[Guest]

Dr.,

Thanks for the info.. One last question on this topic. Obviously I need to work this out with my own Dr. (he is going to make me re-commence my search for a Psychiatrist because he said if I was unsatisfied with Celexa, he was not comfortable with trial and error with these types of drugs, or combos), but maybe I am looknig at this incorrectly.

If a patient presented to you with a basically 50% reduction in symptoms on their primary SSRI and at 3 weeks after an increase to the next level did not see additional improvement, plus was still suffering significantly (my own research has determined that HAMA 14 is just below the "Clinically significant" anxiety levels, and that a 3 on any area is a significant problem, I should be shootnig for below 10, more like 7 or less), what would you recommend to your patient based on your clinical experience. Of course, the first is to wait a few more weeks, assuming nothing changes, then go to 40mg, then what? Especially given the patient has apparently received some, albeit incomplete, benefit that has allowed them to function, although often with significant discomfort.

I know you believe this is something I should discuss with my own Dr., so let's assume the patient above is a hypothetical one. Thanks as always.

[Guest]

Every doctor has a regime. THere is little research to support what to do. Going up to 40 mg would probably be the next step. Then
1) Wait
2) Wait
3) low dose benzo
4) Buspar or nortriptyline
5) switch to Effexor
6) It depends
[quote] Dr. ,

Thanks for the info... [/quote]