Need some reassurance or success stories please.

[kain]

I've been on Cit.for about two years now. I was on 10 for about a year my anxiety came back I upped it to 20mg then 30mg after about 2 months and started feeling better again. Now here I am again with awful anxiety I can't eat,focus,feel generally just sick,sweating,shaking,etc you know plus the intrusive anxious symptom scanning I'm sure everybody knows all too well. It's lasted about a week so I called my doctor she said go up to 40mg. Last night was my first night taking 40. I've beat this before and I know I can beat it again I guess I just want to hear from somebody else that's it's going to be alright and that after a while they had to increase they're dose and it worked. I also take. 25 of klonopin in the morning and at night but I dont know if it's really helping

[panic_down_under]

I was on 10 for about a year my anxiety came back I upped it to 20mg then 30mg after about 2 months and started feeling better again.

Taking only 10mg for a year was probably not wise as it is a sub therapeutic dose for most.

Antidepressants have no direct effect on anxiety (or depression) in the way say aspirin has on a headache. 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.

The problem with taking borderline doses is neurogenesis will be disrupted whenever plasma levels drop below the threshold required to sustain neurogenesis which can occur for any number of reasons, interaction from another med, an illness, etc. This can be a problem because there is growing evidence antidepressants become progressively less effective every time they are stopped and restarted. Two studies, Amsterdam JD (https://www.ncbi.nlm.nih.gov/pubmed/27805299), 2016 and Amsterdam, 2009 (http://www.karger.com/Article/FullText/226611) found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Amsterdam JD (http://www.ncbi.nlm.nih.gov/pubmed/18694599), 2009; Leykin Y (http://www.ncbi.nlm.nih.gov/pubmed/17469884), 2007). The continual interruption to neurogenesis from taking borderline doses may create the same loss of effectiveness as quitting and restarting the med, just at a higher frequency.


I guess I just want to hear from somebody else that's it's going to be alright and that after a while they had to increase they're dose and it worked.

Some of us do need very high doses to get a good outcome. I've always needed doses above the maximum recommended. But there is no way of knowing if this will be the case for you.

Supplementing the citalopram with Buspar (buspirone) might be worth a shot as it has a proven track record for boosting the effectiveness of serotonergic antidepressants. It can also restore failing SSRIs/SNRIs to full function and reducing some of their side-effects.


I also take. 25 of klonopin in the morning and at night but I dont know if it's really helping

Then you'd probably be better off without it. There is evidence benzodiazepines can significantly reduce the effectiveness of antidepressants by blocking hippocampal neurogenesis (see: Boldrini M (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374628/), 2014; Nochi R (https://www.ncbi.nlm.nih.gov/pubmed/23963779), 2013; Sun Y (https://www.ncbi.nlm.nih.gov/pubmed/23639432), 2013; Wu X (http://www.biologicalpsychiatryjournal.com/article/S0006-3223(09)00106-1/abstract), 2009; Stefovska VG (https://www.ncbi.nlm.nih.gov/pubmed/18991352), 2008).

In light of these studies benzodiazepines use should probably be limited to a couple of weeks when first taking antidepressants to ease the increase anxiety levels these meds often trigger initially, for a while after antidepressant dose increases for the same reason, and thereafter for very occasional breakthrough anxiety. If an antidepressant isn't adequately controlling anxiety on its own even at the maximum recommended dose then switching to another which might be more effective should be considered ahead of supplementing it with a benzodiazepine.

[kain]

Thanks for your response I really appreciate it. The klonopin seems to help settle down at night but the entire day is a nightmare. So in your opinion you dont think the 40mgs would be helpful since I stayed on 10 for so long? My doctor said if the 40mgs doesn't help I'm going to have to switch to something else which also makes me nervous if my anxiety is through the roof now I can imagine what a new med might do.