Switching from Citalopram to Sertraline?

[LiveAboveIt]

I've been on 20mg of Citalopram for about 5 weeks now and I'm not reacting all that great to it. Constant brain fog, exhausted but cant sleep, maybe 3-4 hours of sleep a night with constant wakeups, IBS issues, and more.

I've discussed this with my Psychiatrist and he decided to switch me over to Sertraline. I'm worried about going through another 4 weeks of hell, as the Citalopram nearly destroyed me with random panic and increased anxiety/depression for no reason.

Is it easier to switch over to another AD like Sertraline rather than starting from scratch? Are they in the same general drug family? I've heard great things about it from people that didn't do well on Citalopram, but I'm still really nervous. I finally feel like I have my anxiety 60% under control, but I can't handle the side effects of the Citalopram which only seem to be getting worse. The combination of Insomnia/Tiredness and Brain Fog is easily the worst, which I was told should have diminished by week 5.

Any reassurance would be greatly appreciated.

[MyNameIsTerry]

They are both in the SSRI drug class of antidepressants. All this means is that their primary method of action will be similar and they work on Serotonin receptors. However, SSRI's don't only work on Serotonin so the lesser profiles of the drug may differ a bit and you can find all this online if needed. Each drug has a different level of selectivity as well so some are faster than others or have lesser side effect profiles due to this. This also affects the side effect profiles in terms of the types of side effects people can get.

Theoretically when you switch from one SSRI to another you stop one and start the other the next day. (except with Fluoxetine which requires a week "wash out period" due to it's long half life) This switch over means that there will be some overlap between both of the meds and because they both work on your Serotonin, they will compensate for each other making it smoother for you and less in the way of withdrawal. It takes a while for a drug to be eliminated (5 X the half life to reach clinically insignificant levels of <5% and 7 X for complete elimination) so often the new SSRI will be started at a lower dose when compared to the previous one to allow for that and then then will increase it. If someone is on a higher dose of the original SSRI, they may need to taper down first because the new SSRI watch be started at a matched dose to the old so that would mean a fair drop and they could feel that.

It will be easier than completely withdrawing and starting again since this would mean your Serotonin levels dropping, any down regulation changes would be natural reversed before starting the new med, etc.

So, hopefully it should be smoother for you. Side effects free is less likely though but hopefully they will be nothing like what you have been through recently.

Here is the guide to our doctors in the UK:

http://www.gpnotebook.co.uk/simplepa...?ID=1651179592

I've put a link in this thread which shows equivalent doses in the SSRI class:

http://www.nomorepanic.co.uk/showthread.php?t=181065

Good luck!

[Suziewuzie]

I switched from Sertraline to Citalopram & felt better quite quickly, didn't have anything particularly bad in the way of side effects during the cross over period except bad headaches x

[jennielouises]

I've just come on here to post the same thing. I'm on 30mg of citalopram and have been on cit for 10 years from 10mg to 30mg. But I want a baby and I have been told sert is safer and it would mean I could breast feed whereas cit you can't. I'm so worried about switching though. I do get side effects when I up my cit and when I tried coming off it before in 2014 I suffered a major anxiety break down. I've been told I have to wean off cit before I can take sert but that's not what others have done. I'm seeing my GP about it on Friday. I also need to change my acid controlling medicine as well so there are a lot of changes!

[MyNameIsTerry]

I've just come on here to post the same thing. I'm on 30mg of citalopram and have been on cit for 10 years from 10mg to 30mg. But I want a baby and I have been told sert is safer and it would mean I could breast feed whereas cit you can't. I'm so worried about switching though. I do get side effects when I up my cit and when I tried coming off it before in 2014 I suffered a major anxiety break down. I've been told I have to wean off cit before I can take sert but that's not what others have done. I'm seeing my GP about it on Friday. I also need to change my acid controlling medicine as well so there are a lot of changes!

No, you can straight switch and that's the national advice to GP's. See the link above. However, what they probably mean is tapering down to the starting therapeutic dose (20mg) and then switching since they will start you on a lower Sert dose and build up.

Here are the equivalencies in dose:

This is what WHO say:

http://www.whocc.no/atc_ddd_index/?c...description=no

But to add to Nicola's comment, which I agree with, WHO also state the following about how this a comparison of the drug, not the effect on the patient:

Definition and introduction
The basic definition of the defined daily dose (DDD) is:

The DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults.

A DDD will only be assigned for drugs that already have an ATC code.

It should be emphasised that the defined daily dose is a unit of measurement and does not necessarily reflect the recommended or Prescribed Daily Dose. Doses for individual patients and patient groups will often differ from the DDD and will necessarily have to be based on individual characteristics (e.g. age and weight) and pharmacokinetic considerations.

For the optimal use of drugs, it is important to recognise that genetic polymorphism due to ethnic differences can result in variations in pharmaco-kinetics of drugs. The DDD should reflect the global dosage irrespective of genetic variations of drug metabolism.

Drug consumption data presented in DDDs only give a rough estimate of consumption and not an exact picture of actual use. The DDD provide a fixed unit of measurement independent of price and dosage form (e.g. tablet strength) enabling the researcher to assess trends in drug consumption and to perform comparisons between population groups.

Who told you that about Cit? According to NICE Fluoxetine is the safest SSRI in pregnancy yet that also appears in high levels in breast milk as well. Sert is also present in breast milk, just at lower levels:

http://cks.nice.org.uk/depression-an...-and-postnatal
http://www.gpnotebook.co.uk/simplepa...?ID=1785397323

Please note that those are medical websites and so talk about birth abnormalities. If you are sensitive to this, it could be triggering. I can pull sections out of it if so.