good days and bad days on medication

[Ethansmom]

I haven't posted on here in a while, but I've been taking Citalopram for about 5 months now. I went on vacation for a few days and felt fabulous- very little anxiety, if any. Now that I'm back and that my mind isn't distracted, my anxiety has come back. The medication hasn't been perfect, but it has done a few positive things for me. For one, i'm back on the treadmill exercising almost daily. I still have irrational fears & thoughts, but i'm better at challenging them. I haven't seen my therapist in a month and I see her next week (yey!) Is it normal to be up and down on meds. Can anyone relate? I know part of my anxiety is my thinking-- I constantly self monitor and feel everything little body change. I'm trying to take up different hobbies, and exercising more. Not sure if I should switch to Lexapro instead? Would that be better for anxiety than Celexa? I remember trying Lexepro years ago and only made it to the 7 week mark and gave up, maybe I should have stuck it out?

[panic_down_under]

The medication hasn't been perfect, but it has done a few positive things for me. For one, i'm back on the treadmill exercising almost daily. I still have irrational fears & thoughts, but i'm better at challenging them.

...Not sure if I should switch to Lexapro instead? Would that be better for anxiety than Celexa?

Celexa contains two isomers of citalopram, the active "S" aka escitalopram, and the mostly inactive 'R' form. Lexapro (escitalopram) contains only the "S" isomer. The 'R' isomer in Celexa can reduce the effectiveness of the 'S' isomer to a small degree so Lexapro is a more potent reuptake inhibitor at equivalent doses, though in practice this probably isn't that significant. By all means try it, you can do a straight overnight switch to an equivalent dose, but I wouldn't expect a huge difference.

I think a better alternative would be to be to supplement either SSRI with buspirone (Buspar). This is a generalized anxiety specific med which doesn't work for most on its own, but can significantly boost the effectiveness of serotonergic antidepressants and may also reduce the severity of some side-effects.

[Ethansmom]

Thank you Panic for always being so helpful. I can try buspar, but i'm already taking clonazepam twice a day (don't want to overdose and take all these meds). Would that be a problem? I guess i'll have a chat with the psychiatrist next week, but I guess I could try the Lexepro to see if that does anything. THank you.

[panic_down_under]

Thank you Panic for always being so helpful. I can try buspar, but i'm already taking clonazepam twice a day (don't want to overdose and take all these meds). Would that be a problem?

No, they do different things. But you should be thinking about easing off the clonazepam as it is probably reducing the effectiveness of the citalopram as there is good evidence benzodiazepines inhibit the neurogenesis mechanism which produces the antidepressant response (see: Boldrini M, 2014; Nochi R, 2013; Sun Y, 2013; Wu X, 2009; Stefovska VG, 2008).

However, I'd forgotten you were also still on clonazepam and it makes me wonder whether the better option is to replace the antidepressant instead of propping it up with yet another med. If citalopram is performing so poorly that you need to add yet another med to try and get you where you want to be is it really worth persisting with? From what I've observed poly pharmacy, the adding of more and more meds in the hope of striking some magic combination, not only doesn't work that often, but usually ends up creating far more problems. I think you and your psychiatrist need to reevaluate where you're at, and what the best way forward is. Sorry