I should have added I'm on the generic. Never took the name brand.
Actually, no, Celexa has a 10mg dose -- I know because I'm on it. I have to cut it in half because it doesn't make one smaller than 10, which is criminal because it makes it harder to taper off of.
Hitman is on 20 which is the smallest Celexa they make. 20 mg of Celexa is the normal starter dose per my doc and pharmacist. I take it from your earlier post that he should take half in the morning and half in the afternoon that you didn't realize that would involve splitting a 20?
I hope hitman will let us know what he found out from his doc or pharmacist (as I told him to do) about doing 10 twice a day.
Yeah, could be. I interpreted her question as the drug stops working altogether. I didn't have to split the pills, because at a therapeutic dose all of these meds have a lower dose med so you just take one pill in the morning, one in the evening. By the time you get to having to cut the pill in half you're usually tapering off and the company doesn't make the smaller doses, but since most of these meds are best prescribed at step increases, as I say, a therapeutic dose is high enough to where there's almost always a pill at half the dose.
I think she means petering out over the day when you take it in the morning. When I tried Welbutrin in the morning it worked a bit until around 4PM. I trialed it for 8 weeks and every day involved the same frightening wall of blackness coming down at 4-5 PM. There was no way to prep for it as it would just move in like a thick fog. It was so bad that I didn't want to be around people at 4 PM so they wouldn't see my problem or exacerbate it.
My doc switched me to something else that worked and that was the end of the 4PM problem.
If twice daily Welbutrin could be taken it might have made a difference but doc or my pharmacist didn't suggest doing it and for all I know the pill shape might not lend itself to splitting. My pharmacist said the same thing as my doc - the problem with it is most of the effect comes from the current day's dose, and it doesn't have enough staying power to last the day, for me at least. It wasn't very good in the day for me either, but with a few Ativans here and there as needed, it was much better in the day than at the 4PM freakout. I don't take meds now so won't be needing to ask them if I could split it like you do.
I'm not sure the petering out problem is the same problem, as you won't be taking any more of the medication, just splitting the same amount to twice a day. I think it attends more to the sedation side effect and for those who suffer withdrawals in between doses. But I've never had a drug peter out -- the imipramine stopped working when I suffered a painful breakup, which has always been a bad depression trigger for me, but you'd have thought being on an antidepressant for the first time it would both have helped and kept working as far as it did for the phobias, but it stopped working altogether. Go figure.
Makes perfect sense!! I'm absolutely going to keep this in mind moving forward. If the premise is right (and it logically does), then splitting doses could be a first choice in dealing with these meds when they "peter out" over time, rather than jumping straight to a dosage increase. I've just restarted Zoloft myself last night, so I'm going to remember that down the line, should I ever feel it's losing its effectiveness, I'm going to ask to try that first.
Thanks a million! Great info!
I don't know if this differs by person. With me, it started with the Paxil making me feel very sedated. My psychiatrist did two things, one stupid as usual but fortunately nothing bad happened and the second smart. The first was to half my klonopin dose, which of course could have been awful but I didn't notice at all, which was pure luck. The second was to split the Paxil dose to twice a day. And as I say, since then every psychiatrist who put me on a new med has dosed it that way, twice a day. I have read that this is frequently done with these extremely short half-life meds, so obviously the idea is floating around out there. When I was on imipramine, I just took it once a day, and it worked okay until it didn't anymore, but that doesn't have the short half-life. Just as a matter of common sense, it would seem that if you're on a medication that leaves the body very quickly it does make some sense to dose it twice a day to keep it working and to stop withdrawal symptoms, but as to whether there's scientific research on this, I haven't a clue. That clears it up, eh?
Hey, quick question, do you think there are obvious benefits./advantages to dosing twice a day? I know most ADs are written as qday, but you have my curiosity peeked. What about starting out on a med?
(Sorry for the brief hijack OP, but figured this could be good beneficial info to have here anyway)
Yes, Birdie is absolutely correct -- I definitely meant you should discuss this option with your psychiatrist, and not to do it on your own. I only know this option because it's what they do with me -- I'm always dosed half the dose twice a day. It started when Paxil was making me very sedated, but has continued with different psychiatrists and different meds since. And I know Celexa has a 10mg pill because that's what I take.
"There is a reason the minimum pill size is 20mg."
Actually, just for clarification purposes, Celexa is supplied in 10mg, 20mg or 40mg tablets.
Excellent suggestion from Paxiled!
I would check with your doc about giving that a try before doing anything else. If that doesn't end up working, then go from there, but it may!
Let us know!
Better check with your pharmacist or doctor before splitting the pill like Paxiled suggested. You would have to find if there is a minimum dose for efficacy and taking 10 twice a day might not get it either time. There is a reason the minimum pill size is 20mg.
Might be another solution. The brain zaps could indicate you are suffering withdrawal from the medication sooner than your next dose, given as with most ssris other than Prozac it has a short half-life in the body. You might try dividing the dose in two, that might leave enough in the system at all times to avoid this possibility. It's something you can try that wouldn't necessitate a higher dose, especially given the current dose seems to work for you other than the zaps.
My first suggestion was going to be that you probably needed a higher dose. It isn't at all uncommon for these kinds of meds to lose some of their effectiveness. Being that the "brain zaps" are commonly seen in tapers to discontinue these meds, it's very reasonable to assume that a dosage increase will likely remedy the situation for you.
You're absolutely correct about the dosing recommendation in patients over 60, due to some cardiac concerns. Read here under "warnings" for more info:
http://www.drugs.com/pro/celexa.html#s15
(Btw I commend you for being on the ball and educated about your medication!)
This is something you will have to carefully decide with your doctor, and preferably, a cardiologist as well. If you have any significant cardiac history, I would say it's not worth even considering. If you don't have a cardiac history (or a history of something very benign), you and your doctors may decide that the benefits outweigh the risks. I think it's a good idea to run this all by a cardiologist, who will probably be more aware of the real risks involved, and if it's something that would be totally contraindicated for you.
One possible solution that may be agreeable to you would be to ask your doctor to prescribe the liquid instead of the pill form, that way you would have the ability to take a lower dose than 30mg. Most likely, you would notice an abatement of the zaps even with a very minimal increase, and that would probably make YOU feel better about the risks involved.
Definitely have a sit down with your doc, explain your concerns, ask about the liquid, and a referral to a cardiologist. If you and your doctor(s) decide that the risk is too great, then most likely you will have to be switched to another med. Actually, Lexapro was made to be a "cleaner" version of Celexa, and from my understanding, does not come with that same risk, or at least not to the same degree, so if you and your practitioners decided against increasing the Celexa, Lexapro may be a viable option for you.
Very best to you, please let us know how you're doing and what you decide okay?
Better talk to doc again to discuss what you read and also the fact the zaps have stopped after an hour. I am not sure if Celexa can have that much effect on zaps so quickly. Your pharmacist is also an excellent source of info as they see many people on the drug and have access to online info.