Dosage issues

[happybunny13]

Hi all
I have been on 20mg citalopram for 13 years
Recently after a discussion with my doctor I went down to 15mg. (Halfing the 20mg then halfing again) It's been a month now and I feel alot better. More awake. Less tired and feel like 15mg is a good dose for me. When going to pick up my months worth of medication my doctor prescribed me 10mg. I rang him and said I thourght we agreed on 15mg. He said that it's not a recommended dose. I told him I had done alot of research about weaning off of citalopram and because I had been on it so long wanted to do it slowly . He said he isant happy to prescribe me 15mg and will do it for the next t month but after that I have to go to 10mg or back up to 20mg. I said but I'm happy at 15mg. He said it's not something I can recommend or prescribe. We agreed I would try 10mg but i said if I feel unwell on 10mg then that means I have to go back up to 20mg and 20mg feels too much for me now. It makes me so tired. :( hopefully I,ll be fine on the 10mg but I feel disappointed that I dont get the option. What's everyone thourghts on this?

[panic_down_under]

What's everyone thourghts on this?

How long do you intend staying on 15mg? In terms of quitting there is little point in a protracted weaning. Most of the claims for this being necessary are based on a flawed understanding of how ADs work.

The second potential issue is that taking sub therapeutic doses increases the risk of the med failing to work. Antidepressants have no direct effect on anxiety, or depression in the way say aspirin has on a headache. 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 this requires a minimum level of the med in the system to initiate and sustain.

The problem with taking sub/borderline therapeutic doses is neurogenesis may be interrupted whenever AD plasma levels drop below the amount needed to sustain it which could lead to the second issue, the growing evidence antidepressants become progressively less effective every time they are stopped and restarted. 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: Bosman RC (https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/30041180/) 2018; Amsterdam JD (http://www.ncbi.nlm.nih.gov/pubmed/18694599), 2009; Leykin Y (http://www.ncbi.nlm.nih.gov/pubmed/17469884), 2007); Paholpak S (https://www.ncbi.nlm.nih.gov/pubmed/12501907), 2002). Taking a low dose for months may create a similar situation as stopping and restarting it. While the neurogenesis interruptions may only be of short duration, they will probably occur much more frequently.

[happybunny13]

Thank you for the information. I was going to stay on 15mg for 4 months then go down to 10mg. His given me another month so that will be 2 months on 15mg. It just scares me that 10mg may not be enough to make me feel ok then I have no where to go but to 20mg

[panic_down_under]

If tiredness is the main side-effect when taking 20mg citalopram you could try switching to 10mg escitalopram (Lexapro). Citalopram) is made up of two isomers, the 'S' form of citalopram, 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 may change the side-effects experienced. I can't guarantee it will work, but there is a good chance it will and switching between the two at equivalent dose is usually trouble free.

[happybunny13]

I stayed on 15mg for 2 months. Been on 10mg for a week. Not feeling great. Low mood. Tired. Headache. No motivation. Head zaps are going. Just feel very flat thoughts are negative. Going to give it another week . I really hope I can stay on 10mg as I dont want to go back to to 20mg. I'm hesitant to change to another medication as I dont know of it will work or not :( if only I could stay at 15mg

[panic_down_under]

I'm hesitant to change to another medication as I dont know of it will work or not :( if only I could stay at 15mg

Maybe see another GP who will allow the 15mg, although I think this will still increase the risk of the med pooping out. Imho, switching to escitalopram is worth a try as you won't be switching to a new med, just a more refined version of citalopram which might allow you to take a therapeutic dose without the sedating side-effects.