Alternatives to Escitalopram

[alias_kev]

I've had fairly good experience with Escitalopram although it doesn't block the worst parts of my anxiety. It has been very good for avoiding depression or even reasonable sadness and helps with the background level of anxiety. However when faces with a hard situation the anxiety still often wins, leading to avoidance and procrastination.

So I saw GP about alternatives. To add insult to injury the PCT are telling him to stop prescribing Escitalopram and drop back to Citalopram. The old arguement being that there is no difference even though patients and some medical literature advises differently. eg. Esc' is approved for GAD whereas Cit' isn't really.

So any recommendations/experiences for extreme anxiety when faced with those situations which trigger it? ((So in a way its like a broad phobia)).

Apparently they may be able to continue the Esc as I'm already on it and if I make a fuss. I also got one short batch of CBT sessions before (less than 6 hours total) and its unclear if I can have any more.

[suzy-sue]

Hi Kev six sessions doesnt seem enough,id push for some more if i was you.Escitalopram costs a lot more than citalopram and thats why they dont like to perscribe it, its a purer form of citalopram and works quicker with less side effects,.You could try a different ssri ,but would have to come off before you went on another, you dont have to do that if you are switched to citalopram.Personally i wouldnt think it would be as good as the escitalopram,so i would make a stand thereand continue with what your on.If you were to go on seroxat or sertraline theres no guarantee itll be any better .Therapy for the remaining anxiety seams a better course of action.. Good luck Suex

[alias_kev]

Thanks suze-sue. I only got 3 x 2hrs of group (for Stress/Anxiety/Depression) less tea breaks and "how good was this course at the end". So about 5 hours tops I think. I gained one really good txt-friend out of it as we had a lot of symptoms in common, which was one of the best things about it. The CBT elements were good but oh so short.

The doc is meant to push me towards citalopram, they might keep the escitalopram if I push them. He also offered Fluoxetine BUT that's so not listed for GAD or anxiety its untrue! (Allegedly its good for depression, bulimina and OCD). I think he knows "depression" and "anxiety" but is not really informed on GAD - like most of them, sadly.

I've been reading pages like crazy so far I've identified:
* the various 'azepams but they are killers to get of off and most GPs use the wrong withdrawal protocols anyway.
* Escitalopram. In later descriptions it has (some) confirmed effectiveness against GAD. What I've been on. Reduces the broad underlying anxiety but hasn't stopped peaks and phobic responses. Very effective as antidepressant.
* the various other SSRIs because they know the seratonin effect will help a bit, but most are not actually formally identified as an anxiety or GAD treatment.
* Venlafaxine (Effexur) which may be quite effective, but causes weight gain (as in stones). Its also tough to get off of, and seemed to have gained a big dislike among patients in the USA.
* Buspirone (BuSpar) which is meant to be like the 'azepams but without the dependancy and tolerance problems. Like the 'azepams its meant to be a short/medium term fix.

So I am leaning towards:
one-2-one CBT and stay with Esc for now, or
one-2-one CBT and the Buspirone as I've been medicated since June and only really took a few small steps forward.

Anyone else got any thoughts.

[bab]

Hi Kev

I am on escitalopram and i have been on citalopram, seroxat and prozac before. I would say escitalopram is definately a better drug than citalopram - dont let your docs fob you off

[alias_kev]

Hi Kev

I am on escitalopram and i have been on citalopram, seroxat and prozac before. I would say escitalopram is definately a better drug than citalopram - dont let your docs fob you off
Thanks bab. That seems to be the general feeling from patients/sufferers. Our GP had been written to by the PCT to tell him to stop prescribing Esc' and use Cit'. So clearly either the PCT hate the cost locally or NICE have been up to their usual cost saving tricks. ie. examine only those studies that find no difference and conclude that there is no difference.

Anyway as a result of some research I did back in late October and repeated this week I came up with the drug summary I posted above in the thread. Our GP agreed that the 'azepams where poor choices especially for long standing problems. He accepted my information that Fluoroxetine was a poor choice and relies only on the general theory that all SSRI antidepressents help GAD because of the raised Seratonin. Infact its listed for a few other problems include OCD but makes no effort to claim anxiety as a target. Since another choice Venlafaxine had mixed reviews in the USA and is meant to be hard to get off, I asked about Buspirone (BuSpar). It turned out he'd prescribed it before for people and it was on the OK list (my info said generic since 2001).

Anyway I've got 10 days of Buspirone to try. He didn't give me any extra Esc' to use to taper that off so its going to be a bit of a crash there. I'me halving my dose for the last few days and I've added in the Buspirone. Its reported (some info sheets) to take upto 14 days to work so if I crash I'll insist on some Esc' to soften the withdrawal. :shrug:

I'll start a thread in the medication section I think and report on progress and effects.

[bab]

Hi Kev

please do report on progress and I wish you lots of luck x

[alias_kev]

Hi Kev

please do report on progress and I wish you lots of luck xI've posted a lot of info in the Medication forum, here (http://www.nomorepanic.co.uk/showthread.php?goto=newpost&t=47053).