Medication Review: Anti-Depressants- to change or not?

Former Member

So I have a medication review for Citalopram (30mg) on Wednesday. I am debating whether to look into changing my medication or not. I take it for not only depression and suicidal thoughts, but also for anxiety (citalopram good for anxiety too).

Now in the past I’ve felt my medication may be working, but recently I’ve been having intense suicidal thoughts (on and off). They started before I took any meds but have been progressing recently. Each time they have progressed, I’ve had my Citalopram upped, which I believe has helped in the short term. However I’ve had it upped twice (10mg to 20mg to 30mg) and after some time they always progress. I went to the doctors a few times this month for bad episodes of these thoughts. The last doctor (who isn’t my usual doctor) said I could considered upping it to 40mg (the highest dose offered for Citalopram) or changing medication. However, I would have to come completely off Citalopram according to the doctor (from 30mg to 0mg before I could start another medication) - this concerns me.
Initially I said no (but also for family reasons) but now my family know how things have been and mum has this idea that the Citalopram could be making me worse. I don’t think so (as things have got better at times) but I’m unsure. I was actually curious how I would cope with no meds, as it’s been 6months since I started- to see if the citalopram made it worse or better.

I am not sure which option to take, as I am unsure how I will react to a increase or decrease followed by a change in meds. Additionally it may affect my depression one way and anxiety the other. I am unsure if any other anti-depressants are good for anxiety too. In the other hand I do believe it has helped the anxiety but unsure about depression and suicidal thoughts.
My options are:

1. Increase Citalopram to 40mg
2. Decrease Citalopram gradually and then start a new medication
3. Stay at 30mg

I am aware that medical advice can’t be provided here, but I wanted to have an idea of what I planned to do before visiting the doctor. Obviously I will discuss this with the doctor before making any final decisions. Just wanted some general advice?

Former Member

Hey apandav,

Like you say at the end of the day, it is your decision. However, you might want to consider certain things, such as have you felt better or worse since starting the medication? Do you think it has helped your anxiety or depression more than the other? Have you had any side effects and do this present any issues to you to the extent you may consider changing? Do you feel more or less stable than before?

Whilst it can be that when you are tapering up your doses to get to a level that works for you, things can get worse before they get better- but do you feel that things have disproportionally got out of hand - e.g. within a month or two of going up each dose?

My first prescription for anti-depressants was Fluoxetine (Prozac) - within a month of taking it I was actively suicidal and it stopped me eating more than appetite it was meant to give me. I then was prescribed Citalopram 40mg for 40 years, before tapering off for a year or so 2 years ago. Looking back, it was probably not the best drug for me - my mood has actually been a lot more stable since coming off. I had a lot of mood swings and whilst on it received a diagnosis of Bipolar but since coming off I haven't actually had any episodes near as bad as I used to. A lot did change in my life during those 4 years though and the citalopram (or rather, taking an anti-depressant) was definitely the right choice. However, I have been more anxious since coming off citalopram so swings and roundabouts.

There's a good website called headmeds - http://www.headmeds.org.uk - it has loads of information on all the different drugs and might be worth a look to see what the potential ones suggested are and what the potential side effects are etc.

Speaking to your doctor is a good start, good luck

Former Member

Thank you for your reply @Past User - I did read it before my appointment and it gave me a good idea of what to think about. Haven't really been on as been busy but thought I'd update you- I am staying with Citalopram 30mg. My GP said she thinks she's noticed an improvement in my anxiety as I seem less agitated- but she said its perfectly reasonable to question my medication!

Former Member

Forgot to add- only thing I'm annoyed at is she just dismisses my bad thoughts- but I genuinely made plans that day. She said that I'm bound to have these bad episodes as its the "therapy" that will change it. She didn't really understand that I'm not currently getting therapy- I'm just been assessed by the psychologist and even the psychologist said that this is to determine what happens- they might not give me therapy actually thats worrying me a lot