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Dr. Bob is Robert Hsiung, MD,
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Posted by ZeeZee on October 15, 2002, at 18:58:31
In reply to Re: A question for Anxiety Ann, posted by maririp on October 15, 2002, at 9:41:59
Thank you for your support. Over the course of the past 16 years since my first panic attack (although my anxiety disorder has been since childhood) I have done all that you've mentioned. I've had zillions of hours of therapy (am also a retired therapist) read all the books, listened to all the tapes, had biofeedback, learned "proper breathing", did the desensitizaion programs, pushed myself to take steps to keep expanding my "territory" - and yet here I am - back at square one. I have never gotten over the fear of the panic, although for very long periods of time have been much less fearful, I have never lost the fear of the fear completely. I plan on continuing to plug away however tiring this task appears. I am doubtful of any significant change without the right medication. The 5 yrs on MAOI's followed by another nearly 4 yrs symptom free were made possible by the medication. Within 3 weeks of starting the drug there was more improvement and return to normalcy than any small fleeting change noted as a result of many, many, many years of therapy. I wish all I had to do was apply what I have learned to be better, however it doesn't seem to be working that way for me. I am glad you have found success and hope you hold on to it.
Regards,
Lisa
Posted by Micki on October 15, 2002, at 20:31:32
In reply to Re: A question for Anxiety Ann » maririp, posted by ZeeZee on October 15, 2002, at 18:58:31
This press release was on a wire service today.
UCLA Neuroscientists Examining Biology of Learning Discover Distinct
Molecular Key to Overcoming FearATTENTION: Medical editorsLOS ANGELES, Oct. 15 (AScribe Newswire) - In a discovery with implications
for treatment of anxiety disorders, UCLA Neuropsychiatric Institute
investigators have identified a distinct molecular process in the brain
involved in overcoming fear. The findings will be published in the Oct. 15
edition of the Journal of Neuroscience.The study of how mice acquire, express and extinguish conditional fear shows
for the first time that L-type voltage-gated calcium channels (LVGCCs) - one
of hundreds of varieties of electrical switches found in brain cells - are
required to overcome fear but play no role in becoming fearful or expressing
fear. The findings suggest that it may be possible to identify the cells,
synapses and molecular pathways specific to extinguishing fear, and to the
treatment of human anxiety disorders.''Brain plasticity, or the ability of the central nervous system to modify
cellular connections, has long been recognized as a key component to
learning and memory,'' said Dr. Mark Barad, the UCLA Neuropsychiatric
Institute's Tennenbaum Family Center faculty scholar and an assistant
professor in-residence of psychiatry at the David Geffen School of Medicine
at UCLA. ''The discovery of a distinct molecular process in overcoming fear
bodes well for development of new drugs that can make psychotherapy, or talk
therapy, easier and more effective in treating anxiety disorders. More
broadly, the findings also suggest that distinct molecular processes may be
involved in the expression and treatment of other psychiatric disorders.''Both the acquisition and extinction of conditional fear are forms of active
learning. The acquisition of conditional fear requires a unique pairing of
an initially neutral conditional stimulus with an aversive unconditional
stimulus. In this research, the conditional stimulus was a tone and the
unconditional stimulus was a mild foot shock.Although extinction, the reduction of conditional responding after repeated
exposures to the conditional stimulus alone, might initially appear to be a
passive decay, or erasure of this association, many studies indicate that
extinction is new inhibitory learning, which leaves the original memory
intact.In examining this process, UCLA researchers used injections of two LVGCC
inhibitors - nifedipine and nimodipine - to test whether LVGCC activity is
required for the 1) acquisition, 2) expression and 3) extinction of
conditional fear. Results showed that blocking LVGCC activity had no effect
on the acquisition or expression of fear, but effectively prevented
extinction.The research was supported by a National Alliance for Research on
Schizophrenia and Depression Young Investigator Award, and by the Forest
Award of the West Coast College of Biological Psychiatry.Other investigators involved in the project were Chris Cain of the UCLA
Interdepartmental Program in Neuroscience and Ashley Blouin of the UCLA
Department of Psychiatry and Biobehavioral Sciences. Barad also is
affiliated with the UCLA Brain Research Institute.The Tennenbaum Family Center at the UCLA Neuropsychiatric Institute was
created earlier this year with a four-year, $1 million gift from Michael E.
and Suzanne Tennenbaum. Michael Tennenbaum is managing member of Tennenbaum
and Company, a private Los Angeles-based investment firm he founded in 1996.In addition to the faculty scholar program, the center is encouraging
research into brain plasticity by providing seed money to promising research
projects and offering graduate student and post-doctoral fellowship support.The UCLA Neuropsychiatric Institute is an interdisciplinary research and
education institute devoted to the understanding of complex human behavior,
including the genetic, biological, behavioral and sociocultural
underpinnings of normal behavior, and the causes and consequences of
neuropsychiatric disorders.Online Resources:- UCLA Neurospychiatric Institute: www.npi.ucla.edu/- UCLA Brain Research Institute: www.bri.ucla.edu/index.htm- David Geffen School of Medicine at UCLA: www.medsch.ucla.edu/- Journal of Neuroscience: www.jneurosci.org/-30-
Posted by ZeeZee on October 15, 2002, at 20:46:24
In reply to New anxiety research, posted by Micki on October 15, 2002, at 20:31:32
Fascinating! I'll be first in line to try it, if and when they actualize these findings into an anxiolytic. I'll cross my fingers, but won't hold my breath.
Posted by bonnie_ann on October 15, 2002, at 21:05:04
In reply to Lexapro Dosing Info--My Doctor's Opinion, posted by meow mary on October 14, 2002, at 19:03:40
Posted by Charles carter on October 15, 2002, at 22:06:05
In reply to Lexapro side-effects , posted by dr dave on August 28, 2002, at 3:15:33
The primary advancement with respect to Lexapro resides in its increased selectivity for serotonin reuptake (100 x greater) and its increased potency (2 x more potent) versus Celexa....NOT some quantum leap in tolerability.
I would argue that Celexa was already one of the better tolerated SSRI's, if not the best of the bunch, with respect to side effects across all patient types and dosages.
The discontinuation rates with Lexapro in clinical trials are comparable to placebo at the starting dose of 10mg. In the comprehensive database, the only adverse event that occurred greater than 10% versus placebo AT BOTH DOSES was nausea, which occurred at a rate of 15%. In addition to that, the drop-out rates during the clinical trials including all patients AT BOTH DOSES was 6% versus 2% on placebo. I would suggest that most prescribers would be ecstatic if 94% of their patients on SSRI therapy not only were responders,but did not discontinue due to adverse events.
Comparing PI to PI is not an apples-to-apples; however, reps and physicians still do it to identify trends. The three most commonly reported adverse events with Celexa were nausea (21%), somnolence (18%) and insomnia (15%). Lexapro checks in at 15%, 6% and 9% respectively.
Indeed, there may not be conclusive data to suggest that Lexapro is some great leap forward versus Celexa on tolerability; however, it's not too hard to make the case that Lexapro appears to be AT LEAST as well tolerated as what many consider to be the best tolerated SSRI in the class in Citalopram.
Finally, there certainly is data to suggest efficacy, increased potency and earlier onset of action with Lexapro versus Celexa. The fact that the s-isomer is twice as potent as its racemate and still has a side effect profile that compares favorably to ANY other SRI on the market is a leap forward in and of itself.
Respectfully,
Carter
Posted by pharmrep on October 15, 2002, at 22:30:31
In reply to Anyone know the half life of Lexapro? (nm), posted by bonnie_ann on October 15, 2002, at 21:05:04
celexa is 35 hrs...lexapro is 27-32 (most 1/2 lifes are measured in ranges now...dont know why)
why did you want to know?
Posted by pharmrep on October 15, 2002, at 22:38:58
In reply to Re: Anyone switched to Lexapro? « ggrrl, posted by Milla on October 15, 2002, at 16:55:08
> My doctor switched me to Lexapro from prozac almost a month ago. The first two days I experienced nausea, dizziness, and I felt disassociated from reality like nothing was real. I was in a very complient mood and it was like nothing seemed to matter including all that I care about deeply. I haven't taken Lexapro since then. I was diagnosed with depersonalization disorder with derealization traits. My illness is disassociative, so those with another illness may experience Lexapro differently and may have positive results.
> I find that eating incredibly healthy, getting adequate sunshine and excercise combined with Cognitive Therapy and being attuned to who you are is far better for me than any pill that I've taken (and I have tried them all).
> It should be encouraged that medication is not always necessary. Unless there is a severe chemical imbalance present, it is possible to succeed without medicine. Often individuals on medication don't have a chemical imbalance, and are just going through a hard time from a stressful and negative environment. It is true for those with post traumatic stress disorder and disassociative disorders to have a disfunction with the hippocampus but have a normal level of seratonin.
> Regardless of severity of any illness, healing can be influenced for the better with Cognitive Therapy and taking good care of ones self by understanding what makes you happy and what triggers a negative response. Be attuned to who you are and what your body is telling you. No doctor can tell you better than what your own body and mind have to say.
>
** your'e right...you probably know yourself better than anyone else...but you gave a new med in your body only 2 days... I have heard the same s/e you mentioned in dozens of people and doctors so far (many here on this site)...and after the 1st week or so... the same people said most of the s/e lessen to being barely noticeable. You might want to give yourself a "fair" trial of a couple weeks or so to give your body a chance to adjust to lexapro (or any new med for that matter)
Posted by FunBunny on October 15, 2002, at 22:41:56
In reply to Re: lexapro and alcohol » discoduck, posted by johnj on October 15, 2002, at 16:02:51
I just start taking 10 mg of lexapro and I have been on keppra, 1500mg at night for about 6 months and I take .5 klonopin daily, which I will hopefully be able to stop taking once the lexapro starts working. The keppra is for "bi-polar type II" and I had no problems with drinking on it. (being just on the keppra) I agree that everyone tolerates alcohol differently, we all are different people with different DNA. Since it's only been 2 weeks, you're not adjusted to the med yet. Just give it some time to get used to the med before you decide to socially drink...Plus always drink alot of water...Good luck...
Posted by BarbaraCat on October 15, 2002, at 22:58:31
In reply to Re: ANXIETY - Anyone cured?, posted by maririp on October 15, 2002, at 9:23:25
You mentioned working with your breath to control anxiety. It helps me also - when I remember to use my breathing skills. Usually I'm holding my breath despite my best intentions. Any tips you have would be appreciated.
Posted by lmblec on October 15, 2002, at 23:26:58
In reply to so . . . how is everyone doing on lexapro?, posted by emmalie on October 12, 2002, at 16:33:04
see my post under lmblec. i an having in trouble with it at 20 mg. sleep most of the day. do you have any problems with it. most of my anxiety is gone
Posted by BarbaraCat on October 16, 2002, at 0:02:04
In reply to ANXIETY - Anyone cured?, posted by shakingoscar on October 15, 2002, at 5:56:44
I've observed something during my very long history as a cat owner (being owned by them is more like it). The female cats have ALL been very much more anxious than the males. They are not sociable as are the males. The guys all hang out and enjoy life and the girls are on the defensive. They just don't seem as happy or content, much as I love them all equally. This is not just my observation either and is shared with my cat loving friends.
All my cats have been spayed and neutered around 7 months of age so it must not be the normal estrogen/testosterone suspects, at least not as we're used to. Fixed animals still make hormones, but not nearly at the same ratios and concentrations than when they've got all their parts.
I'm not suggesting that human males are any less anxious than human females. It's just that there appears to be something going on in the female brain that engenders fear and anxiety, at least in a cat. And it's not the usual stereotyped male/female hormonal differences if their usual hormones aren't big players anymore. One idea may be that as estrogen decreases, as in spayed cat females, testosterone increases. Neutered male cats experience an increase in estrogen as their testosterone levels decrease. This happens with menopausal and andropausal humans as well. So this is telling me something, but I know not what for sure. Only that there's probably some hormonal common denominator for mood dysfunction and it's not relegated to one sex over the other. It seems to suggest estrogen as being an important mood regulator. But I don't expect men to be lining up for estrogen shots any time soon. And finding spayed and neutered humans might be tough for conducting a proper research study. But Hey, I'm serious about these ponderings and welcome your thoughts. - BarbaraCat
Posted by chad_3 on October 16, 2002, at 0:05:05
In reply to Re: Day 6 on 10 mg and feeling terrible (nm) » Micki, posted by lmblec on October 15, 2002, at 23:50:23
I just looked on PubMed there is less than a dozen available abstracts on Lexapro.
Most of them are not even informative to the efficacy or method of action.
How can this be? Where are Dr's getting their info on this drug?
Chad
Posted by emmalie on October 16, 2002, at 0:28:04
In reply to lexapro and alcohol, posted by discoduck on October 15, 2002, at 15:14:28
Can't say much about lexapro (was only on it for 4 days before i quickly switched back to Celexa) ... but I have noticed that alcohol hits me much stronger on Celexa than it did before. I can't even really finish a second glass of wine . . .
Posted by shakingoscar on October 16, 2002, at 1:06:37
In reply to Anyone know the half life of Lexapro? (nm), posted by bonnie_ann on October 15, 2002, at 21:05:04
27-32hrs.
Posted by maririp on October 16, 2002, at 7:42:23
In reply to Re: ANXIETY - Anyone cured? » maririp, posted by BarbaraCat on October 15, 2002, at 22:58:31
hi BarbaraCat..I think what helped me the most in the long run about panic and axiety was learning to overcome the fear and calm myself during attacks..I would tell myself this isnt going to kill me, I would cup my hands over my mouth and nose and breathe slowly till i had it under control. The more I learned to talk myself through it and lower my adrenalin the easier it was for me to get through panic. You have to be determined and talk to yourself and say you aren't going to let this get the best of you. Might be easier said than done but in time this all worked for me. I just found ways to calm myself. I would immeadiately find something to do to distract myself from the attacks..music..humming..and to not be afraid. I know its a hard thing to get through but the more things you can teach yourself the easier it will get.
Posted by maririp on October 16, 2002, at 8:29:11
In reply to Anxiety and cats, an observation, posted by BarbaraCat on October 16, 2002, at 0:02:04
barbara...lol...i can explain that cat theory easily...how would you like 6-8 babies every few months?? Im just kidding..I have always had cats too and i love them. I agree the males are much more easy going than females. The males are more lovable easily handled. The female cats I have had like to be left alone not coddled to.
Posted by Gaillardia on October 16, 2002, at 12:07:10
In reply to Re: 20%?, posted by Phil on August 1, 2002, at 6:15:48
> pharmrep, Are you saying Celexa is around 20% sexual dysfunction, mostly delayed ejaculation?
> Or are you saying only 20% will talk about it?
> I would think in the real world that it's 50-70%.
> And from personal experience, the sexual problems are more varied. I'm taking 40mg, down from 60mg and don't even think about getting as far as ejaculation. I take Wellbutrin and Adderall and Viagra occasionally and I've still written off sex. It's so frustrating, it's not worth the effort.
> I cannot believe the numbers that companies get away with putting on package inserts.
> Do you, as a rep, encourage doctors to bring the subject up with patients or does every rep say, well, patients just don't want to talk about it.
> If you know that's true, why don't $200.00 an hour psychiatrists bring the subject up? I think that nobody, including drug companies and doctors, want to bring it up. It's difficult to say anything in a 15 minute med check.
>
> Is Forest aggressively trying to overCOME this problem? The first company that makes an effective AD without this SE will never have cash flow problems again. I'm sure pharm co. are aware that they could make a fortune.
>
> What's the figure going to be on Lexapro..2%?
> Have you ever been on meds? Does your company realize that the choice we are given is semi-normalcy at the expense of sex? Semi-normalcy at the expense of 100% apathy?
> Not trying to blame you for the world's depression problems but after 20 of my best years spent on meds, it's all getting a bit tiresome.
>
> PhilAs a psychotherapist (social worker)I routinely ask about s/e to SSRI's. I routinely ask "any sexual problems?" I have strong opinions about the numbers given, and have argued with many doc's abt the true rates of sexual s/e related to orgasm/ejaculation problems and reduced sex drive. Anecdotally, I find the rate of sexual s/e's to be at least 80% to any given ssri, with Effexor perhaps being slightly lower. I want to learn much more abt these new meds for my clientele! SSRI's have changed and saved millions of lives, I expect, although I agree with the studies that indicate antidepressants aren't longterm effective without therapy. Anyone left out there reading this? Any thoughts? --Gail
Posted by emmalie on October 16, 2002, at 13:44:49
In reply to Re: 20%?, posted by Gaillardia on October 16, 2002, at 12:07:10
An anecdote: I've had many friends on SSRIs over the years and I have yet to meet a single person who doesn't complain about reduced sex drive/difficulty achieving orgasm.
Posted by pharmrep on October 16, 2002, at 14:20:35
In reply to Re: 20%?, posted by Gaillardia on October 16, 2002, at 12:07:10
What's the figure going to be on Lexapro..2%?
>
> As a psychotherapist (social worker)I routinely ask about s/e to SSRI's. I routinely ask "any sexual problems?" I have strong opinions about the numbers given, and have argued with many doc's abt the true rates of sexual s/e related to orgasm/ejaculation problems and reduced sex drive. Anecdotally, I find the rate of sexual s/e's to be at least 80% to any given ssri, with Effexor perhaps being slightly lower. I want to learn much more abt these new meds for my clientele! SSRI's have changed and saved millions of lives, I expect, although I agree with the studies that indicate antidepressants aren't longterm effective without therapy. Anyone left out there reading this? Any thoughts? --Gail** The Lexapro study donelast year showed 9%.. is that a bid selling point? No. Sexual s/e are a class effect, only Paxil seems to be a little worse than the rest (prozac/celexa/zoloft/effexor all seem to be about the same...including lexapro so far) The "volunteered" info from the FDA studies from 10+ yrs ago were grossly off since it was not commonly shared for whatever reason. so the 6% -12% range was more like 25%-50% in reality...whether the 9% from just 1 year ago for lexapro holds up (since the topic is hot and the info more readily shared) has yet to be seen...I imagine it will be higher, but not as bad as paxil...it will take time to see, but this is not at all the selling point...the greater efficacy, increased potency, quicker onset of action, s/e and discontinuation due to adverse events comparable to placebo, and least expensive branded ssri are the selling points.
(ps..I know the meds are involved, but have you considered the pre-existing % of sex s/e?...80% seems a little high.)
Posted by ANXIETY ANN on October 16, 2002, at 14:36:04
In reply to Re: 20%? » Gaillardia, posted by pharmrep on October 16, 2002, at 14:20:35
Hi
well its been 10 days now and most of my s/e are gone. I still have sexual s/e that are very frustrating. I"m hoping that the inability to have an orgasim will go away soon! My anxiety (the reason for taking Lexapro)is less, although I have yet to work up the courage to leave my comfort zone by myself. I finally got a good nights sleep last night , the first since starting Lexapro. If I had to rate my response to the drug, I would have to say I'd give it a 7.
How is everyone else doing?
Posted by Gaillardia on October 16, 2002, at 15:02:01
In reply to Re: 20%? » Gaillardia, posted by pharmrep on October 16, 2002, at 14:20:35
Once again anecdotally, because I am not citing any structured study here, I have seen hundreds of people on SSRI's from their outset. I agree that Paxil, and I think Zoloft too, are at the top when it comes to sexual s/e's. However, it is a rare occurrence when someone does NOT have sexual s/e on an SSRI in my observation. I do ask about prior experiences with sexual response, always asking "Is this a change from normal for you?" I'm actually being conservative saying 80%, but considering the people who were sexually dysfunctional previously, or for whom sexual response is not an issue, almost all people experience a decrease in sex drive and ability to have an orgasm/ejaculate. And when you say that decreasing sexual s/e is not the point, come into the ranks with me. That is definitely the main reason that people want to take something else! When people suffering from depression have to chose between decreasing their symptoms of depression and having orgasms, it becomes a very difficult choice! I am not hostile here, I just wish I could tell you exactly how many times I have struggled with that issue with clients, and they have longed for an antidepressant that worked without often severe impact on their sex life. --Gail
Posted by pharmrep on October 16, 2002, at 15:36:26
In reply to Re: 20%? » Gaillardia, posted by pharmrep on October 16, 2002, at 14:20:35
> What's the figure going to be on Lexapro..2%?
> >
> > As a psychotherapist (social worker)I routinely ask about s/e to SSRI's. I routinely ask "any sexual problems?" I have strong opinions about the numbers given, and have argued with many doc's abt the true rates of sexual s/e related to orgasm/ejaculation problems and reduced sex drive. Anecdotally, I find the rate of sexual s/e's to be at least 80% to any given ssri, with Effexor perhaps being slightly lower. I want to learn much more abt these new meds for my clientele! SSRI's have changed and saved millions of lives, I expect, although I agree with the studies that indicate antidepressants aren't longterm effective without therapy. Anyone left out there reading this? Any thoughts? --Gail
>
> ** The Lexapro study donelast year showed 9%.. is that a bid selling point? No. Sexual s/e are a class effect, only Paxil seems to be a little worse than the rest (prozac/celexa/zoloft/effexor all seem to be about the same...including lexapro so far) The "volunteered" info from the FDA studies from 10+ yrs ago were grossly off since it was not commonly shared for whatever reason. so the 6% -12% range was more like 25%-50% in reality...whether the 9% from just 1 year ago for lexapro holds up (since the topic is hot and the info more readily shared) has yet to be seen...I imagine it will be higher, but not as bad as paxil...it will take time to see, but this is not at all the selling point...the greater efficacy, increased potency, quicker onset of action, s/e and discontinuation due to adverse events comparable to placebo, and least expensive branded ssri are the selling points.
>
> (ps..I know the meds are involved, but have you considered the pre-existing % of sex s/e?...80% seems a little high.)*** i said "selling point" not just point in general. I know this is a tough se to work with, and that it is a "class effect"...I was saying that the other ssri's have the same challenge and that there are other ways lexapro separates itself from them. sexual side effects is not the main selling point.
Posted by Abacus on October 16, 2002, at 18:08:33
In reply to Re: ten days on Lexapro, posted by ANXIETY ANN on October 16, 2002, at 14:36:04
Fifteen days for me and it is going very well -- I could almost see the fog lift a couple of days ago.
> Hi
> well its been 10 days now and most of my s/e are gone. I still have sexual s/e that are very frustrating. I"m hoping that the inability to have an orgasim will go away soon! My anxiety (the reason for taking Lexapro)is less, although I have yet to work up the courage to leave my comfort zone by myself. I finally got a good nights sleep last night , the first since starting Lexapro. If I had to rate my response to the drug, I would have to say I'd give it a 7.
> How is everyone else doing?
Posted by mudbunny on October 16, 2002, at 18:33:37
In reply to Re: ten days on Lexapro, posted by ANXIETY ANN on October 16, 2002, at 14:36:04
Hi I have been on lex for 3 weeks everythings great except the orgasims that is so frustrating. I hope it changes soon Im only 31
Posted by Phil on October 16, 2002, at 19:29:27
In reply to Re: 20%?, posted by Gaillardia on October 16, 2002, at 15:02:01
Nicotine's not addictive and our products aren't harmful.
Our SSRI's don't cause over 9-5-2% sexual side effects. It's false and it's a major, major lie to the AD consumer. Tell us the real story on everything, period.
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Dr. Bob is Robert Hsiung, MD,
[email protected]
Script revised: February 4, 2008
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