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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 a low dose of Citalopram for about 10 years

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I have been taking a low dose of Citalopram for about 10 years with no problems. Recently, I have been going through a personal crisis and I started having problems with Sleep( would wake up early at 1:30 am). A doctor here( in Mexico) suggested I take clonzapam along with the citalopram, but it did not help with my sleep.Also, I increased my level of citalopram, but it did not seem to help. I started to get anxiety and the lack of sleep for several weeks wore me down. He then suggested I stop taking the citalopram and switch to Symbyax. I started this 10 days ago and I was able to sleep, but I was told by another doctor online that this should not be used to help for sleep. I do not have bipolar depression and it is used for that. I want to find out where I should go from here. I have only been taking the cymbyax for 10 days, so I thinking it would be best to get off of it soon and go to something that is better indicated for me. I want to find out how I can go off of this safely. I took effexor many years ago and it worked well for me. Any guidance you can give would be helpful

Dr Vikas :

Hello

Dr Vikas :


Hello ! Thank you for your question, I’m Dr. Vikas and I’ll try to help you.

Dr Vikas :

In your case, a combination of Escitalopram and Mirtazapine can be a much better choice instead of Symbax.

Dr Vikas :

You responded well to Citalopram earlier so you should respond well to Escitalopram also. Mirtazapine is a very sedating antidepressant and also a good anti anxiety medicine.

Dr Vikas :

So your doctor can prescribe you Escitalopram in morning and Mirtazapine at night and this should be sufficient for your current symptoms.

Dr Vikas :

The dose range of Escitalopram is from 10-20 mg per day. Your doctor can start Mirtazapine by prescribing 7.5 or 15 mg initially to be taken at night which can be increased further if needed.

Dr Vikas :

If you want to stop Symbax, just discuss with your doctor about start taking it every alternate day for 3-5 days followed by discontinuation. Since your doctor will be prescribing you Escitalopram which is also a SSRI antidepressant so you will not experience any difficulty in stopping Symbax.

Dr Vikas :

My goal is to provide you with excellent service and I hope I’ve provided the information you were seeking, if not, please let me know so that l can continue to help you.

Customer:

hello

Dr Vikas :

are you online?

Customer:

hello

Customer:

what time can I chat with you?

Dr Vikas :

Hello

Dr Vikas :

I am online now

Dr Vikas :

can we chat

Customer:

hello

Customer:

sorry, I was away from the computer

Customer:

if you can give me a time period that you will be online, that will help. maybe an half hour window

Customer:

I had talked with you last week as well about the problems I was having with the medication. I have been taking this symbyax now for almost 2 weeks and I am not feeling better.

Dr Vikas :

I am online right now, are you here

Dr Vikas :

or I have missed you again ?

Dr Vikas :

:)

Customer:

hello

Dr Vikas :

hi

Customer:

thanks for getting back to me

Dr Vikas :

:)

Customer:

I am having a lot of issues with the med I am using

Customer:

I started on this about 2 weeks ago

Dr Vikas :

ya I remember that

Customer:

I am in Mexico and the doctor is not a psych doc

Customer:

I was online with you about 10 days ago

Dr Vikas :

OK,

Customer:

It has helped me sleep, but I feel confused during the day

Dr Vikas :

I can understand that.

Customer:

I can not comprehend 50% of what people are saying to me when they talk

Dr Vikas :

you need a sedating antidepressant as I mentioned earlier.

Customer:

I am scared, becuase this medicine seems to be for bipolar and i do not have that type of depression

Dr Vikas :

and since you responded well to Citalopram so this time a combination of Escitalopram + Mirtazapine can be a very useful combination in your case.

Customer:

what would be the difference. would I have start up side effects as well?

Dr Vikas :

well, SSRI like Escitalopram mainly cause gastrointestinal side effects but Mirtazapine can control them.

Customer:

well, I do not know if I responded well to cital. I had been taking it for 10 years on a low dosage

Customer:

when I increased it, I got no response

Dr Vikas :

in addition, you may experience slight worsening (not necessary) of anxiety but that can be easily controlled by adding a low dose of Clonazepam on as and when needed basis.

Customer:

I had sexual side effects with symbya

Dr Vikas :

see, both Mirtazapine and Escitalopram has different mechanism of action and complement the antidepressant effect of each other.

Dr Vikas :

Yes, it is possible with Symbax,

Customer:

are there any sexual side effects with mirtazapine?

Dr Vikas :

but Mirtazapine can control the sexual side effects too due to SSRI antidepressant like Escitalopram or Fluxoetine.

Dr Vikas :

We usually add Mirtazapine to counteract the sexual side effects due to SSRI antidepressant like Citalopram, Fluoxetine or Escitalopram.

Customer:

The doctor here is telling me to stay on symbyax for a month, then titrate out the one part of it and just be on fluoxentine

Customer:

I never had sexual side effects with citalopram

Dr Vikas :

see, Fluoxetine is also a SSRI antidepressant but it is an activating antidepressant.

Customer:

what does that mean

Dr Vikas :

It can cause insomnia as a side effect

Customer:

how about citalopram

Dr Vikas :

so there is one possible option. What your doctor can do is to continue Fluoxetine and Mirtazapine at night

Dr Vikas :

that is Fluoxetine in morning and Mirtazapine at night

Customer:

I am not sure what to do, I am very frustrated and confused. I was on citalopram for years

Customer:

I took effexor many years ago and it was really good

Dr Vikas :

he can titrate and stop Olanzapine right now also and add Mirtazapine at night

Customer:

i see

Customer:

is effexor an activating antir depressant as well?

Dr Vikas :

no Effexor has a side effect of causing sedation.

Customer:

so, that means better sleep?I was reading that the citalopram will have bad interaction with symbyax. So I need to wait a few days before switching ver

Customer:

so, you can take effexor at night?

Dr Vikas :

well, Effexor is usually prescribed in two or three divided doses.

Dr Vikas :

In my view, Mirtazapine is a much better option

Customer:

i see

Dr Vikas :

as I mentioned earlier, your doctor can prescribe Fluoxetine + Mirtazapine also.

Customer:

or do the citalopram plus mirtz

Dr Vikas :

depends on your choice :)

Dr Vikas :

both of them are SSRI antidepressant.

Customer:

ok,

Customer:

could effexor be an option if I want to change?

Customer:

It worked well years ago, then it stopped working

Customer:

so I made the change

Dr Vikas :

yes, it can be a option too.

Customer:

I was really happy with it back then. I felt better than I had ever felt

Dr Vikas :

in that case, you should definitely try it again

Customer:

So, the fact that it worked well years ago and I stopped taking it, does not mean I cannot take it again?

Dr Vikas :

yes,

Customer:

becuase it stopped working, but I was taking a low dose

Customer:

back then

Dr Vikas :

in fact, we prefer those medicines which a patient responded well earlier.

Customer:

ok, that is good to know

Dr Vikas :

:)

Customer:

thanks

Customer:

I took it once a day, but you said it has changed for the effexor?

Customer:

it is now twice a day to take it

Dr Vikas :

well it depends on the dose

Customer:

I see, what is the common amount to take for this?

Dr Vikas :

in low dose like 37.5 or 75 mg, patient can take it at night or morning

Customer:

ok

Dr Vikas :

for higher dose, usually it is divided

Customer:

it will help with sleep?

Dr Vikas :

most likely, it is sedative in many patients

Customer:

how would I switch over from the symbyax to the effexor?

Dr Vikas :

well, your doctor can stop Symbax and then shift you on Effexor.

Customer:

no wait period?

Dr Vikas :

as soon as Symbax is stopped.

Dr Vikas :

your doctor can start the Effexor from the very next day.

Customer:

do I have to slowly go off the symbyazx, that is all I need to know. dont' want any interacations

Customer:

ok, you answered

Customer:

thanks

Dr Vikas :

:)

Customer:

I will let you go, I may have more questions in a few days. how do I contact you ?

Dr Vikas :

please feel free to request me again when you come back to ask another question. You can Bookmark my profile link in your browser.
( http://www.justanswer.com/mental-health/expert-drvikas/ )

Customer:

ok, thanks

Dr Vikas :

there is a question box in that page.

Dr Vikas :

or you can ask directly by asking "For Dr Vikas only .............

Dr Vikas :

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Kind regards


Vikas

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