Changing to an SNRI?

[NoPoet]

Hi all, the cit is making me feel dog-rough at 20mg with headaches and weird head-feelings, plus some nausea. I was like this on 20mg back in 2009. I've been on 20mg for 6-7 weeks now with no real let-up in headaches.

I am wondering what happens if I wanted to change to another medication. Is it possible that I can just switch to an SNRI (with my doctor's consent) without any break in the two meds, or do I have to wean myself off the cit first?

Can anyone recommend a decent alternative to cit that won't give me massive headaches? What about escitalopram, I know they are very similar but esc is not supposed to be as bad for side effects?

[oldtime]

Our doctors will not prescribe Es-citalopram as it is too expensive. He said I'd need to see a private doctor. Really I guess we should all be on es-cit as its an improved formular.

[KK77]

Have a chat with your doc about escit but there really isn't any compelling evidence that it has fewer side effects than cit. However, it's horses for courses as some would say and worth trying if your headaches continue. Are you getting migraines or tension-type headaches? Give it a week or so more - they may eventually subside as they presumably did last time you were on 20mg.

[haz]

Our doctors will not prescribe Es-citalopram as it is too expensive. He said I'd need to see a private doctor. Really I guess we should all be on es-cit as its an improved formular.

The reason the manufacturers of citalopram brought out escitalopram was because they were about to lose their patent. I think this could be about money rather than a greatly improved drug. But maybe I'm just too cynical about major pharmaceautical companies!

[kibbutz83]

Hi Haz, I don't think you can ever be too cynical about big drug companies... It's big business :(

[NoPoet]

I get the impression that esc was created in order for the citalopram company to make more money, and esc is supposed to be more expensive than some alternatives, but escitalopram is constantly proving its worth against the newer SNRI class and in fact seems to be the only SSRI which can outperform most SNRIs. Also it's newer and there MUST have been lessons learned from cit. The evidence, therefore, suggests that escitalopram is worth looking at.

I just did some checking on Google and the first result actually leads back to NMP! I read a lot of good things about switching from cit to esc, so my bald-headed, Elmer Fudd lookalike doctor will have the pleasure of my company tomorrow.

STUDY 1

Just found an NHS document which states that escitalopram is superior to citalopram for GAD. However it recommends paroxetine over escitalopram purely due to the cost (esc is ten times more expensive than the equivalent cit dose!). I have also read the esc/parox debate elsewhere and while parox is a LOT cheaper, esc does apparently have the edge against anxiety.

RESULT: Escitalopram is superior to citalopram for treating GAD, but is not likely to be a first-line treatment due to massive cost.

STUDY 2

I found an official study which showed that 50% of trial patients who had not responded to cit prescribed for depression, improved or actually went into remission approximately 8 weeks after switching to esc! The study said there were no major issues caused by switching between the meds and they believed that escitalopram is superior to citalopram in treating depression. HOWEVER - 6.5% of patients discontinued treatment due to side effects from the switch.

Personally, I wouldn't say 6 out of every 100 people is a significant statistic, but others might disagree. If you think about it, the overwhelming majority of us had side effects when starting citalopram, probably (at a rough figure pulled out of my bottom) 8 out of 10 people I spoke to had some side effects, although some of that number (like me) suffered much worse than others. I have spoken to a lot of people who only had mild to no side effects from starting cit which always amazes me considering the shitstorm I had to go through. Anyway, is 6.5% significant compared to 80%?

RESULT: Escitalopram is superior to citalopram for treatment of major depression and switching to esc is generally well tolerated by patients.

[haz]

Did nothing for me unfortunately but I've never been on citalopram so I can't compare the two.

[oldtime]

My doctor says the worst the initial side effects the more likely the treatment will work. This makes sense to me if the drug is working well it will be stronly blocking serotonin re-uptake, you will feel awful at first because your brain is not used to having so much serotonin in the synapses.

If you have no side effects then the drug is probably not working, ie. there is no difference in the amount of serotonin in your synapses.

Es-cit has less side effects as you only need half the dose, the other inactive half of the cit drug my be causing some additional unwanted side efects. However the serotonin increase side effects should be the same for both cit and es-cit.