Celexa and no motivation

[David Baxter PhD]

Some other alternatives to Celexa: Cipralex, Zoloft, Prozac.

 

[KarenRB53]

Some other alternatives to Celexa: Cipralex, Zoloft, Prozac.

I was on Prozac for many years and it finally stopped working for me. It also made anxiety worse. Is Cipralex less stimulating than Celexa?

 

[David Baxter PhD]

It's difficult to predict. Prozac can create the type of "body anxiety" you describe in some people but others don't have that problem. Cipralex is chemically related to Celexa but tends to have fewer side effects and fewer interactions with other drugs so it would be worth a try.

 

[KarenRB53]

Can Wellbutrin also cause "body anxiety"?

 

[David Baxter PhD]

In some people, yes.

It is really difficult to predict how individuals are going to react to these types of medication. Even within the same family, reactions can be quite different.

 

[KarenRB53]

Just one more question....would you think that lorazepam (which I've been using for many years and do not abuse it at all) is the best benzo to take with this combination or do you think valium (because of body tension ) or clonazepam (because it stays in system longer) would be any better? Oops, one more....can I just stop taking Celexa and start Cipralex or do I need to taper off the Celexa (I have tapered from 20 to 10mg daily already)? Thanks so very much for your support.

Karen

 

[David Baxter PhD]

Lorazepam acts more quickly but clonazepam might be more effective since its effects last longer. For many reasons, I personally would be hesitant about vlaium but talk to your doctor about this.

You should be able to switch seamlessly between Celexa and Cipralex with no tapering or interval between them. Again, your doctor may have other preferences based on your specific medical history but most people can make the switch immediately.

 

[KarenRB53]

I'm really frustrated after seeing my doctor yesterday. He is so nonchalant and says whatever I want or suggest, he'll go along with it...after all its my body and I know myself better than anyone else. I realize thats true...however...I have issues!! I have a disorder or I wouldn't be going to him!! Anyway, I asked about Wellbutrin being too strong or stimulating for me and he said I should cut the Wellbutrin XL 150mg in half and try that for a while. I said that I was told they were not to be cut or crushed and he said.....they just tell you that to make more money!!! He said they won't kill me so just try it! I can't believe it....he may be right, but I need more support here, we're not talking about taking an aspirin. So, he gave my my script and said to get it filled. He also wants me to try taking Xanax instead of Ativan for a month to see if that helps more with anxiety. He doesn't want to change to Lexpro yet because too many changes at one time aren't good. That I do agree on. I don't know what to do. Sorry, I'm not asking you to disagree with another doctor but I'm quite concerned which is not helping my anxiety or depression at all. Can you give me any advice?? I know we had a few private sessions but don't know if you can prescribe medication for me or not.

Karen

 

[Retired]

Sustained release or Extended release tablets should not be broken, crushed or chewed. Regular tablets may be different, but check with your pharmacist.

Take Wellbutrin by mouth, usually once daily in the morning, with or without food. If nausea occurs, you may take this drug with food. It is important to take your dose at the same time each day, 24 hours apart or as directed by your doctor.

This medication must be swallowed whole. Do not crush, chew or break the tablets. Doing so will destroy the slow release of the drug and increase your risk of side effects, including seizures.

Your pharmacist can provide you with specific details on the specific type of Wellbutrin you have been prescribed, as there may be exceptions.

Administration
Patients should be advised to swallow WELLBUTRIN? SR Tablets whole with fluids, and NOT to chew,
divide, crush or otherwise tamper with the tablets in any way that might affect the release rate of bupropion.

Excerpt from Canadian Product monograph for Wellbutrin SR and Wellbutrin XL, BIOVAIL PHARMACEUTICALS CANADA

 

[Daniel E.]

Anyway, I asked about Wellbutrin being too strong or stimulating for me and he said I should cut the Wellbutrin XL 150mg in half and try that for a while.

As Steve correctly says and as you suggested yourself, I wouldn't mess with cutting extended-release tablets.

If you really need a lower dose, what you could do is ask for a prescription of lower-dose pills of Wellbutrin, which are relatively dirt cheap for the generics.

By messing with the brand name extended-release tablets of Wellbutrin, you would be basically be taking away from the value of those relatively expensive pills, in addition to what Steve mentioned.

 

[Andy]

I think maybe your doctor is being a little too nonchalant. Maybe he is forgetting that your on the XL but I totally agree with Steve you cannot cut WB XL in half! It's dangerous. Instead of getting your usual (minus half) dose throughout the day you will get it all at once and that's not good.
I would suggest you keep taking your 300 until you can get in to see him again to get a proper prescription.
No offense but your doctor needs to wake up and do his job, in my opinion.

 

[KarenRB53]

Yes, I totally agree. I've asked to have another pdoc but my family doctor won't refer me to anyone else as long as this pdoc is practicing. I've also looked into other pdocs in surrounding areas but none are taking new patients. Very difficult. Anyway, meant to ask....is Cipralex the same as Lexapro? Also, has anyone had problems with generic forms of Celexa?

thanks

 

[David Baxter PhD]

is Cipralex the same as Lexapro?

Yes. It's called Cipralex in Canada and Lexapro in the US.

Also, has anyone had problems with generic forms of Celexa?

I'm not aware of any.

 

[KarenRB53]

In your opinion do both Cipralex and Celexa (Cipramil) affect anxiety the same? I've mentioned to you before that I'm on WellbutrinXL 150mg and Celexa 20mg daily. I want to stay on Wellbutrin if I can as its helped me lose 45 lbs that I'd put on over the years from Prozac and it does give me more motivation. However, the combination does not help with my depression all that much. I kind of just live my life, one day after another, not feeling too much of anything. I was much happier when I first started taking Prozac, it was like a miracle pill for me....I remember thinking "this is what normal is". But as I said, it stopped working after about 5 yrs and then I tried several other, I think TCA's and side effects were awful so I started the Celexa which at the most only kept my head above water and when dosage was raised the anxiety increased quite a bit. So then the Wellbutrin was added. I think I'm a little in favour of Wellbutrin because of the weight loss, not so much how it makes me feel. Sorry for rambling. Just trying to figure things out.

Thanks, Karen

 

[David Baxter PhD]

Celexa and Cipralex are very similar chemically, but that doesn't mean that the effects are the same for all patients. Really, the only way to tell would be to try it out.

On the other hand, if you're treating both anxiety and depression, one of the dual action medications like Effexor might be helpful Alternatively, if Prozac worked for you at one time, I'm wondering if you ever tried the combination of Prozac and Wellbutrin. I know that sometimes Wellbutrin is used to offset some of the side-effects of SSRIs.

 

[KarenRB53]

I did try the Wellbutrin with Prozac just before I gave up on the Prozac....together I was very hyper, too much stimulation I guess. I found the Prozac stimulating by itself. Zoloft is dual action, right? I have read of some using Zoloft and Wellbutrin together but wouldn't that be too much norepinephrine? Is it the norepinephrine in Wellbutrin that causes the stimulation or the dopamine? I've never tried Zoloft. Effexor raised my blood pressure right away.

 

[David Baxter PhD]

No, Zoloft is an SSRI, like Celexa and Cipralex and Prozac. And the primary mode of action for Wellbutrin seems to be via dopamine rather than norepinephrine, as far as I know.

 

[jlc]

I'm new to this forum, and to the world of depression. I'm wondering if Cipralex (20 mg for a 170 pound young adult male) causes extreme tiredness, lack of motivation, lethargy, etc. My son's been taking it for 2.5 months, and recently missed two days - wondering if that could trigger his current feelings that the depression is sneaking back? It seemed like he was doing well after the first six weeks of taking it, but now he feels like he's sliding again. Thanks!

 

[KarenRB53]

I'm new to this forum, and to the world of depression. I'm wondering if Cipralex (20 mg for a 170 pound young adult male) causes extreme tiredness, lack of motivation, lethargy, etc. My son's been taking it for 2.5 months, and recently missed two days - wondering if that could trigger his current feelings that the depression is sneaking back? It seemed like he was doing well after the first six weeks of taking it, but now he feels like he's sliding again. Thanks!

Are you asking if missing the Celexa for 2 days could cause these feelings or if Celexa itself could be the cause?
I've missed a day or two and it really hasn't made any difference although its not good to miss days. When I first started taking Celexa it worked well for me but after awhile because of lack of motivation, lethargy etc...my pdoc added Wellbutrin which really worked well. It definitely increased my motivation etc. If after 6 wks he feels the depression coming back it could be that the Celexa isn't the best medication for him. Sometimes it takes 6 to 8 wks before you can tell if a medication is going to work or not. You should talk to his doctor. Is this the first antidepressant he has been on? This is just my opinion and how its affected me...everyone is different.

 

[David Baxter PhD]

I'm new to this forum, and to the world of depression. I'm wondering if Cipralex (20 mg for a 170 pound young adult male) causes extreme tiredness, lack of motivation, lethargy, etc. My son's been taking it for 2.5 months, and recently missed two days - wondering if that could trigger his current feelings that the depression is sneaking back? It seemed like he was doing well after the first six weeks of taking it, but now he feels like he's sliding again. Thanks!

The symptoms you describe are, of course, symptoms of depression itself but yes, it is possible that sleepiness and lethargy could be side-effects of the medication. It's also possible for this type of medication to work for a while and in some people stop working after several weeks or months.

On the other hand, missing 2 days after only 10 weeks on the medication could also have a negative impact.

The key is to get him into see his doctor and talk about whether he should try something else or stick with Cipralex for a while longer. Alternatively, the dose of Cipralex could be increased but in the clinical trials the manufacturer found little evidence of additional benefits beyond 20 mg.