How long should I give citalopram to work?

[Angela1999]

Hi there
I really could do with some advice. My daughter who has learning difficulties ( she is 18) has developed panic disorder with agoraphobia. It seemed to start gradually following an illness last summer when she fainted a few times. Now she is so scared of fainting she will not go anywhere. She trembles and eventually faints through sheer terror. This can happen 4 or 5 times a day. She has got to the point where she will barely leave the house, and even in the house she is terrified of going up and downstairs in case she faints. We have been backwards and forwards to the gp. She has had MRI (clear) and been referred back to cardiology ( she has a congenital heart problem but was operated on as a baby and has had no problems since), and the doctor doesn't think there is a problem with her heart. She was put on citalopram 61/2 weeks ago. 10 mg for 4 weeks and now 20. At first her anxiety reached new levels, she said she felt 'strange' she has developed a really dry cough, has had bouts of sickness, has hot sweats and as far as I can tell does not seem to be improving. It is however really hard to tell how she feels because of her disability. She has also been referred to the psychiatrist and when we saw her for the first time a week ago she suggested a change from citalopram to sertraline. However as my daughter had only just moved to 20mg we agreed to keep her on citalopram to see if there would be any change. So far there hasn't. If anything she is worse. It's really hard because I don't take the medication - only observe. I wonder can anyone advise me if we have given citalopram long enough and should switch to sertraline, or is it likely we just haven't waited long enough? I am seeing the gp in 10 days and know he will agree to switch if I ask him but I just don't know what's for the best? Is sertraline likely to be better? The psychiatrist seemed to be saying she preferred it. I would really welcome any advice. X

[panic_down_under]

Hi there

Welcome to No More Panic,

She was put on citalopram 61/2 weeks ago. 10 mg for 4 weeks and now 20. At first her anxiety reached new levels, she said she felt 'strange' she has developed a really dry cough, has had bouts of sickness, has hot sweats and as far as I can tell does not seem to be improving.

And increase in anxiety when starting SSRIs is quite common, as are the other side-effects. They usually diminish within a few weeks.

I wonder can anyone advise me if we have given citalopram long enough and should switch to sertraline, or is it likely we just haven't waited long enough?

Antidepressants typically take 3-12 weeks to kick-in from when a therapeutic dose if first taken which is usually at least 20mg, so it is still way to early to draw any conclusions about the likely effectiveness of citalopram, imho.

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 (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 they take time to bud, grow and mature. For a more detailed explanation see: How antidepressant drugs act.

Is sertraline likely to be better? The psychiatrist seemed to be saying she preferred it.

With the possible exception of fluvoxamine for OCD, no SSRI is intrinsically more effective than the others, either generally or for a specific anxiety disorder (or depression), though one or two may be for an individual. That said, citalopram is potentially more cardio toxic than sertraline which may, or may not, be significant in your daughter's case. Her GP or cardiologist is much better placed to decide if this is of concern. It is only an issue for those with a specific heart condition.

On the plus side, citalopram, and the almost identical escitalopram, are the two SSRIs which most tolerate the best.

If citalopram ends up not working then sertraline would be my pick of the alternatives, but I'd give citalopram more time.

[Angela1999]

Thanks Panicdownunder. I guess I need to be more patient, it's just really grim seeing her suffer and not be able to leave the house because she is so scared of fainting.

[panic_down_under]

I guess I need to be more patient, it's just really grim seeing her suffer and not be able to leave the house because she is so scared of fainting.

I've been where your daughter is now, Angela. Unable to walk out the front door even to get the post. However, with meds I have since travelled the world.

I can't say whether citalopram is going to be the right med for her, but there is a very good chance one will be. And you're right, patience is needed for there are no quick fixes. The meds can do a lot of the lifting, but your daughter will also need to rebuild confidence and that mainly just needs time.