Sertraline, Citalopram, what next? [Archive]

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tom87

08-10-16, 12:17

Hi guys

just looking for a bit of advice or a recommendation

I have been on Sertraline in the past and alongside therapy I overcame pretty intense GAD. I was doing fine for about 2 years and had been off the Sertraline a while.

Unfortunately I relapsed due to some crazy situations and so went back on the Sertraline which just didn't really work, even working up to the max dose. I was then put on to Citalopram and worked up to the max dose very gradually and again I just don't feel I am getting much from it like the very first time I was on Sertraline.

My symptoms are mainly pure obsessional with a touch of GAD but mainly just Pure O. My therapist believes I am past the OCD now and I am almost left in a traumatised state and shock just from how bad my intrusions were when they first occurred.

Anyhow, I have a great understanding of my symptoms, how to manage and how to recover but I really just need that added extra help from medication to take the 'edge' off

I have no physical symptoms at all, it is all just in my head. I have tried 2 SSRI's now and didn't know wether to switch drug classes. I am being told so many different things by GP's and therapist. I have tried Pregabalin which didn't really do anything.

My GP would want me to go on Duloxetine but I know very little about this drug and my therapist who is highly experienced in OCD etc, advises against this and is advising Prozac.

From what I have explained as symptoms, what route would you suggest with medication? I won't take your answer as gospel don't worry its just good to sometimes hear from people who have experienced the drugs and their outcomes

Thanks,
Tom

Jem21

08-10-16, 19:24

I was on Citalopram on and off for many years but it stopped working, my doctor put me on duloxetine 10 days ago. There really doesn't seem to be many people on here on it at all. I'm only on day 10 I did a straight swap from cit to this with 1 night clean. I'm finding it ok up to now, not as harsh as starting the cit but I'm only on 20mg and going up slowly. It must be hard when you have 2 professionals advising different things. I guess it will come down to who you trust more. Either one has a chance of working I guess.

tom87

08-10-16, 23:01

Thanks for the reply Jem. May I ask for what symptoms was the duloxetine prescribed?

Mermaid16

08-10-16, 23:06

tom87

08-10-16, 23:18

Hi! I had a look on drugs.com at Prozac and it got a very good rap for OCD. It is up to you, but I would probably go with the therapist on this one. It does say that it has a big impact on libido, so I guess you would have to take that into account. Tracy

Thanks for the reply! I do think I am swaying to the idea of Prozac, I have found a lot of positive info through Google. I have had no issues with libido on Sertraline or Citalopram, and so I am hoping Prozac wouldn't either..

Drugs.com is great, I always wondered is it real though or false reviews from the drug companies! some reviews sound too good to be true!

I just hope if I do go for another SSRI that it helps me as I really don't like the idea of changing drug groups as side effects just seem to look that bit more intense

Jem21

09-10-16, 12:11

Hey, I do have some ocd but it's more thoughts than actions. I wouldn't say it was a major part of my problem. I think I am mainly anxiety. With regards to swapping drug groups it wasn't as horrendous as I thought. I stopped the cit and started the duloxetine the next day. Had a lot of nausea, very sleepy and some tummy aches. Anxiety did spike for a while too. I'm 12 days now and they seem to be setting. It wasn't as bad as starting the cit.
Prozac does sound like a good option though. You have to go with what you feel most comfortable and confident with.

tom87

09-10-16, 21:19

Thanks for your response Jem. Fingers crossed you have a positive respone to Duloxetine! I know for some it has been a wonder drug, it is a shame we all react differently to different drugs! if only these medications were as simple as paracetamol for a headache.

I do think Prozac is my route, I just have to work down from the 40mg Cit now and hopefully it shouldn't be too bad. Going from max dose Sertraline and then on to Cit was surprisingly ok

Does Cit come in 30mg or is 10mg availble so I can add that to 20mg?

Thanks guys! :)

MyNameIsTerry

10-10-16, 05:15

This is what is licenced in the UK:

http://www.mhra.gov.uk/spc-pil/index.htm?IdcService=SS_GET_PAGE&nodeId=%3C%25%3D+nodeId+%25%3E&searchFiled=citalopram&SubmitSearch=Search

That's the MHRA drug licencing database.

Cit doesn't come in 30mg so it's either:

- 10mg+20mg
- a 40mg split to a remove a quarter
- 2x20mg and you split one in half
- liquid solution (the most flexible but by far the most expensive so it tends to be for people who need really slow titrations of small dosing)

It's up to your GP really because he/she could advise you split a 40mg up, which is perfectly fine with Cit pills (not with all meds though, you have to check on certain things first) but since the NHS has no official policy on pill splitting, GP's are left to decide whether to stick their necks out giving advice they have no governance on. So, some GP's don't like to say and to be honest, they may not even understand pill splitting enough as it's more for a pharmacist.

This may mean they go with 10mg+20mg. This means paying twice. 10mg tends to be costly by comparison too (to them, not to the patient) because the manufacturers have a nasty habit of over pricing sub-clinical dosages to prevent them being sold.

Pill splitting is pretty easy though. Pill splitters cost a few quid on Ebay. If you want to go for inbetween dosages like 27.5mg, you can even try but you need a jewellery scale so you can measure the pill. AND if you start weighing pills, even if you take a quarter out of the 40mg, remember to weigh the pill first because the active Cit drug weight and the pill gross weight are not the same since most pills have fillers, binding agents, etc.

Shazamataz

10-10-16, 07:33

Prozac does seem to be the way to go with OCD. May be worth a try?

tom87

12-10-16, 07:51

Thanks for the responses guys. I will take the advice on the Cit and hopefully then move on to Prozac. I will keep you all posted, not with too many negatives I hope!

tom87

17-10-16, 16:51

Update and question

Ok my GP has dropped me from 40mg to 30mg (x1 20mg and x1 10mg) and I will slowly work down from there.

My only Prozac concern is that I have heard they are quite activating which concerns me with regards to anxiety! It is a group of OCD which I am recovering from but OCD stems from anxiety, last thing I need is anxiety levels peaking. With them being 'activating' do you think this would affect anxiety or is it nothing to really worry about?

Jem21

17-10-16, 19:17

They might increase anxiety in the beginning as some do for some people but it's hard to say what will affect who. I had increased anxiety on the Citalopram and the duloxetine for the first 2 weeks and they are different classes. My doc gave me some diazepam to help with this and it did take the edge off.

tom87

17-10-16, 22:28