Combining drugs with citalopram?

[Ihavequestionsplease]

hi i am a patient with GAD/panic and wanted to get some advice before seeing my gp. I take 30mg citalopram and 7.5 mg mirtazapine. The mirtazapine is an augmenting drug for me. The citalopram is a bit light alone for anxiety and mirtazapine helps. But heres the problem the mirtazapine makes me very angry. I mean very angry but helps the anxiety. I know it is the mirtazapine as i have taken citalopram alone and not had this anger.

Therefore, is there a drug that i could ask my gp for to combine with citalopram, to replace mirtazapine?

I can only think of asking for buspar along side it. I have tried propranohol, which didnt work and I guess hydroxine would just be like mirtazapine, as they both are like H1 blockers

I know that my gp is the best to ask, but i find they are more family doctors, and combining drugs is a bit more specialist.

Just to say i am doing cbt and need my anxiety at a good level to maintain progess. Therefore i want to combine drugs with cbt.

[DavidS]

Anger is a therapy issue. I would suggest that what you are doing and taking is releasing anger that is within you. ai think a lot of depression is due to repressed anger, so having it come up is a GOOD THING.

Do some/a lot of anger work. Dealing with anger is a skill which can be learned. Have a look at A.n.g.e.r. Workout | LIVESTRONG.COM

The key to success is to start doing the exercises before you get angry. Don't wait.

[Ihavequestionsplease]

Anger is a therapy issue. I would suggest that what you are doing and taking is releasing anger that is within you. ai think a lot of depression is due to repressed anger, so having it come up is a GOOD THING.

Do some/a lot of anger work. Dealing with anger is a skill which can be learned. Have a look at A.n.g.e.r. Workout | LIVESTRONG.COM

The key to success is to start doing the exercises before you get angry. Don't wait.

i see where your coming from. but my point is i am only angry when i take mirtazapine. and i am not depressed. i take these drugs to help keep my anxiety in check.

[DavidS]

Same advice. Do the exercises.

Not that you can't make some other changes too. This is a "both-and" suggestion, not an "either-or."

[bobbin]

hi i am a patient with GAD/panic and wanted to get some advice before seeing my gp. I take 30mg citalopram and 7.5 mg mirtazapine. The mirtazapine is an augmenting drug for me. The citalopram is a bit light alone for anxiety and mirtazapine helps. But heres the problem the mirtazapine makes me very angry. I mean very angry but helps the anxiety. I know it is the mirtazapine as i have taken citalopram alone and not had this anger.

Therefore, is there a drug that i could ask my gp for to combine with citalopram, to replace mirtazapine?

I can only think of asking for buspar along side it. I have tried propranohol, which didnt work and I guess hydroxine would just be like mirtazapine, as they both are like H1 blockers

I know that my gp is the best to ask, but i find they are more family doctors, and combining drugs is a bit more specialist.

Just to say i am doing cbt and need my anxiety at a good level to maintain progess. Therefore i want to combine drugs with cbt.

Mirtazapine has various mechanisms of action. It is indeed a potent antihistamine, but this is unlikely to be what is causing the anger. Unlike mirtazapine, I do not think that hydroxyzine would make you angry. Hydroxyzine is only a 'mild' drug for anxiety but you could try 25mg twice a day (initially) to see whether you find it helpful. Hydroxyzine is not proven to be effective in the long term, so it is often used 'when required'. It's a relatively safe drug however and it does not cause dependence.

Citalopram can be used at higher doses than 30mg for anxiety/panic. Assuming that you are not experiencing any problematic side effects, you could try 40mg and then 60mg if necessary. This way, you may find that additional medication is unnecessary.

Buspirone is sometimes useful for GAD but not panic disorder. Dizziness and nausea are frequent side effects when treatment is first started. Buspirone does not cause dependence. Although it is only licensed for short term use, there is no reason to believe that it would be unsafe in the long term.