Dr. Ashok: We Have Ended Up Puting Me On Celexa

Posted on Tue, 7 May 2019

Question: Dr. Ashok:
We have ended up puting me on celexa and lamictal, a regimen I was on for 10 years. The celexa helps more with mood than anything else I've been on. The mixture of celexa with lamictal, however, has a lot of side effects for me: headaches, increased heartburn and trouble swallowing, nasal congestion, sleep disturbance, and cognitive problems.

I was wondering if a change to escitalopram would decrease the side effects from the combination, seeing as fewer molecules of the SSRI would be needed for the same effect?

Answered by Dr. Dr. Ashok Kumar Choudhary (47 hours later)

Brief Answer:
Consultation

Detailed Answer:
Hello,
Thanks for posting again at Healthcaremagic.

Generally the side effect profile of celexa and lexapro is almost similar other than vomiting which is more common with celexa. The other side effects such as drowsiness, altered taste sensation, agitation, blurred vision, loose motions, cognitive difficulties are completely similar between the two molecules.

Essentially speaking 10 mg of lexapro and 20 mg of celexa contain equal active substance and the inactive substance in Celexa makes difference for the side effects, if any.

Personally I favour Lexapro as antidepressant as this helps in anxiety along with depression. If you ask me my opinion I feel Lexapro is practically better suited for most individuals.

I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regatrds.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Ashok Kumar Choudhary (48 hours later)

would a small dose of nortriptyline help with some of the celexa side effects given its antagonism at the 5ht2 receptors plus motivation/concentration boost with the NE reuptake inhibition? I am an intermediate metabolizer so I would want to keep the dose low...would 10-20 mgs be enough for the 5ht antagonism or is that just at higher doses?

Answered by Dr. Dr. Ashok Kumar Choudhary (10 hours later)

Brief Answer:
Follow up

Detailed Answer:
Hello,
Thanks for follow up.

Even the small dose of nortyptiline is enough to boost the effect of another antidepressant (SSRI) as per my clinical experience. I often add either 10 mg or 25 mg of nortryptiline/amitryptiline to augment the effect of SSRI and at the same time minimising the effect of serotonin reuptake side effects which are common with SSRI.

As per my clinical experience there is no harm attached with the off label use of low dose of TCA (nortryptiline) other than few side effects such as constiptation/sedation in otherwise normal individuals.

I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Ashok Kumar Choudhary (19 hours later)

thanks I will try this. Last time I did my voice/throat constricted quite a bit. I also got very tired around 3pm...this was before I started taking the celexa (I'm still at 5mg celexa).

Does the nortiptyline sedation at 10mgs hit during the daytime or is it just at night?

I will be taking with 125mgs Lamitcal and the 5mg of celexa (maybe going up to 10); .25 mgs klonopin and 10mgs propranolol at night. If I find myself getting manic/compulsive I was prescribed depakote but I am not starting until needed.

Answered by Dr. Dr. Ashok Kumar Choudhary (4 hours later)

Brief Answer:
Sedation is very minimal at low dosages

Detailed Answer:
Hello,
Thanks for follow up.

I think you need to build celexa before adding new medications such as nortyptiline. 5 mg of celexa is just a starting dose and rarely helps among individuals with long standing depression. I feel there is need to build 20 mg before adding any other medication. This is important because the initial side effect of Celexa disappear with progress of time and appearance of effects of Celexa.

Nortyptilne causes minimal sedation or no sedation at low dosages. At 10 mg whatever sedation occurs, will probably limited to night time.

I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks again.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Ashok Kumar Choudhary (2 days later)

thanks again. I might have to shelf the nortriptyline. When I took at night I only got 4 hours of sleep and stayed in bed the whole next day. I wasn't tired or depressed I was just content to stare at the TV for hours on end. I felt like I was on a much higher dose of SSRI which produces this kind of "Overly content" apathy, plus hyper focused. Not sure if Celexa metabolism is slowed or the noredrenaline is making me zone out.

Answered by Dr. Dr. Ashok Kumar Choudhary (19 hours later)

Brief Answer:
Serotonin receptor blockage is most likely cause

Detailed Answer:
Hello,
Thanks for follow up.

In my opinion the apathy side effect, encountered by you, is most likely due to serotonergic action of various medications. Nortryptiline in addition to noradrenaline also increases level of serotonin which is known to cause apathy as side effect.

I hope this helps you.
Feel free to write back to me if you have more questions.
Thanks and regards.

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Kampana