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Dr. Bob is Robert Hsiung, MD,
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Posted by Alan on October 13, 2002, at 10:29:19
In reply to Re: Day 6 on 10 mg » Micki, posted by pharmrep on October 13, 2002, at 2:09:35
YMMV but - A close relative told me about his experience with switching over to Lex. from Celexa for an anxiety disorder and it esentially went something like this:
....Been on Celexa since it came onto the market and it has helped me better than anything else I have ever taken (the list is to long to even think about). PDoc recently asked me to consider switching to Lexapro, which is similar to Celexa without the isomer that causes most of the side effects. However, the Lexapro made me extremely anxious so possibly the sleepiness side effect of Celexa was what I needed. I went back on the Celexa feel better but back to the usual sedation problem....
In response, I didn't want to say anything about the whimsical idea that all of the side effects would reside in the (removed) mirror image molecule and all the therapeutic effect would reside in the remaining molecule, but it's not surprising he discovered that on his own.
Doctors will fall for some pretty flimsy lines if delivered with a straight face and a pert attitude. Any biologist could tell them that when mirror-image isomers of molecules exist, it tends to be so that most of the biological activity resides in one isomer and the other is nearly inactive. However, the isolated-isomer version of Prozac never made it to market because it turned out to be dangerous, so the "one isomer active" rule may apply more to naturally occurring substances than it does to synthetic drugs.
Judging from the public statements I've heard, few authorities who are financially independent of Forest Pharmaceuticals expect Lexapro to be systematically better than Celexa for anything except the maker's bottom line. (There could be a few individual exceptions.) Same goes for Nexium compared to Prilosec and all these other analogous "next-generation" pills.
Interesting how the next generation always makes it to market just as the previous one's patent is expiring.
Skeptical in Seattle,
Alan
Posted by ANXIETY ANN on October 13, 2002, at 16:40:26
In reply to Re: Lexapro treatment status at 4 weeks...., posted by emmalie on October 12, 2002, at 19:23:46
> thanks for responding johnnylex.
>
> That's kind of how I'm feeling after 3 days or so. Celexa definitely took away my anxiety but gave me bad jaw/head tension. Now, on lexapro, the jaw/head tension is much better but I feel more anxious. If only I could merge the two drugs into one . . .*****
I have been taking Lexapro now for A Week. I too have terrible head /jaw tension in back of my neck, like a burning sensation. I only feel it when the lEXAPRO is wearing off. (after about 12 hours). I also have trouble sleeping and my anxiety is much worse. The reason i take it is for anxiety and panic. I,m not depressed at all. Is there anyone out there that Lexapro has helped expressly for anxiety. will the terrible neck and head pain go away? will I ever get a good nights rest? thanks for your help
Posted by Alan on October 13, 2002, at 17:17:59
In reply to Re: Lexapro treatment status at 4 weeks...., posted by ANXIETY ANN on October 13, 2002, at 16:40:26
> >
> > That's kind of how I'm feeling after 3 days or so. Celexa definitely took away my anxiety but gave me bad jaw/head tension. Now, on lexapro, the jaw/head tension is much better but I feel more anxious. If only I could merge the two drugs into one . . .
>
> *****
> I have been taking Lexapro now for A Week. I too have terrible head /jaw tension in back of my neck, like a burning sensation. I only feel it when the lEXAPRO is wearing off. (after about 12 hours). I also have trouble sleeping and my anxiety is much worse. The reason i take it is for anxiety and panic. I,m not depressed at all. Is there anyone out there that Lexapro has helped expressly for anxiety. will the terrible neck and head pain go away? will I ever get a good nights rest? thanks for your help
========================================
The reality is that for anxiety disorders, anxiolytics work at a much higher percentage of the time than do AD's (by the AD co's own stats)for the general population. There are exceptions and stastistics do not, as I suppose you know, apply to individual cases.Have you tried a benzodiazapine at all or alternatively other non AD treatments?
Please read my post directly above yours to explain why you are possibly feeling more rather than less anxiety. It is a bit technical but it speaks to your issue about anxiety related symptoms - in whatever form they appear...
Best,
Alan
Posted by emmalie on October 13, 2002, at 17:27:42
In reply to Re: Lexapro treatment status at 4 weeks...., posted by ANXIETY ANN on October 13, 2002, at 16:40:26
It's day 4 for me on Lexapro.
I was in a total zombie state for much of today (I take it in the morning when I wake up). I feel less anxious but it's at the expense of feeling TOTALLY out of it. Perhaps this will go away with time . . .
Posted by emmalie on October 13, 2002, at 19:24:08
In reply to Anyone switched to Lexapro? « ggrrl, posted by Dr. Bob on June 11, 2002, at 7:52:48
For some reason, right now I feel really sick. Kind of like I'm getting the flu. Body aches, keep getting a little hot and cold. Is this an effect of Lexapro that I should expect to feel since I am just starting it?
Posted by ANXIETY ANN on October 13, 2002, at 21:49:27
In reply to Re: AD's vs. Bzds for Anxiety disorders - Alan, posted by ZeeZee on October 11, 2002, at 23:05:14
Hi alan
I read your recent posts on anxiety and depression. I suffer from anxiety only and have been taking xanax for about 6 years. my doctor has beeen pushing me to get off the xanax because she says I've been on it too long (guess shes never had a panic attack!) when i first started taking xanax I took 3 mg a day. Because of everything i heard and read about the "evils" of xanax, I tapered back to 1.5 mg per day (which was not nearly enough)anyway, the doc gave me Lexapro a week ago and my anxiety is still as strong as ever. My question to you is, is there doctors out there that believe(like I do) that xanax is o.k. to take if you need it? I am dependent on it but not like a drug addict, I just need it to feel "normal". thanks for listening
Posted by Ippopo on October 13, 2002, at 22:20:02
In reply to Re: Anyone switched to Lexapro? « ggrrl, posted by emmalie on October 13, 2002, at 19:24:08
It's kinda a strange drug but as far as deep depression it started to help in just a few days. Suicidal ideation was no longer part of the thought process. I was still depressed and felt like CaCa from s/e. The nausea lasted quite a few days but as far as the flu like symtoms, you may be getting the flu. It's been going around. I don't know where you are but in Chicago though the weather is beautiful it's in flux.
Stay warm and drink lots of fluids
Posted by Alan on October 13, 2002, at 23:17:44
In reply to Re: AD's vs. Bzds for Anxiety disorders - Alan, posted by ANXIETY ANN on October 13, 2002, at 21:49:27
As long as the xanax is working, what is the problem? Are there any besides your doctor? The dose of 3mg a day is relatively medium and dosages usually trace the waxing and waning of the disorder. I at one time was taking 5mg and the PDR range is much higher than that I believe. Do you have any complicating symptoms or do you feel relatively normal taking xanax?
My dose finally came down for awhile with a combo of meds and non-med therapy. But it went back up too once again. The main thing is that I was not provoked with anxiety to have my medication that worked for me to be taken away. That is unethical unless you've got an abuse problem that you are not mentioning. The vast majority of the anxiety population do not abuse their meds. The mere low "potential" is what leads to all of the hysteria.
The irony is that medical dependence applies to all drugs that one is dependent on for a medical condition. The other problem is that there are some archaic docs, co. docs (and some pharm co.s) that exploit that stigma. Chronic anxiety or depression or ANY disease is not cured (save antibiotics), their symptoms are simply merely treated or managed.
What's gonna happen when docs start decreasing or taking away altogether patient's AD's (which well may and does already happen when short term therapy is considered over) - is the need for the drug again going to be considered habituating? Are the same word games with "discontinuation syndrome" (withdrawl) and "poop-out" (tolerance) going to prevail? I don't think so once the public finds out they're being snookered.
If your problem is finding a doctor that is not benzophobic or simply shoveling you the pharmecutical AD line then talk to another doctor. Second and third opinions are sought every day in the medical world. Why should it be any different for psychiatry?
We're tired of being patronised and not listened to by our doctors.
Has your doctor a strategy for treating your anxiety after tapering slowly off of the xanax....another bzd like ativan, klonopin, or valium? Ask them if they are going to accept responsibility for the consequences of what happens if they insist on withdrawing you from a medication that is already working. That will get their attention real fast.
To find a doctor that you trust and that will trust you, you'll have to do a little investigating...asking other primary physicians or friends or other family members for references that have family physicians or KNOW OF physicians that know something about these medications. At least they will have heard of a doc that specialises in the treatment of anxiety disorders - one that considers ALL meds to be offered the patient on an equal footing....enabling you with the right to choose. Ask the doctor outright if that is what they offer - that is, whatever works for you from YOUR experience, not from what THEY have on their agenda.
Good luck.
Armed with enough information and courage, remember, you are the boss and your doctor is your employee.
Best,
Alan
Posted by viridis on October 14, 2002, at 1:13:27
In reply to Re: AD's vs. Bzds for Anxiety disorders - Alan, posted by ANXIETY ANN on October 13, 2002, at 21:49:27
There are sensible doctors out there -- it may just take some looking. After years of psychotherapy, ADs with major side effects, etc., I saw a psychiatrist who recognized that my primary problems were anxiety and panic disorder. He prescribed both Klonopin and Xanax, which have been tremendously helpful. I take K daily, and X occasionally. He offered to increase the dosage if necessary, but since the initial doses (1 mg K/day, and 0.25-0.5 mg X as needed) remained effective, I declined. These doses still work just as well as they did initially, after over a year.
I've asked him about issues of dependency etc., and his response is that (I'm paraphrasing) if it ain't broke, don't fix it. Since I was "broke" and now I'm "fixed", I'm quite happy -- especially since, unlike ADs, the benzos have no side effects that I can detect.
He did say that dependency was very likely to develop, and that if I decide to discontinue benzos he strongly recommends a gradual, supervised withdrawal. According to him, this is generally quite straightforward, although (at least for me) he feels the anxiety is likely to return if I stop the meds (mainly K, since I take X so infrequently).
I have no plans to discontinue either, and would be quite comfortable taking benzos for the rest of my life. My psychiatrist also seems comfortable with this approach -- it's certainly preferable to the ravages of constant anxiety and the recurring, severe depression that can result.
Posted by CarolinaGirl on October 14, 2002, at 8:12:13
In reply to Re: Lexapro or eqiv. vs. Bzds for anxiety disorder » BrittPark, posted by Alan on October 12, 2002, at 13:37:42
This is my experience thus far with lexapro for anxiety. I have been anxious all my life. I have
had a script for xanax for most of my adult life
from my obgyn.(30 .5mgs per month). Sometimes I
took them, sometimes I didn't. Because of a lot
of family and personal problems finally decided to go to a Psychiatrist and see if there was something better for me. I have tried various meds since last April with Lexapro being the last...and final I hope. The only side effect I am having is being sleepy. insomnia was a real problem for me so the lexapro has been great....but, I just don't want to get up in the morning. So far, making it to work on time but really wanting to sleep. Also as I have mentioned in an early post, smoking will give me an anxiety attack (short one)....so guess what, I am not smoking very much at all now. My anxiety is way down...I live with a passive agressive husband and
previously stayed on edge all the time. I am now able to take his comments and reply back without
anger or burst into tears. This is the best part
of taking lexapro....It is like being able to step
away from the situation, reflect on it, make a
logical decision and then being able to be rational about it. The thing that would make me stop the lexapro would be the sleepiness during the day but I am hoping that will lessen. I take it at night after trying it in the morning during the first week. I started out with 5mgs around the middle of September and have been on 10 mgs for about 10 days. I would recommend anyone with anxiety disorder to try lexapro.
Posted by Abacus on October 14, 2002, at 9:33:28
In reply to Re: Anyone switched to Lexapro? « ggrrl, posted by Ippopo on October 13, 2002, at 22:20:02
I went through the flu-like symptoms this weekend. I've started taking the lex at night before bed because of the zombie-like feeling, and this morning, I feel much better. Still having the night-sweats -- I think the bulk of the flu-like stuff was day-sweats (if there is such a term!).
Posted by ZeeZee on October 14, 2002, at 9:58:50
In reply to Re: AD's vs. Bzds for Anxiety disorders - Alan, posted by ANXIETY ANN on October 13, 2002, at 21:49:27
Hi - I too suffer from anxiety/panic attacks. I have used benzo's only when needed, but find that instead of taking them I will often just avoid a situation (usually regarding traveling outside my comfort area.) Thus, I don't have panic or anxiety on a daily basis, but I have unnecesarily restricted my life and activities. Have you experience agoraphobia as well? If so, do you find that taking the benzo's on a daily basis helps you to do the things you would normally avoid?
Any experiences you can share would be appreciated.
Thanks
Posted by mills on October 14, 2002, at 10:04:43
In reply to Re: Anyone switched to Lexapro? « emmalie, posted by Abacus on October 14, 2002, at 9:33:28
yes, i have had flu-ey symptoms for the last few weeks trying to find the right dose of lexapro; i am confident it is depression and not the flue; i think i went up to 20 mg too fast, and have gone down to 15, taking 10 in the morning and the other 5 in the evening; the jury is still out for me even after 6 full weeks on lexapro; my head fees dull and i feel disoriented somewhat; an hour to 3 hours after i take my morning dose, i feel depressed, and i know it is the lexapro; i am going to give it more time though, because it took Paxil a long time to level out my experience, actually much longer than the six weeks everyone says; i wish i knew more about the proper dosing of lexapro; i seem to be hearing some conflicting reports from people's experiences and information
> I went through the flu-like symptoms this weekend. I've started taking the lex at night before bed because of the zombie-like feeling, and this morning, I feel much better. Still having the night-sweats -- I think the bulk of the flu-like stuff was day-sweats (if there is such a term!).
Posted by ANXIETY ANN on October 14, 2002, at 10:10:00
In reply to A question for Anxiety Ann » ANXIETY ANN, posted by ZeeZee on October 14, 2002, at 9:58:50
> Hi - I too suffer from anxiety/panic attacks. I have used benzo's only when needed, but find that instead of taking them I will often just avoid a situation (usually regarding traveling outside my comfort area.) Thus, I don't have panic or anxiety on a daily basis, but I have unnecesarily restricted my life and activities. Have you experience agoraphobia as well? If so, do you find that taking the benzo's on a daily basis helps you to do the things you would normally avoid?
> Any experiences you can share would be appreciated.
> Thanks*****
Hi
Unfortunately the dose of xanax that I was on did not keep me from avoiding going places I feel un comfortable about. Everytime I have to go somewhere, that dreaded feeling of anxiety hits me. I know how you feel, its been six years of this. With my therapist I am learning to plug along through all this. I'm hoping that Lexapro will help. Hang in there
Posted by CarolinaGirl on October 14, 2002, at 10:20:30
In reply to Re: Lexapro treatment status at 4 weeks.... » ANXIETY ANN, posted by Alan on October 13, 2002, at 17:17:59
I have been taking lexapro for a month now. Anxiety level is much less, can face the day without that sinking feeling in the pit of my stomach. Give it a chance BUT it may not work for you. We are all wired so differently.
Posted by ANXIETY ANN on October 14, 2002, at 10:23:12
In reply to Re: AD's vs. Bzds for Anxiety disorders - Alan » ANXIETY ANN, posted by Alan on October 13, 2002, at 23:17:44
> As long as the xanax is working, what is the problem? Are there any besides your doctor? The dose of 3mg a day is relatively medium and dosages usually trace the waxing and waning of the disorder. I at one time was taking 5mg and the PDR range is much higher than that I believe. Do you have any complicating symptoms or do you feel relatively normal taking xanax?
>
> My dose finally came down for awhile with a combo of meds and non-med therapy. But it went back up too once again. The main thing is that I was not provoked with anxiety to have my medication that worked for me to be taken away. That is unethical unless you've got an abuse problem that you are not mentioning. The vast majority of the anxiety population do not abuse their meds. The mere low "potential" is what leads to all of the hysteria.
>
> The irony is that medical dependence applies to all drugs that one is dependent on for a medical condition. The other problem is that there are some archaic docs, co. docs (and some pharm co.s) that exploit that stigma. Chronic anxiety or depression or ANY disease is not cured (save antibiotics), their symptoms are simply merely treated or managed.
>
> What's gonna happen when docs start decreasing or taking away altogether patient's AD's (which well may and does already happen when short term therapy is considered over) - is the need for the drug again going to be considered habituating? Are the same word games with "discontinuation syndrome" (withdrawl) and "poop-out" (tolerance) going to prevail? I don't think so once the public finds out they're being snookered.
>
> If your problem is finding a doctor that is not benzophobic or simply shoveling you the pharmecutical AD line then talk to another doctor. Second and third opinions are sought every day in the medical world. Why should it be any different for psychiatry?
>
> We're tired of being patronised and not listened to by our doctors.
>
> Has your doctor a strategy for treating your anxiety after tapering slowly off of the xanax....another bzd like ativan, klonopin, or valium? Ask them if they are going to accept responsibility for the consequences of what happens if they insist on withdrawing you from a medication that is already working. That will get their attention real fast.
>
> To find a doctor that you trust and that will trust you, you'll have to do a little investigating...asking other primary physicians or friends or other family members for references that have family physicians or KNOW OF physicians that know something about these medications. At least they will have heard of a doc that specialises in the treatment of anxiety disorders - one that considers ALL meds to be offered the patient on an equal footing....enabling you with the right to choose. Ask the doctor outright if that is what they offer - that is, whatever works for you from YOUR experience, not from what THEY have on their agenda.
>
> Good luck.
>
> Armed with enough information and courage, remember, you are the boss and your doctor is your employee.
>
> Best,
>
> Alan
>
>*****
Alan,
Thanks for the info. I do not have any s/e from xanax and I am not abusing it. THe doc did suggest adivan. I will follow your advice and look into finding a new doc. The one I have now is VERY unsympathedic. She does not understand the dispair of anxiety.
Posted by mills on October 14, 2002, at 12:58:54
In reply to Anyone switched to Lexapro? « ggrrl, posted by Dr. Bob on June 11, 2002, at 7:52:48
My head is cloudy after 6 weeks on this stuff; is anyone else experiencing something like that? Seems like it is dulling my memory or something; i'll do things like go to the refrigerator to get a glass, or go to a room and forget why I went in, that sort of thing, and I feel thick-headed or something; hard to label the feeling really. Please let me know if anyone is having this same experience. It's pretty troubling.
Posted by pharmrep on October 14, 2002, at 14:07:17
In reply to Re: Anyone switched to Lexapro? « emmalie, posted by mills on October 14, 2002, at 10:04:43
> yes, i have had flu-ey symptoms for the last few weeks trying to find the right dose of lexapro; i am confident it is depression and not the flue; i think i went up to 20 mg too fast, and have gone down to 15, taking 10 in the morning and the other 5 in the evening; the jury is still out for me even after 6 full weeks on lexapro; my head fees dull and i feel disoriented somewhat; an hour to 3 hours after i take my morning dose, i feel depressed, and i know it is the lexapro; i am going to give it more time though, because it took Paxil a long time to level out my experience, actually much longer than the six weeks everyone says; i wish i knew more about the proper dosing of lexapro; i seem to be hearing some conflicting reports from people's experiences and information
>
***** what was your dose and of which med before? 10mg is the starting dose, and if you go higher, go to 15mg 1st, 20mg is a big jump. if you have a very low tolerance to meds...(ie 10mg of paxil/prozac/celexa seemed strong to you) then try 5mg of lexapro 1st, wait a couple weeks, then see what adjustments are needed (if any)
Posted by mills on October 14, 2002, at 14:19:17
In reply to Re: dosing info » mills, posted by pharmrep on October 14, 2002, at 14:07:17
I used to be on Paxil (worked my way slowly up to 40 mg, and it was a perfect dose), and I weaned my way slowly off (auditory "swooshes" and all) several months ago; started on 10 mg of Lexapro 6 weeks ago; jumped to 20mg the second week, and stayed there for 4 weeks, and then went down to 15 mg one week ago
> > yes, i have had flu-ey symptoms for the last few weeks trying to find the right dose of lexapro; i am confident it is depression and not the flue; i think i went up to 20 mg too fast, and have gone down to 15, taking 10 in the morning and the other 5 in the evening; the jury is still out for me even after 6 full weeks on lexapro; my head fees dull and i feel disoriented somewhat; an hour to 3 hours after i take my morning dose, i feel depressed, and i know it is the lexapro; i am going to give it more time though, because it took Paxil a long time to level out my experience, actually much longer than the six weeks everyone says; i wish i knew more about the proper dosing of lexapro; i seem to be hearing some conflicting reports from people's experiences and information
> >
> ***** what was your dose and of which med before? 10mg is the starting dose, and if you go higher, go to 15mg 1st, 20mg is a big jump. if you have a very low tolerance to meds...(ie 10mg of paxil/prozac/celexa seemed strong to you) then try 5mg of lexapro 1st, wait a couple weeks, then see what adjustments are needed (if any)
>
>
Posted by pharmrep on October 14, 2002, at 16:01:01
In reply to Re: dosing info, posted by mills on October 14, 2002, at 14:19:17
*** why did you go to 20mg? you only gave 10mg 1 wk...it might be enough...if not, 15mg should be...if you can, try going back to 10mg and give it a fair chance (2 weeks) before going up. (the flu stuff might be from going to the higher dose so fast) good luck and keep us posted
Posted by mills on October 14, 2002, at 16:29:29
In reply to Re: dosing info » mills, posted by pharmrep on October 14, 2002, at 16:01:01
my reason for going to 20 mg is I badly need the full effect of whatever medication I am on, and the doctor recommended I increase my dosage to 20 mg; my reason for going back to 15 a week ago or so is the depressed/fluey feeling from the 20; I find it hard to believe that 10 is enough considering I needed 40 of Paxil, but if I continue to feel depressed from the 15 mg, I will definitely go down to 10; if I don't get a sense of Lexapro clearing up my head within another month, I'm going back to Paxil, sexual side effects and all (although I SURE don't want to)
> *** why did you go to 20mg? you only gave 10mg 1 wk...it might be enough...if not, 15mg should be...if you can, try going back to 10mg and give it a fair chance (2 weeks) before going up. (the flu stuff might be from going to the higher dose so fast) good luck and keep us posted
Posted by meow mary on October 14, 2002, at 19:03:40
In reply to Re: dosing info, posted by mills on October 14, 2002, at 16:29:29
I saw my doctor today. He said he's been getting a lot of disappointed responses from his patients who have been at 10mgs, and thinks there is a certain amount of "hype" about that dosage being effective--especially in the case of OCD where a higher dosage is usually required. He doubled my dosage, although he said it would be fine to start with 15 at first.
Posted by Caydi on October 14, 2002, at 20:35:15
In reply to Re: Anyone switched to Lexapro?, posted by mills on October 14, 2002, at 12:58:54
> My head is cloudy after 6 weeks on this stuff; is anyone else experiencing something like that? Seems like it is dulling my memory or something; i'll do things like go to the refrigerator to get a glass, or go to a room and forget why I went in, that sort of thing, and I feel thick-headed or something; hard to label the feeling really. Please let me know if anyone is having this same experience. It's pretty troubling.
i had a problem with that for a while too when i started on lexapro. i was taking it in the morning since it seemed that most people were having problems with insomnia and i already have a little trouble getting to sleep. but the lexapro made me kind of nauseous, sleepy, and gave me that same sort of dulled feeling, like i was just all doped up. so i started taking it just before i go to bed and all of those symptoms went away (or i guess i'm really just sleeping through it). so if you're taking them in the morning, try switching to night.
Posted by emmalie on October 14, 2002, at 20:35:58
In reply to Lexapro Dosing Info--My Doctor's Opinion, posted by meow mary on October 14, 2002, at 19:03:40
Lexapro was WAY too intense for me. I felt like a complete zombie, and sort of had this weird semi out of body experience this morning lying in bed at 4 am. I'm going back to Celexa tomorrow!
Posted by shakingoscar on October 15, 2002, at 1:21:41
In reply to Re: Lexapro Dosing Info--My Doctor's Opinion, posted by emmalie on October 14, 2002, at 20:35:58
Hi
I am also having problems finding the correct lexapro dose.I have been on lex for 7 weeks now and I have just gone up from 15mg to 20mg because my old symptoms have been returning.
Unfortunately 20mg feels really INTENSE and Im not sure if I can take it.
If I cant, I am going back to my trusty 60mg celexa again.
I also wish the dosing of this med was clearer to understand.
Cheers
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Dr. Bob is Robert Hsiung, MD,
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