Brief Answer:
Response to celexa varies

Detailed Answer:
Hi XXXXXX,

Thanks for using health care magic.

I have keenly read your query and found that this is really surprising that you developed a side effect within four days of time with a drug which never caused similar side effect for a duration of four years with four times of the current dose.

I am trying to make out the reason for such development with Cipralex.

The first possibility is the occurrence of class effect of SSRI. You might be knowing that all SSRI as a class have tendency to worsen anxiety symptoms during initial course of treatment. The worsening or new development of anxiety once you start SSRI is not a dose related effect and can occur at any dose. The probable reason for why you never had the same adverse effect is that this side effect is idiosyncratic kind of reaction, which mean it can occur today but there is no necessity that it will be repeated on next dose or vise versa.

The next possibility is that probably your panic episode is unrelated to Cipralex. It is quite possible that any anxiety disorder while relapsing may have slightly different symptom profile. The current episode may be part of your original illness which was started about four years back.

It is premature to say that cipralex not worked second time. The plausible explanation is removal of cipralex on fourth day itself due to intolerable side effects. I guess that if you would have allowed to continue the cipralex it would have worked in similar way as in past, But the development of severe anxiety forced you and your doctor to replace it with celexa.

The third possibility is that it was a kind of sleep terror which is one of the common side effects with SSRI including cipralex.

At last regarding shakiness after starting I like to inform you that it is kind of transient side effect with all SSRI. It is expected that it will be resolved in two weeks.

'Hope I have answered your query. If you have any further questions I will be happy to help".
Thanks

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Brief Answer:
You need to wait

Detailed Answer:
Dear XXXXXXX,
Thanks for reverting back to me.

I understand your concern but it is advisable to wait for at least two weeks before moving to higher dose. There is nothing like best dose for anxiety, the effective dose is 10-40 mg and any dose can be effective for you.

There is likely that if you go so fast side effect profile may be troublesome but with slow progression there is reduced risk of adverse effects.

The nausea, shaky legs will be taken care by low dose of Klonopin that you are receiving currently.

Other than focusing on medication dose you need to take care of healthy life style with nutritious diet and adequate exercise. They work as wonders in preventing many of their side effects.

Hope I have answered your query. If you have any further questions I will be happy to help".
Thanks and Regards
Dr Ashok

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