Strange starting dosage?

[Helliconia]

Hi there, I have recently been prescribed citalopram for anxiety, ocd and the depression from this, however I have not started taking it yet, mainly due to anxiety over having possible panic attacks as a side effect.

The doctor prescribed me a 20mg tablet every other day for two weeks and then to review with my GP. Does this sound like a normal dosage? Because I've read about a lot of people's experiences and I've never seen anyone start on one every other day. I was thinking of changing it to 10mg every day but I also know I should probably trust the doctor.

Any advice would be really appreciated.

[Victory2016]

Hi! Yes that does sound strange to me. I would take it everyday. Also cut the pill and take 10mg to start with to see how you feel.

Is this your first time on an SSRI?

[MyNameIsTerry]

Yes, that is a strange way. I've seen it once before, can't remember which SSRI it was, but compared to the hundreds of threads I've seen where GP's start people off daily it's obviously rare.

The trouble is with GP's, they can have varying knowledge and some of them are just not up to date with the guidance they are given.

Starting at 10mg will reduce the impact of side effects. Starting straight on the minimum therapeutic dose of 20mg will mean they are more pronounced. But you may get little side effects at all, it's impossible to ever say with these meds. Your cautious approach mirrors what others on here have been told by their GP's anyway so it's certainly safe as doctors do it themselves to ease patients in.

This is what the experts say:

http://www.rcpsych.ac.uk/healthadvic...pressants.aspx

How should antidepressants be taken?
•Keep in touch with your doctor when you start treatment. They will monitor you for side-effects and how you feel. They may advise you to change the dose. It doesn’t help to increase the dose above the recommended levels. If you are being given the drug for anxiety, your doctor may suggest that you start on a very low dose for the first few weeks.
•Try not to be put off if you get some side-effects. Many of them wear off in a week or so. Don't stop the tablets unless the side-effects really are unpleasant. If they are, get an urgent appointment to see your doctor. If you feel worse it is important to tell your doctor so that he can decide if the medicines are right for you. Your doctor will also want to know if you get increased feelings of restlessness or agitation.
•Take them every day - if you don't, they won't work.
•Wait for them to work. They don't work straight away. Most people find that they take 1-2 weeks to start working and maybe up to 6 weeks to give their full effect.
•Persevere - stopping too early is the commonest reason for people not getting better and for the depression to return.
•Try not to drink alcohol. Alcohol on its own can make your depression worse, but it can also make you slow and drowsy if you are taking antidepressants. This can lead to problems with driving - or with anything you need to concentrate on.
•Keep them out of the reach of children.
•Tempted to take an overdose? Tell your doctor as soon as possible and give your tablets to someone else to keep for you.
•Tell your doctor about any major changes in how you feel when the dose of antidepressant is changed.

I've highlighted a couple of relevant bits for you.

I've also seen this method of on/off days used in withdrawal, this is more common from reading threads on her but it's still far more uncommon than daily dosages aimed at increasing in stages (starting meds) and decreasing in stages (withdrawing).

I suggest you ask your GP. I don't understand who this other doctor is though? If this is a psychiatrist, they are specialists with more knowledge than your GP. If this is simply another GP level doctor, I would be wary and get a 2nd opinion off your GP.

[Helliconia]

Thank you very much for the advice, both of you. Yes, this is my first time on an SSRI. Yeah, the doctor (a regular gp) i saw was in one of those evening appointments in a different town that they seem to be putting people who work and cant get to the doctor during the day onto. He seemed pretty young but a very nice and understanding chap, but i suppose there is a chance being young and stuck on the evening shift, he could be a little inexperienced. The thing is he gave me 14 tablets at one every other day and to see my gp in 2 weeks, so im not sure how that works out. Maybe it was a mistake and he meant one a day, but it is on the prescription itself.

You've definitely confirmed my suspicions that this is not a normal (or indeed good) way to start. I think i will try cutting the tablets in half and taking 10mg a day. Seems like a good place to start, with a lower dosage and every day, and then see my gp in a couple of weeks or so.

Unfortunately, my gp who knows me well only works part time and is currently on leave for a couple of weeks, and im not sure i want to wait that long to start, so cant really get a second opinion from her. I suppose i could go to another doctor but i feel like i would be wasting his or her time, as it cant possibly hurt to have a lower dosage.

Thanks again for your help.

[sidiam]

If it were me I would start on 5mg a day for a week then up to 10mg a day until you can see your own doctor.
Take them the same time everyday and with some food.
hope you are coping
take care
Sxx