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Offline BusuB

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Mind is stuck...
« on: December 27, 2013, 06:44:42 PM »
An email I sent my pdoc, but wanted to get opinions:

I do have a couple final questions for you though, and to start, I want to be clear that I intend to give clomipramine a fair trial.  I've had some progress with the clomipramine up till this point, but I am certainly going through a set back at this time.  Part of it may be due to feeling physically ill, but to be honest, Christmas Eve, when we last spoke, I was a wreck. I made it through work with the support of my wife (a shoulder to cry on over the phone), and although I'm feeling better today, I'm still not quite satisfied with where I am.  It has always perplexed me in how I can feel well one week and absolutely fall apart the following week.  I'm hopeful to feel better as I physically improve, but after earnest discussion with my wife last night, it was decided that I don't think I can be satisfied with the progress I've made so far long term unless there was opportunity with continued improvement.  The main reasons being ongoing side effects (sexual dysfunction, fatigue and constipation) and sporadic dips in mood/anxiety.  I've considered asking for a med review and put together a list of previous medications I've taken and as I did so, I came to wonder why citalopram was never a consideration.
I understand that we moved away from the SSRI's due to some of the SE's I got from the back end of my Zoloft experience and my Lexapro trial, but at the end of it all, Lexapro did do what it intended to do, albeit too well (the anhedonia).  Through it all though, I did tend to fair favorably on the SSRI's with good responses from both the Paxil and Zoloft, so I was wondering if a return to that class of medication may be worth a shot in the future.  I bring up citalopram specifically because of the wider range of therapeutic dosages than Lexapro and less selectivity on just serotonin (maybe a reason for the zombie-like effect of the Lexapro?).  I understand they're chemically related but from what I understand responses to both drugs could still be fairly different.

Since I wrote this email, my brain has been stuck on this idea of trying citalopram and keep having urges to write my pdoc to just stick me on citalopram already.  I've been on clomipramine for 8 weeks w/ limited results, is that a fair trial?  I never reached the standard therapeutic dose of 100mg due to side effects, but have had reasonable success at 50mg.  However, I have not had enough improvement to justify the numbed genitalia and fatigue.  So what does everyone think about citalopram?
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Offline MobileChucko

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Re: Mind is stuck...
« Reply #1 on: December 27, 2013, 07:25:04 PM »
Hi BusuB...  You were asking about Citalopram (Celexa).  I started having anxiety/panic attacks some four years ago.  I ended-up on Remeron, 30 mg, and felt like my old self.  I didn't have any problems until last summer, when I started having breakthrough panic attacks.  Then, two to three months ago, my 24/7 anxiety returned.  The Remeron had stopped working for me, which I understand is not uncommon for Remeron.  Exactly five weeks ago, my doctor started me on Citalopram.  I was started on a therapeutic dose of 20 mg.  I think if I had to do it over, I would have started off at 10 mg, as my side effects were pretty bad, but I didn't know that at the time.  At five weeks, here is what the Citalopram has done for me...  The depression that I had is completely gone.  Intrusive/negative thoughts are almost gone, and those I do have are minimal and seem to pass right through me.  I haven't had a panic attack in several weeks, and the last two I had were mild and didn't last long at all.  As for my anxiety, I would say that has diminished by 60-70%.  I hope to see more improvement as the weeks go on.  Hope this information helps you.  The best to you, BusuB!...  Chuck
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Re: Mind is stuck...
« Reply #2 on: December 27, 2013, 08:03:16 PM »
Since I wrote this email, my brain has been stuck on this idea of trying citalopram and keep having urges to write my pdoc to just stick me on citalopram already.

I think you are expecting far more than citalopram could deliver. While its effects can be subtle different to those of Lexapro (escitalopram), the emphasis should be on the subtle. The active chemical in both antidepressants is exactly the same, the 'S' isomer escitalopram. The difference is that citalopram also contains the 'R' isomer form of the chemical which is about 50 times less potent than the 'S' variant. It also inhibits the action of the 'S' isomer to some extent. It does slightly change things and if you'd found Lexapro to be almost, but not quite the complete answer then citalopram would definitely be worth a shot. However, I suspect it won't turn the Lexapro pig's ear into the silk purse you're hoping for. 

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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline Abraham2007

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Re: Mind is stuck...
« Reply #3 on: December 29, 2013, 04:06:07 PM »
You should stay on a benzodiazepine full-time, first, before you switch to a new antidepressant.  Another Anxiety Zone member stayed on Valium (two times a day at10mg(2)=20)  for about a month, and was able to die down the uncontrolled anxiety.  She could finally ease up without the anxiety attacks and the feeling of doom at work.  Now she's taking the next step, being on Paxil (Paroxetine) at a therapeutic dose, without feeling she has to rush the process, since the benzodiaezpine is in her system, while keeping her stable.  Once she stabilizes on the Paxil, she will wean off the Valium.  Antidepressants are better long term to handle anxiety, since they replicate neurogenesis, while benzodiazepines activate GABA quickly.

I also think you should stay on the clomipramine.   You had benefited from it temporarily, but on a very low dose. If that dose was below the therapeutic range, you shouldn't expect it to maintain stability long term. At that low dose, it can't.  If you've been on Zoloft at 150mg, then you should equate Anafranil (Clomipramine) with a similar dosage amount for that same affect.  Effective Anafranil (clomipramine) use ranges from 100mg to 300mg (although some sources say 75mg is the starting therapeutic dose).  I don't think you've ever reached 100mg, but regardless, you will probably need 200/250mg, if you needed 150mg Zoloft (Setraline) in the past.
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