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Suggest treatment for anxiety

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Psychiatrist
Practicing since : 2005
Answered : 637 Questions
Question
Hello,
I have had some mild anxiety at the beginning of XXXXXXX and the doc put me on celexa. I dont suffer from depression.
I started with 5, 10, 20 and now im on day 10 at 30.
However, i was on 20 mg for only 3 weeks before upping to 30.
I am always waking up with adrenaline running through my legs (like anxiety) and im thinking that 30 mg might be too high for me.
The only way i can calm down is if i take a klonopin, 0.50 mg.
I had this morning anxiety during my 20 mg dose, but it was going away, and that's why my doc upped to 30.
But it has been 10 days already at 30 mg, and i have the same problem. Really high adrenaline through my body.
Do you think 30 mg is too high for my condition? Should i go back to 20 and see if this improves?
What is your take on it?
Thank you very much!
Posted Mon, 18 Aug 2014 in Eating Disorders
 
 
Answered by Dr. Sunil Gupta 58 minutes later
Brief Answer:
Its worth waiting on same dose for few more days.

Detailed Answer:
Hi,

I went through your query. I can understand your concern regarding the dose of Celexa. But in your case, as you have mentioned, you were having the same sensation even while on 20 mg dose. It implies that you are having the symptoms due to the underlying anxiety disorder. I don't think that this is due to high dose of medication and that reducing the dose will really help.

Currently, I would recommend that you wait for a couple of weeks on the same dose of celexa to see if it is helping in reducing your anxiety symptoms. In case, it doesn't, I would recommend a change in medication. I remember that in you last query you had mentioned that Cipralex had worked well for you the last time you had symptoms. So, may be it is an option you can try again.

I do hope that I was able to answer your query. Please let me know if I can be of any further help. I will be glad to help.

Best wishes,

Dr. Sunil Gupta

Above answer was peer-reviewed by
 
Follow-up: Suggest treatment for anxiety 52 minutes later
Hello,
I really appreciate your answer...
I never had this adrenaline running through my legs...it only started once i started celexa and that is why i thought maybe because my dose is too high. I thought that if i went to a lower dose, i will not get the adrenaline. However, i didnt stay at a specific dose for long, so i cannot say which dose is better. How long should i stay on a specific dose before i know it works?
I dont have depression, just anxiety, but this adrenaline makes me feel lethargic and dont feel like doing much.
Thank you again
 
 
Answered by Dr. Sunil Gupta 4 hours later
Brief Answer:
2-3 weeks at a dose in good enough to know.

Detailed Answer:
Hi,

Thanks for following up. You had been on 20 mg celexa for around 3 weeks and that is good enough time to decide whether to increase the dose or not. We generally, wait for 2-3 weeks before deciding about an increase in dose.

The maximum dose recommended for celexa is 40 mg/day. I am not sure if you have found any kind of benefit in form of lowering of your anxiety with celexa till now. If you feel celexa has been helping you in any way, further dose hike can be done after waiting for another 2 weeks. However, if there has been no benefits, I won't recommend any further increase and rather would consider a change in medication.

Celexa can make you feel lethargic though. It however is not due to adrenaline. If only lethargy is an issue, you can start taking the medicine at night. It will help you combat the lethargy.

I do hope that you get well real soon. Please let me know if I can help you with any further queries. I will be glad to help. In case you decide to close the discussion, please do rate the answer.

Best wishes,

Dr. Sunil Gupta



Above answer was peer-reviewed by
 
Follow-up: Suggest treatment for anxiety 8 minutes later
Thank you so much for your answer. I really appreciate it.
I would like to know, from your expert oppinion, how can one tell if the dose is too high?
Can celexa give me the adrenaline through the legs as a side effect? I dont get a fast beating heart, my pulse is normal. Its just the adrenaline through my legs in the morning.
That is why i ask also, because i dont know how to tell if the dose is high.
Thanks a lot for your help
 
 
Answered by Dr. Sunil Gupta 16 minutes later
Brief Answer:
Please see details below.

Detailed Answer:
Hi,

Thanks for following up and the appreciation. Generally, high doses leads to a combination of side effects. The most common side effects of celexa are the gastro-intestinal side effects like nausea, vomiting, etc. which I remember you had and were extremely concerned about. Other side effects include headache, dry mouth, sleep disturbances. Most of the side effects do go off on their own with time. If they don't, the dose will have to be reduced or medication changed.

In case, this sensation in your legs can be a side effect of celexa, although as I said, it is not due to adrenaline. It can be simply a feeling of restlessness in your legs which can occur while on celexa. If it persists even after couple of weeks, you can consider changing of medication. Reducing it further will not help as you had similar symptoms even on 2 mg of celexa and dose lower than that won't be effective enough for controlling your anxiety.

I do hope that I was able to help you in some way. Please feel free to ask me any further queries. I will be glad if I am able to help you out with your problems.

Best wishes,

Dr. Sunil Gupta





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