[citizen88]

I am currently prescribed valium 5mg 3x daily and celexa 10mg daily. I was interested in looking for a single medication that would be just as beneficial as the two medications I currently take. I've been diagnosed with depression, G.A.D (generalized anxiety disorder), social phobia, S.A.D (season affect disorder), and reactive attachment disorder as an adult.

ADVICE IS GREATLY APPRECIATED!!! THANK YOU!

[serendipidy]

Hello, um I don't think anyone here is doctors and I know I am not....psychologists don't do the whole drug thing either that falls in the field of psychiatrists

but the first thing I do is educate myself on what I am taking, what it is used for, what I am using it for, side effects, pro's and con's of that particular medication and then investigate alternatives....

so first thing first Valium is a benzodiazapine for anxiety obviously....

Celexa is an antidepressant of the SSRI type....

they both do different things....and I wont go into the long diatribe about addiction and SSRI's and yada yada particularly as I don't think that will help you....

but specifically something that does BOTH actions I doubt you will find....

I suffer from anxiety yet don't take either type of drug...because I use an antihistamine to help me sleep because it isn't addictive and a secondary action is it helps with anxiety, and it also helps with my allergies which trigger my asthma....

I also take a pain killer for chronic pain which its secondary action helps with anxiety which is a bonus....the addiction side of things is near impossible to get away from with pain killers but of them all this one carries close to the lower levels of risk of addiction.

now the thing is with all those acronym's going on for you to only be taking valium and celexa ain't too bad a thing I have seen drug lists which could twist your stomach in knots just looking at them....although even though I haven't done the whole lecture on various drugs uses effectiveness and side effects I will still say the addictive nature of Valium and its sedative effects would concern me taking it all the time....as that's about half the dose my mother takes just to be capable of sitting through an airline flight which is not an every day event for her. And I know Celexa literally makes my partner dry heave...which is a known side effect so I can understand your wanting to change meds....but when it comes to alternatives nothing readily springs to mind...I am lucky to be using over the country alternatives because I avoid the prescription stuff like the plague as I already take enough of that for other things.....

the person to approach is your doctor particularly as people react differently to different drugs....and the first step in looking at alternatives is knowing your own medical history....or your doctor knowing your medical history to firstly whittle down the list removing those things which according to your medical history are likely to react badly too or likely to have it negatively impact on a pre-existing medical condition.....this is why face to face consultations and written prescriptions exist, otherwise we would all just go and knock on the door of our local pharmacist, these systems are in place for OUR safety not just to make sure the doctor gets a pay cheque and it really is worth putting the question before them particularly if the motivation is concern about addiction or acid reflux aka adverse side effects.

[citizen88]

Thanks for the response serdipidy! I don't really like the way the citalopram makes me feel at times, due to the fact that it's an SSRI and releases some degree of serotonin in your bloodstream versus releasing it to the center that needs to be most addressed, the brain. It's almost like a cold chill that I get from the medication, but needless to say, the medication is working to an extent. I don't feel as depressed as I used to. I do experience restlessness from it however, and have had to have my diazepam dosage adjusted about three times this past year. I was doing some research on different types of anti-depressants and anti-anxiety medications last night, and although there aren't any anti-depressants that are classified as benzo's, I find a few that proclaim to be used in the treatment of anxiety as well (G.A.D., S.A.D. and social phobia etc). The medication that looked like it may be the one that best suits me is wellbutrin. Wellbutrin works as an anti-depressant, anti-anxiety, ADHD, and is used as a smoking aid. I possess all of the disorders this medication claims to treat, and I'm also a 23 year old smoker who would like to quit smoking as well. I am going to bring it up to my physician next month, but he is a PCP that doesn't specialize in psych, so I'm turning to forums such as this one to seek advice before presenting any new ideas to him. I am a psychology major and aware of most classes of drugs that are used to treat depression and anxiety, as well as other medications used for psych treatment. I'd like to know if anyone has been on citalopram (celexa) and diazepam (valium) and made a switch to a med such as Wellbutrin. If so, what has been your experience with it?
Thank You!

Welcome to the Community, citizen88. Psych Central has a medications library here: http://forums.psychcentral.com/showthread.php?t=100188

FDA: http://www.drugs.com/drug_information.html

[sunrise]

citizen88, there are a number of antidepressants that are very good at helping with anxiety. These include the SSRIs and the SNRIs. Sometimes these meds are prescribed for anxiety even when there is no depression. So the name anti-depressant can be misleading, because some of them are fine anti-anxiety meds. The SSRIs often prescribed for anxiety are Lexapro, Celexa, Paxil, and Zoloft. Effexor, an SNRI, helps some people.

The least helpful antidepressant for Anxiety is often thought to be Wellbutrin. It is a highly activating antidepressant and causes anxiety in some people. It can really give a person the jitters, especially at first, even a person who isn't anxious. So I recommend staying away from the Wellbutrin if you have anxiety. But of course, talk with your pdoc. If Celexa is not working, you could try one of the other SSRIs or Effexor. I think the hope is with these meds that once they start working well for you, you can eliminate the benzos. How long have you been on the Celexa? If you've been on it a few months and it is not helping with your anxiety, your doc might be able to adjust the dose or switch you to another med.

I take Wellbutrin and it has definitely been activating for me. I don't suffer from anxiety so this has not been a problem.

[citizen88]

Thanks for the response sunrise! I don't feel as if the celexa is working as well as it was working when I was first prescribed it. It initially caused a nauseous feeling, as well as a cold feeling (as if I could feel the serotonin running through my veins). This is my main concern with SSRI's because it's harder for them to break through the membrane of the brain, so the serotonin is released into your bloodstream. This creates a feeling of anxiety too, even when taken with the Valium. I've been researching and chatting on this thread to get helpful advice such as yours because I'd like to switch from an SSRI (I've tried zoloft, prozac, and lexapro before the celexa). My doc lowered my dosage of Celexa (cut the dosage in half) because I was also experiencing really intense vivid nightmares, and getting headaches quite frequently. I find that if I take it too close to bedtime, I become very restless. Even with the Valium, I still have trouble getting to sleep, if the medication is administered too late. I know there's no way of testing serotonin levels because I am a psychology major, and licensed to work with people that suffer from psychological disorders and/or terminal illnesses. I feel as though a serotonin rebutake inhibitor is not right for me because, although it does help with the depression in small quantities, the side effects sometimes outweigh the benefit in my case. The reason I brought up Wellbutrin is because it's been approved to treat moderate to major depression, generalized anxiety disorder, seasonal affect disorder, ADHD, and it's used as a smoking cessation. Since it's in a class of it's own and dopamine and norepinepherine are stabilized in the brain, rather than serotonin , I feel that I'd benefit more from it than the celexa. I have been diagnosed with moderate depression, generalized anxiety disorder, ADHD (when not on a sedative), reactive attachment disorder and season affect disorder. I also smoke a pack per day and am rather young (23). I would appreciate the benefits of Wellbutrin if it actually does work. My concern though is the anxiety. You are not the first person that I've spoken with that has listed enhanced anxiety as a side effect from the Wellbutrin. I'm already on 15mg of Valium/day (5mg in the morning and 10 at night to help me sleep), and I really don't want to exceed that regimine. In the past year, my dosage has been changed three times. The initial prescribed dosage was 2mg 3x/day. That was before I started the celexa, and I still experienced high anxiety levels. I do remember reading something about Effexor, but I'm not entirely familiar with that particular medication. I see my doc next month, and am trying to gather as much information as I can before we discuss any change in my current regimine. I will do some research on Effexor, and if you are rather familiar with the med, I would really like to hear your opinion about it. Thanks again!!

[sunrise]

Originally Posted by citizen88

The reason I brought up Wellbutrin is because it's been approved to treat moderate to major depression, generalized anxiety disorder, seasonal affect disorder, ADHD, and it's used as a smoking cessation.

I double checked my Stahl (psychopharm) book and Wellbutrin is not listed as effective for anxiety, either on or off label. In fact, as I mentioned, it is the opposite. Possible side effects include anxiety, agitation, insomnia, tremors (I have the tremor). This med can be highly activating med and may make you have anxiety even if you don't to start! I don't think it is a good choice if your main concern is anxiety. However, as my prescriber once said to me, one pill may not deal with all of a person's concerns, so if you don't mind the possibility of being made more anxious by the Wellbutrin, you could give it a try. Maybe a second med could be added to the Wellbutrin to try to deal with your anxiety. I always hate the idea, though, of having to add a med just to undo what another med is doing, and since you are already on benzos, I don't know where you would turn to try to counteract the Wellbutrin.

It sounds like you have several concerns that might be helped pharmacologically. Maybe start with the most concerning and try to get a med that will help with that one. So if anxiety is your most important concern, don't go for the Wellbutrin, perhaps try Effexor or Mirtazapine. If it is depression that is your biggest concern and anxiety not so much, maybe the Wellbutrin would be fine. Those are my thoughts but as you know, these meds all act differently in different people.

Also, with the SSRIs, don't take right before bedtime, especially Lexapro and Celexa. Take in the AM so you will be able to sleep better. If you have trouble falling asleep, again, Wellbutrin is not a good choice.

Effexor is a serotonin and norephinephrine reuptake inhibitor. Some people find that it works well for them whereas the SSRIs did not. The thing about Effexor is that it can be hard to stop taking. You need a gradual taper plan or else you can get the dreaded "brain zaps."

Another anti-depressant that is often prescribed for GAD is mirtazapine. Have you tried that one? It acts by a different mechanism than the SSRIs and is also helpful for insomnia. If it works, it can be a Godsend. But it doesn't work for everyone. Doesn't it seem like that's always the case?

Some people with co-occurring depression/anxiety/insomnia use trazodone.

At one time I took Buspar for anxiety. It didn't help me, but it is another option that is not a benzo.

I also know that usually a person is recommended to also do psychotherapy for an anxiety disorder, and it can be quite effective. Studies have shown that psychotherapy tends to lead to longterm improvement with anxiety, whereas meds do not (when you stop taking the meds, the anxiety comes back). A clinical psychologist who taught one of my classes a while back saw clients mainly for anxiety and she sounded great--had a lot of great therapy techniques to help people with GAD, panic disorder, OCD, etc. So you might seek out a therapist specializing in anxiety if you don't already have one.

citizen88, I'm glad you have a pdoc who can help you sort through all of this and find something that works for you. You can help your pdoc by prioritizing your concerns for him/her. What is the most important thing you are dealing with? The one that is causing the most dysfunctionality in your life? Is it anxiety? Depression? Addiction to nicotine?

Good luck with all of this, and best of luck too on your career in psychology.

[citizen88]

So I went to my doc today and he changed my prescriptions! Instead of 15mg of Valium/day and 20mg/celexa, I am now on 75mg of Wellbutrin, 2mg Clonazipam, and up to 40mg of Elavil to help me get to sleep! I'm hoping this regimine will work! Wish me luck!

[citizen88]

So I decided to go into my doctor this morning bc in the past two weeks, I had too really low episodes. (uncontrollable crying and about 4 hours of sleep in 48 hours. I did not have to ween off of the celexa and was able to start the new regimen today. Of course, the first thing my body wanted to do was play catch up on sleep! I woke up about an hour ago and can already notice a difference in the medications. This seems like the perfect match for me (so far) and I feel so much clear headed! Thanks again for all of the advice and personal stories that you all have shared with me!

[Kiya]

Lexapro does cover both anxiety and depression fairly well. When i went off it to citalopram (celexa) my anxiety was FAR WORSE and I had to be dosed with 3 other meds. I just couldn't afford Lexapro.