Question: I am on a low dose of Celexa and I have developed a mild to moderate tremor. It’s not severe or disabling but I think other people would notice if they saw me holding something. First, I want to ask if this means I’m at a heightened risk of a seizure? I otherwise feel fine but I just read about there possibly being a seizure risk with Celexa and now I’m worried. Note that my plan was to wait until Monday to talk to my doctor.

I’d like to give you more detail about my long history with Celexa/SSRIs and Wellbutrin (all for anxiety) and ask you some more questions. I’ve been on an SSRI (first Lexapro and then Zoloft and now Celexa) and Wellbutrin for about 15 years. In 2015, over about 8 months I tapered off the Celexa. A few weeks after I was completely off it, bad anxiety hit me. After a few months off, I did a low dose reinstatement (1.5 ml or 3.0 mg). Note that I had been on 40 mg of Celexa before the taper and have been on 200 mg of Wellbutrin for many years. The reinstatement was helpful although I never got entirely back to normal. I gradually lowered the dose to 0.5 ml and was on that for many months until mid-May of this year. My anxiety had gotten worse and I tried increasing the Celexa to 1.5 ml. My anxiety got better but after about 3 weeks, I developed a hand tremor. (I technically have had a very mild hand tremor my whole life but it got significantly worse). After it took me a month to realize this was likely due to the Celexa, I decided to get off the Celexa. I tapered it in about 2 weeks. For a while I was doing well and the tremor was gone but about 3 weeks after I had completely stopped the Celexa, my anxiety was really bad again and the tremor returned. I could tell this was not my normal anxiety (and low mood). This was more like how I felt off Celexa in 2015. After thinking it over for a few days, I did a low dose reinstatement of 0.5 ml on August 13th since that’s the dose I had been stabilized on as recently as May and I was doing adequately on that. My mood got better and for about 3 weeks, the tremor went away. However, earlier this week the tremor gradually came back and it’s now almost at the point where it was back earlier in the summer. I know this is a low dose of Celexa but this has been my experience. I think that my brain is very sensitive to even tiny changes in the Celexa dose.

So I’m not really sure what to do now. I’m wondering if my brain has simply gone through a lot of dose changes and needs time to adapt. That is, I’m wondering if I should just stay at 0.5 ml for a while and see if the tremor goes away. I’d be very concerned about the idea of quickly stopping the Celexa since stopping has backfired twice already. An alternative I’d feel comfortable with is gradually decreasing the dose (perhaps by 0.1 every few weeks). What are your thoughts regarding my Celexa dose?

The main reason I tapered in the first place (way back in 2015) is that I was worried about long-term effects of being on psychiatric medications. Ideally, I’d like to be off both the Celexa and Wellbutrin but that’s a long-term goal. I just wanted to add that I am willing to tolerate the tremor for now and just see if it goes away unless you think that's a bad idea.

Thanks for your reply. I’ve been thinking back about my symptoms/side effects this summer. I just realized that at times when I had increased to 1.5 ml over the summer, I was worried my memory wasn’t quite as sharp as normal and I thought I might be a little less alert driving. I just realized that this week the alertness issue may have been coming back. There were a couple of times driving where I wasn’t certain I was paying quite as close attention as usual. I’m not sure if this is temporary and how serious it is. I haven’t come close to causing an accident. But there was one instance where I was turning and I assumed oncoming traffic had a stop sign but it didn’t. It was also XXXXXXX and hard to see and thankfully the cars were far enough back that it didn’t matter. I think/hope that if the traffic was closer and still going fast, I would have realized it but now I’m worried. I’m not sure what to do.

That’s a reasonable interpretation but I’m not certain it’s what’s happening. I’m sorry to keep bothering you but I just want to give a little more information and double check that you still believe this is anxiety and I should not change the dose. The reason I’m not certain is that I’m often finding that when I have these symptoms, it’s during things I enjoy and find relaxing and I’ve been feeling relaxed despite having them. (Well, I was feeling relaxed until yesterday when I started worrying this was due to Celexa.) The tremor is most noticeable during photography, which is a very relaxing hobby for me. And I just realized that I’ve been having the lack of alertness while watching baseball too. I just want to give more detail about the lack of alertness since I found a better way to describe it: It seems like my mind is wondering or daydreaming (not necessarily to unpleasant things) when I would normally be paying more conscious attention.
Do you still think this is anxiety and I should keep the dose the same? Hypothetically, if it was due to the Celexa, is there a chance it would go away with time and how long would that take? It’s puzzling because I didn’t have these symptoms when I was on the same Celexa dose before the summer started, but I did make a lot changes in between. Thanks for getting back to my other two messages so quickly.
Actually, I'm not sure if it's more accurate to say my mind goes blank or is wondering sometimes when I feel a little less alert.

OK that makes sense. Another question. I've been thinking more about my symptoms and how to describe them. My lack of attention and concentration are worrying me. I'm often just staring and not really paying attention to things. I'm not sure if I'd say I'm drowsy or just "out of it."

I'm wondering if I should try taking the Celexa at night instead of in the morning. Maybe these effects would partly wear off by the morning. I do feel a little better in the morning before I've taken my Celexa dose. The reason I'm a bit reluctant to do this though is that I already take Benadryl at night. If the Celexa is also making me drowsy or out of it, I'm wondering if the two together could have a bad effect. Drugs.com says there's a moderate risk of a bad interaction between the two (drowsiness and lack of concentration). I may already be experiencing this interaction actually, even though I don't think I did in the past (before I made any changes to my doses in May). I'm wondering if the interaction could be worse or even dangerous if I take the two together.