Citalopram not working

[Tinalou]

Hi I am really feeling desperate. After recovering on 40g of citalopram a couple of years ago I dropped my dose down to 10mg. I started feeling low in November last year and upped my dose to back to 40g over a few months. I feel worse if anything no motivation and scared of everything. I don't know what to do. I feel I'll never well again. I was on doselipine but that's been withdrawn in the U.K. . I have tried mirtazapine which gave me awful jerking legs and arms at night. Prozac makes me super anxious. I feel I am running out of options ☹️

[panic_down_under]

Hi I am really feeling desperate. After recovering on 40g of citalopram a couple of years ago I dropped my dose down to 10mg.

Unfortunately, dropping back to a sub therapeutic dose for an extended period may have been a very bad move. There is growing evidence that antidepressants become progressively less effective every time they are stopped and restarted. Two studies, Amsterdam JD, 2016 and Amsterdam, 2009 found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Amsterdam JD, 2009; Leykin Y, 2007). Taking borderline doses risks the amount of med in your system dropping below the therapeutic threshold from time to time essentially setting up mini stopping/restarting cycles.

I was on doselipine but that's been withdrawn in the U.K. . I have tried mirtazapine which gave me awful jerking legs and arms at night. Prozac makes me super anxious. I feel I am running out of options ☹️

You're a long way from running out of options. The closest TCA to dosulepin in serotonin and noradrenaline reuptake inhibition is amitriptyline (Elavil), however, it may be a little worse in terms of the usual TCA side-effects such as dry-mouth and constipation. Also consider imipramine (Tofranil). Sertraline (Zoloft) is your best shot among the SSRIs.