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Author Topic: Citalopram--20 mg vs 40 mg  (Read 24980 times)

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Offline eg4238

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Citalopram--20 mg vs 40 mg
« on: November 12, 2010, 08:10:09 PM »
Just went to my doctor today and he increased my dose from 20 mg to 40mg.  Just wondering what dose others have found effective in treating GAD.  Any remarkable difference between 20 mg and 40 mg? Since it is already in my system, I am not expecting to experience any of my initial start up side effects. My doctor suggested that I take the 40 mg it at night, but I told him that the 20 mg does not  make me tired...it actually has the opposite effect.  Maybe the increased dose will affect me differently.
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Offline joegilbert

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Re: Citalopram--20 mg vs 40 mg
« Reply #1 on: November 13, 2010, 10:40:20 AM »
Just went to my doctor today and he increased my dose from 20 mg to 40mg.  Just wondering what dose others have found effective in treating GAD.  Any remarkable difference between 20 mg and 40 mg? Since it is already in my system, I am not expecting to experience any of my initial start up side effects. My doctor suggested that I take the 40 mg it at night, but I told him that the 20 mg does not  make me tired...it actually has the opposite effect.  Maybe the increased dose will affect me differently.

Wow.. that's a pretty big dose change there. Usually, you work your way up in dosage to prevent FURTHER start up effects. Just because you're already on it doesn't mean you can change dose sizes that large w/out side effects. Maybe you will be lucky and not have them. I really suggest that you do some research on that drug on your own and not just trust your doctors advice. In my 18 months of dealing with a bout of high anxiety, most PCP doctors don't know as much as they should about the start up side effects and withdrawals when dosing down or stopping them.

What else are you doing to get your GA to calm down besides meds? Medicine dosen't "cure" the anxiety like an antibiotic. If the med works, it only masks the symptoms. Again, some people can get lucky and find a med that covers up the anxiety until they work thru whatever started their anxiety with therapy or self help books. The can then discontinue the meds.
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Offline eg4238

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Re: Citalopram--20 mg vs 40 mg
« Reply #2 on: November 13, 2010, 11:37:57 AM »
Well, now you have me a little worried about switching from 20 mg to 40 mg.   :(  I started off taking Lexapro.  I was on 10 mg of Lexapro for about a month.  After a month, I was suppose to start taking 20 mg of the Lexapro.  When I went to get my prescription filled, my insurance would not cover this particular drug until I tried at least two other generics.  At that time my PCP switched me to 20 mg of Citalopram.  I was taking 20 mg for about a month.  I had a some side effects (insomnia, increased anxiety, excessive yawning, dry mouth) initially.  After about two months total, I took 40 mg this morning and have not noticed any side effects...yet.  I have also been seeing a counselor for CBT and am reading a self-help book.  I am eating better, cut out caffeine, exercise and practice breathing, relaxation techniques on a daily basis.  Thanks for the insight. 

 
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Offline dreamingoflife

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Re: Citalopram--20 mg vs 40 mg
« Reply #3 on: November 13, 2010, 04:40:29 PM »
Eg, don't let anyone scare you from doing what you need to. While I agree with war on the part of increasing too fast causing side effects, if you feel confident enough to try going right to 40mg and have a doctor's supervision then do it. You can always cut your dose in half if you have bothersome side effects.

Some people take meds and never have 1 side effect so don't let anyone freak you out and keep you from continuing your medicine. I ran into that problem a lot before I started celexa. I kept hearing people saying negative things about it and it scared me so I never wanted to go on it. I am now on day 11 of celexa and as of to date all I have experienced is slight headache and upset stomach. I may have more side effects when I go up on my dose but I am not going to let horror stories get in my way of potentially getting better.

I also agree that medicine doesn't "cure" you but they are wonderful tools to get you in the right direction. Good luck!
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Offline joegilbert

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Re: Citalopram--20 mg vs 40 mg
« Reply #4 on: November 13, 2010, 11:27:40 PM »
Eg, don't let anyone scare you from doing what you need to. While I agree with war on the part of increasing too fast causing side effects, if you feel confident enough to try going right to 40mg and have a doctor's supervision then do it. You can always cut your dose in half if you have bothersome side effects.

Some people take meds and never have 1 side effect so don't let anyone freak you out and keep you from continuing your medicine. I ran into that problem a lot before I started celexa. I kept hearing people saying negative things about it and it scared me so I never wanted to go on it. I am now on day 11 of celexa and as of to date all I have experienced is slight headache and upset stomach. I may have more side effects when I go up on my dose but I am not going to let horror stories get in my way of potentially getting better.

I also agree that medicine doesn't "cure" you but they are wonderful tools to get you in the right direction. Good luck!

Hum.. I re-read my post here and don't feel like I was trying to "scare" anyone? My simple advise was for him to educate himself on ANY drug that he was potentially going to take. Each drug has their own risks/rewards. I'm speaking from experience here. I'm not against drugs. I am against people that blindly drink the cool-aid that their doctors prescribe for them w/out doing the proper research on the drugs and the advise they provide. Often times, PCP doctors are arogant or ignorant in regards to these drugs. That's a fact. I went thru hell a couple of times due to being lazy and not double checking what the doctor told me.
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Offline hope-girl

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Re: Citalopram--20 mg vs 40 mg
« Reply #5 on: November 13, 2010, 11:49:38 PM »
First of all, I highly suggest going to a Psychiatrist for any psychiatric drug. You wouldn't get your heart medicine from a foot doctor. That said, I took Citalopram for 10 years. My initial dosage was 20 then I went to 40. During 2 periods of rough times I went up to 60, but then always back down to 40. I think that's how they make Citalopram/Celexa. In 10 mg, 20 mg, 40 mg, 60 mg. So, your doc is just getting you to the next step up.

Quote
Wow.. that's a pretty big dose change there. Usually, you work your way up in dosage to prevent FURTHER start up effects. Just because you're already on it doesn't mean you can change dose sizes that large w/out side effects. Maybe you will be lucky and not have them.

No, actually, it's not a pretty big dose change. It's not a strong drug. I think his doctor knows what he/she is doing. Unless you happen to be a doctor yourself.

Quote
I really suggest that you do some research on that drug on your own and not just trust your doctors advice. In my 18 months of dealing with a bout of high anxiety, most PCP doctors don't know as much as they should about the start up side effects and withdrawals when dosing down or stopping them.

I disagree. Trust your doctor. Not the internet. The internet is a bad place to "research" on your own. Any doctor will tell you that. There is no such thing as a "start up side effect". There are side effects. And you have to find the right drug for you. So just give it time. It takes 3 months to get the full effects anyway.

Quote
What else are you doing to get your GA to calm down besides meds? Medicine dosen't "cure" the anxiety like an antibiotic. If the med works, it only masks the symptoms. Again, some people can get lucky and find a med that covers up the anxiety until they work thru whatever started their anxiety with therapy or self help books. The can then discontinue the meds.

Well, Warbird, something we can agree on! But you don't have to think of the meds as a "mask" - it's a way to clear the picture better so that you can work through the issues. I def. think meds (when it comes to anxiety) should be used in conjunction with a therapist. Though there are many mental issues that require meds for stabilization. And if you just can't function in daily life, then meds can be a huge asset. But they are an asset. Not a cure.

Do NOT mess with your doses before consulting your doctor. You cannot mess with psychiatric meds. This is where you have to lay your trust in the doctor's hands because he/she knows reams and reams more of information about your body, about medicine, about treatment and side effects. Research on your own does not even begin to hold a candle to what doctors know. Never stop your med suddenly. I did this once and had a terrible reaction. My advice is trust your doc, get a psychiatrist if you have not one already, and just realize that finding the right medicine is sometimes a process of elimination.

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Offline joegilbert

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Re: Citalopram--20 mg vs 40 mg
« Reply #6 on: November 14, 2010, 07:37:33 PM »

No, actually, it's not a pretty big dose change. It's not a strong drug. I think his doctor knows what he/she is doing. Unless you happen to be a doctor yourself.

Really?? Doubling a dose isn't a big change huh?? Maybe you're a doctor with the wonderful advise you provide.


I disagree. Trust your doctor. Not the internet. The internet is a bad place to "research" on your own. Any doctor will tell you that. There is no such thing as a "start up side effect". There are side effects. And you have to find the right drug for you. So just give it time. It takes 3 months to get the full effects anyway.

Did you really say to BLINDLY follow any doctors advice? Really? It's a FACT that many doctors give extremely poor advice on these drugs. I personally have been given wrong advice several times in the past year with one doctor admitting it. I suffered terribly as a result of not doing BASIC research on a particular drug. Telling someone to look up a drug on reputible job sites is an appropriate thing to do and to tell someone to listen to doctors blindly is idiotic.

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Offline hope-girl

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Re: Citalopram--20 mg vs 40 mg
« Reply #7 on: November 15, 2010, 12:15:33 AM »
Warbird, it sounds like you have had some tough times, and for that I am sorry.

I do think your response was hostile towards me, and I don't think it was appropriate.

I was being cheeky by saying "unless you're a doctor" so I'm sorry if that struck a nerve with you.

I agree with you in that PCPs should not be prescribing these drugs. I strongly feel that Psychiatrists should be the only doctors to prescribe these types of medication. So, I suppose I was writing that post from my perspective because I have seen a psychiatrist since first getting on meds.

No, I am not a doctor. But I took this specific drug for 10 years, so I know a little bit about it. It is standard practice to go from 20 mg of citalopram to 40 mg. I've had 3 Psychiatrists confirm that. Where do you do your research? Reading here and there on the internet does not compare to a Psychiatrist who has been through medical school, residency and had years of practice. Those years of training and practice give them a very solid understanding of the drug makeup and how exactly the drugs interact with the physiology of the brain. When psychiatrist have many patients on the same drugs, they also can draw conclusions based on what their patients tell them. So it's personalized research as well. That simply does not compare with some reading on the internet.

All a psychiatrist does is work with mental issues and drugs. So of course, that is who we need to see to get meds for mental issues. Psychiatrists specialize in this. So why go to a doctor who does not?

So I guess what I am saying is lay your trust in the specialist's hands.
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Offline sixpack

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Re: Citalopram--20 mg vs 40 mg
« Reply #8 on: November 15, 2010, 07:10:43 AM »
hmmm, warbird while I understand you may have had an issue with a doctor, strong opinions on med use, and have had a hard time on meds,  some of your responses, primarily to hope-girl,  are a bit harsh. 


Eg---Docs do tend to go straight to the prescription pad.   :yes:  It isn't necessarily the docs fault either.  As a society, we've come to expect a cure for everything with a pill.  I think the best way, in most cases (although I've taken them for post-partum without doing this),  to take SSRIs is through a psychologist(they know just as much about meds and can suggest to your GP) or psychiatrist.  My take on going up from 20 to 40 is ask your doctor/pharmacist about any potential upping of the dosage.  It sounds to me like, for this particular medication, that it is often the next step up in that regard.  Some people do have a hard time increasing a dosage.  When I took two SSRIs a few years back, I was started on a med that had built in titrating program--IE--I had a weeks worth of one dose, and another week of a slightly higher dose and then onto the first cruising dose.  This helps minimize any start up side effects.   My usual suggestion, if you don't have this built in titration and it is feasible, is to break a pill in half and go up slowly--do that for a week or two.  SSRIS aren't masking anxiety symptoms. I think benzoes do that, which are a different class of drugs.  What SSRIs are designed to do is help correct the overthinking by changing or correcting the imbalances of the neurotransmitters.  They aren't a cure, in most cases.  However, they are an excellent tool.

All medications have risks/benefits.  Some of the side effects that are listed may not even have to do with the medication.  It just happened when the test study participant was taking the med, but it has to be put on the bank of "potential" side effects.  Other "scary" ones occur only rarely.  Often the problem with doing internet research on medications, especially for those of us with anxiety, is that med websites are full of other scared/freaked out people who only post horror scenarios.  We anxiety folks often can't pick through the good info from the bad.  Most things that happen in our lives--good, bad or indifferent--are highly influenced by our expectations.  So depending on how you think and react to such websites (even reputable ones), I would be leary of doing even "basic research".  I would stick to asking the doctor and the pharmacist what issues could come up.
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MOST anxiety occurs on a subconscious level.  JUST because you don't feel consciously anxious or had a day or two of calm doesn't mean your mind & body are relaxed.  It can take months of reduced anxiety before a body goes back to a more non-reactive state

Offline joegilbert

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Re: Citalopram--20 mg vs 40 mg
« Reply #9 on: November 15, 2010, 07:57:24 AM »

I do think your response was hostile towards me, and I don't think it was appropriate.


Really? Well, I disagree. I also think people in glass houses shouldn't throw stones.


Sixpack, I'm not anti-doctor nor anti-med.
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Offline xdc020

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Re: Citalopram--20 mg vs 40 mg
« Reply #10 on: November 23, 2010, 08:07:34 PM »
My doctor just prescribed me 30mg instead of 20mg. So I take a 10mg and a 20 mg daily....seems easier to me to keep increasing my 10...he told me to increase slowly...you could do that too?
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Offline eg4238

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Re: Citalopram--20 mg vs 40 mg
« Reply #11 on: November 24, 2010, 09:51:18 PM »
So far no major concerns with the 40 mg. ;D Thanks everyone for your input/advice.
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