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Thread: 15mg Lexapro - but how long until positive or any effects?

  1. #1
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    15mg Lexapro - but how long until positive or any effects?

    Hi,

    I have GAD and it's pretty bad at the moment and have had it a few times before in my past. This time, I'm staying on the Lexapro!

    I started taking 5mg for 10 days, then 10mg for 10 days and now just started 15mg - and this is where I will stay. My question is, that although I know it takes 4-6 weeks to get full effects, how long have I been on it? Do I count my weeks from when I started the 5mg or when I started the 15mg?
    If it's from the 5mg then I've been on it for almost 3 weeks and I can't say I'm reaping ANY benefits yet and infact feel more anxious than when I started, which again I know can happen but I'm so desperate for a little relief. Anxiety is exhausting and debilitating.

    I'll try and keep this thread updated too to help others and myself as time goes on...

    Thanks all,
    Lisa

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    Re: 15mg Lexapro - but how long until positive or any effects?

    Quote Originally Posted by LisaS View Post
    My question is, that although I know it takes 4-6 weeks to get full effects, how long have I been on it? Do I count my weeks from when I started the 5mg or when I started the 15mg?
    The clock starts running from when you start taking a therapeutic dose, Lisa. Just how much this is varies from person to person, but the minimum recommended Lexapro (escitalopram) dose is 10mg so you can be sure that will be having a positive affect. Also, while most people do begin to get a response in the 4-7 week range, it can take longer for some, perhaps as long as 12 weeks.

    infact feel more anxious than when I started
    Despite the common myth that serotonin is a 'feel good' neurotransmitter, it is in fact the *opposite hence the spike in anxiety. After a few weeks the brain and body (other organs make/use much more than the brain) will respond to the extra serotonin activity by down-regulating its synthesis and expression and the heightened anxiety and other side-effects will then usually begin to diminish, but they may return for a while after dose increases.

    * not strictly true as neurotransmitters don't have any intrinsic qualities, their action is determined by the receptors they bind to, not the molecule itself

    I'm curious why you've been prescribed 15mg as the usual initial dose is 10mg, increasing only if that proves insufficient. Have you been on escitalopram before and needed the higher dose?

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    Re: 15mg Lexapro - but how long until positive or any effects?

    Thank you so much for your helpful and informative response.
    I have been on Lexapro before and needed 20mg and stayed on that for 6 months before coming down to 10mg again.
    This time my doc said we may have to go to 20mg again. I told my psychologist this and she is the one that suggested I do 15mg instead. I actually wasnít sure whether to give the 10mg a bit longer but then I also donít want to waste time if Iím inevitably going to go to 20mg again. Iím hesitant to do 20mg again as I did feel I was a bit emotionless.
    Does that all make sense?

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    Re: 15mg Lexapro - but how long until positive or any effects?

    Quote Originally Posted by LisaS View Post
    I have been on Lexapro before and needed 20mg and stayed on that for 6 months before coming down to 10mg again.
    This time my doc said we may have to go to 20mg again. I told my psychologist this and she is the one that suggested I do 15mg instead.
    Unfortunately, you may need the full 20mg given this is the second time you've been on escitalopram because there is *evidence antidepressants (ADs) become progressively less effective each time they are stopped and restarted.

    * Bosman RC, 2018; Amsterdam JD, 2016; Amsterdam JD, 2009; Amsterdam JD, 2009; Leykin Y, 2007; Paholpak S, 2002

    Iím hesitant to do 20mg again as I did feel I was a bit emotionless.
    If this reoccurs there are a couple of things which may work. Citalopram (Celexa) and escitalopram are nearly the same drug. Citalopram is made up of two isomers, the 'S' form which is the active component, and a 'R' mirror image form which is a poorer fit biologically and so is mostly inactive. Escitalopram is more refined and only contains the 'S' isomer. Despite the chemical closeness there can be differences in side-effects and it possible the emotionless won't be a problem with citalopram, or less so.

    The second option is to supplement the 15mg dose with buspirone (Buspar) instead of taking more. Buspirone is generalised anxiety med which only works for some, but in small adjuvant doses it will often increase the effectiveness of SSRIs and also reduce some of their side-effects. It may also reinvigorate SSRIs which have stopped working so might counter the effectiveness loss when returning to an AD mentioned above.

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    Re: 15mg Lexapro - but how long until positive or any effects?

    Hey - I'm in need of some advice.

    I took 10mg for 10 days and 2 weeks of 15mg so 4 weeks all up. Things were really beginning to improve and I could really start feeling the benefits of lexapro. However, since Friday I have taken a crashing nose dive and have probably the worst anxiety I have had to date. I have got really shaky hands, nausea again, loss of apetite and feel extremely anxious its affecting everything.

    Does anyone know what's happening to me?! I've recently had the mirena fitted and I am due on now so I guess hormones would play a part but I never get anxiety like this.

    I'd be really grateful for some advice. I feel so defeated as I thought things were going upwards.

    Thanks,
    Lisa

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    Re: 15mg Lexapro - but how long until positive or any effects?

    Quote Originally Posted by LisaS View Post
    I took 10mg for 10 days and 2 weeks of 15mg so 4 weeks all up. Things were really beginning to improve and I could really start feeling the benefits of lexapro. However, since Friday I have taken a crashing nose dive and have probably the worst anxiety I have had to date. I have got really shaky hands, nausea again, loss of apetite and feel extremely anxious its affecting everything.

    Does anyone know what's happening to me?
    It can take up to 12 weeks for antidepressants to fully kick in with most seeing improvement in the 4-7 week range so you're just entering that window, Lisa. Plus, for some there can be periods when progress becomes one step forward, two back, and occasional three, or four back. Welcome to the wacky world of antidepressants!

    Hormones may also be a factor, though I think it's mostly just the typical initial AD weirdness. The fact this is your second time on escitalopram may also be playing a part.

    I feel so defeated as I thought things were going upwards.
    Don't be. What you've experienced is par for the course.

    Antidepressants are unlike most medications in that they don't directly address the symptoms, as say, Panadol does where you take a tablet and an hour later the headache is mostly gone. They work on the underlying biological deficits by turbo charging the growth of new brain cells and rewiring connections between neurons and brain regions. It is those new cells and connections which produce the therapeutic response, not the AD. This all takes time and isn't a linear process.

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    Re: 15mg Lexapro - but how long until positive or any effects?

    Thank you so much PDU,

    I was half expecting a blip as I've been here before but I'm a bit thrown this one is lasting so long - the flutterings of anxiety are lasting all day, it's exhausting.

    I hope its just the AD weirdness and that it passes soon because it's horrible.

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    Re: 15mg Lexapro - but how long until positive or any effects?

    Quote Originally Posted by LisaS View Post
    I was half expecting a blip as I've been here before but I'm a bit thrown this one is lasting so long - the flutterings of anxiety are lasting all day, it's exhausting.
    Talk to you doctor if it becomes too difficult as the heightened anxiety can be minimised. No one is handing out gold stars for white knuckling anxiety. It's counterproductive.

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    Re: 15mg Lexapro - but how long until positive or any effects?

    Quote Originally Posted by panic_down_under View Post
    Talk to you doctor if it becomes too difficult as the heightened anxiety can be minimised. No one is handing out gold stars for white knuckling anxiety. It's counterproductive.
    I went to the doctor this evening and she recommended going up to 20mg.
    Iím a bit fed up as this means side effects again and I really want some relief.
    She doesnít agree with Benzodiazapines and would rather I took propranolol in the interim.
    Feeling miffed again.

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    Re: 15mg Lexapro - but how long until positive or any effects?

    Quote Originally Posted by LisaS View Post
    She doesnít agree with Benzodiazapines and would rather I took propranolol in the interim.
    I agree with her on the benzodiazepines (BZDs), though probably not for the same reason. The dependency issue is overblown, imho, however, there is strong evidence1 BZDs block the neurogenesis mechanism by which antidepressants work.

    Propranolol is a beta-blocker which prevents adrenaline binding to its receptors. This can prevent the adrenaline surge of the flight-or-flight response which can help cope with anxiety, but doesn't directly diminish the anxiety itself. It is definitely worth a try, but if it isn't effective ask for *hydroxyzine instead. It is a mild prescription antihistamine with pretty good anti anxiety properties. Not quite as potent as the BZDs, but often potent enough.

    *Hydroxyzine comes in two forms, hydroxyzine pamoate (Vistaril) and hydroxyzine hydrochloride (Atarax). Anecdotally, the pamoate form is claimed to be the more effective anxiolytic, but just how true this is remains a matter of debate in forums.


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    Boldrini M, Butt TH, Santiago AN, et al. (2014)
    Benzodiazepines and the potential trophic effect of antidepressants on dentate gyrus cells in mood disorders.
    Int J Neuropsychopharmacol. Dec;17(12):1923-33 (Abstract | Full text)

    Nochi R, Kaneko J, Okada N, et al. (2013)
    Diazepam treatment blocks the elevation of hippocampal activity and the accelerated proliferation of hippocampal neural stem cells after focal cerebral ischemia in mice.
    J Neurosci Res. Nov;91(11):1429-39 (Abstract)

    Sun Y, Evans J, Russell B, et al (2013)
    A benzodiazepine impairs the neurogenic and behavioural effects of fluoxetine in a rodent model of chronic stress.
    Neuropharmacology. Sep;72:20-8 (Abstract)

    Song J, Zhong C, Bonaguidi MA, et al (2012)
    Neuronal circuitry mechanism regulating adult quiescent neural stem-cell fate decision.
    Nature. Sep 6;489(7414):150-4 (Article | Study full text)

    Chen J, Cai F, Cao J, et al. (2009)
    Long-term antiepileptic drug administration during early life inhibits hippocampal neurogenesis in the developing brain.
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    Wu X, Castren E. (2009)
    Co-treatment with diazepam prevents the effects of fluoxetine on the proliferation and survival of hippocampal dentate granule cells.
    Biol Psychiatry. Jul 1;66(1):5-8 (Abstract)

    Stefovska VG, Uckermann O, Czuczwar M, et al (2008)
    Sedative and anticonvulsant drugs suppress postnatal neurogenesis
    Ann Neurol. 2008 Oct;64(4):434-45 (Abstract)

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