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Ask Dr. D. Love Your Own Question

Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17510
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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Iam on 40mg of citolopram and have been years ive been

Customer Question

Iam on 40mg of citolopram and have been for ten years ive been put on propranolol 40mg twice a day I feel very depressed still panicking and can't do much apart from feeling very sick is there any other antidepressant I can take with the citolapram at all
Submitted: 7 months ago.
Category: Medical
Expert:  Dr. D. Love replied 7 months ago.
Hello from JustAnswer.What is the diagnosis for which you were started on the propranolol?Have you previously been tried on any other antidepressants?
Customer: replied 7 months ago.
For my anxcity cause it's awful right now no never and ThAy said that would have to take me off citolapram first before that start me on another and I no I won't cope with that
Expert:  Dr. D. Love replied 7 months ago.
Thank you for the additional information. The propranolol does not directly treat anxiety or panic, but it can help ease many of the symptoms associated with anxiety. However, propranolol also can cause or exacerbate depression as a side effect to the propranolol. If it wirks well, that is fine, but if it does not work well or makes the depression worse, then it would be better to avoid th use of propranolol. As for another antidepressant, there are several options to consider. If an antidepressant is not helping, then it wold be reasonable to try a different antidepressant. If an antidepressant is working partially, then it would be reasonable to add to the antidepressant. There are several option of what can be added to an antidepressant. It is an option to add a second antidepressant, and particularly an antidepressant that is in a different class of antidepressants. Commonly used antidepressants that would be in a different class would include bupropion or trazodone. It is true that adding two antidepressants is associated with an increased risk of side effects. Most doctors do not consider these interactions to be a reason to completely avoid combining antidepressants, but it certainly is a reason to be very cautious when combining antidepressants. There are also a group of medicines that can augment the effect of the antidepressants. These augmenting medicines have little or no antidepressant action, by themselves, but when added to antidepressants, they can help increase the effectiveness of the antidepressant. This includes Seroquel, Abilify, Valproic Acid, Cytomel, or lithium. While these medicines do not have the same interaction as using two antidepressants, there are side effects associated with each drug, so are also usually added cautiously. It also may help to add a medicine that will more directly treat anxiety, such as buspirone. While this does not have direct action to relief depression, easing the anxiety component may secondarily help improve the mood. If your primary care physician is uncomfortable in using drug combination for treatment of depression and anxiety, then it may be necessary to consult with a Psychiatrist. If I can provide any additional information, please let me know.
Customer: replied 7 months ago.
If I add another antidepressant would the side affects be serious because I don't no how much more I can cope with i feel so ill and low
Expert:  Dr. D. Love replied 7 months ago.
Most of the side effects are not serious, but there are some serious side effects that can occur in a small percentage of patients, such as excessive serotonin levels in the brain, called serotonin syndrome, or seizures. If the second antidepressant is added cautiously, then the risk of the serious side effects can be minimized.
Customer: replied 7 months ago.
Wots the best anxcity medicine to take cause that's wot I need
Expert:  Dr. D. Love replied 7 months ago.
There is no single best. The benzodiazepines, such as lorazepam or alprazolam, are the best for control of acute symptoms, but can make the problem worse with long-term use. The SSRIs, such as the citalopram, are the usual best first-line medicine for chronic treatment. Although antidepressants, they also have anti-anxiety effect and does not make the problem worse with long-term use. The buspirone that I mention above is a second-line medicine, that can be used when an SSRI is not sufficient, although it will only have an indirect effect on depression, as I said above.
Customer: replied 7 months ago.
Will it help the panic attacks also?
Expert:  Dr. D. Love replied 7 months ago.
Yes, each of the medicines that may help anxiety also may help panic.
Customer: replied 7 months ago.
How long does the propranolol take to start working propley its day 5 for me and I just burst in to tears
Customer: replied 7 months ago.
Also feel sick tired
Expert:  Dr. D. Love replied 7 months ago.
It will act within a few days to a week or so.
Customer: replied 7 months ago.
Are these normal side affects and should I carry on with them
Expert:  Dr. D. Love replied 7 months ago.
They are common side effects, but when they are significant, we would usually prefer to use a different medicine.
Customer: replied 7 months ago.
How long do the side affects normally last on these Iam on day 5
Expert:  Dr. D. Love replied 7 months ago.
It varies. In some people the side effects will continue for as long a the medicine is taken.
Customer: replied 7 months ago.
Is that rare tho cause I don't no how much longer to give it as its only day 5
Expert:  Dr. D. Love replied 7 months ago.
No. The drug is usually tolerated well, but when side effects occur, it is fairly common for the side effects to continue for as long as the drug is taken.
Customer: replied 7 months ago.
Should the side affects have gone buy now then??
Expert:  Dr. D. Love replied 7 months ago.
There is no “should” in this situation. Sometimes they do and sometimes they do not, and we have to deal with whatever happens for a particular patient.
Customer: replied 7 months ago.
Would it be to early to give up on them now as its only day 5
Expert:  Dr. D. Love replied 7 months ago.
As I said above, when the side effects are significant, we would usually prefer to use a different drug.
Customer: replied 7 months ago.
So wot do u sugest cause my doctor said that could take a week to work there slowing my heart race but I just feel low and anxious
Expert:  Dr. D. Love replied 7 months ago.
Your only choice is to discuss this with your doctor. You can ask for a referral to a Psychiatrist, for the reason that I noted above, but it will take some time to arrange that consultation.
Customer: replied 7 months ago.
Can I ask too be put on buspirone can I takr that with citolopram
Expert:  Dr. D. Love replied 7 months ago.
Yes.
Customer: replied 7 months ago.
Is that better than propranolol
Expert:  Dr. D. Love replied 7 months ago.
It varies for each individual. Each has the different effects that I noted above, and which is better for an individual depends upon which effect is desired.
Customer: replied 7 months ago.
Can it take time for the propranolol to work Iam giving up hope
Expert:  Dr. D. Love replied 7 months ago.
I answered that above - It will act within a few days to a week or so.
Customer: replied 7 months ago.
So it's still taking time to work at the miment
Expert:  Dr. D. Love replied 7 months ago.
If it is causing significant side effects, it is not relevant whether you are a person in whom it may work in a few days or a week, because the side effects are the same in either case.
Customer: replied 7 months ago.
But u said it take about a week to work so won't no if the symptoms will go or not
Expert:  Dr. D. Love replied 7 months ago.
If the side effects are not significant, then it is fine to wait, but I thought I understood you to say that the side effects were significant.
Customer: replied 7 months ago.
Ive felt down and sick?
Expert:  Dr. D. Love replied 7 months ago.
Yes. I discussed that above.
Customer: replied 7 months ago.
But is it a normal side Affect of these tablets and should I hold them out cause I don't no wot to do
Expert:  Dr. D. Love replied 7 months ago.
As I said above, they are common side effects, but when they are significant, we would usually prefer to use a different medicine.
Customer: replied 7 months ago.
How do I no if there significant or not ive only been on them 5days how long do Thay normally recommend that u wait until thay work
Expert:  Dr. D. Love replied 7 months ago.
By how significant the symptoms feel to you.
Customer: replied 7 months ago.
I can handle them yes but will thay stop cause Iam crying every day and think that Iam going mad
Expert:  Dr. D. Love replied 7 months ago.
As I said above, sometimes they do and sometimes they do not.
Customer: replied 7 months ago.
How much longer do u suggest I carry on on them to see a improvement?
Expert:  Dr. D. Love replied 7 months ago.
If you are having significant side effects, there is no reason to wait any longer.
Customer: replied 7 months ago.
Only after 5 days when u said it can take a week
Expert:  Dr. D. Love replied 7 months ago.
I answered that above.
Customer: replied 7 months ago.
But it dosent make any sence u said it can take a week but now saying maybe I should stop because of the side affects after only 5days
Expert:  Dr. D. Love replied 7 months ago.
As I said above, the reason to change is because of the significant side effects, so it is irrelevant whether you have been on the medicine for a sufficient period of time.
Customer: replied 7 months ago.
But how do u no thay won't go away after a week if Iam only on day 5 that's my point??
Expert:  Dr. D. Love replied 7 months ago.
The number of days is not relevant to the side effects. The number of days is only relevant to the desired positive effect. The number of days is not relevant to the undesired negative effects, because they are already present. Even if the medicine gets a little better at easing the symptoms of the anxiety, that will not change that the side effects are already there.
Customer: replied 7 months ago.
So my side affects will stay
Expert:  Dr. D. Love replied 7 months ago.
As I said above, sometimes they do and sometimes they do not, but it has nothing to do with whether there has been enough days for the positive effect of the drug to be achieved.

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