Brief Answer:
CBT is a good option but takes time.

Detailed Answer:
Hi XXXXX
Welcome to Healthcare Magic!

You discontinued Cipralex after taking it for about a year for depression and are now having a relapse of the depression. Usually antidepressants can be stopped after around a year of recovery, they must not be abruptly stopped but gradually tapered off as a relapse may occur.

The other thing is since you have already had two episodes in the past, you are vulnerable to having further recurrence of depressive episodes. So please consider if you can continue with the antidepressant for longer periods. If however you are unwilling to use medicine, then cognitive behavior therapy (CBT) is indeed a good option. It is as effective as medication but you will need to find a good therapist. CBT involves changing the way you think about things, replacing negative thoughts with positive ones and ensuring that this becomes a habit so that relapse is prevented. It, however, is a long process and takes around three months.

Xanax can only give transient relief by controlling the anxiety, but will not be able to get rid of the negative thoughts. In my opinion, you should discuss with your doctor regarding restarting Cipralex, while you are arranging to start CBT.

Hope this is of help. Please feel free to ask if you need any clarifications.

Best wishes.

Dr Preeti Parakh
MD Psychiatry

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Brief Answer:
Ideally for at least five years.

Detailed Answer:
Hi XXXXX,

Welcome back.

Both disturbance in serotonin levels and faulty thinking patterns can cause depression. Also abnormalities in brain chemicals can cause change in our thoughts and behavior. At the time it has also been shown that changing thinking patterns is associated with changes in brain functioning. Thus all three, mood state, brain chemical balance and thought processes are inter-related and influence each other. In fact, our sensations, feelings, thoughts and behavior are all influenced by neurotransmitters like serotonin, which are chemicals found in the brain. So it is possible the abrupt discontinuation of Cipralex can alter brain serotonin levels, which then causes negative thoughts and low mood.

There are some objective criteria regarding stopping antidepressants. For people with first episode of depression, they can be stopped after 9 to 12 months of recovery. But for those who have had recurrent episodes, around five years of treatment is recommended. But these are not hard and fast rules and the actual decision can vary from case to case, depending on the severity and frequency of episodes, personality, background and other factors. In some cases, antidepressants may be taken lifelong. The decision is made after discussion with the patient who must be willing to face the risk of relapse after stopping the medication.

In your case, if the previous two episodes were severe then, ideally you should take it for at least five years. You may however choose to stop it earlier after discussion with your doctor, in case the previous episodes were manageable and you are willing to face the risk.

Cipralex is a safe drug with the major side effects being nausea, vomiting altered bowel movements and sexual dysfunction. Most people however perceive no side effects.

Benzodiazepines like Xanax provide transient relief which lasts for few hours only. At the end of few hours, the effect wears off and one has to repeat the dose. One week of Xanax is unlikely to result in an addiction. However, when you stop, take care to gradually taper it off as you may have some discontinuation symptoms like worsening of anxiety, even after short duration of use.

Hope this makes things clearer for you.

Best wishes.

Dr Preeti Parakh
MD Psychiatry

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Brief Answer:
Thanks.

Detailed Answer:
Hi XXXXX,

Many thanks for your kind words. Please do not worry about the fees. The satisfaction of being able to help people and their thanks and appreciation makes up for everything.

Please go ahead with whatever questions you have. I shall try to answer them to the best of my ability. You can ask as many questions as you want by topping up this thread from time to time. If you have any queries after this thread is closed, you can do so by posting a direct query in my name.

Best wishes.

Dr Preeti Parakh
MD Psychiatry

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Brief Answer:
Four to six weeks time.

Detailed Answer:
Hi XXXXX
Thanks!

It is true that Cipralex (escitalopram) can cause sexual dysfunction. At the same time, some of the loss of libido can be due to depression itself. Cipralex also causes weight gain but usually it is not too much. Since you have gained 8 kgs, I was wondering if any thyroid problem might be contributing to it. If your blood has not been tested for thyroid hormones in the last few months, it will be prudent to get it done once.

The actual mechanism of weight gain is not well understood but it is related to serotonin levels in brain. Fluid retention is not a mechanism as escitalopram lowers the sodium levels in the body and does not retain fluid.

The time taken for complete response to escitalopram is 4 to 6 weeks, but I expect you will be able to see some improvement within a week.

If the sexual dysfunction and weight gain are troublesome, there is the option of trying Bupropion. It is an anti-depressant with no sexual side effects. It also causes weight loss. Usual dose range is 150 to 300 mg per day. It acts faster than escitalopram and gives good results in mild to moderate cases of depression. However, it is not safe for people who have a history of seizures.

I hope this helps you. My contact details are given in my profile page on this site.

Best wishes.

Dr Preeti Parakh
MD Psychiatry

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Brief Answer:
Yes, bupropion can be started.

Detailed Answer:
Hi XXXXX,

If you found a good response with Wellbutrin (Bupropion) in the previous episode, then it can be expected to work this time also. And since you have just started Cipralex, there is no harm in stopping it and starting bupropion.

Best wishes.

Dr Preeti Parakh
MD Psychiatry

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Brief Answer:
Once daily in the morning.

Detailed Answer:
Hi XXXXX
Bupropion is best taken in the morning as it has activating property and reduces the lethargy associated with depression. The XL preparation is fine as it can be taken just once a day. The initial dosage of 150 mg XL preparation once daily in the morning can later be hiked to 300 mg if required.

Best wishes.

Dr Preeti Parakh
MD Psychiatry

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