[Guest]

Dr.,

I have spoken to my Dr. about my recent increase in anxiety while taking my Celexa and will wait another week or so and then raise the dose (his opinion was the same as yours), but he said I should expect to raise it and not to get concerned whether or not the increase will help. I have been very concerned whether an increase will do the trick, I had read that an increase to promote better response is not that well-supported. My Dr. says that is not really true until you exceed certain ranges, and that PD doses can frequently be higher than depression and not as well studied for Celexa, so an increase to 30 or 40 (even up to 60mg sometimes for PD) is very likely to help since I seem to have some response at 20mg, even if it is not where I had hoped to be.

3 Questions:

1. I thought PD doses were generally lower, not higher than depression doses(as my Dr. says), which tends to be more true?

2. My Dr. says that even though I read that there isn't much evidence for increasing doses to promote better response it simply isn't true. He says I have my information mixed up, and that until we have spent at least 4 weeks at 40mg (30mg first though) he does not believe we should switch because he doesn't believe I have given the drug a fair trial till then. He also says I shouldn't be concerned if I am not satisfied yet, my chances are just as good on this drug, I probably just need a higher dose. Are these statements true?

3. Are higher doses reflective of greater severity of illness or other factors?

I trust my Dr., (although it may not sound like it) but he tends to sugarcoat things for me sometimes and I really hate that, I don't like surprises. Thanks as always.

[Guest]

As a general response, I agree with your doctor. While dose is standardized on a large population, there is an inter individual difference in dose/response. This may reflect how the drug is absorbed or distributed or the binding affinity in any given individual. There is no real correlation with severity and dose. Because of these factors, it makes sense to slowly go up with the individual. There is some evidence that 40 is better for some people than 20. There is a lot less evidence that 60 is better than 40. There is a dose response curve and at a certain point going up on dose may only increases side effects. We think that this is on the North side of 50-60 mg with Celexa, but it varies with the individual.
[quote] Dr. ,

I have spoken to my Dr... [/quote]