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Suggest Treatment For Depression And Anxiety
Question: Hi there, I have been back on mirtazapine 45mg for 7 weeks after coming off them after 2 yrs as felt so good. Big mistake!!
I am still severely depressed and anxious but just about functioning. I used to be on 10mg citalopram with them which worked wonders. Still have some and wondering whether to start taking them but a quarter tablet for a week then half etc. My main question is should I take at night with my mirtazapine or in the morning? I vaguely remember my anxiety being sky high when took in morning which I definitely don't need as high enough already and have propranolol and diazepam for this!! Have gone from a no meds sane person to a desperate for an answer depressed anxious wreck!
I am still severely depressed and anxious but just about functioning. I used to be on 10mg citalopram with them which worked wonders. Still have some and wondering whether to start taking them but a quarter tablet for a week then half etc. My main question is should I take at night with my mirtazapine or in the morning? I vaguely remember my anxiety being sky high when took in morning which I definitely don't need as high enough already and have propranolol and diazepam for this!! Have gone from a no meds sane person to a desperate for an answer depressed anxious wreck!
Brief Answer:
You may take both drugs together at night.
Detailed Answer:
Hi, Welcome to health care magic, I am Dr Alok Sinha, MD Psychiatry from XXXXXXX
Mirtazapine and Citalopram both are good antidepressants and anti anxiety medicines. Each medication is potent enough to treat depression/anxiety. If combined together they may have synergistic action. This is helpful in few resistant cases like in your case.
After few months of therapy some of the patients show resistance to antidepressant and anxiolytic effect of medicine. They no longer experience the same benefit with the same drug and same dose. Since you have been on medicine for long (2 years) and recently already tried the medicine for 07 weeks (which is fairly adequate time period to show its effects) with an optimum dose (45 mg of Mirtazapine is a good dose), apparently you have developed little resistance to it.
Augmentation with an SSRI like Citalopram is a good option as it may further boost the antidepressant and anxiolytic effect of Mirtazapine. But I suggest you to keep your doctor in picture and not to self medicate with higher doses.
Citalopram can be taken at any time day/night. Since you had tried this drug earlier at day time with poor tolerance, I think it will be wise to start the medicine at bed time. You may see a difference within a week or two.
I hope it answers your query. I wish you all the best.
You may take both drugs together at night.
Detailed Answer:
Hi, Welcome to health care magic, I am Dr Alok Sinha, MD Psychiatry from XXXXXXX
Mirtazapine and Citalopram both are good antidepressants and anti anxiety medicines. Each medication is potent enough to treat depression/anxiety. If combined together they may have synergistic action. This is helpful in few resistant cases like in your case.
After few months of therapy some of the patients show resistance to antidepressant and anxiolytic effect of medicine. They no longer experience the same benefit with the same drug and same dose. Since you have been on medicine for long (2 years) and recently already tried the medicine for 07 weeks (which is fairly adequate time period to show its effects) with an optimum dose (45 mg of Mirtazapine is a good dose), apparently you have developed little resistance to it.
Augmentation with an SSRI like Citalopram is a good option as it may further boost the antidepressant and anxiolytic effect of Mirtazapine. But I suggest you to keep your doctor in picture and not to self medicate with higher doses.
Citalopram can be taken at any time day/night. Since you had tried this drug earlier at day time with poor tolerance, I think it will be wise to start the medicine at bed time. You may see a difference within a week or two.
I hope it answers your query. I wish you all the best.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Ok thank you..I just want my happy life back. Was too scared to take even a quarter of a tablet tonight incase I have non sleeping side effects. Already been asleep since 830 and just woken briefly. Will see how feel tomorrow and take a quarter of a 10 mg tablet if no better. Had acupuncture today which has helped with anxiety but not depression as yet.
Brief Answer:
You will feel better soon.
Detailed Answer:
Hi,
Welcome back.
Good to know that you are hopeful now. This is the first step towards remission. Getting sound sleep is another good sign of recovery.
I wish you a better health.
You will feel better soon.
Detailed Answer:
Hi,
Welcome back.
Good to know that you are hopeful now. This is the first step towards remission. Getting sound sleep is another good sign of recovery.
I wish you a better health.
Above answer was peer-reviewed by :
Dr. Yogesh D
I am unsure whether to try quarter of a 10 mg tablet. Tonight or whether this could make me worse, ie not sleep and raging anxiety. I have woken this morning and so far not taken propananol or diazepam but a Chinese remedy and had a bath. I guess will see how day goes. I need to continue to work and look after my children.
Jo
Jo
Brief Answer:
It is better to start with a quarter of tablet.
Detailed Answer:
Hi, welcome back.
I understand your concern. As a doctor I always try to give importance to patient's functionality, so that the person can perform their role efficiently.
In case of combination of two antidepressants it is always better to start with lower doses.
Although Mirtazapine is a safer drug without much interaction with other medicines, augmenting it with higher doses of Citalopram has theoretical risk of causing excessive Serotonin level in body, which may cause restlessness, mood swings, tremors, diarrhoea, ataxia, hyperthermia, sweating and even collapse.
So to avoid this risk it is always better to start with lower doses. However in clinical practice this risk is rare.
You must put your doctor in picture (as I suggested earlier) for monitoring and follow-ups. He may consider augmenting your therapy with venlafaxine (Mirtazapine and Venlafaxine combination) if needed as this is well recommended in treatment guidelines based on a large patient trial.
You may discuss this options also with your doctor.
I hope this answers your question. I wish you a better health.
It is better to start with a quarter of tablet.
Detailed Answer:
Hi, welcome back.
I understand your concern. As a doctor I always try to give importance to patient's functionality, so that the person can perform their role efficiently.
In case of combination of two antidepressants it is always better to start with lower doses.
Although Mirtazapine is a safer drug without much interaction with other medicines, augmenting it with higher doses of Citalopram has theoretical risk of causing excessive Serotonin level in body, which may cause restlessness, mood swings, tremors, diarrhoea, ataxia, hyperthermia, sweating and even collapse.
So to avoid this risk it is always better to start with lower doses. However in clinical practice this risk is rare.
You must put your doctor in picture (as I suggested earlier) for monitoring and follow-ups. He may consider augmenting your therapy with venlafaxine (Mirtazapine and Venlafaxine combination) if needed as this is well recommended in treatment guidelines based on a large patient trial.
You may discuss this options also with your doctor.
I hope this answers your question. I wish you a better health.
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Prasad
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