20 mgs for 3 years

[Maj]

Hi everyone. Popped in again after a few years break. I've been on 20 mgs citalopram daily for almost three years. I no longer feels as though it's working as I feel very low. Is 20 mgs a high dose?

[MyNameIsTerry]

20mg is considered the standard therapeutic dose. 40mg is the max these days so your GP could try an increase.

[xliljosiex]

Not a low dose not a high dose, if you've not been feeling low long you could ride it out, it's possible it could be a blip and will pass . Or you could try increasing to 30mgs and see how that goes. If that doesn't work perhaps you should consider switching xxx

[ricardo]

20mg is considered the standard therapeutic dose. 40mg is the max these days so your GP could try an increase.


Terry as your knowledge and research is so great and extensive about practically everything to do with triggers,drugs, anxiety,depression, who to go to, who not to go to, and many members are extremely grateful, my question is why aren't you actually better yourself, or have you found the key to unlock the door and are slowly attempting to walk through it.This is a genuine question.

[Greenman50]

Terry as your knowledge and research is so great and extensive about practically everything to do with triggers,drugs, anxiety,depression, who to go to, who not to go to, and many members are extremely grateful, my question is why aren't you actually better yourself, or have you found the key to unlock the door and are slowly attempting to walk through it.This is a genuine question.

Maybe Terry just uses Google as his Bible ?

As you say Ricardo .....Terry is very helpful and members are grateful for help many are in a bad way but we all have to be mindful in the advice we give as we are not experts ...well i,m certainly not !

:hugs:

[MyNameIsTerry]

Terry as your knowledge and research is so great and extensive about practically everything to do with triggers,drugs, anxiety,depression, who to go to, who not to go to, and many members are extremely grateful, my question is why aren't you actually better yourself, or have you found the key to unlock the door and are slowly attempting to walk through it.This is a genuine question.

I think you could read every article, book, paper, etc ever produced and you would still have anxiety. I know I would. It has helped me to learn about my OCD as I was making myself worse in what I did and how I was thinking about it. Other OCDers have said that too as you feel like you are losing your mind and can't control your own body. So, it does help to read enough about that to know and learn to accept it. Reading from there can be obsessive, I think. It's helped me less with GAD though as thats a struggle to find triggers...it's just there!

I am much better than I was a few years ago. I've got rid of the intrusive thoughts (other than some new ones that have come along that I am dealing with now) and stopped pretty much all my compulsions that were physical i.e. touching, checking, repeating, tics, etc. BUT I struggle with the obsession side still which is all about daily routine, sleep cycles, etc. These have been around a long time and they are the most ingrained. The sleep issues were around from my GAD, the daily routine is a bit of both.

The thing is, I didn't have a lot of my anxiety symptoms until I went on Duloxetine so I've been trying to stop things I never needed to. My GP was insistent all the way that it wasn't the meds but from talking to people on here (Ven board) I can see it is not the case. The problem has been trying to resolve some of the badly ingrained stuff in order to get back to my GP so it's a bit of a catch 22 and I am struggling to move forward with this.

I spent nearly 18 months fighting my employer for better conditions and this partly wrecked my CBT. My therapist admitted she didn't think I would be able to resolve most things until I resigned. Obviously, she said this after I had so as not to influence me. 18 months, 1 appeal one, 1 grevience lodged and won, occupational health not getting responses and offering to put their own complaint in to the business and yet they still wouldn't change despite agreeing to. I could have logged the same grevience again but when you are just marching up the senior management chain of a multinational, and they all played golf together, I knew unless I brought a solicitor in I wouldn't get anywhere. I decided it was a cultural issue, so I can't try to change that, and my health mattered more so I resigned. Sadly, my CBT was ending. I did now start to make progress but before that it was few & far between. At this point I starting resolving my OCD issues.

I continued to resolve issues but once I started Duloxetine, my issues were many & severe. I was nowhere near as bad before. Years of side effects and a GP telling me "it's your anxiety". I was naive back then and trusted my GP.

This is the hardest thing I've ever been through in my life and I've always said I don't consider myself anywhere near recovered. Maybe 50%. I did go back to work the first time around and made a lot of improvements but the environment was not a good place for someone like me and led me back into a relapse that was worse.

If I can help, I try because thats what I have been like all my life. I'm analytical by nature and I've had many a rollocking off bosses for not getting things done to help someone who needed helping. I'll go the extra mile for the vulnerable granny on the phone scared of her bills even if my boss doesn't like it. Whilst that made me unpopular with some line managers, the kind that just chase their goals and to hell with customers, it meant I had a good relationship with others. When I joined the charity walk-ins, after a time I found I could help people in the group further back than I was. I learned from those in front of me and it felt right to do what they did. So, if I can take the hassle out of something for someone who is probably struggling to think straight let alone navigate all the red tape. I don't mind.

Back at my worst, I couldn't get on the internet, use my laptop, call someone, check a text, etc without a hell of a lot of anxiety. The enldess hours fighting my employer took it's toll as they were contacting me daily at some points. Having to argue with them over them making changes to paperwork after I had signed it so that it reflected something good for them & bad for me, was a nightmare I did not expect. It just brought on paranoia.

Reading and relaying information is easy. Analysing a problem to come up with some options, is easy. Doing it yourself is the hardest part and I have always struggled with it.

I've been on Citalopram for a good 3 years after my first breakdown, so I know some about that one.

[mark84]

I'd say 20mg is a low dose, get yourself put on 30 and I think you'll be better. Nothing to worry about, plenty of room to increase dose or other anti depressants to try, you'll be ok :)

[Maj]

Thanks everyone for your responses. I will ask my gp about increasing to 30 mgs, but have to say my gp seems to struggle with prescribing these meds in the first place.

[MyNameIsTerry]

Mine is the same, Maj. I remember him telling me he wasn't allowed to prescribe above standard dosages. :doh: What a numpty! Plenty of GP's do and it's in NICE guidance for them to do it and they have a meds service they can call whenever they wish that supports them.

[Greenman50]

Hmmm....

Dosage , i read and recently got offered a higher dose , i,m on 20 mg and said i would stick with it , i was prepared to maybe go to 30 mg by taking a 20 mg and a 10mg or cutting another 20 mg in halve .

My doctor said 40 mg is still a low dose ( really ? ) its double what i,m on , and he said you can go up to 80 mg but thats been proved of no benefit iirc and 80 mg gives no better results over 80 mg ???

Anyway stuck with 20 mg and feel reasonable but i am helping myself by keeping busy etc which helps .

Thoughts anyone :shrug:

[pulisa]

Antidepressants and dosages are all a bit variable depending on who you see. It's the same with psychiatrists-see 5 psychiatrists and it's possible to get 5 different diagnoses

[MyNameIsTerry]

Hmmm....

Dosage , i read and recently got offered a higher dose , i,m on 20 mg and said i would stick with it , i was prepared to maybe go to 30 mg by taking a 20 mg and a 10mg or cutting another 20 mg in halve .

My doctor said 40 mg is still a low dose ( really ? ) its double what i,m on , and he said you can go up to 80 mg but thats been proved of no benefit iirc and 80 mg gives no better results over 80 mg ???

Anyway stuck with 20 mg and feel reasonable but i am helping myself by keeping busy etc which helps .

Thoughts anyone :shrug:

:doh:

That's aimed at your GP. Citalopram has been reduced to a maximum dosage of 40mg worldwide! This was years ago. Studies proved 60mg provided very little benefit over 40mg and also created a big risk to people with a specific long QT issue that was dangerous hence it was stopped.

Your GP can't prescribe above that as it's against national formulary guidelines now. They would otherwise need to be monitoring you, for little benefit, in case there was a problem.

https://www.gov.uk/drug-safety-update/citalopram-and-escitalopram-qt-interval-prolongation

[bernie1977]

I was on citalooram several years ago and it was my CPN who told me about the new guidelines, my GP wasn't aware which is scary. It was also before the 2012 announcement that my CPN told me so I think it's something they've known about and not fully addressed for many years. NHS link to citalopram safety warning

http://www.nhs.uk/news/2012/07July/Pages/antidepressant-citalopram-qt-heart-rhythm-safety-warning.aspx

[MyNameIsTerry]

It's a bit strange really since my .gov link shows the MHRA publishing on 12/12/2011 yet the NHS one form Bernie says the MHRA issued the guidance 24/10/2011. Mine says letter sent in October so it's like the MHRA didn't do a great job at updating their website.

[Greenman50]

:doh:

That's aimed at your GP. Citalopram has been reduced to a maximum dosage of 40mg worldwide! This was years ago. Studies proved 60mg provided very little benefit over 40mg and also created a big risk to people with a specific long QT issue that was dangerous hence it was stopped.

Your GP can't prescribe above that as it's against national formulary guidelines now. They would otherwise need to be monitoring you, for little benefit, in case there was a problem.

https://www.gov.uk/drug-safety-update/citalopram-and-escitalopram-qt-interval-prolongation

Thanks Terry

Can,t believe my Dr did know this :mad:

[pulisa]

The long QT risks apply to the SNRIs as well but I haven't seen that discussed much on here so maybe it's yet to be disclosed?

[MyNameIsTerry]

The long QT risks apply to the SNRIs as well but I haven't seen that discussed much on here so maybe it's yet to be disclosed?

Does it apply to all SSRI & SNRI's? They only seemed to indicate Citalopram & Escitalopram in the reports.

It's dose dependant and I doubt that will be as big an issue for Duloxetine since looking at this forum not many people seem to be using it and it always seems to be standard doses. Ven could be worrying though as they mess about with the dosages of that very quickly.

EDIT: Just seen the MHRA stating Fluoxetine shouldn't be used as well as Cital & Escital with people with long QT. The NHS has a response on it's site to a BBC report which also mentions amitriptyline and bupropion.

[pulisa]

Certainly venlafaxine, Terry. My daughter's psych talked about it before she started on ven and she had to have an ECG. I doubt whether GPs are aware of this yet.

[MyNameIsTerry]

My GP's of the same ilk as Greenwood's, pulisa, so I would expect about the same from him. These long QT issues were published in national media on 2 occasions and featured in a NHS article so there really is no excuse for GP's.

It will be interesting to see about SNRI's. I would imagine the adrenaline feature could be a problem anyway...I know how much it has caused me problems. Ramping peoples adrenaline up may seem useful in depression but I've never understood it in anxiety and it's certainly got an impact onto palps. I never had much of that before, but it's not a major symptom to me so it's never been a problem...but my pulse has always seemed faster.

[pulisa]

I think they would act like dynamite for me!:D