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View Full Version : Escitalopram - stick with it or stick it?



Biggle
21-01-05, 13:55
Hello everyone.

This is my first post. I think firstly I'll say what a delight it is to have found this forum. I have been reading through the posts and have found them very helpful, particularly as there is an absence of anti/pro-med agendas that appear to prevade other websites.

Now for an introduction and a description of where I am currently. I could really do with some advice. I'll try not to go on too long.

I have been off work for 3 months now. My GP first diagnosed me with anxiety from being overworked.

The symptoms I went with I had been expreiencing for about 3 months before:
Insomnia - averaging 4 hours sleep a night (previously sleeping 7/8) some nights sleeping an hour and a half. Impossible to get to sleep - thoughts racing, smallest sounds keeping me awake. Pulsations in temples and pressure felt in forehead. Weakness in the legs, periods of exhaustion, moments when I felt like I was going to collapse, butterflies in the stomach for no apparent reason, general sense of dread, fits of rage over small things, snapping at people close to me, feeling very hot at night, uncontrollable scratching of the calves (of all places).

GP gave me Lorazepam - this gave me a different problem. Sleeping more, but a full dose (1mg x3) made me drowsy and absent-minded. Very difficult to get out of bed. Not able to function properly - going back to work out of the question. Taking it in halves made it slightly better, but then sometimes would not enable me to sleep - very difficult to find a happy medium.

I have just seen a psychiatrist who has taken a slightly different line - diagnosing depression with moderate anxiety.

My meds are now:
Escitalopram (5mg for 3 days then 10mg)
Bromazepam 1.5mg morning
Lormetazepam 1mg last thing at night.

The 3 of them together are an absolute bomb. However, I have been given the option to use the Escitalopram as the base, taking the others when there seems to be a need for them.

First of all, the Lormatazepram is a great thing indeed - gets me to sleep after 15 minutes and I can wake up no problem 8 hours later.

The Escitalopram however I found hits me very hard. This is at 5mg only: I feel like a Zombie. I have no interest in anything, I'm a witty guy but that has deserted me, I'm constantly tired, yawning, taking naps. I can't concentrate, can't express myself well - don't have any desire to talk. I can't even read. I did not take it this morning (I don't think I could have written this while medicated) and asked my GP if I could stop taking them and just take the Lormatazepam but she was very adamant that I should continue with the base medication, that I should try and force myself to do normal things despite the symptoms and that within a few weeks I would feel a lot better. I could even be convincing myself that the sides were worse than they really are. After reading the psychiatrist's report she said it was clear that my problem was depression and it must be treated. Also, I had to accept I was depressed as it was characteristic of a person with depression to think that they are not depressed.

Surely there is a problem with the logic of this? People who are not depressed don't think they are depressed either. Couldn't I be one of them? :)

But there is some truth in what she is saying. I am not sure that I need this medication. It feels like using a sledgehammer to crack a nut. If this is all based around not being able to sleep and the Lormatazepam takes care of that, then should I really take the risk of sedating myself with the Escitalopram in the hope that it wears off? And then have the problem of trying to come off it later? Will I be THAT much happier if the sides wear off and the effect comes in?

I also asked if I could take it at night, thinking the days might be less foggy. I was advised against this however.

Today I haven't yet taken it and I don't know if I should. Some people say they have almost no side effects at all from their meds. Wouldn't it be preferable to change and search for this?
Or am I being a wuss and

camilla
21-01-05, 14:21
hi welcome

i have a similar sleeping problem i need a strong sleeping tablet 2 get me off to sleep. but then i can't get up in the mornings.

i have often had side effects from medication. some people are more senstive than others this is normal.

when i was on a lot of medication i could never made it through the day without sleeping. Maybe your senstive to the medication so you don't need so much of it. if so i can still help you with less side-effects.

i suggested you could talk to your dr about reducing it.

camilla

Meg
21-01-05, 14:41
Hi Biggle,

Welcome to the site. Glad you like it . We're very pro choice here.

We support all those who want to take meds to see it through and derive the benefit from them when taken properly and also support those who want to do it med free which is totally doable for most but takes lots of stamina without the break that meds can provide.

You say 'I have just seen a psychiatrist' I'm presuming this is within the last week or so so the schedule is new to you .

My history is similar in that I was doing 15-17 hr days and one day it all just collapsed around me.
My GP said depression and prozac. I was not depressed. I was full of self pity/sad days and mortified that my life as I knew might be over and I had several of the symptoms but I was not clinically depressed .
I stayed on prozac long enough 16 weeks to get the ready brek glow feeling and realized there was life after panic and then took myself off it and went it alone- knowing that I could return to meds if I didn't suceed. It was very hard but its now way behind me.

I would first of all like to ask about how she proposed addressing the root cause of this issue ... the overwork and occupational stress ?

Incidentally, I find some people who worked very hard and long and suddenly stop actually get worse in the very initial periods as they have lonliness and bordom to contend with and all the time to dwell on their predicament. I do not advocate staying at work whilst you're acute but I do recommend spending the days doing something proactive to help yourself and keeping out of mischief.

All your symptoms are very common ones and nothing there gives me cause for concern

The Escitalopram will take about a month to kick in. The side effects should wear off in a few days but perhaps consider not increasing the dose to 10mg until they are wearing off. If you go this route stay on it for at least a month

Bromazepam - maybe the sledge hammer one. Its essentially a strong valium cousin. You could try without it or breaking it in half.

Lormetazepam- great for sleep but don't allow yourself to get used to it. How are your dreams ?

You might want to put a post in the Introduction section as well and share some of your history so you can get the benefit of other peoples wealth of experience.

Take care

Let us know what you decide and how you're doing




Meg
www.overcominganxiety.co.uk

You cannot conquer fear until you have learned what it is you're afraid of. The enemy is ignorance. Vivian Vance

vernon
21-01-05, 15:31
Hi. Welcome to the site I am sure u will find lots of help here. Meg is very experience with these things and has also suffered herself and has lots of medical knowledge. I went to see a physiatrist a while ago and he gave me an antidepressant and larazapam to calm me when I get to anxious and panicky. But, I try to just take the antidepressants, as I know the tranx are addictive. I would have thought he would have give u the tranx as an emergency and see how u got on with just the antidepressants to start? Seems a lot of meds before just trying antidepressants alone first? I found the antidepressant helped me a lot with sleep, and stopped the waking early real scared. But with any recovery I still get some horrid days, but these seem to get less. Take care Vernon

Biggle
21-01-05, 15:46
Hi Camilla and Meg,

Thanks very much for your replies. I've just noticed the introductions board and I'll be putting in something after reading through some others.

Meg, I saw the psychiatrist this Monday. It was the first time I had seen one and I just basically trotted out my recent work history and the symptoms history with him for a good half an hour. My GP said that from this he will have been able to form a good diagnosis and he will be able to notice things about me that she can't. According to his report, he gives 6 headings for indications for depression - I actually can't understand any of them (doctor's writing) apart from the one that he thought I wasn't failing under, which was apathy. I am not apathetic it says here. I fail, or rather, show depressive tendencies on the other 5. I don't know if this system means anything to you - one of the headings looks like "astemia."


The general plan is 6 months of this medication during which I will have sessions with the Psychiatrist every few weeks and try to form a new perspective on my job situation and how to stop pushing myself too hard, and I imagine allowing myself to be pushed too hard. At work things have been bad and I have been pushed to the limit. I was not sleeping, and my response, also just to get something positive out of the day, was to get up earlier, go to the gym and work hard. The idea was that I would get to sleep earlier as a result. In fact what actually happened, was that although I felt more energy during the day, I would actually still have that energy at night, and it was even more difficult to get to sleep. I was actually sleeping less with this situation. I didn't even realise this had been happening until I had been off work for some weeks and forced to reflect on what had been happening.

I would say that my situation is similar to yours in that I am not convinced that I am depressed either. I have said this to the GP and she told me that I should see me from where she's sitting. However, I do feel fine most of the time. It's just that there's the not sleeping and the mental cat and mouse I play in my brain whenever the subject of work comes up. Also the exhaustion can still hit me even after doing very little. So clearly some things are not right and I do wonder if I could be depressed yet not think it.

I think my tactics will be to persevere with Escitalopram and see what happens. I will leave the other two unless there is a definite need at a particular time. I will wait though. For example, I have my best friend's wedding this weekend and I don't want it to seem like I am not there. If it's going to take a week or so before I feel like a human being it might as well be a slow week. So I will start again next week. Thanks for the advice of keeping it to 5mg. I was initially wondering if maybe upping the dose would actually make me feel better, as I couldn't imagine the sides possibly being any more severe.

What do you think generally?

Biggle
21-01-05, 15:54
Yes Vernon!!

I had forgotten that also, if I get to sleep at the right time (12.30/1am), I sometimes wake at about 4 or 5, feeling wired and unable to get back to sleep. Infact, it happened this morning at 6. My response? Get up and go to the gym and work hard. I tried to get a siesta after lunch - no chance. Still completely wired. I should add however that I feel quite good. This sort of thing I'm sure is part of the whole problem. The question is, do I really have to put myself through the effects that the anti-depressants have to beat it?

It's a tough one. It's good to know I'm not the only one who is getting this type of thing.

:)

vernon
21-01-05, 16:23
hi, I didnt find any bad side effects realy with the Antidepresant i started about 50 days ago, Its cipralex. Doc did try prozac before that but i heard that many good reporst on cipralex i asked for it. My shrink also said its a low dose anti and has is very tolorant. It has no side effects reported with most other meds. take care, Vernon

Meg
21-01-05, 16:32
Hi Biggle,

When I was in your dilemma I did numerous on line depression test - about 8- and I went with the aggregated conclusions.

http://www.depression-recovery-life.com/depression-tests.html

No need to pay for any results - ignore those ones. It will give you an inner idea of where you sit on the scale and whether you need to go down that route .

I hope you've found First Steps : First Steps to overcoming Panic and Anxiety (http://www.nomorepanic.co.uk/showthread.php?t=942)

Sleep is so vital so I do recommend you use your night time one - but perhaps every other night so you can be assured of enough sleep. Also I really really recommend that you join a Tai Chi, yoga or meditation class- one that runs in the evening as that will teach you to breathe correctly and how to relax and get a good relaxation CD . Your gym work is terrific but doesn't wind you down at night.

If you're really shaky get a full body massage it'll get all the tension out

Eat well and do fun things - get out in the countryside for a long walk.

Where are you getting your support from at home ?

When you decide to start taking the Escitalopram do it properly and be fully compliant.

Take care.



Meg
www.overcominganxiety.co.uk

You cannot conquer fear until you have learned what it is you're afraid of. The enemy is ignorance. Vivian Vance

Biggle
21-01-05, 19:04
Hi again Meg. Yes, the online tests are showing me as moderately depressed. It's quite surprising but there must be something in it.

Thanks very much for the help and ideas this afternoon. This in itself has been quite a tonic.

twister
22-01-05, 23:23
Hi Biggle

One thing to note - escitalopram and cipralex are the same thing. I take this, at first you may well get side effects but these do wear off after a week or so. I would not recommend taking it at night - I did at first and had the most horrendous nightmares and panic attacks. I do seem to remember being more sleepy but as I said this wear off and I am normal now.

Don't worry too much about depression classifications - doctors etc always feel the need to pigeonhole people according to the DSM IV. If you have the classic symptoms of anxiety you may well score as having depression because of the questions about tiredness, self esteem and concentration. I was scored as being moderately depressed by my psychiatrist even though I answered that I was not unhappy - solely because of these things. My CBT therapist has since agreed with me that I am definitely not depressed and pointed out the problems with questionnaires.

Hope you get on okay









Emily

Knowledge is knowing a tomato is a fruit
Understanding is knowing not to put it in a fruit salad

Biggle
27-01-05, 11:47
Thanks for that Twister.

Well I started taking the Escitalopram again and, lo and behold, had no more symptoms. So I had 3 days of hell, but from the 4th day no problems.

I increased the dosage from 5 to 10mg a couple of days back and the symptoms have come back. I'm banking on the idea that they will go away again in the next few days as the body gets used to it. I'll post on the progress.

Biggle
10-02-05, 18:21
Hi everyone,

Thought I would post on the progress - basically I decided to stick with the Escitalopram as opposed to sticking them, and I'm glad I did.

The side effects have now all but vanished. I am not aware of any effect at present, neither good nor bad. To be honest I am not really sure what is supposed to be happening - maybe it already is. I have read about a "Ready Brek glow" though and I can't say that I can feel that or in any way markedly more cheerful. I do however appear to be sleeping better. I think the tablets maybe make me a little bit more tired, although if that IS happening it is so subtle that I can't be sure. Nevertheless I have been sleeping regularly 8 hours and on time the last few nights without sleeping tablets. We will see if this continues.

One thing that has been very helpful has been seeing the psychiatrist. He has explained that although I have been diagnosed with depression, it is not a chronic thing and is not due to a lack of serotonin. So I am not "depressed" per se. A more accurate reading would be that it is a disorder with a cause (in my case exhaustion) and the course of medication gives you time out from what what caused it (something similar to what Meg mentions earlier on in the post). Therefore you don't blame yourself for the state you're in or push yourself to get back to normal - you relax and come back at your own pace.

So I have to say that I have been encouraged and supported by the medical professionals so far. There is so much bad press around about psychiatry and pharmaceuticals but in my case I have found it very helpful up till now.

Still early days but hopeful :)

FAN
10-02-05, 18:41
hi glad to hear you stuck with it, im not sure how soon the effects of any medication starts to kick in but i think you have to take them for a while before you get the effects, but saying that you sound to be in a really positive mood so perhaps they are working but not causing massive changes that you can see just a slow subtle change

fan x

Meg
10-02-05, 19:40
Thats good news Biggle,

I'be heard people say that the benefit crept up and one day they recognised that they felt much better and more comfortable in their outlook. Not such a struggle each day.

With exhaustion take care to replenish reserves that will have run dry over several months - so eat well and regularly too.


Meg
www.anxietymanagementltd.com

You cannot conquer fear until you have learned what it is you're afraid of. The enemy is ignorance. Vivian Vance

Biggle
01-04-05, 13:42
Hello everyone. I thought I would continue the journal, as I myself have never liked reading posts which start, only for the poster to fall off the radar with the result that you don't know how the situation ends!

Well, since the last post I have continued to take Escitalopram without fail. I was taking Bromazapam and Lormetazepam on an as-needed basis, but my psychiatrist took me off them about a month ago. At the same time he increased the Escitalopram dose to 15mg. There has certainly been improvement and I would say, for those readers at an earlier stage, that the improvement happens over time. I don't think I really knew what the improvements were until the last week or so, although the seeds were there very early on. I do not feel ecstatic or like I am seeing everything through rose-tinted glasses. I do however feel more solid, more stable.

I find that I react to frustrating situations with more equanimity. Also, when a situation arises where I would get a panicky feeling that would escalate or linger, I do recognise the situation and I think "oh here we go" and then....it doesn't happen. It is strange but comforting. The psychiatrist has been at pains to point out that this is NOT coming from the medication, that it is coming from me. I suppose that this can only tested months after stopping the medication, but I get the point, which is that this is how I can and have to be after leaving the medication. And I believe it is possible and that it lies with me.

The downside to the Escitalopram has been a decrease of interest in sex. Also the inability to drink alcohol. The second not necessarily being a bad thing. I was prone to a binge or two (or three) per week. Since the start of the medication, after one or two drinks, I just don't fancy any more, and I feel tired at the time and the next day if I have any more. At first I didn't know if these problems were really happening or not but over the last month it has been noticeable. I mentioned the first of these to the psychiatrist and he lowered the dose back to 10mg. I have only started this dose again this morning so I couldn't comment as to whether it has helped. I have also been advised that due to my progress I could leave the medication now, or continue until 6 months is up. The recommendation is to come off it after 6 months as there is less chance of a relapse.

The psychiatric counselling has been excellent. Without going into too much detail, he points me in the right direction, guiding me how to plan the coming month. Most of it is simple stuff but it works. He appears to have worked me out and presses the right buttons. All the thinking is done by me, but I am given gentle hints about how to go about it. It has helped me formulate a plan regarding work I have run by my doctor and psychiatrist and was greeted with enthusiasm.

So, cautiously optimistic then.

Meg
01-04-05, 16:05
Biggle,

Thanks you for coming back to update us and I'm very glad to hear you feeling that you're doing well and making progress.

Additionally, I am very relieved to hear you praising the mental health care you're getting. We tend to hear an awful lot of negative stories and experiences and having been on the other end delivering the care I know its not all bad.

Keep it up and hear from you next time you're passing.




Meg
www.anxietymanagementltd.com

Watch your thoughts, they become your words...
Watch your words, they become your actions... Watch your actions, they become your habits... Watch your habits, they become your character... Watch your character, it becomes your destiny...

nomorepanic
01-04-05, 19:35
Biggle

Hey good to see you back and yes we do wonder about previous members that disappear into the ether!

Glad the counselling is going well and I hope it continues to do so.

Well done on the progress so far!

Nicola

Biggle
11-08-05, 20:26
Hi everyone.

I decided to resurrect this one as I came off medication 10 days ago. I went from 15mg of escitalopram at the highest point, to 10mg and tapered off after 6 months in total, doing 1 then 1/2 every other day for 15 days, followed by 15 days of halves, and finally 15 days of 1/2 and zero every other day.

For the first 5 days I was ok and kept busy. However, I then started with terrible headaches - whole left side of the head sensitive and tense, with stabbing pains on the left temple every 5/10 seconds. I had these for 3 days before I went to the doctor, who prescribed Triptan for 2 blasts in case it was Migraine and anti-inflammatories. These have helped lessen the pain, but the tension is still there - in the face, jaw and temples. Mood wise, I´ve been alternately depressive/cheerful/tearful/morbid/dazed since the headaches came.

My psychiatrist suggested starting escitalopram again, but I objected that I was just postponing what was happening until the next time I came off. In the end he suggested giving it a month off the meds and then, if the headaches persisted, that he would put me on Lexapro and Triptan full time.

So a month it is then. I have to say though, it really is hard going. If anyone there has had similar problems coming off anti-depressants, or if you think it is pure co-incidence for the headaches and moods to start up now, I´d love to hear your opinions.

Biggle.

Meg
11-08-05, 21:06
You still came off in 6 weeks which is quick but hey - done now and these symptoms will ease and pass within 4-6 weeks .

Its unlikely to be pure coincidence - they are classic symptoms.


Meg
www.anxietymanagementltd.com

Your anxiety is the human representation of the pictures that you paint using your many vivid colours of revolving and reoccurring thoughts.
How big is your gallery ?

Biggle
11-08-05, 22:22
Thanks for the reply Meg. I´m a little irritated that none of the medical professionals warned me about this, but anyway, never mind, here we are.

I´ll keep posting the progress, or lack of, over the next few weeks.

Meg
11-08-05, 22:41
Its only recently been brought to GPs attention that it can really be awful but I don't think still that hey have had any useful guidelines on how to manage it.


Just slowly taper it but there is slow and slow !!



Meg
www.anxietymanagementltd.com

Your anxiety is the human representation of the pictures that you paint using your many vivid colours of revolving and reoccurring thoughts.
How big is your gallery ?