How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Dr. Z Your Own Question

Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 5767
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
74815544
Type Your Mental Health Question Here...
Dr. Z is online now
A new question is answered every 9 seconds

I have been on Citalopram 20mg for almost 9 weeks now, I have

Resolved Question:

I have been on Citalopram 20mg for almost 9 weeks now, I have noticed no difference. I have had severe social anxiety my whole life, I also have depression (secondary to the anxiety). The only drug I have any effect from is Oxazepam, which obviously I can't take all the time... and I always "crash" after taking Oxazepam, the anxiety hits me and I get very upset that I need to take medication to feel somewhat "normal".
What do I do now? Do I ask for a higher dose, or? I guess I am never going to get rid of my anxiety, but I wish that there was something that could help a little.
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Z replied 1 year ago.

DoctorZ :

Hello I believe I can help you with your concern

DoctorZ :

You mention that you are on Citalopram for anxiety, but it is not having its desired effect of reducing your anxiety

DoctorZ :

And you do not want to go back on the benzodiazepine because of the physical dependence

DoctorZ :

It is possible that increasing the dosage of the Citalopram, which is labeled as an antidepressant, can help with your anxiety or adding another anti-depressant like wellbutrin that can help with anxiety and the secondary depression as well.

DoctorZ :

In addition I would like to ask if you are currently in therapy for your social anxiety? Studies consistently show more positive treatment results when an individual uses psychotropic medication in combination with the cognitive behavioral therapy

Customer:

I've always been very reluctant to trying medication, I'm afraid it's going to make me feel numb or just change my personality somehow. I'm not in therapy, one of my biggest problems that I've had since I was a child is that I am unable to speak in certain situations and to certain people. I tried therapy once, it was a really bad experience as the therapist kept telling me he couldn't help me if I didn't say anything...it just made the anxiety worse. I know there is no easy fix to this problem, I just don't know how to approach it... and now I've tried both therapy and medications and neither are working for me.

DoctorZ :

Well I am sorry for the way that therapist acted with you, most therapists are professional and allow you to take the time to trust and open up when you are ready. It may take time to find the right therapist, but I do encourage therapy for social anxiety because medications helps with the symptoms of social anxiety, but it does not help with the underlying thinking and root cause of it. Cognitive Behavioral Therapy is very specialized type of therapy that has great success with individuals that are diagnosed with Social Anxiety Disorder. I definitely do not think you should give up on the Citalopram as 20mg a day is the initial dose and you can get that bumped up to 40mg a day with is usually the maximum dose, so that is something you may bring up with your prescribing physician

DoctorZ :

Citalopram also has a low incidence rate of side effects, so if you have not had any bad side effects in the last 9 weeks, I do not believe you will get any even with an increased dosage.

Customer:

But if I have no effect of the 20mg dose, will the 40mg dose really make that much of a difference?

DoctorZ :

Its difficult to say, it might is the best answer. Unfortunately psychotropic medication is not an exact science and it works as a trial and error approach. Some medications work well for some people and some do not work well. And unfortunately it takes some time to find the right medication for you or the right combination of medications that will help lessen the symptoms of your anxiety.

DoctorZ :

I really wish I could give you a firm yes or no answer if 40mg will be helpful. But the brain is the most complicated biological machinery ever and we do not know with certainty how the medication will react with it. Sometimes it reacts well and other times the brain is resistant to the medication and at this point we just do not know why

Customer:

I understand. I'll ask for a higher dose and then go from there. Is it another couple of months on the 40mg dose before I can tell if it's working or not?

DoctorZ :

Since you have had a good amount of Citalopram in your system I would suspect 4-6 weeks should be enough time to see a results or at least the start of positive results by the lessening of your anxiety, but give it 8 weeks to be safe in case your body chemistry takes longer to metabolize medications. Also you can ask your physician what would be the plan if this does not work, like do we add another anti-depressant and which one? Its always good to know what the plan of action is ahead of time

DoctorZ :

And in the mean time though I would recommend searching for a good Cognitive Behavioral Therapist, maybe try a few of them to see which one you would like and explain how it may take you time to open up in therapy and how they would handle that.

Customer:

Alright, I will try that. Thanks for your help.

DoctorZ :

Anytime, I am always happy to help. If you have any other questions or concerns, please feel free to contact me anytime

DoctorZ :

I hope I provided you with excellent service today

Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 5767
Experience: Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
Dr. Z and 2 other Mental Health Specialists are ready to help you

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
< Last | Next >
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ
 
 
 

Meet The Experts:

 
 
 
  • Dr. Keane

    Therapist

    Satisfied Customers:

    1262
    Clinical Psychology PhD, Licensed Professional Counselor with experience in marriage/family, teens and child psychology.
< Last | Next >
  • http://ww2.justanswer.com/uploads/DR/Dr.Keane/2013-8-20_204325_drkeane.64x64.jpg Dr. Keane's Avatar

    Dr. Keane

    Therapist

    Satisfied Customers:

    1262
    Clinical Psychology PhD, Licensed Professional Counselor with experience in marriage/family, teens and child psychology.
  • http://ww2.justanswer.com/uploads/RE/resolutions66/2011-1-17_05728_IMG8202smilingeditedforJustAnswer.64x64.jpg Elliott, LPCC, NCC's Avatar

    Elliott, LPCC, NCC

    Psychotherapist

    Satisfied Customers:

    5024
    35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.
  • http://ww2.justanswer.com/uploads/formybunch/2010-12-06_191055_img_0975.jpg Kate McCoy, M.Ed, NBCC, LPC's Avatar

    Kate McCoy, M.Ed, NBCC, LPC

    Therapist

    Satisfied Customers:

    3733
    Over 20 years experience specializing in anxiety, depression, drug and alcohol, and relationship issues.
  • http://ww2.justanswer.com/uploads/DR/DrAkiraOlsen/2012-2-20_746_AkiraADpicmain.64x64.jpg Dr. Olsen's Avatar

    Dr. Olsen

    Psychologist

    Satisfied Customers:

    2336
    PsyD Psychologist
  • http://ww2.justanswer.com/uploads/norriem/2009-5-27_134249_nm.jpg Norman M.'s Avatar

    Norman M.

    Psychotherapist

    Satisfied Customers:

    2193
    UK trained in hypnotherapy, counselling and psychotherapy and have been in private practice. ADHP(NC), DEHP(NC), UKCP Registered and ECP.
  • http://ww2.justanswer.com/uploads/PsychologyProf/2010-07-15_171248_logos060400409.jpg Dr. Michael's Avatar

    Dr. Michael

    Psychologist

    Satisfied Customers:

    2177
    Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
  • http://ww2.justanswer.com/uploads/KURTEMMERLING/2010-07-23_215531_just_ask_picture1.jpg Steven Olsen's Avatar

    Steven Olsen

    Therapist

    Satisfied Customers:

    1727
    More than twenty years of expertise in counseling, psychological diagnosis and education
 
 
 
Chat Now With A Mental Health Professional
Dr. Z
Dr. Z
Mental Health Professional
5767 Satisfied Customers
Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.