I am wondering whether I have given this medication a decent trial and it is time to switch.
About six months ago I developed nocturnal panic attacks and morning anxiety.This developed shortly after I retired (65M). It was accompanied by fairly mild depressive symptoms but also GI complaints (nausea, loss of appetite - negative investigations). I was on mirtazepine 15mg for 2.5 months without any effect apart from somewhat better sleep. Escitalopram was added 3 months ago and I have tapered the mirtazepine slowly to currently 3.75mg.
I started the escitalopram slowly beginning with 2.5mg. Within a few days I had marked nausea, insomnia and greatly increased anxiety/agitation.I slowly increased the dose so that in total I have been on 2.5mg 2weeks, 5mg 2 weeks, 7.5mg one week, 8.5mg 3 weeks and then 10mg for the last six weeks.
Overall I still feel worse than before I started. The insomnia has improved to some degree (with added zopiclone) but the panic attacks on waking are just the same. The increase in anxiety has reduced but I am still plagued by unfocused, unpleasant anxiety till about noon every day - this was not the case before I started.The mild feeling of depression is, if anything worse, as I am now downcast at the failure of two drugs.
Have I given escitalopram a decent shot or should I give it longer at 10mg (8weeks, 12 weeks?)? If so any suggestions for what next? Thanks for your thoughts.