15mg Lexapro - but how long until positive or any effects?

[LisaS]

Hi,

I have GAD and it's pretty bad at the moment and have had it a few times before in my past. This time, I'm staying on the Lexapro!

I started taking 5mg for 10 days, then 10mg for 10 days and now just started 15mg - and this is where I will stay. My question is, that although I know it takes 4-6 weeks to get full effects, how long have I been on it? Do I count my weeks from when I started the 5mg or when I started the 15mg?
If it's from the 5mg then I've been on it for almost 3 weeks and I can't say I'm reaping ANY benefits yet and infact feel more anxious than when I started, which again I know can happen but I'm so desperate for a little relief. Anxiety is exhausting and debilitating.

I'll try and keep this thread updated too to help others and myself as time goes on...

Thanks all,
Lisa

[panic_down_under]

My question is, that although I know it takes 4-6 weeks to get full effects, how long have I been on it? Do I count my weeks from when I started the 5mg or when I started the 15mg?

The clock starts running from when you start taking a therapeutic dose, Lisa. Just how much this is varies from person to person, but the minimum recommended Lexapro (escitalopram) dose is 10mg so you can be sure that will be having a positive affect. Also, while most people do begin to get a response in the 4-7 week range, it can take longer for some, perhaps as long as 12 weeks.


infact feel more anxious than when I started

Despite the common myth that serotonin is a 'feel good' neurotransmitter, it is in fact the *opposite hence the spike in anxiety. After a few weeks the brain and body (other organs make/use much more than the brain) will respond to the extra serotonin activity by down-regulating its synthesis and expression and the heightened anxiety and other side-effects will then usually begin to diminish, but they may return for a while after dose increases.


* not strictly true as neurotransmitters don't have any intrinsic qualities, their action is determined by the receptors they bind to, not the molecule itself

I'm curious why you've been prescribed 15mg as the usual initial dose is 10mg, increasing only if that proves insufficient. Have you been on escitalopram before and needed the higher dose?

[LisaS]

Thank you so much for your helpful and informative response.
I have been on Lexapro before and needed 20mg and stayed on that for 6 months before coming down to 10mg again.
This time my doc said we may have to go to 20mg again. I told my psychologist this and she is the one that suggested I do 15mg instead. I actually wasn’t sure whether to give the 10mg a bit longer but then I also don’t want to waste time if I’m inevitably going to go to 20mg again. I’m hesitant to do 20mg again as I did feel I was a bit emotionless.
Does that all make sense?

[panic_down_under]

I have been on Lexapro before and needed 20mg and stayed on that for 6 months before coming down to 10mg again.
This time my doc said we may have to go to 20mg again. I told my psychologist this and she is the one that suggested I do 15mg instead.

Unfortunately, you may need the full 20mg given this is the second time you've been on escitalopram because there is *evidence antidepressants (ADs) become progressively less effective each time they are stopped and restarted.


* Bosman RC (https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/30041180/), 2018; Amsterdam JD (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5123793/), 2016; Amsterdam JD (http://www.karger.com/Article/FullText/226611), 2009; Amsterdam JD (http://www.ncbi.nlm.nih.gov/pubmed/18694599), 2009; Leykin Y (http://www.ncbi.nlm.nih.gov/pubmed/17469884), 2007; Paholpak S (https://www.ncbi.nlm.nih.gov/pubmed/12501907), 2002


I’m hesitant to do 20mg again as I did feel I was a bit emotionless.

If this reoccurs there are a couple of things which may work. Citalopram (Celexa) and escitalopram are nearly the same drug. Citalopram is made up of two isomers, the 'S' form which is the active component, and a 'R' mirror image (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC314378/) form which is a poorer fit biologically and so is mostly inactive. Escitalopram is more refined and only contains the 'S' isomer. Despite the chemical closeness there can be differences in side-effects and it possible the emotionless won't be a problem with citalopram, or less so.

The second option is to supplement the 15mg dose with buspirone (Buspar) instead of taking more. Buspirone is generalised anxiety med which only works for some, but in small adjuvant doses it will often increase the effectiveness of SSRIs and also reduce some of their side-effects. It may also reinvigorate SSRIs which have stopped working so might counter the effectiveness loss when returning to an AD mentioned above.

[LisaS]

Hey - I'm in need of some advice.

I took 10mg for 10 days and 2 weeks of 15mg so 4 weeks all up. Things were really beginning to improve and I could really start feeling the benefits of lexapro. However, since Friday I have taken a crashing nose dive and have probably the worst anxiety I have had to date. I have got really shaky hands, nausea again, loss of apetite and feel extremely anxious its affecting everything.

Does anyone know what's happening to me?! I've recently had the mirena fitted and I am due on now so I guess hormones would play a part but I never get anxiety like this.

I'd be really grateful for some advice. I feel so defeated as I thought things were going upwards.

Thanks,
Lisa

[panic_down_under]

I took 10mg for 10 days and 2 weeks of 15mg so 4 weeks all up. Things were really beginning to improve and I could really start feeling the benefits of lexapro. However, since Friday I have taken a crashing nose dive and have probably the worst anxiety I have had to date. I have got really shaky hands, nausea again, loss of apetite and feel extremely anxious its affecting everything.

Does anyone know what's happening to me?

It can take up to 12 weeks for antidepressants to fully kick in with most seeing improvement in the 4-7 week range so you're just entering that window, Lisa. Plus, for some there can be periods when progress becomes one step forward, two back, and occasional three, or four back. Welcome to the wacky world of antidepressants! :wacko:

Hormones may also be a factor, though I think it's mostly just the typical initial AD weirdness. The fact this is your second time on escitalopram may also be playing a part.


I feel so defeated as I thought things were going upwards.

Don't be. What you've experienced is par for the course.

Antidepressants are unlike most medications in that they don't directly address the symptoms, as say, Panadol does where you take a tablet and an hour later the headache is mostly gone. They work on the underlying biological deficits by turbo charging the growth of new brain cells (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC60045/) and rewiring connections between neurons and brain regions. It is those new cells and connections which produce the therapeutic response, not the AD. This all takes time and isn't a linear process.

[LisaS]

Thank you so much PDU,

I was half expecting a blip as I've been here before but I'm a bit thrown this one is lasting so long - the flutterings of anxiety are lasting all day, it's exhausting.

I hope its just the AD weirdness and that it passes soon because it's horrible.

[panic_down_under]

I was half expecting a blip as I've been here before but I'm a bit thrown this one is lasting so long - the flutterings of anxiety are lasting all day, it's exhausting.

Talk to you doctor if it becomes too difficult as the heightened anxiety can be minimised. No one is handing out gold stars for white knuckling anxiety. It's counterproductive.

[LisaS]

Talk to you doctor if it becomes too difficult as the heightened anxiety can be minimised. No one is handing out gold stars for white knuckling anxiety. It's counterproductive.

I went to the doctor this evening and she recommended going up to 20mg.
I’m a bit fed up as this means side effects again and I really want some relief.
She doesn’t agree with Benzodiazapines and would rather I took propranolol in the interim.
Feeling miffed again.

[panic_down_under]

She doesn’t agree with Benzodiazapines and would rather I took propranolol in the interim.

I agree with her on the benzodiazepines (BZDs), though probably not for the same reason. The dependency issue is overblown, imho, however, there is strong evidence1 BZDs block the neurogenesis mechanism by which antidepressants work.

Propranolol is a beta-blocker which prevents adrenaline binding to its receptors. This can prevent the adrenaline surge of the flight-or-flight response which can help cope with anxiety, but doesn't directly diminish the anxiety itself. It is definitely worth a try, but if it isn't effective ask for *hydroxyzine instead. It is a mild prescription antihistamine with pretty good anti anxiety properties. Not quite as potent as the BZDs, but often potent enough.


*Hydroxyzine comes in two forms, hydroxyzine pamoate (Vistaril) and hydroxyzine hydrochloride (Atarax). Anecdotally, the pamoate form is claimed to be the more effective anxiolytic, but just how true this is remains a matter of debate in forums.


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Boldrini M, Butt TH, Santiago AN, et al. (2014)
Benzodiazepines and the potential trophic effect of antidepressants on dentate gyrus cells in mood disorders.
Int J Neuropsychopharmacol. Dec;17(12):1923-33 (Abstract (https://www.ncbi.nlm.nih.gov/pubmed/24969726) | Full text (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374628/))

Nochi R, Kaneko J, Okada N, et al. (2013)
Diazepam treatment blocks the elevation of hippocampal activity and the accelerated proliferation of hippocampal neural stem cells after focal cerebral ischemia in mice.
J Neurosci Res. Nov;91(11):1429-39 (Abstract (https://www.ncbi.nlm.nih.gov/pubmed/23963779))

Sun Y, Evans J, Russell B, et al (2013)
A benzodiazepine impairs the neurogenic and behavioural effects of fluoxetine in a rodent model of chronic stress.
Neuropharmacology. Sep;72:20-8 (Abstract (https://www.ncbi.nlm.nih.gov/pubmed/23639432))

Song J, Zhong C, Bonaguidi MA, et al (2012)
Neuronal circuitry mechanism regulating adult quiescent neural stem-cell fate decision.
Nature. Sep 6;489(7414):150-4 (Article (https://www.kurzweilai.net/how-the-brains-stem-cells-find-out-when-to-make-new-neurons/comment-page-1#comment-96481) | Study full text (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3438284/))

Chen J, Cai F, Cao J, et al. (2009)
Long-term antiepileptic drug administration during early life inhibits hippocampal neurogenesis in the developing brain.
J Neurosci Res. Oct;87(13):2898-907 (Abstract (https://onlinelibrary.wiley.com/doi/abs/10.1002/jnr.22125))

Wu X, Castren E. (2009)
Co-treatment with diazepam prevents the effects of fluoxetine on the proliferation and survival of hippocampal dentate granule cells.
Biol Psychiatry. Jul 1;66(1):5-8 (Abstract (https://www.ncbi.nlm.nih.gov/pubmed/19251245))

Stefovska VG, Uckermann O, Czuczwar M, et al (2008)
Sedative and anticonvulsant drugs suppress postnatal neurogenesis
Ann Neurol. 2008 Oct;64(4):434-45 (Abstract (https://www.ncbi.nlm.nih.gov/pubmed/18991352))

[LisaS]

So a quick update, it has been a week on 20mg and its been a rocky road as usual. Headaches, dizzyness, dreamy feeling and of course my old friend increased anxiety. Yesterday I had a really good day but today has been weird again! I also heard on another forum that my clock resets every time I go up a dose and that I can expect another 4-6 weeks of side effects, so that has put a bit of a downer on me again.
The story continues....

[panic_down_under]

I also heard on another forum that my clock resets every time I go up a dose and that I can expect another 4-6 weeks of side effects,

It would be unusual for the side-effects after a dose increase to continue for 4-6 weeks. Around 10-14 days is more likely. It takes about 7 days for citalopram plasma levels to settle to a steady-state after an increase (or decrease) after which side-effects typically begin the diminish. However, as with everything about ADs, YMMV.

[LisaS]

It would be unusual for the side-effects after a dose increase to continue for 4-6 weeks. Around 10-14 days is more likely. It takes about 7 days for citalopram plasma levels to settle to a steady-state after an increase (or decrease) after which side-effects typically begin the diminish. However, as with everything about ADs, YMMV.

Thanks again PDU.
I’m on day 12 of the increase and the past few days as well as the feelings of nervousness, I now feel down and have very little motivation to do anything. I feel like I could just lay in bed all day staring out the window (I don’t).

I know I seem impatient but I seem to be getting worse not better. It’s been 5 weeks on 10mg and 4 on 15mg... I have 2 assignments due and prac to attend next week. Any words or advice would be appreciated...

[panic_down_under]

Thanks again PDU.
I’m on day 12 of the increase and the past few days as well as the feelings of nervousness, I now feel down and have very little motivation to do anything. I feel like I could just lay in bed all day staring out the window (I don’t).

It is not uncommon for some to feel flat after a dose increase. There is a lot going on in the brain and the affect on other organs can be harsh too. Much of what you're feeling is what happens when we're ill. It's the body's way of dampening activity so there is more energy available to fight off infection, or repair damage.


I know I seem impatient but I seem to be getting worse not better. It’s been 5 weeks on 10mg and 4 on 15mg... I have 2 assignments due and prac to attend next week. Any words or advice would be appreciated...

They say it is darkest just before the dawn. While this isn't actually true, it is an apt analogy in this case. ADs can, and often do make things worse at the beginning and they tend to hit rock bottom just before the 'magic' starts. So hang in there Lisa. It is not as hopeless as it appears.

[LisaS]

They say it is darkest just before the dawn. While this isn't actually true, it is an apt analogy in this case. ADs can, and often do make things worse at the beginning and they tend to hit rock bottom just before the 'magic' starts. So hang in there Lisa. It is not as hopeless as it appears.[/QUOTE]

I love this advice and I even took a screen shot!

I’ve been getting progressively worse since starting the 20mg 2 weeks ago. Today could be my final straw. I was in tears on the bathroom floor this morning, had many moments of panic through the day along with racing heart even lying on the bed and shaking. I really don’t think this is doing me any favours. I wonder if I should have given 15mg a bit longer as I had a few good days on this dose.
I’m going to docs on Weds but would be interested in your opinion.
Thanks for everything PDU.

[LisaS]

Update:
So I went back to the docs after having enough of the racing heart and tremors and we both agreed to go back to 15mg and stay here for at least a month.
The day after I felt a real relief and have been having VERY SLOW improvement but improvement all the same. Now this is what I thought would happen..
I’m certainly not quite out of the woods yet but the light at the end of the tunnel is brighter.
I still have nervousness in the mornings and slight tremor but it’s been 12 days since I went back down to 15mg so possibly still settling in.
Fingers crossed!

[Mrsmitchell1984]

How are you now Lisa? X

[LisaS]

Definitely making improvements every day. I have probably gone from 9 or 10/10 anxiety to a 6/10.
Feeling much more hopeful.
It’s taken such a lot of time, tears and frustration but I think I’ve found the right dose.
Still see my psychologist every couple of weeks which really helps.
Literally taking one day at a time and not looking any further ahead.
Distraction is great. I either go for a walk with the dog, work on an assignment, weed the garden or listen to interesting podcasts.
How are you?

[LisaS]

Well I'm still going! This is such a rocky road, damn these SSRI's.... Looking back on it, I wish I had stayed on 10mg now... but anyway here I am with my story so far
5mg - 11 days,
10mg - 10 days,
15mg - 19 days,
20mg - 13 days,
15mg - 24 days and counting

It's no wonder I don't know if I'm Arthur or Martha... Still have shaky tremor hands, slight jaw clenching and anxiety STILL high... Urghhh so tired of it....

[panic_down_under]

Still have shaky tremor hands, slight jaw clenching and anxiety STILL high... Urghhh so tired of it....

If my abacus is correct, you're now at 9 weeks since first taking 10mg, Lisa, so if the med is going to work then you should begin to notice at least the beginning of an improvement in the next week or two. The jaw clenching may be the last side-effect to go as it and the Lexapro Yawn tend to hang around like unwelcome guests. :sad:

[LisaS]

If my abacus is correct, you're now at 9 weeks since first taking 10mg, Lisa, so if the med is going to work then you should begin to notice at least the beginning of an improvement in the next week or two. The jaw clenching may be the last side-effect to go as it and the Lexapro Yawn tend to hang around like unwelcome guests. :sad:

Thanks PDU

Yes timing sounds about right. It’s practically been my whole uni semester - it’s been majorly tough going through this.

Would all the chopping and changing of dose set me back a bit though?

[panic_down_under]

Would all the chopping and changing of dose set me back a bit though?

In theory it shouldn't as you didn't drop below the therapeutic dose range, but in practice it can't be ruled out. ADs can be unpredictable because of the way they work. But even in the worst case it shouldn't add more than a couple of days.

[NervousKel]

Well I'm still going! This is such a rocky road, damn these SSRI's.... Looking back on it, I wish I had stayed on 10mg now... but anyway here I am with my story so far
5mg - 11 days,
10mg - 10 days,
15mg - 19 days,
20mg - 13 days,
15mg - 24 days and counting

It's no wonder I don't know if I'm Arthur or Martha... Still have shaky tremor hands, slight jaw clenching and anxiety STILL high... Urghhh so tired of it....


Hi Lisa! How are you doing now?

Going up in doses is never fun. I was like you; started at 5 and then slowly made my way up to 15 mg. I've been on 15 mg for over a year now, and it's worked well for me:-).

I think you will start to have positive results soon....

[LisaS]

Hi!
I just sat down to reply to your thread! Are you still having a blip?

I read it took a while for it to work with you too. It’s so utterly frustrating especially when I hear such success stories!

I have definitely had some good days but it’s still interspersed by crappy ones. I know recovery is not linear but it still always disappoints me so much when I wake up feeling nervous and having the shakes.

Ive lately not really been interested in socialising either as I generally feel like I can’t relax just in case I feel really anxious. I just want to return to being me again and not thinking about it all the time.

Its such a long slog.

I hope you are having a better day xx

[NervousKel]

Yep, I'm still blipping along, although yesterday was a really good day.

Definitely a long slog!

I'm going to order a self help book or two about anxiety, and see if I can pick up some good tips by reading one of those. Have you had any luck with that, or with therapy? I admit I've never done either, as I felt the meds were always enough in the past.

[LisaS]

I’ve had anxiety on and off for years so I have a bookcase full of self help books!
The most useful has been Paul David - at last a life. Also the happiness trap by Russ Harris. I also watch Dr Amy Johnson on youtube. She is so awesome.
I see a psychologist too who is brilliant but the only thing that can get through it is us!

How long did the meds take for you this time? I think I’m on 10 weeks but 5 weeks on 15mg.. I also have PMS and I always find it worse at that time of the month.

Are your friends understanding? I think mine are confused and wonder why I’m not “ better” yet...

[Geller]

I had the very same reaction with Lexepro but my doctor gave me a very low dose of Pregabilin 50mg twice a day and now no more anxiety......

[LisaS]

I had the very same reaction with Lexepro but my doctor gave me a very low dose of Pregabilin 50mg twice a day and now no more anxiety......

It took a long time or the side effects?

Do you take the Pregabalin alongside the Lexapro or instead of?

[LisaS]

I’m not sure when to call it a day with this led now. I’m about to go into a lecture and feeling anxious... this has certainly not helped me in the way I hoped it would. The side effects of agitation are lingering on...
or is 15 too much? So over it.
I’m functioning but it’s not easy.

[panic_down_under]

I’m not sure when to call it a day with this led now.

If I've done the calculation right you've now been on 15mg for 30 days which is still a little early to draw a firm conclusion, imho. I'd give it at least another 2 weeks.


The side effects of agitation are lingering on...
or is 15 too much?

Given you've needed to take 20mg in the past I don't think you're on an excess dose now. Agitation tends to occur a little more often with escitalopram than the parent compound citalopram, so if it continues to be a problem switching to the older med might resolve it. As they share the same active drug (citalopram also contains a mostly inactive isomer of it) there should be few if any side-effects.

[LisaS]

If I've done the calculation right you've now been on 15mg for 30 days which is still a little early to draw a firm conclusion, imho. I'd give it at least another 2 weeks.
It’s been 5 weeks on 15mg. 12 wks since I started 10mg..


Given you've needed to take 20mg in the past I don't think you're on an excess dose now. Agitation tends to occur a little more often with escitalopram than the parent compound citalopram, so if it continues to be a problem switching to the older med might resolve it. As they share the same active drug (citalopram also contains a mostly inactive isomer of it) there should be few if any side-effects.

I did take 20mg a couple of years ago but I was in a much more debilitating state than I am this time.

If I were to switch to Citalopram, is it a straight switch or do I have to come off ESC than back on Cit?

[panic_down_under]

If I were to switch to Citalopram, is it a straight switch or do I have to come off ESC than back on Cit?

A straight overnight switch should present few, if any problems. The active drug in both is exactly the same, the S-enantiomer of citalopram, aka escitalopram, the difference is citalopram also contains a mostly inactive form of the drug, the R-enantiomer, which produces some minor differences in how the drug interacts with biology, but most won't notice any difference except maybe in side-effects. There can be subtle differences which is actually what you'd be hoping for with respect to the agitation. I can't guarantee it'll work, but there is usually little downside in giving it a shot. It is just as easy to switch back if you choose to.

[LisaS]

Hey PDU,
Before you referred to the amount of time I'd been on 10mg but now you mention the 15mg. FWIW, it's now been 13 weeks since I started the 10mg and almost 6 weeks on the 15mg.
I probably had one of my worst days yesterday and was back to the diazepam and propanolol. Today I feel a bit spaced out and down in the dumps (fed up).. I'm so disappointed. I am seeing my GP on Tuesday and see what he thinks.

Part of me wants to keep going, part of me wants to come off and reset and start again and part of me wants to go to 10mg ... I hate how there is no quick fix to this.

thanks for your support this far though.

[panic_down_under]

FWIW, it's now been 13 weeks since I started the 10mg and almost 6 weeks on the 15mg.

If the 15mg is going to work then from now on would be when it is most likely too. That said, I suspect it'll take 20mg.


Part of me wants to keep going, part of me wants to come off and reset and start again and part of me wants to go to 10mg

There are good arguments for the first two, but I doubt 10mg will work, Lisa.

[LisaS]

I saw a new GP yesterday who said he didn’t think meds would work for me at all which was not the best thing to hear! He’s doing full blood work up and then go from there. He thinks I need to work more on my psychology, which I have been actively doing for years.
After waking at 4am today with a major panic, I think I’ve made me own decision to come off. I’ve given it a damn good go.
I’ll prob go down to 10mg for a while and take it slow from there.

He mentioned Valdoxan but I’m keen to try Pristiq..

[panic_down_under]

I saw a new GP yesterday who said he didn’t think meds would work for me at all

Based on what? Escitalopram worked for you in the past so obviously you can and do respond to ADs. The fact it hasn't this time can probably be attributed to the loss of efficacy after discontinuation and restart hoodoo, but this doesn't mean no ADs will work and this would be true even if SSRIs were the only ADs available, which isn't the case. There are many other ADs acting on a range of different pathways.

BTW-have you been treated by a psychiatrist in the past? If not, now might be a good time to ask for a referral.


He’s doing full blood work up and then go from there. He thinks I need to work more on my psychology, which I have been actively doing for years.

Blood work is always a good idea as there are some conditions which can produce similar symptoms as the anxiety disorders, though they are uncommon. As for therapy, it too could be worth while doing a formal refresher.


After waking at 4am today with a major panic, I think I’ve made me own decision to come off. I’ve given it a damn good go.
I’ll prob go down to 10mg for a while and take it slow from there.

I'd be tempted to ask for a small dose of buspirone (Buspar) to be added. It is a GAD specific med which works very well for a few and not at all for most and then only for GAD and maybe social anxiety. However, it has a pretty good track record for increasing the effectiveness of SSRIs and SNRIs and/or reinvigorating those that are/have failed. It may also ease some of the common SSRI/SNRI side-effects. If it is going to work you can expect to see positive indications within 2-3 weeks, though it may take another few to hit peak efficiency.


He mentioned Valdoxan

Valdoxan (agomelatine) is a unique melatonin acting AD which doesn't seem to be prescribed much, possibly because it wasn't able to gain FDA approval due to indifferent trial results and some doubts about its affect on the liver. It took several attempts before the TGA approved it in AU too (PDF (https://www.tga.gov.au/sites/default/files/auspar-valdoxan.pdf)). It might prove to be a very effective med for you, but it is well down my to try list. It does reportedly usually produce few initial side-effects and appears to be easy to discontinue.


but I’m keen to try Pristiq..

Any reason?

[LisaS]

Hi PDU

I appreciate your response and totally agree with you regards to the efficacy of SSRIS and me. I have had success with Effexor and Escitalopram in the past so I’m not immune.

I have seen a psychiatrist last year when I was having excessive twitching from Sertraline and my plan was to come off and restart Pristiq. But when I came off I felt great so didn’t restart anything which has led to anxiety creeping back again.
Pristiq came up as a recommendation from a DNA test I did due to the fact it is independent of pharmacogenetic status, apparently.. plus being an offshoot of Effexor that has worked for me in the past.
I will try and see the psych again but I’m aware there is a long wait list....

[Quinn1]

I am on Valdoxan,along with Lyrica.Thinking about asking my psychiatrist about changing the Valdoxan it is so expensive.

[panic_down_under]

I am on Valdoxan,along with Lyrica.Thinking about asking my psychiatrist about changing the Valdoxan it is so expensive.

How many kidneys do you have to sell each month?

If it was working well then it might be worth the price, but that you're also taking Lyrica (pregabalin) suggests it isn't.

[Quinn1]

How many kidneys do you have to sell each month?

If it was working well then it might be worth the price, but that you're also taking Lyrica (pregabalin) suggests it isn't.


The GP prescribed Lyrica for nerve pain 3yrs ago,my psych put me on Valdoxan 6mths ago and I have been ok on them,
I take a few more meds for HIV,so far so good as in no interactions.

I already sell a lot of kidneys on the black market.:D

[panic_down_under]

The GP prescribed Lyrica for nerve pain 3yrs ago,my psych put me on Valdoxan 6mths ago and I have been ok on them,

I take a few more meds for HIV,so far so good as in no interactions.

If Valdoxan (agomelatine) is working well for you then that is a good argument for staying on it, especially as it seems to have no interactions with HIV meds which I'm guessing is why it was chosen.

However, its cost is likely to remain high as it was approved by the TGA about 10 years ago yet still hasn't been added to the PBS. This suggests it probably won't be anytime soon, mostly, I suspect, because it it hasn't been shown to be superior to other, cheaper ADs.

[NervousKel]

I saw a new GP yesterday who said he didn’t think meds would work for me at all which was not the best thing to hear! He’s doing full blood work up and then go from there. He thinks I need to work more on my psychology, which I have been actively doing for years.
After waking at 4am today with a major panic, I think I’ve made me own decision to come off. I’ve given it a damn good go.
I’ll prob go down to 10mg for a while and take it slow from there.











He mentioned Valdoxan but I’m keen to try Pristiq..


What a shame the new GP said that he didn't think meds would work for you! That's the last thing you want to hear right now when you are already having doubts.

Since you've already put in this much time on the escitalopram, I think I would be tempted to try increasing to 20 mg to see if that helps, before switching to something else.

[LisaS]

Ok so a bit of an update - I managed to get an appointment with a psychiatrist I saw last year as she had a cancellation - had an hour long chat with her $$$$! and she said it's a no brainer to come off the lexapro as I've been on it so long with sub optimal efficacy. She said there is lots of options for me, which is nice to hear after what the GP said, so she's going outside the box and going with Clonidine... predominantly a med for ADHD but can be used off label for anxiety.
She said as I'm mid 40s there could be some hormonal influence to my increase in anxiety episodes of late and this should help with executive functioning, emotional regulation and sleep.

Fingers crossed.
So my next Question is - how do I come off the escitalopram - shall I alternate 15/10mg for a while or just go straight to 10mg? I have an exam on Tuesday so I'll probably do it after this.

[panic_down_under]

So my next Question is - how do I come off the escitalopram - shall I alternate 15/10mg for a while or just go straight to 10mg? I have an exam on Tuesday so I'll probably do it after this.

I don't think it will make much difference either way as escitalopram has a fairly long half-life compared to most other SSRIs so pick whichever approach you're most comfortable with. Psychology is at least as important as chemistry when weaning off meds.

It takes 7-8 days for escitalopram plasma levels to stabilize after a dose reduction (or increase). Cutting back the dose at shorter intervals may increase the severity of any withdrawal symptoms, but delaying the decrease usually won't significantly reduce their severity.

[LisaS]

Hello!

So Uni finished for this year (thank god) and now on 10mg lexapro..... I had a REALLY GREAT week there for a moment, probably a big part of getting through this semester but maybe the lexapro too?

Anyway, I started the Clonidine and have had 2 nights of really bad sleep - I've been awake more than asleep and felt rise of anxiety again.... I've sent my psychiatrist an email to see if she thinks I should hang on but man oh man I'm tired of these start up side effects....and not knowing if this is going to work or not...

I am very tempted to just stick with the 10mg of lexapro but then I don't want to be stuck when a stressful time comes up and I find it not being effective. I am pre-empting the future here but I don't want to have to struggle through another semester again and almost want to get to a really good place mentally before 3rd year starts in Feb...

The story continues.....

[panic_down_under]

I started the Clonidine and have had 2 nights of really bad sleep - I've been awake more than asleep and felt rise of anxiety again.... I've sent my psychiatrist an email to see if she thinks I should hang on but man oh man I'm tired of these start up side effects....and not knowing if this is going to work or not...

Clonidine is usually sedating, but some do have paradoxical reactions, Lisa. The insomnia may also be due to heightened anxiety at taking a new med. It has a very short half-life with plasma levels typically reaching a steady-state within 3 days and as side-effects tend to then begin diminishing I'd take it for another day or two to see whether the insomnia starts to ease.


I am very tempted to just stick with the 10mg of lexapro but then I don't want to be stuck when a stressful time comes up and I find it not being effective.

Is the rise in anxiety still within tolerable limits? If it is then maybe wait to see how you cope with Christmas which is often very stressful. If the 10mg proves inadequate there's still just enough time for an increased dose to become effective before Uni begins again.

[LisaS]

Clonidine is usually sedating, but some do have paradoxical reactions, Lisa. The insomnia may also be due to heightened anxiety at taking a new med. It has a very short half-life with plasma levels typically reaching a steady-state within 3 days and as side-effects tend to then begin diminishing I'd take it for another day or two to see whether the insomnia starts to ease.

You know me so well - yes quite possibly anxiety starting a new med! I thought a short half life meant it takes longer to reach steady state. Good advice all the same.

Is the rise in anxiety still within tolerable limits? If it is then maybe wait to see how you cope with Christmas which is often very stressful. If the 10mg proves inadequate there's still just enough time for an increased dose to become effective before Uni begins again.

Yes it is tolerable but her plan is to wean off Lexapro completely and just rely on Clonidine...
Christmas isn’t hugely stressful as we emigrated to Australia 12 years ago and none of my family are here to stress me out!

Thanks again. Were you a psych in a past life or have you just been interested in this field for a while?

[Phill2]

Good to have you here Lisa :yesyes:
Always best to consult a doctor than rely on advice here.

[LisaS]

Good to have you here Lisa :yesyes:
Always best to consult a doctor than rely on advice here.

Absolutely - I have close comms with my GP and psychiatrist when it comes to meds. It’s a minefield.

Still waiting for the magic pill 😁

[panic_down_under]

Were you a psych in a past life

No, I still have some sanity left...I hope :winks:


or have you just been interested in this field for a while?

Yep, ever since I developed panic disorder in the 1980s. I've been active in anxiety support groups since before the internet was invented gaining insights in how these disorders and meds affect people and also from researchers who contributed to an anxiety disorders info site I used to run.

[Windywel]

What medications are you on now PDU? What have you found most effective for anxiety?

[panic_down_under]

What medications are you on now PDU? What have you found most effective for anxiety?

I can't tolerate SSRIs/SNRIs, so have only taken MAOIs, imipramine and for the last 25 years, dosulepin, aka dothiepin. The MAOIs were the most effective, but back in the late 1980s the dietary restrictions were an issue for me. Modern food preparation techniques have apparently significantly reduced the risk, so should I need to stop taking dosulepin, which is probably inevitable as my heart ages, then tranylcypromine (Parnate) is at the top of my list.

[Windywel]

Interesting. Why can’t you tolerate SSRIs/SNRIs? Do they give you awful side effects? Is dusolepin a TCA? Do you have depression as well as anxiety?

[panic_down_under]

Interesting. Why can’t you tolerate SSRIs/SNRIs? Do they give you awful side effects?

They make me manic.


Is dusolepin a TCA? Do you have depression as well as anxiety?

Yes, and no, only panic disorder.

[LisaS]

Another week, another med....

So Clonidine didn’t really work out due to my already low bp. Next stop Pregabalin. Still on 10mg Escitalopram until and if P works. I’ve been on 25mg for a week and feel so drowsy and dizzy, which is expected - just really hoping it wears off.

Still kind of want to come off everything and start again. Not a huge fan of now taking 2 brain altering medications. I’ll go another week and see how it goes....

Hope everyone else doing ok! NervousKel?

[panic_down_under]

Still on 10mg Escitalopram until and if P works. I’ve been on 25mg for a week and feel so drowsy and dizzy, which is expected - just really hoping it wears off.

Still kind of want to come off everything and start again. Not a huge fan of now taking 2 brain altering medications.

Agreed on the two meds. If escitalopram isn't working at a dose you can tolerate then, imho, it isn't worth taking, but it is best left until you're stabilized on pregabalin as changing two med doses will just create confusion. Also, 25mg pregabalin is a very low dose. I wouldn't expect much from it until you're taking well into triple figures.

[LisaS]

Hi All,

Merry Christmas to you all and a quick update.
I started levelling out on the 25mg of pregabalin but felt slight anxiety creeping back so upped it to 50mg. My psychiatrist is under the impression that I will not need to go into the triple figures.
I've also come down to 5mg of escitalopram and looking to drop to 2.5mg in the next few days.
It definitely seems to take a while for the pregabalin to settle - I feel pretty dreamy for a couple of weeks before starting to feel 'normal' again which can be a little odd and dreamlike and disconcerting.
My psych loves chatting about meds and also mentioned Reboxetine and Brintellix - I'm sure you'd enjoy talking to her PDU! She also was keen on a 'sprinkle' of dexamphetamine! What are your views on these ones!?

I mean I'm happy to just be on the pregabalin tbh if it turns out to be effective, and if it doesn't I'm not sure I'm up for guinea pigging these random ones and would rather go for Effexor, Pristiq or Duloxetine/Cymbalta...

Question for you about the SNRI's - I know that effexor is basically an SSRI until the higher doses, but is this the same story for Pristiq and Cymbalta too? (I know pristiq is a v similar drug to Effexor..)

Thanks!
P.s. I am overall feeling much better - I'd say around 75% there....

[panic_down_under]

My psych loves chatting about meds and also mentioned Reboxetine and Brintellix - I'm sure you'd enjoy talking to her PDU! She also was keen on a 'sprinkle' of dexamphetamine! What are your views on these ones!?

Neither reboxetine or vortioxetine (recently rebranded to Trintellix because of potential confusion of Brintellix with another med of a similar name) haven't really set the world on fire. Reboxetine is a weak noradrenaline (NA), aka norepinephrine, reuptake inhibitor. The NA inhibiting TCAs nortriptyline (Pamelor), or desipramine (Norpramin) would be better bets. Vortioxetine is just another SSRI. It may be a better fit to your biology than other SSRIs so might be worth trying, but as a generalisation it hasn't proved significantly more effective than the others.


I know that effexor is basically an SSRI until the higher doses, but is this the same story for Pristiq and Cymbalta too?

Even at the maximum 375mg dose venlafaxine (Effexor) is still only a weak NA reuptake inhibitor. Its active metabolite desvenlafaxine (Pristiq) is a little better and duloxetine (Cymbalta) more potent again. However, I don't recommend any of them because of their very short half-lives which can make starting and stopping them difficult, exacerbated with duloxetine by the limited range of doses it come in. The serotonin+noradrenaline reuptake inhibiting TCAs are a much better bet, imho. They usually produce fewer initial side-effects aided by being available in very low dose tablets, are arguable more effective than SSRIs and SNRIs, especially for depression, and are also usually easier to wean off. OTOH, they do tend to have more ongoing side-effects, mostly nuisance ones such as dry-mouth and constipation which can usually be managed.


She also was keen on a 'sprinkle' of dexamphetamine

Or maybe the AD bupropion (Wellbutrin) which is quite stimulating. Too stimulating as a primary AD for most with anxiety, but very useful for depression. At low supplemental doses it may also counter some SSRI/SNRI side-effects.

[LisaS]

Well after saying I was feeling much better, today I feel worse than I have in ages.
Woke up with a panic at 4am and have been anxious/nervous and shaky ever since.. I've just taken a propanolol to see if it helps as it seems to be purely physical. Why this is happening, I don't know.
I can't imagine it would be anything to do with coming off escitalopram as I've been on 5mg for 2 weeks and haven't had any other side effects while coming off.
It's been just over a week at 50mg pregabalin and I am not keen on how weird it makes me feel sometimes - so could be that. Otherwise its the after effects of Christmas. Either way this is a journey I am on that I didn't buy a ticket for!
My clinical psychiatrist is lovely and well versed in her field but its as much a minefield in relation to meds as it is for the GP. It's basically pick one and see how you go.

PDU you mentioned Effexor and the half life - I took the extended release version around 15 yrs ago and although it was a hideous start up, I do vaguely remember it helped... I was on it about 18 months before I came off as I was pregnant. I remember a few head shocks but don't remember it being hugely traumatic coming off, so could be a potential for me to try again! I think you can now get an ER version of pristiq too?

Anyway... onwards I go....

[panic_down_under]

I can't imagine it would be anything to do with coming off escitalopram as I've been on 5mg for 2 weeks and haven't had any other side effects while coming off.

Withdrawal symptoms usually start before the reduced dose stabilizes to a steady-state again, so in under a week for escitalopram. However, very occasionally I have heard from people who have had delayed onset. Unlikely, but not impossible.


Otherwise its the after effects of Christmas.

Christmas can be the most stressful time of the year so a likely candidate, imo.


PDU you mentioned Effexor and the half life - I took the extended release version around 15 yrs ago and although it was a hideous start up, I do vaguely remember it helped... I was on it about 18 months before I came off as I was pregnant. I remember a few head shocks but don't remember it being hugely traumatic coming off, so could be a potential for me to try again! I think you can now get an ER version of pristiq too?.

Extended release versions don't change the half-life, just release the med over 24 hours instead of immediately. That provides a smoother ride while taking it, but doesn't help when weaning off. The amount in your system still drops off the cliff soon after the dose if cut back. It also adds a further complication because there are only a few extended-release dose options so often people need to switch to and cut immediate-release tablets instead to shave the dose down by small steps. That said, trying to wean off venlafaxine directly is the heroic way of doing it. Usually the easier option is to switch to fluoxetine (Prozac) for a while and then weaning off it. A lot of hassle for an AD that doesn't have any real advantage over SSRIs and a couple of significant disadvantages. Desvenlafaxine is a little easier, but I still don't see the point

[LisaS]

Thanks PDU.

Out of interest what is the difference between Nortriptyline and Reboxetine. You said before the TCA would be a better bet so how is their action different? My psych quite happily handed me a script for Reboxetine with 5 repeats on it, just incase.... plus a long list of other meds to try.. and of course the Trintellix but tbh I think the meds just aggravate my anxiety. I want to ditch the lot of them (don't worry, I won't)

I'm losing patience with Pregabalin - I just feel so drowsy and spaced out (not to mention anxious).. I just can't function properly and I need to be able to.

It's possible I may just stay on 5mg escitalopram for now and reset. I've started up yoga again and getting more organised and eating healthier. I've told myself I will only improve if I take meds but I don't think this is always the case if you can make lifestyle changes.

[panic_down_under]

Out of interest what is the difference between Nortriptyline and Reboxetine.

Reboxetine is a weak inhibitor of noradrenaline (NA), aka norepinephrine, reuptake, nortriptyline is a more potent NA inhibitor and also inhibits serotonin reuptake.


You said before the TCA would be a better bet so how is their action different?

That's complicated because unlike SSRIs, they don't all the the same thing. Some, only inhibit serotonin reuptake, others both serotonin and NA and others only NA.

The dual action TCAs generally inhibit NA reuptake much more than the SNRIs, with the exception of milnacipran and levomilnacipran, have longer half-lives so are less likely to trigger severe withdrawal symptoms and because they are available in low dose tablets relative to their therapeutic range, starting at a low dose and ramping it up by small amounts to reduce the severity of initial side-effects is much easier than with SNRIs. Plus, as a generalisation, TCAs are often more effective, both for anxiety and especially depression. The SSRIs/SNRIs didn't replace TCAs because they were more effective, but because they are safer in overdose, and even that isn't true for all of them.


I'm losing patience with Pregabalin - I just feel so drowsy and spaced out (not to mention anxious).. I just can't function properly and I need to be able to.

I'm not a fan either. I could understand the rationale for prescribing it instead of BZDs before it became clear it (and the similar gabapentin) have the same tolerance issues as the BZDs, but now why not just prescribe a BZD. They are usually more effective anxiety meds with fewer side-effects.


It's possible I may just stay on 5mg escitalopram for now and reset.

If you want to keep taking it then please take no less than 10mg, or quit it completely to avoid increasing the risk of it pooping out entirely. Long term sub therapeutic dosing is not a good idea according to a number of studies.


I've started up yoga again and getting more organised and eating healthier. I've told myself I will only improve if I take meds but I don't think this is always the case if you can make lifestyle changes.

Cool. It's worth a shot. If cognitive, behavioural, or mindfulness therapy is an option then I urge you to also try it.

[LisaS]

Update from me

Nearly off escitalopram. I was at 2.5mg and felt almost normal. When I started alternating 2.5mg with nothing I’ve really felt an uptick in my anxiety. In fact last night was pretty awful. I’m not sure this is withdrawal or anxiety returning...

Still really not sure if to go med free or start on the vorioxetine.. psych said to start vorioxetine at 5mg and increase to 10mg as tolerated. So thinking I may go 2.5mg for a few days first.
Obviously I’m concerned about side effects knowing my history but then I feel maybe I should give it a try....

ugh ��

[panic_down_under]

Nearly off escitalopram. I was at 2.5mg and felt almost normal. When I started alternating 2.5mg with nothing I’ve really felt an uptick in my anxiety. In fact last night was pretty awful. I’m not sure this is withdrawal or anxiety returning...

Not a fan of weaning off ADs by missed doses, Lisa. It just sets up a roller-coaster at small doses which can become more disconcerting than any withdrawal symptoms from simply quitting.


psych said to start vorioxetine at 5mg and increase to 10mg as tolerated. So thinking I may go 2.5mg for a few days first.

The most common vortioxetine side-effects are mild headache and nausea. Any of the common painkillers should fix the first, although paracetamol (aka acetaminophen) rather than aspirin, or another of the NSAIDs, such as ibuprofen, is preferable because it isn't an anticoagulant, and ginger and/or vitamin B6 supplements for the nausea.

Ideally, stay on whatever starting dose you decide on for 14 days before increasing. Upping the dose earlier may increase side-effects severity (however, delaying the increase for longer won't significantly reduce their severity no matter how long the delay).