Started up my escitalopram (Lexapro)

[Golden]

Back story - I was on it for a year and it helped with my anxiety SO much. The health worries minimized, the constant anxiety was so much better. I weaned off at the end of summer because we are Trying to conceive #3. I was Doing better and also was tired of feeling sleepy all the time and having bad food cravings. However - I forgot how bad fall and winter is for me. (Even in hot/sunny Texas!) the anxiety has been sooo bad. I’ve spiraled over health stuff 3 times in a month. Etc. And I’m literally constantly anxious and irritable because of feeling on edge.

So 3 nights ago I decided to start it again. I want to know if ANYONE remembers when they started lexapro. Did you have nausea/fluttery stomach feelings? I vaguely remember having some gastro issues with it at the beginning but I’m just not sure and I’m afraid to google - since I’m in a current health anxiety scare over some stomach trouble stuff it’s making me a nervous wreck!

Thanks for taking the time to respond with your experiences. 🙏

[Phill2]

I don't remember any gastro.
Just a bit floaty at the start but my GP gave me some 5mg Valium to take with it to minimise the side effects.
I was on 5mg for a week then up to 10mg where I've stayed for years.

[Golden]

Thank you I was given 10mg but I think i should have started them at half. So last night I took half to see if it helps.

[panic_down_under]

I weaned off at the end of summer because we are Trying to conceive #3.

You probably didn't need to go off escitalopram. With the exception of paroxetine (Paxil) it is unclear that antidepressants significantly increase the odds of birth defects or complications. Studies have reported slightly higher incidents of defects, but there doesn't seem to be a common pattern to them which may indicate the studies aren't showing a real issue, but just reporting statistical noise. The problem is that the number of patients in each study tends to be low, the defects tend to be mostly the rare ones and the increases they report are often small.

If planning to breastfeeding then sertraline (Zoloft) may be the better bet as very little, if any sertraline is expressed in the milk (Pinheiro E (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4366287/), 2015).

To complicate matters, maternal anxiety and/or depression can also affect the baby, both during gestation and later in life. Unfortunately, antidepressants and pregnancy is an issue where there is no clearcut 'right' answer. It needs to be thoroughly discussed with the family doctor and obstetrician and/or gynecologist.


So 3 nights ago I decided to start it again. I want to know if ANYONE remembers when they started lexapro. Did you have nausea/fluttery stomach feelings? I vaguely remember having some gastro issues with it at the beginning

Nausea and gastro issues are common initial side-effects of serotonergic antidepressants. Serotonin isn't only a brain neurotransmitter, it has many roles in the body, nor is the brain the most significant maker and user. It is in fact only a minor player accounting for less than 2% of all the serotonin made/used. By far the most serotonergic organ is the gut, particular the enteric nervous system (http://www.scientificamerican.com/article/gut-second-brain/), the mini brain which controls it (and via the vagus nerves has a major influence on the heart, lungs and brain, it seems to be the 'tail' that wags the brain 'dog'). It makes around 50 times as much serotonin as the brain and thus can be much more affected initially by SSRIs, SNRIs and some TCAs. It usually adapts within a couple of weeks, but symptoms may return for a short while after dose increases.

Ginger and/or vitamin B6 supplements are usual effective for nausea (B6 is apparently also great for morning sickness, btw), and loperamide (Imodium) should help if diarrhoea becomes an issue, however, seek medical advice before taking it if pregnant.

[AntsyVee]

I had a lot of food cravings when I started Lexapro...especially for Salt & Vinegar potato chips.

[swgrl09]

Definitely had that during startup ... for what it’s worth I also weaned off when we were trying to conceive. Anxiety came back big time once i was pregnant. I went back on during my pregnancy and stayed on through breastfeeding too for over a year. My daughter is perfectly healthy and it was the best decision I could have made for both of us.

[Golden]

Thank you so much for all of the information! I do worry that the bad anxiety can affect conception and also a baby. It was much better during my first two pregnancies. I want my mental health to be better if I do have another baby.

It’s been about a week now and the nausea is less frequent but still there. There has been some wakefulness at night also but not terrible. On the other hand I can definitely tell a difference in my constant what if thinking, so that’s a plus.

[Golden]

It’s been a few weeks and I’m so frustrated by the sleepy, lazy feeling I have throughout the day. It’s part of the reason I weaned off of it at the end of summer. It’s back and it’s so frustrating! I take it around 7:30pm and go to bed around 11ish most nights. But it still leaves me lazy and sluggish all day long.

Has anyone found any way of avoiding this? Taking it at a different time maybe? I’m also struggling with food: snacking and wanting carbs more.

Any tips would be great. It helps with the anxious thoughts but not perfectly.

[AntsyVee]

I've never had the lazy sluggish feeling from Lexapro. For me, the food cravings took 2 or 3 months to wear off. It was awhile.

[Golden]

Thank you for the reply! I’m hoping the cravings wear off. But the sluggish drowsy type feeling is very difficult with two little ones depending on me throughout the day. I’m hoping it wears off too. But I remember it almost constantly from last year when I was on it. So I may have to look into alternatives :/ but it helps so much with the anxious thoughts that I’m torn.

[AntsyVee]

Maybe cross taper to something else eventually? Ian would be the one to ask about that.

[panic_down_under]

But I remember it almost constantly from last year when I was on it. So I may have to look into alternatives :/ but it helps so much with the anxious thoughts that I’m torn.

If it persists you could try switching to citalopram (Celexa). It contains the same active chemical, the 'S' isomer of citalopram, aka escitalopram, the difference is citalopram also contains the 'R' mirror image (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC314378/) form of it which is a poorer fit biologically and so is mostly inactive. However, the 'R' isomer can produce slight differences in the side-effects each med produces. I can't guarantee it will resolve the drowsiness, or carb cravings, but switching to citalopram will be far easier than to another med and any change in the side-effects should become apparent within a week or two.

[Golden]

Thank you for the information. I believe I tried celexa prior to Lexapro but felt it wasn’t helping me. Of course - I may not have given it enough time. For the past two days I took my lexapro dose around noon and I noticed I wasn’t as sluggish during the day. It was easier to get up and about and take care of what I needed to. But I still definitely could take a nap at any moment it seemed. So going to try it for a while longer at this dose and see if it help. In a pretty bad health anxiety spiral right now worrying about myself, my husband and my two small kiddos so I’m really needing it to help me some until I can get up the courage to see a therapist. I’ve never been but it feels like my anxiety is getting worse and it’s starting to really affect my life in a negative way.

Thanks for all the helpful feedback!

[panic_down_under]

I believe I tried celexa prior to Lexapro but felt it wasn’t helping me. Of course - I may not have given it enough time.

It typically takes 4-12 weeks for ADs to kick-in from when a therapeutic dose - 20mg for citalopram, 10mg for escitalopram - is first taken.


So going to try it for a while longer at this dose and see if it help.

Given you've been on ADs before escitalopram may take a little longer to kick-in than the last time.


In a pretty bad health anxiety spiral right now worrying about myself, my husband and my two small kiddos so I’m really needing it to help me some until I can get up the courage to see a therapist.

Therapists and therapy are nothing to be scared of, just the opposite in fact. Plus, remember you're the most important person in the meetings. Therapists are just the hired help, someone you're paying, directly or indirectly, for services rendered. That goes for GPs/PCPs and psychiatrists too.


I’ve never been but it feels like my anxiety is getting worse and it’s starting to really affect my life in a negative way.

ADs can worsen anxiety (and depression) at the beginning because of the extra serotonin activity, but this usually diminishes after a few weeks as biofeedback mechanisms come into play and begin downregulating serotonin synthesis and expression. Let your doctor know what is happening as the anxiety can be eased with one of the benzodiazepines (BZDs), or other meds such as the prescription antihistamine *hydroxyzine. It isn't as potent as the BZDs, but often potent enough to make a significant difference.


*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 considerable debate in forums.