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[Penguin]

Hi
I've been on estrogel / utrogrstan since end of December,  and citalopram 10mg for over a year. It has made a big dent in my anxiety, along with talking therapies. However, I'm still left with this low level anxiety that seems to now be constant. There's always some health niggle or other that I am worried about turning into something bigger. And even when there isn't, I have a constant low level worry about having something undiagnosed and asymptomatic. For others who have used hrt and ad's to treat anxiety, is it normal to still have low level, easy to react to anything, anxiety? Or do I need to change doses etc. It just feels like my nervous system won't switch off and I can't ever be present for long.

[Dotty]

What dose of Oestrogel are you on ?

[Penguin]

2 pumps most of the month,  some days leading up to ovulation I need to drop down to 1 pump as I get too jittery. 2 pumps I'd hate tho as it makes me more acidy/ upper GI symptoms.

[CLKD]

An appropriate anti-anxiety medication should be prescribed, though some anti-depressants apparently may ease symptoms.

I managed my anxiety in the 1980s/90s with Valium under GP supervision in that he prescribed each week what I would require.  Once my anxiety levels had settled I took either 1mg or 5mg [can't remember which] the night B4 an Event that I was unable to avoid, knowing that I could take another dose the next day; which I never required.

How does your anxiety affect you?  Is there a worse time of day, for me it was early mornings  . Also eating regularly may help, every 3 hours, 24/7 ;-)

[Penguin]

An appropriate anti-anxiety medication should be prescribed, though some anti-depressants apparently may ease symptoms.

I managed my anxiety in the 1980s/90s with Valium under GP supervision in that he prescribed each week what I would require.  Once my anxiety levels had settled I took either 1mg or 5mg [can't remember which] the night B4 an Event that I was unable to avoid, knowing that I could take another dose the next day; which I never required.

How does your anxiety affect you?  Is there a worse time of day, for me it was early mornings  . Also eating regularly may help, every 3 hours, 24/7 ;-)

I do have diazepam for emergency use, but this is constant low level anxiety and it doesn't work as well for that, although it definitely helps in acute situations.

It is worse early morning for sure, and by mid pm I am usually feeling better and then fine in the evening. I am just fed up of feeling so aware of my body all the time, it feels like my brain is constantly scanning for the next thing. I just want it to stop for a bit. I know exercise would help too but I have zero motivation at the moment, I don't know why. I just feel down and I miss my mum.

[Gnatty]

Hi there. I do think 10mg is a very dose of Citalopram. The fact you still have low level background anxiety suggests to me that it's not quite the right level. When you find your sweet spot that low level feeling of uneasiness should dissipate and you should feel so much better. Have a chat with your GP and see if he thinks it's a good plan. It's worth trying before you switch to another AD. You definitely don't need to put up with these feelings xx

[SarahT]

Hi Penguin,
Just wanted to send some love your way.
From my own experience, peri made me develops the worse anxiety I have ever had, made me feel a bit out of control. I have worked hard with myself, accepting that I can't be the person I used to be, that the additional anxiety was hormonal related and for me, I had to try to accept it. It's like other peri stuff that I needed to find a way to work best with the symptoms. But the low level anxiety you speak of, yes, it remains, just a bit  less unstable if you like.
In some ways I altered my life a bit ( lucky to be in a family situation where I can do so),  accept that I can mostly only concentrate on one ' big' task at a time, because trying to multi task freaked me out and the anxiety spiralled. I upped my hrt patches to 125, luckily this dose doesn't give me side affects and have a low dose AD. Maybe explain to to our Dr and see if a different form of hrt may benefit? Or a change in AD?

Also have now begun some counselling as well, to help me work with some massive life changes. I too lost my mum, early this year.

Maybe you may be able to understand and accept you are living with some huge changes,physically and emotionally. Be kind to yourself. None of this as a 'fault' or weakness with yourself. I sometimes look at what is happening in my life and wonder how I am even still standing. It may not feel like it sometimes, but you're bloody amazing. X

[Penguin]

Hi there. I do think 10mg is a very dose of Citalopram. The fact you still have low level background anxiety suggests to me that it's not quite the right level. When you find your sweet spot that low level feeling of uneasiness should dissipate and you should feel so much better. Have a chat with your GP and see if he thinks it's a good plan. It's worth trying before you switch to another AD. You definitely don't need to put up with these feelings xx

Thank you xx I actually did try to increase about a month ago, GP said I could go to 20mg. But it was at same time as I was increasing the hrt and anxiety went through the roof, I mean it was unbearable, I was beside with it. Perhaps I should give it another go. Gp said I shouldn't have had additional side effects. Do you think it's normal for side effects with an increase? I tried to go from 10mg to 15mg, so not even straight up to 20mg.

[Penguin]

Hi Penguin,
Just wanted to send some love your way.
From my own experience, peri made me develops the worse anxiety I have ever had, made me feel a bit out of control. I have worked hard with myself, accepting that I can't be the person I used to be, that the additional anxiety was hormonal related and for me, I had to try to accept it. It's like other peri stuff that I needed to find a way to work best with the symptoms. But the low level anxiety you speak of, yes, it remains, just a bit  less unstable if you like.
In some ways I altered my life a bit ( lucky to be in a family situation where I can do so),  accept that I can mostly only concentrate on one ' big' task at a time, because trying to multi task freaked me out and the anxiety spiralled. I upped my hrt patches to 125, luckily this dose doesn't give me side affects and have a low dose AD. Maybe explain to to our Dr and see if a different form of hrt may benefit? Or a change in AD?

Also have now begun some counselling as well, to help me work with some massive life changes. I too lost my mum, early this year.

Maybe you may be able to understand and accept you are living with some huge changes,physically and emotionally. Be kind to yourself. None of this as a 'fault' or weakness with yourself. I sometimes look at what is happening in my life and wonder how I am even still standing. It may not feel like it sometimes, but you're bloody amazing. X

Thank you and yes you're right, it still feels like a huge change, plus I'm not working at the moment so that doesn't help. I do think I need more of something but don't know what. I can't increase the estrogel more than 2 pumps as GI side effects too much. Perhaps I need to try again and increase the citalopram as Gnatty suggests.

I think I feel the same as you in that it's always there but less unstable. And perhaps I wouldn't notice it as much if I were busier.  But anxiety really impacts my confidence so I am holding out for work with my usual company again, as I can do it at home and don't have to see clients. Do you still work and, if so, do you find it helps?

[SarahT]

Yes Penguin don't underestimate the huge changes, and therefore the impacts these have on both physical and mental\emotional heath.
As it seems the hrt is at a level your physical side accepts it makes sense to consider the AD increase instead.

And whilst being less busy as such gives more time to think about our health, the slight positive aspect is We are listening to what is going on. We may not like it ( hate it myself) but acknowledging it helps me understand myself better and maybe helps me form a way to combat the symptoms if that makes sense?
 I am fortunate in I don't work as such, but I do some casual work for friends on an ad hoc basis.  Gives me some structure and a sense of usefulness,a I get the confidence bit. Upside is it is part-time and so can work my day to what suits me in some respects,something you may be able to do to a point of your can work from home. But I have other health stuff, ME is back and am under investigations for adrenal deficiency so the exhaustion is impacting day to day stuff. Crap sometimes isn't it? X

[CLKD]

I never found being busy helped: when anxiety floors me I'm curled up in a ball in bed 

How about upping the AD every other day initially?  It's a bit trial and error for me: I take 5mg in the morning and 10mg at night [escitalopram] but if my brain feels low for more than 3 mornings in a row, I add an extra 5mg at breakfast for 3-5 days. 

[Penguin]

I never found being busy helped: when anxiety floors me I'm curled up in a ball in bed 

How about upping the AD every other day initially?  It's a bit trial and error for me: I take 5mg in the morning and 10mg at night [escitalopram] but if my brain feels low for more than 3 mornings in a row, I add an extra 5mg at breakfast for 3-5 days.

Thanks, I hadn't actually thought about splitting the dose and did the increase to 15mg in one go, so that is a good idea. Maybe I need to eat breakfast earlier so I can take the 10mg earlier too. It is once it is kicking in that my day starts to improve I think. So I wonder if one shortly after 6am and then half after lunch would be a good idea. Worth a try.

Yes when my anxiety is that bad I cannot do anything either. I go into total freeze mode, my lovely husband ends up picking up the slack with everything. That's how I know I am better than I was, in that I can function and still do stuff right now, it's just background whirring in my brain all the time.

[Penguin]

Yes Penguin don't underestimate the huge changes, and therefore the impacts these have on both physical and mental\emotional heath.
As it seems the hrt is at a level your physical side accepts it makes sense to consider the AD increase instead.

And whilst being less busy as such gives more time to think about our health, the slight positive aspect is We are listening to what is going on. We may not like it ( hate it myself) but acknowledging it helps me understand myself better and maybe helps me form a way to combat the symptoms if that makes sense?
 I am fortunate in I don't work as such, but I do some casual work for friends on an ad hoc basis.  Gives me some structure and a sense of usefulness,a I get the confidence bit. Upside is it is part-time and so can work my day to what suits me in some respects,something you may be able to do to a point of your can work from home. But I have other health stuff, ME is back and am under investigations for adrenal deficiency so the exhaustion is impacting day to day stuff. Crap sometimes isn't it? X

Yes it certainly is. And it's very tiring. Still counting my blessings though, I am better than I was this time last year. I a. Going to try CLKD's suggestion re alternate day increase, and not take the extra all in one go. I seem to be very sensitive to all kinds of medication.

[CLKD]

The brain is up there, out of sight.   . But it doesn't want too much stuffed into it at one go .......... mine has to be allowed to absorb anything extra on a slow basis.  Let us know how you get on.

[Kathleen]

Hello Penguin


I am experiencing low grade but constant anxiety at the moment so you have my sympathy.  The internal shaking feeling that I have reminds me of the sensation that I had just before I started HRT. Back then the feeling was much more intense and I learned from my trusty Meno book that it was due to low Oestrogen ( a recent blood test has confirmed that my Oestradiol is low again despite being on a medium dose HRT).

I am also on an AD but my tablets are slow release and I wonder if similar Citalopram tablets are available? It might be worth asking your GP about this if splitting your dose doesn't work as well as you would like.

Wishing you well and take care.

K.