symptoms of an abnormal heart rate or rhythm (e.g., dizziness, palpitations, or syncope). If patients experience symptoms, the prescriber should initiate further evaluation, including cardiac monitoring.
    • Report adverse events involving Celexa to FDA’s MedWatch program, at 1-800-FDA-1088, or on the Internet at www.fda.gov/medwatch.

    Related Information

    • FDA Drug Safety Communication: Revised recommendations for Celexa (citalopram hydrobromide) related to a potential risk of abnormal heart rhythms with high doses

    FDA Warns Against High-Dose Citalopram

    Citing increased risk of cardiac arrhythmias and a lack of therapeutic benefit associated with high doses of the selective serotonin reuptake inhibitor (SSRI) citalopram hydrobromide (Celexa), the FDA has reduced the recommended maximum to 40 mg/day.

    Previously, the agency had approved a 60-mg/day dose of the antidepressant for certain patients.

    The new dosing instruction was prompted by postmarketing surveillance reports and a prospective trial linking the 60-mg dose to unacceptable QT interval prolongations and Torsade de Pointes.

    The trial — a randomized, placebo-controlled, crossover study in 119 adults — examined citalopram’s effects on QT intervals at doses of 20 mg and 60 mg, the FDA said.

    By interpolating these results, the FDA estimated that a 40-mg dose would prolong QT intervals by an average of 12.6 msec (90% CI 10.9 to 14.3), which it deemed marginally acceptable.

    “As a result of this thorough QT study, FDA has determined that citalopram causes dose-dependent QT interval prolongation and should no longer be used at doses above 40 mg per day,” the agency said in a drug safety communication.

    Congestive heart failure, bradyarrhythmias, and predispositions to potassium or magnesium deficiencies are risk factors for Torsade de Pointes, the FDA noted.

    Consequently, the agency recommended that patients with these conditions should undergo regular electrocardiography if given citalopram, and hypokalemia and hypomagnesemia should be corrected before starting patients on the drug.

    Patients currently taking citalopram at doses higher than 40 mg/day should not stop the drug abruptly, but should talk to their doctors about lowering the dose, and should seek treatment immediately for irregular heartbeats, shortness of breath, fainting, or dizziness.

    Package inserts for citalopram, which is also available in generic forms, will be rewritten to include the new information, the agency said.

    The FDA did not indicate that the cardiac effects were an issue with escitalopram (Lexapro), which is the S-enantiomer of citalopram — suggesting that the arrhythmias stem from the latter’s R-enantiomer.

    Comment

    Most people know about SSRIs, the antidepressant drugs that stop the brain from re-absorbing too much of the serotonin we produce, to regulate mood, anxiety and happiness. And a lot of people know about these drugs first hand, for the simple reason that they have used them. Last year, according to NHS Digital, no fewer than 64.7m antidepressant prescriptions were given in England alone. In a decade, the number of prescriptions has doubled.

    On Tuesday I joined the throng, and popped my first Citalopram. It was quite a thing – not least because, like an idiot, I dropped my pill about 90 minutes before curtain up for the Royal Shakespeare Company’s production of The Tempest at the Barbican. That’s right. This isn’t just mental illness: this is metropolitan-elite mental illness. It was a pretty overwhelming theatrical experience.

    The first indication that something was up came as I approached my local tube station. I noticed that I was in a state of extreme dissociation, walking along looking as though I was entirely present in the world yet feeling completely detached from it. I had drifted into total mental autopilot.

    Luckily, I was able to recognise my fugue. It’s a symptom of my condition, which, as I’ve written before, is complex post-traumatic stress disorder. The drug-induced dissociation was more intense than I’m used to when it’s happening naturally. I use the word advisedly. Much of what is thought of as illness is actually an extreme and sensible protective reaction to unbearable interventions from outside the self.

    Because I’ve been in very good psychotherapy for about a year now, I’ve learned to identify times of dissociation, and “ground” myself. Hitting myself in the centre of the chest works best for me, especially now that I’ve stopped wearing the necklace I used to thump into my breastbone. Of course, you look like a bit of a prat, striding about banging your chest, but there you are. The one thing that makes you feel normal is the one thing that alerts others to the fact that something weird’s going on.

    I’ve been resisting dissociation for pretty much every minute I’ve been on the drug since then. Being in good company helps most, and being in parks, fields, gardens and nature. You have to keep busy. The leaflet that came with the drug, which I read thoroughly before starting the course, does warn that in the first few days you might find that the symptoms you’re trying to escape come back more strongly. Unfortunately, I tend to dissociate in order to avoid having panic attacks. So, as I get better at managing the dissociation, the panic attacks surge. It’s like playing symptom whack-a-mole, except that you’re whacking bits of your psyche, as well as your chest.

    I spent pretty much all of Thursday in one long low-level panic attack – keeping busy, telling no one. I didn’t want to mention it, because that would make it worse. At one point, in the park with my brother, he insisted, randomly, that I walk up the hill to the bus stop instead of down it, like I wanted to, in the heat. By the time I got to the bus stop, my legs were barely working, and I was in the grip of convulsive shudders.

    I go along with things I don’t want to do, things that ignore my wants and needs, then hate myself for my compliance. The little examples, such as this one, reawaken my feelings about the huge ones. I was bullied a lot as a child, and my parents were needlessly strict and deludedly all-knowing. It’s grown into a major cognitive dissonance. I loathe being bullied or bossed about, yet at the same time it feels so familiar and comfortable that I’m complying before I even know it, eager to please people who can’t be pleased.

    Then I feel full of resentment and anger against the perpetrator of the control – so much so that it becomes overwhelming, and my mind and body rebel. I literally shake the feelings out. It’s the reason why I recently began to seek NHS psychiatric help, on top of private psychotherapeutic help. A couple of interventions of epic proportions have recently been perpetrated against me. They have left me so poleaxed that I’m unable to assert myself enough to walk downhill.

    A breakthrough occurred, though. I was able to tell my brother, calmly, what was happening to me and why. He kissed me on the cheek. He never does that.

    Why am I writing this down for publication? Practically, it’s because these powerful drugs arrived with so little guidance about what to expect. An NHS case-worker I’d been interviewed by once – not a doctor – called my GP’s practice and arranged for a prescription to be written by a GP I’d had nothing to do with. I was told on the phone what the prescription was, and that it was waiting for me to pick up from the local pharmacy. I wasn’t consulted about the drug I was being offered at all, although I had said that I wanted to try an antidepressant. I’ll meet a different GP and the case-worker in two weeks’ time.

    The process has taken about five weeks, and has been circular. In crisis at the end of May, I asked my GP practice for help and was told to go to A&E instead. I didn’t react well, and left upset and furious. Returning a few days later, I said that I would prefer a less dramatic referral to mental health services than A&E, which is how I met the case-worker. Then, back to the GP practice and that remotely dispatched prescription. Which is not to blame the practice. The whole system is itself in crisis mode all the time. Which is particularly bad, obviously, for people with mental health problems.

    There is “soaring demand” for NHS mental health services. Some 80% of bosses of NHS trusts surveyed by the trade organisation, NHS Providers, have expressed worries that they have too little budget to provide “timely, high-quality care”. That’s so dangerous. I absolutely needed a year of psychotherapy before I started taking this drug. At the start of the therapy, I had become emotionally numb, unable even to weep. I wouldn’t have had the insight to understand what this drug was doing to me, let alone control it or explain it to others when I couldn’t.

    I might never even have got the diagnosis that helps me so much to make sense of my entire life, because that took months. All I can do, apart from look after myself and my kids, is speak out about how complex is the task of managing a mental health condition. There’s so very, very much more to it than popping pills.

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