Do I need a higher dose?

[80wales]

Hi all, I have recently been prescribed citalopram for the first time for depression and anxiety that in retrospect I have been suffering with for years (I'm 35)

I was on 10 mg for the first 4 weeks and noticed a slight improvement that got me out of 'the hole' but was still getting panic attacks (albeit slightly milder) and constant depressive thoughts.

My doctor increased my dosage to 20mg for one month and for the first two weeks I felt great, as if a weight had been lifted and I actually felt happy for the first time. However the second two weeks that is coming to an end in the next few days I feel I have gone back a step and am getting the old symptoms back a bit. Ie mental chatter, constant low level anxiousness (but no panic attacks yet) and depressive negative thoughts.

I am seeing my gp again at the end of the week and will obviously discuss this with him but has anyone else experienced the initial elevation followed by a return back down that I described above?

And does that mean I will need a higher dose? Those initial two weeks were great and I achieved a lot in all aspects of my life but wondering if that honeymoon period is going to return?

Any help would be appreciated thank you.

[william wallace]

All sounds familiar, some folks call it the Citalopram Ladder. Keep climbing until you find the right rung, probably 30.

[80wales]

Well thats encouraging to hear so thanks for the help. It's as though I've had a short glimpse of how things could be and I desperately want to get back to that place.

It's interesting that you can respond so positively initially and then find that it wears off.

Hopefully my GP will be able to help Friday. I'll keep you all informed. Thanks again.

[william wallace]

Citalopram is one of those drugs that, if they started you off on 30mg it would drive you off your nut, so they give you increments of 10-20-30 to a max of 40. Basically every time you go up 10 you reach a plateau and hopefully you'll be feeling ok on 30. This gives a buffer of an extra 10 to cover long blips, dramas, traumas etc.
Good Luck

[80wales]

Citalopram is one of those drugs that, if they started you off on 30mg it would drive you off your nut

Ha ha thanks that makes sense, the baseline that I'm at now is much better than before I started so I can understand the plateau thing, here's hoping 30 does the trick all together. Thanks again.

[NoPoet]

Hi, glad the cit started to help. I call what you're going through a "blip", which is a temporary worsening of symptoms. There are a million causes. In your case, you started feeling better which made you feel elated and relieved, but when your anxiety started slipping back it doesn't mean the meds aren't working, it simply means that the cause of your anxiety has not been dealt with. It is totally normal to feel some anxiety even on higher doses of meds and if you are not receiving any kind of therapy, meds alone won't make things go away.

It's tough to start getting better and then feel like you're slipping back. Be assured that you are not relapsing, this is all normal and is part of the learning curve. Just be grateful that the meds work and you were allowed a glimpse of what life will be like as you continue to get better.

[80wales]

Thanks for the encouragement. I started CBT last week and am also booked in for counselling at MIND (but theres a 4 month waiting list for the counselling) so therapy will be ongoing over the next year or so.

During those first two weeks on 20mg I had no anxiety whatsoever and it was such a relief. I still would like to see if 30mg will help me get back to that place which could then really help with approaching the CBT & counselling side of things.

Thanks for your advice Poet it's very much appreciated.