View Full Version : CBT therapist recommended I up my dosage to 40mg
I have an appointment with my doctor in a week to discuss this. The thing is though when I upped from 20 to 30mg I experienced paresthesis (sp?) which terrified me so I will inevitable get this again? Also I hate medication and due to the link in Citalopram and heart problems (albeit at a higher dosage but worries me all the same) I was hoping to decrease it.
Any suggestions on what I should do?
CBT practitioners are not doctors and as such not able to prescribe medications.......
you should speak with your doctor about it and really, if you don't feel comfortable with increasing the dosage it is probably going to be counterproductive anyway.
30mg is a pretty good dose. I wish I could find the link now (can't) - but I read something recently about Citalopram showing that the increase in what the medication actually achieves in the brain is very little between 20mg and 40mg..... i.e. it 'maxes out'. You could ramp up the dose to 40....60...80mg and not actually achieve a whole lot more effect over 20mg.
Some people will swear a higher dose did the job for them but IMO if 30mg isn't helping you 40mg isn't going to improve the situation, probably just increase any side effects. Perhaps the medication isn't the right one for you.
Do you feel citalopram is helping you now?
I feel it is helping me in the same way Fluoxetine did. I don't think I will improve anymore from meds. I have very low self esteem and it is literally ruining my life. I will discuss with doctor next week as I am happy to stay on meds but its 20mg per day the way I have for almost 5 years.
Thank you for your reply.
Definitely discuss it with your doc. (S)he may think it better to try to increase the dose, stay at the current dose, or switch to something else, like escitalopram.
What is the CBT therapist's justification for increasing?
Hi I will do that.
She said I have a 'flat' mood at the moment which is correct if I am honest. She is giving me tasks to complete and I am struggling to get started on them. She said she would speak to the doctor for me but I like to then I can give my opinion directly to him.
Well, frankly, I question the wisdom of pressing forward with CBT while you are undergoing any dose change and adjustment. What can happen is that you are working hard just to cope with the side effects of the med.
Maybe the best thing is to try the new dose and let it settle at least a few weeks, and then see how you feel.
Also bear in mind that CBT may simply not be your ticket. At least for me ACT has proven far more useful.
Hmm, I'm thinking along the same lines at Keith here...... CBT (done properly) is quite a big commitment and messing about with meds at the same time could make things overwhelming unless managed very carefully.
I've had some success with CBT when I was younger and not leaving the house due to severe social anxiety, but more recently as I try to apply the same techniques I have hit a brick wall really. So I do confess I am a little biased against CBT in general right now.
The other thing I would say is that having a 'flat' mood is often the effect of the medication itself. One of positive comments or complaints (depending on perspective) you will see about antidepressants from reviews is that they do 'flatten' and 'blunt' the emotions a little bit - they really can make people flat line so while they don't necessarily feel depressed or sad anymore they might find it difficult to experience normal excitement/joy/enthusiasm/etc.
The other thing I would say is that having a 'flat' mood is often the effect of the medication itself. One of positive comments or complaints (depending on perspective) you will see about antidepressants from reviews is that they do 'flatten' and 'blunt' the emotions a little bit - they really can make people flat line so while they don't necessarily feel depressed or sad anymore they might find it difficult to experience normal excitement/joy/enthusiasm/etc.
Good point. One of the reported side effects is to feel sort of numb to things and absent from them. The more extreme form of this is depersonalization to the point that you don't feel involved in your own life.
An inexperienced therapist (and some docs, unfortunately) think that these meds are supposed to make us happy happy! No, they're not narcotics, and if you think about it, you don't want them to be. I don't think you really want to be numb or happy about an underlying circumstance that needs to be addressed; you want to be more aware of it, more willing to approach it from different angles, and thus more able to deal with it rationally.
I think the goal of these meds, as a therapy aid, is to give you a bit of extra time between the thoughts and your automatic nervous reaction to them... so that you can begin to sort your thoughts and deal with them in a more rational way.
Hi Guys, thanks again for the information.
When I was referred for CBT I admit I was gutted, I wanted (and half expected) 1 on 1 counselling. So I started CBT with little expectations. I also remember when I was switched to Citalopram some months ago the doctor said it is a mood stabiliser. Since taking this I have noticed my emotions decreasing, yes my depression has, but so has my empathy and sympathy and that isn't a good thing when you have a 6 year old child.
I sincerely believe (although I have no proof and am no professional) that my depression started due to self esteem issues (based on my appearance). These have worsened and I cant do anything I would like to do. I can guarantee this will not get better unless I can 'alter' my appearance. I do not mean plastic surgery, but there are a few things I would like to tweak.
I have thought that maybe I have a hormone imbalance? I am also going to mention this to the doctor next week.
I agree that therapists aren't doctors. when I told my therapist that I thought my meds were making me hyper, she told me to discuss it with my doctor. I will say though that because I was so very unhappy, my therapist had encouraged me to think about taking meds. but she did suggest I spoke with my doctor about that. it was only after a lot of soul searching I finally took them. definitely talk to your doctor about it & only up the meds if you feel its right for you.
---------- Post added at 20:38 ---------- Previous post was at 20:36 ----------
oh, keekee the other thing i'd say is that during winter months, I find my fluoxetine really helps me stay positive and focused. it does level out my moods, so in addition to not feeling anywhere near as low or angry, I do also find that my higher end moods lessen as well.
when it comes to summer months (like now) I become very aware of my upper moods not being as high as they could and often I reduce my meds or come right off them for this reason. it also means when winter comes, rather than continuing to up the dose I can simply go back on them when I feel the need.
hope this helps!!
---------- Post added at 20:39 ---------- Previous post was at 20:38 ----------
oh and definitely talk hormones with your doctor. believe me, hormones really can mess with your perception of yourself, or whats going on around you or anything at all for that matter.
Thank you Tessar.
I do think it may be hormones as my depression started around the time I got bad skin. This all happened after the birth of my daughter so maybe that messed up my hormones?
I made a double appointment so I will mention this and I am thinking about asking if I can return to fluoxetine. I had absolutely no problems with that.
Thank you Tessar.
I do think it may be hormones as my depression started around the time I got bad skin. This all happened after the birth of my daughter so maybe that messed up my hormones?
I made a double appointment so I will mention this and I am thinking about asking if I can return to fluoxetine. I had absolutely no problems with that.
I'm a guy and I had a hormone problem (low testosterone) that was definitely contributing to my anxiety and low mood. Getting it detected was pure luck really and getting treatment was tricky too.
I don't see why it would be any different for a woman really - if the hormones (which ever ones it may be for a female?) are out of balance it would seem reasonable to think it may have an impact on mental health as well. How you get it tested and ruled out I don't know. Worth asking the GP for reassurance though.
Postnatal depression is so common it seems logical to assume there is some kind of physical / hormonal cause really.
Thank you yenool. I am kind of hoping that's what it is as sort of an easy way out from what I am feeling. I have been llike this now for almost 6 years and I am terrified my partner will leave me. This will then mean joint custody of our daughter and I will literally be alone, which is something I like on occasion, but not for a full day etc.
I actually cant wait until my appt. on Thursday. Dreading my CBT tomorrow though haven't did my homework this week due to bad weather. (As I have health anxiety also my homework was to walk up a set of steep stairs that I live close to, however these are on a big field and its soaking and muddy at the moment. Maybe I can do it in the morning on my way to CBT?)
Just had a thought in regards to hormone imbalance - I had my thyroid checked a few months ago (bloodtest) and it was fine. WWouldn't that have shown a hormone imbalance?
Oh, unfortunately I don't know the answer to that one. I'd been thinking more like hormones as in periods etc. but anyway, when you have your appointment with your GP you can discuss all this. Don't dread your CBT..... Although its not easy to face going and to discuss difficult things, it is going to help you ultimately. I know I make that sound easy but I have been in the same boat. You keep your chin up & you stick at it as best you can. Hopefully in a few days things will be better sorted for you.
Thank you yenool. I am kind of hoping that's what it is as sort of an easy way out from what I am feeling. I have been llike this now for almost 6 years and I am terrified my partner will leave me. This will then mean joint custody of our daughter and I will literally be alone, which is something I like on occasion, but not for a full day etc.
I actually cant wait until my appt. on Thursday. Dreading my CBT tomorrow though haven't did my homework this week due to bad weather. (As I have health anxiety also my homework was to walk up a set of steep stairs that I live close to, however these are on a big field and its soaking and muddy at the moment. Maybe I can do it in the morning on my way to CBT?)
Well try not to panic about the lack of homework - the idea isn't to get even more stressed about it. I would say though that if you are really struggling to do the homework on a regular basis then it may be worth having a think and making sure that the goals/work you are being set is motivating for you and tacking the issues you are most bothered by. I mean if deep down you don't think it is helpful of course you are going to struggle to do it!
To be honest I don't think there is a quick fix way out - even if there is a physical issue going on it is most likely just a contributing factor and not the root cause, if that makes sense?
The other thing is I notice you are catastrophizing and projecting it into the future a lot - What if my partner leaves, what if he gets custody and so on..... well what if none of that happens, what if you win the lottery.......... 'what if' is an absolutely deadly phrase IMO and nearly always leads to pointless procrastination and negative emotions.
He has been with you for 6 years and that would suggest he sees something in you that he loves and good qualities he is attracted to. The depression/anxiety is not allowing you to see any positives about yourself right now, but others will be able to see them.
Try and hang in there because there will be better times ahead..... things can and do get better.
Thank you both I really appreciate the effort in your replies. A friend of mine did suggest going on the pill as her periods made her down and CBT therapist has suggested I keep track of my moods throughout my cycle in a diary so I guess it could still be related.
at the minute it does feel like I am at a dead end which is weird as I still always have a level head on me. I think the panic attacks are what seriously knocked me back. I haven't been right since then (March) even though I don't get them anymore. I also believe that if I had more support from my family I wouldn't be finding things so difficult.
I am starting to feel emotionless in certain factors and over-emotional in others.
After feeling horrible all day (possibly due to crying in front of my dad, something I have never done other than when my partner left me before we had our daughter) I really believe the Citalopram is causing these strange sense of nothingness?
Thanks again for the replies as I know lately I have been morning about various things on various Sun-Timesforums.
Went to my CBT appointment and feel a little better for doing so. She wasn't mad at me or anything for not doing my homework and said maybe I would benefit from seeing a counsellor as she said I seem to want to discuss things (I do like to talk about my own 'theories' etc and could probably go on for hours). I'm at the Docs in 2 days so hoping I'll feel better after that. I haven't been in 8 weeks I was goin every 3 but tried to reduce it as I didn't want to rely on reassurance from the doctor.
Part of me feels like Citalopram isn't the med for me but on the other hand I was on Fluoxetine for almost 5 years and still had 'down' days. So maybe it's just a minor setback that I have been experiencing recently.
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