About William J. Walker, Pharm.D. Expertise Homeopathic, alternative, herbal, natural, adverse drug reactions, side effects, risks, outcomes, research, medication, rational therapeutics, infectious diseases, cardiology, pain management, nutrition, psychopharmacology, oncology, pediatrics, sleep disorders, tropical diseases, HIV, drug interactions, substance abuse, illicit drugs of abuse, geriatrics
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Past/Present clients State of California Department of Youth Authority
State of California Department of Mental Health
County of San Luis Obispo Public Defenders Office
County of San Luis Obispo District Attorney Office
TenetHealth Corporation
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Better Life Institute
Campus Crusade for Christ
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Question I have been taking 10mg of Cipramil for about 12 months for treatment of panic attacks and depression. I was fine up until a few weeks agowhen my appetite decreased and I started feeling nauseous and anxious. Last week I increased my dosage to 15mg after consulting the stand-in local GP. My own GP is away until next week. However the increased dosage has only slightly mad me better.
What advice can you give me?
Answer Citalopram is classically representative of the entire SSRI family of compounds. It is well documented in the literature and widely used. The dosage you were taking at 10 mg daily is actually low in comparison to the dosage range being utilized. In my experience 10 mg is seldom enough for most patients.
The adverse effects that you described are by themselves too vague to truly implicate as indications of side effects from the medication or as manifestation of your condition. These same symptoms could result from either situation. Depression is commonly known to produce loss in appetite. Along with many other symptoms too however. Anxiousness is part of the original complaint that lead to your treatment but it could also stem from an unsuccessful treatment of depression as well as medication side effect. Nausea is similar in that respect.
The usual expectation with drug side effects is that they would have emerged much sooner than 12 months into treatment. SSRI side effects also seem to wane over time and with improvement in depression. Yet it is still not entirely impossible to suggest that this could be happening.
The picture does fit better into the line of reasoning that seems to be in place here. The decision to increase your dosage indicates that it is felt that you are not yet adequately treated. Increasing the dose to 15 mg is a very safe and conservative gesture. And since you claim to feel slightly improved this also supports this notion. It also suggests what I am inclined to believe that you are still using an inadequate dosage. In my experience it would be prudent to consider raising your dose to 20 mg daily. And from there to consider going as high as 40 mg. I have used doses as high as 80 mg in some patients. In very few have I had to go higher than that. My suggestion is to discuss this again with your physician and at least press on to 20 mg.
Another option you have is to consider the congener called escitalopram. You may not have this agent in your country. Here we have it marketed as Lexapro. It is the levorotatory isomer of the same medication that you are taking now. The concept is that the desirable effects are attributed to the s-isomer while the undesirable effects are attributed to the r-isomer. Your medication contains both. Some clinicians have found this supposition to be quite true while others have not. In your case I would certainly give it consideration, if it is at all possible. This agent is dosed at roughly half of the normal citalopram dose. In other words if you are going to need 20 mg of citalopram you would probably do fine on only 10 mg of escitalopram. And thereby also encounter fewer and less profound side effects. Allegedly.
The only other thought that I have is that it would be helpful to know what other medications you are taking in conjunction with this one.
