Beginning cross taper from citalopram to fluxotine tomorrow.

[kain]

Hey I've been on citalopram for 4 year and believe It has pooped out on me as my anxiety came back and I'm on the max dose.

I tried to treat it as a "blip" which I don't really buy into I'm in the first place maybe one or two days but not weeks.

So tomorrow my doctor wants me to cross taper onto fluxotine. Not sure how fast or how long a cross taper but we'll figure it out.

I have 2 questions I guess.

1. Is there a huge risk of serotonin syndrome when cross tapering ssris?

2. And has 1 ssri ever stopped working and found switching to another ssri worked?

Doctor thinks fluxotine will help with my "OCD" symptoms would she attributes to my racing thoughts and constantly seeking reassurance lol. Has anybody found fluxotine helpful in this aspect.

[panic_down_under]

1. Is there a huge risk of serotonin syndrome when cross tapering ssris?

No. At least not to the extent that it will do any harm. Serotonin syndrome is a much rarer beast than Dr Google would have us believe.

2. And has 1 ssri ever stopped working and found switching to another ssri worked?

If citalopram is the first SSRI you've taken then switching to another SSRI is worth trying as it is the easiest, and likely quickest acting option available. OTOH, if you've had other SSRIs fail previously then either a SNRI, or TCA should be considered instead, with a preference for TCAs.

Doctor thinks fluxotine will help with my "OCD" symptoms would she attributes to my racing thoughts and constantly seeking reassurance lol. Has anybody found fluxotine helpful in this aspect.

Fluoxetine seems to be reasonably effective for OCD, however, this is the hardest of the *anxiety disorders to control, so there are no guarantees.

* OCD has recently been reclassified and is technically no longer an anxiety disorder, but anxiety remains a major component of it.

[kain]

Yes citalopram is the first ssri I tried...ive been stable enough to work so I'm thinking of asking her if I can start the cross taper during April vacation since I work at a school and theres no school that week so I don't have any pressure to do anything but I might as well start getting it over with.

[panic_down_under]

Yes citalopram is the first ssri I tried...ive been stable enough to work so I'm thinking of asking her if I can start the cross taper during April vacation since I work at a school and theres no school that week so I don't have any pressure to do anything but I might as well start getting it over with.

Sounds like a plan. There are usually few serious issues when switching from one SSRI to another, however, switching to fluoxetine is a little more complicated because it has a very long half-life so it can take several weeks for plasma levels to build and stabilize. But a slow and steady cross-taper should minimize any side-effects.

[MyNameIsTerry]

No. At least not to the extent that it will do any harm. Serotonin syndrome is a much rarer beast than Dr Google would have us believe.



If citalopram is the first SSRI you've taken then switching to another SSRI is worth trying as it is the easiest, and likely quickest acting option available. OTOH, if you've had other SSRIs fail previously then either a SNRI, or TCA should be considered instead, with a preference for TCAs.



Fluoxetine seems to be reasonably effective for OCD, however, this is the hardest of the *anxiety disorders to control, so there are no guarantees.

* OCD has recently been reclassified and is technically no longer an anxiety disorder, but anxiety remains a major component of it.

Who has reclassified it? It's due to stay where it is in the latest ICD release last I looked. If you mean the OCD Spectrum Disorders group in the DSM-V, we use the WHO ICD so it won't be relevant to us.

The sooner they stop this two manual approach though, the better. And the ASA seem to be moving more & more towards creating disorders for normal human behaviour, something they have been criticised for.

[panic_down_under]

Who has reclassified it?

...If you mean the OCD Spectrum Disorders group in the DSM-V

Yes, I was referring to the DSM-V change.

The sooner they stop this two manual approach though, the better. And the ASA seem to be moving more & more towards creating disorders for normal human behaviour, something they have been criticised for.

True, but I tend to agree that OCD should be in a category of its own together with the other disorders in the spectrum as anxiety is only one component of OCD and for some is only a minor one.

[MyNameIsTerry]

Yes, I was referring to the DSM-V change.



True, but I tend to agree that OCD should be in a category of its own together with the other disorders in the spectrum as anxiety is only one component of OCD and for some is only a minor one.

I had a feeling it might be the DSM. There are some categorisations that completely disagree with each other between WHO and the ASA, Somatoform Disorders and certain impulse disorders spring to mind. It just seems bizarre that the two major manuals can't agree.

In the ICD OCD is in it's own category with other anxiety disorders clearly separated.

When anxiety reduces, obsessive compulsive behaviours tend to decrease naturally. I would regard them as closely correlated. But it can be that anxiety symptoms appear controlled by compulsions but take them away and the anxiety will become more prominent.

I'm interested that you mention it can be a more minor symptom as I've never found that in mine or others. Always interested to learn about variance though do if there is anything found in research, I would be interested to read it.

[kain]

So my doctor has decided I'm going to 30mg citalopram and 10 mg fluxotine for a month? Seems like a long time.

[panic_down_under]

So my doctor has decided I'm going to 30mg citalopram and 10 mg fluxotine for a month? Seems like a long time.

It is probably longer than it needs to be. I would have suggested 2 weeks on 10mg fluoxetine then 20mg with a drop in the citalopram. But your doctor is in a better position to make that call.

[kain]

Your right I just don't always know what to think with doctors. They all have different opinions on everything....i heard your body metabolizes fluxotine diffrent then citalopram.