Citalopram not working

[Tinalou]

Hi I am really feeling desperate. After recovering on 40g of citalopram a couple of years ago I dropped my dose down to 10mg. I started feeling low in November last year and upped my dose to back to 40g over a few months. I feel worse if anything no motivation and scared of everything. I don't know what to do. I feel I'll never well again. I was on doselipine but that's been withdrawn in the U.K. . I have tried mirtazapine which gave me awful jerking legs and arms at night. Prozac makes me super anxious. I feel I am running out of options ☹️

[panic_down_under]

Hi I am really feeling desperate. After recovering on 40g of citalopram a couple of years ago I dropped my dose down to 10mg.

Unfortunately, dropping back to a sub therapeutic dose for an extended period may have been a very bad move. There is growing evidence that 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). Taking borderline doses risks the amount of med in your system dropping below the therapeutic threshold from time to time essentially setting up mini stopping/restarting cycles.


I was on doselipine but that's been withdrawn in the U.K. . I have tried mirtazapine which gave me awful jerking legs and arms at night. Prozac makes me super anxious. I feel I am running out of options ☹️

You're a long way from running out of options. The closest TCA to dosulepin in serotonin and noradrenaline reuptake inhibition is amitriptyline (Elavil), however, it may be a little worse in terms of the usual TCA side-effects such as dry-mouth and constipation. Also consider imipramine (Tofranil). Sertraline (Zoloft) is your best shot among the SSRIs.