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Re: 15mg Lexapro - but how long until positive or any effects?
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Originally Posted by
Quinn1
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.
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Re: 15mg Lexapro - but how long until positive or any effects?
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Originally Posted by
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..
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.
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Re: 15mg Lexapro - but how long until positive or any effects?
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.
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Re: 15mg Lexapro - but how long until positive or any effects?
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Originally Posted by
LisaS
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.
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Re: 15mg Lexapro - but how long until positive or any effects?
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.....
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Re: 15mg Lexapro - but how long until positive or any effects?
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Originally Posted by
LisaS
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.
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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.
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Re: 15mg Lexapro - but how long until positive or any effects?
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Originally Posted by
panic_down_under
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?
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Re: 15mg Lexapro - but how long until positive or any effects?
Good to have you here Lisa :yesyes:
Always best to consult a doctor than rely on advice here.
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Re: 15mg Lexapro - but how long until positive or any effects?
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Originally Posted by
Phill2
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 😁
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Re: 15mg Lexapro - but how long until positive or any effects?
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Originally Posted by
LisaS
Were you a psych in a past life
No, I still have some sanity left...I hope :winks:
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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.
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Re: 15mg Lexapro - but how long until positive or any effects?
What medications are you on now PDU? What have you found most effective for anxiety?
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Re: 15mg Lexapro - but how long until positive or any effects?
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Originally Posted by
Windywel
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.
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Re: 15mg Lexapro - but how long until positive or any effects?
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?
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Re: 15mg Lexapro - but how long until positive or any effects?
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Originally Posted by
Windywel
Interesting. Why can’t you tolerate SSRIs/SNRIs? Do they give you awful side effects?
They make me manic.
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Is dusolepin a TCA? Do you have depression as well as anxiety?
Yes, and no, only panic disorder.
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Re: 15mg Lexapro - but how long until positive or any effects?
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?
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Re: 15mg Lexapro - but how long until positive or any effects?
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Originally Posted by
LisaS
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.
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Re: 15mg Lexapro - but how long until positive or any effects?
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....
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Re: 15mg Lexapro - but how long until positive or any effects?
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Originally Posted by
LisaS
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.
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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.
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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.
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Re: 15mg Lexapro - but how long until positive or any effects?
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....
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Re: 15mg Lexapro - but how long until positive or any effects?
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Originally Posted by
LisaS
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.
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Otherwise its the after effects of Christmas.
Christmas can be the most stressful time of the year so a likely candidate, imo.
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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
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Re: 15mg Lexapro - but how long until positive or any effects?
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.
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Re: 15mg Lexapro - but how long until positive or any effects?
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Originally Posted by
LisaS
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.
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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.
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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.
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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.
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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.
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Re: 15mg Lexapro - but how long until positive or any effects?
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
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Re: 15mg Lexapro - but how long until positive or any effects?
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Originally Posted by
LisaS
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.
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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).