Swapping citalopram to Escitalopram

[Louisejane18]

My doctor changed my medication from 40 mg of citalopram (as it pooped out after been on 20 mg for years )to 20mg Escitalopram but just feel very anxious, tired and spacey

[Louisejane18]

Any advice please is this too strong a dose did 15mg for 25 days now 20 mg for 11 days

[panic_down_under]

My doctor changed my medication from 40 mg of citalopram (as it pooped out after been on 20 mg for years )to 20mg Escitalopram but just feel very anxious, tired and spacey

to NMP,

Your symptoms are almost certainly driven by anxiety/stress, not the escitalopram. Citalopram and escitalopram share the same active drug, the 'S' isomer of citalopram, i.e. escitalopram. The difference is Celexa also contains the 'R' mirror image isomer which is a poorer fit biologically and so is mostly inactive (this is why the citalopram dose is double that of escitalopram). While a few have success with switching from one to the other, most don't.

[Louisejane18]

What would you recommend to switch to
After citalopram

[panic_down_under]

What would you recommend to switch to
After citalopram

Unfortunately, no antidepressant (AD) is intrinsically more effective than the others, either generally, or for a specific disorder. So picking a name out of a hat is as good a method as any other.

However, if your GP suggests switching to another SSRI then I'd go for either fluoxetine (Prozac), or sertraline (Zoloft). Each has its advantages. Fluoxetine has a very long half-life which usually makes it easy to quit. Sertraline would be a little easier to switch too from escitalopram as their half-lives are much closer. If you are planning to have children in the future sertraline is rated as the safest AD in pregnancy.

Avoid paroxetine (Paxil) as it has a very short half-life and no active metabolite to extend it which makes it one of the two hardest antidepressants to quit. The other is the 'SNRI' -it is really only a SSRI - venlafaxine (Effexor). There is also some suspicion that paroxetine may cause birth defects although the evidence is contradictory.

[Louisejane18]

Hi , I’m sticking with the lexapro for a bit longer as dr said I need to give it more time 13 days isn’t long enough the anxiety is not quite as bad but feeling unmotivated and flat was thinking sertraline if I do swap.
How long would you give the lexapro

[panic_down_under]

How long would you give the lexapro

If you had switched to a different SSRI I'd say 4-6 weeks. However, you've switched to essentially the same med so... But you might be the exception which proves the rule. Stranger things have happened. The only predictable thing about antidepressants is their unpredictability.

was thinking sertraline if I do swap

Good choice, imo.

[Louisejane18]

My dr did a direct swap from citalopram to Escitalopram as I had a lot of trauma and the citalopram wasn’t doing enough anyhow I didn’t really feel many side effects swapping until day 14 then I got a really bad tension pain behind my left ear on my head so reduced to 15 had a couple of good evenings on 15 and then only took 10 for a couple of days thinking 10 might be enough I carried on 10 for a week but then went worse again so back up to 15 then 20 ( a lot of yo yoing ) I’m now on day 15 of the 20 mg . Spoke to dr told her I had a couple of ok days on 10mg but she just thinks it could be a fluke as she thinks with what I have been through I will need higher dose of 20 mg
Any advice please

[panic_down_under]

If you were taking 40mg citalopram then the equivalent escitalopram dose is 20mg.

>had a couple of good evenings on 15 and then only took 10 for a couple of days thinking 10 might be enough I carried on 10 for a week but then went worse again so back up to 15 then 20 ( a lot of yo yoing )

Constantly changing the dose depending on how you feel on the day is not how these meds should be taken. They don't work like aspirin which has an immediate effect. Antidepressants work by stimulating physical changes within the brain. It is these changes which produce the therapeutic response, not the meds directly and the changes don't happen overnight. Neurons take about 7 weeks to grow and mature. Consistent dosing is the key. Chopping and changing all the time increases the risk of the med pooping-out.

[Louisejane18]

Thankyou yes I understand this now .
I’m now on day 15 I think of 20 mg . Just hoping they work , when should I notice a slight change I did feel a little bit better last night with the anxiety