4 weeks of cit not much improvement - reassurance please??!

[Windywel]

hi all-just need some reassurance. Been on cit second time for 4 weeks now for anxiety and depression - last 11 days on 20mg. there has been some small improvement but definately still have lots of anxiety and need to take lorazepam to sleep and even then it’s not great. Really bad morning anxiety and slightly less anxiety during the day but I can eat a bit now which I wasn’t able to aweek ago. i am really worried that its not going to work this time. just need some reassurance that it can still work even after 4 weeks. i know they normally say 4-6 weeks - thanks heaps

[Windywel]

Panic down under does the 4-6 weeks start from the beginning of the therapeutic dose? In other words 11 days is still early and I just need to be patient?

[panic_down_under]

Panic down under does the 4-6 weeks start from the beginning of the therapeutic dose? In other words 11 days is still early and I just need to be patient?

There will be some 'credit' from the 2 weeks you were on 10mg. How much depends on how well citalopram meshes with your biology. But even in the best case 11 days is likely too early except possibly as a placebo response.

With ADs patience is definitely a virtue. There are no short cuts.

[Windywel]

So will still be likely a few weeks before I see much benefit? I feel depressed as well as anxious at the moment

[nomorepanic]

It can take weeks/months but there are other things you can do to help apart from drugs.

[Windywel]

Thanks Nicola - I am trying meditation, rest, exercise but not much use so far. The medication made my anxiety disorder much worse as I started to feel really anxious about the medication side effects and whether it would work a second time so still trying to get to grips with that. I’m feeling better than I was for the first two weeks on the meds but not back to where I was before the medication yet. The problem is if I stop the citalopram now the anxiety will be much worse because of the experience of the last few weeks so I’m stuck on this path now.

[panic_down_under]

So will still be likely a few weeks before I see much benefit?

Unfortunately, yes. ADs (and therapy) work by stimulating the growth of new brain cells which provide the therapeutic response and they take weeks to bud, grow and mature.

I feel depressed as well as anxious at the moment

This is not unusual. SSRIs can make both anxiety and depression worse in the initial weeks, and for a while after dose increases, because of the heightened serotonin activity at the beginning.

Please let your GP know how you're doing as there are ways of reducing SSRI induced anxiety which may then also ease the depression.

[Windywel]

Thanks PDU - what do you mean? What are the options for reducing the SSRI induced anxiety? Would it still be the SSRI's if its 4 weeks? I guess I have only been on the 20mg for 13 days. I have tried propranalol on and off for a week but it really didn't seem to do much for me. I have also been using the 0.5mg of lorazepam at night to sleep for the holiday as well as ocasionally another one during the day if I really needed it but really conscious its been a week of that now so I shouldnt really use it anymore. We can't get hydroxyzine here in NZ unfortunately so I did buy some unisom sleep gels which are diphenhyrdramine but they arent supposed to be used for me than a week either and I'm scared to try them. Have some melatonin pills from the doc too but have read very mixed reviews about that so haven't tried them either.

[panic_down_under]

Thanks PDU - what do you mean? What are the options for reducing the SSRI induced anxiety? Would it still be the SSRI's if its 4 weeks? I guess I have only been on the 20mg for 13 days.

It could be because dose increases often trigger it again.

I have tried propranalol on and off for a week but it really didn't seem to do much for me.

The beta-blockers can be effective when adrenaline surges are a significant driver of the anxiety, but they have no direct affect on anxiety itself.

I have also been using the 0.5mg of lorazepam at night to sleep for the holiday as well as ocasionally another one during the day if I really needed it but really conscious its been a week of that now so I shouldnt really use it anymore.

The benzodiazepines can be counterproductive as they inhibit the mechanism by which ADs (and therapy) work. However, it is still better to take them than to quit taking the ADs because they've raised anxiety levels beyond tolerable levels.

We can't get hydroxyzine here in NZ unfortunately

Pity because it can be very effective. Wonder why that is. Mirtazapine is a good alternative.

so I did buy some unisom sleep gels which are diphenhyrdramine but they arent supposed to be used for me than a week either and I'm scared to try them.

Tolerance to diphenhyrdramine's (Benadryl in the U.S., but not always elsewhere) sedating affect can develop within a few weeks. You could alternate it every few days with lorazepam to greatly delay tolerance onset of each.

Have some melatonin pills from the doc too but have read very mixed reviews about that so haven't tried them either.

For sleep, or anxiety? Melatonin is a metabolite of serotonin and atm you're probably not lacking either.

[Windywel]

Really freaking out now - been emailing psychiatrist and he said i should be noticing some inprovement after 4 weeks (there hasn’t been much!) and he wants me to persevere for 4 weeks (so another 2 on 20) and if no improvement by then he'll look at changes - so now im really freaking out that its not working and that I’m going to have to start all over again on something else and be ill for months ��