Celexa's not working anymore. Should I give Prozac a shot again?
July 7, 2013 11:10 PM   Subscribe

I've been taking Celexa for a year and 9 months. It doesn't work as well anymore, and due to FDA warnings, I don't want to up my dosage anymore (currently at 40mg/day). I took Prozac a dozen years ago and it worked well. Should I switch back to Prozac?

(Sock puppet account used due to the nature of the question.)

Me: late 30's, female, family history of depression, diabetes, heart problems.
Current issues making depression worse: Recent unemployment, spousal caretaker stress
I am not in therapy due to financial issues, but I get regular exercise.

Prozac helped with my depression and anorexia in my mid-20's, and the sexual side effects weren't bothersome. I stopped because I lost health insurance, and my anorexia was in remission.

Before Celexa, I was on Zoloft due to depression, stress, and another anorexia bout. Zoloft worked okay, but made me violent if I tried to up the dose when I felt like it wasn't working anymore. (Yeah, bad idea, and I do not recommend it.)

Celexa, which was prescribed for me by the therapist I had to fire (long story) worked great for awhile. I was upped from 10 to 20 about a year and a half ago. I upped from 20 to 30 at the end of last year, and from 30 to 40 a couple months ago. Each time was due to the Celexa not working as well as before, and each increase helped. Not anymore, though. I think my time with Celexa is at an end.

In addition, the weight gain as I've upped my dosage has not been pleasant (like 30 pounds in 6 months). I can't go on a diet because of the anorexia--can't restrict eating or keep weighing myself or I'll go overboard.

I'm seeing my regular doc in 2 weeks for a physical and to discuss medications. I plan on asking her to take me off Celexa and put me on Prozac. My research leaves me wondering a few things--can I just switch from one to the other, or do I need to wean myself off one and then start taking the other? I'm sure my doc will have an answer, but I'd like to query the hivemind so I can get other perspectives.

Thanks. :)
posted by Val_E_Yum to Health & Fitness (13 answers total) 1 user marked this as a favorite
I know that there have been issues with Celexa, and that many providers switched to Lexapro, its newer cousin. You might want to talk to your provider about that.

In addition, treating depression takes a lot of patience. It can take a long time to get the right set of medications and dosages to get it right. Yes, there is usually a weaning off period, unless the doctor decides to supplement the Celexa with something else. Either way, consult your doctor before weaning!

I wouldn't go in making a recommendation on what drug to move to next. I would, instead, ask a lot of questions about what hasn't been working and how to best create the best plan moving forward. Pharmaceuticals are tricky business, and I wouldn't trust my online research skills to make those decisions for me.
posted by frizz at 11:38 PM on July 7, 2013

I'd guess your doctor would have you cross-taper from one medication to the other, rather than weaning all the way off one before starting the other or switching abruptly.

You say prozac worked for you before, and you stopped for reasons unrelated to the medication itself; that seems like a pretty good argument in its favor (and fluoxetine, like citalopram, is off patent). Of course you should discuss it with your doctor, who may have a better idea, but I think it's perfectly reasonable for you to ask for a change and suggest prozac.

(You have new problems in your life, so you might make another stab at finding a therapist you can afford (sliding scale, or something?) or even just finding ways on your own to draw yourself out for self examination the way therapy can. Everything says that meds+therapy work better together than on their own.

And, good luck, kudos for managing the exercise, and I hope you start to get back on top of things soon.)
posted by hattifattener at 1:38 AM on July 8, 2013

First, I am not a medical doctor, nor am I in any way licensed to give medical advice.

People have vastly different responses to medication. It's fine to go to a GP, but especially if you are looking to change medications, you might want to ask for a referral to a psychiatrist who will have more experience in finding the right medication for your needs.

That may not be possible with your financial issues, which is understandable, but your doctor may be able to suggest someone who can take you on a sliding scale. It doesn't hurt to ask, right?

Personally, I'm fairly happy with generic Wellbutrin.
posted by gryftir at 4:31 AM on July 8, 2013

You should see a psychiatrist about this question. People here cannot answer it for you.
posted by OmieWise at 5:00 AM on July 8, 2013 [2 favorites]

My wife did Celexa followed by Lexapro for around 4 years and had a similar experience with waining efficacy. There were a couple especially rough bits. She switched to Zoloft about a year ago. I can't guess which SSRI is best for you, but I'd say that Lexapro is essentially identical to Celexa and is likely to have the same effects and issues. Her switch to Zoloft was a Lexapro today/Zoloft tomorrow thing with no break. The first 4 weeks on the new SSRI were rough. A weeky counseling session was extremely helpful through that period. It can get dicey. The year since then has been remarkably better than life on Celexa.
She's slightly older than you, had a weird time on Prozac many years ago and she'll take one SSRI or another until the end of time.
posted by putzface_dickman at 5:54 AM on July 8, 2013

I am not a doctor, please follow your doctor's advice when you see her. I have no idea what medication is appropriate for you.

I switched from Celexa to Zoloft because of the new-at-the-time FDA warnings about high doses - I was on 80mg/day of Celexa. My psychiatrist had me cross-taper the medications very quickly, the switchover only took about two weeks. I believe that in most cases most SSRIs can be cross-tapered, BUT of course your own doctor knows best for you!
posted by insectosaurus at 7:08 AM on July 8, 2013

Instead of asking the GP to switch your SSRI, I think that you would be better served saying that you're still having symptoms (from both the depression and maybe anorexia) and asking to see a psychiatrist. Most GPs are not really comfortable with managing this situation; once you're not adequately treated with a maxed out SSRI it's time to see someone with more specialized experience. Psychiatrists are also nice in that they generally have more time allocated per patient than a GP. A psychiatrist need not be multiple expensive therapy visits; much of what they do is managing non-trivial psych medications. AskMe can really not tell you what's going to be the most helpful.
posted by a robot made out of meat at 8:43 AM on July 8, 2013 [1 favorite]

I agree that you should talk to a psychiatrist, who will both be more knowledgeable about what kind of antidepressant might be most effective to try next given your history and better able to manage your concerns regarding weight gain and your history of anorexia.
posted by fox problems at 8:59 AM on July 8, 2013

I don't have time right now to research this for you, but I believe new research has shown that Celexa is dangerous at the 40mg level? There is a sign in my Doctor's office saying to make an appointment with your GP if you're taking Celexa, and I seem to recall the reason was that there are heart issues at the 40mg dose. Given your family history of heart problems I would ask your doctor about this ASAP.
posted by whalebreath at 10:20 AM on July 8, 2013 [1 favorite]

I know I should seek out a therapist to discuss meds, but my county's resources for mental health suck (costly intakes, long waiting times for appointments). My last therapist was fired because she cared more about getting paid than helping me (and a few other things). And my health insurance runs out at the end of the month.

However, my martial arts training is a pretty good therapy substitute. My studio is my second home, and I've been marked to be trained to open my own branch of the studio in the not so distant future. :) It's given me a goal and a way to frame my being fired as a blessing in disguise.
posted by Val_E_Yum at 10:25 AM on July 8, 2013

FWIW "therapist" != psychiatrist; the latter are actual doctors. Insurers in the US are often very stingy about therapy visits, but won't stop you from getting a medication consult. Next month, public aid psychiatry in the US is often really tough (and I don't know where you are), but it might be worth trying before your insurance runs out.
posted by a robot made out of meat at 4:41 PM on July 8, 2013 [1 favorite]

Update: I discussed SSRI options with my doctor during my physical, and we decided on Prozac together. Starting off at 20mg and we'll go from there.

My doc is also having me test my T4 levels again to make sure everything's good there.
posted by Val_E_Yum at 8:42 AM on July 30, 2013

Yeah, so. . . . transitioning to Prozac hasn't been easy. *sigh*
I don't wallow in self-pity, but I'm anxious all the time.

I have a new therapist, and will work on a few issues I've never quite resolved.

I also found San Bernardino County, CA's Crisis Walk In Centers. They're free.
posted by Val_E_Yum at 2:49 PM on September 11, 2013

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