Need advice!

[littleme92]

Hi

I had a visit with the doctor at the hospital today to discuss changing my meds, I am on citalopram and have been for 7 years. The doctor upped my dose from 20mg to 30mg about 2 weeks ago. However I am still feeling like I am at rock bottom and am currently under the mental health crisis team.

He wants me to either up the citalopram to 40mg or ween myself off it by going down to 20mg for 3 days then 10mg for 3 days then 0 for 3 days and then starting a different antidepressant.

I am scared as I still feel very fragile at the moment and don't know what the withdrawal symptoms will be like and when I am at my lowest I feel like there is no hope so I don't want to go back to that feeling again and that was only a couple of days ago! I am also on diazapam at the moment 5mg twice a day. I woke up this morning actually feeling a little better, less tense but still anxious!

Has anybody had to make a decision like this before and does it seem like they want to ween me off it too quickly?

[panic_down_under]

I am on citalopram and have been for 7 years. The doctor upped my dose from 20mg to 30mg about 2 weeks ago.

I assume the dose was increased because 20mg wasn't effective anymore. If so, have you been under greater than normal stress in the last few months, or has it just come out of the blue?


He wants me to either up the citalopram to 40mg or ween myself off it by going down to 20mg for 3 days then 10mg for 3 days then 0 for 3 days and then starting a different antidepressant.

Upping the dose to 40mg will give you the fastest result with the least problems...if it works.

However, if you decide to switch meds then in most cases there is no reason to wean off citalopram first. Most can switch to an equivalent dose of another SSRI overnight without experiencing significant side-effects, but some doctors prefer to do it via a short cross-taper for psychological reasons. Switching to SNRIs and TCAs is best done by cross-tapering. The only antidepressants which require a washout period before switching to/from them are the MAOIs, but I doubt they are being contemplated (which may be a pity as they are very effective meds).

[littleme92]

I assume the dose was increased because 20mg wasn't effective anymore. If so, have you been under greater than normal stress in the last few months, or has it just come out of the blue?

I have been worrying for quite a while about a holiday I booked and was going on my own, I have cancelled this since I started having panic attacks and my depression returned. I won't go into extreme details but basically I was at rock bottom and am now under the mental health crisis team.



Upping the dose to 40mg will give you the fastest result with the least problems...if it works.

However, if you decide to switch meds then in most cases there is no reason to wean off citalopram first. Most can switch to an equivalent dose of another SSRI overnight without experiencing significant side-effects, but some doctors prefer to do it via a short cross-taper for psychological reasons. Switching to SNRIs and TCAs is best done by cross-tapering. The only antidepressants which require a washout period before switching to/from them are the MAOIs, but I doubt they are being contemplated (which may be a pity as they are very effective meds).

I think I am going to up the dose to 40mg, I have had a meeting with my care worker today and she thinks that is the best option as well. I am still anxious about the side effects though as I used my last diazapam today (I was only prescribed 5 days worth) so I dont want the anxiety to return as strong as it was when I dont have anything that can relax me.

[panic_down_under]

I have been worrying for quite a while about a holiday I booked and was going on my own, I have cancelled this since I started having panic attacks and my depression returned. I won't go into extreme details but basically I was at rock bottom and am now under the mental health crisis team.

Which probably explains why the 20mg isn't as effective as it was.

Antidepressants are in a continual tug or war with brain stress hormones. High stress hormone levels, mainly cortisol, kill or inhibit the growth of new brain cells in an area of the two hippocampus regions of the brain and the atrophy of these areas is thought to produce the anxiety and/or depression symptoms.

Antidepressants reverse this by stimulating the growth of new hippocampal neurons (neurogenesis) and to strengthen connections between brain regions. As stress hormone levels rise there may need to be a corresponding dose increase to keep neurogenesis going.


I am still anxious about the side effects though as I used my last diazapam today (I was only prescribed 5 days worth) so I dont want the anxiety to return as strong as it was when I dont have anything that can relax me.

If they won't prescribe any more diazepam ask for a small dose of mirtazapine (Remeron) instead. It is a pretty good sedative and may speed up the kick-in of the higher citalopram dose a little too. As with diazepam, the main side-effect is sedation which can slow reaction times so take extra care when doing anything potentially hazardous, including driving.