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How can you compensate when you're going down on an AD


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I am on 60 mg celexa, and have been for a year.  I never really wanted to be on a dose this high but I was in a group home at the time when it was upped to 60 mg and didn't have much say or time to think about it then.  Things were bad enough that I just figured I might as well be maxed out on serotonin and didn't want to go through

the mood adjust ment of lowering it.

 

Now I really can't stand it.  All my medicine levels are too high.  I've never really been on the highest dosage for an AD because I always felt like I became too numb and things felt worse after a certain point.  Now I want to go down on celexa, but I'm worrying about how I will adjust to the mood change.  I've been on such a high dose for so long that I think I've become dependent on it, and going down it will be hard to pick up my mood anyway.

 

Does anyone have much experience with going down from a high level of antidepressant?  Any recommendations on coping strategies.  I'm thinking like supplements or any other coping strategies to adjust

 

 

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What is considered the usual max dose of celexa per the prescribing info? 40mg? If its 40mg I'm betting you could probably go from 60mg to 40mg with little problem. Why? Because I doubt you are getting much benefit at all being on 60mg over 40mg. There's a reason why max doses are set. It's because during the trials and pharmacological research of the drug they find a dose that which going above finds very negligible efficacy and just adds more possible side effects. I remember reading a blog entry a while back, from the last psychiatrist's blog I believe, where he was talking about the practice of prescribing AD above max recommended doses. He had these nice little charts showing efficacies of AD's across dosage ranges. AD's like celexa and lexapro, and Effexor, etc... They show that above the max dosages the efficacy is so minuscule that it just doesnt warrant it. Their efficacies pretty much plateaued when they hit the usual max recommended dosage. I see people like you on your dosage of celexa, people like on 30 or 40mg of lexapro, 90mg of remeron, etc......and I just don't agree with it.

But anyway, just my opinion.

Edited by quiet storm
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I can only relate to going down from high doses of AAPs... I took it slowly staggering my reductions. This helped. After I was used to the process I knew what to expect - it got easier with each reduction until I reached a minimal dose (actually the recommended dose for BP but I was on a high dose). I suffered mainly depression and anxiety from reducing the dose each time but this would only last for 1 to 2 weeks.

I kind of braced myself for it every time and used any coping strategy I had available to me. I focussed on self care and listening to what I needed at the time. If it was company I sought friends, if it was alone time I sought space. I tried to go easy on myself and assure myself that "This too, shall pass".

I hope you find some suitable coping strategies to deal with the depression that may come with reducing ADs.

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From what I've read, it appears that 60mg is the max dose. Typically 40mg is the max but in certain cases it can be increased to 60mg. I also read that according to studies, there is little difference between 40mg and 60mg.

If it were me, I'd talk to my pdoc and tell him that I'd like to try lowering the dose. This is assuming that I was stable and had been for a while. I always get the okay from my pdoc first because he needs to be aware so that he can help look for subtle changes and so that he can help me pick up the pieces if it all goes wrong.

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Here's that celexa chart from the blog post I mentioned:

 

post-4218-0-51073600-1374772472_thumb.pn

 

 

As mentioned in the blog going from 40mg to 60mg gets you a whopping 3%. Heck, even going from 20mg to 40mg doesn't get you a whole lot more.

 

 

Here's the link to the blog post. Pretty interesting read.

 

 

http://thelastpsychiatrist.com/2007/07/no_not_effexor_too_the_most_im.html#more

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I have been all over with celexa 5mg-60mg. I was on 60 for about 3.5 months last year and then it got to be overloading for me so I tirated down all the way off on the celexa on supervision of a pdoc. Long story short I am pretty sensitive to mgs and right now 45mgs is working well (I know werid). But when I was going from 60-40 the only thing I felt was better. Like the fog had lifted.

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I tapered very slowly from 200mg to 150mg of sertraline, I did not experience any withdrawal despite my Doctor saying I would feel crappy.

 

What I did was zigzag my dose 200mg, 175mg, 200mg, 175mg, each day for a week, then 175mg constant for a week, then 150/175mg zigzag again for a week.

 

I think very gradual withdrawal is the best, also if you are looking for something extra I would guess exercise.

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