Re: Switching from Citalopram to Escitalopram?
Hi. Its generally recognised that chemically Esc = 2 * Cit. Since it lacks the 50% of R-Citalopram which is not beneficial. It may even be more than twice as effective as the R-Cit is not getting in the way or producing extra side effects.
This means your does of 1ml = 10mg would have been about half of the equivalent to the dose of Citalopram that you had before. 10mg is the normal staring dose for Esc, but on someone coming off 40mg Cit it does look a bit low. Did the Dr just stop Cit and replace it with Esc, or did you tapper across (reducing one and increasing the other)?
There is some debate in the literature as to how much 20mg Esc is any stronger than 10mg. From personal experience the chemistry and side effects are stronger on 20mg, although I'm less sure about the benefits being double. I class Esc as a very effective anti-depressant, but only a bit effective against my severe GAD. It does actually have clinical claims in its specification for a number of anxiety disorders, which is more than you can say for many SSRIs. Also most of the comparison studies of SSRIs look at their anti-depressant effect not their effect on anxiety.
Drs seem to assume the SSRIs are identical when it suits them, but if they were there would not be so many of them in use. The different meds strive for the same effect but (may) produce it in a different way; which would suit different patients. Eg. Even the manufacturer can't quite explain why "Esc > 2 * Cit." , different studies reaching different rationalisations even though these two have the closest chemical similarity.
When I went up to 20mg I did it in a single step - although perhaps uniquely my GP had me take 10mg twice a day rather than 20gm in one go. This was completely off-packet as the specification always says to take a single daily dose. I suspect 20mg lengthens the duration of the full effect of the med, rather than increasing the peak effectiveness, but that's just a guess on my part. I did find I had to skip 10mg occasionally as a migrainy headache developed after about 7-10 days which cleared after the missed dose. Kind of implied I was full of either the medication or Serotonin
after about a week!
In short you may be ok doing it in one go. Maths suggests its about a week for your body levels to catch up with the change in dose. Clearly the full benefit must take a bit longer than that, even on just a dosage increase.
In this post I summarised my ongoing side effects at the point I switched off the Escitalopram.
Take Care
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Kevin, Southend-on-Sea, Essex, UK
Probably GAD & Phobias. Anxiety and renewed Depression medicated (Venlafaxine). Trying to improve.