Managing Long-Term Depression: Medication Adjustments and Safety Concerns

Feeling down?

I have been suffering from depression for over ten years and have been managing it with medication.
However, a couple of years ago, I saw a news report on television stating that Ativan could cause cancer, which triggered a relapse in my condition.
Previously, my doctor prescribed citalopram 20 mg, but after the relapse, it seemed ineffective.
I was then switched to Kinloft 50 mg, which I have been taking for over a year.
Recently, due to a relative's suicide related to depression, I experienced another relapse, and I am now experiencing side effects from Kinloft.
I would like to ask the doctor if I should increase the dosage of citalopram now that I have switched back to it.
Will there be withdrawal issues from Kinloft? Also, what is the maximum daily dosage of Ativan? Can I take magnesium supplements, and is it safe to take them alongside my depression medication? Thank you for your response, doctor.

Yue, 30~39 year old female. Ask Date: 2016/07/12

Dr. Lin Niqi reply Psychiatry

The inquiry did not clearly explain the past medication history (including whether other medications were used simultaneously with antidepressants and sedatives), your physiological condition at that time, and what the side effects of the mentioned medications were.
The dosage of the medications should not only consider the maximum dosage but also take into account individual physiological conditions (such as the presence of internal diseases, liver and kidney function, etc.) and personal experiences after use (effectiveness, side effects).
It is recommended that you seek consultation with a psychiatrist, and you should discuss these matters in detail with the psychiatrist in person.

Reply Date: 2016/07/12

More Info

Managing long-term depression can be a complex and challenging process, especially when it comes to medication adjustments and addressing safety concerns. Your situation, having dealt with depression for over a decade and experiencing medication changes, is not uncommon. It’s important to approach this with a comprehensive understanding of the medications involved, their potential side effects, and the implications of switching or adjusting dosages.

Understanding Your Medications
1. Citalopram and Kinloft: Citalopram is a selective serotonin reuptake inhibitor (SSRI) commonly prescribed for depression and anxiety. Kinloft (likely referring to a brand of escitalopram) is also an SSRI, which is often considered more potent and may have a different side effect profile. If you have switched back to citalopram after experiencing side effects from Kinloft, it’s crucial to monitor how you feel on the new medication.
2. Dosage Adjustments: When considering dosage increases, it’s essential to consult your healthcare provider. They will evaluate your current symptoms, how you responded to previous doses, and any side effects you experienced. Increasing the dose of citalopram may be appropriate if you are not experiencing relief from your symptoms, but this should always be done under medical supervision.

3. Withdrawal Symptoms: Regarding Kinloft, if you have been taking it for over a year, stopping it suddenly can lead to withdrawal symptoms. These may include mood swings, irritability, dizziness, and flu-like symptoms. It’s advisable to taper off the medication gradually under the guidance of your physician to minimize withdrawal effects.

Addressing Safety Concerns
1. Ativan (Lorazepam): Ativan is a benzodiazepine used for anxiety and can be effective in the short term. However, it is not recommended for long-term use due to the risk of dependence and withdrawal symptoms. The maximum recommended dose varies, but typically, it should not exceed 10 mg per day for most patients. Always follow your doctor’s advice regarding dosage.

2. Magnesium Supplements: Magnesium is often touted for its potential benefits in mood regulation and anxiety relief. It can be taken alongside antidepressants, but it’s essential to discuss this with your healthcare provider first. They can help determine the appropriate dosage and ensure it won’t interact negatively with your current medications.

Additional Considerations
- Therapeutic Monitoring: Regular follow-ups with your healthcare provider are crucial. They can help monitor your response to medications, adjust dosages as needed, and provide support for any side effects you may experience.

- Psychotherapy: In addition to medication, engaging in therapy can be beneficial. Cognitive-behavioral therapy (CBT) and other forms of psychotherapy can provide tools to manage depression and anxiety effectively.

- Lifestyle Modifications: Incorporating regular exercise, a balanced diet, and mindfulness practices can significantly impact your overall mental health. These lifestyle changes can complement your medication regimen and improve your mood.

- Support Systems: Surrounding yourself with supportive friends and family can also play a vital role in your recovery. Consider joining support groups where you can share experiences with others facing similar challenges.

In conclusion, managing long-term depression requires a multifaceted approach, including careful medication management, therapeutic support, and lifestyle changes. Always consult with your healthcare provider before making any changes to your medication regimen, and ensure that you have a solid support system in place. Your mental health is paramount, and with the right strategies, improvement is possible.

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