Got back in Escitalopram 2.5 months ago and it's not working

[matrix123]

I started Escitalopram for the first time 8 years ago...first month was difficult but then started working and I got better. After 3 years or so I got off and was fine for close to 6 months. Started it again, got better and after some time got off again. I think this was repeated 3 times. Now last time I started was 2.5 months ago (10 mg and increased to 20 mg), however it doesn't seem to be working anymore. Recently I read that getting off it and starting it again increased the chance to not work and probably.

Can it happen that it needs more time to work? If not, what would be an alternative to Escitalopram that I can ask the doctor to prescribe (I don't trust much the doctors here, but on the other hand it's good that they can prescribe what you ask).

[panic_down_under]

Can it happen that it needs more time to work?

Maybe. What was the maximum dose taken the first 2 times and how long have you been on 20mg this time?


If not, what would be an alternative to Escitalopram that I can ask the doctor to prescribe (I don't trust much the doctors here, but on the other hand it's good that they can prescribe what you ask).

One option could be supplementing escitalopram with buspirone (Buspar). This is a GAD specific med which works well for some, but not at all for most. However, it has a good track record for reinvigorating pooped out serotonergic ADs. It may boost their effectiveness and ease long term side-effects such as sexual dysfunction. No guarantees, but it is an easier and quicker option than switching to another AD. If it works you should begin to see positive results within 3 weeks.

As for alternative ADs, either the SSRI sertraline (Zoloft), or the TCA amitriptyline (Elavil). You should be able to do a direct overnight switch to sertraline with minimal issues. Switching to amitriptyline is better done via a short cross taper.

[matrix123]

Thank you for the reply. I've been taking 20mg for 2 months, so don't have much hope that it will work. I guess I'll first ask for Buspar and give it a try...hopefully will help.

[panic_down_under]

Thank you for the reply. I've been taking 20mg for 2 months, so don't have much hope that it will work. I guess I'll first ask for Buspar and give it a try...hopefully will help.

Yeah, it's not looking promising. That said, it can take ADs longer to kick-in than before each time they're taken so escitalopram might still kick-in in the next few weeks, but I would try the buspirone anyway.

And once you're on something that works well for you, be it escitalopram+buspirone, sertraline, amitriptyline, or another med, seriously consider staying on it permanently. I've been taking ADs almost continually since 1987, and my current one since 1995 without a break. It still works and my brain hasn't dissolved ye...Oh! :winks:

[matrix123]

Thanks for all your help. I've thought I could get off because I was feeling better, but was wrong. I hope some combination will work and stick to that.

[panic_down_under]

Thanks for all your help. I've thought I could get off because I was feeling better, but was wrong. I hope some combination will work and stick to that.

Unfortunately, for some of us these disorders are chronic conditions which wax and wane in intensity, sometimes with longish periods of remission, but never completely go away. Given the potential issue of tolerance building each time ADs are stopped and restarted I think it a good idea to stay on them permanently after going back on one for the third time. ADs generally do no significant harm and some have mild to moderate health benefits such as reducing the risk of heart attacks and dementia.

[matrix123]

Had a visit to the doctor today and mentioned to her Buspar. She dismissed it (it seems buspirone is not available here). Also mentioned that probably the reason it's not working is that I have stopped several times and she said that's not true, so I've lost confidence in her judgment.

She initially suggested going to 30mg Escitalopram and later changed the mind and prescribed Faverin 100mg. Now I'm not sure what to do, try out Faverin, which she said can be done overnight, played out with increased Escitalopram dosage or look for alternatives?

I have more confidence in the people here that in some doctors who very clearly do not know enough regarding anxiety/depression and latest research on meds.

Thanks

[matrix123]

I'm reading a bit for Faverin (fluvoxamine) and it's usually prescribed for OCD which I do not have...really confused

[matrix123]

Two years later and still struggling. I have another doctor (I moved to another country) and she added Pregabalin to Escitalopram. I'm almost 4 months now on Escitalopram and 6 weeks with Pregabalin and it's not working...main issue are intrusive thoughts that I can't get rid.

Any suggestion on what would be a good option to switch from Escitalopram?

[panic_down_under]

Any suggestion on what would be a good option to switch from Escitalopram?

Are SSRIs the only ADs you've taken? If so, I think one of the TCA meds would be your best bet. Amitriptyline, or imipramine. Your doctor will likely want you on a SNRI. I'm not a fan. They are no more effective than the TCAs, but because they all have short half-lives can be a rough ride when first taking them and hard to discontinue.

[matrix123]

Yes, I've taken only SSRIs. Will ask the doctor for TCA and see what she'll say. Thank you