Re: Medication advice needed asap!!
Hiya. Welcome to the world of GAD. You may find your GP has never heard of it and many people appear to me to be treated with a random drug out of a raffle box!
Sorry this is long - I prefer to help you see info rather than just say good/bad/indifferent. Sadly we have to take responsibility for our own treatment all to often.
Taking things roughly in reverse:
citalopram
(please double check the SPELLING on your packet as some patients or their GPs seem to confuse different meds and dosages... eg. Escitalopram is similar BUT roughly twice as strong even before we argue effectiveness.)
If it was citalopram the 10mg PER DAY would be a very light dose. And I'm not impressed they left you on that med & dose for that long if it did not help much.
From my reading citalopram is very commonly used for GAD but its not as clear how effective it is. Like most treatments dished out its primarily an Anti-Depressant. Most documentation (eg link) show thats its also helpful with some anxieties:
4.1 Therapeutic indications
Treatment of depressive illness in the initial phase and as maintenance against potential relapse/recurrence.
Cipramil is also indicated in the treatment of panic disorder with or without agoraphobia.
Now in my reading there is a significant difference between having anxiety or GAD (or a real event) and panicing sometimes and "Panic Disorder" which is what we'd normally call "Panic Attacks". Panic Attacks can be a feature of GAD (along with depression, stress, etc) but are not the GAD itself.
Even if citalopram was appropriate to your original symptoms that link also confirms that the dosage would have been adjusted AFTER THE FIRST WEEK typically to 20mg - 60mg PER DAY. (Did you have a lot of panic attacks? ie. panic without any trigger except the panic itself?) So even if the medication was appropriate the dosage again seems very low. (Unless you are elderly (more effective/dangerous) or a child (untested)).
Citalopram is also often prescribed for anxiety (including GAD) under the general rule that an SSRI (that type of med) will help it. I have yet to find much information that clinically confirms this! In the UK the NHS seems to like SSRI's as they are cheap, fairly safe, and might do some good.
Diazepam
In the old days this and the other Benzoidazepines were given out like smarties and very effective they were and are. The BIG problem is that they can be very very addictive - chemically, mentally and behaviorally. The way you report taking them is safer as you or your body doesn't like them too much. These days GPs are encouraged to ONLY prescribe them for up to a month in total, see this - section 3. They are effective and troublesome for exactly the same reasons: very fast acting, effective against the anxiety, leave the body quickly. So like smoking or alcohol the patient is easily drawn to frequent increasing dosages, and its very tough to get off them.
Propranolol
This is a beta blocker. Beta blockers are very good at blocking the physical symptoms of anxiety BUT have no effect on your mental state or brain chemistry. This is why they are not allowed for sports people who need a calm physical state: eg. shooting, archery, etc. If your life was impeded by (say) physical shaking or a racing heart there would be a clear benefit. I suspect they also help those with clinical panic attacks since the fear of the panic symptoms should be much reduced if they are actually lessened or blocked.
But again GAD is not clinical panic attacks although you may panic occasionally - usually with a situational trigger.
Cymbalta (Duloxetine)
[size=2]I have not read much on this one.http://emc.medicines.org.uk/searchresults.aspx?term=duloxetine&searchtype=Quic kSearchSo here is a source of the patient and pharmacist data.
We immediately see a remarkable thing:
4.1 Therapeutic indications
Treatment of major depressive episodes.
Treatment of diabetic peripheral neuropathic pain in adults.
Treatment of generalised anxiety disorder.
Amazing a GAD patient has been given a medication with documented effectiveness against GAD!
The SPC also says:
Generalised Anxiety Disorder: The recommended starting dose in patients with Generalised Anxiety Disorder is 30 mg once daily with or without food. In patients with insufficient response, the dose should be increased to 60 mg, which is the usual maintenance dose in most patients.
In patients with co-morbid Major Depressive Episodes, the starting and maintenance dose is 60 mg once daily (please see also dosing recommendation above).
Doses up to 120 mg per day have been shown to be efficacious and have been evaluated from a safety perspective in clinical trials. In patients with insufficient response to 60 mg, escalation up to 90 mg or 120 mg may therefore be considered. Dose escalation should be based upon clinical response and tolerability.
After consolidation of the response, it is recommended to continue treatment for several months, in order to avoid relapse.
Now it may or may not help and you may need the dosage altered but thats all pretty clear and suited to your GAD. The side-effect list is large as for most of these meds. Changing brain chemistry has lots of room for this.
Eventually the dose should be tapered off over at least 1-2 weeks when you don't need them any more. Typically people say the higher and longer the dose the slower the withdrawal should be. NB: GPs do not always know or understand this!
The info is a bit vague about how fast it will help. For depression it says 2-4 weeks, so use that as a guide for GAD treatment.
Unless you have health anxiety I suggest you study both the PIL and SPC as they can be very informative unless you are a hypochondriac about side effects. Also remember that the UK documentation now has to tell us everything that might happen no matter how rare, infrequent or whatever. They used to just say in effect "you might feel a bit ill for a bit, if it gets bad, lasts ages or kills you please tell your GP", now its proper information!
Good luck with this. The new tablet sounds like a good try and in honesty far more appropriate to a diagnosis of GAD.
Last edited by alias_kev; 20-04-09 at 16:20.
Reason: typo: more fool me.
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Kevin, Southend-on-Sea, Essex, UK
Probably GAD & Phobias. Anxiety and renewed Depression medicated (Venlafaxine). Trying to improve.
but I have generalised anxiety disorder. I have been on citalopram 10mg for about 3 years and i think my body's got too use to it so he's changed my meds and im sooo scared taking the new ones as I had a bad experience with seroxat years ago
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Jen x
