Medicine, at highest dose, has stopped working- what now?

[hazey00]

Hi all,
I'm a sixteen year old girl with really bad anxiety and OCD. When I was a little kid, I had a phobia of choking for four years, which got so bad that I stopped eating solid food entirely, and had panic attacks if I was around "choking hazards" (small toys, beads, etc). It was mainly about breathing, not choking itself, since I was also very scared of drowning, suffocating, having a heart attack, etc. My psychiatrist at the time put me on 20mg of citalopram, which didn't help, so she bumped it up to 30, and then 40. Somehow this fixed it, and I started eating normally again. I've been on 40mg for the past eight years, and have had anxiety around school, social things, etc, but not phobias. I also haven't had many panic attacks. But recently, it seems like the medicine has all but stopped working. I am suddenly terrified to eat, and need someone present if I'm going to. Even then, my throat feels like it's closing up. In the past week, I've had a panic attack every day. It also seems to be getting worse. It started out that I was just a little wary while eating, but now it's gotten to the point where I can't eat anything without feeling immense panic and discomfort. I've talked to my psychiatrist, but 40mg is the highest approved dose of citalopram, so I cannot go up. I've asked about other medicines, but I haven't had much luck with them in the past. I tried welbutrin once, and had a terrible reaction, as well as another non-ssri type anxiety medication. It seems like I need to stick to an ssri, but I don't know if any other would be as effective as citalopram has been for me. My mom has an anxiety disorder as well, and has tried many ssri's, but citalopram is the only one that works for her. Has anyone else experienced something similar, or have suggestions of medication? Obviously I need something very strong, but I just don't know what.

[Paxiled]

I'm just wondering -- you're very young to be taking these meds at all.  Not to say some don't find them the only thing that helps, but I'm wondering if anyone referred you to therapy before giving you a medication meant for older adults?  I'd say therapy is your best bet to get off this roller coaster -- if it works, and it'll require work on your part but you're very young and resilient, then your problem is solved, whereas meds only treat symptoms and, as you've discovered, can poop out and have side effects.  

[hazey00]

Thank you. I have had therapy. Like, a lot of therapy. But it hasn't been very intensive in the past eight years, and it hasn't been focused on eating since that hasn't been an issue for so long. You're probably right, that I should seek therapy, maybe particularly for eating and breathing problems.

[Jason7784]

I agree with paxiled. I was started on SSRI's at the age of 12 and I am now 32, it hasn't been the best thing for me for major parts of my adult life, however they are what I need now and they work for me. I would suggest talking to a therapist and trying to get into something called Cognitive Behavior Therapy or Exposure Therapy. Medication should be a last resort for someone your age.

SSRI use in people under 25 increases the risk of suicidal thoughts/behaviors. If you do need medication you could try switching to another SSRI or an atypical antidepressant like Mirtazapine. You could also look into Gabapentin. Gabapentin works well for me for my panic disorder. I wish you well.