Posted by JohnL on December 1, 2000, at 4:57:30
In reply to Celexa for melancholic depression, posted by ben on November 30, 2000, at 12:55:51
> Does anyone have experiences with Celexa (Citalopram) for melancholic depression in doses above 60 mg/day. My Doc is a specialist in pharmacology and had several patients who responded very well (remission) with doses above 60 mg/day (up to 140 mg/day).
I've heard of people taking doses of Prozac as high as 200mg. Serzone up to 1000mg. Zoloft 300mg. These off-the-charts doses can be effective and safe, but for many people the side effects become intolerable before reaching those doses. If it can be tolerated though, it can and is done.
I would get dispute and even hostile debate from most doctors for my next comment. That is, the farther away a drug is from targeting the real underlying chemistry problem, the higher the dose it will take to correct that problem. And the longer it will take to work, if it ever works at all. About 30% of people are not helped at all by any particular medicine. Of those that do respond to a medicine, only about 10% to 30% of them experience total (versus partial) relief. For several reasons. One, the drug may have poor receptor binding in the particular person. Just not a good molecular match. Two, the drug may be acting through domino chain reactions that eventually get around to the real problem, but don't influence the problem head-on. A lot of the drug is wasted in those domino chain reactions, and requires higher doses to get the job done. Regardless, good results can be achieved by either targeting the problem head-on, or by correcting it through domino chain reactions.
I think it all comes down to two questions: 1)How willing am I to experiment with other drugs that might affect the problem more directly? 2)Am I able to tolerate the side effects of very high doses? The answers to these questions will determine which route to take.
All that being said, a high dose of Celexa could work. But in general, I am more inclined to think that melancholic symptoms are usually related more to norepinephrine and dopamine circuits than serotonin. The addition of any of the following could yield better overall results than a high dose of Celexa alone: Ritalin or Adderall; Nortriptyline or Desipramine; Zyprexa or Risperdal; Lithium; or in the mailorder arena, Amisulpride+Adrafinil.
Experiment more? Or raise the dose of Celexa? Raising the dose is probably the easiest most logical thing to do. But if it doesn't work out, there are plenty of other options.
John
poster:JohnL
thread:49689
URL: http://www.dr-bob.org/babble/20001130/msgs/49743.html