Increased anxiety 10 days after reducing from 10 to 5mg, and heavy cold

[Sparkle1984]

As of Friday, I will have been on 20mg for 12 weeks. I'm feeling a lot better than I was, but still not 100%. I'd say I'm about 80% of my usual self - I can do all my usual day to day tasks, I've been able to get back into my hobbies and I'm sleeping better than I was even 3 weeks ago, but that feeling of anxiety in the back of my mind is still there most of the time. It's like a feeling that something's not right. I still get intrusive thoughts but I don't ruminate on them as much as I used to.

Although I'm making progress, it feels extremely slow. The previous times I was on citalopram, I had very few intrusive thoughts and when I did have them, I could dismiss them very easily. That seems to be the main difference between this time and the previous times. Should I consider going up to 30mg in the hope that it will be more effective at reducing the intrusive thoughts and the almost-constant feeling that something isn't right? Or should I stay on 20mg for longer? I have heard that some people can take 6 months or more to make a full recovery even if they stay on a relatively low dose. I've never been higher than 20mg before, so I'm reluctant to go up. I'd be worried that I'd need higher doses as the years go by, especially as 40mg is the maximum.

[panic_down_under]

Although I'm making progress, it feels extremely slow. The previous times I was on citalopram, I had very few intrusive thoughts and when I did have them, I could dismiss them very easily. That seems to be the main difference between this time and the previous times.

Antidepressants can become progressively less effective each time they are stopped and reinstalled, the initial side-effects can be different and/or more severe, a higher dose may be needed to achieve previous results and they may take longer to kick-in. Afaik, no one has worked out why this is. So your experience fits with that pattern.

Should I consider going up to 30mg in the hope that it will be more effective at reducing the intrusive thoughts and the almost-constant feeling that something isn't right?

...I'd be worried that I'd need higher doses as the years go by, especially as 40mg is the maximum.

You may need to increase the dose to get similar results to the last time. Staying on 20mg to reduce the risk of the med pooping-out in the future probably won't make any difference. In fact, still having some ongoing anxiety due to the lower dose might speed it up. Plus, citalopram isn't the only antidepressant, nor necessarily the most effective, so if it ever does fail there are many other options.

Live for today. You'll likely never have to cross most of those bridges your mind is conjuring up to scare yourself with.

[Sparkle1984]

Thank you for your reply. In the last day or so, I've been thinking maybe I should ask about switching to another medication instead, maybe sertraline. I've seen research online saying that sertraline tends to be better for anxiety and intrusive thoughts than citalopram. In the UK, it seems that citalopram was initially licensed for treating depression, and is used off-label for anxiety, whereas some of the other SSRIs such as sertraline were licensed for treating anxiety as well as depression. For me, this time around, citalopram seems fairly good at treating my symptoms of depression, but not so good at treating my anxiety.

What is your opinion on this? Should I ask to increase my citalopram dose and see how it goes, or should I ask if I can switch straight to sertraline (or one of the other meds that are recommended for anxiety with intrusive thoughts)?

[panic_down_under]

I've seen research online saying that sertraline tends to be better for anxiety and intrusive thoughts than citalopram. In the UK, it seems that citalopram was initially licensed for treating depression, and is used off-label for anxiety, whereas some of the other SSRIs such as sertraline were licensed for treating anxiety as well as depression.

...For me, this time around, citalopram seems fairly good at treating my symptoms of depression, but not so good at treating my anxiety.

To have a med licensed for a specific disorder requires a repeat of the drug trials to prove its efficacy and safety which is expensive. It doesn't necessarily mean it will be more effective than a med which isn't approved for the disorder. As a generalisation the SSRIs are usually more effective for anxiety than depression.

Would sertraline be more effective than citalopram for you? Haven't the foggiest. That's something only trying it will determine, unfortunately.