Is celexa stimulating or sedating
When withdrawing treatment on completion or otherwise, reduce the dose gradually over at least 4 weeks to avoid discontinuation symptoms.Some improvement is usually seen within two weeks of starting antidepressant treatment at a therapeutic dose.Regular symptom review and monitoring of suicide risk are essential adjuncts to drug treatment.An assessment tool such as the Patient Health Questionnaire for Depression (PHQ-9) can be used to assist in the monitoring of treatment response in an adult with depression.Other factors to consider include: Some people experience withdrawal effects after missing 1 or 2 doses, especially when using a drug with a short half-life (e.g. At the end of a treatment course, taper antidepressant over several weeks and monitor for withdrawal symptoms. SSRIs are relatively activating and usually best given as a single daily dose each morning.Routine use of doses above those recommended rarely increases antidepressant effect.start with 25–50 mg of nortriptyline and increase by 25 mg every third night to 100 mg.It is usual to take SSRIs in the morning due to the risk of insomnia and TCAs at night because they may be sedative.
Up to a third of patients have a relatively slow response to antidepressants.
For most indications the SSRIs are considered first-line as they are better tolerated and have a wider safety margin than the tricyclic antidepressants (TCAs) and irreversible nonselective monoamine oxidase inhibitors (MAOIs).
MAOIs (phenelzine, tranylcypromine) are now rarely used because of their severe, and potentially fatal, interactions with some foods and medications.
Continuation of the same antidepressant can also be considered in patients who show a partial response at 6 weeks.
Treatment resistance This is defined as a lack of satisfactory response after a trial of two antidepressants given sequentially at an adequate dose for an adequate time, with or without psychological therapy.