Hi. I said on the Escitalopram forum that I'd write up my experiences of this medication change. So here it is. I will edit this post or reply-to-myself to continue diary.

NOTE: I have tried to be frank, and detailed, so be warned and get your reading glasses out.

Background
I concluded in October that I had suffered from GAD for a long time. Originally it slowly intruded, and in recent years had impacted me more and more. It always had the greatest effect at home - slow decison making and poor effort. Work had always been very different. In April-June 08 I added depression to the mix for fairly reasonable causes, but it was certainly no help. In June I went to my GP. He treated me primarily for depression/stress. Anxiety doesn't seem to mean much to GPs. Thats when I started Escitalopram. Later he also requested some counselling (for me!). I got an assessment in October 08 and as I needed a fast improvement, I managed to start Group CBT (stress/depression/anxiety management course) the Next Day. You only get about 5 real hours though.

Escitalopram
I've been taking Escitalopram (Cipralex, Lexapro) since June 08. Originally 10mg per day and later 20mg per day (the official maximum). Unusually my GP had me take the larger dose in two parts morning & night. All the documentation says to have a single dose but it seemed to work. This worked very well on the depression I had in June 08
but only really took the worst of the background anxiety away.

Esc' did not touch the peak anxiety or remove the general level. Using the NHS GAD-7 assessment (on patient.co.uk) I & my wife reckon that in June 08 I was 20/21 = very severe. Now April 09 she reckoned 17/21 = severe, the lowest I could give myself was 14-15/21 = the moderate/severe boundary.

The anti-depressant effect was strong enough that I felt no major emotional lows when my Father died in November. Although maybe I was too weird already, or just to busy. He was 89 and had not been well, so on one level it was not a shock which may have altered the experience.

I did not have too many side effects, or those I did get were no worse than the mental/physical situation I had already. (In the following ML = medication leaflet - the packet insert or better online versions).

The only ongoing side-effects for me (if any) include:
  1. Interaction with blood sugar or GA tolerance (ML: confirms), I had some of this before starting the meds so might be me, the meds, or part of my physical anxiety-stress.
  2. A tendancy to headache/migraine (ML: confirms headache). I generally found that the meds stopped me getting migraine and removed my chocolate sensitivity. When I felt I had a lot of the medication in me (eg. in March) it seemed to push me toward migraine pain. This was controllable by missing a dose occasionally.
  3. A slight mental heaviness. Not a sedative effect or emotionally but like a mental burden. I can't really say if this had any effect. I became most aware of it as it reduced while I have been reducing the dosage. I think its a symptom of the high seratonin load.
  4. The physical sexual response can be weakened especially orgasm. (ML: mentions this - male & female.) Again this was partly sensitive to recent dosage. I think you have so much seratonin kicking about that the body cannot experience its natural reactions properly as they may respond to the level or rate of change.
  5. A tendancy to clamp my back teeth together (ML: says grinding, but for me it was clamping).
  6. Any others are indistinguishable from the general anxiety-stress-depression symptoms you have when you start taking them.
October 08
The CBT course happened. It was quite good and I found the group context quite supportive. Its primary focuses felt like stress and depression though. It gave me a boost and I made a good friend too; they had similar
symptoms and phobias. I did lots of reading - websites and books - and then things fell apart as Dad went from ill to dead in a short time.

April 09
I went to the GP as I felt I was not gaining enough from the Esc' as my anxiety still dominated. My high GAD-7 score seems to confirm this. I hoped he might offer something better/stronger. In fact the most significant thing that came to light was that the PCT wanted him to stop prescribing Esc' as they claim citalopram is the same. Many posters here might deny that - its merely similar. He gave me a couple of days to think about what I wanted. There is a post in the Esc' forum about this.

I reminded my GP about GAD - and gave him a copy of the NHS fact sheet from patient.co.uk. All seemed very new to him. He read the epidemiology bit and said in effect "blimey - this sounds like you". That was what I'd told him in late october, sigh. Anyway we agreed that I could give Buspirone (Buspar) a try. He had prescribed it before to someone, its generic and its specifically listed for GAD on the NHS fact sheet. So if the PCT complain we can hit them with that! Oddly its name seems to rarely come up which is odd as writeups compare it to the 'Azepams without the addiction.

Buspirone (Buspar)I took a copy of the medicine leaflet with me so we concured that the starting dose was 10-15mg per day in 5mg doses and that the lowest theraputic dose was 15mg per day. He gave me an initial prescription of 30 tablets, so we could review before going further.

I'd have hoped for a few more Escitalopram as I only had a few left - but he thought there were enough. I said I'd revisit if withdrawal was a problem. My eventual plan was to halve the dose and then halve it again. I am less concerned than I might be as Buspirone is a seratonin agonist so it should (eventually) fake the seratonin that the reduction in Esc' loses. me.

Transition Plan
My plan was to start making the switch Friday night, so I got to include Friday's medication in the transition giving me an extra day or two:
Day Esc' Buspirone
Was 10 + 10; none
Fri 10 + 0; 0 + 0 + 5 (morning and bedtime)
Sat 10 + 0; 5 + 0 + 5
Sun 10 + 0; 5 + 0 + 5
Mon 10 + 0; 5 + 0 + 5
Tue 5 + 0; 5 + 5 + 5 (At 8 hours if possible)
Wed 5 + 0; 5 + 5 + 5
Thu 5 + 0; as above
Fri 5 + 0; as above
Sat 0 + 0; as above
This has turned out quite a long post so I will record my progress in a separate reply.