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

[panic_down_under]

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.

[NervousKel]

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.

[LisaS]

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.

[panic_down_under]

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.

[LisaS]

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.....

[panic_down_under]

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.

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.

[LisaS]

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?

[Phill2]

Good to have you here Lisa
Always best to consult a doctor than rely on advice here.

[LisaS]

Good to have you here Lisa
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 😁

[panic_down_under]

Were you a psych in a past life

No, I still have some sanity left...I hope

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.