:welcome: back Robert,
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Originally Posted by
rcs
I have been on citalopram for 10 years and have asked my GP several times for a change as i am 40mg and sometimes was struggling.
So to be clear, at 40mg/day you are still having considerable anxiety? If so, daily, several times a week, less often?
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My GP who can be quite reasonable but would get a bit annoyed saying that the med was helping me and basically be grateful.
Sigh!! :mad:
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I have stopped taking it twice before and when i had to unfortunately restart i suffered terribly the first 1-2 weeks and i was prescribed diazepam. When i informed GP of this he said it was more likely my anxiety increasing as i was not well and maybe some minor side effects.
Increase anxiety when first taking an AD is very common. It is caused by the extra serotonin activity. After a while there is a bio-feedback response of reduced serotonin synthesis and expression which eases the anxiety, although it may reoccur for a while after dose increases. This isn't rocket science. Using diazepam to manage the heightened anxiety is common, although this may delay AD kick-in, but it's better than having folk stop taking the AD.
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My third time on citalopram i was in tears and did not sleep for 3 nights in a row and i am a 40 year old man. I had asked the GP who was different to prescribe me another ssri and was told this is the best med for my condition .
No AD is intrinsically better/more effective than any other either generally, or for a specific disorder, although clomipramine and fluvoxamine for OCD may be the exceptions which prove the rule. However, one or two may be more effective for an individual. Unfortunately, there is no way of determining which one/s except by trial and error. It is possible that citalopram is the best AD for you, but the only way to know is by trying all the others.
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I had anticipated 1-2 weeks of hell and i was right even down to suicidal thoughts (trigger warning!). I eventually talked to psychiatrist who agreed with me and did explain that Citalopram can lower your mood initially when you are in bad shape anyway and later on a therapist thought that as well and did not rate citaopram but said it was cheaper than other meds.
The Star*D trial, biggest of ADs so far undertaken (for depression, but much also pertains to anxiety) did find citalopram tended to produce slightly fewer initial side-effects than the other SSRIs, but that doesn't mean it will for everyone.
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It confuses me to this day how sometimes you are ignored by some medical professionals who have not gone through extreme anxiety , i know 10 min consultations are not the best for mental health discussions and the NHS/GPs are under pressure from and Government at times (Jeremy Hunt etc) and reduced finances, but other countries Doctors mentioned on this forum such as USA seem more amenable to discuss pros and cons of various SSRIs and let the patient have a say.
My sense if that the NHS is run as a dictatorship laying out a by the numbers procedure to follow with few doctors willing to step outside the guidelines. Which might just be acceptable if they were well founded. Imho, they are not. For example they seem to place a lot of store in venlafaxine and mirtazapine, two ADs with a number of problems. The NHS also restricts the meds available. For example, if citalopram were nearly, but not quite fully effective for you then one thing worth trying would be adding a small supplementary dose of buspirone (Buspar). This is a GAD specific med which works for some, but not at all for most. However, it has a good track record for increasing the effectiveness of SSRIs, easing some of their ongoing side-effects, particularly sexual dysfunction, and reinvigorating those that have stopped working. But I believe it isn't available on the NHS.
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I worry about long term use of this med as my memory and concentration can be terrible,
Anxiety (also depression) may affect memory and concentration too. Indeed, is more likely to than ADs. Anxiety and depression are the emotional manifestations of the loss of brain cells in the hippocampal regions of the brain killed and inhibited from growing by high brain stress hormone levels. The hippocampus is involved in converting short term memory to long-term. ADs work by stimulating the growth of hippocampal brain cells. It is the new cells and the connections they form which produce the therapeutic response, not the ADs themselves. For a more detailed explanations also see: Depression and the Birth and Death of Brain Cells (PDF) and How antidepressant drugs act.
There is pretty good evidence SSRIs can protect against Alzheimer's. The tricyclic class antidepressants (TCAs) seem to be better at diminishing other dementias.
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i sweat a lot , increased weight and struggle to sleep regularly .
Serotonin is not just a brain neurotransmitter. It has many functions in the body, including in the regulation of blood vessel tone, constriction and dilation, and serotonergic ADs can effect this with one symptom being sweating. Citalopram tends to be less likely to increase weight than some other SSRIs, but as with everything AD related, YMMV. If citalopram were working well for you I'd be suggesting a switch to escitalopram because despite sharing the same active drug, the small differences in there chemical structure can change the side-effects each produces. As for insomnia, ask your GP to prescribe a small dose of mirtazapine. Despite what it claims on the box, mirtazapine is really only a very sedating antihistamine. The AD trazodone would be even better because it has a much shorter half-life so its sedation is less likely to last into the next morning, but apparently the NHS isn't a fan so...
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I feel my GP has had enough of me and i try to see other GPs in the practice but they seem be the same ,
Unfortunately, all too often GPs see themselves as minor deities. They need constant reminding that they are in fact just the hired help who we pay, directly, or via taxes/premiums for advice and if they want the honour of our custom they need to dance to our tune.
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I know i cannot expect a complete cure with SSRIs which i naively thought years ago but i can't shake these nagging doubts..
It is often possible to find an AD that produces 99% of what we want. The difficult bit is finding the right one/s. Plus, don't limit yourself to SSRIs. They are the flavour of the month only because they are perceived to be safer in overdose, which is not actually true of all, not because they are intrinsically more effective. In fact, the older TCA and MAOI ADs are generally more effective, but they may produce more ongoing side-effects, mainly nuisance ones such as dry-mouth and constipation which can be managed. Fwiw, two TCAs, imipramine, and for the last ~25 years dosulepin, have keep me pretty much panic free since 1987 (I can't tolerate SSRIs, they make me manic).
