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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17647
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I was on sertraline for 3 years for endogenous depression

Resolved Question:

I was on sertraline for 3 years for endogenous depression and did well till sertraline lost its efficacy, then switched to venaflaxine for almost 2 years ,did very well , tapered the medication from 75 to 37.5 then eventually stopped it since 6 weeks as the dr said it was homeopathic like dose that I was taking hence could try to stop it and I was also getting very unpleasant side effects like nausea .
6 weeks later my symptoms have hit me like a ton of bricks and the dr has started me on citalopram , as it is the first line of treatment, 20 mg, what do you advise from what I have described so far.
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. D. Love replied 2 years ago.
Hello from JustAnswer. I will be glad to assist you today.

The 20 mg dose of citalopram is the usual starting dose of the drug. The dose can be increased up to 40 mg per day, but it usually will only be done if the 20 mg dose is not sufficient after 2-3 weeks.

If the venlafaxine dose at 75 mg per day was effective, then there is a good chance that the citalopram will be effective at 20 mg per day. The 75 mg per day of venlafaxine is the starting dose, and it can be increased up to 225 mg per day.

So, at this point, it is reasonable to continue the 20 mg dose and it will likely be sufficient. However, if it is not sufficient, the dose can be increased up to 40 mg per day.

If I can provide any further information, please let me know.

Customer: replied 2 years ago.

since the mechanism of action of the 2 drugs is quite different, will citalopram be effective after quitting venaflaxine

Expert:  Dr. D. Love replied 2 years ago.
Yes, it has a good chance of being effective. As with any antidepressant, there is no assurance that it will work, but most antidepressants will work for most people. The fact that you have recently quit the venlafaxine does not increase or decrease the likelihood that you will respond to the citalopram.

However, since you were getting side effects to the venlafaxine, it is appropriate to change to a drug in a different chemical class, so that it hopefully will work for you without causing the side effect.

Customer: replied 2 years ago.

Thanks, ***** ***** it . I exercise, eat healthy , circumstances are favourable, do deep breathing, however I don't seem to still do well without the medication, I am happy to be on it if I have to however, this seems to be an indication of the body seriously not producing enough serotonin from what I understand.? mornings are worse than the night.


How long should this take before I see good results?


Is it recommended in the future to attempt giving it up like I did this time?


Are there any other suggestions that you have?


 


 

Expert:  Dr. D. Love replied 2 years ago.
It usually requires 2-3 weeks for the drug to accumulate in the system, and in this sense is similar to other antidepressants.

It is true that certain people require long-term treatment with antidepressants, but it is still reasonable to periodically try to get off the medicine to see if it is still needed. For someone that is doing well on medicine, there is no way to know whether it is still needed without periodically stopping the drug. It is appropriate that this only be done infrequently in someone that has failed prior attempts to stop the antidepressant, but it is appropriate to still try on a regular basis.

As for other suggestions, the exercise is good, as regular aerobic exercise has shown to help depression. The other aspect that pairs with this is getting regular sun exposure, so it is good to be getting the exercise outdoors to also be in the sun.

The only other comment is that there is evidence that in some people, vitamin B6 or folic acid may play a role, but if you are eating a healthy diet, this would be unlikely. If your diet is poor, then taking a vitamin supplement would be reasonable.

Customer: replied 2 years ago.

I think I am very happy with your advise and if I need further assistance , would you be the one to respond to my question?

Expert:  Dr. D. Love replied 2 years ago.
Whether I would be the one to respond is your decision. I would be glad to assist you on this or any other question, but it is your choice. If you would like my assistance in the future on another question, you can request me as part of posting the question, by accessing my profile and/or by stating the request in the first line of the question.

Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17647
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
Dr. D. Love and 2 other Medical Specialists are ready to help you
Customer: replied 2 years ago.

Had another question please.


I just wonder is venaflaxine more effective than first line of treatment as it works on serotonin and non epineohrine neurotransmitters?


Or citrolopram can be equally effective ?


Since I have started taking the latter just yesterday ,I just hope it works.


is first line of treatment like citrolopram less effective than the venaflaxine class of medication ?


Thanks

Customer: replied 2 years ago.

Would like dr love to respond please

Expert:  Dr. D. Love replied 2 years ago.
The SSRIs (selective serotonin reuptake inhibitors), such as citalopram, are considered the first-line drugs for treatment of depression. There is no evidence that the SNRIs (serotonin and norepinephrine reuptake inhibitors) are superior to the SSRIs and have not replaced them as first-line drugs. In direct comparison studies, there either is no difference or only minor differences in response rates. There are some specific considerations, though. For example, there is more evidence to support the use of SSRIs for treatment of anxiety, either as a primary problem or associated with depression. On the other hand, the SNRIs have better evidence that they may help when there is a concomitant chronic pain syndrome, such as headaches or chronic back pain.

In your case, where there is a desire to avoid the side effect caused by an SNRI, it would make more sense to move to a different chemical class than choose a different drug in the same chemical class.

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