DOSE:	30 mg	oral	Pharms - Citalopram	(daily)
	350 mg	oral	Clozapine	(daily)
		smoked	Tobacco	(daily)

BODY WEIGHT:

90 kg

I'm a male in my 20s. My weight is >90 kg (lowest weight I have been was 70 kg, but I've gained over 20 kg, while I've been on clozapine).

I was diagnosed with schizophrenia when I was 19. I started having depression and anxiety when I was 13. My school didn't go that well, because the lack of motivation. I first tried alcohol when I was 15. Also at that age I had experiments with benzos and opiates. They helped my symptoms, so I used them once in a while. I wasn't really motivated into eating SSRIs or antipsychotics. I had my first hospital visit when I took too much benzos and tried to kill myself. It was a paradoxical reaction. I was in the psychiatric ward for a few weeks - it didn't help. I was on quetiapine and oxazepam then, but they didn't do much so I never took them after that. Quetiapine (Seroquel) made me tired and dried my mouth, with a dose of 50 mg a day. The oxazepam was something like 15 - 30 mg a day - it was too little.

Anyway, second time I was hospitalised a few years from that - at the age of 19.

I was started on risperidone. The dose was 3 mg / day mostly. It made me restless and I couldn't concentrate on anything. I never heard voices or had hallucinations, but I had other (negative) symptoms - many of them. Anxiety, depression, abnormal thought process, emotional dullness and extreme sensitivity. I couldn't handle stress even a little bit.

Risperdal made my depression worse, so I was put on citalopram. Back then I felt like shit. One night I was given 50 mg levomepromazine - and I've never felt so dysphoric. It made me so tired and I couldn't walk, but had to support my body against the wall to stay up. That wore off, and I was given lorazepam 2 mg / day - while the citalopram was starting to take effect (3-4 weeks). The lorazepam helped - but it was stopped after some time.

The citalopram was started at 10 mg / day. After a while it was increased to 20 mg / day. I started feeling better with the depression and I think it cut some of the anxiety also. A few months and I started having minor depression - then it was increased to 30 mg. And it helped - again. I haven't noticed any side-effects with citalopram. It's usually well tolerated. I'm still taking it - after years.

I used the risperidone for a half a year. Then I did some stupid things and my doctor decided to start clozapine to calm me down. The risperidone was cut off and I was started with 12,5 mg clozapine a day (very small dose). It was prescribed to be taken in the evening. Next day my blood pressure collapsed and I 'saw stars' - that went quickly away and it never happened again. I was quickly increased to 300 mg day. (Today I'm taking 350 mg in the evening). Clozapine requires bloodwork to be done once a month, because it has some effects like affecting the amount of leukocytes and other blood cells (I don't really know much about the blood stuff). My leukocytes have been really down and then up again like a rollercoaster - my doctor has been worried about this. Currently the bloodwork is OK.

I'm a smoker and smoking has an effect on some liver enzymes, that metabolize clozapine - so my clozapine plasma concentration is lower than it would be if I wouldn't smoke. On the other hand: caffeine actually increases the concentration - vice versa. Currently my concentration is 0,6 nmol or mmol / L. (Not really sure if it's nano or micro mols), but my doctor said this is a low concentration. He's not going to increase my dose, because I'm feeling okay, despite the low concentration

The side-effects of clozapine are extreme tiredness (after taking the dose), pronounced production of saliva (night time) and constipation (all the time). There's not much I can do to the saliva issue, but the constipation I can help with drinking coffee (in the morning) to stimulate my bowel. The tiredness is so extreme, that caffeine only does little to that. After sleeping for 10 hours I don't feel tired anymore when I wake up in the morning, and I can function normally in the daytime. Clozapine takes effect within an hour of dosing (usually less than hour). It's really good, because I don't have insomnia issues while on this medication.

Currently I'm feeling well, thanks to the medication. Clozapine is usually one of the last antipsychotics to be prescribed due to the side-effects. It's not really good if one is into alcohol or other downers, because the synergy effects can be dangerous e.g. respiratory collapse or breath deprivation. I know one case, where one died after dosing alcohol, benzos and clozapine at the same time. I don't really have an alcohol or a drug problem, but if I'm going to use downers I'm going to be really damn careful and probably skip or delay taking clozapine for that day.

I'm still having some symptoms related to my mental condition, but I can handle them and live with them. Clozapine is a great antipsychotic, but not really a miracle drug.

Exp Year: 2012	ExpID: 94636
Gender: Male
Age at time of experience: 20
Published: Jan 27, 2012	Views: 21,697
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Clozapine (562), Pharms - Citalopram (227) : Not Applicable (38), Medical Use (47), Combinations (3)