Is Citalopram better than Effexor XR and Mirtazapine?

Question

Hello doctor,

I cannot tolerate the side effects of Citalopram 10 mg (headaches, shaking legs, fatigue, upset stomach and pain, shortness of breath, hip pain), so I was going to go back on Effexor XR 150 mg and 15 mg Mirtazapine that I was on three weeks ago before suddenly stopping, which is not a good idea. I have been on Citalopram for a week, reducing it to five mg for the past two days. Is it fine to resume my dose of Effexor XR and Mirtazapine without the risk of serotonin syndrome? Will there still be any in my system from three weeks ago, so I do not have to start all over and wait another four to six weeks?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

It is better to take Citalopram (a selective serotonin reuptake inhibitor) than Effexor XR (Venlafaxine extended release) and Mirtazapine (a tetracyclic antidepressant). Citalopram has minimal side effects. You keep continuing to take Citalopram for 10 mg (milligrams). You also do non-pharmacological management.

Do 30 to 45 minutes of exercise daily.
Do meditation for 15 to 20 minutes daily.
Eat healthy home-cooked food and avoid junk food.
Take a good sleep of seven to eight hours.
Spend time on creative hobbies like reading good books, writing journals, painting, drawing, and learning new skills, languages, or musical instruments.
Take enough sun exposure.
Spend quality time with your friends and family.
Rather than merely spending your life, live it.

You do not have any serotonin syndrome or are less likely to do so in the future.

Do not restart your old medication without personally consulting a psychiatrist. If you were not good on the last medicine, then allow the new medication to take full effect. You need four to six weeks for the full effect of Citalopram. Do not reduce it. Do not keep changing medications.

I would suggest you do investigations to rule out thyroid disorder, TSH (thyroid-stimulating hormone), anemia, CBC (complete blood count), vitamin B12 deficiency, and vitamin D deficiency, as all may lead to depressive features and somatic complaints.

I hope I have answered your question.

Let me know if I can assist you further.

Regards.