Hello doctor,
I am suffering from anxiety and social phobia. I consulted my psychiatrist to use either Citalopram or Mirtazapine. I doubt to take Citalopram because I know this causes sexual side effects more often than Mirtazapine does. However, regarding Mirtazapine, I read various things online that, because it is a norephedrine activator (SNRI) instead of SSRI, it can cause anxiety to become worse. I want a second opinion, if I were to use Mirtazapine, what is the recommended dose for anxiety and social phobia?
Hello,
Welcome to icliniq.com.
1. Both Citalopram and Mirtazapine are good choices for managing anxiety and social phobia.
2. If you are worried about sexual side effects, Mirtazapine will be a better choice.
3. Both Citalopram and Mirtazapine can take up to four weeks for the therapeutic benefits to become apparent. Some people can experience agitation and anxiety during the first week or so, but usually, it settles down. Mirtazapine has a sedative effect as well, so it should be beneficial.
4. The usual starting dose for Mirtazapine will be 15 mg once daily at bedtime. If needed depending on your response and tolerability, the dose can be titrated up to 30 mg or 45 mg per day. Medication can only be started after your doctor has ruled out any contraindications and should be able to monitor your response.
5. Finally, in addition to medication, you can also try psychological therapy and CBT (cognitive behavioral therapy) for anxiety. They are highly effective and help to prevent relapse after the medication is discontinued when you have improved. Usually, antidepressant medication needs to be continued at least for six months after you feel better.
I hope this helps.
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