Hi there, a friend of mine (58, male) had a mitral valve operation two years ago....and it all went well apart from a little hemorrhage after the operation. He is taking all the medicines (at least 5 related to this), and now he has been depressed for about 3 months. After trying Citalopram 20mg for a month the doctor put the dosis up to 40 mg but this does not seem to be doing anything much after another month, so he went to the doctor yesterday and asked him please to try 60mg, as his anxiety levels are still very high, he cannot sleep and he thinks the drug could help a bit more. But I have read that this doses is not recommended for people that have heart problems, I read somewhere also that it could lead to internal hemorrhages and arrhythmia . Maybe the doctor did not study his heart problems before deciding on 60 mgs??? Or he is not up to date with the lattest research??? Thanks for your help
If depression does not respond to citalopram 40 mg/day for 3 months, options can be: 1. change to antidepressants from same class or from other class 2. A new antidepressant, at therapeutic dose, if does not some response by 2-6 week, it is unlikely to respond to 3. In presence of heart disease, any medication dose to be kept at minimum dose, by principle, of course some exceptions are there