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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 10566
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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I have been on Citalopram 20mg for almost 9 weeks now, I have

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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.

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

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