Question: I have history of PTSD, Panic Disorder with Agoraphobia and MDD. First diagnosed when I was about 27. Prescribed Elavil and Xanax 3 x's per day. Next MDD relapse occurred about 3 years ago (50 yrs of age). Prescribed citalopram 20 mg and Xanax as needed. I recovered quickly about 30 days thankfully due to getting the SSRI going. It was rough the first 10 days or so--anxiety. I'm a LPC and new how to manage panic using mindfulness primarily, exercise, and stress management. Citalopram also had benefit on my thinking--family history of ADHD (My mother and my son officially dx. I score high on these scales as well.) So, I liked it and wanted to stay on it even after feeling better. However after a few months I noticed emotional blunting and weight gain on the citalopram so I began to vary time of dosage and amount. Felt better emotionally and began to lose some weight. I started to experience what I now understand to be discontinuation syndrome. One symptom in particular would set off panic--feeling a sense of what to me felt like losing consciousness. When I first began the citalopram (3 years ago) about two weeks into it I felt my stream of consciousness slow down--hard to describe--but effect was the fear that I was losing control of my mind. I can manage visceral panic symptoms but the unwanted thought--that this weird feeling will return--as a result bothers me. It happened a couple of times and I would notice that feeling if I took citalopram a bit earlier than 24 hours. On another note, I notice onset of agitation, anxiety sometimes when I have gastrointestinal distress or the need for a BM (I have history of IBS and have had a gut-brain type of anxiety trigger since college.) I do exercise and have been under a lot of stress during the first half of this year--I suspect that I over-exercised (example: back to back days of a hard 3.5 mile run) in addition to ongoing running. I have since reconfigured my running and weightlifting to be less intense. But I recently returned to full dose of citalopram and after 13 days had onset of agitation / anxiety--needed to take xanax. General Practitioner changed me to escitalopram 10 mg. After two days I'd feel some of that agitation although not as intense. Yesterday it was intense enough for me to take a xanax. Xanax does relieve the agitation and I do feel like normal. So in summary I've been under a lot of stress and in addition to that probably was pushing too much with exercise. I had varied dosage and timing of citalopram for past 2 years and likely was experiencing symptoms of discontinuation. These would trigger panic and anxiety resulting in onset of depression. I'm on my 6th day of escitalopram and wonder if I'm experiencing emotional blunting and maybe I just don't need to be on the med. My depression scores tend to fall in the mild range (Hamilton Dep Scale today scored 11). My anxiety is definitely lessened and I can feel the med's putting a limit on panic sensations. But I'm bothered most by the agitation / anxiety that tends to follow dosage. I'm also fearful that I may have anxiety occasionally triggered by IBS--not sure that much can be done about this. The current treatment plan involves keeping on the escitalopram and use xanax as needed to give the SSRI time to get to therapeutic levels. That means at least two more weeks before I can re-evaluate effect on mood. I'm primarily unmotivated and loss of interest in work and relaxation activities--I do them and do have glimpses of enjoyment but mostly don't feel my happy self. Or should I wean off of the escitalopram while its only been 6 days. Since the agitation and anxiety follows the dosage--I'm anticipating agitation and this may interfere with work--unless I take the xanax. Hope this makes sense.

Thank You!