So I was prescribed Citalopram 10mg. I was too scared to take the whole dose so I took 2.5 mg for a few days, then 5mg, then 10mg. I took 10mg for a few days, and one night I had fast heart beat. It kept me up all night. I was afraid to take it again so I missed a day. Now I’m wondering if it’s safe after missing a dose to go back to a lower dose. My anxiety is high due to MAV and I can’t deal with any symptoms of the heart or I get really scared and anxious. My chest has been hurting and feeling tight, but I’m thinking it might be due to the fact I feel kind of depressed now.

So, do you guys think a 5mg or 2.5 mg dose today would be safe?

Hi Lucille,

The rapid heart rate in the night etc is a start up effect when you begin using Citalopram or Lexapro. If you can tolerate the med at 10 mg apart from the heart racing I’d actually stick it out at 10 mg. I’m sure things will settle for you in a week or two. Another thing you can do is take it in the morning and not before bed. When I was on it I took it before bed for years and would have a racing heart in the night sometimes. When I switched to morning it all went away. Robert Baloh calls this med his current favourite so well worth sticking it out. It’s a very safe med. It sounds like your chest tightness etc is from some anxiety you’ve had which Celexa will alleviate.

If you find that you just can’t do the 10 mg then you could drop to 5 mg for a little while and move up again although you might still get the added effect at first while your body adjusts when you do go to 10 mg. 10 mg was a good maintenance dose for me. It’s a shame the SSRIs cause me so much myalgia otherwise I’d be back on it.

Scott :slight_smile:

Thanks so much for the reply. That day, after I read it, it gave me the courage to take it. I only took 2.5 mg. But I think if I wouldn’t have had any help, I wouldn’t have taken it all together. Sometimes the anxiety takes over me. I took 5mg, and now I’ve been taking 10mg for the past while. I feel like it’s helped with my anxiety somewhat. I’ve been told it takes anti-depressants 4-6 weeks to start really working. I’ve been on it since April 30th, so I’m just waiting. Maybe I can up the dose. I’m glad I at least have some relief. The anxiety this BS produces is unreal. Do all SSRIs cause you pain? What do you take then?

Thanks so much!

Hi Stacey,

Glad you’re making progress. Yup, MAV certainly does cause a lot of anxiety. I’ve been to hell and back with that, that’s for sure. Another thing you can do while your nervous system calms down again (note, this is a long process once the CNS is sensitised so don’t be alarmed if you still feel wired at times but it will come back to baseline) is to grab some valium. I used to use it and still do when things flare up or when it disrupts sleep. Most find that valium causes no side effects even for me and that’s really saying something considering even vit C tabs give me a headache.

Give it 6 weeks on Cip and then bump it up to 15 mg. When I was really wrecked, 15 was the magic number and then, over time, I was good on 10.

Right now I’m on a low dose of Paxil which seems to not aggravate myalgia and have been trialling 5 mg of valium before bed for a few days straight to see what effect it has on migraine control. So far I definitely feel better. It’s a bummer it’s nearly impossible to get scripts for it in Sydney.

S 8)

Hiya Scott,

Thanks for always being so helpful and informative. You mentioned my CNS is sensitive and it will take a while to calm down, does MAV cause that? So MAV does have affect on the CNS? Thanks for the advice, I’ll def ask a doctor about Valium. I’m sorry you’re so med sensitive. I’ve never heard of myalgia and MAV. Are they related or two separate problems?

I have a question for some advice about the Citalopram. I’m just SO med sensitive now. I was never like this growing up. I had no problems taking whatever, but now I feel like my body freaks out over everything. Anyways, I’ve been dealing with the increased heart rate, I heard anti-depressants cause that until your body gets use to it. So I’ve been dealing with it. But last night, my heart was beating so fast it woke me up. It was very uncomfortable, so I stood up and walked around. And all of the sudden, my body felt flushed and strange all over, like pins and needles intensely all through my body. And I got very mentally confused, I wanted to put on some shorts to go to the ER (I felt like I was having a stroke!!) and I didn’t know what I was doing. I was walking around the room trying to figure it out. It was the weirdest and scariest thing I’ve ever experienced. Then, all of the sudden, after a few minutes, it stopped. I relaxed and was relieved. I don’t like going to the doctors, especially the ER. After dealing with all this BS, I’m convinced most don’t know what the hell they’re doing. Well, I called and left a message at my doctor’s office, but of course today just had to be a Sunday so no one is going to be around. Do you think I should take another one or wait til I hear from my doctor? If it’s just my body getting use to it, I can handle it. The Citalopram has helped a lot with anxiety. So I’m not that worried about things anymore. But if it’s something that could be dangerous, I’ll figure something else out. I gotta say I really love this drug though. It’s hard to believe this is suppose to be one of the mildest ones out there. I’d hate to see myself on a non mild one. I apologize it’s so long. I know you’ve had experience with it, I’m just curious if it’s ever caused that for you.

– Stacey.

Well, I ended up pushing through and am bumping it up now. My doct gave me 20mg. I’ve taken a 10mg and half of a 10mg and it’ll be 15mg. Then gradually to 20mg. I’m wondering if I even need to go up that high. It kind of started wearing off effects a several weeks after taking it. I feel like I have the kind of body that always adjusts to things and gets use to it and then the effects begin to wear fast.

Hi Stacey,

I think there’s two things that happen to sensitise someone – they genuinely and undersatndably freak out when all of this arrives in their lives and second, migraine and MAV itself can provoke a physiological anxiety. When it hits, you’re sitting there wondering where it came from. When that happens I throw back valium to ride it out. Occasionally it screws up my sleep too with heart thumping all night.

Steve Rauch said once that migraineurs expoerience and amplification of other things that most people may not notice. So if you have sore joints on a given day, for a migraineur it feels a lot worse. Many here, including me, experience myalgia here and there with attacks. Sometimes it feel like I have the flu.

Are you still getting the rapid heart beat at night? Cipramil did that to me as well but I mostly avoided it if I took it in the morning.

I would bump it up to 15 mg and see what that’s like for a month before hitting 20 mg. For me it was the spot where I got better and then I dropped to 10 mg months later to reduce the side effects and maintain things. The side effects are proportional to dose according to a psych friend of mine.

Cheers … Scott

I think you’re exactly right about the anxiety. I actually asked my neuro-ologist about Valium and he said he’d rather not have me on it. He doesn’t like to use it. He likes to lower the anxiety I guess with a medicine that gradually does it. He thinks that it’s not good to use something like Valium when you are having a panic attack because he says your brain gets use to and expects that chemical every time you go in a panic mode. I think it’d be better to have it just in case. But whatever.

I generally just feel like sh*t 24/7. I guess flu like is a description. Just tired and crappy feeling.

I bumped the Citalopram up to 30mg. It’s the same thing every time. I up it. I feel like crap. I get use to it. I feel good and then bam, my body gets use to it and it doesn’t have the good effect. So I increase it again. I think it’s just not for me. It’s helped somewhat with the anxiety and made me feel good at times, but did nothing for the 24/7 off feeling.

I guess maybe Citalopram only helps with anxiety, but not with the dizziness or cognitive problems?
What’s your advice on trying Citalopram and Topamax together? I went to a drug checker online and saw I could take them together. I’m thinking of asking my doc, not sure if anyone knows about how they would work together.

Hi Stacey,

It appears you’ve given this a good bunch of time to see if it’s going to eliminate all of the symptoms. Sorry to hear it hasn’t killed the crappiness completely. For some citalopram does totally control the migraine and thus everything else it dishes up. It never controlled the pain for me however, and so I still got the headaches if I didn’t avoid trigger foods and I think I already mentioned that Cital also caused me to develop a weird myalgia and more headaches some of which I still have now.

As far as combining it with Topamax, I cannot see any problem with this. I have a Medscape app that checks for drug interactions and there are none for these two. Still, you should obviously review this with your GP.

It sure is strange how some drugs clean up the dizziness for some but not others.

Keep us posted on the Topamax trial if you go there.

Best … Scott


I saw on Dr. Hain’s flowchart it says not to take Topamax with Effexor…it’s the same type of drug…now that is confusing to me as one is an antidepressant and the other an anti-seizure med, and so I don’t get it. Any input on that one?
I’ve been wondering about adding Neurontin to my Cymbalta, as I feel fine mood wise, but still get the visual dizziness. If I take Klonopin, it helps. That leads me to believe that anxiety is at the root, or that calming my central nervous system down more calms the visual hypersensitivity. In either case, Neurontin is supposed to be good for that…and anxiety…

My internist said maybe I should just accept that this is the new “norm” and try yoga, biofeedback etc…of course I think it’s a chemical thing and want to adjust the chemicals to feel like my old self again…



I just wanted to say that I’m on 40 mg of Celexa and I feel 50% better. It took me a few month to get up there. I did feel really tired everytime I increased the dose… I think you should stick with it. If you have any questions about ask away!!


I’ve been on this med for 4 days at a very teensy dose (1/2 of 5 mg) and have had severe nausea. I know this is a common start-up side effect but at such a small dose I’m astonished that it’s this bad! Anyone else on this med experience nausea like this and did it get better with time? I wonder if MAV has just made me uber sensitive to all meds now!

Hi Emma,

Just wondering how long it took you to get to 40. What dose did you start with and how often did you increase? On what dose did you start feeling a bit better? what symptoms have gone for you? I ask all this as i just started (on 10mg). tolerating it very well, with some nausea that was more severe at the beginning.


Lisa - Can you tell me how long the nausea lasted for you when starting this med? What mg did you start with? Was nausea a symptom of your MAV before you started Cit?
Sorry for all the q’s, I just know you’ve said you are med-sensitive like me and am encouraged to hear that the nausea improved for you as it’s the only side effect I’m experiencing, but of course is very uncomfortable.

No problem. let’s see. I started on 5mg for 2 days and then increased to 10mg. my doc said start with 10,but I decided to start with 5 first. The nausea at the beginning was pretty severe, especially after I took the pill. I take the pill at night. throughout the day, I was also nauseous until midday. this lasted approx 4 days or so then got better, but strangely reappeared after 7 days on the med. I am still nauseous but not as nauseous as the beginning, and I know this will pass. I have some mild nausea with MAV, but this is definitely med related. did a neurologist prescribe you celexa? what were you told in terms of therapeutic dose for MAV, etc.?

I was prescribed it by a neurologist at 20 mg but insisted that I started at a lower dose. Good thing because even 5 mg was a lot for me to start on which is what I did the first 2 days (I cut a 10 mg in 1/4s for the last 2 days). The doctor was saying I might need to go up to 40 mg. The nausea seems to be at its worst in the morning but that’s also when I’m most anxious with getting a new day started so I’m sure that adds to the feeling. I’m going to try to stick it out for at least 2 weeks barring that the nausea doesn’t get any worse in the meantime. I would really love for this medication to work and don’t want to feel like I gave up without giving it a real try which I sorta think I did with Effexor. Did you switch to this recently from another med?

I did switch. was on nort. got up to 50mg over the course of many months. seemed to be getting worse past 30mg, so I am decreasing the nort and trying celexa. all the best to you. please keep us posted.

Hi Lisa,

It took me about 2 months to get up to 40 mg, and I started with 5 mg. At around 20 mg I started feeling a difference.
Since I’ve been on Cipramil I don’t feel as dizzy and I don’t get as tired. I can work and feel somewhat normal. But the dizziness is still there but not as much as before. However, I have this tilting sensation to the left that never goes away …


do you have disequlibrium. that is my most debilitating symptom. did it take care of that?

Hi Lisa – it definitely killed my dysequilibrium at 15 mg. That was one of my worst symptoms … that and visual vertigo.