Brief Answer:
Explained below.
Detailed Answer:
Hi XXXXXXX
Welcome to Healthcare Magic!
You mention that you have been on medication for last two months and are not satisfied with the response. You also mentioned having side effects. I have gone through the report of your gene test. According to this report, you are likely to have slow or poor response with SSRI group of medicines and are also likely to have adverse effects with both SSRIs and atypical anti-psychotics.
Since your diagnosis is of anxiety and
depression, we need not be concerned with anti-psychotics. You are currently on one SSRI
citalopram and a second antidepressant bupropion which is not a SSRI. Lorazepam is a
benzodiazepine and controls anxiety.
The doses of both citalopram and bupropion are low and can be hiked up. However, you have expressed a desire to try a new medication. In my opinion, it should first be assessed which medicine is causing you side effects. I cannot comment on it as you have not specifically mentioned the side effects. But going by your gene test report, bupropion should suit you better than citalopram. These genetic tests have a limitation that they can give information about only those genes that are known. For example, you may have adverse effects from bupropion or any other medicine as well but the test will not be able to tell you so if the specific gene mediating it is not known. That is why, no one can predict that a particular medicine will suit you or not.
I feel that once it can be identified which of the two antidepressants is harming you most, the offending agent should be tapered off and the dose of the other one should be hiked. Whether it is working for you or not should be decided only after a few weeks as all antidepressants take a few weeks to show their response.
If you are absolutely not willing to continue with both these, then there are some other options like
Venlafaxine,
Duloxetine and
Milnacipran which are SNRIs as well as
Mirtazapine and Agomelatine which have completely different mechanisms of action. I personally prefer Venlafaxine for its excellent response but it has some adverse effects similar to that of citalopram.
I hope this clears up things for you to some extent. Please feel free to ask if you need any clarifications.
Best wishes.
Dr Preeti Parakh
MD Psychiatry