Increase in Citalopram, does this make your panic attacks worse?

Hello,

As you probably already may know, Citalopram is among medications known as Selective Serotonin Reuptake Inhibitors, or SSRIs, which function by blocking neuronal re-uptake of the neurotransmitter serotonin which is responsible among other transmitters for mood regulation. They are most often prescribed for unipolar depression. It is important to realize that the efficacy, or positive effects, can vary greatly among patients as can the side-effects as well.

With respect to feeling "detached," it is clinically referred to as depersonalization-derealization and can commonly arise from patients experiencing side-effects of SSRI treatment, manifestations or the malady under treatment or exacerbation of the malady itself. While there are a good deal of claims by the pharmaceutical brands who manufacture these drugs and several research studies that the drugs are effective with generalized anxiety disorder and in particular Panic Disorder, the actual circumstances waver regarding such information.

It's important to note that while SSRI treatment can result in favorable outcomes regarding anxious depression, all persons do respond differently to such treatment as already stated and the outcome can actually be worse in some instances. With particular regard to Panic Disorder, SSRIs and SNRIs can actually increase the frequency of the events. Panic Disorder, in the clinical context, is thought by many practitioners to arise from extreme separation anxiety initially experienced in early childhood and in many cases persists throughout life. From a neurological perspective, it has been determined that a reduction in the neurotransmitter GABA can result in the formation of Panic Disorder and its associated symptoms.

Panic Disorder, however, can arise from abrupt trauma or significant life changes as well. So a patient can be initially treated for depression with SSRIs for many years only to find at some point the expression of Panic Disorder arises as an initial consequence of such trauma or life change(s). Increasing the dosage of an SSRI can be observed to either bring about relief of the panic episodes or alternatively increase their occurrence since mood under SSRI treatment is intended to be up-regulated. This would be consistent with what we would want to see in a patient suffering from a variant of depression. Thus, an up-regulated mood through certain changes in neurochemistry can result in a likewise increase in panic episodes in some patients. Anti-depressant therapy is not generally aimed at a calming effect but rather an elevation in mood and physical well-being. In other words, its primary goal is to uplift the depressed mood and desire for increased engagement of activity and socialization as a means to suppress the negative effects of depression.

I am presuming by your comment that having underwent SSRI treatment for 25 years that it was originally prescribed for a variant of clinical depression since you state that the panic attacks have only recently arisen unless I misunderstood your comment. It's important to determine whether the panic episodes have been present for many years in a cyclic fashion or whether they may be associated with very recent psychic trauma of some type or an abrupt unwanted or undesirable change in life circumstances. It is also a good idea to review any changes to your medications and/or dietary supplements regimen because there are an ample number of both medications and supplements capable of interaction with SSRI medications that can result in the manifestation of unwanted effects, i.e. panic attacks as an example.

In short answer to your direct question regarding the Citalopram dosing schedule, you should certainly see improvement within two weeks if an increase to 30mg qd, or once daily, has been prescribed by your doctor and followed by you accordingly. I'll also point out here that while online forums can be a very helpful resource to interact with others regarding health conditions, any attention and questions specifically related to medication regimens should always first be discussed with the prescribing physician.

I'll pause here and trust that the information provided helps offer support regarding your questions and comments. Lastly, the nature of the medications under discussion here can very often require dosage adjustments and even changes to different medications or the addition of other medications to obtain the best results since as already mentioned the effects of such drugs can vary considerably between patients so I'll also suggest here that you speak directly with the prescribing physician and maintain close and regular contact regarding your progress or lack thereof in response to medication adjustments in order to obtain the best and most expedient results being sought.

I'll be glad to respond further if you wish to provide more information regarding the reason for initial treatment with Citalopram and responses to other concerns mentioned that may be playing a role in the presence and treatment of the panic attacks.

Best regards

hi

i started taking citalopram i think every dr starts with these i ended up on duloxetine 120 mg which helped me alot but also try mindfulness meditation i thought what will this do and it really helped me