Switching from Citalopram to Escitalopram?

Hi guys,

Brief outline-

Started AD's in April, Dosulepin, 3 months on them, didn't work out.

Started on Citalopram in August to present date, currently on 40mg

I'm currently at a crossroads at the moment, I did reach a peak on these were I wasn't exactly doing cartwheels but the anxiety went,I was content and I was fully concentrated at work etc. While my anxiety is still ok and I'm not as worked up as I once was, my original symptoms are back from before I started on AD's. Lack of concentration, feeling flat, strange crawling sensations in my brain (the reason why I was put on AD's, after seeing a specialist). I even started a new temp-perm job 2 weeks ago and I was so bad I didn't go back after the first day as my head was all over the place.
Now some of you might say this is the medication that maybe the cause, but I will state again this is exactly what I was like before starting AD's, so it makes me believe that the meds are losing there effectiveness.

I have an appointment with my GP tonight and i do feel that this is the last throw of the dice regarding AD's so I feel its important to finally find one that will suit me.

I was thinking it was maybe an option to switch to Escitalopram, i know it's a purer form of citalopram, has any done this? if so was it more effective and what dose did you start on bearing in mind that I am currently on 40mg .

I was also looking into the possibility of switching to Cymbalta, but I will discuss this with my GP tonight, just wanted your opinions first.

All help apprecitated!


Thanks

If we accept what Wikipedia tell us then:

Quote:

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citalopram (Celexa): usual dosing is 20 mg initially; maintenance 40 mg per day; maximum dose 60 mg per day.
escitalopram oxalate (Lexapro): usual dosing is 10 mg and shown to be as effective as 20 mg in most cases. Maximum dose 20 mg. Also helps with anxiety.

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So on that basis 20mg escitalopram would be at least equivalent to your drug. How the transition should be managed I am unclear. The newer drug seems to always be credited with less side effects and perhaps more effectiveness. So you may well gain from that. I've only had esc' so I cannot really add much.

I've just found this site http://www.globalrph.com/antidepressants.h whose accuracy I cannot vouch for, claims that:

Quote:

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Approximate equivalent dosages of SSRIs:
citalopram 20mg
escitalopram 5 mg

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So esc' may well be more effective.

Good Luck

hi there
i did this switch and i would say there is a slight improvement on cipralex

Hi,

Thanks for the replies, I went to the doctors yesterday to see if she could switch me to escitalopram but she said it was exactly the same. I tried explaining to her that some people said it was more effective but she wasn't having any of it.

She prescribed me Effexor, starting dose of 37.5mg while I taper down off citalopram, I am wary about taking this drug as I have heard bad things about it. I haven't picked the prescription up yet, just mulling it over.

hi there,
interesting post, i have used Escitalopram (aka cipralex) twice before, for anxiety, over the last 3 years both times with success after a couple of weeks. this latest time was put on citalopram 10mg which took a good 3 weeks to kick in then kinda slid back to square one after a couple of good weeks, upped to 20mg then same scenario took a while to kick in, a couple of good weeks, then yesterday i felt a wave of adrenaline/anxiety while at work (for no apparent reason). i would be interested to hear how people get on, i'm toying with coming off present med getting it out of my system seeing where i'm at then going back onto cipralex as i know these work.

the reason they are different is that escitalopram is the purer form of citalopram so u need less of it and there are fewer side effects = the reason its not prescribed as much is that citalopram costs about 40p a box and cipralex about £30 -

hey there
i was on citalapram on and off for 4 years. started and stayed on 20mg dose all the time. had awful side effects.

i then was on a stop and knew i needed to get back on something again so gp suggested i try escitalapram this was 3 yaers ago and im still on them today. started on 5mg and still on that dose. gp said 5mg escitalapram is = to 10mg citalapram and it has much fewer side effetcs.

I agree with Babs. I was put on Citalopram but this time around asked for Escitalopram. I have a new doctor and she said yes this could be better for you as has less side effects. I asked her why I wasn't give it before by my old doctor and she told me probably because it costs a lot more!

hi

I was on Citalopram for only 2 months and the side effects were so unbareable!! I was off work the whole time

My Dr then prescribed me Ecitalopram a few days ago and this is day 5 on 5mg and i have to say the only side effect i am having is tiredness and dizzyness, almost like a pressure in my head. But nothing like the 5 mg i was taking on the Citalopram, i would never take those pills again.

My Dr told me in theory they are similiar tablets but Ecitalopram(cipralex) are more advanced and give less side effects and also have a quicker effect.
She went on to tell me that Ecitalopramm are much more expensive for the NHS than Citalopram so they prefer to try patients on these first rather than the more expensive Ecitalopram...


:)

I was on 40mg Citalopram then down to 20mg. After 1 year I was changed to Escitalopram as I was going back to work but was put on 10mg. I take the 10mg when I am very nervy (not very often now) as I found they made me very sleepy in the mornings as I take my tablets when going to bed at night. I mostly take 5mg which seems to stabilise me at moment. I did not have any side effects when i changed to Escitalopram accept sleepiness in the mornings. Hope this helps

This is a bit off topic, but I must say that I'm almost shocked to hear that doctors withhold medications they know will go easier on the patient just because they're more expensive. I would pay five times the price of Cipralex for a med I knew would get me back on my feet again - that would be cheaper than not being able to work because of unbearable side effects. At least patients should be given a choise.

I have just changed from cital to escital. Did anyone get side effects changing?what were they? Gone straight from 40 mg cital to liquid 1 ml. today. Hope its better for anxiety and panic :scared15:

Quote:

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Originally Posted by reallyfedup

I have just changed from cital to escital. Did anyone get side effects changing?what were they? Gone straight from 40 mg cital to liquid 1 ml. today. Hope its better for anxiety and panic :scared15:

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I am now 2 and half weeks from changing onto escital and anxiety and panic have shot through the roof. Dr told me to go up to 2 ml ie 20 mg, so any advice welcomed please. Will it help. How long? Side effects? Should I do it slowly? Thanks x

Hi. Its generally recognised that chemically Esc = 2 * Cit. Since it lacks the 50% of R-Citalopram which is not beneficial. It may even be more than twice as effective as the R-Cit is not getting in the way or producing extra side effects.

This means your does of 1ml = 10mg would have been about half of the equivalent to the dose of Citalopram that you had before. 10mg is the normal staring dose for Esc, but on someone coming off 40mg Cit it does look a bit low. Did the Dr just stop Cit and replace it with Esc, or did you tapper across (reducing one and increasing the other)?

There is some debate in the literature as to how much 20mg Esc is any stronger than 10mg. From personal experience the chemistry and side effects are stronger on 20mg, although I'm less sure about the benefits being double. I class Esc as a very effective anti-depressant, but only a bit effective against my severe GAD. It does actually have clinical claims in its specification for a number of anxiety disorders, which is more than you can say for many SSRIs. Also most of the comparison studies of SSRIs look at their anti-depressant effect not their effect on anxiety.

Drs seem to assume the SSRIs are identical when it suits them, but if they were there would not be so many of them in use. The different meds strive for the same effect but (may) produce it in a different way; which would suit different patients. Eg. Even the manufacturer can't quite explain why "Esc > 2 * Cit." , different studies reaching different rationalisations even though these two have the closest chemical similarity.

When I went up to 20mg I did it in a single step - although perhaps uniquely my GP had me take 10mg twice a day rather than 20gm in one go. This was completely off-packet as the specification always says to take a single daily dose. I suspect 20mg lengthens the duration of the full effect of the med, rather than increasing the peak effectiveness, but that's just a guess on my part. I did find I had to skip 10mg occasionally as a migrainy headache developed after about 7-10 days which cleared after the missed dose. Kind of implied I was full of either the medication or Serotonin
after about a week!

In short you may be ok doing it in one go. Maths suggests its about a week for your body levels to catch up with the change in dose. Clearly the full benefit must take a bit longer than that, even on just a dosage increase.
In this post I summarised my ongoing side effects at the point I switched off the Escitalopram.

Take Care

thanks for your reply x

Hi, I was interested when I came across this forum as I have recently been prescribed escitalpram as my previous AD citalopram didn't seem to be as effective as it had previously. I have spent most of my adult life on anti ds and as a recovering alcoholic have spent many a time struggling with depression anxiety and life in general. Most recently I found that although I was on 60mg of citalopram I was feeling total despair. After a long discussion with my GP she advised I switch to 20mgs of escitalopram as I didn't need have a break inbetween meds. To date I have to say I am beginning to feel more normal, although I still have a way to go with my alcohol recovery. So in summary I would highly recommend at least discussing escitaopram with your GP as anything has got to be better than sitting on the edge of the blackhole!

Hi,I'm currently on Amitriptyline 100mg at night,also Temazepam 15mg.I was going to ask my G.P if I could start taking Escitalopram as my anxiety,panic attacks are becoming unbearable during the day.Does any body know if you can take Temazepam as well.Many Thanks