Dosage help please :'(

[Batman]

Hi all, so I've been on 30mg a day for about 3 years now. Recently, I've had a play with my dosage because I've not been feeling so great, I've felt kinda level but not in a good way... I've been talking 20mg dose of I know I've got nothing to do the following day or so, but if I've got work out something on, I take 40mg... On 40mg dose I feel top of the world, I've got energy and feel positive, and happy.

I can't quite quite believe I need 40mg a day to feel better though, that seems a stupid high dose compared to most others who are on 10 or 20..... Can I ask my doctor for a change of dose? Do I need a different medication?

[Shazamataz]

This med doesn't work by taking different doses depending on your plans for the day. It takes a couple of weeks to stabilise at each dose, so you are probably feeling the effects of the lack of stability.

[panic_down_under]

I've been talking 20mg dose of I know I've got nothing to do the following day or so, but if I've got work out something on, I take 40mg...

NO!!!!!! Please do not do this. Antidepressants are not aspirin, or diazepam, where you take a tablet and an hour later it works.

They work by stimulating the growth of new brain cells (http://www.americanscientist.org/issues/feature/depression-and-the-birth-and-death-of-brain-cells/99999) (neurogenesis) to replace cells killed, or prevented from growing by high brain stress hormone levels. The therapeutic response is produced by these new cells and the stronger interconnections they forge, not the meds directly, and they take time to bud, grow and mature. Neurogenesis does not respond instantly to an higher dose, however, playing around with the dose as you've been doing may inhibit it and increase the risk of the drug quitting on you.


On 40mg dose I feel top of the world, I've got energy and feel positive, and happy.

Isn't the placebo effect wonderful?


I can't quite quite believe I need 40mg a day to feel better though, that seems a stupid high dose compared to most others who are on 10 or 20.....

You may indeed do better on 40mg/day independent of the placebo effect, but you're going to have to take it consistently for some weeks to know. How much others take is immaterial to how much you need. It all comes down to individual biology.

And for anyone reading this who is on only 10mg/day, get up to 20mg asap if you want to lessen the risk of the med pooping-out.


Can I ask my doctor for a change of dose? Do I need a different medication?

Yes, you can ask for a dose increase if 30mg isn't cutting it. If it still isn't working satisfactorily after a couple of months at 40mg then switching to something else is your best option.

[Mojo61]

I would be interested to know the science behind meds "pooping-out"

If the new brain cells have grown what makes the meds stop working?