Question: I have a long history of panic disorder. For 20 or so years I've been on prozac usually 20 mg. I have several relapses that were always treated the same way double the prozac, therapy, a short 4 or 5 month course of klonopin, and when symptoms subsided I would eventually return to 20 mg. of prozac. This April I had what has turned into my worst relapse. I could feel my anxiety building for the first time in many years, know I was heading into relapse, one Saturday morning in anticipation of seeking out a psychiatrist I took 40 mg of prozac. That night I had terrible heart palpitations and will never know if it was the med or my head. Next morning I went to urgent care for ekg and follow up halter monitor that were both fine, but figured I better get checked out as this was the first panic attack episode in my 50s. My GP sent me to find a psychiatrist, kept stressing that prozac was the most agitating of the antidepressants and I should change. Find a psychiatrist, he put my on klonopin 1mg, and Ambien CR for sleep, didn't touch the prozac 20 mg. dosage. Four weeks later my GP sends me back, "you're now on two extra medcations, because one failed. Ask for something less agitating (even though I've been on prozac 20 years" So with the confusion that this psychiatrist had done nothing about the antidepressant and my doctor pushing me I reluctantly changed to celexa. 4 weeks later at the follow up when I explained that I had increased anxiety and anxiety attacks he wanted to add effexor XR 75, and risperdal .25. The combination of the ssri and snri confused me and the pharmacist. This was not meant to be a change of meds but a combination. So I sought out a 2nd opinion from a psychiatrist at the center where I am in therapy. He thought my GM should not have been involved in the first place, was reluctant to go back to square one with the prozac, and decided to up the celexa to 40mg. So here I am 1 week of celexa at 10 mg. during prozac cross taper, 5 weeks at 20 mg., and 3 weeks at 40 mg. Slight improvement in depression, no change in anxiety, becoming more agoraphobic each day. Lots of avoidance. He wants to give the celexa 2 more weeks at this dose, but is not sure its the med for me. I am supposed to resume teaching elementary school in 3 weeks and am terrified I'll be going through the start up symptoms of a new med at the beginning of the school year. Looking for suggestions on possible course of action.

Thank you. You were so helpful with your last answers too. Yes at this point the Celexa still is not working well, though I am very frightened by the start up of Fluoxetine deep down it feels like an old friend. I wish I had never changed. The first psychiatrist did nothing about the antidepressant until pushed, so I feel like I've wasted 3 months that would have been better spent with a simple increase in the prozac originally. Can you suggest the cross taper back to prozac?

How much fluoxetine at Celexa 20?

Sorry I meant specifically on your cross taper schedule you omitted how much fluoxotine for the 20 mg celexa week.