linus2000 Posted March 12, 2017 Share Posted March 12, 2017 Hi , I took Cipralex (lexapro) for over 12 years, first 10mg then 20mg for anxiety and panic attacs. It worked perfectly but now has stopped working. I tried to resist for 6 months but nothing . My doctor told me that we must change antidepressant, and I'm really anxious and scared now. It ' happened to someone, to change after years of usage? As it has been the switch? I read scary stories about antideprassant switch. It is possobile change the drug after 12 years and beyond? some experience ? My doctor propose me to switch to citalopram (celexa) I do not understand if escitalopram no longer work how may Elopram can work again as it is a mixture of escitalopram + the same molecule but different chirality. The doctor says, by is experice, that this can work. Excuse me for my basic English. Link to comment Share on other sites More sharing options...
notloki Posted March 12, 2017 Share Posted March 12, 2017 Yes it happens to some who are on an AD's for long periods. Sometimes a dosage change will fix it or some augmentation like with Abilify. With the exception of Wellbutrin and Abilify I have not met an AD that works for decades. Listen to your doc and try the citalopram, it is a good next step. Link to comment Share on other sites More sharing options...
jt07 Posted March 12, 2017 Share Posted March 12, 2017 Yes, it is possible that a med stops working after years. It even has a fancy scientific name: tachyphylaxis. It is certainly quite common an is one of the reasons people go off meds. Theoretically, citalopram and escitalopram have the same psycho-active molecule and theoretcally if one of these meds stopped working then the other one shouldn't work either. But that is theoretically. Your doctor is the best to tell you what actually happens in practice. Link to comment Share on other sites More sharing options...
linus2000 Posted March 12, 2017 Author Share Posted March 12, 2017 (edited) thank you both for the answer, I'm already at the maximum dosage for Cipralex and I asked everything possible to my doctor, but I am very afraid. Has anyone had any direct experience of antidepressant switch after many years of usage? Edited March 12, 2017 by linus2000 Link to comment Share on other sites More sharing options...
mikl_pls Posted March 22, 2017 Share Posted March 22, 2017 My friend was on Effexor XR for 13 years and had a horrible time on it, then switched to Zoloft and is a whole new person, like night and day. He still has bad days, but they're nowhere near as bad as they used to be. He's now on the max dose of Zoloft (200 mg) and I've noticed that he's become way more outgoing and he talks a lot more, something I'm not used to (the talking anyway). So don't worry about switching antidepressants after you've been on one for a long time. It may be for the better, although I personally share your doubts that citalopram will do you any better if escitalopram quit on you since citalopram is a racemic molecule with EScitalopram in it (the R-enantiomer cancels out the SSRI action of the S-enantiomer...) If it were me in your situation, I would plead with my doctor to consider something else, *anything* else... fluoxetine, sertraline, etc., something with a bit different pharmacology... That's just me, though. Good luck! Link to comment Share on other sites More sharing options...
Kain Posted March 22, 2017 Share Posted March 22, 2017 I'm in a similar situation I'm on my last legs with citalopram and my doctor said prozoc will be the next one to try. II've done some reading and there seems to be 3 ways to switch A cross taper where you go down on one and up on the other slowly. Dead switch where you stop the antideppresnt your on and start a new one at the same strength which is usually done when switching from.one ssri to another And third I've read is the safest way which is to withdraw from one and start the other. People do switch all the time so it may seem hard but it's possible. Link to comment Share on other sites More sharing options...
Catwoman Posted March 25, 2017 Share Posted March 25, 2017 (edited) On 12-3-2017 at 5:08 PM, linus2000 said: thank you both for the answer, I'm already at the maximum dosage for Cipralex and I asked everything possible to my doctor, but I am very afraid. Has anyone had any direct experience of antidepressant switch after many years of usage? Hi, I was in the same boat twice. I was on Luvox, which I restarted a couple of times over a period of 2/3 years. With my third restart is didn't work anymore. I switched over to Lexapro (escitalopram) and had much succes with it. I was on it for about 6 years (varying dosages, but I was on 5 mg for the last 2 years). At first I thought I stopped working all of a sudden, but later I realized I was having some withdrawal symptoms in the two/three months before the "AD-poop out". My gdoc advised me to taper the escitalopram and I was med-free for about 4 months. This January I started with Zoloft. I'm almost at 200 mg, but I'm sorry to say that this switch wasn't a big success. I don't experience much side effects (restless legs and ringing ears before bed), but I still have intrusive thoughts. I feel less depressed though, so maybe it is working for low moods! I do agree with Mik though...if I were you I would ask for either Zoloft or Prozac. Luvox would be fine as well, but Zoloft has a better side effect profile. Evaluate the new AD after 4/6 weeks. I know this seems like a long time, but you can switch without having to taper down (or you can do a cross taper). Edited March 25, 2017 by Catwoman Link to comment Share on other sites More sharing options...
linus2000 Posted April 1, 2017 Author Share Posted April 1, 2017 Thank you all, I have just completed the switch from lexapro to celexa, no side effects, still no improvement for now. My problem is anxiety disorder/panic, I had to do this test, I hope to find something that will work again. Thanks. Link to comment Share on other sites More sharing options...
linus2000 Posted April 15, 2017 Author Share Posted April 15, 2017 Hi, after two weeks from the switch form 20mg of escitalopram to 40mm of citalopram and no improvement, my psychiatrist wants to add 10mg of Amitriptyline (elavil) and 2mg of Perphenazine(trilafon), these are availabre in combination called Mutabon. Do you know these drugs?Is it cumbersome to add them to citalopram?Can they be effective? Link to comment Share on other sites More sharing options...
jt07 Posted April 15, 2017 Share Posted April 15, 2017 The first antidepressant I ever took was called Triavil which was a combination of Trilafon and amitriptyline. The perphenazine is nice in that it calmed my anxiety almost immediately. I did not like the amitriptyline (Elavil) at all. It warped my sense of time and made me sleepy all the time and feel dysphoric and spacey. I know it was the amitriptyline because later I took just plain amitriptyline with the same effect. I wish they had just given me the Trilafon. However, there are people who love amitriptyline. It is my aunt's med of choice. We've had several members who claim it was a lifesaver for them. Just be prepared for possible sedation. Wait a second ... I just now see that you are adding only 10 mg of amitriptyline. That is a baby dose. Therapeutic doses are around 100 mg or more. You might not be so sedated and spacey on only 10 mg. As to whether they can be effective ... you won't know until you try. Link to comment Share on other sites More sharing options...
linus2000 Posted April 15, 2017 Author Share Posted April 15, 2017 Hi jt07, my prescription is 40mg of citalopram + 10mg of amitriptyline + 2mg of perphenazine. The ssri + tricyclic combination scares me. How are Amitriptyline and perphenazine withdrawal? Link to comment Share on other sites More sharing options...
jt07 Posted April 15, 2017 Share Posted April 15, 2017 I understand that. I was just focusing on the new meds. I don't see any reason to be scared of the combination. Amitriptylinen and citalopram have different mechanisms of action so you should not be at risk for serotonin syndrome or anything. And perphenazine is completely different. Also, the new meds are at really low doses. I wouldn't sweat it if I were you. I cannot remember any withdrawal from either perphenazine or amiltriptyline. That doesn't mean there isn't any, but the withdrawal is going to be much less than it is for an SSRI. More recently (about 5 years ago) when I was between psychiatrists, my family doctor prescribed me 50 mg of amitriptyline to go with the 60 mg of Paxil I was taking at the time. I didn't have any withdrawal from the amitriptyline when my new psychiatrist too me off it. One thing to be aware of is that amitriptyline, even at low doses, can cause otthostatic hypotension so you want to get up slowly from geing seated. Link to comment Share on other sites More sharing options...
Iceberg Posted April 15, 2017 Share Posted April 15, 2017 I was on a zillion of perphenazine and had no issues at all coming off it, although we did a semi cross taper. 2 mg is nothing and the 10 mg isn't much...but these are 2 meds where you REALLY have to take it slow (unless your my last psych who cranked up the trilfon like every day). Link to comment Share on other sites More sharing options...
linus2000 Posted April 17, 2017 Author Share Posted April 17, 2017 Thanks to everyone, I will do this attempt, I do not understand why it just does not change my antidepressant (citalopram is too similar to escitalopram): venlafaxine, paroxetine, sertraline, fluvoxamine .... Maybe why did I take the same antidepressant for a long time (12 years)? It is common to augment SSRI with tricyclic and low dosage antispicotics for diagnosis of Panic disorder (for now only anxiety no true panic attacs) and Ossessive Compulsive Disorder? Link to comment Share on other sites More sharing options...
Iceberg Posted April 17, 2017 Share Posted April 17, 2017 Maybe some but usually not trilafon Link to comment Share on other sites More sharing options...
linus2000 Posted April 18, 2017 Author Share Posted April 18, 2017 (edited) I'm sorry I do not understand you can explain iceberg? This is the medicine that my doctor wants to add to citaloparm (40mg): https://en.wikipedia.org/wiki/Amitriptyline/perphenazine thank you 19 hours ago, Iceberg said: Maybe some but usually not trilafon Edited April 18, 2017 by linus2000 Link to comment Share on other sites More sharing options...
Iceberg Posted April 18, 2017 Share Posted April 18, 2017 I just meant trilafon isn't the typical first choice, not that you shouldn't try it Link to comment Share on other sites More sharing options...
jt07 Posted April 18, 2017 Share Posted April 18, 2017 I think the amitriptiptyline and trilafon added to the Celexa is definitely worth a try. It might be a bit unorthodox, but I like doctors who think outside the box. If I didn't have such a doctor then I would be in trouble because antidepressants themselves never worked for me. Link to comment Share on other sites More sharing options...
linus2000 Posted April 18, 2017 Author Share Posted April 18, 2017 51 minutes ago, jt07 said: I think the amitriptiptyline and trilafon added to the Celexa is definitely worth a try. It might be a bit unorthodox, but I like doctors who think outside the box. If I didn't have such a doctor then I would be in trouble because antidepressants themselves never worked for me. Hi jt07, Why amitriptiptyline and trilafon added to the Celexa is a bit unorthodox? What would be an orthodox cure in my case? Link to comment Share on other sites More sharing options...
jt07 Posted April 18, 2017 Share Posted April 18, 2017 It's unorthodox because you don't see it very often. I didn't mean it's unorthodox because there is something wrong with it. Maybe I should not have used the word unorthodox. A more orthodox approach would be to put you on the med merry-go-round for months or perhaps even years until you found something that worked. Link to comment Share on other sites More sharing options...
Iceberg Posted April 18, 2017 Share Posted April 18, 2017 Perphenazine itself is pretty off the beaten path. But for me it wasn't sedating so that might be good Link to comment Share on other sites More sharing options...
jt07 Posted April 18, 2017 Share Posted April 18, 2017 I really liked the perphenazine part of Triavil because it was great for my anxiety. Amitriptyline was very sedating to me. But you never know how it's going to affect YOU until YOU try it. Really, there is nothing to worry about. Worst case scenario is that it doesn't work and you quit. Link to comment Share on other sites More sharing options...
Iceberg Posted April 18, 2017 Share Posted April 18, 2017 And that's a low dose so it makes side effects less likely Link to comment Share on other sites More sharing options...
linus2000 Posted April 19, 2017 Author Share Posted April 19, 2017 Ok guys, I understand, you have been very useful and valuable, i appreciate it, I will do this test, and inform you. Many thanks. Link to comment Share on other sites More sharing options...
BrianOCD Posted April 27, 2017 Share Posted April 27, 2017 Happened to me, and I switched to Effexor which was even better than Lexapro....Been on Effexor approx 6 years. Link to comment Share on other sites More sharing options...
linus2000 Posted April 27, 2017 Author Share Posted April 27, 2017 15 hours ago, BrianOCD said: Happened to me, and I switched to Effexor which was even better than Lexapro....Been on Effexor approx 6 years. Hi BianOCD, thanks for the answer, lexapro what dose was it? Was the switch difficult? Cross Taper? Link to comment Share on other sites More sharing options...
linus2000 Posted May 22, 2017 Author Share Posted May 22, 2017 Hello everyone, after three weeks that my psychiatrist added to the 40mg of citalopram I had taken for years and that did not effect anymore, 2mg of perfenazine + 10mg amitriptyline, available here in a single drug, seems to start getting better , Very low anxiety and very good mood, only side effects somewhat drowsy and constipated but improve. In two weeks I'll have to go back to the doctor, do you think it's okay as a cure for a long time? Probably it will lead to removing one of the two substances (anitriptyline or perfenazibe) and leaving the other. Thanks to all, I will inform you. Link to comment Share on other sites More sharing options...
Iceberg Posted May 22, 2017 Share Posted May 22, 2017 They are both low doses you could probably stay on both if it's working Link to comment Share on other sites More sharing options...
linus2000 Posted June 20, 2017 Author Share Posted June 20, 2017 (edited) Hello everyone, after 7 weeks that my psychiatrist added to the 40mg of citalopram I had taken for years (9+) and that did not effect anymore, 2mg of perfenazine + 10mg amitriptylineof , seemed to be much better not axiety at all, but this morning I had a bad peak of anxiety, fortunately no panic. My pdoc said that can happen and not worry too much. What's going on? I am very scared. Edited June 20, 2017 by linus2000 Link to comment Share on other sites More sharing options...
Iceberg Posted June 21, 2017 Share Posted June 21, 2017 Pdoc could be right, every combo will. Have some residual symptoms. I wouldn't worry too much of its not a reoccurring thing. Now if it's happening every day that different Link to comment Share on other sites More sharing options...
Recommended Posts