[Guest]

Dr.,

You have answered a similar question for me in the past, so I apologize in advance if it sounds like I am asking the same question.

I am into my 5th week at 20mg. for Celexa with daily physical anxiety (not worry so much, somatic symptoms). For the 1st four weeks, things seemed to be getting much better. On the last day of the fourth week through today (4 days later), my anxiety has picked up considerably. Even to the point where I needed to take one of my Klonopin on Saturday (first time in 5 weeks). I was very disappointed. I am struggling to bounce back. I am not having full blown attacks, but lingering somatic anxiety such as very strong chest pain in the center of the chest like the muscle is really tight and burns and really has gotten me down because when these episodes start, they tend to last almost a week, and cause sleep problems as well with frequent wakenings and chest pain in the night.

I must admit, they are not quite as severe as prior to the medication, (the psychological effects seemed to be more intense before and more physical symptoms, such as light-headedness, tingling, etc.). However the intensity was strong enough to make me take a Klonopin, which made me feel like I failed for having to need one (I am also doing CBT, but on Saturday no matter how many times I tried my exercises, it was just too strong)and that my Celexa failed me.

I was under the impression that the intensity of these episodes would decrease to the point where I wouldn't need the Klonopin at all, and the duration would be much shorter. In a previous reply to a similar question you had told me that it takes 4 to 8 weeks to judge the medication, but this episode seems too long and uncomfortable given the length of treatment.

Today is my 3rd day into my 5th week. Should I ask to have my dosage adjusted, wait a few more weeks, or are my expectations too high and maybe these episodes are expected to happen sometimes (although a week is a long time to be very uncomfortable)? Thanks as always, I am sorry this one is so long, myself and my wife and family had been so happy about the apparent progress in the previous weeks that I am so disappointed and really hate to let them see how disappointed I am.

[Guest]

We are very close to crossing the edge into topics that you should be discussing with your own MD. It is a judgement call whether to stay the course or increase the dose and judgements vary with MD. Since we have been corresponding for a while, I will give you my opinion, which is ot stay the course for another week or two and then if symptoms persist go up. Your doctor may have another approach. THe scientific justification for one approach over another is minimal at this point and becomes one of clinical practice and experience.
[quote] Dr. ,

You have answered a similar question for me in the past, so I apologize in advance if it sounds like I am asking the same question... [/quote]