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Thread: medication question

  1. #1
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    medication question

    Hiya quick question which I think I know the answer for and it is probably a no.


    If you start on a higher dose of SSRI's..... does it then kick in quicker??

    I swapped from 40mg citalopram straight off to 100mg Sertraline which is obviously a higher starting dose than normal

    will this work quicker than if i had started on 25mg?

    many thanks xx
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  2. #2
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    Re: medication question

    That question is more complicated than it may seem.

    For instance, is the switch a matched dose? If not, that has an impact too. And there is the question of different receptor response per med which makes matching not an exact science.

    But essentially a larger dose is going to provide a higher volume of receptor saturation so in terms of "the help" kicking in, it's more power to attack anxiety with. What it won't do is reach steady-state any quicker since the half life dictates most of that. And the longer term effect of down regulation likely takes the same length but again with more saturation. But the first stage effect of SSRI, stimulating Serotonin into the synapse more than normal for it to be accessed from, will be affected by the higher dose from the start.

    25mg being under minimum therapeutic dosage may do little or nothing in the same way a 10mg Cit dose would. But if you compared the minimum therapeutic dose to a higher one, the same length of time to work in terms of drug effect applies but it's more that the higher dose may be giving the anxiety a more appropriate kicking rather than a slowing nipping away at it (if that makes sense? )

    Something to consider though is matched dosing. If you switch from a higher dose of one to another then theoretically anything the higher old med was doing should be backing itself out as the new dose takes over. But if a med has stopped working, perhaps some of that is debatable too?
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  3. #3
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    Re: medication question

    Thank you MNIT

    I swapped from the 40mg citalopram to the nearest equivelent of Sertraline 100mg.

    the drs said that the Cit should be out of my system in 2 weeks and the sert should be in my system in 2 weeks too

    but of course the sert will take over that time to actually start to work.....

    So my brain is going to be an arse for a while yet..

    Lets put it this way. the Sertraline is definitely letting me know it is there. Which I was hoping it would help faster lol
    Last edited by venusbluejeans; 07-02-18 at 19:06.
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  4. #4
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    Re: medication question

    You know, when I started Lexapro, my husband said he noticed a difference by day 3... You just have to take it and see. I don't think there is any way to fully predict it.
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  5. #5
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    Re: medication question

    Sert is slightly faster in reaching steady-state over Cit but it's literally about a day from memory so no biggie. But it will reach that within a week.

    The effects are a different matter. The usual minefield and just observing how you go like any of them (always a big annoyance with these meds!).

    Certainly with them both working on Serotonin there is an overlap of effect going on and that is supposed to make a switch easier. So, it's not like withdrawing & going up again which would see a decrease in the stimulated Serotonin. And with down regulation being a longer a process you would expect that takes longer to unpick, hence withdrawal lasting longer than merely how long it takes a drug to get out of the body, so it makes sense the new med heads that off before it starts.

    Sert is more activating because it stimulates more norepinephrine and things like this might mean some side effects as you get used to it but as long as it's manageable it's well worth a try. To be honest, without withdrawing Cit slower and introducing Sert slower in a cross taper I would imagine if side effects were going to be bad, you would know.
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