Citalopram

[Amanda_George]

I take 40mg of Citalopram every night and while it really has helped me a lot over the years, it's starting to become less effective now.

Should I shut my mouth and hope I'm just going through a particularly bad patch right now or should I ask my GP to increase the dose or should I ask to try a different one all together?

I just don't want to try and fix something that isn't broken, so should I be more diligent about taking my vitamin B12 instead?

I take 15mg of Olanzapine every night too but I really don't want to mess around with that 'cos I haven't been psychotic since it replaced the Zyprexa!

So, should I just put up and shut up, take the vitamin B12 every day to see if that helps, do I ask for an increase in the Citalopram when I see my GP in a couple of weeks or should I ask to try something different altogether?

[SteveW]

I am afraid that increasing Citalopram to 60 mg is no longer an option. Because of concerns about its effect on the hearts QT interval the maximum dose was lowered to 40 mg. You could carry on as you are and hope things settle down or you could switch to another AD or augment Citalopram. There is some guidance in the form of the Star*D project I'll include a jpeg file.

Each line represents a treatment episode. So people who didn't respond to Citalopram were given a choice of things on the next row. If they didn't respond to that they were given something from the next row and so on.

One thing I should say is that Bupropion isn't approved as an anti-depressant in England. Star*D was done in America. I think it is approved to help people stop smoking here. But your GP could legally prescribe it if he thinks it is in your best interests.

I hope you can read the graphic.

Love

Steve

[SteveW]

I forgot something. If you want to know the percentages of people who responded on different things this link outlines the
statistics.

     http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2292446/

[Amanda_George]

I think what I'll do is dose up on multivitamins and B12 every morning then take my prescriptions in the evening to see what happens... just got to get into a new routine so that I don't forget now!   

Don't suppose anyone fancies reminding me to take them each morning starting tomorrow for a week or so do they?  Please?

[SteveW]

Taking Citalopram in the evening or morning isn't going to make much difference to you. What is significant is the blood and brain levels. Citalopram doesn't leave the body quickly. When you take your 40 mg dose half of it will still be in your system 36 hours later. What is significant is the steady state level in your body. Timing of dosing won't make much difference to that. Your whole project is probably pointless. The makers state this.

There is no clear relationship between citalopram plasma levels and therapeutic response or side effects.

So why bother playing with dosing . One you'll fail to alter your plasma levels. Two the makers would suggest that were you successful it wouldn't make any real difference. But it is a free country enjoy yourself.

[milkyjoe]

hi. i been on citalopram a while and im prettty sure its not working. so gonna see what the quack says!!!!

[Amanda_George]

I hope your doctor is good to you when you see them, Joe!  What dose are you on?  How would you feel if your doc wanted to up your dose instead of changing to something else?

[Amanda_George]

Just taken me multivitamin and B12 and I'm back to feeling like I was before so it's not that the Citalopram isn't as effective, I'm just low in vitamin B12 again is all!

If I remember to take them both every morning, hopefully that's all I'll need as well as the prescriptions in the evening!

[milkyjoe]

hi amanda. im on the full whack. 40mg

[Amanda_George]

Same as me then.  Maybe ask to have your vitamin levels checked, especially B12 'cos that really helps me!  How would you feel about going onto a different AD?

[milkyjoe]

im on b12 tabs already. i defo wanna try new ad meds

[Amanda_George]

I hope your doc agrees to change your pills when you see them!