While treating a patient for depression, when can we add in Celexa?

Question

Hi doctor,

I am a psychiatrist. I would like to switch a patient from 300 mg Effexor to Celexa. I know how to taper the Effexor. But, when can I add in Celexa? I have tried Cipralex, Prozac, Effexor and Abilify, but the depression is not responding. All the routine laboratory tests are normal.

Answer 1

Hi,

Welcome to icliniq.com.

You seem to be dealing with a patient with treatment-resistant depression. What is the thyroid status of the patient? Since you have tried SSRIs (selective serotonin reuptake inhibitor) and the patient seems to be a non-responder to these, I feel that Celexa (Citalopram) will not benefit this patient. I suggest a mood stabiliser Lamotrigine 25 mg to the existing Venlafaxine. I would also consider a low dose of Olanzapine 5 mg at night as augmentation. You can also prescribe Bupropion 150 mg once daily to the existing combination. Let us wait for one month and look for at least 25 percent reduction in Hamilton depression rating scale scores. If still non-responsive, then you can add 25 mcg of Thyroxine to the current regimen and admit the patient for a course of electroconvulsive therapy (ECT). Thank you.