So, as a brief backstory, I have been afflicted by panic attacks for most of my adult life, and when I had a stroke, I had hoped that these pernicious yet physically benign interruptions might have been zapped by the strike and that I would, instead, have gained the skill of a polyglot. Alas, the panic attacks endured and I have a long way to go before I can utter a sentence in any of the Proto-Indo-European languages. A panic attack is like a threat of death with all the trimmings yet, in theory, there’s probably a more real and present danger of choking on the silver sixpence in your slice of Christmas pudding. With all the brain fog, disorientation, fatigue, fear, psychical and mental malaise associated with having a stroke, I just couldn’t face adding panic attacks to the mix. I opted for long-term medication, I already used short-term medication if a really nasty panic should arise, and the Mental Health GP dished out some Prozac which knocked me about silly, and was the same medication I suspected might have kicked off all these panics in the first place, but that is another story. I did a small amount of research and came across Citalopram which is used to treat panic attacks and panic disorder, besides also being an antidepressant. In the same way that the anti-depressant, Amitriptyline, is also used for a number of other conditions, including insomnia.
I have been taking 20mg of Citalopram for three years now, since having had the stroke. The first four weeks of taking the medication made me feel like I was cast into Dante’s Purgatorio. Everything got worse before the medication settled, and then only after six months was I, at last, able to come up for air. It did work. It did the trick. It suppressed the panic attacks. On another positive note, SSRIs help neurogenesis (especially the hippocampus) and neuroplasticity, so as someone who, after stroke, really could do with some push on these things, I was not reluctant to take them. Yet, after three years, I feel my brain is stable enough now to proceed tapering off this medication, and plucky enough to tackle the potential attack of panic with all the useful Mindfulness techniques and other ways of being I have adopted subsequent to having my brain smote.
To taper off this medication, I have reduced my quantity by half. That’s 10mg per day. My aim is to stay on 10mg for about six months. So far, it has been two weeks. Already some unpleasant feelings have arisen, mainly feelings of anxiety, hot flushes, and an impending feeling of doom. I have been prepared for this and have, so far, contended with those feelings quite confidently. I have used the Mindfulness technique of observing the negative sensations and letting them pass. I have also practiced a bit of exposure therapy and allowed myself to press on despite wanting to run away and worry. The latter does not feel good but coming out the other side, knowing that I made it, gives me that extra boost of confidence for when it next occurs. It also compels the brain to make new pathways it might otherwise retreat from because I have retreated. A case in point, I recently had an argument with my brother-in-law, it was a colourful one. I was very much in the moment. There was lots of finger pointing, knitted brows, and exclamations of exasperation. I eventually walked away to cool down. I felt mentally exhausted for two days but then something twigged. It was if I had exerted some neurones to the point of making a connection or two. Now, I am not saying, go out and have a quarrel with someone, but my point is that often as stroke survivors we get to a point in our rehabilitation where we just stop short of the mark for a myriad of reasons, be they fear, fatigue, disillusionment, disheartenment, failure, or the task is frustratingly put in the too hard basket. That’s when a neurone that might have made a connection backs off as well.
I suspect these feelings associated with tapering off will continue for about six weeks. I plan to add to this post until the edit-by-date, and describe as best I can my experience and coping strategies.
The interesting thing about Citalopram, is that it doesn’t eradicate a panic attack, it merely inhibits it. So, as far as I can see, the panic is still occurring but I don’t feel it. So, when dropping the dosage, I’m not experiencing a full blown panic but it is a little more intense than if I were on 20mg. So, beginning from two weeks after having dropped to 10mg, I expect at least four to six weeks of this feeling before my brain gets to grips with the adjusted level of serotonin.