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Dr-A-Greene, Psychologist
Category: Mental Health
Satisfied Customers: 309
Experience:  Clinical and Forensic Psychologist
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Been on 20mg Cipralex for about 7 years with great results. 5

Resolved Question:

Been on 20mg Cipralex for about 7 years with great results.
5 weeks ago I had a terrible panic attack and I'm now deeply depressed, strong feeling of deperzonalization. As i live in a dream and my personality is gone.

Upped my dose of cipralex from 20-30 mg 5 weeks ago. Still no effect :(
What do to? Increase dose to 40 mg or change medication ? Can it be that Cipralex 40 mg will work for me ?
It seems that Cipralex don't work anymore :(

I receive psychoterapy at the moment, but it's not so easy when I'm extremely depressed.
Submitted: 4 years ago.
Category: Mental Health
Expert:  Dr-A-Greene replied 4 years ago.

It might be worth upping the dose if Cipralex works for you and has a history of working for you. However, the literature suggests that after 20mg, there are diminishing returns (meaning that if you don't respond to 20mg, increasing may not be effective). Additionally, if you've been on the same medication for a number of years, its not unusual for it to stop working. Your body simply acclimates to the drug and over time it loses it's effectiveness. In that case, changing medications could be beneficial. Switching to another SSRI like Prozac or Paxil may be worth looking into as their chemical structure is slightly different from Cipralex (also known as Lexapro). Your body won't recognize it and should respond.

The good news about that is that after the switch, if you feel like going back to Cipralex in a year or so, your body may respond again. It just needs sufficient time to get out of your system.

My best guess is that after 7 years on the same drug at the same dose, your body just got accustomed to it. Also, we change as we age. Hormones and other factors always play a part in our mental health, so it could just be a function of how your body is responding over time.

Finally, if you keep having feelings of depersonalization, be wary of other drugs like benzodiazepines (xanax, klonopin, etc) or sleep aids, as they increase dissociation. I would stay away from alcohol or marijuana as well.

I hope this helps - please let me know if you have any further questions!

Best of luck to you,

Dr. G.

Customer: replied 4 years ago.
Thank you !

I guess you're right. My doctor said to me that I should wait 6 weeks to see if i respond on the increased dose. I'm now at week 5 and nothing has changed. It's hard to believe that the medication will start working next week.

The feeling of deperzonalization is the feeling who feed my anxiety and vica versa. It really feels like I have gone crazy( but i know i haven't)

I'm really scared that no medication will work for me, but I hope you are right! I just need a little help from the medication to come through this nightmare. My doctor told me that they would try tricyclic antidepressants ( but I hope he meant SSRI ) . Do you think it's better to try another SSRI thant a tricyclic?

I've gone through this in 2005. After three weeks on Cipramil I just woke up one day and felt much better. A way out on the nightware.
Expert:  Dr-A-Greene replied 4 years ago.

I know it can be scary, especially when you've relied on something for a while and it stops working. It's strange how that happens. Some people can take one drug for 20 years and others have to switch it up every twelve months or so. It totally depends on the person. However, I have to say that I often see it in younger people who are pretty healthy. My hunch is that when we're young our livers are more efficient at processing and our brains are a bit more elastic, so we acclimate faster (this is good news in some ways!).

Don't be too scared about switching. If an SSRI worked well for you, it stands to reason that another one will work just as well (seriously - I have patients who have gone from Paxil to Zoloft to Prozac and back again and they all work!). It's very common.

Although, I am a bit concerned about the statement that your doc might try a tricyclic (I hope you're right and that was a misstatement). There are many side effects and interactions with tricyclics and usually they're only suggested if the SSRIs or SNRIs (serotonin/norepinephrin reuptake inhibitors like Effexor) don't work. I really hesitate with tricylics & suggest that people avoid them if possible... Unless there is some compelling evidence that another SSRI won't work for you, I would stick in that category of medication personally. I would just talk to your doctor honestly about your concerns and see if they're willing to try another SSRI as there seems like there's no reason not to. I truly think you'd have good luck with a different SSRI if Lexapro worked so well - (PS - Celexa and Lexapro are essentially the same thing with only slight variations, so switching to Celexa probably wouldn't work - Paxil, Zoloft, or Prozac are all good bets).

I wish you the best of luck with this and I'm happy you're researching it on your own. You're too young to be started on heftier meds for no reason!

Thanks and let me know if you have any more question, okay?

Take care,

Dr. G.

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Customer: replied 4 years ago.
Thank you for your great support (and sorry for my bad English. I'm from Norway)
You give me some hope. Thank you very much!!
You know, it's so incredible scary and makes me so depressed to stay in this condition. Normally I'm a healthy young man with many friends, a great job and simply love my life!

I went to my psychologist today and she said I suffer from OCD, anxiety and depression . This feed the feeling of deperzonalization.

Well, 5 weeks since I increased Lexapro dose to 30 mg. No action yet. Should I call the doctor tomorrow and tell him that I want to change medication now, or should I give it another week ?
I will tell him that I want to try Zoloft, Prozak or Paxil.
Expert:  Dr-A-Greene replied 4 years ago.

Hmmm - well, if you want to give it another week, you can, but I wouldn't expect a huge change. It might be time to change to a different SSRI. I would probably call him.

Also, the OCD would explain why the meds might not be working as well either! OCD typically requires a higher dose of antidepressants than just typical depression does. Researchers aren't sure of why this is, but people with OCD usually just need more to respond in the same way (e.g. 60mg of Prozac as opposed to 20mg for someone with just depression).

So, it sounds like you are completely headed down the right path! Since I have a few OCD symptoms myself, I know it can be hard to deal with. Luckily, once the right medication is on board you should feel like your normal happy self again. I'm so glad that you're advocating for yourself despite feeling a little down lately. Don't worry. You'll feel better soon - I just have a feeling about it.

Best wishes,

Dr. G.

Customer: replied 4 years ago.
Thanks for your answer.
She did not say OCD, but obsessive thoughts. The feeling of sadness and strong depersonalization and anxiety creates more fear and I can't think or feel anything else than depressive and scary thoughts. I read so many things about depersonalization and people who suffer many years from this disorder. This creates even more depressive and scary thoughts. And i don't "feel" myself . It's like that i have lost my personality.

But i don't need to check things all the time. (wash my hands, etc.). It's just intense thoughts and feelings..

The same thing happened in 2005, but after three weeks on celexa , one morning I just woke up and felt much better. Wanted to do things. Felt calmer.
I pray every night that i will soon feel better, because I've been in "hell" for five weeks now and the pain is killing me.
But I don't give up (NEVER) :)
My doc will call me today and I'm SO ready for Prozak, Paxil or Zoloft (Best feeling for Zoloft)
Customer: replied 4 years ago.

My doc called me. Guess what: He wantet me to add Seroquel ! It's not my doc who recommended this, but a psychiatrist I totally freaked out. I said that I rather want to change medication to Zoloft and he agreed. But he said that I should give Seroquel a chance. I REALLY hesitate to do this. I had a panic attack and have anxiety disorder, not Schizofrenia. I have read so much about this and for me it seems obvious that SSRI are the first choice to deal with anxiety.

He also mentioned a tricyclic antidepressants..

Do you think I have made the right choice? Now he prescribing me Zoloft and I will start to take this today. NO tricyclic antidepressants and NO
Expert:  Dr-A-Greene replied 4 years ago.

Really? I have to say that I'm surprised. Seroquel is an antipsychotic and when it's not being prescribed for psychotic symptoms, it is generally given to calm severe agitation, restlessness or insomnia issues. SSRIs are the first-line treatment of choice for anxiety. If the panic gets out of hand a benzodiazepine like ativan can be given with the SSRI. In your case I am truly baffled as to why Seroquel would be suggested when straight Lexapro was working in the past. Of course, your doctor is familiar with you personally and might have another idea about why he was going in the direction of heavier meds.

However, from my standpoint, I believe that trying out another SSRI would be the best option for you. There are less side effects and there seems to be no reason not to go this route. Additionally, the Mayo Clinic suggests SSRIs as treatment for the symptoms you're describing.

Finally, if you feel that the depersonalization component trumps all other symptoms, you can try other types of meds like those listed here:

Keep your chin up - I hope the Zoloft works for you!

Take care,

Dr. G.

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Customer: replied 4 years ago.
Thank you!
Yes, the depersonalization feeling is the most disturbing symptom. But that's because that's the thing who scares me most, I guess. But the depression and depersonalization/anxiety goes hand in hand.

So, I'll now try Zoloft (will gradually change from Lexapro) over a couple of weeks
My doctor also gave me Trimipramine. Don't know why.
Expert:  Dr-A-Greene replied 4 years ago.

Hmmm - so you got a prescription for a tricyclic anti-depressant too. He may be giving it to you in case the regular SSRI doesn't work? Either way, I'm hoping that the Zoloft will work for you.

I wish you the best of luck!

Dr. G.

Customer: replied 4 years ago.
He wanted me to take both Zoloft and Surmontil,
so.. I'll do it

Thanks for all the answers. Keep up the good work!
Expert:  Dr-A-Greene replied 4 years ago.
Thanks and best of luck to you!!!
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Expert:  Dr-A-Greene replied 4 years ago.
Hi. it's Dr. Greene - I'm just writing to check in and see how it's going with the anti-depressants. I hope that you're doing well - if you get a chance, let me know.
Dr. G.
Customer: replied 4 years ago.
Thank you so much.
You know. This is the most difficult time in my life. And all I want is to feel myself again.
I'm a healthy young man and really love my life. But it's really frightening what a single panic attack can do with your mental health. I never thought I would go through this again because i stayed on Lexapro for so many years. It's difficult to stay positive and believe that Zoloft or Surmontil will be a success.

Here's my medication update:
Surmontil: Been taken 70mg since wednesday ( No side effects)
Zoloft: Took 25 mg fridag, 50 mg saturday, 50 mg sunday and 100 mg today. I will stay at this dose for two weeks.
Lexapro: 20mg Thursdag, 15 mg Friday, 10mg Saturday and then quit.

I know this is a very fast swtich, but I have never noticed any side effects from these medication. And in my opinion, a deep depression is much more serious than some side effects. My doc said that I should do this switch over three weeks, but I guess he will understand my situation.

So, do you think this is a good plan ? I now just have to wait for to-four weeks. It's REALLY difficult for me to handle this situation because I feel so depressed, desperate and scared.

If this meds won't work I really don't know what do do.

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