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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 443 to 467 of 8406. Go back in thread:
Posted by Dr. Bob on September 19, 2002, at 18:39:35
In reply to Re: dosing, posted by Alice Anne on September 19, 2002, at 11:48:50
Posted by Lexy1 on September 19, 2002, at 22:35:14
In reply to Re: So Sensitive, posted by Alice Anne on September 19, 2002, at 15:43:21
I started taking Lexapro one week ago after being on Celexa for 3 weeks. The Celexa was horrible, I wasn't eating or sleeping, the Lexapro has been fabulous. My appetite has returned and I have no problems sleeping. The only real issue that I'm having with it is that it's not really working that great for my anxiety. I had an anxiety attack today at work after never having one while I was on Prozac for 6 years. I'm wondering if there's anything better for all of the anxiety disorders or if I should up my dosage of Lexapro.
Posted by anxiousgrrrl on September 20, 2002, at 0:14:51
In reply to Lexapro User, posted by Lexy1 on September 19, 2002, at 22:35:14
So far so good for me. My anxiety was worse with Effexor than Prozac, worse with Prozac than Zoloft.
I've been on Lexapro for 2 weeks or so, no panic attacks yet, but some twinges. I keep some klonopin around for periods of more acute anxiety and haven't felt the need to use it yet (since switching).
I'd recommend giving it more time, 4-6 weeks at least. Switching meds always involves a bit of time for adjustment. Don't give up yet!
But if you're having panic attacks, ask your pdoc for a benzodiazapene. Mine prescribed klonopin because it's longer-acting and has a more mellow efficacy curve.
You could take klonopin for a few weeks and then taper it off and see how the lexapro is doing.
Posted by pharmrep on September 20, 2002, at 1:00:17
In reply to Lexapro User, posted by Lexy1 on September 19, 2002, at 22:35:14
> I started taking Lexapro one week ago after being on Celexa for 3 weeks. The Celexa was horrible, I wasn't eating or sleeping, the Lexapro has been fabulous. My appetite has returned and I have no problems sleeping. The only real issue that I'm having with it is that it's not really working that great for my anxiety. I had an anxiety attack today at work after never having one while I was on Prozac for 6 years. I'm wondering if there's anything better for all of the anxiety disorders or if I should up my dosage of Lexapro.
** Dont up it yet...Prozac has a long 1/2 life, and when you switched to celexa, you still had prozac in you to for at least 1 wk...maybe more. It is out of you now, but remember Lexapro is effective at 1-2 weeks for most people...give it a little more time to work (treat the anxiety).
ps...are you taking 10mg? That is the starting dose.
Posted by hawkeye on September 20, 2002, at 12:56:49
In reply to Re: LEXAPRO » hawkeye, posted by pharmrep on September 14, 2002, at 9:57:47
Hi. I have been taking Lexapro (10mg/day) for two weeks. I did drop to 5mgs/day for a couple of days, but then returned to 20mgs. I have also stopped taking Lamictal to see if it was playing any role in the sexual dysfunction that I have been experiencing since starting Lexapro.
HERE's The GOOD NEWS: For me, this is a terrific drug for alleviating depression. I really feel better than I have for a very long time!
HERE's the BAD NEWS: Sexual Dysfunction
So I am faced with the proverbial Hobsian's Choice. Sex or Depression.
Tomorrow I am going to cut back to 5mgs/day. I'll let you know what happens.
Posted by pharmrep on September 20, 2002, at 20:22:45
In reply to Re: LEXAPRO -- UPDATE #2, posted by hawkeye on September 20, 2002, at 12:56:49
> Hi. I have been taking Lexapro (10mg/day) for two weeks. I did drop to 5mgs/day for a couple of days, but then returned to 20mgs. I have also stopped taking Lamictal to see if it was playing any role in the sexual dysfunction that I have been experiencing since starting Lexapro.
>
> HERE's The GOOD NEWS: For me, this is a terrific drug for alleviating depression. I really feel better than I have for a very long time!
>
> HERE's the BAD NEWS: Sexual Dysfunction
>
> So I am faced with the proverbial Hobsian's Choice. Sex or Depression.
>
> Tomorrow I am going to cut back to 5mgs/day. I'll let you know what happens.** I am curious...why up and down...10mg was ok i thought...also, I know the sex s/e are a class effect of ssri's, and these numbers are not exact, but 10mg had sex s/e (ejac delay) of 6% vs 20mg of 11%, so if you can...stay at 10. Glad to hear your success. Good luck and keep us posted.
Posted by hawkeye on September 21, 2002, at 8:20:08
In reply to Re: % » hawkeye, posted by pharmrep on September 20, 2002, at 20:22:45
OOPS! My mistake. should read 10mgs (not 20mgs). No. 10mgs was not OK. My last message should read:
" Hi. I have been taking Lexapro (10mg/day) for two weeks. I did drop to 5mgs/day for a couple of days, but then returned to 10mgs. I have also stopped taking Lamictal to see if it was playing any role in the sexual dysfunction that I have been experiencing since starting Lexapro.
>
> HERE's The GOOD NEWS: For me, this is a terrific drug for alleviating depression. I really feel better than I have for a very long time!
>
> HERE's the BAD NEWS: Sexual Dysfunction
>
> So I am faced with the proverbial Hobsian's Choice. Sex or Depression.
>
> Tomorrow I am going to cut back to 5mgs/day. I'll let you know what happens."
Posted by URCONFUSED on September 21, 2002, at 16:39:34
In reply to Re: LEXAPRO/lobotomy » sjb, posted by johnj on September 17, 2002, at 9:18:55
HO HO HO! I never heard being on an SSRI being compared to a "lobotomy." Always something funny on these message boards to make me laugh. Id say comparing an SSRI to a lobotomy is kinda ridiculous to say the least.
For most depressives, SSRIs will do the opposite. Make your feelings, emotions and senses come back to life. While Im no big fan of "Lexapro" as I feel all the hype about it is unneeded (its just another SSRI afterall), I cant see comparing it to a lobotomy.
URCONFUSED
Posted by babs on September 21, 2002, at 17:54:35
In reply to Re: LEXAPRO/lobotomy...HAHAHA!!!!, posted by URCONFUSED on September 21, 2002, at 16:39:34
OK. I had two good days on lexapro and then felt sick all over again this afternoon. vomiting, nausea, dizziness. I talked to my pdoc and he wants me to discontinue taking Wellbutrin and Risperdal for a few days to see if it's the Lexapro. Is anyone else having these problems? Mentally I feel fine but physically is another story.
Posted by Roman on September 21, 2002, at 18:24:35
In reply to feeling ill again, posted by babs on September 21, 2002, at 17:54:35
I wonder what physiological effects can be attributed to the Celexa R-enantiomer. Wouldn't it be interesting to know if you're experiencing withdrawal from half of your previous Celexa therapy?
Since the R-enantiomer is blamed for much of Celexa's s/e profile, it can't be inert. Therefore, a physiological response to the sudden absense of half the Celexa molecule (30mg R-enantiomer) is possible.
What do you think?
Hope you feel better soon!
Posted by pharmrep on September 21, 2002, at 19:06:34
In reply to Re: feeling ill again » babs, posted by Roman on September 21, 2002, at 18:24:35
> I wonder what physiological effects can be attributed to the Celexa R-enantiomer. Wouldn't it be interesting to know if you're experiencing withdrawal from half of your previous Celexa therapy?
>
> Since the R-enantiomer is blamed for much of Celexa's s/e profile, it can't be inert. Therefore, a physiological response to the sudden absense of half the Celexa molecule (30mg R-enantiomer) is possible.
>
> What do you think?
>
*** interesting concept...although i cant swear it isnt possible, neither Celexa (nor Lexapro) have been associated with discontinuation syndrome (like paxil and effexor can be) The 1st few weeks is usually the toughest to adjust to any new med (hang in there)
Posted by hawkeye on September 21, 2002, at 19:40:53
In reply to Re: LEXAPRO » hawkeye, posted by pharmrep on September 14, 2002, at 9:57:47
Does this data mean that approx. 7mgs of Lexapro is the functional equivalent of 40mgs of Celexa?
[7mgs of Lex. raises brain seretonin by %2100;
40mgs of Cel raises brain seretonin by %2000"The new study shows that Lexapro (the S-enantiomer of citalopram), when given at 2 mg/kg subcutaneously (s.c.), was more than twice as potent as Celexa at 4 mg/kg s.c. (2.0 mg/kg S-enantiomer + 2.0 mg/kg R-enantiomer) in increasing brain serotonin levels (about 300 percent vs. 200 percent, respectively). In contrast to Lexapro, the R-enantiomer of citalopram, when given at 2.5 mg/kg s.c., did not increase brain serotonin levels."
http://biz.yahoo.com/prnews/020624/nym009_1.html
It has been my understanding that while 40mgs of Celexa is the recomended dosage, that comparable results may also be obtained at 20mgs.
"In a 6-week fixed-dose study, patients received citalopram, 20 or 40 mg/day, or placebo (n=64 to 70 per group). Patients treated with citalopram 40 mg/day, showed significantly greater improvement than placebo-treated patients. The difference between the lower dose of citalopram and placebo was not significant. "
"The effectiveness of citalopram in preventing relapse was assessed in two long-term studies. Depressed patients who responded to citalopram during an initial 6 or 8 weeks of acute treatment (fixed doses of 20 or 40 mg/day in one study and flexible doses of 20-60 mg/day in the second study) were randomized to continue on citalopram or receive placebo. The number of patients who received citalopram and placebo was 257 and 116, respectively. In both studies, patients who continued on citalopram experienced significantly lower relapse rates over the subsequent 6 months compared to those receiving placebo. In the fixed-dose study, the relapse rates were similar at the 20 and 40 mg/day doses, namely 10% and 12%, respectively. "
http://www.mentalhealth.com/drug/p30-c04.html#Head_3
So, maybe 5mgs of Celexa Professional Edition will be more than enough.
Posted by hawkeye on September 21, 2002, at 19:44:21
In reply to Question for PharmRep Re: Dosage Equivalent Celexa, posted by hawkeye on September 21, 2002, at 19:40:53
Calculations are Wrong.
Sorry
Posted by hawkeye on September 21, 2002, at 20:04:33
In reply to Re: LEXAPRO » hawkeye, posted by pharmrep on September 14, 2002, at 9:57:47
Does this data mean that approx. 7mgs of Lexapro is the functional equivalent of 20mgs of Celexa?
[7mgs of Lex. raises brain seretonin by %1050;
20mgs of Cel raises brain seretonin by %1000"The new study shows that Lexapro (the S-enantiomer of citalopram), when given at 2 mg/kg subcutaneously (s.c.), was more than twice as potent as Celexa at 4 mg/kg s.c. (2.0 mg/kg S-enantiomer + 2.0 mg/kg R-enantiomer) in increasing brain serotonin levels (about 300 percent vs. 200 percent, respectively). In contrast to Lexapro, the R-enantiomer of citalopram, when given at 2.5 mg/kg s.c., did not increase brain serotonin levels."
http://biz.yahoo.com/prnews/020624/nym009_1.html
It has been my understanding that while 40mgs of Celexa is the recomended dosage, that comparable results may also be obtained at 20mgs.
"The effectiveness of citalopram in preventing relapse was assessed in two long-term studies. Depressed patients who responded to citalopram during an initial 6 or 8 weeks of acute treatment (fixed doses of 20 or 40 mg/day in one study and flexible doses of 20-60 mg/day in the second study) were randomized to continue on citalopram or receive placebo. The number of patients who received citalopram and placebo was 257 and 116, respectively. In both studies, patients who continued on citalopram experienced significantly lower relapse rates over the subsequent 6 months compared to those receiving placebo. In the fixed-dose study, the relapse rates were similar at the 20 and 40 mg/day doses, namely 10% and 12%, respectively. "
http://www.mentalhealth.com/drug/p30-c04.html#Head_3
So, maybe 5mgs of Celexa Professional Edition will be enough. Or, 7mgs will be more than enough (by dividing a 10mg tablet and then subdividing one half again)
Posted by Alice Anne on September 21, 2002, at 23:43:32
In reply to feeling ill again, posted by babs on September 21, 2002, at 17:54:35
Hi babs, I'm still playing around with my 2.5 mgs. and not having fun yet. Weird pressure headache, spaciness--just not comfortable. I feel like there's a band of led behind my eyes. I imagine at the full 10mgs. I'd be quite a case. But your two good days were a good sign. Hope you feel better.
Posted by pharmrep on September 21, 2002, at 23:59:42
In reply to Question for PharmRep Re: Dosage Equivalent Celexa, posted by hawkeye on September 21, 2002, at 19:40:53
> Does this data mean that approx. 7mgs of Lexapro is the functional equivalent of 40mgs of Celexa?
>
> [7mgs of Lex. raises brain seretonin by %2100;
> 40mgs of Cel raises brain seretonin by %2000
>
> "The new study shows that Lexapro (the S-enantiomer of citalopram), when given at 2 mg/kg subcutaneously (s.c.), was more than twice as potent as Celexa at 4 mg/kg s.c. (2.0 mg/kg S-enantiomer + 2.0 mg/kg R-enantiomer) in increasing brain serotonin levels (about 300 percent vs. 200 percent, respectively). In contrast to Lexapro, the R-enantiomer of citalopram, when given at 2.5 mg/kg s.c., did not increase brain serotonin levels."
>
> http://biz.yahoo.com/prnews/020624/nym009_1.html
>
> It has been my understanding that while 40mgs of Celexa is the recomended dosage, that comparable results may also be obtained at 20mgs.
>
> "In a 6-week fixed-dose study, patients received citalopram, 20 or 40 mg/day, or placebo (n=64 to 70 per group). Patients treated with citalopram 40 mg/day, showed significantly greater improvement than placebo-treated patients. The difference between the lower dose of citalopram and placebo was not significant. "
>
> "The effectiveness of citalopram in preventing relapse was assessed in two long-term studies. Depressed patients who responded to citalopram during an initial 6 or 8 weeks of acute treatment (fixed doses of 20 or 40 mg/day in one study and flexible doses of 20-60 mg/day in the second study) were randomized to continue on citalopram or receive placebo. The number of patients who received citalopram and placebo was 257 and 116, respectively. In both studies, patients who continued on citalopram experienced significantly lower relapse rates over the subsequent 6 months compared to those receiving placebo. In the fixed-dose study, the relapse rates were similar at the 20 and 40 mg/day doses, namely 10% and 12%, respectively. "
>
> http://www.mentalhealth.com/drug/p30-c04.html#Head_3
>
> So, maybe 5mgs of Celexa Professional Edition will be more than enough.** great question. 10mg of Lex is at least as efficacious as 40mg of cx...but with less s/e, less drug to drug interactions, and less discontinuation due to adverse events, and will work as fast as 1-2 weeks for most people. It is linear, however...5mg will not work as fast, and is not the recommended starting dose. In general, for most drugs many doctors reduce dosages to avoid side effects, but since Lexapro at 10mg is "comparable to placebo" it shouldnt be needed. In the Dr's I've seen...I would say 95%+ are starting w/ 10mg...only a few have gone to 20mg (only 2 weeks out now) and maybe a few Dr's are just "set in there ways" and are starting with 5mg (for a week or so...then up to 10mg) So far...I have only heard good responses from them, but most of their patients havent been back for their "monthly" visit...I'll hear more in about 2 weeks or so.
PS...the starting dose for celexa was 20mg (62% of patients stayed there)...40mg was at about 30% (for a total of 92% of all Celexa prescriptions...the last 8% were at 60mg or higher.) I think Lexapro at 10mg will be effective for 80%+ of patients...then 15mg+ will make up the last 20%
Posted by Dr. Bob on September 22, 2002, at 0:00:12
In reply to Re: LEXAPRO/lobotomy...HAHAHA!!!!, posted by URCONFUSED on September 21, 2002, at 16:39:34
> URCONFUSED
Sorry, but I'd like you to choose a name that's less likely to lead others to feel accused or put down. Thanks,
Bob
PS: Follow-ups regarding posting policies should be redirected to Psycho-Babble Administration; otherwise, they may be deleted.
Posted by pharmrep on September 22, 2002, at 0:07:15
In reply to CORRECTED POST (I Think), posted by hawkeye on September 21, 2002, at 20:04:33
> Does this data mean that approx. 7mgs of Lexapro is the functional equivalent of 20mgs of Celexa?
>
> [7mgs of Lex. raises brain seretonin by %1050;
> 20mgs of Cel raises brain seretonin by %1000
>
> "The new study shows that Lexapro (the S-enantiomer of citalopram), when given at 2 mg/kg subcutaneously (s.c.), was more than twice as potent as Celexa at 4 mg/kg s.c. (2.0 mg/kg S-enantiomer + 2.0 mg/kg R-enantiomer) in increasing brain serotonin levels (about 300 percent vs. 200 percent, respectively). In contrast to Lexapro, the R-enantiomer of citalopram, when given at 2.5 mg/kg s.c., did not increase brain serotonin levels."
>
> http://biz.yahoo.com/prnews/020624/nym009_1.html
>
> It has been my understanding that while 40mgs of Celexa is the recomended dosage, that comparable results may also be obtained at 20mgs.
>
> "The effectiveness of citalopram in preventing relapse was assessed in two long-term studies. Depressed patients who responded to citalopram during an initial 6 or 8 weeks of acute treatment (fixed doses of 20 or 40 mg/day in one study and flexible doses of 20-60 mg/day in the second study) were randomized to continue on citalopram or receive placebo. The number of patients who received citalopram and placebo was 257 and 116, respectively. In both studies, patients who continued on citalopram experienced significantly lower relapse rates over the subsequent 6 months compared to those receiving placebo. In the fixed-dose study, the relapse rates were similar at the 20 and 40 mg/day doses, namely 10% and 12%, respectively. "
>
> http://www.mentalhealth.com/drug/p30-c04.html#Head_3
>
> So, maybe 5mgs of Celexa Professional Edition will be enough. Or, 7mgs will be more than enough (by dividing a 10mg tablet and then subdividing one half again)** if Lexapro is "comparable to placebo" with side effects, adverse events, and has a quick onset...why are you wanting to use less? I know that not everybody responds the same, and that 10mg will work for the majority of people...using less than 10mg should be for those patients in the minority who are showing a "sensitivity" different than most other people. Wouldnt you agree?
Posted by IsoM on September 22, 2002, at 1:43:56
In reply to Re: LEXAPRO/lobotomy...HAHAHA!!!!, posted by URCONFUSED on September 21, 2002, at 16:39:34
URCONFUSED, a lot of people seem to have a flattening of emotions on SSRIs. It's not that unusual. I'm not affected like that - emotions are sharper & more real for me but when I was talking to my biology prof once (she's about my age & we got along great) about anti-depressants, she said when she was prescribed an SSRI briefly, she felt strangely unmoved by anything. Things that would normally make her sad (or happy) instead made her completely detached with a "could care less" attitude. She didn't like the blunting effect & discontinued them. I've also heard that from a few others who've taken SSRIs. Don't be too quick to discount other's reactions, even if yours aren't similar.
Posted by IsoM on September 22, 2002, at 1:53:13
In reply to Re: feeling ill again » Roman, posted by pharmrep on September 21, 2002, at 19:06:34
Pharmrep, I'm sure I'm unusual, though not unique, with my senstivity to stopping SSRIs. I NEVER lost my symptoms when stopping Paxil, even after almost 1/2 year & switching over to Celexa. I ended up going back on 5 mg to keep symptoms at bay. It was only when I started adrafinil that the symptoms went & didn't come back & I was able to quit the Paxil completely.
But even with Celexa, if I miss the dose as I did one day in a rush to make an appointment, I can feel the beginnings of vertigo, queasiness, & a degree of malaise. I normally take my Celexa first thing in the morning but didn't that day till evening. I was starting to feel pretty weird. And yes, it was the same discontinuation symptoms, not illness. I never get sick, colds, or anything else, so I know for a certainty what it was.
So I suppose in more susceptible persons, discontinuation problems may arise with stopping any SSRI.
Posted by hawkeye on September 22, 2002, at 7:05:02
In reply to why/see bottom » hawkeye, posted by pharmrep on September 22, 2002, at 0:07:15
".why are you wanting to use less?"
Because at 10 mgs I was having unacceptable sexual side effects. Because the drug is working so well for my depression I am trying to find a way to keep with it.
One additional thought, You say that at 5mg the onset of the anti-depressant effect is slower than at 10mg. Perhaps the way to go for those who are known to be sensitive to this drug from their experience with Celexa would be to start at 10mgs to get a rapid antidepressant response and then cut back to 5mg to reduce the side effects.
Bummer for me that I am having these side effects at 10mgs/day. For me the side effects at 10 mgs of Lexapro are as severe as they were at 40mgs of Celexa.
Posted by babs on September 22, 2002, at 9:47:59
In reply to Re: why/see bottom, posted by hawkeye on September 22, 2002, at 7:05:02
Just wanted to say thanks to eveyone for your support and input! I'll keep you posted.
Posted by pharmrep on September 22, 2002, at 10:26:10
In reply to Re: discontinuation syndrome with Celexa » pharmrep, posted by IsoM on September 22, 2002, at 1:53:13
> Pharmrep, I'm sure I'm unusual, though not unique, with my senstivity to stopping SSRIs. I NEVER lost my symptoms when stopping Paxil, even after almost 1/2 year & switching over to Celexa. I ended up going back on 5 mg to keep symptoms at bay. It was only when I started adrafinil that the symptoms went & didn't come back & I was able to quit the Paxil completely.
>
> But even with Celexa, if I miss the dose as I did one day in a rush to make an appointment, I can feel the beginnings of vertigo, queasiness, & a degree of malaise. I normally take my Celexa first thing in the morning but didn't that day till evening. I was starting to feel pretty weird. And yes, it was the same discontinuation symptoms, not illness. I never get sick, colds, or anything else, so I know for a certainty what it was.
>
> So I suppose in more susceptible persons, discontinuation problems may arise with stopping any SSRI.** As I said before...I can not like most of you...refer to specific syptoms like you all can since I am not taking an AD. I can only speak in generalities...and only be specific when speaking with each of you individually. So if I seem to speak about "majority" often...dont think I am leaving you out, I care about how you are doing and what reactions you have. I just normally work with large numbers of patients and doctors and refer to pooled info a lot, good luck to all and hang in there
Posted by Alan on September 22, 2002, at 11:01:11
In reply to generalities » IsoM, posted by pharmrep on September 22, 2002, at 10:26:10
> ** As I said before...I can not like most of you...refer to specific syptoms like you all can since I am not taking an AD. I can only speak in generalities...and only be specific when speaking with each of you individually. So if I seem to speak about "majority" often...dont think I am leaving you out, I care about how you are doing and what reactions you have. I just normally work with large numbers of patients and doctors and refer to pooled info a lot, good luck to all and hang in there
============================================Therein lies the problem.
Statistics don't apply to individual cases. So when using statistics to reply to an individual the practice at some level is meaningless - particularly re: individual side effects.
Posted by Ritch on September 22, 2002, at 11:07:14
In reply to Re: why/see bottom, posted by hawkeye on September 22, 2002, at 7:05:02
> ".why are you wanting to use less?"
>
> Because at 10 mgs I was having unacceptable sexual side effects. Because the drug is working so well for my depression I am trying to find a way to keep with it.
>
> One additional thought, You say that at 5mg the onset of the anti-depressant effect is slower than at 10mg. Perhaps the way to go for those who are known to be sensitive to this drug from their experience with Celexa would be to start at 10mgs to get a rapid antidepressant response and then cut back to 5mg to reduce the side effects.
>
> Bummer for me that I am having these side effects at 10mgs/day. For me the side effects at 10 mgs of Lexapro are as severe as they were at 40mgs of Celexa.
Hawkeye,When I was started on Celexa for the first time a few years ago-when it was available in the US for the first time-I started at 10mg (half a 20mg tab) first off. I felt better, had some side effects, but they weren't real bad. Then later on as my depression worsened (mid-winter bpII seasonal), my pdoc had me up it to 20mg. I felt a *little* better, but my side effects got a lot worse, so I backed down to 10mg and added some Wellbutrin (which did the trick). Anyhow, over about 3 years of being on and off Celexa (most on-and with other AD's,etc.), I found that 5mg and 10mg of Celexa felt pretty much the same (but with 5mg being much more tolerable). Even 2.5 didn't feel much different than 5.0mg. So, in my experience, the range of 2.5-10mg felt little different except for s/e. I think they need to put a score on those 5mg tabs of Lexapro. If they do, I might give Lexapro a try. Even scored *2.5mg* tabs would be neat (esp. for those that take other meds with it).
Mitch
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