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This is Dr. David
you have used this medication before. 20mg of citalopram is a very reasonable dose and is actually the starting dose.
maximum dose of citalopram is 40mg a day, so you are still not close to the maximum dose.
you should also add on a long acting benzodiazepine like valium or klonopin along with yoru citalopram to help your anxiety as well.
it doesn't sound like the mirtazapine has helped.
it sounds like you are more depressed on the mirtazapine.
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?
yes, I think you have given it 3 weeks.
it doesn't seem to be working for you.
it is doing the opposite and making you more depressed.
you should talk to your doctor about tapering off of it and starting up 20mg of citalopram.
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.
they can be very effective to help decrease anxiety
and can be used along with agents like citalopram.
you might want to ask him to refer you to see a psychiatrist as well.
and also a psychotherapist for counseling regularly for your anxiety and panic disorder.
I hope your anxiety symptoms get better
best of luck to you
let me know if you have other questions.
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That sounds like a good idea. I will book an appointment to see my gp and tell him what you advise.
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One more question
Do you think using a low dose of say value daily would be the way forward or just as and when required?
valium is a long acting benzo and can be used daily on an as needed basis to help decrease severe anxiety.
but is best used along medications like citalopram.
so using both together would work better, especially the higher dose of 20mg of citalopram.
and then using 2.5 or 5mg of Valium occasionally to help decrease severe anxiety.
does that make sense?
Yes, that's very helpful. Thanks very much.