Changing Sertaline for Citalopram for Anxiety?

[MarkAdams1]

Hi there,

I suffer from mild anxiety (including anxiety attacks) and currently take 50mg of sertraline for the anxiety and 10mg Aripiprazole for a psychotic disorder.

Would it be more effective to taper down the sertraline and add a low dose of Citalopram to help eliminate anxiety?

Any input and advice greatly appreciated.

 

[madog11]

What does your doctor think?

 

[MarkAdams1]

I havent seen my doctor yet, I would just like to know beforehand if this is a safe and more importantly effective way of chemically beating anxiety? Or am I barking up completely the wrong tree?

 

[madog11]

My mistake.

 

[Sepher]

Madog, Citalopram is quite commonly prescribed for anxiety and can be pretty effective. It's quite sedating / calming unlike say Fluoxetine which I found to be more stimulating, its effects seeming to be quite different from other SSRIs I've tried. In fact it was too calming, to the point of just flatlining all emotion, so that while I was no longer in the very deepest pits of despair I could not be said to be any happier as a result. Just completely blah and meh on it. Found pretty much the exact opposite of what you suggested then: great for anxiety, useless for depression.

 

[effie]

^^ Actually for the UK anyway SSRIs are the first line pharmacological treatment for anxiety now (according to the NICE guidelines)

Sertraline and citalopram are both commonly used, as is paroxetine and the SNRI venlafaxine. Your doctor would usually recommend a trial of 12 weeks, as anxiety can often increase slightly initially before any improvement. As with depression there appears to be no real difference in efficacy, but what works well for one person may not work at all for someone else. This is why it is hard to advise someone, and also why listening to others' experiences is not always the best way to go about things.

Citalopram doesn't have particularly serious side effects compared to other antidepressants as far as I am aware - all SSRIs are fairly similar; the commonest one is sexual dysfunction, along with insomnia, agitation and poor appetite; they tend to be worse at the start of treatment and often disappear altogether. I'll have a hunt for a paper about them in a minute.

OP, if you have tried sertraline with no great benefit, and you have given it an adequate trial, then it is definitely reasonable to try another SSRI. If you have more generalised anxiety disorder then paroxetine is often chosen, where as for panic disorder citalopram is a common choice, although there is overlap and this indicates more what trials have been done rather than which drug treats which disorder best. A different option would be venlafaxine. Again, no real difference in effectiveness - it just depends what suits you.

Along with medication it is really important to investigate therapy. Cognitive Behavioural Therapy can give excellent results. It's hard work and takes time but it can give you lifelong skills in managing your anxiety. Counselling, psychotherapy and more specific things such as exposure therapy can also be beneficial.

Benzos are not commonly used in the UK and are not a good long term solution due to tolerance and dependence. Taking a short-acting anxiolytic benzodiazepine can work well for panic disorder as long as the use is regulated, where as taking a long-acting benzo daily for generalised anxiety means dependence is far more likely.

Various other medications are also tried such as sedating antihistamines especially hydroxyzine, tricyclic antidepressants and gabapentin/pregabalin.

I see you have a psychotic disorder, is your anxiety is secondary to that or is it a stand alone diagnosis? Does the aripiprazole help your anxiety at all? I am not sure about the role of antidepressants in anxiety secondary to psychosis.

^^ all of the above are general guidelines only, so you have some background knowledge before your appointment. Your doctor will be able to assess your history and talk through your options with you. We can't give you actual medical advice here and even a doctor would struggle over the internet.

There is a recent thread in BDD on non-prescription meds for anxiety which may interest you, especially as your anxiety is mild, and I would also highly recommend checking out the anxiety disorder megathread in The Dark Side forum (in their directory). Good luck

 

[pally pete]

Hi there,

I suffer from mild anxiety (including anxiety attacks) and currently take 50mg of sertraline for the anxiety and 10mg Aripiprazole for a psychotic disorder.

Would it be more effective to taper down the sertraline and add a low dose of Citalopram to help eliminate anxiety?

Any input and advice greatly appreciated.

I was started off on 20mg Citalopram per day for a couple of months but it didnt do a thing for my Anxiety or Depression, so i went back to my G.P who prescribed me 50mg per day which was upped to 100mg Sertraline instead as she said it was known to be particulary good for Anxiety.

Btw that didnt help me at all, yet i dont say that do dishearten you, it may work wonders for you.

Best of Luck

What does your doctor think?

Well my G.P is clueless so i pray to god that his or her G.P does have a clue!

 

[Alex000]

I don't know how long you have been on the sertraline, but as mentioned it is better to give it a trial run before just getting rid of it, like a few weeks +. However, if you have been on it for really any amount of time, and tolerate it well, I might suggest an increase to either 75 mg or 100 mg. My aunt had very good success with sertraline for all of her depressive and anxiety-related symptoms, but she had to titrate to 300 mg, I think, before it began to really start working its magic. I am not suggesting go up to 300 mg, but a bit of an increase might be the best option, and see what that does for you. Also, because sertraline has a relatively short half-life, I might suggest taking it in divided doses, maybe twice, even three times a day, to achieve the most steady plasma level possible.

 

[flymethod]

I could never take over 25mg of Zoloft. It made me so edgy. I couldn't take Celexa because it made me super dizzy. I haven't really had any luck with SSRIs but that doesn't mean you won't.

0.5 mg of klonopin BID helps me but there are dependency issues. My anxiety got so bad I had to choose the lesser evil. I used to have a really bad habit years ago (10 Xanax bars a day). I told myself I'd never abuse benzos again. I was taken off cold turkey when I was locked up for a year. Horrible withdrawals. I know you can still develop dependence even on a low dose but it's changed my life drastically as far as helping social anxiety/panic attacks.

 

[Allein]

Both are similar and in the UK Citalopram IME seems to be prescribed first then Sertraline after if not success with the Citalopram.

I don't seem to be able to tolerate SSRIs at all, read the list of side effects and I'll get most of them including some doctors haven't seen before, but are listed in the small print

This sort of medication has to be manged by a doctor who is able to see you face to face and discuss you symptoms and options, Like Effie I would also recommend CBT or similar to anyone with anxiety and depression, I am taking an AD at present (Venlafaxine) but CBT had done much more for me in the long term than any tablet every will.