Citalopram - Up to 30?

[Jebdog]

Good afternoon,

I’ve been on 20mg Citalopram A couple of times for some time over the last few years. At its best it provided me 4 years of relief 2012-2016 and the last year. There have been blips but generally it’s been great for me.

But sadly Just recently I’ve been hit by a spell of anxiety and depression. Not sure which is causing which. Historically, I’ve felt it’s anxiety led, I’m always been a worrier and that plays out heavily in both, worrying about whether I’ll get better this time is the main playbook.

So the gp has put me up to 30mg, I’m on day 5 and no relief yet, will it take 4-6 weeks with the dose increase? If anything I’m a little more anxious/flat, is that normal?

Anyone had experience of a dose increase helping after some time? Is it known to work?

If it doesn’t help out, do I still have hope with other SSRI’s? I’m concerned I’m running out of options. I’ve tried Fluoxetine but didn’t find it helped all that much.

[Pamplemousse]

I'm sorry to hear how you're feeling at this moment.

I'm in a similar position; I'm wondering if I need to go up to 40mg with my citalopram or just find something else, as I'm worried I've become 'resistant' to it.

To be honest, I'd sooner try and come off it as if it doesn't seem to be working, what's the point?

[Redsmum]

Good afternoon,

I’ve been on 20mg Citalopram A couple of times for some time over the last few years. At its best it provided me 4 years of relief 2012-2016 and the last year. There have been blips but generally it’s been great for me.

But sadly Just recently I’ve been hit by a spell of anxiety and depression. Not sure which is causing which. Historically, I’ve felt it’s anxiety led, I’m always been a worrier and that plays out heavily in both, worrying about whether I’ll get better this time is the main playbook.

So the gp has put me up to 30mg, I’m on day 5 and no relief yet, will it take 4-6 weeks with the dose increase? If anything I’m a little more anxious/flat, is that normal?

Anyone had experience of a dose increase helping after some time? Is it known to work?

If it doesn’t help out, do I still have hope with other SSRI’s? I’m concerned I’m running out of options. I’ve tried Fluoxetine but didn’t find it helped all that much.

I’m in exactly the same position as you Jebdog. Always been a worrier. Have been on & off citalopram several times over the years & 20 mg always did the trick, i’ve been on it again since 13th june but it just doesn’t seem to be doing it for me so as of yesterday started on 30mg suppose i’m going to go through all the side effects again, oh god i’m sick of it i just want to feel normal whatever that is, i just know how i am now is not normal, wake up everyday shaking so much i can barely control it, never been this bad before. Sorry i can’t be of any help to you but will be interested in others opinions.

[panic_down_under]

So the gp has put me up to 30mg, I’m on day 5 and no relief yet, will it take 4-6 weeks with the dose increase? If anything I’m a little more anxious/flat, is that normal?

It will likely take some weeks for the increased dose to work. How many I can't say as there are too many variable, but 4-6 weeks is probably a good guess.

Anyone had experience of a dose increase helping after some time? Is it known to work?

There is a good chance it will and it is the fastest and easiest option. But there are no guarantees. ADs do sometimes poop-out and the more often they are stopped and restarted the more likely this becomes, unfortunately.

If it doesn’t help out, do I still have hope with other SSRI’s? I’m concerned I’m running out of options. I’ve tried Fluoxetine but didn’t find it helped all that much.

Yes, other SSRIs may work, but even if none do there are plenty of other options. SSRIs are not the first choice ADs because they are the most effective, but because they are perceived to be safer in overdose, although this isn't true of all of them. Some of the alternatives such as the TCAs and MAOIs are often more effective (the latter especially for treatment-resistant anxiety, or depression) and usually less prone to poop-out. I've been taking my current TCA continually for about 25 years and it is working as well now as when I started, albeit that I've always needed to take more than the recommended maximum dose.

[panic_down_under]

I'm in a similar position; I'm wondering if I need to go up to 40mg with my citalopram or just find something else, as I'm worried I've become 'resistant' to it.

To be honest, I'd sooner try and come off it as if it doesn't seem to be working, what's the point?

Given the extra stress from the times we live in now it is possible that upping the dose will work. It is worth a shot as you'll get a fairly quick answer. Quicker than from switching to another AD anyway.

[Jebdog]

It will likely take some weeks for the increased dose to work. How many I can't say as there are too many variable, but 4-6 weeks is probably a good guess.



There is a good chance it will and it is the fastest and easiest option. But there are no guarantees. ADs do sometimes poop-out and the more often they are stopped and restarted the more likely this becomes, unfortunately.



Yes, other SSRIs may work, but even if none do there are plenty of other options. SSRIs are not the first choice ADs because they are the most effective, but because they are perceived to be safer in overdose, although this isn't true of all of them. Some of the alternatives such as the TCAs and MAOIs are often more effective (the latter especially for treatment-resistant anxiety, or depression) and usually less prone to poop-out. I've been taking my current TCA continually for about 25 years and it is working as well now as when I started, albeit that I've always needed to take more than the recommended maximum dose.

Thanks for the advice. I’ve only stopped and restarted Citalopram twice so I’m hoping I’ve just grown a little tolerant / had a relapse and need a slightly higher dose. As I say at day 5 and found today really tough but could be increased side effects of upping dosage.

As tough as it is got to ride it out until week 4-6 I guess. Fingers crossed I get some effect.

As I say my biggest fear is nothing will treat me and this is now me for life, I know when I’m not in a depressive/anxious spell that I can be productive, have a beautiful family, home, job, etc... good to know there are other options just hope the increase works.

Off topic, PDU but what do you make of the growing work in the psychedelic treatment? Growing evidence of effectiveness in mental health and MDMA now in Phase 3 trial with PTSD with success highly likely.

https://maps.org/news/media/8154-pre...-psychotherapy

[panic_down_under]

Thanks for the advice. I’ve only stopped and restarted Citalopram twice so I’m hoping I’ve just grown a little tolerant / had a relapse and need a slightly higher dose.

Fingers crossed. Given the *evidence that ADs become progressively less effective through each stop-restart cycle you and your GP/psychiatrist may consider you remaining on an AD permanently.

* two studies, Amsterdam JD, 2016 and Amsterdam JD, 2009, found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Bosman RC, 2018; Amsterdam JD, 2009; Leykin Y, 2007; Paholpak S, 2002).

As I say my biggest fear is nothing will treat me and this is now me for life, I know when I’m not in a depressive/anxious spell that I can be productive, have a beautiful family, home, job, etc... good to know there are other options just hope the increase works.

The biggest problem with this is that most GPs, even psychiatrists, have a small bag of ADs, often a few SSRIs and SRNIs they prescribe and when these fail they give up and/or start throwing more and more meds into the mix in the vain hope something will stick instead of considering other AD classes.

Off topic, PDU but what do you make of the growing work in the psychedelic treatment? Growing evidence of effectiveness in mental health and MDMA now in Phase 3 trial with PTSD with success highly likely.

https://maps.org/news/media/8154-pre...-psychotherapy

Interesting, but there is a big gap between study findings and what works in the clinic setting. For example on PTSD a few years ago there were many studies showing the antibiotic D-cycloserine enhanced therapy effectiveness, but it doesn't seem to be used much in the clinical setting as far as I can see. Similarly, ketamine was touted as a fast depression treatment, but issues with administration, and/or cost means it will probably only be a niche treatment.

[Jebdog]

A Cochrane review showed no benefit of D-cycloserine in therapy for anxiety disorder (https://www.cochranelibrary.com/cdsr...7803.pub2/full). MDMA is on the verge of passing a phase 3 clinical trial having already come through several phase 2. At 66% remission it’ll hopefully get a bit of commitment thrown at it. But agree scaling it up will be the challenge otherwise it just becomes a niche treatment.

There’s also studies looking at Psilocybin and treatment resistant depression. These are smaller but also promising.

I suppose as a patient it’s up to us to advise that we’d like to try one of the TCA range rather than try several medications at once.

I’ve some increased anxiety at the moment. Guess that’s normal on day 6 of upping a dose.

[panic_down_under]

I suppose as a patient it’s up to us to advise that we’d like to try one of the TCA range rather than try several medications at once.

The problem is most patients would never have heard of TCAs. Heck, some GPs seem to have only a vague understanding. When I move into a new area I quiz the local pharmacists about which doctors are prescribing TCAs to ensure I'm seeing someone who has an understanding of the class and to avoid the almost inevitable discussion about switching to a SSRI or SNRI.

I’ve some increased anxiety at the moment. Guess that’s normal on day 6 of upping a dose.

Yeah, it tends to begin either almost immediately after the increase, or at around 4-7 days.