Citalopram and Amitryptiline

[sandie]

I would have stuck with Amit, but the counsellor said she felt it wasn't touching the depression and I should consider something else - hence the low dose Citalopram in the morning, and then subsequently the 10 mg of Amit being added around 10 days ago.

Ideally, I would like to see if perhaps it is advisable to continue with 10 mg Citalopram in the morning, but increase the Amit at night to say 20 or even 30 mg ? Have left a message at the GP surgery, for my GP but they are so slow in getting back to patients and it is almost impossible to get an appointment without waiting 3 weeks for a GP of choice or 10 days for another GP. Telephone appointments are also as rare as gold dust !

[panic_down_under]

I would have stuck with Amit, but the counsellor said she felt it wasn't touching the depression

Hardly surprising. The usual starting dose is 75mg and most take 100-150mg for depression which is typically harder to bring under control than anxiety. The maximum recommended dose is 300mg/day with medical supervision. There are readily available blood tests for TCAs to determine whether plasma levels are in the therapeutic range and they should be used initially to optimize the dose.

Ideally, I would like to see if perhaps it is advisable to continue with 10 mg Citalopram in the morning, but increase the Amit at night to say 20 or even 30 mg ?

There are two potential problems with this. Firstly, the usual minimum therapeutic citalopram dose is 20mg and ideally you should be increasing to that after a week. Staying on 10mg for extended periods is not a good idea as it can increase the risk of the med ceasing to work, assuming it even kicks-in at 10mg. And 20-30mg amitriptyline might be iffy even with 10mg citalopram, at 20mg the alarm bells would likely be ringing, however, that is something a psycho-pharmacologist should be deciding. I suspect your GP doesn't have the knowledge. Even many psychiatrists may not these days as few seem to have much experience with the older ADs.