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November 27, 2006 12:09 PM   Subscribe

One week into citalopram...will it get better??

Posting for a good friend that I send thread after MeFi thread to...

" I started taking citalopram (generic Celexa) and I feel like crap ever since.
I'm wondering if this will go away or is permanent."

She has been taking it for one week today.
She has been depressed (has very difficult family issues/probably care giver burnout) and I would say is prone to depression. She is also prone to lots of anxiety.

She has gone off other meds due to inablility to function because of pressing work/care giving schedule.

Is there light at the end of the tunnel??
posted by beccaj to Health & Fitness (14 answers total) 2 users marked this as a favorite
The beneficial effect doesn't kick in for 4-6 weeks. During the first couple of weeks a lot of patients experience a worsening of the symptoms they were prescribed the meds for.

The prescribing doc should be made aware of these things.
posted by ikkyu2 at 12:22 PM on November 27, 2006

A lot of times SSRI's make you feel really "loopy" for a week or two.
posted by radioamy at 12:29 PM on November 27, 2006

IANAD, but I took Citalopram for two years and felt that it was the most effective medication I have taken for my depression and anxiety. However, everyone reacts to antidepressants differently.

That said, when I first went on Citalopram, it made me ridiculously sleepy and just "weird" feeling for a week or two. This slowly improved over the next two-three weeks.

My biggest advice is that if she is not taking it right before bed, to do that. It almost worked like a sleep aid for me - once I switched from taking it in the morning to taking it at bedtime, I felt normal during the day and slept like a baby at night.

It takes at least a month if not two for the positive effects for most SSRI's to occur. You have to be patient with antidepressants. Also, the changes can be subtle - you don't just wake up one day and say "I feel fucking awesome!!!", it is more slow and gradual, and after a few weeks you might notice that you are more interested in things again and more able to cope with day to day crap that would previously make you want to stay in bed all day.

I would recommend to your friend that she keeps a mood log to track her mood on a scale of 1-10 throughout the day. I got into the habit of doing this for both my depression & anxiety for when I went to talk to my doctor and therapist. I know it sounds cheesy, and I know it can be hard for a depressed person to stick with things like that (mine is really sporadic - I only really followed it the first few weeks on a new dosage or medication, but that was enough to be pretty helpful).

If she's still feeling wonky after a few weeks though, she should definitely talk to her doctor about trying something different. There are a lot of options out there, so I hope she is able to find one that works for her.
posted by tastybrains at 12:48 PM on November 27, 2006

When I started Lexapri (another SSRI) it took about three weeks to kick in. I felt pretty miserable the first week. When it did start to kick in, it wasn't an omg, I feel great kind of thing, but I suddenly realized things weren't so bad after all.

When the dosage was increased some months later, I felt incredibly depressed for two weeks (note: it was prescribed for anxiety) but after that I started to feel okay. Then REALLY good, then leveled off to a pleasant good. Probably over a period of 4-6 weeks.
posted by [insert clever name here] at 1:08 PM on November 27, 2006

Just wanted to add that Lexapro is pretty closely related to citalopram (Celexa), so I think the experiences are probably going to be somewhat similar between them.
posted by tastybrains at 1:10 PM on November 27, 2006

My experience was very similar to tastybrains'. Celexa has been nothing short of a godsend for me, but it took almost the full six weeks for it to become effective (even a week before I was convinced it was never going to work for me). And it's been working for me for six years -- with the exception of one summer when I stupidly thought I should try coming off of it.
posted by pardonyou? at 2:06 PM on November 27, 2006

Just to put another kind of experience out there, when I took Celexa, I had some definite side effect issues. After those first few weeks, mood-wise I felt pretty good, but the sleep problems, new teeth-grinding habit, and an insane craving for sugar weren't fun.
posted by cabingirl at 2:18 PM on November 27, 2006

It appears you are getting good feedback from others. I started on Prozac about 2-3 years ago. It worked for a year and then it didn't.

About a year ago I started Celexa (40mg) and have generally been doing fine. I am bi-polar, so they say. About 4-6 months ago I became more manic with pressured speech and racing thoughts. It was fun and I don't really drop, but it caused some problems. I decreased the dose to 20mg (under psychiatric guidance) and found about 3 weeks ago after being at the new dose for 8 weeks that it was too low. Now I am trying 30mg.

I sleep way too much since I started these drugs..up to 10 hours or more at a shot? But then I'm an ol' guy. I've never had sleep issues, but now my sleeping patterns are erratic. Normal hours some days and then unusual shifts. I often just stay up through the night for no real reason than I want to. My life allows this. Last nite it went until 6am this morning. Gonna take a nap soon. But then I spend a lot of fun time with my rather normal manic self.

These drugs and the time frames for full effect when first starting or making dosage changes, take several weeks to judge. Everyone pretty much confirms that. And like you have been told she should consult with a clinical person that really knows what is going on, not all do. Matching the SSRI to the person and diagnosis is not a simple thing, and you have to give whatever a fair trial before making decisions about changing things.

I agree it is best to take a bedtime or late evening.

When I first started Prozac the first week was mentally hectic, 'loopy' as you have been told and kinda like spinning out on a mild acid trip. It was not comfortable. The second week was find, but during the third I really wanted out. Just too much anxiety, fear and emotional stress. I called in and a psych person told me I was perseverating and to stop it and assured me I would get through. Good advice, I did and everything got better. Wonderful drugs when they work. Some people do not get through the trials. Sometimes a SSRI is not the right thing. Don't self diagnose without guidance.

I got through the switch to Celexa with no issues whatsoever. Once you get on these things it can be Easy Rider...or it can be like..."That's just how it goes, first your money and then your clothes."

I have been told recently by psychiatric folks that Lexapro is now considered a really good starter, Celexa is next on the list, but not always as easy, and Zoloft is more iffy. My wife has been on Zoloft for 3 years now and it is going fine.

Wishing you all the best.
posted by GhislainTwo at 2:21 PM on November 27, 2006

I'm wondering how much citalopram your friend is taking. Most people end up using at least 20 mg, but when you're ramping up to your final amount, it can be easier to do increases of 5 or 10 mg. (Pills are available in 10, 20 and 40 mg, and are easy enough to cut into smaller pieces.) Her doctor would probably tell her to wait 3-4 weeks before giving up; if she's really hating it, she can ask him about taking a smaller amount for now, and then increasing it gradually. In my experience, the first 7-9 days can be very uncomfortable, maybe because the drug hasn't reached a steady state plasma level (just a guess on my part). Even though the positive effects can take several weeks to emerge, a lot of people do feel a noticeable benefit after a week to ten days.

Some doctors figure it's best to start at 20 mg and get the worst of the suffering out of the way as quickly as possible, instead of dragging it out with small increases. I can see the wisdom of this approach, as well.

Encourage her to contact her doctor to ask about her side effects and how she should proceed. Antidepressants can be scary, especialy for someone who's new to them.
posted by wryly at 3:12 PM on November 27, 2006

Another concern (and this applies to any antidepressant therapy, drugs or not) is that some symptoms tend to lift earlier than others. It's especially common for the exhaustion and fatigue to lift before the mood; this can be dangerous because suddenly the sufferer feels physically stronger, but is still depressed. This is the most common time for suicide, I'm afraid, since the person's still depressed but finally strong enough to make an attempt.
posted by watsondog at 4:34 PM on November 27, 2006

it takes too long for SSRIs to work. while waiting for them to work, why not try some fast acting anti-anxiety meds? ativan or klonopin work wonders, especially for the short-term.
posted by brandz at 8:09 PM on November 27, 2006

Celexa and lexapro are similar but they don't both work for all people. Lexapro works great for me.

On the other hand when I was on Celexa - I didn't really care about anything but was somehow still anxious about everything.

Your friend needs to stay on the meds for 4-8 weeks to see what they do for her. (Most people say 4-6 weeks but each of three different anti-depressants I've been on it's taken me exactly six weeks to see the effects or non-effects.) She needs to be patient with the process.
posted by fluffy battle kitten at 8:18 PM on November 27, 2006

She needs to stay on it for at least a month before she'll know. It's a bitch, but it is what it is with the SSRI meds. If it's absolutely unbearable, she must see her doctor and let him/her know what is going on.

She has gone off other meds due to inablility to function because of pressing work/care giving schedule.

She absolutely needs to tell her doctor about this. Going off meds incorrectly can mess all sorts of things up. Her doctor prescribed the dosage of citalopram she is on by accounting for all of the other meds she is also taking (hopefully). If she's stopping some prescriptions because of side effects of other prescriptions her doctor needs to be told so that adjustments can be made. It's hard to say what's making her worse -- withdrawals from one med or ramping up of another.

As an additional anecdote, I tried Lexapro, which is a similar to Celexa, and it made me even more depressed than I was unmedicated, after an initial 3-day "I feel pretty good" phase. I took it for 6 weeks before my doctor and I decided that it wasn't going to work for me because I was pretty much unable to do anything other than sleep all day.
posted by macadamiaranch at 8:57 PM on November 27, 2006

Thank you everyone.
I sent her the info and she feels much better and remarked how nice it was for everyone here to take there time to answer. I told her so!
posted by beccaj at 10:23 AM on November 28, 2006

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