Posted by ed_uk2010 on May 23, 2010, at 3:24:23
In reply to Re: Valproic acid for unipolar depression? » ed_uk2010, posted by Phillipa on May 22, 2010, at 21:34:07
> Ed hi is not better it's the length of time on the theuraputic dose? Love PJxx
Studies suggest that increasing SSRI doses to above the normal therapeutic dose does not necessarily work much better for depression than staying on the same dose for a few more weeks. There is a tendency to increase the dose before giving the standard dose a chance to work eg. by increasing after only 2 weeks at the standard dose.
For example, if someone had been on fluoxetine (Prozac) 20mg for four weeks without benefit, increasing the dose to 40mg might not work any better than just staying on 20mg for a bit longer. 20mg is the normal antidepressant dose of fluoxetine. Higher doses tend to cause more side effects.
This does not apply to OCD, where high doses may be necessary and response can taken several months in severe cases.
Response can vary substantially (we are all individuals), but for most people, optimal maintenance doses of SSRIs for *depression* are approximately.....
Fluoxetine 20mg/day
Paroxetine 20mg/day
Citalopram 20-40mg/day
Escitalopram 10-20mg/day
Sertraline 50-100mg/dayIf a patient has not previously taken (and tolerated) an SSRI, it makes sense to start with a low dose and then to increase to the usual therapeutic dose if side effects are not problematic eg. citalopram can be started at 10mg and then increased to 20mg after two weeks. 10mg citalopram is often too low to alleviate depression, but it is a sensible dose to start with. Similarly, sertraline can be started at 25mg. Fluoxetine and paroxetine can be started at 10mg. Escitalopram can be started at 5mg. Some people react very badly to SSRIs - high starting doses are not a good idea, except for people who have previously tolerated high doses well.
poster:ed_uk2010
thread:947893
URL: http://www.dr-bob.org/babble/20100514/msgs/948389.html