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I Am Not Planning To Rock The Boat


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I continue to do very well which is wonderful. 

The repeat prescription of the SSRI drug Citalopram, which was prescribed by my former doctors practice in London, is now due for review. 

One of my new practice's doctors - a doctor I do know from my wife's treatment, will review it with me by telephone conference, and my intention at this time is to ask for it to be renewed. 

The only downside of it is reduced libido, but at the age of 68 I can manage to cope with that. 

And the benefits I perceive from the medication are a smoothing out of the intense mood peaks and troughs I previously experienced, and more resilience. 

I am also wary at this time, when we still have lots to do following our move to Northampton, of seeking to reduce the dose from 20 to 10mg. This is a longer term plan but I don't want to risk encouraging a relapse when I have been going along beautifully now for nearly 18 months, with only a short blip in July 2017.

Hopefully the doctor will see it that way too. 

Edited by taurean
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I think that's a wise choice Roy, I am on medication myself and am due a review just after Christmas. At the moment there are a fair few issues going on and life in general is tough at the moment . As a result I feel a bit anxious and on edge. 

I benefit like yourself from feeling a bit more balanced when on medication so am happy to remain on them for the time being. 

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While every medication works differently for every person, one thing you might consider is seeing if it’s possible to go from Citalopram to Escitalopram. Citalopram is a combination of two chemical components (enantiomers) which are mirrors of each other. R-Citalopram and S-Citalopram. The thing is the S-Citalopram component is much much much more effective (or the only part that’s effective). That’s where Escitalopram comes in, it contains only that part, none of the R-Citalopram component. As a result it seems to have fewer side effects and is more effective in lower doses. I switched about 4 years ago and while Citalopram was fine, Escitalopram has been even better. 

The downside is that since it’s newer Escitalopram may not be available in generic (ie cheaper) versions so your doctor may be less likely to prescribe it. Still if you are having unwanted side effects it might be worth discussing. 

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Hi Dksea. 

Thanks for this. 

Fortunately in my case the  problematic diarrhoea side effect eased off after a few initial weeks so some 4 years ago now. And the lower libido isn't a problem. 

So I think all is well. 

 

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Guest OCDhavenobrain

Escitalopram comes in many generic brands here in Sweden. I did try both citalopram and escitalopram and I didn't find much difference. 

Something I would like to mention when we speak about SSRI is that everybody that wants to taper off should do it slowly, and if you are unlucky maybe you should take it even more slowly if you find yourself with withdrawl-symptoms..

However, nobody should stop it just because they feel like they "have to stop it. Personally I believe in CBT much more than I believe in medications, and If someone have conquered his/her thoughts with CBT it is highly possible to taper off and having OCD under control. 

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It's good you mention the need to gradually taper if reducing or withdrawing. 

When some people have not done this, they have had major setbacks. 

And for some the drug was doing rather more than just providing support, and in some way improvement had been attributable to the drug. 

I would like to stick onboard with it for the time being, then give some thought to a tapered reduction when things are settled here. 

 

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I am by nature a confident person. 

But I have only met this doctor once acting as additional ears for my - deaf - wife's consultation with her, so I don't really know her. 

But what came out from that is that she is dedicated and thorough. 

So hopefully the consultation (by telephone) will go well. 

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All went well.

Doctor is renewing the medication for up to 12 months, but with the possibility that if I am still fine in Spring we may look to work towards a reduction from 20 to 10mg.

I know this will need to be gradually phased in. 

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On 07/10/2018 at 11:51, dksea said:

While every medication works differently for every person, one thing you might consider is seeing if it’s possible to go from Citalopram to Escitalopram. Citalopram is a combination of two chemical components (enantiomers) which are mirrors of each other. R-Citalopram and S-Citalopram. The thing is the S-Citalopram component is much much much more effective (or the only part that’s effective). That’s where Escitalopram comes in, it contains only that part, none of the R-Citalopram component. As a result it seems to have fewer side effects and is more effective in lower doses. I switched about 4 years ago and while Citalopram was fine, Escitalopram has been even better. 

The downside is that since it’s newer Escitalopram may not be available in generic (ie cheaper) versions so your doctor may be less likely to prescribe it. Still if you are having unwanted side effects it might be worth discussing. 

May I ask what dosage of Escitalopram you have found to be most effective for you? I know it certainly varies by the individual, but I am just curious about how low of a dose you have found helps to manage symptoms. Thanks.

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As Dksea hasn't responded I will just put in my own sixpennyworth here. 

Whether an SSRI drug has any especial benefit at all for an OCD sufferer is highly individually subjective. 

Then whether any one particular drug works for them, at what doseage and what exactly benefit it might have is also highly individually subjective. 

I had to be patient, tolerate initial side effects of acute diarrhoea, and gradually acclimatise on a lower 10mg dose of Citalopram before I could manage on 20mg. 

I now understand that, after discovering that bad side effect of Citalopram - which took a long time to go away, with the doctor authorising anti-diarrhoea meds meanwhile, I could probably have been able to be put on the - much more expensive - escitalopram, which is apparently less likely to have side effects. 

Does the Citalopram help my intrusions go away?  No. But it helped me better engage with therapy, so my intrusions faded away. It also eased away secondary depression, and smoothed mood peaks and troughs. 

Others report that, once they are settled on the drug - and the time it takes for this is also individually subjective - they notice significant reductions in intrusions. 

And such sufferers have tended to report that, if they then look in due course to reduce the doseage, this can have a really bad relapse effect. 

What can we take from this? 

Comparisons between sufferers and medications aren't greatly beneficial, as sadly there is too much individual subjectivity. 

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Guest OCDhavenobrain

Everybody should decide for themselves they want to be on medication, I feel like I am guilty for preaching about SSRI. I do think that the ultimate method is to use CBT. Just don't want people to only rely on medication. 

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Exactly have no brain. 

We need to learn and practice CBT in order to get better. 

Probably for many that may be sufficient. 

As it hadn't been enough to solve my own OCD difficulties, I made the choice to pursue an SSRI. 

And as I said in my piece above, in my own, particular, individual, case even those two were insufficient to resolve my OCD problems. 

I had to learn, then factor in, meditation, mindfulness, love kindness meditation and The Four Steps as well. 

Whilst OCD operates in the same way fundamentally, what will work to tackle it for each individual may be a varied mix of psychological tools, and medication can, but not necessarily may, play a part. 

Edited by taurean
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14 hours ago, taurean said:

As Dksea hasn't responded I will just put in my own sixpennyworth here. 

Whether an SSRI drug has any especial benefit at all for an OCD sufferer is highly individually subjective. 

Then whether any one particular drug works for them, at what doseage and what exactly benefit it might have is also highly individually subjective. 

I had to be patient, tolerate initial side effects of acute diarrhoea, and gradually acclimatise on a lower 10mg dose of Citalopram before I could manage on 20mg. 

I now understand that, after discovering that bad side effect of Citalopram - which took a long time to go away, with the doctor authorising anti-diarrhoea meds meanwhile, I could probably have been able to be put on the - much more expensive - escitalopram, which is apparently less likely to have side effects. 

Does the Citalopram help my intrusions go away?  No. But it helped me better engage with therapy, so my intrusions faded away. It also eased away secondary depression, and smoothed mood peaks and troughs. 

Others report that, once they are settled on the drug - and the time it takes for this is also individually subjective - they notice significant reductions in intrusions. 

And such sufferers have tended to report that, if they then look in due course to reduce the doseage, this can have a really bad relapse effect. 

What can we take from this? 

Comparisons between sufferers and medications aren't greatly beneficial, as sadly there is too much individual subjectivity. 

Thank you. I wholeheartedly agree that it’s very subjective. I guess I was just working under the assumption that the smallest dosage possible would be best to avoid potential side effects because I don’t do well with any meds in general. I have no expectations about medication ridding me of OCD thoughts. I don’t see how that would be possible. But I’m wondering if the OCD may be easier to tackle if there was something I could do to at least help cope and lessen the generalized anxiety and depression.

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3 hours ago, ExpectoPatronum said:

But I’m wondering if the OCD may be easier to tackle if there was something I could do to at least help cope and lessen the generalized anxiety and depression.

The best way I think with meds is in any case to start with a low dose and gradually increase it - it can take several to a few weeks for the drug to settle into our bodies and for its real effect to materialise. 

Having just had a med review with my new surgery (having relocated from London)  my new doctor wanted to check if I still experienced side effects. The escitalopram is very low on side effects but much more expensive than Citalopram. I have heard that the NHS might only prescribe it therefore if Citalopram is a problem to the patient. 

Why not go and discuss with your doctors? Knowing your medical record they might be willing to prescribe escitalopram. Plenty of people, myself included, find the meds helpful in aiding us to feel better up to engaging with therapy? 

As another option, propranolol - a beta-blocker - might help you re anxiety. I have it to hand, but have barely needed it recently as I am doing very well. It is a prescription med but, unlike SSRIs, works straight away. The dose would need careful consideration and monitoring with your doctor as it works by reducing blood pressure. 

 

 

Edited by taurean
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18 hours ago, taurean said:

The best way I think with meds is in any case to start with a low dose and gradually increase it - it can take several to a few weeks for the drug to settle into our bodies and for its real effect to materialise. 

Having just had a med review with my new surgery (having relocated from London)  my new doctor wanted to check if I still experienced side effects. The escitalopram is very low on side effects but much more expensive than Citalopram. I have heard that the NHS might only prescribe it therefore if Citalopram is a problem to the patient. 

Why not go and discuss with your doctors? Knowing your medical record they might be willing to prescribe escitalopram. Plenty of people, myself included, find the meds helpful in aiding us to feel better up to engaging with therapy? 

As another option, propranolol - a beta-blocker - might help you re anxiety. I have it to hand, but have barely needed it recently as I am doing very well. It is a prescription med but, unlike SSRIs, works straight away. The dose would need careful consideration and monitoring with your doctor as it works by reducing blood pressure. 

 

 

Thank you. I will discuss with my doctor. I do actually already have some propranolol on hand. 

Again, I realize that meds will certainly be no magic solution, but I’m just so shut down right now that it’s hard to focus on getting better. 

I hope your med review went well and you’re able to work something out that doesn’t cause you any uncomfortable side effects. 

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28 minutes ago, ExpectoPatronum said:

I hope your med review went well and you’re able to work something out that doesn’t cause you any uncomfortable side effects. 

Hi Expecto, 

The doctor and I got on well. I am fine with the Citalopram, no issue with side effects, so she will carry on with the 20mg repeat prescription for up to another year. 

If I wish to seek to reduce that next year, she will support me through that process (has to be gradual as the body and mind gets accustomed to a certain dose). 

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