Switching antidepressants, how??

Hi JP1986,

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Patient

Dear JP . . . it sounds like you need the close supervision of your prescribing doctor in order to make any change in your medication and it sounds as if a change is called for here. You also need 24 hour access to a suicide hotline in order to make the transition. And I hope you're in therapy too.

I'm the same, if i forget to take my meds then i will start becoming unable to manage feeling suicidal. They keep not working so well so i have to up the dose, i upped mine to 250mg (maximum dose is 200mg) and that works for now but obv my GP is unlikely to prescribe this for me so i'll have to change over to other meds it seems and i've no idea how i will cope for 6 weeks either.

Talking to someone does help with my anxiety but it takes hours of distraction for that to happen.

It's best to see a psychiatrist that knows about various anti-depressant medications. Also, as I understand, the best procedure is to decrease and come off one medication while simultaneously introducing and increasing the new medication.

i think theres good news for you. because you can take ativan or a benzo or something temporary while your adjusting you new medication to prevent withdraw and bad anxiety and depression! more so i think u can still take your current drug but lower the dosage and than at the same time take a small dosage of ur new med and introduce it slowly BUT you need to get proper instructions from ur doc or phychiatrist. dont just read internet instructions ull probably get wrong info so make an appointment and tell ur doc how u feel AND be sure to ask for something like arivan short term during the switch to prevent panic attacks and depression bouts!

Hi JP1986!

First, remember that all states of well-being pass.

Now about your problems with Escitalopram...

1. A psychiatrist would be the best person to discuss these things with. Not a GP, please. They're typically completely clueless about these things and anyway usually limited in which drugs they can prescribe directly.

2. 20 mg is actually a very high dose, so reducing to 15 and then to 10 mg should be easy (if suicidal, see your shrink immediately).

Options:

1. Adding low-dose lithium (150 - 300 mg - dosages that work for many, but not harmful to your kidney. Dosages for Bipolar d. are 800 - 1200 mg) to escitalopram (especially if you reduce escitalopram first as reportedly there's a chance of serotonin syndrome)
2. Adding bupropion to escitalopram if you're more tired and lacking motivation than sad
3. Adding mirtazapine to escitalopram if you're prone to insomnia and/or anxiety
4. Replacing escitalopram with duloxetine (you're still getting serotonin, but adding noradrenaline with a single drug)
5. Combining bupropion or mirtazapine with low-dose lithium has been found efficient for refractory depression, more so than combining lithium with SSRIs (you can do that before stopping escitalopram, giving you a chance to reduce it to zero over several months)

Please write these options down and discuss them with a qualified psychiatrist who hopefully knows you.

All the best!

Kris