![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Peter on October 31, 2003, at 7:14:37
Hi all:
Well, 8 weeks of lexapro 10mg, and my pdoc is finally telling me it's a 'no-go' for me. In all these 2 months, it has not produced any significant or lasting therapeutic effects. In addition, it is the first anti-depressant that I have taken without a mood-stabilizer, and I've experienced a lot of heightened agitation and evening hypomania. My doc always said I had atypical, 'soft' bipolar disorder underlying all my other symptoms. But after going thru hell coming off of my last medication 'cocktail' (lamictal, prozac, trazadone, adderall, straterra, ambien, temazepam,klonopin), we decided to ditch the mood stabilizer and just see how the lexapro would work for my depression and anxieties, while still taking klonopin for sleep/anxiety and dexedrine for comorbid ADHD.
But, seeing my lack of therapeutic response to the lexapro and the worsening of my agitation and mood swings, he said his theory of my mood disorder had been verified: basically, he told me that the type of bipolar disorder I have can be thought of as an underlying 'engine' to which all of my other comorbid disorders (social anxiety, GAD, ADHD symptoms, etc.) are tied. When the engine gets 'revved-up,' either naturally or from anti-depressant 'kindling,' my hypomania becomes manifest as heightened anxieties, impulsiveness, and all my other symptoms get worse. So it is important to stabilize that underlying engine.
So now wants me to just come off the lexapro and has given me depakote (which, although not the ideal med, is the most tolerable for me out of all the mood stabilizers I've tried) so that my 'underlying bipolar engine' will stabilize. Meanwhile, he said I should continue the dexedrine spansules. After I am more stabilized, we will discuss other routes of treating my depression/anxiety - either with another SSRI, or a traditional MAOI (which I have not yet tried).
Here's my question:
He has told me to cut my lexapro dose in half, and take 5mg each day for a week, and then 5mg every other day until I receive further instructions from him. Because of the high-potency of lexapro (10mg=40mg celexa, etc.), I am scared about withdrawal symptoms, even though my doc said he really doesn't 'think' I will experience any. All I know is that the worst hell I've ever been through was zoloft withdrawal which resulted from my tapering it a bit too quickly. Is tapering the lexapro like I stated above a good way to taper it? Or will I experience withdrawal?
I can understand why he would want to get me off the lexapro completely so I can 're-stabilize' before going on to another antidepressant, but I wonder the following:
If we are going to end up treating me with another SSRI ANYWAY, there seem to me to be advantages of switching immediately over to another SSRI instead of waiting until the lexapro is 100% out of my system: Firstly, this would avoid SSRI-discontinuation symptoms; secondly, the onset of action of the new SSRI will probably begin much more quickly than if I started it after all the lexapro was out of my system. I think this is because (correct me if I'm wrong) my brain is already used to the whole seratonin reuptake inhibition mechanism, and if I switch to, let's say Prozac, the Prozac will sort of continue from where the lexapro left off. Whereas, if I waited until all the lexapro was out of my system, my brain would sort of have to re-learn and re-adjust to the SRI mechanism, which could take many months.
On the other hand, if we decide to start me up on an MAOI, then switching to prozac would pretty much exclude that possibility, or at least stall it for many more months, as you need to wait at least 5 weeks after stopping prozac to begin an MAOI.
I've taken prozac before and it worked in much more noticeable, positive ways for me than lexapro, even though I only took it for a few weeks, combined with many different meds; that leads me to think that it COULD work even better taken just with depakote, dexedrine, and klonopin.
On the other hand, I've been battling with the idea of trying an MAOI for years; I've heard they are extremely effective, but I have a lot of trouble getting over my phobias about MAOI interactions and Side-effects.
I don't know: do you think I should taper the lexapro in the way that he said and stabilize on depakote before we decide on trying me on another AD?
Or should I introduce Prozac while tapering lexapro to avoid withdrawal and make a smooth transition?
Or should I just get off the lexapro as instructed, endure any hellish withdrawal, say good-bye to SSRI's (I've tried 'em all), and go the MAOI route in a few weeks?
thanks,
Peter
Posted by wsj on November 1, 2003, at 16:44:33
In reply to ADVICE PLEASE - stopping lexapro, back on depakote, posted by Peter on October 31, 2003, at 7:14:37
peter - i stopped lexapro cold turkey wednesday. only s/e so far are insomnia and itchiness. my mood has actually been better ever since stopping! i had minor surgery and didn't bring a lex to hospital so i just stopped w/ the intent of washing 2 weeks and going to parnate. i'm not sure the insomnia or itching is even do to stopping lex > but might be a result of my surgery and healing. (surgery for apnea - soft palate reduction, repair dev. septum and reduce turbinates. on lortabs for recovery > might be helping lex w/d.
Posted by Peter on November 1, 2003, at 18:26:13
In reply to Re: ADVICE PLEASE - stopping lexapro, back on depakote » Peter , posted by wsj on November 1, 2003, at 16:44:33
> peter - i stopped lexapro cold turkey wednesday. only s/e so far are insomnia and itchiness. my mood has actually been better ever since stopping! i had minor surgery and didn't bring a lex to hospital so i just stopped w/ the intent of washing 2 weeks and going to parnate. i'm not sure the insomnia or itching is even do to stopping lex > but might be a result of my surgery and healing. (surgery for apnea - soft palate reduction, repair dev. septum and reduce turbinates. on lortabs for recovery > might be helping lex w/d
>>wsj:
I'm glad your surgery went well and that you're feeling better from stopping the lex. I reduced from 10mg to 5mg a few days ago, and this week I'll take 5mg every other day for a few days and then stop it completely (these are my pdoc's orders; I've always been really sensitive w/meds, so it might very well be fine that you stopped it cold. And if you haven't felt any withdrawal by now, I'm sure you won't).
I started 250mg depakote also, and find that my overall mood is actually better from adding the depakote and tapering the lex.
At my next session, I'll discuss starting an MAOI w/my doc. I'm still taking dexedrine spansules 25mg/day, but I'll probably lower it or stop it altogether if I start an MAOI (especially if it's parnate, since I've heard parnate is more stimulating on its own than Nardil).
Are you still taking dex? If so, how much?
Well, good to know you are well. Best of luck with the parnate; keep me updated!
Peter
Posted by wsj on November 2, 2003, at 9:59:37
In reply to Re: ADVICE PLEASE - stopping lexapro, back on depakote » wsj, posted by Peter on November 1, 2003, at 18:26:13
im not well! i do however feel better on the klonopin .5-.75/day and dexedrine 20-25mg/day than i did when i included lexapro. my pdoc is one that says no dex w/ maoi . so i have to stop the dex b/f starting parnate. im also in quite a bit of pain from the surgery and still taking lortab. but if i do start something new it will be parnate > if no success then i will go to nardil > if no success then i will take ect. i'm tired of existing and not living!
good luck peter,
wsj
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
[email protected]
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.