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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Butch on March 28, 2000, at 10:23:14
I am surprised by the number of posts from people taking relatively small doses of Celexa. The manufacturer itself recommends 40mg per day, and my layman's reading of the drug studies tells me that lower doses afford only placebo effects. Check out Celexa.com (if for no other reason than to hoot at the photographs of joyous Celexa users, radiating well-being). Although I sure as hell do not hold a brief for the drug manufacturers, I wonder what prescribing physicians know, or think they know, that the manufacturer doesn't know. For me, Celexa didn't kick in until I began taking 40mg, one year ago.
I would be concerned that taking a less than full dosage could give one the annoying side effects but without the desired benefits. Furthermore, it seems that the emerging conventional wisdom on treating recurrent depression is to thoroughly stomp it out for a solid year, side effects be damned, in hopes of counteracting the "kindling effect." By that view, being timid with dosage would not merely deprive the patient of the benefits, but could actually aggravate matters by prolonging the depression and the maddening side effects.
In my personal experience I was lucky, I guess, that I became inured to side effects. The debilitating mental drama went away after a couple of months, and was no scarier than the depression itself. The most stubborn side effects for me were dermatitis and delayed orgasm. A drug holiday over a couple days sufficed to work around the sex problem.
After a year at 40mg, I have recently reduced to a maintenance dosage of 20mg, which maintenance dosage is an approach allowed, if not necessarily recommended, by the manufacturer. I feel just great, and nearly all side effects have vanished.
People taking these pills for the first time and referring to PsychoBabble (a terrifically valuable resource) should remember that the PsychoBabble commentators are not a representative sampling of medicated depressives insofar as a disproportionate number are acutely distressed or have unusually stubborn conditions. People who feel well are not motivated to post a message.
Don't despair! ADs work for most people. Bull your way through the side effects and will yourself to believe in better living through chemistry.
Posted by saint james on March 28, 2000, at 11:01:14
In reply to Celexa dosage; personal experience, posted by Butch on March 28, 2000, at 10:23:14
> People taking these pills for the first time and referring to PsychoBabble (a terrifically valuable resource) should remember that the PsychoBabble commentators are not a representative sampling of medicated depressives insofar as a disproportionate number are acutely distressed or have unusually stubborn conditions. People who feel well are not motivated to post a message.
>James here....
Thanks for making this point, Butch !
j
Posted by A. on March 28, 2000, at 16:54:27
In reply to Celexa dosage; personal experience, posted by Butch on March 28, 2000, at 10:23:14
I just started taking Celexa for generalized panic disorder. At one time I spent 2 years on prozac for clinical depression (20 mg), with no side effects at all.
I mention this b/c I don't know if the panic is related to the depression, but overall, right now I am generally happy and do not consider myself depressed in any way! I just happen to worry so much and just get panic attacks out of nowhere.
Anyway, the doctor prescribed 20mg Celexa. I've had the nausea, the sweaty hands, and general inability to "sit still." I am also generally tired, but I've always been tired, so I can deal with that. It's the nausea that is bothering me the most.
It is to the point it is hard to eat or drink. I can't imagine why anyone would experience weight gain on this drug! I tried switching my dose from morning to night, and also cutting my dose to 10mg for this week just to "get used to" to the drug -- maybe this will help alleviate the side effects by gradual increase in dosage... ?
Butch, you mention 40mg as what you feel the only way to get the full affect -- I am wondering if you worked up to that dosage, and if so how did you do it? Since I just started this week, I can't say for sure if this drug is going to work for me -- as the panic stuff isn't always every day...
Are the side effects amplified by higher dose? Is starting off small going to work, does anyone think? ~Thanks.
Posted by Butch on March 28, 2000, at 17:35:50
In reply to Re: Celexa dosage; personal experience, posted by A. on March 28, 2000, at 16:54:27
I worked up to 40mg over six weeks.
I never experienced nausea. This may be a crashingly obvious question, but does it help to take it with food?
The initial side effects for me, in addition to those I mentioned previously, were sweating, agitation, yawning and light sleep. The pill kicked in with a bang for me, and I was so pleased to be feeling better that it was not a big problem for me to tolerate the unwanted side effects and they eventually went away or I was able to ignore them; it's hard to tell which. If memory serves, there was some increase in some unwanted effects when I increased the dosage, but those increases were marginal in comparison to the initial strangeness of taking even 10mg.
I will tell you about one side effect that I had that was not listed in the literature: I had about three paralyzing panic attacks in the first three months I took the pill. In years past I have had panic attacks from time to time. I am not sure in my own mind if the Celexa caused the panic attack, or if the strangeness of the experience of taking an AD precipitated them; I suspect the latter. I have not had any problems with panic since the beginning, and Celexa has ultimately greatly lessened my propensity for anxiety and panic. Anyhow, keep a big jar of benzos handy.
Posted by A. on March 28, 2000, at 20:25:13
In reply to To: A, posted by Butch on March 28, 2000, at 17:35:50
The nausea generally comes in waves -- it's always lingering, although at times it is very mild and almost nonexistant - while at other times I think I truly am going to throw up, although I never have thus far.
I've tried taking the drug with food and without food. Generally, the effects of the nausea don't kick in until 30-60 minutes after the pill is taken, so if I take it with food, I generally feel fine enough to eat that first meal. But any meals *after* the nausea begins is difficult, as feeling the food enter my nauseated stomach only aggrivates the problem, it seems.
Since I started taking the drug at night, by the next evening, the nausea is generally gone. Like right now, I am pretty hungry and I believe eating will be no problem. But earlier in the day I could barely finish my food!
It is strange to hear that Celexa may have caused panic attacks in you, as I am taking Celexa to stop my panic attacks! From what I read, general anxiety disorder is thought to be caused by too much serotonin in the brain, causing the feeling of anxiety all day long (mine is episodal, so it's just panic disorder). It was strange to read that it was too much serotonin -- since lack of serotonin is generally associated with depression! I wonder if the usage of antidepressant drugs can at times lead to such levels of too much serotonin, thus creating a panic attack? That is just my guess. Regardless, I don't see how Celexa is used for treating panic disorders, yet that is what they are doing studies on right now.
Regardless, it is inspiring to read your side effects went away with time. My hands are constantly sweaty, and my feet always feel hot, although the rest of my body is fine! Strange that it only occurs in the hands and feet... but this I can tolerate. Just as long as the nausea will go away! I am thinking that drinking ginger/peppermint tea might help, as it is usually used to calm upset stomachs.
Posted by MA on March 29, 2000, at 11:39:45
In reply to Re: To: A, posted by A. on March 28, 2000, at 20:25:13
When I started Celexa back in August of 1999, I began at 10 mg and had alot of problems with anorexia, where I couldn't eat. I continued to have nuasea on 20 mg and my doctor wanted me to try and go to 40 mg rather rapidly since my depression was very severe. I continued with nausea and wanted to stop Celexa because i felt so bad. I also had alot of anxiety and early morning wakening during this period. I did split the dosage in half taking 20 mg in the morning and 20 mg at night. This was the only way I could tolerate 40 mg daily.
Little by little my side effects lessened and I started to feel better. This took about a full month.
My concentration and energy level was still very poor and eventually I added Wellbutrin to the Celexa. A trial of ritalin failed prior to this. I have always been convinced I have a touch of ADD on top of my depression.
After several months of experimentation with Wellbutrin, Ritalin, and Neurontin, I am currently "stable" on Celexa 30 mg, Wellbutrin 150 mg, and Neurontin 300 mg daily.
But the nausea did pass as my Celexa dosage was raised so sticking with it did prove to be worthwhile.
Good luck with your trial.
Posted by Kath on May 29, 2000, at 9:42:09
In reply to Nausea at low dose, posted by MA on March 29, 2000, at 11:39:45
> My daughter found that taking powdered ginger (she bought the powder & empty capsules & filled them herself) helped with extreme nausea that she used to experience in vehicles. It might be worth a try.
Posted by Jennifer on May 30, 2000, at 1:36:48
In reply to Re: Nausea, posted by Kath on May 29, 2000, at 9:42:09
I agree with Kath. You can get ginger tablets at a health food store. Also the reason people drink ginger ale when they are sick!
> > My daughter found that taking powdered ginger (she bought the powder & empty capsules & filled them herself) helped with extreme nausea that she used to experience in vehicles. It might be worth a try.
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