[Guest]

Dr.,

I am now up to 40mg. of Celexa to try and erase the generalized anxiety that accompanies my Panic Disorder (oddly, I always thought the generalized anxiety would be the first to dissipate, not the Panic). Anyway, I am only one day into my second week, so I can't make any judgements, but am certainly wondering about next steps (even though I know I should be patient and see what happens first).

Since I am at a relatively high dose of Celexa, and you had mentioned that with Buspar one may need to maximize the dose to get the best response, I am wondering about the risk of Serotonin Syndrome with 2 serotonergic agents at such high doses. Is the risk more prevelant among combining more potent serotonergic agents (such as adding 2 SSRIs)? Or is the combination of Buspar and Celexa at the above mentioned doses a real threat, enough to be a consideration in treatment approach? What would the period of the threat be, the first few weeks of titrations, or persistent threat? I understand this syndrome is quite rare, but more common when combining drugs.

Thanks as always

[Guest]

There is a literature supporting the use of Buspar to augment SSRIs and I am not aware of any reports of Serotonin Syndrome with this approach. You should start talking to your own doctor because "too many chefs spoil the broth". The reason that we don't treat over the web is not a foolish technicality. I have never seen you and might well have quite different ideas if you were under my care. Therefore, I would advise against putting too much faith in my counsel. I am only commenting on questions I have been asked. I am not asking questions or treating. Indeed, the mention of Buspar was in response to your questions about it. Your questions are usually of general interest, but specific treatment strategies including benefits and risks are best left to the treatment provider.
[quote] Dr. ,

I am now up to 40mg... [/quote]