When to up your antidepressant?

[Pioneer]

Does anyone have any thoughts on when it's clear that you should talk to your dr about increasing the dose of your antidepressant?

I'm on Celexa. I started taking it for the first time this Summer (my first time trying an antidepressant, though I'm sure I've needed it for several years). I started at 10mg (which is a really low dose) and I could tell it was helping but it wasn't lasting a full 24hrs. And then my doctor bumped me up to 20mg and that has been much more consistent for me. I've still been experiencing lots of highs and lows - the highs are much higher and the lows can be very sudden and tumultuous. I read on someone's posts (wish I could remember where) that these more intense highs and lows are a sign of recovery, which is encouraging. Still I can't help but wonder (especially on a rough day) if a higher dose would help level out the rough days where depression steals my emotions.

I know you all aren't doctors, but I'm curious what your experience has been with choosing to increase your dosage.

[Blueberry]

I would only increase if my psych doc said to. I have asked before though. One time in inpatient T, I was told that was the highest dosage available so I was prescribed an additional anti-dep (Mirtazapin or something) which was also for insomnia which I didn't have. So actually I wish I'd never asked. A couple of years later my psych doc took me back off that. I think my present anti-deps (Citalopram) could be increased slightly, from 30 to 40 mg, but I discovered with those other meds from the inpatient stay that more doesn't necessarily mean fewer symptoms, faster healing or any of that. So I trust my psych doc that it's the correct dosage for me. I wouldn't hesitate to ask though if I weren't sure.  In fact I seem to remember when on a new med or when the dosage has been changed that psych doc will give me more frequent appointments specifically to find out how it's going.

[Pioneer]

Thank you so much, Blueberry, for sharing your experience with me! I thought it was interesting and insightful when you mentioned that an increased dosage doesn't necessarily mean a faster recovery. I've been processing that as well lately. I am confident that my antidepressant really helps regulate my emotions, but it doesn't replace the actual recovery process. The recovery has to happen over time as I grieve and heal, and the medication is a helpful tool in that process. I think it's a good point, too, that your psych doc would give you additional appointments when med changes were made. That does make sense. I get nervous about approaching my doctor about it - it is difficult to ask for help, even when I know someone actually cares. I think, I've come to the conclusion that I am going to hold off on asking about an increase is dosage for now at least, but I'll try to ask my doc if more uncertainty arises. Thanks again 

[Blueberry]

Glad it helped!

In fact I had an appointment on the 28th and my psych doc said that in really bad weeks ( I have generally about 10 days to 2-3 weeks when things go fairly well and then due to exhaustion etc etc I have a bad week or 10 days, rinse and repeat ad nauseam), I can up to 45 mg. 40mg is generally-speaking max but I have a 30 mg pill which I can't split into thirds very well. I say this because I've been on this medication for a long time now - maybe 10 years - and because my psych doc obviously knows me and my reactions well enough to be able to say 45mg is OK for a few days. W/o him saying that, I never would have considered going above 30 never mind 40.

[Pioneer]

That is some interesting food for thought. I also have cycles of good and bad days. I can't say I've measured them out, though - it seems to be a changing and shifting thing right now. I hadn't considered the idea of asking about increased dosage on the harder days. I wonder if that would make me feel some medication symptoms, at least initially, since when starting or increasing the dosage the med gave me some mild symptoms. That is interesting to note. Thank you for sharing!