Starting Citalopram

[Dragonsblonde74]

Morning Everyone!

Starting citalopram at the moment and just taken pill number 3 so I understand I am early on in the recovery, but the side effects have side swiped me a little. I thought setting this thread up might help me in the journey as I can at least look back and see when things were worse

Background for me is that this is my 5th break in my life and the past year has been a tough one and I have not been able to keep the break from happening, lots of work stress, a death in the family and a lot of health investigations. I have PCOS, Diabetes type 2 and Severe Anemia as well as having to see a physio for a weak ankle and I hate all of it. I was on citalopram once before about 7 years ago and remember that it really was wonderful once it started working and allowed me to do my CBT and develop other techniques that worked well for years.

So I am talking my tablets in the morning and they are not making me sleepy so far. Day 1 was ok, managed to still get out to the cinema with only my usual level of anxiety. Day 2 though WOW - anxiety through the roof, few panics, hot leaden feeling in the chest and feeling sick and struggled to eat (which I have to do for the diabetes). The night was awful, full on waves of panic and anxiety before bed and when i got in. My husband basically had to hold me until about 2am when I fell asleep and then I was awake at 5. He is wonderful and a real comfort and rock of support.

Taken todays anyway, but scared to death of being like that again and spiked the fear that the meds are harming me in some way and that there is no way out of this. My meditations don't seem to help and panic is climbing right now just 90 minutes after the tablet. I know I could easily be doing it to myself, but as you will know well it isn't easy to switch that off.

Anyway - a blog for myself, but if anyone has any kind or assuring experiences please feel free to share as I am struggling right now

[Carnation]

Hi, you might want to look at Stressed Eric's thread who started citalopram 2 weeks ago headed 'high anxiety' and Suemarieeee who has gone past the 3 month barrier. x

[Dragonsblonde74]

Hi Carnation

Thanks for the advice. I have been stalking the forum for a little while and have read the threads, I guess I wanted to journal for my own sanity, but will reach out to the others as well.

I am experiencing rolling panic and sweats at the moment and even unpacking some shopping we had delivered was really difficult. It is hard at the beginning I think to see the way out

[Carnation]

You just have to keep telling yourself that the reward at the end is worth the struggle now and take more tlc time in the meantime. It won't hurt to not do all the jobs you normally do for a week or two. You are more important! x

[panic_down_under]

Background for me is that this is my 5th break in my life

Welcome to NMP,

Have you considered staying on an antidepressants permanently given your history? Not only would you not have to go through this again, but there is evidence antidepressants 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/pmc/articles/PMC5123793/), 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.


The night was awful, full on waves of panic and anxiety before bed and when i got in. My husband basically had to hold me until about 2am when I fell asleep and then I was awake at 5.

Please discuss this with the prescribing physician as there are ways of easing these side-effects. Small doses of the ADs mirtazapine, or trazodone should help you sleep better, as could the antihistamine *hydroxyzine (Vistaril) which is also pretty good at dampening anxiety, however, I've heard that UK GPs are reluctant to prescribe it for this purpose for some reason, but it won't hurt to ask.


*Hydroxyzine comes in two forms, hydroxyzine pamoate (Vistaril) and hydroxyzine hydrochloride (Atarax). Anecdotally, the pamoate form is claimed to be the more effective anxiolytic, but just how true this is remains a matter of debate.


My meditations don't seem to help and panic is climbing right now just 90 minutes after the tablet. I know I could easily be doing it to myself, but as you will know well it isn't easy to switch that off.

While there is almost certainly a strong psychological component, ADs, and especially the SSRIs and SNRIs, often initially significantly increase anxiety levels. Serotonin is not the 'feel good' neurotransmitter of popular belief, nor are anxiety (and depression) caused by low brain serotonin levels. Stress actually *increases serotonin in areas linked to these disorders, particularly the amygdala, hippocampus, hypothalamus and nucleus caudatus. This increase should prevent that stress from triggering anxiety and depression if the low serotonin hypothesis was correct, but it has the opposite effect.

While ADs do increase serotonin levels for the first few weeks, their longer term effect is to significantly *reduce them to well below pretreatment levels. Unfortunately, that initial serotonin spike often significantly worsens anxiety and is also responsible for some of the other common initial side-effects. For example, the gut is by far the most serotonergic organ of the body, not the brain, making and using over 90% (http://www.nytimes.com/2005/08/23/health/23gut.html) of the body's output compared to less than 2% for the brain. Consequently, it is often more greatly affected by serotonergic ADs triggering side-effects such as nausea and diarrhoea, or, conversely, constipation at the beginning.


*See my: Serotonin - The 'chemical imbalance' myth (http://www.nomorepanic.co.uk/showthread.php?t=193671)

[Dragonsblonde74]

Hi there

Thank you for such a considered and informative response.

I have considered a scenario where I am on tablets for life and personally I don't think it would worry me at all, just not sure how hard I would have to convince a doctor that that is the right way. I know some don't seem to mind, but others try hard for you to come off.

I had pretty anxious day again yesterday, although got off to sleep a little easier, still awake at 5, but I had to get up by 6 today to try for work anyway. Actually now sat at my desk after a few initial freezes and rushes of anxiety. Very shaky today, but trying to just let things happen as normally as possible. If the panic still stays as high and impacts too much I will try to get in to see my doctor again to see if they can help more.

I am currently taking my table after breakfast to reduce the risk of nausea at around 8.30 and it doesn't seem to be making me sleepy so I wouldn't switch it to the evening which I know some people have done to make the days easier. Hoping that the effects at least lessen slightly as each day passes.

[panic_down_under]

I am currently taking my table after breakfast to reduce the risk of nausea at around 8.30 and it doesn't seem to be making me sleepy so I wouldn't switch it to the evening which I know some people have done to make the days easier. Hoping that the effects at least lessen slightly as each day passes.

Citalopram has a fairly long half-life so in theory it shouldn't make a difference when the dose is taken, but in practice it frequently does so switching to evenings is definitely worth trying.

[Dragonsblonde74]

So - Day 5 today and getting ready to take my tablet. Feeling shaky and some burning in the chest, I know that I am anxious about being anxious and that foreboding that something bad or a meltdown must be just around the corner is still with me. I know it is early days though and take some comfort from the fact I did a full day at work yesterday, with a meeting in the afternoon. I am not fully 'with-it' and I can tell I am not engaging as much, but that is also a symptom of my panic issues as well.

Slept a bit better last night, still cuddling my husband before I sleep and I know he isn't getting as much sleep as he needs, but he tells me its worth it and its not forever as I will feel better at some point. He is a great support. Did wake up at 3am and 3.30 having to dash to the toilet, but I think I remember that from last time as well. Upset stomach for sure, maybe from the panic and the not so great diet (appetite very low) as much as the tablets.

So some good news in there

[BlueIris]

I've been on citalopram for almost a year, and I can confirm that stomach upsets can be an issue. Not sure if you consume much spicy food; I do, and I found my tolerance for it was drastically reduced.

[Dragonsblonde74]

I've been on citalopram for almost a year, and I can confirm that stomach upsets can be an issue. Not sure if you consume much spicy food; I do, and I found my tolerance for it was drastically reduced.


Hi there. I haven't been eating much the past couple of weeks and keeping it fairly plain, but did have a chilli stir fry last night so that could have triggered something extra I guess. Like you I like spicy things so may have to watch that - thanks x

[Carnation]

I think it's a good idea you decided to keep a day-to-day diary. It will help you and others.
Keep remembering the reward at the end and also congratulate yourself for being so brave. x

[Dragonsblonde74]

I think it's a good idea you decided to keep a day-to-day diary. It will help you and others.
Keep remembering the reward at the end and also congratulate yourself for being so brave. x

Thank you for the support! I think it is a good thing as it gives me something to focus on in the morning when the anxiety is at its highest. Yesterday was quite a good day as I had a day full of different meetings including a briefing in a lecture hall and whilst I admit I sat at the end of a row near the front in case it got too much I lasted right through. Not without anxiety for sure, but managed to keep it in check. Also cooked supper last night for the first time in a while, nothing exciting, but at least I could face doing it. Other goods news was last night I slept better than the past few nights.

Today is day 6 - and my anxiety is quite high this morning and I am trying to remind myself that it is still early and I will have ups and downs. Also I am starting a local Managing Stress and Anxiety 6 week programme this afternoon and new places and people are a slight trigger for me at the best of times. Combining that with some fear of facing these things anyway and I am extra shaky today. Streaming Claire Weekes for half an hour whilst I eat breakfast and take my tablet

[Dragonsblonde74]

Ok then and onto day 7! Feels like a little milestone actually that it is a week since I started the tablets and I remember thinking I wouldn't make it to the end of the week without stopping the tablets or just going totally mad. Since neither of those things has happened - a small hurrah!

Yesterday was probably the most challenging day I had had so far in that I had a meeting with my boss to talk about my current state and he is quite senior so I expected the worse and for him to look at me as if I was less than he needed. Turns out he was lovely about it and he even opened up to me that he struggles with an auto-immune disease which he has to manage and is struggling with. We had a great talk about how you can never tell what someone has going on in their life.

Then the dread of the course I was going on, felt sick right up to the door and was a bit quiet in it, but got chatting to a couple of people. It is a 6 week CBT programme run by the local mental health organisation and having done the first week I am more comfortable with doing the rest. The people are nice, the group is a real mix of ages and sexes which kind of comforted me a lot that this is problem that can hit anyone at anytime, but that we can be open about it and work together. After the course I was calmer and had a friend round for supper and a movie whilst my husband was out which was good for both of us I think.

Side effects - still anxious in the mornings and when challenged (also aware that is my own anxiety and potentially not just the meds) - I would have slept ok last night I think if a car alarm outside hadn't kept going off in the early hours!! Muscles aching a lot, but probably from just being so tensed up all the time. Starting to increase my food intake a little and introduce some healthier choices (not loads - but small and often).

All in All - not horrible

[BlueIris]

Great to hear you're doing better - cheering you on from the sidelines here!

[Carnation]

I think rewarding yourself for achievements is important and a good excuse for a treat. :winks:

[Dragonsblonde74]

And on into Day 8

Yesterday was a fairly good day! I had a quiet day at work based at my desk so I was able to take things at my pace without having to face a lot of challenges, cooked supper again veggie packed pasta dish and slept well. Declaring it a success as as suggested I celebrated with a chocolate mousse for pudding!

This morning a little shaky again, but I think mainly because I have a challenging day ahead with two big meetings and two video conference calls (which I have always hated!) lol. Also some apprehension I suspect about the weekend. We put pressure on ourselves to be 'better' at weekends when we should be able to enjoy ourselves and I am trying to recognise that about myself and just take it easy. Remembering it is still early days and I don't actually have to do anything I don't feel I can cope with just yet.

[Carnation]

Yummy, chocolate mousse. :)
Remember, another treat after your meetings.
If you feel tensed, imagine your colleagues as naked, it will certainly take the edge off the tension and make you smile. :D

[Dragonsblonde74]

Well today is day 10. I took a day off posting yesterday as it was a Saturday and we did a fair few things around the house so kept quite busy.

Friday was challenging with all the meetings, but I did do them all and didn't crack or freeze and actually managed to give some decent contributions I think. Very challenging, but felt good when I finished them all.

Saturday I was expecting some anxiety as the days are less structured, but mostly it ended up being focused around when we went food shopping. Not too bad, but certainly there the whole time. I can't really concentrate as well so end up being a little useless. Luckily my husband understands and steps in to make decisions when needed.

Today - last night had some anxiety in bed and anxious this morning, We have plans this afternoon to go out to a gentle concert in a park and we did this a lot last year as my husband plays in the band. I really want to go, but anxiety grows at the thought of it with the gnawing stomach pain and nausea. Will see how it goes today and update you all later!

[Carnation]

Remember you are still early days on the meds, but I can already see your confidence building. x

[Dragonsblonde74]

Remember you are still early days on the meds, but I can already see your confidence building. x

Morning x thank you for that - sometimes hard to look out from the inside of something

The positive news from yesterday is that I went to the concert in the park and really enjoyed it!. It was a gentle few hours with my friend sat on the grass watching the band and then back to ours for an indoor picnic tea and group computer game play. A really lovely day. I should mention that I am also trying to follow the Claire Weekes work and just going with the flow a little. I have started talking about things after the thing that scares me like 'after we get back from the concert I will make those Italian potatoes everyone likes' and I find that is helping me. If I can see past the fear to the next thing it does seem to take some of the fear out of it, like I have already agreed with myself that I am doing it and I know that it has an end. I hope that makes sense and doesn't just sound like the ramblings of a madwoman lol

So - onto day 11. Slept well last night and back at work today. Stay well all xx

[Dragonsblonde74]

Day 12 - Yesterday was a calmish day at work so anxiety stayed low which was lovely. Getting hotter and I struggle in heat, but luckily we have air con at work and a few years ago i bought a portable unit for home that just has a hose that poke outs a window. Will be needing that this week for sure

Today am actually trying out working from home as I have struggled in the past spending time at home on my own and it is a trigger for increased anxiety, but last night decided to try not to avoid it, but try it today with some meds on board and a bit of other coping mechanisms now a bit more embedded.

This weekend we have a campervan trip booked and I had to cancel the last one as the panic was too high, but I would really like to go on this one as once i am there I know it usually helps me. I imagine that the anxiety may build as it gets closer, but lets see what happens

[BlueIris]

Crossing fingers for you!

For what it's worth, I have a Skype meeting this morning and I'm terrified.

[Dragonsblonde74]

Crossing fingers for you!

For what it's worth, I have a Skype meeting this morning and I'm terrified.

Hey! xx Am sure it went ok in the end? I hate those things just in general, but when anxious they feel nearly impossible. I actually prefer to be in the same room as people as I can get a better idea of how they are reacting and feeling as opposed to everyone looking like they are a bit awkward and stiff

[Dragonsblonde74]

Day 13 - lucky for some? Yesterday at home went ok actually. There were a coupe of times I felt the anxiety starting to lift, but also a couple of times that I felt a little bored so on balance ok. I actually did a little bit of advance sorting out for the holiday, getting a few essentials for cooking together and putting together some clothes to take. My thinking was to do a little bit a day rather than rush around in a panic the night before and it might slowly get me used to the idea a bit more in a more gentle way.

This afternoon I have the 2nd of my managing stress and anxiety groups sessions and the only thing that bothers me was that is was really hot in the room last week and this week I may boil in my own skin

[BlueIris]

Thanks for asking; I was a little more awkward than I wanted to be, but everything was covered that needed to be and that's the important thing.

My sympathies on the heat; I don't do well in high temperatures and my office has no aircon. Luckily once I make it to noon that'll be me done for the week.

[Carnation]

You're doing brilliantly Dragonsblonde and if you can achieve this in a heatwave, you can do anything!
And remember any little blip will pass and is probably due to the heat anyway.
As for boiling in your skin, the body has an amazing adaptation to temperatures. And I rather like the number 13. :)

[Dragonsblonde74]

Morning All - haven't been on in a few days as I was prepping to go away and then happily managed to get away for a long weekend. Not anxiety free of course, but in general had a good weekend with a trip to the seaside and a walk around a lake with a visit to an old manor house. Some afternoon naps in the fresh air and am really pleased I got away and that I actually wanted to get away. A few times I had the rising panic and had trouble sleeping one night, but all in all I declare it a success.

It is now day 22 which surprised me when I realised that this morning! Had my first med review this morning with my Doctor and I am not really suffering with any side effects now at all. The anxiety is still there, but maybe a little less intense and I have fewer full panic flare ups. I managed to almost get round a supermarket on my own without panic, but the last 10 minutes it did start to build. Still finished the shop though. Have eaten out in public a few times in busy restaurants or cafes without too much issue.

I have also completed 3 weeks of the group CBT class and still meditate and have started some progressive muscle relaxation which does seem to be really beneficial so am not not relying in the meds, but very glad I started them again. The doctor is happy with the 20mg dose for now as am I and reassuringly doesn't want to rush me off of them, but rather wanted me to understand not to think about coming off of them soon. Just let them and the other things embed

Wanted to say really that small things every day remind me that you can still live with anxiety and there are things that can work you just need to find the things that work for you and I think for me taking some 'ownership' of me and my issues has helped and is something I need to keep working on.

Hope everyone else is ok and survived the heatwave - nice to see some rain back although typically its now just a bit muggy feeling here again

[Dragonsblonde74]

Day 25 Monday morning and I have been a little poorly over the weekend and prepping the flat for a visit from my in-laws in soon as well as getting closer to the time my husband goes away for a few nights so my anxiety has risen over the past couple of days. I am off work today with the illness which I don't think is related to the anxiety, but is possibly feeding it somewhat. I see people talking about blips on here and I think I am probably having one of those and reminding myself that I am still early days and trying not to be too sad or down on myself about it

[Carnation]

I think you need to remember how incredibly well you have been coping and allow yourself a bit of slack. It's only been a few weeks and most meds take a good month to have any affect.
I think what it's done for you so far has taken the edge off so you've been able to function and given you extra confidence.
Most people need a rest from time to time and most people get a bit anxious when they have visitors or their other half is not around. Especially when he has been there for you during anxiety highs and fears.
Make a list of things to do when he is away, not all work though. It will help to prevent the panicking. x

[Dragonsblonde74]

Thanks x I think I had fallen a little into the 'oh I'm feeling sooo much better', but ignored the fact it is still early yet'

Day 29 and opened by second box of tablets today. This week has been an odd one and have been feeling it so took yesterday off work and went and spent 3 hours in the hairdresser getting a cut and full highlights/lowlights and the a head neck and shoulder massage. Met my husband for a late lazy lunch in a country pub in the sunshine and last night just felt very chilled and relaxed. Decided that I really needed some spoiling myself time

Feel a little more prepared for visitors now, did some sorting out and tidying up with just a bit more needed this weekend which has helped me feel ready I think, but have also made plans to meet some friends for brunch on Sunday so trying to balance out things for others with things for me

[Dragonsblonde74]

Day 34 and this week is a little more challenging with some big work projects going on, visitors in the house and knowing I have the house to myself for a couple of days. Yesterday on a site visit whilst waiting for a meeting the panic started to climb and I was hot and feeling sick, but started chatting to someone next to me and sipping water and got it back under control and had a good meeting on the end.

Am very tired and the weather is dark and rainy and miserable so I know I am facing a lot, but I do know that I am dealing a lot better with things in general and holding onto that. Good times are coming back soon

[Carnation]

Of course you are going to feel a bit nervy, even without anxiety. The good thing is from this point it will improve as you've got over the first and hardest hurdle already. x

[Kendra]

Hi,
I just wanted to pop on on say I think you are doing great. Your posts reminded me a bit when I started out on CIT. Although I was off work and barely living so I think you are amazing for how well you are coping with it all. Well done you. I'm having a blip at the moment but I am no where near the starting out process and reading through your thread has reminded me of that. So we'll done you you are doing great xx

[Dragonsblonde74]

Thanks guys for the comments and support. I think the hardest thing at times is to acknowledge that anxiety/stress/nervousness are all part of life and are actually there to protect us and it is only when it gets out of control that we have problems. I suspect like most I was looking to feel nothing in the way of 'bad' emotions when I started the meds as I was so tired of feeling anxious all the time, but need to come around a little more now to see that if I get rid of those I am just aiming at being numb to happiness and all the other 'good' emotions.

It isn't always easy to see and it is very tiring, but I am moving towards a balance and trying to re-learn that I am made up of all emotions and will feel them all.

So onto day 39 - have had the in-laws now for 5 days, they head home tomorrow and had a couple of days without anyone at home. Met up with a friend each day to do something and was at work and mostly was fine. Couple of flashes, but not much more.

Have noticed that I have trouble sleeping on a Sunday night and always some anxiety Monday morning when it is time to get up and go into work, but I was reminded that I have never been a Monday person anyway - a lot of my nervy periods are around transitioning from one place or routine to another. Work to home, home to work, home to holiday etc.

I do have some peace of mind now to be able to see some of the specific things that cause me anxiety and the next step for me now is to reinstate and practice some long term CBT, Mindfulness and Meditation techniques back into my life.

Wishing you all a positive day!

[Windywel]

Hi all I am new to this forum and would really appreciate some support and reassurance. I have just restarted citalopram after 6 months off due to a relapse of anxiety and depression. I was on it for 4 years and it did help a lot. I decided to come off it as I was feeling better. It has been 5 days now - I took 5 mg for the first 2 days and then 10 mg for the last three. My anxiety has gotten much worse with panic attacks now too and an unusual sensation of burning on the arms and chest when really anxious. I remember that from the first time but not feeling much more anxious. Though I was already really bad before I went on the citalopram the first time so might not have noticed much difference. Is it normal to have a marked increase in anxiety at the beginning and should I just try and ride it out? Or should I talk the doctor about changing to another medication? It definitely did end up working for me last time - I just remember that the anxiety did take a while to go away. I’m feeling really panicky about the medication not working and being stuck with this awful anxious panicky feeling. I can’t relax or sleep or even sit still for long and I can’t eat anything!How long does it take to go away? Please just supportive positive replies right now - I just need to hear about people’s good experiences going back on medication. Surely because it worked last time it’s more likely than not to provide some benefit even if it doesn’t take it away entirely?
Thanks so much - really looking forward to your replies

[panic_down_under]

Hi all I am new to this forum and would really appreciate some support and reassurance.

:welcome: to No More Panic,



Is it normal to have a marked increase in anxiety at the beginning and should I just try and ride it out? Or should I talk the doctor about changing to another medication?

Yes, it is a common initial side-effect of most serotonergic antidepressants (ADs), caused by the increased serotonin activity. The brain will respond after a while by downregulating serotonin synthesis and expression, but the heightned anxiety may return for a while after dose increases.


I’m feeling really panicky about the medication not working and being stuck with this awful anxious panicky feeling. I can’t relax or sleep or even sit still for long and I can’t eat anything!How long does it take to go away?

If citalopram worked before then there is a good chance it will again. Talk to your GP or psychiatrist about the side-effects as there is no need to suffer. Small doses of one of the benzodiazepines (BZDs) - diazepam (Valium), etc - should help, but they can interfere with the mechanism by which ADs work, so maybe try *hydroxyzine first. It is a prescription antihistamine with good anti anxiety properties, not quite as potent as the BZDs, but often potent enough. It is also mildly sedating which may help you sleep, however, be aware of this if driving, or engaging in any other potentially hazardous activity.


*Hydroxyzine comes in two forms, hydroxyzine pamoate (Vistaril) and hydroxyzine hydrochloride (Atarax). Anecdotally, the pamoate form is claimed to be the more effective anxiolytic, but just how true this is remains a matter of debate in forums


I just need to hear about people’s good experiences going back on medication. Surely because it worked last time it’s more likely than not to provide some benefit even if it doesn’t take it away entirely?

It is likely to work as well as before, but some find the initial side-effects are different than the first time.

[Windywel]

Thanks so much for your reply panicdownunder. I am also down under in NZ. How long until the heightened anxiety starts to wear off? I went to the doctor this afternoon and now have some propranolol and some lorazepam but I’m too scared to take either of them. She didn’t suggest the antihistamine unfortunately. Do the benzos stop the citalopram from working properly? She also suggested that I try escitalopram as she reckoned it was more calming and worked faster so I got a script for that but I’m thinking I will persist with the cit for a bit longer as it did work last time. I can also switch to that next week if no improvement.

[panic_down_under]

How long until the heightened anxiety starts to wear off?

That's one of those 'how long is a piece of string' questions which can only be answered with, 'it depends'. It all comes down to how the med meshes with your individual biology. Anything from a few days to a few weeks, plus there should be a dose increase to 20mg at some point which will extend the time. There are no quick solutions, unfortunately.


I went to the doctor this afternoon and now have some propranolol and some lorazepam but I’m too scared to take either of them.

Propranolol is a beta-blocker which works by inhibiting the symptoms of the adrenaline surge which often accompanies anxiety/panic attacks, but it doesn't have a direct affect on anxiety itself. However, if those surges are the main problem it can be a useful med. They main problem with it usually is that it can be fatiguing.

Lorazepam is arguably the best BZD to use in this situation thanks to its moderate half-life. It is one of the naturally occurring BZDs found in most foods so your brain is well used to dealing with it. So much so that it couldn't function without it and the other BZDs in your diet.


Do the benzos stop the citalopram from working properly?

They can slow down the onset of the therapeutic response. However, this doesn't mean they shouldn't be used if needed. It's better to delay the response for a little while than stop taking the AD because the anxiety is too unbearable and this never get a response at all.

ADs work by stimulating the growth of new brain cells (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC60045/) (neurogenesis) in the twin hippocampal regions of the brain 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 (see also: How antidepressant drugs act (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025168/)).

There is now good evidence BZDs (also alcohol) can block hippocampal neurogenesis (see: Boldrini M (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374628/), 2014; Nochi R (https://www.ncbi.nlm.nih.gov/pubmed/23963779), 2013; Sun Y (https://www.ncbi.nlm.nih.gov/pubmed/23639432), 2013; Song J (https://www.kurzweilai.net/how-the-brains-stem-cells-find-out-when-to-make-new-neurons/comment-page-1#comment-96481), 2012; Wu X (http://www.biologicalpsychiatryjournal.com/article/S0006-3223(09)00106-1/abstract), 2009; Stefovska VG (https://www.ncbi.nlm.nih.gov/pubmed/18991352), 2008).

In light of this BZDs use should probably be limited to a couple of weeks when first taking ADs just to ease the initial increase in anxiety levels, for a while after AD dose increases for the same reason and thereafter only for occasional breakthrough anxiety.


She also suggested that I try escitalopram as she reckoned it was more calming and worked faster so I got a script for that but I’m thinking I will persist with the cit for a bit longer as it did work last time. I can also switch to that next week if no improvement.

Citalopram is made up of two isomers, the 'S' form which is the active component, and a 'R' mirror image (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC314378/) form which is a poorer fit biologically and so is mostly inactive. Escitalopram is more refined and only contains the 'S' isomer which is why the doses are half that of citalopram. I'm not convinced there is really that much difference between them. Their side-effects can be subtly different, however, so if there is an ongoing SE with one which is bothersome then switching to the other med might solve the issue, but if one doesn't work the other probably won't either.