day 6 of citalopram [Archive]

panic_down_under

23-01-17, 21:08

I am on day 6 of taking citalopram and i've been having panic attacks as well as high anxiety. This is my second time on citalopram. It worked wonders for me before and i'm hoping it will again. I can't remember feeling this bad. I am also withdrawing from mirtazapine so i'm not sure whats causing the symptoms i am getting.

It could be a more severe initial increase in anxiety from the citalopram, withdrawal symptoms from the mirtazapine, or a combination of both. There is no real way of knowing.

There is growing anecdotal evidence that antidepressants can produce more severe, and/or different, initial side-effects the second time around. They also become progressively less effective every time they are stopped and restarted, often requiring higher doses to achieve the previous level of control. According to one study (http://www.karger.com/Article/FullText/226611) the odds of antidepressants working after each restart drops by nearly 20% (see also: Amsterdam JD (https://www.ncbi.nlm.nih.gov/pubmed/27805299), 2016, Amsterdam JD (http://www.ncbi.nlm.nih.gov/pubmed/18694599), 2009; Leykin Y (http://www.ncbi.nlm.nih.gov/pubmed/17469884), 2007). This applies whether returning to a previously taken antidepressant or a different one.

If the panic attacks continue ask your doctor to prescribe a small dose of one of the benzodiazepines to ease you over this hump, or if s/he doesn't prescribe them then hydroxyzine (Vistaril) would be a good alternative. It is a prescription antihistamine with good anti anxiety properties.

*Hydroxyzine comes in two forms, hydroxyzine pamoate (Vistaril) and hydroxyzine hydrochloride (Atarax). Anecdotally, the pamoate form is supposedly the more effective anxiolytic, but just how true this is is a matter of debate.