Still waiting...

[rjh17]

Hi folks,

I'll keep it as short as possible.

Three years ago I got my first bout of intense anxiety and was reluctant to take meds of any kind. Eventually I got on 15mg of Citalopram and some Clonazepam for the "build up period". Took some time to get over but got over alright.

Fast forward to May 2017: Around Victoria Day (May 22 if your not from BC, Canada) I got a viral infection which had me throwing up and getting low (hypoglycemia) which sent me into panic attacks. I started 10mg of Cit on the 22nd and saw my doc on the following Friday. She pulled me up to 15mg. I saw small results through the next few weeks but nothing major. On June 21 or 22, I had a bit of a blip. I called the doc and she said to up to 20mg. It's been one week on that now and I'm waiting for results. I have kind of run out of things to worry about so my anxious brain has moved on to the scary existential questions like "what's the meaning of life?" and "why is there life?" and "what if the universe never formed" etc. etc. Any survival stories or tips would be greatly appreciated!

Thanks Friends and stay strong,

R.

[panic_down_under]

Hi folks,

Welcome to No More Panic, :welcome:


I started 10mg of Cit on the 22nd and saw my doc on the following Friday. She pulled me up to 15mg. I saw small results through the next few weeks but nothing major. On June 21 or 22, I had a bit of a blip. I called the doc and she said to up to 20mg. It's been one week on that now and I'm waiting for results.

Okay, there are a few different things to be considered.

Firstly, the usual minimum therapeutic citalopram dose for adults is 20mg, so you've only been on an effective dose for a week. You may have done okay on 15mg the first time, but taking marginal doses for long periods acn increase the risk of the med failing to work.

Secondly, for reasons which aren't that clear, antidepressants seem to become progressively less effective every time they are stopped and restarted, often requiring higher doses to achieve the previous level of control. They may also produce more severe, and/or different, initial side-effects. 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). This applies whether returning to a previously taken antidepressant or a different one.

Thirdly, antidepressants typically take 3-12 weeks to kick-in from when a therapeutic dose is first taken. They do not have an immediate effect in the way benzodiazepines such as clonazepam, or aspirin do. They work by stimulating the growth of new brain cells (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC60045/) (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. For a more detailed explanation see: How antidepressant drugs act (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025168/).

All of which means you're going to have to be patient. Anxiety disorders and/or depression are often long in the making, years, and once they get up a head of steam they don't give up easily.

In addition to meds is therapy an option? The cognitive and/or behavioural (CBT, REBT, etc) and mindfulness therapies can be very effective treatments.


"what's the meaning of life?"

2, or whatever meaning you give it

"why is there life?"

Because the chemical processes which kick start it seem to occur readily. Amino acids, the basic building blocks of proteins have been detected in large quantities even in deep space. Life here seems to have begun within about 300 million years of the planet's formation, so pretty much as soon as the crust cooled enough to allow it.

"what if the universe never formed"

They're be no psychiatrists. :winks:

[rjh17]

Thanks for the quick reply!

I too had heard about the 20mg being the "lowest therapeutic dose". I wondered if it would kick in sooner since I have already been on 10-15mg for the last 6 weeks but I guess I'll just have to wait and yes I am going to a psychologist tomorrow to start therapy. I didn't know about the diminishing returns from stopping 3 years ago and starting again but I have found that this time for sure. So, maybe the higher dose will do the trick.

Warm regards,

R