To suggest he should increase the dose?

[giftponderings]

My husband has recently started taking Citalopram after years of depression and anxiety. He started on 20mg dose.

Within a week the difference in him was unbelievable, so much happier and relaxed. It was amazing.

After about 3 weeks the old depression/anxiety/ fatigue started to creep back in again. I suggested to him to visit the doctor with requesting to perhaps increase to 30mg. He was extremely reluctant as he doesn't want to be on a higher dose as he feels there would be a risk of side effects/withdrawal if he ever decided to stop in the future. He feels if he is on the highest dose and if it still doesn't work, there's nowhere to go from there. I suggested trying 30mg (with docs permission) and he can still go to 40mg if needed. He's not keen.

Am I wrong in suggesting to increase?

Has anyone had an experience of Citalopram helping to begin with and then stopping it's beneficial effects?

What is the average dosage that people are on?

Any other advice welcome, thank you.

Yes, the dosage needs to be increased and tweaked. Though initially it will have been a partial placebo effect, suggesting maybe DH's depression and anxiety is situational, rather than chemical.

That's what he wondered, that at firsr he was taking something, so it seemed like he was getting better. Which makes it so much more frustrating, as it shows he can help himself if he chooses to. He doesn't like his work and it is stressful but he can't afford to change jobs currently.

Yes I started off at 10mg and slowly increased to 30mg. It's been a godsend for me (and my family).

I'm on 30mg. I've been taking it since 2013. I started on 20mg. For most of the time I have been on 20mg and it worked pretty well for low mood/depression (basically feeling rubbish about myself). These symptoms were well managed but I did develop anxiety a few years ago. I tried to come off it after very slowly reducing to 5mg. This was a disaster and resulted in panic attacks. I did this because I thought it wasn't helping my anxiety. Which it wasn't. But the 30mg is great. I was so resistant to increase the dose. My GP even said at the time I know you see this as a failure. (he knows me well) but I wish I'd done it before. Sorry if this is long just wanted to share my experience.

Drugs can't cure situational depression, so he does kind of have a point.

It usually takes three weeks to kick in as that’s how long the cumulative effects take to increase the serotonin in the brain or something.

Perhaps speaking with the doctor was helpful for him? Talking about his problems, like counselling? And that’s why he felt better? Perhaps counselling would be an option for him? Also the placebo effect of something changing and uplifting him would have felt positive but then not much happened as the drugs take weeks to work and he got fed up again....

Sounds like he’s making excuses to not try a higher dose. You can easily wean yourself off them by reducing the dose over a few weeks. It’s easy. They are not addictive. It’s more worrying that he doesn’t want to try in case it fails and then there is no hope for him type thing. He needs to get over that and crack on. It could even be that he will need a different antidepressant. He has to try. He can’t just give up.

Sounds like his job is his problem. Is there really nothing that can be done to move departments or work fewer hours or something?

@Elieza

Sounds like he’s making excuses to not try a higher dose. You can easily wean yourself off them by reducing the dose over a few weeks. It’s easy. They are not addictive. It’s more worrying that he doesn’t want to try in case it fails and then there is no hope for him type thing. He needs to get over that and crack on. It could even be that he will need a different antidepressant. He has to try. He can’t just give up.

This was sounding like exactly what I've been saying... to try different ones, he just seems resigned to the fact that he will always be like this.

Thank you to all your comments. I was worried that people would think I shouldn't be pushing him and just let him sort himself.

With regards to his job, the anxiety/Low confidence means he wouldn't feel Abel to attend an interview. And the stress of meeting new people and leaving a new workplace just means it would be added stress right now. He had talked about when he feels better to then try interviewing and then the tablets appeared to stop
Working and then back to the feeling low again with no way out.

@giftponderings, the first thing I would do is to stop assuming he is looking for excuse, could help himself if he wanted etc...
Because basically you are saying that it’s his fault if he is depressed!!

Increasing the dose sounds the logical thing to do for you. It is t for him an ima frais you have to accept that. The best you ca;do is to suggest he goes to see his gp and have a chat with them and see what they say. He needs to tell them how he is feeling (the up and then the down) as well as his fear of increasing the dose.

FWIW I know quite a few people on ADs and yes it IS hard to wean from them.
They can also make some people MORE anxious than before (aka the issue might not be the dosage but the medication itself)
But more I portant,y, it is up to him to decide how he is going to look after himself and whether he is happy to take x medication. You have nothing to say about that (and certainly no right to ‘tell him’ to increase the dose)

Xpost.

Sorry to put a spanner in your work lol.

I’m a MH nurse and second what others have said re situational depression. However, If it is not a situational depression then there are many types of antidepressant and it is never a one size fits all. He should try not to worry about thinking that there would be no where left to go should the Citalioram not work. It’s often trial and error until people find an antidepressant that works for them.

Having read up just now about situational depression, I'm not sure it's that as it says it's usually short term. DH has had this since his childhood, he says he always remembers being like this and has been in and off AD's for years and he felt them do no good. He was really reluctant to even go on these this time, but after being desperate one weekend he decided to visit the doctor and followed their advice. I think ill advise him to see his Gp again.

I have been on and off citalopram for years. One of the possible side effects after the first couple of weeks is the symptoms come back temporarily. See how he feels over the next couple of weeks then get him to reassess

There are side-effects when you come off it, even from a low dose, but they are manageable. It's not addictive. I would give it a couple more weeks to see how it settles down, but then he should see the GP to review the dosage. Mine always wanted to see me a month after starting new medication anyway.

I would be surprised if what he is experiencing Is a depressive disorder due to this starting in childhood. Have you ever looked into personality disorders? Possibly anxious/avoidant?

Thank you to all your comments. I was worried that people would think I shouldn't be pushing him and just let him sort himself

You shouldn’t be pushing him to increase his medication. You’re not his doctor.

You can push him to seek further help. Whether that’s returning to the GP, counselling, whatever.

Increasing his medication may not be the solution, or even the best thing for him. Leave that decision to his HCP.

Thank you for your replies.

No I haven't looked into personality disorders. I will have a google now.

@ultrablue

How long did the symptoms come back for? It's been about a month or the old symptoms. I would say it's been a month of feeling better (he thinks two weeks. But I've just checked the dates of when he started and when he said the feelings came back again and it's a month) so 1 month of feeling better and 1 month of feeling the same as before.

He did go for a month review, it would have been just over a month and told the doctor all was fine and then a few days later began to feel like before.

He has had counselling and it helped a little to begin with and then stopped helping after a while too.

I found that when things were bad, I couldn't face going to the doctor about it, and when things were better, it was easy to hope that it would never get worse again. I would say it sounds as though he does need to see the doctor and ask about a higher dose, but you may need to be patient with him until he feels able to do that.

Why did the counselling only help for a while and then it didn’t? Did he ever tell you?

I’m wondering if he talked about some stuff and it was helpful but then the counsellor wanted to go deeper and he couldn’t face it?

If there has been childhood abuse or something really horrific (which you may or may not know about) it can make you worse for a while as you tell the counsellor and it brings up the past and you cry and feel helpless etc again, the way you did then and if you aren’t strong enough and walk away from counselling at that stage you never work through it.

I’m just wondering if that’s what happened. He got to far, he was hurting, he bailed and said it wasn’t any good?

If so he needs to get back to the counselling and keep going until all his free sessions are finished.

@Elieza
That is very perceptive of you, this is pretty much word for word what happened.

He was paying for counselling sessions and as they got closer to the root of the problem, which I know about, but won't go into here, he says it frustrates him to go round and round in circles about it and it never seems to get resolved. He's been to different therapists over the years and the same result, helps for a while and then doesn't.

On a positive note he has arranged a docs appmnt for Wed, so fingers crossed that will be productive. Medication has been the only thing that has helped him previously.

Fingers crossed for a relaxed happy Christmas 🤗

Ok, just an update.

So he has increased the dose from 20-30mg at the doctors recommendation.

That was 9 days ago. He says he doesn't feel any improvement, and is quite down and depressed still, and very fatigued.

Is it just going to take a while to get into his system, and is the fatigue a side effect? Or are these tablets probably not for him? If it is a side effect, how long until it passes?

Would really appreciate some advice tonight.

It takes a long time, sometimes a few months, to settle down and to feel better.

@giftponderings antidepressants aren't like magic beans which will make a difference overnight. To reach therapeutic levels can take anywhere between 6 weeks and 6 months, depending on the medication, and ultimately the diagnosis! Generally GP's are quick to prescribe a "typical" antidepressant but if your husband has something like bipolar disorder, borderline personality disorder etc then it is down to a psychiatrist to diagnose and treat accordingly.

I have bipolar disorder, and my GP is not allowed to make any changes to my prescription, only my psychiatrist can do that, gradually.

I’m surprised a doctor increased the dose so soon.