Should I increase or change antidepressant?

[Pineappledancer]

I have been on 10mg escitalopram for 8 weeks.

I have struggled really badly over those 8 weeks with various side effects and symptoms, particularly weight loss due to nausea and lack of appetite and difficulty sleeping, and increase in anxiety and depression, including SI.

I have had some slight improvement but it has been slow going with lots of ups and downs.

My doctor has suggested that I should be showing more improvement after 8 weeks and asked me to consider the following options:

1. Continue on 10mg for a bit longer
2. Up dose to 15mg
3. Wean off and change to a different SSRI
4. Wean off and change to mirtazapine

5.Continue on 10mg and add in a low dose of mirtazapine

I have no clue what to do.

I am terrified of all of these options for a variety of reasons.

I know nobody can tell me what to do but if anyone has any thoughts, experience of any of these options or just some supportive words I would be grateful.

This was my experience as well on citalopram. I persevered for 14 weeks with barely any improvement and at the end my depression just seemed to get worse and I felt suicidal. I’m so glad I switched to venlafaxine it worked very quickly for my depression and panic attacks are nowhere near as bad, my anxiety is better although it is still there. 8 weeks should show more improvement you might be better swapping to a different med although a cross taper rather than a direct switch is easier. Good luck @Pineappledancer xx

Different ssri suit different people. Citalopram worked within 2 weeks and saved my mental health and yet it made my friend worse. It may be time for to try a different ssri as 8 weeks is a long time and you should be feeling some improvement.
I wish you relief and a climb back to happiness, unless someone has experienced what you are going through then it's impossible to imagine x

@Catsservant @Rubyupbeat

Thank you so much for your replies.
I am worrying so much about this.

How are you today

@Catsservant I ended up deciding to give an increase a try. It seemed the most logical after spending so long already on this med rather than starting all over again.

I took the first increase last night and am trying to stay calm and not panic that I have made a terrible mistake.

I had a lot of difficulty getting to sleep and my anxiety is higher today, but that could just be me worrying rather than the medication. I'm just so scared of a return to the worst of the side effects.

Really not sure about this.

Please don’t worry if this doesn’t work you can easily cross taper to another. I’ve done that twice this year it was fine and to be honest if you still feel so unwell you probably wouldn’t notice any withdrawal symptoms anyway. I dropped citalopram over 2 weeks from 30mg, good luck x

Also have you been on the Facebook group for escitalopram, you can search to see if anyone else has experienced the same thing.

I did it by adding 7.5mg of mirtazapine to 150mg of sertraline. However it’s making me gain weight which I don’t want

@JustAboutMuddlingThrough
Did the mirtazapine help? How long until you noticed a difference?

I think mirtazapine has been suggested for me as weight gain would be helpful for me at the moment (although I may not sure I would be keen on it long term) also as it might help me with sleep.

Thanks for the reassurance @Catsservant

I am finding it hard not to just see the negative in everything. The thought of changing really terrifies me. I just want to feel a bit better and be able to get back to work.

i take mirtazapine 15mg for sleep it’s good for that but didn’t do anything as an antidepressant or make me gain weight but we are all different. It can make you feel very groggy at first until you get used to it.

I didn't find Mirtazapine worked for me at all and it's a pain to taper off. Maybe try 15/20mg of Escitalopram because you've already got it in your system and if that doesn't work, cross taper to Venlafaxine.
(That's going to be my next move if Escitalopram doesn't work. I've tried Sertraline this time last year for 11 weeks and it was awful, then Mirtazapine for 6 months which just didn't work for me at any dose and I'm still tapering off and I'm now trying Escitalopram 10mg with a lot of hope!)

It's a really horrid time and I hope we all get better xxx

@BramleySweet i cross tapered 4 weeks ago from citalopram to venlafaxine, really scared about the withdrawal aspect but it’s unbelievable how quickly it worked. Within days my depression lifted, panic attacks have virtually disappeared and if I do have one the only symptom i do get is hyperventilation, although my anxiety could be better I’m hoping this improves.

I don't know why, but I'm so very if Venlafaxine - I think because it seems to be one of the strong ones and one that's tricky to taper off. That being said, I've been unwell for such a long time, that if Escitalopram doesn't work for me, it's what I'll be trying next.

Can I ask you a bit about it? (No rush/pressure to reply):

What's your background with anxiety/depression? (That's super personal, so no obligation to answer!)

What other meds had you tried?

How gradual was your cross taper?

Will you increase the Venlafaxine or do you think you'll settle on the dose you're on?

I'm glad everything is evening out for you and I can't believe it worked so quickly for you 🥰🥰

I had postnatal depression 26 years ago, spent 25 years on Paroxetine unable to get off it until last October when I decided to lose weight with mounjaro 3 weeks later my anxiety was through the roof so I stopped. Unfortunately it never improved and then followed depression, GP increased the Paroxetine over 2 months then I spent 14 weeks on citalopram. This seemed to work a bit for the depression but I had a hysterectomy at 8 weeks then I just felt even worse. 4 weeks ago (on Tuesday) I started venlafaxine at 37.5 increasing by 37.5 to 112.5mg now. As I increased dose I decreased the citalopram ath the same time. I was really scared as well, I set my alarm to take it everyday at the same time so I don’t forget.
I do have a med review appointment on Tuesday I think GP wants me to increase again to 150mg but I will see what she says.
the only side effect I found is I need less sleep not even the sweating that everyone mentions.
there is a face book group positive Effexor if you want to have a look as well.
sorry a bit long winded I hope that helped😊

Just to add it does seem to work very quickly for a lot of other people in that group as well

Thank you so much - it sounds like you've had quite the journey and I hope everything settles for you and you've found your med. It's such a minefield trying to find what will work for you and get you back to yourself xxx

How are you now @Pineappledancer do you feel any better?

@Catsservant Hi! Thanks for the message.

I increased 5 days ago. I was worried that the increase would stop my eating again, but so far there has been no significant change in this.

Some of my anxiety symptoms are definitely heightened though.

I had a pretty rough evening yesterday and my sleep was worse. I always wake multiple times, but last night it was more often and I was waking with stronger physical anxiety which made getting back to sleep tough.

Strangely though this morning has been a bit 'better' so far.

I am trying to remain hopefully that this increase will do the trick and soon I will notice a difference. It is so hard to be positive though.

Has your doctor not thought about adding propanalol. I have them alongside the escitalopram.

I'm on 15mg of escitalopram to help my anxiety and depression symptoms.

But when my physical symptoms of fast heart rate sweating etc happen I take 40mg of propanalol to ease those symptoms. Usually this is at night when my body plays tricks on me.

It really helps as it then stops the physical symptoms so I can calm down and not spiral and feel mentally worse if that makes any sense?

@soberfutures

Hi! Thanks for the suggestion.

Unfortunately I have propranolol but I don't find that it helps. I don't tend to get a fast heart rate and sweaty.

My physical symptoms are hard to describe, it is more like waves of burning and tingling in my arms and body and a sort of jitteryness in my back and chest.

Can i ask how long have you been on 15mg of escitalopram and how are you finding it? Did you increase doses up to 15mg? I would be very interested to hear your experience. I have had a very rough time so far.

Ah OK that's a shame as I have found that a life saver.

I found going from 10 to 15 was a struggle for about a week. But now been on that dose for 9 weeks now and I'm doing OK.

It's hard to know what is the best as no one persons symptoms are the same. I was on sertraline for many years and that seemed to work.

Although the start of that was hell on earth with side effects. But at about week 8/9 they seemed to subside. Then I was OK for a few years. I only stopped and switched to escitalopram as I suddenly felt I had reached a plateau and my mood really went low.

And since then escitalopram has been good for me. I would keep trying that dose for a bit longer then maybe discuss the mirtazipine with your Dr to maybe have low dose at night. Wishing u all the best and everyone on here also struggling.

@Pineappledancer hope you feel better soon x

@Catsservant how are you?

I am still struggling. Need to decide between upping to 20mg escitalopram or switching to something else.

Mirtazipine is a difficult one OP. It can have the opposite effect of what it’s meant to do - in other words make you more anxious, and it can interfere quite significantly with sleep. I’ve been on anti depressants on and off for over thirty years and by far the most effective I’ve found is Sertraline. They all have various side effects within the first few weeks, but these subside over about 4-6 weeks, so I agree with your GP. If you’re still struggling, it’s either because you’re not suited to it, or the dose isn’t doing much for you apart from causing side effects.

Sertraline is one of the best mood stabilisers and it has less side effects - takes less time to get into your system and start working. It’s considered one of the safest anti depressants.