4 weeks of cit not much improvement - reassurance please??!

[Windywel]

hi all-just need some reassurance. Been on cit second time for 4 weeks now for anxiety and depression - last 11 days on 20mg. there has been some small improvement but definately still have lots of anxiety and need to take lorazepam to sleep and even then it’s not great. Really bad morning anxiety and slightly less anxiety during the day but I can eat a bit now which I wasn’t able to aweek ago. i am really worried that its not going to work this time. just need some reassurance that it can still work even after 4 weeks. i know they normally say 4-6 weeks - thanks heaps

[Windywel]

Panic down under does the 4-6 weeks start from the beginning of the therapeutic dose? In other words 11 days is still early and I just need to be patient?

[panic_down_under]

Panic down under does the 4-6 weeks start from the beginning of the therapeutic dose? In other words 11 days is still early and I just need to be patient?

There will be some 'credit' from the 2 weeks you were on 10mg. How much depends on how well citalopram meshes with your biology. But even in the best case 11 days is likely too early except possibly as a placebo response.

With ADs patience is definitely a virtue. There are no short cuts. :sad:

[Windywel]

So will still be likely a few weeks before I see much benefit? I feel depressed as well as anxious at the moment

[nomorepanic]

It can take weeks/months but there are other things you can do to help apart from drugs.

[Windywel]

Thanks Nicola - I am trying meditation, rest, exercise but not much use so far. The medication made my anxiety disorder much worse as I started to feel really anxious about the medication side effects and whether it would work a second time so still trying to get to grips with that. I’m feeling better than I was for the first two weeks on the meds but not back to where I was before the medication yet. The problem is if I stop the citalopram now the anxiety will be much worse because of the experience of the last few weeks so I’m stuck on this path now.

[panic_down_under]

So will still be likely a few weeks before I see much benefit?

Unfortunately, yes. ADs (and therapy) work by stimulating the growth of new brain cells which provide the therapeutic response and they take weeks to bud, grow and mature.


I feel depressed as well as anxious at the moment

This is not unusual. SSRIs can make both anxiety and depression worse in the initial weeks, and for a while after dose increases, because of the heightened serotonin activity at the beginning.

Please let your GP know how you're doing as there are ways of reducing SSRI induced anxiety which may then also ease the depression.

[Windywel]

Thanks PDU - what do you mean? What are the options for reducing the SSRI induced anxiety? Would it still be the SSRI's if its 4 weeks? I guess I have only been on the 20mg for 13 days. I have tried propranalol on and off for a week but it really didn't seem to do much for me. I have also been using the 0.5mg of lorazepam at night to sleep for the holiday as well as ocasionally another one during the day if I really needed it but really conscious its been a week of that now so I shouldnt really use it anymore. We can't get hydroxyzine here in NZ unfortunately so I did buy some unisom sleep gels which are diphenhyrdramine but they arent supposed to be used for me than a week either and I'm scared to try them. Have some melatonin pills from the doc too but have read very mixed reviews about that so haven't tried them either.

[panic_down_under]

Thanks PDU - what do you mean? What are the options for reducing the SSRI induced anxiety? Would it still be the SSRI's if its 4 weeks? I guess I have only been on the 20mg for 13 days.

It could be because dose increases often trigger it again.


I have tried propranalol on and off for a week but it really didn't seem to do much for me.

The beta-blockers can be effective when adrenaline surges are a significant driver of the anxiety, but they have no direct affect on anxiety itself.


I have also been using the 0.5mg of lorazepam at night to sleep for the holiday as well as ocasionally another one during the day if I really needed it but really conscious its been a week of that now so I shouldnt really use it anymore.

The benzodiazepines can be counterproductive as they inhibit the mechanism by which ADs (and therapy) work. However, it is still better to take them than to quit taking the ADs because they've raised anxiety levels beyond tolerable levels.


We can't get hydroxyzine here in NZ unfortunately

Pity because it can be very effective. Wonder why that is. Mirtazapine is a good alternative.


so I did buy some unisom sleep gels which are diphenhyrdramine but they arent supposed to be used for me than a week either and I'm scared to try them.

Tolerance to diphenhyrdramine's (Benadryl in the U.S., but not always elsewhere) sedating affect can develop within a few weeks. You could alternate it every few days with lorazepam to greatly delay tolerance onset of each.


Have some melatonin pills from the doc too but have read very mixed reviews about that so haven't tried them either.

For sleep, or anxiety? Melatonin is a metabolite of serotonin and atm you're probably not lacking either.

[Windywel]

Really freaking out now - been emailing psychiatrist and he said i should be noticing some inprovement after 4 weeks (there hasn’t been much!) and he wants me to persevere for 4 weeks (so another 2 on 20) and if no improvement by then he'll look at changes - so now im really freaking out that its not working and that I’m going to have to start all over again on something else and be ill for months ��

[Windywel]

I’ve been recommended to try ashwaghanda alongside citalopram as apparently it’s really good for stress and anxiety. Does anyone have any experience with it?

[Windywel]

Has anyone used low doses of lorazepam daily in the first few months of starting citalopram and been able to come off them ok?

[nomorepanic]

Hi

This is just a courtesy reply to let you know that your thread was merged with another of your threads.

Please when posting on similar topics add it onto your previous post rather than starting a new one.

It is nothing personal it is just to make it easier for people to follow your story and to give you advice as a whole.

[Windywel]

Thanks but the two latest posts were deliberately made new threads as they were unrelated to the previous thread - it is unlikely that I will get any replies now

[Windywel]

PDU how much do I need to worry about withdrawal from propranolol? I’ve been taking it a bit over the last 2 weeks, mostly intermittently though have taken 20mg in the morning the last 2 days. I think it helps a little bit but someone told me it can cause terrible withdrawal symptoms so I’ve decided I don’t want to take it anymore. Do I need to worry about tapering/withdrawal? Have only taken 10 or 20mg at a time once a day when I have taken it

[panic_down_under]

Really freaking out now - been emailing psychiatrist and he said i should be noticing some inprovement after 4 weeks (there hasn’t been much!)

I think that's optimistic. Most begin seeing improvement at around 4-7 weeks from beginning to take 20mg, but it can take as long as 12. It all comes down to individual biology.


so now im really freaking out that its not working and that I’m going to have to start all over again on something else and be ill for months

I can't predict whether citalopram will be the right med for you, but it is as likely to work as the other ADs, and more likely to than some. Two weeks on 20mg is way to early to draw any conclusions, imho.


I’ve been recommended to try ashwaghanda alongside citalopram as apparently it’s really good for stress and anxiety. Does anyone have any experience with it?

Your best bets would be Omega-3/fish oil and/or moderate exercise 4-5 days a week. There's no need to run a daily marathon, a good 30 minute amble 4-5 times a week can do wonders. Both have the same positive effect on the brain as ADs, albeit to a lesser extent although they may be all that's needed for mild anxiety and/or depression.


Has anyone used low doses of lorazepam daily in the first few months of starting citalopram and been able to come off them ok?

If you take lorazepam daily for several months you will likely develop some dependency to the med and need to wean of it. However, you shouldn't need to take it for months anyway. Also be aware that benzodiazepines may reduce the effectiveness of antidepressants so their use should arguably be limited to a few weeks when first taking an AD, or for occasional breakthrough anxiety.

[Windywel]

Thanks PDU - what about the sedating antihistamines and the propranolol? Also I’m get intermittent brief ringing in the ears. I know this is a side effect - does it usually go away?

[panic_down_under]

PDU how much do I need to worry about withdrawal from propranolol? I’ve been taking it a bit over the last 2 weeks, mostly intermittently though have taken 20mg in the morning the last 2 days. I think it helps a little bit but someone told me it can cause terrible withdrawal symptoms so I’ve decided I don’t want to take it anymore. Do I need to worry about tapering/withdrawal? Have only taken 10 or 20mg at a time once a day when I have taken it

Few people have physical withdrawal symptoms when discontinuing propranolol. Psychological dependence is another issue. The main reason for needing to taper off this med after long term use is to limit potential rebound spikes in blood pressure. You unlikely to have withdrawal symptoms based on the short time you've been on it and the way you've taken it. Propranalol has a very short half-life, about 4 hours, so a single dose will be out of your system in under a day. Regular washouts significantly reduce the risk of dependency developing. If it helps, take it.

[Windywel]

Thanks - what’s a regular washout? You mean taking it every second day or so?

[panic_down_under]

what about the sedating antihistamines and the propranolol?

In terms of dependency? If so, I've already covered propranolol. With antihistamines, it varies depending on which one. But as you also have lorazepam, then one way of limiting dependency onset is to rotate between the two (3 with propranolol) types of med.


Also I’m get intermittent brief ringing in the ears. I know this is a side effect - does it usually go away?

Tinnitus is a strange symptom which can be triggered by many meds, including otc pain-killers and also anxiety, btw. Just about all the ADs and other anxiety/depression meds may produce it, including lorazepam and propranolol, but most are also prescribed to treat it. It may not be a single med, either, but the combination you're on, possibly with the underlying anxiety also contributing. Whether it will be a long term issue for you I can't say, but usually it isn't.

[panic_down_under]

Thanks - what’s a regular washout? You mean taking it every second day or so?

Yes. Not having any of the med in your system for a while.

[Windywel]

Thanks again re the sedating antihistamines I was wondering which Is the safest? We can’t get hydroxyzine here so that leaves promethazine or diphenhydramine. If I’m not going to take the lorazepam every night I really need something for the insomnia as the anxiety at night is stopping me from getting to sleep.

do you think it is likely I will have withdrawal from taking 0.5mg lorazepam a day for 12 days?

[panic_down_under]

Thanks again re the sedating antihistamines I was wondering which Is the safest? We can’t get hydroxyzine here so that leaves promethazine or diphenhydramine.

It's a toss up. They are both mild otc meds which you'd cause significant problems. The main difference is in their half-lives. Diphenhydramine's is 2-9 hours compared to 10-20 hr for promethazine, so you're likely to be less sedated into the next morning with diphenhydramine, however, as with most things med related, ymmv.

As with all sedating meds taken extra care if engaging in potentially hazardous activities, including driving, if noticeably affected. You may be less aware and take longer to react.


If I’m not going to take the lorazepam every night I really need something for the insomnia as the anxiety at night is stopping me from getting to sleep.

Tolerance to BZD sedation tends to develop fairly quickly, as little as a week, or two, as it's activated through different receptor binding sites than the anti anxiety activity.


do you think it is likely I will have withdrawal from taking 0.5mg lorazepam a day for 12 days?

I suspect not, but there is only one way of knowing and that is to stop taking it.

[Windywel]

Thanks - I don’t really need the loraz to sleep as such - it calms me enough to feel sleepy if you know what I mean. It still seems to be working fine - just feels like a gentle return to some calmness. Neither of those other options sound great but I guess the diphenhydramine is a better option. Seems a bit like I’m stuck between a rock and hard place - why can’t there be any anxiety medication that doesn’t cause dependence and withdrawal!

[panic_down_under]

why can’t there be any anxiety medication that doesn’t cause dependence and withdrawal!

It isn't for a lack of trying. The company that cracks that puzzle will be able to buy the world with its petty cash.