20mg didnt work so now 30mg

[MN]

Will this ever get better?

Am sick of morning anxiety.

30mg makes me sleepy. Cant concentrate at work.

Beginning to think citalopram isnt for me

[panic_down_under]

Will this ever get better?

Am sick of morning anxiety.

30mg makes me sleepy. Cant concentrate at work.

Beginning to think citalopram isnt for me

As I understand it you've only been on citalopram for 7 weeks and 30mg for just a few days, so it is too early to draw any conclusions about it, unfortunately. :unsure:

[MN]

Yes although i was on 10mg for 4 years beforehand

[panic_down_under]

Yes although i was on 10mg for 4 years beforehand

Ah. Taking what is usually a sub therapeutic dose for such a long time may have been unwise as it may have effectively 'trained' your brain to ignore the med.

Did you get any positive response from the increase to 20mg?

[MN]

not really!

[panic_down_under]

not really!

Then 30mg is probably a long shot, though 40mg might still do the trick.

[SilverFern]

Sorry to hear that you're still not feeling right MN and hope you will feel better soon. I'm in the same boat really, have been taking Citalopram for 12 weeks now, 10 weeks on 10 mg and 2 weeks on 20 mg. I'm not feeling as good as I want to (and know that I can because I've been on the drug before). The morning anxiety has never gone away and I'm finding it hard to go out anywhere on my own. I cannot increase the dose anymore as the doctor said 20 mg is the maximum for someone of my 'mature' age. I will make an appointment to discuss this with the doctor as I'm thinking the Citalopram is not doing its job this time. Keep positive MN! x

[MN]

Then 30mg is probably a long shot, though 40mg might still do the trick.

I'm concerned what the alternative might be.

[panic_down_under]

have been taking Citalopram for 12 weeks now, 10 weeks on 10 mg and 2 weeks on 20 mg.

Unfortunately, assuming your liver is still working efficiently, the 'kick-in clock' only started running 2 weeks ago.


I cannot increase the dose anymore as the doctor said 20 mg is the maximum for someone of my 'mature' age.

Is this because of concerns about citalopram's potential impact on your heart?

---------- Post added at 21:45 ---------- Previous post was at 21:38 ----------


I'm concerned what the alternative might be.

You could try switching to sertraline (Zoloft), but the SNRI duloxetine (Cymbalta) might be a better bet, or perhaps a TCA, as when one SSRI fails the chances of another working lessen somewhat. The dual action SNRIs and TCAs are generally more resistant to quitting than the SSRIs.

[SilverFern]

Thank you panic_down_under - as far as I know my liver is working efficiently so I guess I'll just have to be patient and hopefully the Citalopram will work soon! It did work in the past but just seems to be taking a bit longer this time. I didn't ask the Doctor why 20mg is the maximum recommended dose for 'over-60's' but you could be right about the potential impact on a person's heart.

[panic_down_under]

I didn't ask the Doctor why 20mg is the maximum recommended dose for 'over-60's' but you could be right about the potential impact on a person's heart.

The FDA reduced the recommended maximum adult citalopram dose from 60mg to 40mg about a decade ago because of concerns it could cause prolongation of the QTc interval (https://en.wikipedia.org/wiki/QT_interval) which increases the risk of arrhythmias, especially Torsades de Pointes (https://en.wikipedia.org/wiki/Torsades_de_pointes). The FDA's decision has been disputed in recent years as some believe it is based on flawed data.

The recommended dose for the elderly is half that for adults on the assumption their livers work less efficiently so metabolizes the drug more slowly thus increasing plasma levels. Another consideration is that many medications commonly taken by the elderly also potentially prolong the QTc interval including some antibiotics, diabetes meds, even, ironically, some meds for cardiovascular disease, and the affect is cumulative.

Whether any of this is a concern for you I can't say, but, imho, such decisions should be based on the individual patient's risk factors, not by a blanket age based rule. I take more than the recommended maximum dose of dosulepin, aka dothiepin, widely considered the most cardio-toxic antidepressant made and my 70yo heart is doing fine according to the annual ECGs despite being under greater than normal strain since I has a lung removed a decade ago.

[MN]

Sorry to hear that you're still not feeling right MN and hope you will feel better soon. I'm in the same boat really, have been taking Citalopram for 12 weeks now, 10 weeks on 10 mg and 2 weeks on 20 mg. I'm not feeling as good as I want to (and know that I can because I've been on the drug before). The morning anxiety has never gone away and I'm finding it hard to go out anywhere on my own. I cannot increase the dose anymore as the doctor said 20 mg is the maximum for someone of my 'mature' age. I will make an appointment to discuss this with the doctor as I'm thinking the Citalopram is not doing its job this time. Keep positive MN! x

How are you feeling?