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Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2241
Experience:  MBBS ; M.D Psychiatry, MS. Health Informatics
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I have been taking citbalopram for over ten years on a low

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I have been taking citbalopram for over ten years on a low dosage. I have recently been having some problems in my life and I was getting anxiety and a little depressed. I increased the dosage of citalopram up to 40 mg, but there seemed to be no improvement. I was having problems with sleep now for over 5 weeks where I would wake up at 2am after only 3 hours of sleep and I could not go back to sleep. A doctor suggested I take symbyax for while to help with my sleep and depression. It has put me to sleep, but I am not really sure if this is the best medicine for me. He told me to stop taking the citalopram right away, but I am thinking I should taper off of it. I am taking the 6/25 mg of Symbyax. I am in Mexico for a few months, so I am not seeing a regular doctor in the states at the moment. I am concerned about the change and that it will create more problems. Any suggestions if I should continue using this and also how long it takes for it to kick in.

Dr Vikas :

Hello

Dr Vikas :

Symbax is a combination of Fluoxetine + Olanzapine if I am correct?

Customer:

hello

Customer:

yes, that is correct

Dr Vikas :

what do you mean by 6/25 mg?

Customer:

well, that is the amount for the olanzapine and the amount for the fluoxetine

Dr Vikas :

OK, 6 mg of Olanzapine and 25 mg of Fluoxetine.

Customer:

6 mg and 25 mg

Dr Vikas :

Are you finding this medicine useful?

Dr Vikas :

as such it is not indicated for depression alone and is mainly used in Bipolar depression.

Customer:

well, I have taken it only 3 nights now

Customer:

it has helped me sleep

Dr Vikas :

what exactly is your diagnosis?

Customer:

I am worried though about taking it long term

Customer:

I have a history of depression, that is why I was on citalopram for many years

Customer:

Right now, it has been axiety

Customer:

lack of sleep

Dr Vikas :

OK, see Fluoxetine is also a SSRI antidepressant just like Citalopram while Olanzapine is an antipsychotic.

Customer:

should I continue to take a low dose of citalopram ?

Dr Vikas :

it is not a good idea to take both Citalopram or Fluoxetine together.

Customer:

ok

Dr Vikas :

so in your case there are two possible options in my view.

Customer:

why do I need an antipsychotic?

Customer:

yes

Customer:

the doctor here is telling me to take this for a month, then switch to the fluoxetine by itself

Dr Vikas :

either you can continue Symbax and taper down Citalopram or you want to continue Citalopram than your doctor can add a sedating antidepressant like Mirtazapine to augment the effect of Citalopram. Mirtazapine being an sedating antidepressant can not only help in sleeping at night but will also add to the antianxiety and antidepressant effect of Citalopram.

Customer:

This one is to get me to sleep

Dr Vikas :

I don't think that taking Olanzapine for sleeping is a good option.

Customer:

why does it help my sleep?

Dr Vikas :

in that case, a combination of Citalopram with Mirtazapine is a much better option.

Dr Vikas :

Olanzapine has a side effect of causing sedation

Customer:

i see. how about mirtazapine?

Dr Vikas :

Mirtazapine is an antidepressant

Customer:

ok

Dr Vikas :

a sedating antidepressant.

Customer:

So, you think that combination would be better?

Dr Vikas :

in my view, yes

Dr Vikas :

you can discuss with your doctor about this combination and stopping Symbax

Customer:

what is mirtazapine called , other name for it

Dr Vikas :

Remeron

Customer:

are there start up side effects?

Dr Vikas :

it is very sedating

Customer:

to help sleep?

Dr Vikas :

and just like Olanzapine can cause weight gain later on

Dr Vikas :

yes

Customer:

can i take it for a short period - say 3 weeks so my sleep gets normal, then go off of it?

Dr Vikas :

well, Mirtazapine can also help in controlling the sexual side effects of Citalopram if any and we usually prescribe them together for long durations in our patients.

Dr Vikas :

so you can take it along with Citalopram for long duration. No use of taking it for 3 weeks

Customer:

I have not had any sexual side effects from citalopram.

Dr Vikas :

it is a good thing

Customer:

What amount would you take of each?

Dr Vikas :

dose range is from 15-45 mg per day

Dr Vikas :

Citalopram can be continued in the current dose

Customer:

I stopped taking the citalopram 3 days ago, should I just start up on it again and ad the remeron?

Dr Vikas :

well, first discuss with your doctor about this combination in my view

Dr Vikas :

and then you can decide.

Customer:

ok

Customer:

so, in your view. smbayax is not a good option for the sleep

Dr Vikas :

Yes

Dr Vikas :

it is not

Customer:

and do not take it together wih cyatalopram. I am worried about the going off citalopram

Customer:

it has only been trhee days

Dr Vikas :

Citalopram 40 mg is not working now so it is better to add a sedating antidepressant which will augment the effect of Citalopram.

Dr Vikas :

as you are taking Fluoxetine so there are chances that you will not experience withdrawal symptoms because of stopping Citalopram.

Customer:

just one other thing

Customer:

the remeron is an ssri drug? it is not like the anit pychsoic part of symbayax

Dr Vikas :

no it is not SSRI, it has different mechanism of action.

Dr Vikas :

it is an antidepressant as I mentioned above

Customer:

ok

Customer:

thanks

Dr Vikas :

are you there?

Customer:

yes

Dr Vikas :

welcome

Customer:

yes

Customer:

I am very concerned about these changessl, but maybe staying with the citalopram and adding the other is less risk, correct?

Dr Vikas :

In my view, this combination is a better option.

Dr Vikas :

and should be helpful in your case. :)

Customer:

tha\nks

Dr Vikas :

:)

Dr Vikas :

do you have any other question to ask?

Customer:

hello

Dr Vikas :

I am her

Dr Vikas :

here

Dr Vikas :

:)

Dr Vikas :

do you have any other query to ask/

Dr Vikas :

are you there?

Hello Thomas,

I am here for you, do you have any other question to ask?

Thanks

Vikas
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Kind regards

Vikas
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