How To Get 15 mg. of Celexa

She was 28, a bit overweight but tired and nervous at the same time.

“I’d like 15mg. of Celexa. My other psychiatrist wouldn’t give it to me, so I left him. He said it was either 10mg. or 20 mg. and that’s it.”

Not the usual “chief complaint” for why someone comes to a psychiatrist — but what the heck?

I verified her diagnosis with my usual questionnaire. Yes, she had a depression with anxiety. A relatively common diagnosis, and Celexa (citalopram) was certainly an appropriate treatment.

She felt “zombie-like” on 20 so she had wanted to try 15mg. — which was a perfectly valid request.

Celexa is old enough that I had worked on the clinical trials for it to pass the FDA. Its patent has long expired, so it is made by a variety of generic drug makers. They only have to put in the same amount of the compound to get the same biological activity of the original. The bioavailabily might be different, but that should not make a lot of difference.

I knew the drug pretty well, and there really should not be any metabolic breakdown products that are toxic with exposure to air, I asked her to describe the pill — basically to make sure it was a tablet and not a capsule. It wasn’t.

If it had been, I would have asked her to open it in half and dump out the powder into two equally-sized mountains and only consume one of them.

It was a tablet. “Fantastic,” I said. I told her to buy a pill-cutter at the drugstore. I still have not seen one, in this day and age, that costs more than five dollars — usually less.

“They usually look like miniature guillotines,” I told her. Perhaps a little of my French medical training showing through …

Of course, I never miss a chance to make a patient laugh. “You can pretend you are Marie Antoinette,” I said, “And shout ‘off with his head’ as you cut the pill in half.”

I wrote her a fresh prescription so the pharmacist would not think she was abusing the drug when she ran out early. I had told her to take 1 1/2 pills daily instead of 2. Celexa is basically not abusable but I have considerable experience with pharmacists.

The woman hugged me spontaneously and fought tears and thanked me for “talking to her like a human” and “really listening.”

I am on a one-woman mission to improve the quality of psychiatry and medicine.

I hope others will join me.