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Thread: Citalopram and Amitryptiline

  1. #1
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    Citalopram and Amitryptiline

    Please stick with me on this - I feel I need to give some background so this may be a lengthy post.

    Female aged 66. Diagnosed 4 years ago with anxiety/depression after an extremely stressful few years.

    Initial prescriptions of Sertraline - which had me bouncing off the walls, and then Mirtazapine which did nothing to help my sleep and made me eat for England !

    Having stopped both, I was given 50 mg of Amitryptiline at night and the drug's sedative properties helped me sleep and I managed the anxiety etc. Like so many people, if I get some decent amount of quality sleep life is so much easier, despite having anxiety/depression.

    At the suggestion of the Counsellor I am seeing, I spoke to the GP who suggested I wean myself off Amitryptiline around a month ago, and begin 10 mg Citalopram.

    Began 10 mg Citalopram at night and within a very short time my sleep has been shot to pieces - barely functioning on 2-3 hours. Saw the GP again who said I should take the Citalopram in the morning - not at bedtime, and he re-introduced 10 mg Amitryptiline at night to hopefully help improve my sleep.

    At my request (and for the first time ever), he also gave me 10 days supply of 3.5 mg Zopiclone to help - especially as I am in the middle of a very complex and difficult house move and the stress is at a level never experienced before.

    On the night's I have taken a Zopiclone, I do sleep better, - without them, the sleep is crap.

    Now I do understand and realise that because of drug interactions we have to be very careful with dosages and mixing meds etc.

    .... and here is the question

    10 mg Citalopram in the morning and 10 mg Amitryptiline.

    Any room for increasing the Amitryptiline at night to help with my sleep ?


    I am 5.6" tall and weigh around 9 st 10lbs and as far as I am aware I have no health problems - other than very mild asthma. I also take a low dose Propanalol as and when required - and up to 3 times daily, to help with the palpitations.

    Thanks

    Sandie

  2. #2
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    Re: Citalopram and Amitryptiline

    Quote Originally Posted by sandie View Post
    Please stick with me on this - I feel I need to give some background so this may be a lengthy post.

    Female aged 66. Diagnosed 4 years ago with anxiety/depression after an extremely stressful few years.

    Initial prescriptions of Sertraline - which had me bouncing off the walls, and then Mirtazapine which did nothing to help my sleep and made me eat for England !

    Having stopped both, I was given 50 mg of Amitryptiline at night and the drug's sedative properties helped me sleep and I managed the anxiety etc. Like so many people, if I get some decent amount of quality sleep life is so much easier, despite having anxiety/depression.

    At the suggestion of the Counsellor I am seeing, I spoke to the GP who suggested I wean myself off Amitryptiline around a month ago, and begin 10 mg Citalopram.

    Began 10 mg Citalopram at night and within a very short time my sleep has been shot to pieces - barely functioning on 2-3 hours. Saw the GP again who said I should take the Citalopram in the morning - not at bedtime, and he re-introduced 10 mg Amitryptiline at night to hopefully help improve my sleep.

    At my request (and for the first time ever), he also gave me 10 days supply of 3.5 mg Zopiclone to help - especially as I am in the middle of a very complex and difficult house n themove and the stress is at a level never experienced before.

    O night's I have taken a Zopiclone, I do sleep better, - without them, the sleep is crap.

    Now I do understand and realise that because of drug interactions we have to be very careful with dosages and mixing meds etc.

    .... and here is the question

    10 mg Citalopram in the morning and 10 mg Amitryptiline.

    Any room for increasing the Amitryptiline at night to help with my sleep ?

    I am 5.6" tall and weigh around 9 st 10lbs and as far as I am aware I have no health problems - other than very mild asthma. I also take a low dose Propanalol as and when required - and up to 3 times daily, to help with the palpitations.

    Thanks

    Sandie
    Personally, I'd go back to the Amitryptline and then cut the dose down from there. I'm on Doxepin 10 mgs (cousin of Ami) and will be switching to Ami soon as Doxepin isn't being produced anymore. I'm can only take tricyclics, all the other antidepressants have me climbing the walls, they just don't suit me. I've been on it for over 20 years (at a low dose). It also helps with my Chronic Fatigue Syndrome, as well as sleep.

  3. #3
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    Re: Citalopram and Amitryptiline

    Quote Originally Posted by sandie View Post
    I was given 50 mg of Amitryptiline at night and the drug's sedative properties helped me sleep and I managed the anxiety etc. Like so many people, if I get some decent amount of quality sleep life is so much easier, despite having anxiety/depression.
    Was any thought given to you taking amitriptyline at a higher therapeutic dose, Sandie. It is a pretty good antidepressant (AD) in its own right.

    Began 10 mg Citalopram at night and within a very short time my sleep has been shot to pieces - barely functioning on 2-3 hours.
    SSRI induced insomnia is very common at the beginning. It does usually diminish after a few weeks, but may return for a while after dose increases.

    On the night's I have taken a Zopiclone, I do sleep better, - without them, the sleep is crap.
    While zopiclone can be very effective tolerance tends to build fairly quickly, often within 2-3 weeks, and dependence can be an issue with longer term use. Its usefulness can be extended by having regular washout periods of 2-3 days (for someone your age it takes up to 50 hours to be completely metabolised and eliminated).

    Now I do understand and realise that because of drug interactions we have to be very careful with dosages and mixing meds etc.

    .... and here is the question

    10 mg Citalopram in the morning and 10 mg Amitryptiline.

    Any room for increasing the Amitryptiline at night to help with my sleep ?
    You'd need to seek the advice of a psycho-pharmacologist, but I'd be doubtful as amitriptyline is a pretty potent serotonin reuptake inhibitor, as is citalopram so there is a risk of triggering serotonin syndrome.

    Outside the UK the standard treatment for SSRI induced insomnia is low doses, <=50mg, of immediate-release trazodone (Desyrel), but for some reason it isn't prescribed much in the UK. Trazodone becomes less sedating as the dose increases so low is usually better. An alternative is low doses, 5-25mg, of the TCA class AD (same class as amitriptyline), doxepin, which despite the classification is *really only a very sedating antihistamine with comparatively little impact on serotonin reuptake. But your GP may baulk at that because his computer will flag the potential for serotonin syndrome anyway. A lot of the data doctors have about the syndrome is wrong, but attempts by the experts to improve the situation seem to fall on deaf ears.

    * To quote Dr Ken Gillman, one of the two leading experts on serotonin syndrome:

    When they were introduced in the early 1960s these drugs were labelled as either anti-histamines, or anti-depressants (according to how their properties were then perceived), some were mis-classified (e.g. doxepin should have been classified as an anti-histamine, and chlorpheniramine as an anti-depressant). Some readers may realise than in fact doxepin has recently been ‘rebadged’ as a sleeping tablet (only 50 years too late! But that is psychiatrists’ knowledge of pharmacology for you!). I have been using it as a hypnotic for twenty-five years or so, nice to see people catching up at last. (from: Antidepressants – TCAs Intro)
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    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  4. #4
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    Re: Citalopram and Amitryptiline

    Quote Originally Posted by WiseMonkey View Post
    I'm on Doxepin 10 mgs (cousin of Ami) and will be switching to Ami soon as Doxepin isn't being produced anymore.
    It isn't? 50 x 10mg capsules are still readily available this side of the Ditch for the bargain price of AU$20-46, plus $7-51 if you want the brand. Maybe you should immigrate to the Promised Land
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    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  5. #5
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    Re: Citalopram and Amitryptiline

    I would have stuck with Amit, but the counsellor said she felt it wasn't touching the depression and I should consider something else - hence the low dose Citalopram in the morning, and then subsequently the 10 mg of Amit being added around 10 days ago.

    Ideally, I would like to see if perhaps it is advisable to continue with 10 mg Citalopram in the morning, but increase the Amit at night to say 20 or even 30 mg ? Have left a message at the GP surgery, for my GP but they are so slow in getting back to patients and it is almost impossible to get an appointment without waiting 3 weeks for a GP of choice or 10 days for another GP. Telephone appointments are also as rare as gold dust !

  6. #6
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    Re: Citalopram and Amitryptiline

    Quote Originally Posted by sandie View Post
    I would have stuck with Amit, but the counsellor said she felt it wasn't touching the depression
    Hardly surprising. The usual starting dose is 75mg and most take 100-150mg for depression which is typically harder to bring under control than anxiety. The maximum recommended dose is 300mg/day with medical supervision. There are readily available blood tests for TCAs to determine whether plasma levels are in the therapeutic range and they should be used initially to optimize the dose.

    Ideally, I would like to see if perhaps it is advisable to continue with 10 mg Citalopram in the morning, but increase the Amit at night to say 20 or even 30 mg ?
    There are two potential problems with this. Firstly, the usual minimum therapeutic citalopram dose is 20mg and ideally you should be increasing to that after a week. Staying on 10mg for extended periods is not a good idea as it can increase the risk of the med ceasing to work, assuming it even kicks-in at 10mg. And 20-30mg amitriptyline might be iffy even with 10mg citalopram, at 20mg the alarm bells would likely be ringing, however, that is something a psycho-pharmacologist should be deciding. I suspect your GP doesn't have the knowledge. Even many psychiatrists may not these days as few seem to have much experience with the older ADs.
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    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  7. #7
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    Re: Citalopram and Amitryptiline

    Thanks for this. Think I will take myself off the Citalopram and go
    back onto Amitryptiline.

  8. #8
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    Re: Citalopram and Amitryptiline

    Quote Originally Posted by sandie View Post
    Thanks for this. Think I will take myself off the Citalopram and go
    back onto Amitryptiline.
    Talk to your GP first just in case there are other factors we might not be aware of.
    __________________



    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

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