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.
poster:ed_uk2010
thread:947893
URL: http://www.dr-bob.org/babble/20100514/msgs/948329.html