Brief Answer:
I think augmentation is better strategy

Detailed Answer:
Hello,
Thanks for using Healthcaremagic.

I read your query and understand your concerns about ongoing anxiety despite six months of medication use.

In the current situation following are options for you.
1. To change the medicine from some other group such as SNRI. This group includes effexor and pristiq considering the anxiety. This option should be exercised if there is no response with Cipralex despite the six months of use. Here we are talking about replacing cipralex with pristiq or effexor.

2. Have add on therapy. This could include other SNRI group of medication along with cipralex or Mirtazapine or Buspirone. This option should be exercised if there is at least some response with Cipralex. I mean to say that for better alternatives the positive effect of cipralex gained over the last six months should not be thrown away.

I do not think increasing the dose is option as you are already taking maximum recommended dose. I must acknowledge that most patients develop more side effects after a certain dose of cipralex with no or little added benefit.

Regarding the duration I think you have used for sufficient duration of time and no more trial is necessary for Cipralex.

I hope this answers you.
If you have any further query, I would be glad to help you.
In future if you wish to ask any more questions , you can use the below mentioned link to contact me.

http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386

Thanks and regards.

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Brief Answer:
Follow up

Detailed Answer:
Hello,
Thanks for follow up.

In case you plan to change, cipralex should be taper down along with upward tapering of new medication. I mean cross tapering can be used here.

Moving directly can cause you withdrawal symptoms as it is likely to have withdrawal symptoms after six month of use.

I hope this answers you further.
Thanks and regards.

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