Suggest Treatment For Anxiety And Depression

Posted on Fri, 18 Apr 2014

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Fri, 18 Apr 2014 Answered on

Mon, 5 May 2014 Last reviewed on

Question : Hi Doctor. I suffer from depression, general anxiety disorder and panic attacks. I was original prescribed 60 mg Citalopram, then down to 40. It helps immensely. My primary care doctor retired and I notice now that my Rx is for 20 mg of Citalopram. I am wondering whether the doc did this because he put me on twice daily 20 mg doses of Omeprazole, I have enough to last awhile. But I am worried that going down to 20 mg Citalopram will cause my anxiety and depression to increase. I've read that Omeprazole raises the effect o Citalopram and that too much Citalopram can cause heart problems. I will be getting a new primary care physician in about a month. I am 59 years old and throid meds XXXXXXX clonazepam and ambien. Thanks in advance

Answered by Dr. Manisha Gopal (25 minutes later)

Brief Answer: the drug is good fro you, taper slowly Detailed Answer: Hello, The drug has helped you in getting better and has not given any untoward side effect till now. please dont fear using it for few more weeks. Had i been rerating you I would have reduced the dosage slowly over time. Going from 40mg to 20mg is.not very appropriate. It can.be 30mg for some days and then.20mg. This will help in preventing any relapse. Omeprazoel is used for treating acidity and not for potentiating citalopram. So, I am almost sure that your doctor has given you this to help in gastric symptoms and.not for any other purpose. Please see that you taper the drug slowly, this will only help you. Do ask more questions for clarification. Wish you good health Dr. XXXXXXX Gopal MD psychiatry

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

Follow up: Dr. Manisha Gopal (16 minutes later)

I noticed no difference going from 60 to 40 mg Citalopram each day. But 20 doesn't seem to be as effective. Mild to moderate depression returns as does anxiety, more frequent breakthrough panic attacks and obsessive negative thoughts. I am being assigned a new Internal Medicine doctor and I wonder if it is proper to ask to have my dosage bumped back up to 40. What if she says no. My prescription won't run out for almost a year [3 90 day refills] I am tapering myself by cutting one of the 20 mgs in half so that my total dose is 30. But I feel [and perhaps I am wrong] that 40 works best for me. I am worried to ask to have my dose bumped up [drug seeking behavior] or switched to a different med. Thanks Doctor. I have been hospitalized for depression once. I wonder if I should let a psychiatrist handle me and my meds instead of an internal medicine doctor. Thanks for your help doctor

Answered by Dr. Manisha Gopal (12 hours later)

Brief Answer: continue citalopram but hike the dose Detailed Answer: Hello, Your reply only strengthens my point that the dosage reduction should be done slowly and with little reduction each time. As your symptoms are coming back there is no point in feeling shame in asking the doctor to increase your medicine to 40mg. This is not a drug seeking behaviour. Drug seeking or addiction is considered where a person tries to take a drug without the need of the body or takes something which does more harm than good to the body. Asking for a dose hike in your case is your right. Your whole treatment which you took uptill now will get waste if the illness comes back in full force. So, I will strongly recommend that you must go back to 40mg, keep it like this for few months and then reduce only 5-10mg at a time. If your internal medicine doctor is not able to do this due to any reason, please shift to a psychiatrist. You have had complete response to 60 & 40mg citalopram, so there is no logic in changing the drug. Continue with this molecule but hike the dose. I hope the reply helps your doubts. Wish you speedy recovery. Do feel free to ask more questions for clarification. Dr. Manisha Gopal MD psychiatry

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