Switching from Escitalopram to clomipramine

[Martha21]

Hi, I hope someone can reassure me.

Ive had a terrible relapse over the past 6 weeks with anxiety, depression and scary thoughts which has resulted in me getting help from my local crisis team. They organised an appointment for me with a senior psychiatrist for assessment and medication review.

I have been on escitalopram for 5 years but is not helping any more so he has prescribed me clomipramine. He has told me to do a straight swap starting at 10mg clomipramine for 3 days then up to 30mg for the next 3 days. No taper.

Has anyone else had a similar experience? really scared swapping to a TCA.

Thanks for any comments

[panic_down_under]

I have been on escitalopram for 5 years but is not helping any more so he has prescribed me clomipramine. He has told me to do a straight swap starting at 10mg clomipramine for 3 days then up to 30mg for the next 3 days. No taper.

This a reasonable way of switching. 10mg clomipramine is a very small dose, as is 30mg with most needing 100mg/day for optimum results. How much escitalopram were you taking?


Has anyone else had a similar experience? really scared swapping to a TCA.

What concerns do you have with TCAs?

[cos123]

Hi I have been on escitalopram for 7 years and did really well up to a few months ago, I’ve upped my dose but still not helping. The anxiety is killing me. I’m taking ativan but doesn’t seem to do much anymore. Scared. But just wanted to let u know you are not alone

[panic_down_under]

Hi I have been on escitalopram for 7 years and did really well up to a few months ago, I’ve upped my dose but still not helping.

How much were you taking, when did you increase the dose and to how much?


The anxiety is killing me. I’m taking ativan but doesn’t seem to do much anymore.

Benzodiazepines are useful in the short term, but they actually trigger the same brain changes which manifest anxiety (also depression) as high brain stress hormone levels do and block the neurogenesis mechanism (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC60045/) by which ADs and therapy work (see: Boldrini M (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374628/), 2014; Nochi R (https://www.ncbi.nlm.nih.gov/pubmed/23963779), 2013; Sun Y (https://www.ncbi.nlm.nih.gov/pubmed/23639432), 2013; Song J (https://www.kurzweilai.net/how-the-brains-stem-cells-find-out-when-to-make-new-neurons/comment-page-1#comment-96481), 2012; Wu X (http://www.biologicalpsychiatryjournal.com/article/S0006-3223(09)00106-1/abstract), 2009; Stefovska VG (https://www.ncbi.nlm.nih.gov/pubmed/18991352), 2008).


Scared.

Have you discussed your relapse with your doctor?

[Martha21]

I was on 10mg escitalopram.
My concerns with TCAs are the side effects sound scary, especially with the heart rate increase, tremors, triggering mania, etc.
I am not super fit or anything, so i always panic when my heart rate goes up and I am worried about the TCA changing my personality or something

[panic_down_under]

I was on 10mg escitalopram.

And you increased the dose to 20mg? If so, how long did you take the higher dose?


My concerns with TCAs are the side effects sound scary, especially with the heart rate increase, tremors, triggering mania, etc.

Which are all potential escitalopram side-effects (https://www.drugs.com/sfx/escitalopram-side-effects.html) too. Just because a side-effect is listed doesn't mean you will experience it. Nor are all listed side-effects actually caused by the med. For example, a number of ADs, including escitalopram, list herpes and tuberculosis as potential side-effects which is at odds with what is known about infectious diseases. Side-effects lists contain every symptom reported during drug trials irrespective of whether they were likely to be caused by the drug.

The TCAs generally produce less severe initial side-effects than the SSRIs and SNRIs and are usually easier to taper off than them too, though as with everything about ADs, YMMV. They are also less prone to stop working and are often more effective than the SSRIs. Their main ongoing side-effects are dry-mouth and constipation which are manageable, with clomipramine being less likely to do so than most of the others.

I've been taking TCAs pretty much continuously since early 1987, mostly at doses above the recommended maximum with few issues. I can't tolerate SSRIs because I become manic within an hour or so of the first dose.


I am not super fit or anything, so i always panic when my heart rate goes up and I am worried about the TCA changing my personality or something

Consider doing some regular exercise. Not only is it good for your physical health, exercise also stimulates (https://doi.org/10.3727%2F096368910X532846) hippocampal neurogenesis just as ADs and therapy do, though not as strongly, however, a 30 minute walk 4-5 days a week can be enough to diminish mild anxiety and/or depression. ADs don't usually change personalities and the TCAs are no more likely to than SSRIs.

The TCAs didn't fall out of favour because the SSRIs/SNRIs were more effective, or had fewer side-effects, but because the newer drugs were safer in overdose and even this isn't true of all of them, with escitalopram being one of the exceptions.