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Dr. David
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 47552
Experience:  Board Certified Physician
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I am a 23 year old male. I've have suffered from a general

Customer Question

I am a 23 year old male. I've have suffered from a general anxiety and panic disorder for as long as I can remember. I have been on 10mg of citalopram for the past 10 years to treat depression and anxiety which has been a success up until recently.
Unfortunately I have again started to suffer again from panic attacks and my anxiety in general including hyperventilating.
My doctor told me to increase my dose of citalopram to 20mg which caused an increase in anxiety. I quickly went back to my normal dose.
My doctor then advised trying a new anti depressant Mirtazapine.
I was on 10mg of citalopram and 30mg mirtazapine for 3 weeks. Unfortunately although my anxiety has subsided I feel little desire for life and my emotions have been flat lined. I feel a different person, I feel exhausted, angry and exercising is becoming extremely difficult and no longer enjoy sport.
My thought tonight are that I should come off the mirtazapine.
I wanted to have a second opinion as to what direction I should take next how.
I'm due to go on holiday in a few weeks and the thought of which are worryingly me greatly.
I look forward to hearing from you.
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. David replied 3 years ago.
Dr. David :

This is Dr. David

Dr. David :

you have used this medication before. 20mg of citalopram is a very reasonable dose and is actually the starting dose.

Dr. David :

maximum dose of citalopram is 40mg a day, so you are still not close to the maximum dose.

Dr. David :

you should also add on a long acting benzodiazepine like valium or klonopin along with yoru citalopram to help your anxiety as well.

Dr. David :

it doesn't sound like the mirtazapine has helped.

Dr. David :

it sounds like you are more depressed on the mirtazapine.

Dr. David :

hello?

JACUSTOMER-0pxqbyeu- :

Yes, the mirtazapine is making me more down and as I say making it harder to wake up in the morning and exercise. Do you think I have given the mirtazapine long enough to work?

Dr. David :

yes, I think you have given it 3 weeks.

Dr. David :

it doesn't seem to be working for you.

Dr. David :

it is doing the opposite and making you more depressed.

Dr. David :

you should talk to your doctor about tapering off of it and starting up 20mg of citalopram.

JACUSTOMER-0pxqbyeu- :

My doctor doesn't seem to want to offer a benzodiazpine type medication but having had this before it seems the only thing to actually help.

Dr. David :

they can be very effective to help decrease anxiety

Dr. David :

and can be used along with agents like citalopram.

Dr. David :

you might want to ask him to refer you to see a psychiatrist as well.

Dr. David :

and also a psychotherapist for counseling regularly for your anxiety and panic disorder.

Dr. David :

I hope your anxiety symptoms get better

Dr. David :

best of luck to you

Dr. David :

let me know if you have other questions.

Dr. David :

if done for now, please leave positive feedback below the chat box.

Dr. David :

http://www.justanswer.com/medical/expert-dr-david

Dr. David :

is my website if you need to reach me again.

JACUSTOMER-0pxqbyeu- :

That sounds like a good idea. I will book an appointment to see my gp and tell him what you advise.

Dr. David :

we only get credit for helping clients after positive feedback.

Dr. David :

good luck

Dr. David :

don't forget to leave positive feedback below

Dr. David :

I hope you have a good holiday.

Dr. David :

thanks for using JustAnswer.com

JACUSTOMER-0pxqbyeu- :

One more question

Dr. David :

yes.

JACUSTOMER-0pxqbyeu- :

Do you think using a low dose of say value daily would be the way forward or just as and when required?

JACUSTOMER-0pxqbyeu- :

Valium*

Dr. David :

valium is a long acting benzo and can be used daily on an as needed basis to help decrease severe anxiety.

Dr. David :

but is best used along medications like citalopram.

Dr. David :

so using both together would work better, especially the higher dose of 20mg of citalopram.

Dr. David :

and then using 2.5 or 5mg of Valium occasionally to help decrease severe anxiety.

Dr. David :

does that make sense?

JACUSTOMER-0pxqbyeu- :

Yes, that's very helpful. Thanks very much.

Dr. David :

thanks. y

Dr. David :

thanks.

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