Hi I'm new to this site so hoping to find some new friends and help my question is im really really struggling with severe anxiety and depression, I'm now back on citalopram after being previously on it 4-5 years until last dec when I had a really bad time panicked when it was doubled and was put on mirtazapine, long story but I was worse off so now on this again, I cannot remember feeling this ill on it when I first started on it? I'm so nauseous, anxiety through the roof and non stop crying, I am on 20 mg since this last tues after being on 10mg with the mirtazapine then 15mg and now just the citalopram, I'm so low I cannot go on much more, mental health team are ok but not brill and I'm worried because my family are so badly affected by this, am I expecting too much too soon, I'm also having to take Valium daily, I've decided to switch taking the citalopram to tonight for the first time as was taking it in the morning, but I'd always took it at night when I was on it before! Please please does anyone have any advice and how to cope with this and these awful side effects? thank you x Hello sunflower, sorry to hear you are having such a rough time. I'm going to give it some thought and reply to tomorrow ( as my meds are about to kick in ) I have been where you are and it WILL be OK. I have taken citalopram on three separate occasions for horrific anxiety and panic. Check out the thread on mental health entitled 'Andes' as there is some great advice and support on there. I always started on 10mg for two weeks then up to 20mg as I find starting it do hard. The prob with taking these meds for anxiety is they initially increase it. cipro clearance Mylan is a global healthcare company focused on making high quality medicines available to everyone who needs them. Our broad and diverse portfolio of more than 7,500 products is available to customers of all types including retail and pharmacy establishments, wholesalers, governments, institutions and physicians. 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Selective serotonin reuptake inhibitors (SSRIs) are a widely used type of antidepressant. They're mainly prescribed to treat depression, particularly persistent or severe cases, and are often used in combination with a talking therapy such as cognitive behavioural therapy (CBT). SSRIs are usually the first choice medication for depression because they generally have fewer side effects than most other types of antidepressant. As well as depression, SSRIs can be used to treat a number of other mental health conditions, including: SSRIs can sometimes be used to treat other conditions, such as premature ejaculation, premenstrual syndrome (PMS), fibromyalgia and irritable bowel syndrome (IBS). Occasionally, they may also be prescribed to treat pain. It's thought that SSRIs work by increasing serotonin levels in the brain. Serotonin is a neurotransmitter (a messenger chemical that carries signals between nerve cells in the brain). The aim of this review was to assess the clinical relevance of the relative antidepressant efficacy of escitalopram and citalopram by meta-analysis. Studies in major depressive disorder (MDD) with both escitalopram and citalopram treatment arms were identified. Adult patients had to meet DSM-IV criteria for MDD. The primary outcome measure was the treatment difference in Montgomery–Asberg Depression Rating Scale (MADRS) total score at week 8 (or last assessment if =0.0002) (six RCTs used the MADRS), and in responder rate (8.3 percentage points, 95% CI 4.4–12.3) (eight RCTs) and remitter rate (17.6 percentage points, 95% CI 12.1–23.1) analyses (reported for four RCTs), corresponding to number-needed-to-treat (NNT) values of 11.9 ( Escitalopram has been found to have superior efficacy to other antidepressants in the treatment of major depressive disorder (MDD) in a number of individual studies and in a series of meta-analyses. Escitalopram has been shown to be superior to paroxetine (Boulenger . The superiority of escitalopram is even more clear-cut in severe depression, as shown in individual studies in which it was compared to citalopram (the racemic mixture of escitalopram and the R-enantiomer), paroxetine, and venlafaxine (Boulenger (2005) was designed to test prospectively for a possible difference between 20 mg escitalopram and 40 mg citalopram in patients with severe depression [Montgomery–Asberg Depression Rating Scale (MADRS; Montgomery & Åsberg, 1979) score of ⩾30], and the observed difference of 2.1 was significant and clinically relevant. In patients with very severe depression there is an even more striking treatment effect. In the study of Yevtushenko (2007) in severe depression (MADRS ⩾30, except for 12 patients) a difference of 3.51 for 10 mg escitalopram compared to 20 mg citalopram increases to 3.99 in very severe depression (MADRS ⩾35). 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