![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 727 to 751 of 8406. Go back in thread:
Posted by shakingoscar on October 10, 2002, at 1:12:15
In reply to Re: Weird question for anyone concerning lexapro, posted by Satori on October 9, 2002, at 16:45:06
I too have been a regular pot smoker for years now, and since having depression and anxiety, for the last 2 years, Ive had to really cut down my smoking habits (used to smoke pot daily).
I find that if I smoke pot continually for a few weeks I become very depressed and anxious and it take another few weeks of not smoking pot to recover (about 3 weeks to recover).
Now I only smoke very occasionally to de-stress, but for me, it does have a bad effect on my illness.
Apparently it is because cannabis is associated with lowering of serotonin which is precisely what you dont want when you are depressed!!
Good luck, but my advice is stay away from the pot and give it a few weeks to recover.
Pot can take quite a while to be elimated from your system....
Posted by jane d on October 10, 2002, at 1:13:06
In reply to Re: there is no Lexapro-Toprol interaction /bottom » jane d, posted by pharmrep on October 8, 2002, at 0:43:06
You know I actually re-downloaded the prescribing information from the Lexapro site to see if it had been changed and you were looking at a different version. You aren't. So i'll try to show you what I saw there that you apparently didn't see.
The prescribing information is from: http://www.lexapro.com/home/default.asp under prescribing information.
PHARMREP SAID:
>>Did you read the Package Insert? it states "coadministration of lexapro and metoprol had no clinically significant effects on blood pressure or heart rate." Under the "drug interactions" section...10+ "common" meds are mentioned to show that they were specifically looked at...and none of them had "interactions." So what are you referring too?Sorry Pharmrep. We seem to have some misunderstandings here but I'll try to explain. I'm talking here about the drug interactons section that starts on page 4. One thing I found interesting is that metoprolol was NOT listed alongside that list of drugs that are not supposed to interact significantly (and it actually doesn't always say that if you read closely). They are lumped together and then you get a paragraph explaining that there is some 2D6 inhibition and saying "caution is indicated in coadministration of escitalopram(lexapro) and drugs metabolized by CYP2D6".
(By the way, if you don't really understand the CYP 450 enzyme system this is a great place to ask. There are a lot of posters here who are great at explaining that kind of thing. I'm not one of them unfortunately.)
The drugs metabolized by CYP2D6 include Toprol and, in fact, Toprol now gets it's own section. It does indeed say that there was a study where giving Toprol and Lexapro at the same time did not increase the patients heart rate or blood pressure. But it also says that this raises the level of Toprol found in the blood. And that increased levels of Toprol may effect how the Toprol works. The one thing it does NOT say is that there is NO interaction. It makes me a little nervous that you are taking a position that your own employer was unwilling to (or perhaps not legally permitted) to take.
By the way, the post by JLM also describes a possible interaction of a totally different kind (and a quick check of medline will get you more of the same). Remember the CYP 450 system is only one possible source of interactions.
Please don't take this as an attack on Lexapro or a statement that no one can combine the drugs at all. If I were facing this choice myself I might decide that I cared about the study on heart rate more than the one on blood levels - although I'd want to see the study, how many people were involved, and think about what other drugs I was taking before making that decision. I don't have a problem with you pointing out both facts or even with you giving an explanation for why you would give one more weight than the other. That's not the same as providing only half the facts or saying "there is no interaction" which doesn't help anyone make their own decision.
Jane
PS. Does anyone have an opinion on whether metoprolol should be counted as a CNS drug. I doesn't seem to be listed as one but it seems to me that it should be.
Posted by shakingoscar on October 10, 2002, at 1:18:54
In reply to Forest, posted by Mr.Scott on October 9, 2002, at 21:10:12
Mr Scott,
may I ask what business it is of yours?pharmrep,
I appreciate your presence here, please stay.Cheers
Posted by jane d on October 10, 2002, at 1:19:23
In reply to me » Ippopo, posted by pharmrep on October 8, 2002, at 1:41:13
Pharmrep,
How long have you worked for Forest? Did you start with the Lexapro push? And did you work in the industry before that? I have noticed that you have learned quite a bit since you started posting here.
Jane
> *** I am a pharmaceutical rep for Forest (makers of Celexa and Lexapro). I found this site about 2-3 months ago...
Posted by Ippopo on October 10, 2002, at 1:26:33
In reply to Re: I AM GOING BACK, posted by shakingoscar on October 10, 2002, at 1:07:33
I Knew there was someone on a higher dose of Lexapro but couldn't remember who. I was just about to shut down when...
Anyway, after crying at the Doc's office today because I thought I'd feel more improvement after three weeks and after he told me to up the dossage to 20mgs, he said I should just quick taking medication /go into the hospital/see someone else.
I took 10mg during an early dinner. I'm going to take 20mg with breakfast. After 7hrs of the 10mg I feel no s/e. Is it still going to take a few days to feel anything if it does infact prove to be the proper dossage?
Posted by viridis on October 10, 2002, at 1:33:45
In reply to Re: AD's vs. Bzds for Anxiety disorders » Alan, posted by johnj on October 9, 2002, at 22:36:23
For me, Klonopin (a bzd) greatly reduced depression. I'm sure the causes of depression vary among individuals, but in my case the pattern was typically a period of severe anxiety, followed by a crash into intense depression (often very agitated depression). By stopping the anxiety, it seems that Klonopin (and occasional Xanax) prevent the episodes that precipitate serious depression for me. I did continue to experience some mild depression after starting K, but nothing like before. A low dose of Adderall cleared this up, and has also helped my attention and focus.
By the way, I had a terrible time with the SSRIs I tried, and also Wellbutrin, even at tiny doses -- wild mood swings, agitation, multiple other side effects etc. But I know people who do extremely well on SSRIs and other ADs for depression and anxiety. It just goes to show how differently individuals respond to various meds. The variation in response strongly supports the idea that there are many biological causes of depression and anxiety -- it doesn't all revolve around serotonin, as many doctors still seem to think.
Posted by shakingoscar on October 10, 2002, at 2:38:44
In reply to Re: I AM GOING BACK, posted by Ippopo on October 10, 2002, at 1:26:33
Hi lppopo
Im sorry you are suffering too... I am feeling better today, but as Ive been up and down for the last couple of weeks, I dont have any answers for you.
My situation is different. My supid doctor over-prescribed my dose and STARTED me on 30mg which I took for 4 weeks and became really ill because of.
8 days ago I lowered my dose to 15mg in light of the information I received here. I am still up and down but I think maybe the general direction is improvement...
The only advice I can offer you, from having tried all of the SSRIs, is that patience usually pays dividends, so give it a good shot.
When I first became ill (really severe anxiety) it took me 3 months to settle down on Paxil!!! But the wait was definitely worth it in the end.
Stick with it.
Good luck
Posted by maririp on October 10, 2002, at 7:31:03
In reply to Forest, posted by Mr.Scott on October 9, 2002, at 21:10:12
> Pharmrep,
>
> Does Forest know how much time you spend on this website talking "directly to patients"? I wonder what the legal ramifications are. Hmmm...I'll have to get in touch with some of my med-reg/DDMAC friends who will know.
>LOL!!!! at mr scott...are you bothered by pharmrep? I think its a good thing that he is interested in the how people are reacting to the meds he represents..and after all its a free country :-)
Posted by maririp on October 10, 2002, at 7:41:42
In reply to Re: Weird question for anyone concerning lexapro » johnj, posted by ANXIETY ANN on October 9, 2002, at 22:26:18
> johnj-i think your attitude about meds is great. i also suffer from severe anxiety and panic attacks. i take xanax fot the attacks and adivan for anxiety. just started taking lexapro because docs want me off of bzs.do you take any BZs? how long have you been on lexapro and has it helped the anxiety? panic attacks ?
> thanks for your inputHi..I also suffered from anxiety disorder since 1986..I went through agoraphobia..In time with help of therapist I learned to not be afraid of the attacks..the fear of them was the worst. I still have xanax on hand but do not depend on it on a daily basis. I recently started lexapro and I have noticed a huge change in my anxiety..It has helped me a great deal. I have been on it 3 weeks.
Posted by dr. dave on October 10, 2002, at 8:10:49
In reply to Re: Technical questions /bottom. » JLM, posted by pharmrep on October 9, 2002, at 16:18:08
The relative side-effects of Lexapro and Celexa are as follows
Side effect..........................Lexapro..............CelexaHeadache............................15.8%..............19.9%
Nausea................................15.0%..............17.2%
Ejaculation disorder..............9.3%(of men)...8.8%
Insomnia..............................9.2%................8.6%
Diarrhoea.............................8.0%...............10.8%
Somnolence.........................6.9%................4.7%
Mouth dry............................6.2%...............8.1%
Upper resp tract infection.....6.2%...............3.9%
Dizziness..............................6.0%...............5.6%
Flu-like symptoms................5.0%...............6.1%
Rhinitis.................................4.9%...............5.6%
Sinusitis................................4.3%...............5.1%
'Overall, the type and frequency of TEAEs (treatment-emergent adverse events) reported with escitalopram and citalopram were very similar, and are in line with AEs reported for citalopram previously. For the TEAEs listed (above) there were no statistically significant differences for incidences of these events between the escitalopram and citalopram treatment groups.'
This is the official information from Lundbeck about relative side-effects. I wonder if you still stand by the comments that Lexapro has fewer side-effects than Celexa, and that Celexa causes somnolence while Lexapro does not?
Posted by Anyuser on October 10, 2002, at 8:41:01
In reply to Lexapro and Celexa relative side-effects » pharmrep, posted by dr. dave on October 10, 2002, at 8:10:49
From docguide.com:
"Escitalopram 10 to 20 mg/day for treatment of moderately to severely depressed subjects showed ongoing and increasing efficacy throughout a 12-month, open-label study conducted at 97 sites.
"The study's findings were reported at the 15th Congress of the European College of Neuropsychopharmacology (ECNP).
"'The remission rate among the subjects continuing in the open-label study reached 86 percent by week 52,' said lead investigator Alan Wade, MBChB, director at the CPS Clinical Research Centre, in Glasgow, United Kingdom. 'This long-term, primary care-based data begins to fill out the picture of escitalopram as a drug that raises the bar of expectations for effective and tolerable treatment of this group of patients.'"
This study was funded by Lundbeck.
Do you think this is news? Good science?
I wish we could see the data re clinical experience, but it is not reported.
Posted by johnj on October 10, 2002, at 8:52:42
In reply to Re: Weird question for anyone concerning lexapro, posted by maririp on October 10, 2002, at 7:41:42
HI,
I have been on nortryptline(pamelor) 50 mg for 10 years and tranzene( an ok benzo), and lithium for the same amount of time. My problem is I cannot work out and the culprit seems to point to The TCA. That is why I want to change. I have received 14 days of 10 mg of lexapro, but have not taken it yet. I have an exam in two weeks and cannot afford any side effects that could be harmful. My goal is to find somehting, maybe lexapro, that will allow me a better AD effect without so many s/e. Lexapro looks to be worth a try. I would prefer changing benzo's, but my doc says no. In November I will be giving lexapro a try, not sure if I will go 5 mg or 10 to start with.
johnj
Posted by Ippopo on October 10, 2002, at 8:56:23
In reply to Re: I AM GOING BACK, posted by shakingoscar on October 10, 2002, at 2:38:44
Shakingoscar, Thank you for your response. I am so curious and understand little. When you or others talk of anxiety, what does this mean?
When you became ill from being overprescribed, what were the effects? Were they a magnified version of all the listed s/es?
As far as sexual side effects...Aside from not being in a relationship and being depressed, my drive is little or next to nothing. I am much more concerned with being able to walk down the street and be happy/content again.....or is this going to be first time?
Did your thoughts feel jumbled and almost contridictory? Am I begining to sound like a poorly written romance novel?
Posted by johnj on October 10, 2002, at 8:59:25
In reply to Lexapro and Celexa relative side-effects » pharmrep, posted by dr. dave on October 10, 2002, at 8:10:49
Were these numbers based on equivalent doses? For example, if you need less lexapro than celexa maybe the side effects are less. Isn't this true for most AD's? The higher I go on pamelor the WORSE the s/e. So, is this a fair comparison because I don't know??? If the %'s that you stated were for 20 mg of lexa and 20 of celexa how fair a comparison is this? Am I missing something Dr. Dave? Sometimes I really get the feeling you hate celexa and lexapro.
johnj
Posted by Ippopo on October 10, 2002, at 9:02:18
In reply to Re: Forest » Mr.Scott, posted by maririp on October 10, 2002, at 7:31:03
Cheers!
Posted by shakingoscar on October 10, 2002, at 9:18:35
In reply to Lexapro and Celexa relative side-effects » pharmrep, posted by dr. dave on October 10, 2002, at 8:10:49
Hi Dr Dave,
I would just like to say one thing.I find I sleep fine on lexapro, and can take it before bedtime and still sleep well.
With citalopram, I could never take it in the evening because I find it far more stimulating than lexapro.
In fact, I am hoping I can stop taking trazodone which I have always needed with SSRIs because I find them so stimulating (except Paxil/seroxat)
Cheers
Posted by mills on October 10, 2002, at 9:21:16
In reply to Anxiety, depression, indecision, posted by Micki on October 9, 2002, at 21:13:21
My depression is related to long term compulsive introspection, worry, self-consciousness, labored thinking, second-guessing, etc., etc., that I have labored under for 25 years, and I can't stop on my own; I haven't been on Lexapro long enough to know how it will work, but Paxil (another SSRI) saved my life, although it had unacceptable side effects; it did help with my OCD and chronic worry
> I am just switching to Lexapro after taking Pamelor for 12 years. I have been on and off antidepressants since I was a teenager. I have always had a difficult time making decisions, and am currently in a state of extreme stress and anxiety over a situation in my love life--choosing which of two people to get involvoed with. I think about it constantly, think I've made a decision, then change my mind the next hour or day. I went to a new psychiatrist who felt this is a form of OCD (although I do not have symptoms such as washing my hands repeatedly).
>
> I lowered the Pamelor, went off it for a few days, took 5 mg Lexapro (mornings) for 3 days and now have taken 10 mg Lexapro for 3 days. I thought I felt better yesterday, today I am extremely stressed out and depressed again. The psychiatrist said the drug should help with the depression in about a 3 or 4 weeks, but that it takes 8 to 12 weeks for it to really affect the obsessive thinking. Anyone have any feedback on how accurate this is? Also, after reading Alan's post about AD's vx BZD's for anxiety disorders, I'm wondering how likely the Lexapro is to help with the anxiety, or if I really need a Bzd. Also wondering if anyone has any comments on Lexapro (or another SSRI) and decision making. I have a terrible time making decisions, and then often think I've made the wrong one and torment myself with second-guessing.
Posted by shakingoscar on October 10, 2002, at 9:30:03
In reply to Re: I AM GOING BACK, posted by Ippopo on October 10, 2002, at 8:56:23
Hi lppopo
For me, anxiety produces many physical symptoms which are:
tremors - inside feels like its shaking
sweating excessively
palpitations
back ache!!!
painfully tight chestIf the anxiety is really bad, I get severe headaches, facial flushing, heavier sweating, loss of balance, confusion, dizziness.. you name it!
Different people suffer anxiety in different ways because each individual can respond to the illness differently.
WRT sexual side effects, for the first 18 months of my illness, relationships and intimacy are just out of the question... For me at least, I think, if Im not happy with me, how can I expect anyone else to be? I dont want to "carry baggage" into a relationship.
However, I brought about my illness through excessive street drug use when I was younger which has knocked my brain chemistry off balance.
Therefore, it is reasonable to think that I should get better, but Im still waiting for that day!
Now that the anxeity and depression are reasonably under control - ie I can work and function almost normally, the natural progression of that is the need for a relationship etc... so the sexual s/e become an issue then ofcourse...
I have always had a really high sex drive and feel like a neutuered (sp?) cat on these pills.
The main mental thought process that causes me problems but I have overcome it with CBD therapy is the thought of imminent disaster when Im in a panic-stricken state (I have suffered with panic attacks too, but not since Ive been on SSRIs).
It is helpful to learn how to cope with the feelings of impending doom, and the pills help with this, but CBT is far more powerful in dealing with actual thought processes. For me, unfortunately, my anxiety is not just based on bad thoughts, but also on chemical imbalance, as already mentioned above, so for many people, therapy + pills are the best solution.
Good luck and be patient and try to think to the future (which is easier said than done ofcourse)
Posted by mills on October 10, 2002, at 9:35:51
In reply to Re: I AM GOING BACK, posted by shakingoscar on October 10, 2002, at 2:38:44
I wholeheartedly agree with oscar on this one; it took me a full 6 weeks plus on Paxil to get any relief from ocd/anxiety/depression, and then I had to work for that much more to regulate the dosage, but once I got it, I found relief and was able to be happy for the first time in a long long time; these medications take patience, at least Paxil does, so hang in there
> Hi lppopo
>
> Im sorry you are suffering too... I am feeling better today, but as Ive been up and down for the last couple of weeks, I dont have any answers for you.
>
> My situation is different. My supid doctor over-prescribed my dose and STARTED me on 30mg which I took for 4 weeks and became really ill because of.
>
> 8 days ago I lowered my dose to 15mg in light of the information I received here. I am still up and down but I think maybe the general direction is improvement...
>
> The only advice I can offer you, from having tried all of the SSRIs, is that patience usually pays dividends, so give it a good shot.
>
> When I first became ill (really severe anxiety) it took me 3 months to settle down on Paxil!!! But the wait was definitely worth it in the end.
>
> Stick with it.
>
> Good luck
Posted by Abacus on October 10, 2002, at 9:47:21
In reply to Re: lexapro and blood pressure » pharmrep, posted by ANXIETY ANN on October 9, 2002, at 21:56:49
I too feel like a zombie during the day. Please let us know how taking it at night works. Thanks.
Posted by dr dave on October 10, 2002, at 12:06:48
In reply to Lexapro news » dr. dave, posted by Anyuser on October 10, 2002, at 8:41:01
It sounds like good news. I don't have comparative data to hand to know whether this
represents a significant improvement over other antidepressants though.As to whether it's good science, that's the $64,000 dollar question, and we have no way of knowing without seeing the details of the actual study. If the study is flawed, the information may be worthless. If it's a sound study, then it's potentially very useful.
What we've got is a marketing claim which may or may not be true. We need to see the details before we can accept it. That's only common sense, in my view.
> From docguide.com:
>
> "Escitalopram 10 to 20 mg/day for treatment of moderately to severely depressed subjects showed ongoing and increasing efficacy throughout a 12-month, open-label study conducted at 97 sites.
>
> "The study's findings were reported at the 15th Congress of the European College of Neuropsychopharmacology (ECNP).
>
> "'The remission rate among the subjects continuing in the open-label study reached 86 percent by week 52,' said lead investigator Alan Wade, MBChB, director at the CPS Clinical Research Centre, in Glasgow, United Kingdom. 'This long-term, primary care-based data begins to fill out the picture of escitalopram as a drug that raises the bar of expectations for effective and tolerable treatment of this group of patients.'"
>
> This study was funded by Lundbeck.
>
> Do you think this is news? Good science?
>
> I wish we could see the data re clinical experience, but it is not reported.
Posted by dr dave on October 10, 2002, at 12:20:11
In reply to Re: Lexapro and Celexa relative side-effects » dr. dave, posted by johnj on October 10, 2002, at 8:59:25
This is the combined data for everyone on any dose of either drug. The average doses were equivalent, in that the average dose of Celexa was about twice that of Lexapro. It is Lundbeck's view, not only mine, that these doses were equivalent. The data show that whether you take s-citalopram alone (eg Lexapro 10mg) or in combination with an equal amount of r-citalopram (eg Celexa 20mg), there is no difference in the side-effects you are likely to experience. So as far as side-effects go, there is no justification for preferring Lexapro over Celexa.
I don't hate Celexa at all. I prescribe it all the time, and started at least one person on it today, because it is an effective antidepressant which I think is remarkably well-tolerated. If I had to take any antidepressant, I think I would take Celexa. What I dislike is what I see as unjustified claims which mislead desparate people. I can see no pharmacological reason why Lexapro should work any differently from Celexa, and I'm not convinved by the results of clinical trials. I think this is reasonable given the long history of new drugs being promoted as new and different and experience showing the advantages have been wildly overstated.
I don't think Lexapro can be any worse than Celexa - it therefore must be an effective and well-tolerated drug, and so I would probably choose it over Paxil, Zoloft etc. However I suspect it's very existence has more to do with extending patent protection than it being any different to Celexa. Here in Europe Celexa has come off-patent and is available at about 50% of the price of the patented version. I'm not going to prescribe a drug that's twice the price of something I already use if it doesn't seem to offer any advantages.
> Were these numbers based on equivalent doses? For example, if you need less lexapro than celexa maybe the side effects are less. Isn't this true for most AD's? The higher I go on pamelor the WORSE the s/e. So, is this a fair comparison because I don't know??? If the %'s that you stated were for 20 mg of lexa and 20 of celexa how fair a comparison is this? Am I missing something Dr. Dave? Sometimes I really get the feeling you hate celexa and lexapro.
> johnj
>
Posted by dr dave on October 10, 2002, at 12:28:02
In reply to Re: Lexapro and Celexa relative side-eff- SLEEP, posted by shakingoscar on October 10, 2002, at 9:18:35
Hi shakingoscar,
I'm glad you're feeling better on the Lexapro. It's difficult to know why you are sleeping better on it than on celexa, but the important thing is that you are, so who cares? If it works, let's not worry too much about it.
People react very individually to antidepressants and there are a whole load of other things going on in most people's lives that will affect that response at any given time. My concern is whether IN GENERAL I can expect people to sleep better on Lexapro than Celexa. The research so far shows that I can't.
It's an important point though to remember that what has been shown to work for a particular patient is more important than what the general research shows.
> Hi Dr Dave,
> I would just like to say one thing.
>
> I find I sleep fine on lexapro, and can take it before bedtime and still sleep well.
>
> With citalopram, I could never take it in the evening because I find it far more stimulating than lexapro.
>
> In fact, I am hoping I can stop taking trazodone which I have always needed with SSRIs because I find them so stimulating (except Paxil/seroxat)
>
> Cheers
>
>
Posted by johnj on October 10, 2002, at 13:22:02
In reply to Re: Lexapro and Celexa relative side-effects » johnj, posted by dr dave on October 10, 2002, at 12:20:11
Thanks Dr. Dave, I appreciate your time and opinion. I do have a few questions in general about AD's. When a person is switching how does one go about doing this? Is there a chart some where that describes how to switch from one class to the another. For ex, I take pamelor and for various reasons need a change. It has not been confirmed and frankly I don't know how it could be, but I have serious s/e after excercise on the TCA.
I have been given some lexapro samples and will not start for another few weeks due to an exam. Is is generally accepted to take the new AD and see if the reaction/remission occurs before reducing the current AD? Or do you titrate down while you titrate up on the new? Lastly, does it matter if one starts at 2.5 mgs, 5 mg or 10 mgs of lexapro, or any other AD for that matter? Could there be higher/harsher s/e at a lower dose?(kind of like you get with remeron). Thanks for any input. I will see my doc again before starting, but I wanted to get another opinion from someone in the field that has seen and has directly worked with such examples. Thank you
johnj
Posted by dr dave on October 10, 2002, at 14:43:23
In reply to Re: Lexapro and Celexa relative side-effects » dr dave, posted by johnj on October 10, 2002, at 13:22:02
There are some guidelines at
http://www.nhslothian.scot.nhs.uk/lothianformulary/appendices/append5.htm#
They are adapted from the Maudsley Prescribing Guidelines, which are my favourite reference. The advice here is, if swapping from tricyclic to citalopram, to halve the dose of tricyclic and introduce citalopram, before gradually withdrawing the tricyclic. This seems sensible to me, but ASK YOUR DOCTOR FIRST! I would continue with this process even if you feel rough and get side-effects, because in a few weeks the side-effects may go and the antidepressant effect kick in.
The higher dose you start on the greater risk of side-effects but the greater probability of an effect. The usual starting dose of Lexapro is 10mg, so I would start on that unless you have a history of being particlarly susceptible to side-effects. Then you could start on five for a week or two and go up to ten.
Best of luck.
> Thanks Dr. Dave, I appreciate your time and opinion. I do have a few questions in general about AD's. When a person is switching how does one go about doing this? Is there a chart some where that describes how to switch from one class to the another. For ex, I take pamelor and for various reasons need a change. It has not been confirmed and frankly I don't know how it could be, but I have serious s/e after excercise on the TCA.
> I have been given some lexapro samples and will not start for another few weeks due to an exam. Is is generally accepted to take the new AD and see if the reaction/remission occurs before reducing the current AD? Or do you titrate down while you titrate up on the new? Lastly, does it matter if one starts at 2.5 mgs, 5 mg or 10 mgs of lexapro, or any other AD for that matter? Could there be higher/harsher s/e at a lower dose?(kind of like you get with remeron). Thanks for any input. I will see my doc again before starting, but I wanted to get another opinion from someone in the field that has seen and has directly worked with such examples. Thank you
> johnj
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