Escitalopram - stick with it or stick it?

[Biggle]

Hello everyone.

This is my first post. I think firstly I'll say what a delight it is to have found this forum. I have been reading through the posts and have found them very helpful, particularly as there is an absence of anti/pro-med agendas that appear to prevade other websites.

Now for an introduction and a description of where I am currently. I could really do with some advice. I'll try not to go on too long.

I have been off work for 3 months now. My GP first diagnosed me with anxiety from being overworked.

The symptoms I went with I had been expreiencing for about 3 months before:
Insomnia - averaging 4 hours sleep a night (previously sleeping 7/8) some nights sleeping an hour and a half. Impossible to get to sleep - thoughts racing, smallest sounds keeping me awake. Pulsations in temples and pressure felt in forehead. Weakness in the legs, periods of exhaustion, moments when I felt like I was going to collapse, butterflies in the stomach for no apparent reason, general sense of dread, fits of rage over small things, snapping at people close to me, feeling very hot at night, uncontrollable scratching of the calves (of all places).

GP gave me Lorazepam - this gave me a different problem. Sleeping more, but a full dose (1mg x3) made me drowsy and absent-minded. Very difficult to get out of bed. Not able to function properly - going back to work out of the question. Taking it in halves made it slightly better, but then sometimes would not enable me to sleep - very difficult to find a happy medium.

I have just seen a psychiatrist who has taken a slightly different line - diagnosing depression with moderate anxiety.

My meds are now:
Escitalopram (5mg for 3 days then 10mg)
Bromazepam 1.5mg morning
Lormetazepam 1mg last thing at night.

The 3 of them together are an absolute bomb. However, I have been given the option to use the Escitalopram as the base, taking the others when there seems to be a need for them.

First of all, the Lormatazepram is a great thing indeed - gets me to sleep after 15 minutes and I can wake up no problem 8 hours later.

The Escitalopram however I found hits me very hard. This is at 5mg only: I feel like a Zombie. I have no interest in anything, I'm a witty guy but that has deserted me, I'm constantly tired, yawning, taking naps. I can't concentrate, can't express myself well - don't have any desire to talk. I can't even read. I did not take it this morning (I don't think I could have written this while medicated) and asked my GP if I could stop taking them and just take the Lormatazepam but she was very adamant that I should continue with the base medication, that I should try and force myself to do normal things despite the symptoms and that within a few weeks I would feel a lot better. I could even be convincing myself that the sides were worse than they really are. After reading the psychiatrist's report she said it was clear that my problem was depression and it must be treated. Also, I had to accept I was depressed as it was characteristic of a person with depression to think that they are not depressed.

Surely there is a problem with the logic of this? People who are not depressed don't think they are depressed either. Couldn't I be one of them?

But there is some truth in what she is saying. I am not sure that I need this medication. It feels like using a sledgehammer to crack a nut. If this is all based around not being able to sleep and the Lormatazepam takes care of that, then should I really take the risk of sedating myself with the Escitalopram in the hope that it wears off? And then have the problem of trying to come off it later? Will I be THAT much happier if the sides wear off and the effect comes in?

I also asked if I could take it at night, thinking the days might be less foggy. I was advised against this however.

Today I haven't yet taken it and I don't know if I should. Some people say they have almost no side effects at all from their meds. Wouldn't it be preferable to change and search for this?
Or am I being a wuss and

[camilla]

hi welcome

i have a similar sleeping problem i need a strong sleeping tablet 2 get me off to sleep. but then i can't get up in the mornings.

i have often had side effects from medication. some people are more senstive than others this is normal.

when i was on a lot of medication i could never made it through the day without sleeping. Maybe your senstive to the medication so you don't need so much of it. if so i can still help you with less side-effects.

i suggested you could talk to your dr about reducing it.

camilla

[Meg]

Hi Biggle,

Welcome to the site. Glad you like it . We're very pro choice here.

We support all those who want to take meds to see it through and derive the benefit from them when taken properly and also support those who want to do it med free which is totally doable for most but takes lots of stamina without the break that meds can provide.

You say 'I have just seen a psychiatrist' I'm presuming this is within the last week or so so the schedule is new to you .

My history is similar in that I was doing 15-17 hr days and one day it all just collapsed around me.
My GP said depression and prozac. I was not depressed. I was full of self pity/sad days and mortified that my life as I knew might be over and I had several of the symptoms but I was not clinically depressed .
I stayed on prozac long enough 16 weeks to get the ready brek glow feeling and realized there was life after panic and then took myself off it and went it alone- knowing that I could return to meds if I didn't suceed. It was very hard but its now way behind me.

I would first of all like to ask about how she proposed addressing the root cause of this issue ... the overwork and occupational stress ?

Incidentally, I find some people who worked very hard and long and suddenly stop actually get worse in the very initial periods as they have lonliness and bordom to contend with and all the time to dwell on their predicament. I do not advocate staying at work whilst you're acute but I do recommend spending the days doing something proactive to help yourself and keeping out of mischief.

All your symptoms are very common ones and nothing there gives me cause for concern

The Escitalopram will take about a month to kick in. The side effects should wear off in a few days but perhaps consider not increasing the dose to 10mg until they are wearing off. If you go this route stay on it for at least a month

Bromazepam - maybe the sledge hammer one. Its essentially a strong valium cousin. You could try without it or breaking it in half.

Lormetazepam- great for sleep but don't allow yourself to get used to it. How are your dreams ?

You might want to put a post in the Introduction section as well and share some of your history so you can get the benefit of other peoples wealth of experience.

Take care

Let us know what you decide and how you're doing




Meg
www.overcominganxiety.co.uk

You cannot conquer fear until you have learned what it is you're afraid of. The enemy is ignorance. Vivian Vance

[vernon]

Hi. Welcome to the site I am sure u will find lots of help here. Meg is very experience with these things and has also suffered herself and has lots of medical knowledge. I went to see a physiatrist a while ago and he gave me an antidepressant and larazapam to calm me when I get to anxious and panicky. But, I try to just take the antidepressants, as I know the tranx are addictive. I would have thought he would have give u the tranx as an emergency and see how u got on with just the antidepressants to start? Seems a lot of meds before just trying antidepressants alone first? I found the antidepressant helped me a lot with sleep, and stopped the waking early real scared. But with any recovery I still get some horrid days, but these seem to get less. Take care Vernon

[Biggle]

Hi Camilla and Meg,

Thanks very much for your replies. I've just noticed the introductions board and I'll be putting in something after reading through some others.

Meg, I saw the psychiatrist this Monday. It was the first time I had seen one and I just basically trotted out my recent work history and the symptoms history with him for a good half an hour. My GP said that from this he will have been able to form a good diagnosis and he will be able to notice things about me that she can't. According to his report, he gives 6 headings for indications for depression - I actually can't understand any of them (doctor's writing) apart from the one that he thought I wasn't failing under, which was apathy. I am not apathetic it says here. I fail, or rather, show depressive tendencies on the other 5. I don't know if this system means anything to you - one of the headings looks like "astemia."


The general plan is 6 months of this medication during which I will have sessions with the Psychiatrist every few weeks and try to form a new perspective on my job situation and how to stop pushing myself too hard, and I imagine allowing myself to be pushed too hard. At work things have been bad and I have been pushed to the limit. I was not sleeping, and my response, also just to get something positive out of the day, was to get up earlier, go to the gym and work hard. The idea was that I would get to sleep earlier as a result. In fact what actually happened, was that although I felt more energy during the day, I would actually still have that energy at night, and it was even more difficult to get to sleep. I was actually sleeping less with this situation. I didn't even realise this had been happening until I had been off work for some weeks and forced to reflect on what had been happening.

I would say that my situation is similar to yours in that I am not convinced that I am depressed either. I have said this to the GP and she told me that I should see me from where she's sitting. However, I do feel fine most of the time. It's just that there's the not sleeping and the mental cat and mouse I play in my brain whenever the subject of work comes up. Also the exhaustion can still hit me even after doing very little. So clearly some things are not right and I do wonder if I could be depressed yet not think it.

I think my tactics will be to persevere with Escitalopram and see what happens. I will leave the other two unless there is a definite need at a particular time. I will wait though. For example, I have my best friend's wedding this weekend and I don't want it to seem like I am not there. If it's going to take a week or so before I feel like a human being it might as well be a slow week. So I will start again next week. Thanks for the advice of keeping it to 5mg. I was initially wondering if maybe upping the dose would actually make me feel better, as I couldn't imagine the sides possibly being any more severe.

What do you think generally?

[Biggle]

Yes Vernon!!

I had forgotten that also, if I get to sleep at the right time (12.30/1am), I sometimes wake at about 4 or 5, feeling wired and unable to get back to sleep. Infact, it happened this morning at 6. My response? Get up and go to the gym and work hard. I tried to get a siesta after lunch - no chance. Still completely wired. I should add however that I feel quite good. This sort of thing I'm sure is part of the whole problem. The question is, do I really have to put myself through the effects that the anti-depressants have to beat it?

It's a tough one. It's good to know I'm not the only one who is getting this type of thing.

[vernon]

hi, I didnt find any bad side effects realy with the Antidepresant i started about 50 days ago, Its cipralex. Doc did try prozac before that but i heard that many good reporst on cipralex i asked for it. My shrink also said its a low dose anti and has is very tolorant. It has no side effects reported with most other meds. take care, Vernon

[Meg]

Hi Biggle,

When I was in your dilemma I did numerous on line depression test - about 8- and I went with the aggregated conclusions.

http://www.depression-recovery-life....ion-tests.html

No need to pay for any results - ignore those ones. It will give you an inner idea of where you sit on the scale and whether you need to go down that route .

I hope you've found First Steps : First Steps to overcoming Panic and Anxiety

Sleep is so vital so I do recommend you use your night time one - but perhaps every other night so you can be assured of enough sleep. Also I really really recommend that you join a Tai Chi, yoga or meditation class- one that runs in the evening as that will teach you to breathe correctly and how to relax and get a good relaxation CD . Your gym work is terrific but doesn't wind you down at night.

If you're really shaky get a full body massage it'll get all the tension out

Eat well and do fun things - get out in the countryside for a long walk.

Where are you getting your support from at home ?

When you decide to start taking the Escitalopram do it properly and be fully compliant.

Take care.



Meg
www.overcominganxiety.co.uk

You cannot conquer fear until you have learned what it is you're afraid of. The enemy is ignorance. Vivian Vance

[Biggle]

Hi again Meg. Yes, the online tests are showing me as moderately depressed. It's quite surprising but there must be something in it.

Thanks very much for the help and ideas this afternoon. This in itself has been quite a tonic.

[twister]

Hi Biggle

One thing to note - escitalopram and cipralex are the same thing. I take this, at first you may well get side effects but these do wear off after a week or so. I would not recommend taking it at night - I did at first and had the most horrendous nightmares and panic attacks. I do seem to remember being more sleepy but as I said this wear off and I am normal now.

Don't worry too much about depression classifications - doctors etc always feel the need to pigeonhole people according to the DSM IV. If you have the classic symptoms of anxiety you may well score as having depression because of the questions about tiredness, self esteem and concentration. I was scored as being moderately depressed by my psychiatrist even though I answered that I was not unhappy - solely because of these things. My CBT therapist has since agreed with me that I am definitely not depressed and pointed out the problems with questionnaires.

Hope you get on okay









Emily

Knowledge is knowing a tomato is a fruit
Understanding is knowing not to put it in a fruit salad