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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by agmatine on May 18, 2010, at 20:56:06
I'm not having much of a response to citalopram 40mg after about 5-6 weeks, so my doctor has prescribed citalopram 60mg qd + valproic acid 250mg tid. As far as I know, valproate is mainly used as an anticonvulsant, or for acute mania, not in unipolar depression. As such, I'm having some difficulty finding information on its efficacy for my type of mood disorder. Does anyone have any relevant knowledge?
Furthermore, is there any real evidence that SSRIs like citalopram are more effective in high doses than in more typically used doses (for this one in particular, I believe the usual range is 20-40mg). I haven't had any real side effects from Celexa so far, but I fear I may at this increased dose, and considering my lack of response to it so far, I have to wonder if it's even worth bothering with...
Posted by Phillipa on May 19, 2010, at 13:11:40
In reply to Valproic acid for unipolar depression?, posted by agmatine on May 18, 2010, at 20:56:06
Only think was what I saw that was alcholic on low dose lithium after about a week looked and acted for relaxed and mellow. Phillipa
Posted by linkadge on May 19, 2010, at 18:04:32
In reply to Valproic acid for unipolar depression?, posted by agmatine on May 18, 2010, at 20:56:06
valproate can be very good for anxiety and agitation. I personally found that it had some antidepressant qualities.
Linkadge
Posted by ed_uk2010 on May 22, 2010, at 14:33:55
In reply to Valproic acid for unipolar depression?, posted by agmatine on May 18, 2010, at 20:56:06
>I'm not having much of a response to citalopram 40mg after about 5-6 weeks, so my doctor has prescribed citalopram 60mg qd
High doses of SSRIs are frequently necessary for severe obsessive-compulsive disorder, in which case the response rate does appear to improve. For depression and most types of anxiety, there isn't much evidence to suggest that high doses are any more effective than standard doses. Also, adverse effects are more frequent at high doses.
>valproic acid 250mg tid. As far as I know, valproate is mainly used as an anticonvulsant, or for acute mania, not in unipolar depression.
Vaproic acid may be useful if you are very agitated eg. with racing thoughts. I am not aware of it being used for unipolar depression in the absence of agitation or manic-type symptoms. Some people suffer certain manic symptoms at the same time as depressive symptoms, in which case valproic acid is often a useful medication.
I think it would be wise to ask your doctor why he decided to prescribe valproic acid. He may have a valid reason. If not, it might be worth considering other antidepressant treatments instead. The choice will depend on your symptoms and 'med history'. There is the option of switching to a different type of drug if citalopram is providing no benefit. Combination of citalopram + another med might be useful if citalopram was producing some benefit, but it doesn't sound like it is.
The usual maintenance dose of citalopram for depression is 20-40mg per day, as you say. An initial dose of 10mg is suitable for people who have not previously taken SSRIs, and for people who have had side effects when starting SSRIs in the past. The dose can then be increased, if necessary. The starting dose should not normally exceed 20mg, except for people who have taken high doses before with no side effects. High maintenance doses eg. 60mg are particularly suitable for OCD. In some cases, an apparent increase in antidepressant response to doses higher than 40mg may actually be due to 'giving the drug time to work', rather than being due to the dose increase itself. This can lead to people taking unnecessarily high doses.
Posted by Phillipa on May 22, 2010, at 21:34:07
In reply to Re: Valproic acid for unipolar depression? » agmatine, posted by ed_uk2010 on May 22, 2010, at 14:33:55
Ed hi is not better it's the length of time on the theuraputic dose? Love PJxx
Posted by ed_uk2010 on May 23, 2010, at 3:24:23
In reply to Re: Valproic acid for unipolar depression? » ed_uk2010, posted by Phillipa on May 22, 2010, at 21:34:07
> Ed hi is not better it's the length of time on the theuraputic dose? Love PJxx
Studies suggest that increasing SSRI doses to above the normal therapeutic dose does not necessarily work much better for depression than staying on the same dose for a few more weeks. There is a tendency to increase the dose before giving the standard dose a chance to work eg. by increasing after only 2 weeks at the standard dose.
For example, if someone had been on fluoxetine (Prozac) 20mg for four weeks without benefit, increasing the dose to 40mg might not work any better than just staying on 20mg for a bit longer. 20mg is the normal antidepressant dose of fluoxetine. Higher doses tend to cause more side effects.
This does not apply to OCD, where high doses may be necessary and response can taken several months in severe cases.
Response can vary substantially (we are all individuals), but for most people, optimal maintenance doses of SSRIs for *depression* are approximately.....
Fluoxetine 20mg/day
Paroxetine 20mg/day
Citalopram 20-40mg/day
Escitalopram 10-20mg/day
Sertraline 50-100mg/dayIf a patient has not previously taken (and tolerated) an SSRI, it makes sense to start with a low dose and then to increase to the usual therapeutic dose if side effects are not problematic eg. citalopram can be started at 10mg and then increased to 20mg after two weeks. 10mg citalopram is often too low to alleviate depression, but it is a sensible dose to start with. Similarly, sertraline can be started at 25mg. Fluoxetine and paroxetine can be started at 10mg. Escitalopram can be started at 5mg. Some people react very badly to SSRIs - high starting doses are not a good idea, except for people who have previously tolerated high doses well.
Posted by Phillipa on May 23, 2010, at 18:46:25
In reply to Re: Valproic acid for unipolar depression? » Phillipa, posted by ed_uk2010 on May 23, 2010, at 3:24:23
Ed guess one of them as the most paxil first ad the doc would allow was l0mg and with benzo and 25mg lopressor. Never given higher doseage. Took three months for body to stabalize. But it didn't relieve anxiety and I wasn't depressed. So what do you feel happened. Ps that was when also drinking beer at night. Love PJxx
Posted by ed_uk2010 on May 24, 2010, at 14:51:33
In reply to Re: Valproic acid for unipolar depression? » ed_uk2010, posted by Phillipa on May 23, 2010, at 18:46:25
> Ed guess one of them as the most paxil first ad the doc would allow was l0mg and with benzo and 25mg lopressor. Never given higher doseage. Took three months for body to stabalize. But it didn't relieve anxiety and I wasn't depressed. So what do you feel happened. Ps that was when also drinking beer at night. Love PJxx
SSRIs frequently do relieve anxiety, but they also frequently don't.........so there's not much I can read into this!
Posted by Phillipa on May 24, 2010, at 19:27:55
In reply to Re: Valproic acid for unipolar depression? » Phillipa, posted by ed_uk2010 on May 24, 2010, at 14:51:33
Ed finally someone admits it. Thanks so tired of others not here in real life saying it does. Love PJxx
This is the end of the thread.
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