Question: Hi Dr. Iliri,
I am here to ask you another follow-up question.
You have been answering my questions over the last month about the PVCs I have been diagnosed with, along with symptoms of shortness of breath and an achy feeling in my legs upon activity, especially climbing stairs, etc. I hope you remember me! I have attached the results that my doctors have given me that I have shown you before.

I had the Ankle Brachial Indices test done the other day which came back negative and showed good circulation in my legs.I was glad about that.

As I have mentioned before, I have terrible anxiety which may be at the root of my problems. I have been on 150mg of Wellbutrin for 4 weeks now. I saw my doctor yesterday and said I am still feeling anxious. He prescribed Citalopram. I am to take 10mg a day for one week and 20mg a day after that in addition to the Wellbutrin. I am to follow up with him in 4 weeks.

I read the information that came with my prescription about the Citalopram. There are many possible side effects which concern me, but it said not to be taken if you have an irregular heart beat or other heart problems and that it may cause palpitations (which I already have). I am very nervous to start the drug. I called the pharmacist who told me I am fine to take it. I also called my doctor back today and he said I will be fine to take it. I would like to hear your opinion as to whether I should take the Citalopram. I also continue to have an internal shaky feeling like I have had too much caffeine (even though I have had none) which comes and goes. I am assuming it is anxiety as well, but thought I would mention it.
Thank you!

Hi Dr. Iliri,
Thank you for getting back to me so quickly. I am glad I asked you about the Citalopram before I took one. I am concerned about going on another antidepressant, especially if it can have rather serious side effects.

My doctor also gave me a referral for counselling. I just need to find a counsellor in my area.

I am wondering if it is best for me to not take the Citalopram. To get my anxiety under control, I will stay on the Wellbutrin as it does not cause me any side effects and I will try to get an appointment with a counsellor soon. I will also try relaxation techniques such as yoga. I am reluctant to start a medication that can cause heart problems, especially since I have already been so worried about my heart!

I know that anxiety is not good for my heart either, but I think that when I am done with all of the testing on my heart (my stress test is on Sept. 21), get my results, consult with the cardiologist and get treated (if necessary) I will begin to feel less anxious. Sometimes I think I get more anxious waiting to find out if there is something wrong with me. Also, I am thinking that maybe a counsellor can help me learn to redirect my negative thoughts and worries. I would prefer to not take a lot of medication to reduce my anxiety if I don't have to. Just thinking about taking the Citalopram is causing me anxiety!

Someone told me that St. John's wort is good for anxiety and is a natural alternative. What are your thoughts on that and is it safe to use that while on Wellbutrin?

Thank you again for all of your help!

Thank you so much! I will definitely try yoga and meditation. I am going to look into psychotherapy as well.

I will not take St. John's wort as a further precaution.

Thank you for your help and advice. I am glad I consulted with you.

Hi Dr. Iliri,
I have made the decision to not take the Citalopram. To try to decrease my anxiety I am continuing to take the Wellbutrin and I am in the midst of looking for a therapist. I am also going to try meditation and yoga.

I have been doing better since I saw my doctor on Wednesday and discussed my decision not to take the Citalopram with you. I have been trying to stay more calm and relaxed, and although I still get that achy feeling in my legs from going up the stairs and doing other activities, I have noticed it has not been quite as bad in the last couple of days. When I am paying attention to it, I do notice that my muscles are fairly tense and I sometimes realize I am often clenching my teeth, so I know I am still not completely relaxed and know that this will probably be a process to get better.

I feel like I had a setback today though, but maybe I am just expecting too much. I like to think that I can get all better in a few days and maybe that is unrealistic. I was putting laundry in and out of the washing machine and dryer, lifting some laundry in a basket, and moving fairly quick. Then I had to clean my hands. While I was cleaning my hands I felt like my heart was beating quickly and I had that achy feeling mostly in my arms, but my legs, too and I started to get anxious. I sat down to rest. I took my pulse and it was 100 beats/minute which kind of scared me, too. Once I felt better I tried to put it out of my mind and do other things. Maybe I am just expecting to get better quicker than is possible.

I realized that I didn't think to ask you and my doctor how long it could take for me to start to feel back to myself physically once I can settle my mind down, if anxiety really is to blame for a lot of my problems. Now, I have had anxiety for a few years, it has been worse over the last few months and very bad since I noticed the palpitations more than a month ago. Maybe I am expecting to be all better too soon. I know it would be difficult to say how long this could take but is it reasonable to assume it could take me a couple of weeks or more (maybe a few weeks/months) to feel better mentally and physically?

I guess I should not put so much pressure on myself to relax and get better! I suppose that will create anxiety, too!

Thanks again!