Citalopram 40mg - when to increase dosage?

[Suky]

I have had panic attacks for 10 years and am now into my fourth episode (every three years or so...). I took Anafranil 30mg the first two times and Citalopram 20mg for the third. I have come off medication slowly after a year or so each time.

I have been to therapy, done CBT, exercise, drink coffee once a day and alcohol hardly ever, and have learnt to be nicer to myself and not to plan too much. Work full time in a well-paid job and have a very active three year old. Am a Brit living in Sweden and enjoy cheap childcare, flexible working hours. Have good support from partner, lovely friends and (now) sympathetic managers.

Have had a horrible two years privately and at work but things are better now on all fronts. Occasional panic attacks (with months in between) were manageable but they began again every day with a vengeance at the end of April this year and I went back on Citalopram. I have reacted ABSOLUTELY AWFULLY to them this time and was more or less a prisoner at home for 2 weeks with anxiety over the smallest things. Know you have to feel worse to feel better and things got better but after being on 20mg I was still feeling ropey. Upped to 30 mg and felt fine but after 2½-3 weeks had milder attacks and felt ever-present burning pins and needles/anxiety for nearly a week. Upped to 40mg and it's the same story; fine for 2½ weeks and pins and needles/anxiety for 5 days now.

Have been in regular contact with my doctor and have even phoned the drug company for more information about Citalopram as I need to know why I have reacted so badly this time. My doctor says that I can increase by 10mg to 50 and 60 if need be as I know how I feel.

Read some posts and saw that some people have taken 60mg at some point and wonder if anyone can give me some advice. Am sticking it out without Oxascand 5mg (Oxazepam) this time and feeling very virtuous but relatively dire at the same time! Am really working on talking myself out of the nasty feelings but I would like to know if anyone has similar experiences.

How bad does it have to get before I should up the dose again? Have been taking medication for just over 8 weeks. Shall I just stick it out? Should I increase to 50mg? The drug company says I should feel better after two weeks...

Have read a lot about panic attacks and done a lot to reduce stress in my life but I am flummoxed by why it's so hard this time. The agoraphobia is worse this time although I force myself to do things (within reason), rather than avoid them. Am resigned to the fact that I will probably have to take an SSRI for a long time and have no problem with that.

Am very glad to have found this site and hope you can help me with information from real people who have been through all of this.

Suky

[flatterycat]

Hi Suky

This sounds very similar to me at the moment. My problem is anxiety which comes in extreme waves. I am currently signed off work with it all. I have been on Citalopram on and off a few times and have had to go back on it again. In the past I have also had to up my dose to feel better. I am currently taking 20mg (5th week now)and still struggling. My doc also prescribed 5mg of diazapam to help until the Citalopram kicks in, but I don't like to take it. I have to return to the doc on Thursday and won't be surprised if he ups my dose to 40mg! Everyone keeps telling me it WILL get better, but it's hard to believe when you are in the midst of these awful feelings.

Hope this help
Sarah x

[nieve]

Hi Suky

This is the second time I've been on Citalopram. The first time I went on it, a few years ago, my dose was upped to 60mg. I have to say it worked really well and made my panic attacks disappear. I was on them for about two years and then weaned myself off. After about 2 years my symptoms started coming back, so once again, I started taking the Citalopram. I'm on 40mg now, but to be honest, it's really not working like it did first time round. I'm not sure why. I don't know if I should increase my dose to 60mg again (I really don't want to)... I've only been on 40mg for about 2 and a half weeks now, so I'm going to see if there's any change after a month.

It's strange that it doesn't work the same second time round. I've tried researching it a bit on the net, but can't really find anything useful. I guess you can try pushing up to 60mg, who knows, maybe it'll help you like it did for me the first time round.

Take care!

[groovygranny]

Hi Suky

I've replied to your PM.

Hang on in there!

:flowers:

[Suky]

Thanks everyone.

Will take GG's advice and give it a bit more time before upping the dose. Spoke to a very nice nurse at the psychiatric part of the local hospital (in my quest for more information about meds/side effects). She said that medical staff are starting to recommend that people who have repeated episodes (like my four in 10 years) should not stop and start treatment. We should see it rather like having to take pills for high blood pressure/diabetes etc.

What do you think? Am quite happy with that thought to be honest. Anyone taking SSRIs for life? Or do we have to beat back the panic attack demon at all costs?

Suky

[groovygranny]

Hi Suky,

Glad you spoke to a someone medical as well as considering my opinion - and that's what it is because we are all different. I'm also glad that you are feeling more comfortable with your decision.

I've had to seriously re-consider my attitude to medication since my 'black time' - my own mother has been on medication for anx and panic for nearly 47 years. This used to annoy me, frustrate me and upset me (very long story!) and I would feel as if she wasn't even wanting to become well and not rely on them.

However, I have had to eat an enormous slice of humble pie over the last two years and I realise now that if she came off medication altogether she would have an even much less a quality of life than she does at the moment.

So, carry on listening to other opinions but always seek medical advice when having to make important decisions about medication.

Keep in touch ok?

:flowers:

[Suky]

Thanks everyone. :flowers:

I spoke to the professionals right at the beginning of this episode but it's one thing them telling you how meds are supposed to work, isn't it? They are kind and supportive but they don't really have a clue about symptoms. It's left up to me as to when I should up the dose (Sweden is soooooooo democratic!)http://www.nomorepanic.co.uk/images/icons/icon12.gif.

Basically, I am feeling dodgy most days at present but I am certainly not as bad as some people have obviously been feeling. Still, I can only compare me to myself and this time is a real TOUGHIE. Will wait till the end of this week annd will then increase to 50.

Am pleased that I am riding out the awfulness (thanks NMP) and not needing to go for the oxazepam and am trying just to take one day at a time. Next big hurdle is getting on a train, then plane in August to go back and see my family in England. Don't think I can do that just on an iron constitution just yet I fear (sigh...).

Have some questions as I have never joined a forum or been in a chatroom until this week:

- When do people use private messages ? When it is not OK?
- Is it OK just to go in to the chatroom and say hello and then just listen in?
- What about leaving the chatroom - are you supposed to say goodbye? I have a temperamental ASDL connection that keeps cutting out so I am often disconnected from the Internet with no warning.

Well, there are no such things as stupid questions, only stupid people as my dad used to say (he was a bu**er!). It was while I was racing back and forth between England and Sweden while he was dying last year that I had a panic attack on a plane - and yes - I was on my own! Not been good on planes since then.

Off out with the dog now. She's getting lots more exercise these days thanks to the adrenaline in my body!

Have a good week everyone.

Suky.

[joy]

it seems that when one tries to go back on a med that worked the first time,it doesnt the second almost as if one has become immune to it. We are hearing more and more about this

Love Joy

[mkeeley]

Just to let you know that I read some research papers on dosage and they concluded that 40mg is the maximum theraputic dosage, taking any more didn't make any difference. So you can try upping your dosage but they say it's a waste of time, haven't first hand experience though.

[witherz]

hiya i have been on citalopram for the last 5 years, i have had another bout of anxiety and panic attacks over the last 9 weeks. the first bout i had i took 20mg citalopram and second they put me up to 40mg wher i have stayed for last 2 years, i have always associated getting well with medication. my doctor would not put my dose up saying there is very little evidence to say 60mg works better than 40mg and that medication only takes the edge of it and helps by around 10%. I am still on 40mg citalopram and i am improving each day probably as quick as i have done in the past. My point is for me anyway i wanted to do this myself as what happens when i am on maximum dose and it happens again. I am improving and it is not thanks to upping my meds. have faith and take one day at a time, remember meds are good to help you cope in the short term but are an aid and not a cure. xxxxx t.c. xxxx

[hickman]

Hiya, I started on 20mg of Citalopram 4 weeks ago, then increased to 40mg after 2 weeks (on docs advice). Still feeling anxious/uptight almost all day. Not sure how long I should give them. Should they be working by now? I was taking amitriptyline for about 10 years (a low dose 25mg) but because I was starting to feel anxious doc decided to try me on Citalopram & she told me they were very effective for anxiety. Amitriptyline is not widely used now for depression as it is an old antidepressant, I think they are given more for pain now. Has anyone else ever changed from a tricylic ad to a SSRI? Would appreciate advice, Suzie

[Asha1979]

Hickman you only increased your dose 2 weeks ago, it takes 6 weeks for the 1st dosage to properly kick in and with the extra increase of 20mg it may just take a little longer. It will kick in soon and then you will feel much better. Your doctor is right Citalopram is brilliant for anxiety, I take them and have for 3 years, off once with no withdrawal symptoms went back on them after 2 months due to drinking too much one night and the anxiety next day never left so I went back on them. needless to say I only drink 2 or 3 at most now, its not worth it for me. Hang on in there Suzie you will be feeling your old self very soon xxxxxxxx

[suzy-sue]

Suky s Posts are old .They were written in 2007 .. she doesnt come on anymore .

[Asha1979]

Suky s Posts are old .They were written in 2007 .. she doesnt come on anymore .

oh thanks, just goes to show where my head is at the moment:roflmao::roflmao: