Hi, I'm WorriedSon

HI @WorriedSon, welcome! First of all, your mom is fortunate to have such a caring and concerned son who wants to help. Bear with me as I address your points the best I can. Hopefully some other members can offer their input as well.

"My Mum was prescribed Citalopram in late 2024 due to symptoms that my family and I are not entirely sure of, but which must have been significant enough for her to agree to treatment." — @WorriedSon

I'm curious as to the reason she was put on it in the first place. I wonder what symptoms she was having. Question: How is your mom now compared to the way she was before going on these drugs? Is she worse, better, or about the same?

"After just a few weeks her dose was doubled, and she was given Zopiclone to help with Insomnia side-effects. This is when we became aware of her condition and she was in a zombie-like state." — @WorriedSon

I'm sorry this happened to her. A drug causes a side effect and then another drug is added to "treat" the side effect of the first one. This is how polypharmacy starts.

"We got her to a private doctor, who took her off the zopiclone, switched to melatonin, and Citalopram dose back down to 20mg. She then improved a little, exited the zombie state, but just improved to very very low mood, poor cognition, isolated signs of paranoia, eating problems" — @WorriedSon

I wonder how long she was on the Zopiclone and how fast she was taken off. She probably experienced withdrawal effects from that and then effects from the reduction of Citalopram.

"She was then prescribed Mirtazapine and she stayed on an unknown dose of that for a little while. Retrospectively, we think around this time she improved quite significantly, but, she came off that drug for unclear reasons and since then has been in a very emotionally muted s..." — @WorriedSon

This is another drug that was added (probably due to withdrawal effects from the other two) and then taking her off of this one produced additional withdrawal effects. Making too many changes in drugs and doses can cause issues and sensitize the nervous system.

"In the last year we have seen quite frequent instances of her old self emerging, but these are isolated against a backdrop of general emotional mutedness." — @WorriedSon

Seeing her old self emerge is a great sign that she's starting to heal from all the drug changes. Any "emotional mutedness" is most likely a residual withdrawal symptom. We have some information about this: https://taper.community/thread/01f52b44-64c9-44d7-9e37-280e1818c90c https://taper.community/resources/blog/emotional-blunting-from-ssris Regarding your options ... considering your mom's history, frequent drug changes, and her current state it might be best to actually not make anymore changes at the moment. Adding more drugs could complicate her situation even further. A suggestion would be to give it some time so she can stabilize a bit more and then slowly wean off the Citalopram. I know that's not what AI suggested, but that's what I feel would be the safest and best option. Let me know your thoughts. I know you want the best for your mom, but I'm not sure that more drugs are the answer. Also, here is some helpful information since you're caring for her: https://taper.community/thread/ecea5d5c-ab7a-43f4-80b2-994bbee9fbf8 Catina 🩷

Hello Catina, and thank you for your reply to my post. I'm so grateful to have feedback from people that understand the nuances of situations with these drugs. I will try and do what you have done and reply to your questions one by one. Hopefully it will appear as your post, with quoted questions and then my answers, but if it doesn't work apologies.

"welcome! First of all, your mom is fortunate to have such a caring and concerned son who wants to help.""

Thank you :)

"I'm curious as to the reason she was put on it in the first place. I wonder what symptoms she was having. Question: How is your mom now compared to the way she was before going on these drugs? Is she worse, better, or about the same? "

Part of the problem we have is that we don't know. Well, we do and we don't. She was absolutely fine. She had recently moved home, and we (my siblings and I) had visited her in her new home. She seemed fine. But, something changed that we did not notice, and she did not share with us. In the space of a couple of months she deteriorated to a state that made her seek medical support from her GP. What she was feeling is something that we have not been able to get her to share with us. She either does not want to tell us, because as her role as Mother, she does not want to burden us, or, she can't remember, or, she cannot articulate the experience. My assumption is that she felt pretty bad, and I think it was either anxiety or depression. My Mum is ideologically against drugs and lives quite a natural lifestyle, so for her to go on anti-depressants is out of character.

"I wonder how long she was on the Zopiclone and how fast she was taken off. She probably experienced withdrawal effects from that and then effects from the reduction of Citalopram."

It was all very quick, and at this time we were paying very close attention. We noticed her being in such a terrible state 1-3 weeks after the 20 to 40mg Citalopram increase. This was in combination with the prescription of the Zopiclone. So she wasn't on the Zopiclone for very long, and was only taking it sparingly. The doctor had warned her not to take it too much, and she was following that advice. My view is the 20mg extra Citalopram with the Zopiclone is what pushed her into the very deep decline. I think she was actively taking Zopiclone for one month - six weeks and only intermittently. If I compare my Mum today to let's say 6 weeks before going onto the drugs, I would say that she is a different person. Whilst the drugs might have solved the symptoms that she did not share with us, let's call them possible depression/anxiety, her personality is entirely subdued, her ability to interact in social situations is massively impaired and her ability to converse is hugely dampened. All of her previous interests are almost entirely gone. The way I currently see my Mum is like a very cloudy day. Her identity is almost completely obscured by clouds, but, occasionally, the clouds break and I see my Mum again, which reassures me that she is still there, but, she is massively subdued.

"This is another drug that was added (probably due to withdrawal effects from the other two) and then taking her off of this one produced additional withdrawal effects. Making too many changes in drugs and doses can cause issues and sensitize the nervous system."

I don't think she was on the Zopiclone for long enough for withdrawal to be an issue, and the same for the 40mg dose of Citalopram. It was so short. Less than a month. My interpretation of the prescription of Mirtazapine was to address motivation,

"Any "emotional mutedness" is most likely a residual withdrawal symptom."

My understanding is that the mutedness is just a sideffect of the neurotransmitter imbalance caused by the Citalopram, rather than withdrawal, as she was only on the increased dose for a short time and was not taking the Zopiclone every day.

"Regarding your options ... considering your mom's history, frequent drug changes, and her current state it might be best to actually not make anymore changes at the moment. Adding more drugs could complicate her situation even further. A suggestion would be to give it some time so she can stabilize a bit more and then slowly wean off the Citalopram. I know that's not what AI suggested, but that's what I feel would be the safest and best option. Let me know your thoughts. I know you want the best for your mom, but I'm not sure that more drugs are the answer. "

So, I totally agree with you, caution is the best option. The changes happened 2024->2025 Late 2024 20mg Citalopram. Late 2024 40mg Citalopram. Zopiclone, intermittent Early 2025 20mg Citalopram Zopiclone removed Early 2025 20mg Citalopram Mirtazapine introduced MId 2025 20mg Citalopram Mirtazapine stopped by my Mum That was the last change. So my view is that early 2027 is when we should consider a new direction, preparing for it now. But, cautiously. However, your advice is exactly why I'm posting here, so if you think it's still too soon, then I will think again.

Thanks for your reply. Perhaps some other members can offer their input as well. You're approaching everything with great care, which is the best course of action. Continue to keep a watchful eye on things and hopefully in a few months you will know better what to do. Please keep us posted on any thoughts or concerns that come up in the meantime. 🌸

Thank you for the reassurance Catina, it is very much appreciated.

Hi WorriedSon, my thoughts go out to your poor Mother for what's happened to her and IMO potentially exacerbated by her Dr. I know the drugs part has been discussed but there's also the counselling side. Obviously something very upsetting happened to trigger all this, which she doesn't want to talk about, but is there a best friend that could try and get it out of her? Is she religious, maybe her religous leader? or even a trained counselor that can visit her in strict confidence where she feels safe and get to her open up a little. Please accept my apologies if you've already tried all this.

Hi Cosmic. So, I am very much with you on the situation with the Dr. I feel like it was a massive mistake for them to prescribe the drug, because all that drug is doing is a. first of all caused the cognitive crash, b. it kind of cuts off much of her identity and provides her with a state of chemical placatedness, and c, complicates her recovery massively. I think the counselor suggestion is a good one, and ideally it is what would have been recommended by the doctor in the beginning. I have to be careful in my criticism of the doctor, because I was not there in that initial consultation, and don't know what my Mum told her that resulted in this prescription. But retrospectively, and without all the facts, it looks like a massive mistake. In terms of the counseling, this is something that she is resisting. This resistance is something that my family and my Mum's friends are struggling to interpret. She resists counceling and she resists opening up to anyone. We don't know why. We partly believe that it is due to cognitive impairment, exacerbated by these drugs, that is making it difficult for her to articulate the thoughts and answers to engage in the conversations that people are asking her. Thus she finds these conversations very difficult, as she simply can't answer. We partly believe that she is trying to maintain a kind of protection of her situation, and to not share with other people, based on her belief that she does not want to worry people. It is her problem and she wants to solve it herself. There are other factors at play too, including that we are concerned that there might be a mild element of coorcive control coming from her husband. If this were true, then we believe that she does not want to be seen to be taking guidance from people other than him, for fear of exacerbating his overbearing character. If my Mum were herself, she would agree with you, and she would encourage the same advice that you are giving. Get counciling. Or, speak to your friends. The key is speaking. She has suffered a trauma. The initial trigger was a trauma in itself, and the corresponding treatment programme has caused trama too, and she needs to talk about it, but currently won't, or can't. I went to see her Tuesday night, and her husband was not there. In these instances I have begun to notice that she is much better. When he is around she retreats, but when he is not there, she comes out of her shell significantly. She exhibited many of the traits that I identify with her. The next day her husband was there and she was retreated again. Either way, one of my objectives of the visit was to engage with her the topic of considering her treatment and to reingage with the specialist adult mental health service that we managed to get her referred to in 2025, that she herself stopped participating in. To me this is what we need, because this service engages with people in her situation on a daily basis and has longitudinal experience in how patients react to drugs, in contrast to her GP, who has a much more fleeting and intermittent interaction with people. This service also provides counceling. However, whilst I was there, I did not do this. The reason is that I'm afraid to. When I have this time with my Mum, and I feel like she is coming out of her shell, I feel like this is a therapy for her in itself, and it allows her true identity to step out and to stretch it's legs and exercise itself. Especially when away from her husband. So, in this case, I can either let her do this, become herself, and be in a safe environment, or I can myself challenge her, and bring up the topic that she does not want to engage with. I opted for the more nurturing approach, and I think that the best advice I can give myself is to try and find more opportunities to spend time with her, away from her husband, and allow her to spread her wings, in a manner of speaking. The more she is able to do this, I believe the more of her personality will emerge, and with time her resilience and agency will return.

Hey worried, She could not have wished for a better son. I understand your situation as my mother had a bullying husband (my father) but her 'old fashioned' role as housewife meant she absolutely did not have the strength to do anything about it. I'm not a trained councilor, but it appears to me that all you can do is what you're already doing, just being there for her, no pressure, without her husband, which i'm sure you making happen more often. Just feeling better and coming out of her shell during those moments is a positive sign. Once she's processed what's happened, she'll open up a little more and begin sharing little fragments.

Thanks Cosmic for the optimism and faith that it will turn out well. I have actually just tried to organise another trip next week, and so if I can make that happen, I will update here, as it is just nice to have somewhere to organise these thoughts and to gain some encouragement that I am doing the right thing. I'm battling with the feeling that I am intefering, so this really helps. Thank you :)

"feel like this is a therapy for her in itself, and it allows her true identity to step out and to stretch it's legs and exercise itself. Especially when away from her husband. So, in this case, I can either let her do this, become herself, and be in a safe environment, or I ..." — @WorriedSon

You are 100% right in believing that your visits are therapy. It indeed sounds like your mom has experienced some sort of trauma and is dealing with it to the best of her ability under the current circumstances. Her ability to “ be herself” when you are around is more therapeutic than you know. Please don’t feel like you are interfering, you are giving your mom space to be herself away from her spouse, which is fabulous as it doesn’t sound like she is able to do that right now when he is around. Keep doing what you are doing and hopefully your mom will continue to improve. Perhaps once she has gathered some of her strength back she may be more willing to engage with outside services 💕

Thank you Mama for the encouragement. I went to see her again this week and we cooked dinner together. She says that she has no interest in cooking anymore, yet, we had fun in the kitchen together and she cooked the meal. So I am feeling that I am on the right track here.

This week I read the book The Inflamed Mind, by: Edward Bullmore and I feel like this theory of inflammation-depression really resonates with the situation with my Mum, and there are various things in her medical history that make me feel like inflammation relates to her. Super interesting book.

"inflammation" — @WorriedSon

I think inflammation is behind so many health issues.