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Thread: Scared to start

  1. #1
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    Scared to start

    Hey,

    I wondered if someone would be able to send some words of encouragement re: taking Escitalopram? My mental health isn't the best at the moment and I'm beginning to really suffer now actually. I've been med-free for quite some time and have been very proud of that, but I'm struggling now, largely due to fear of Covid-19, recent losses and therapy digging into trauma.

    My worries are:
    - that Escitalopram will cause me to have long QT syndrome (I've experienced this before, but I was on 40mg Fluoxetine and Venlafaxine at the same time) and/or cause sudden cardiac death
    - that it will fluff up my arteries (I read once about a link between SSRI's and clogged arteries) even more than they probably are now
    (see a theme here)

    Basically I'm constantly worried I'm going to die. This is exasperated by the current situation. I'm worried that taking these pills will increase the chance of something bad happening to me. I think it's only a small dose.

    I don't know what else to say, I am just looking for courage I guess as I can't give it myself.

    Emma
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  2. #2
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    Re: Scared to start

    Yikes Almighty! What the devil were you doing taking Fluox and Ven at the same time? That's enough to give anyone a long ahem

    But I would say you're safe with Escit and Long QT Syndrome is a rare side effect. Also, there have been studies linking SSRIs to improved blood flow and anti-inflammatory properties, so furred up arteries, esp in your age group, is highly unlikely. SSRIs are also believed to promote neurogenesis in the brain, which is more good news. But, as you probably know, you have to give these meds time to work - usually a couple of months minimum.

    Lastly, I've always regarded you as a survivor and certainly no wimp.

    May the Force be with you
    Last edited by KK77; 18-05-20 at 22:33.
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  3. #3
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    Re: Scared to start

    I take 20 mg of escitalopram daily. I love it. ITs one of the best things since sliced bread, for me anyway. I’m not sure I’d be here without it.
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    Re: Scared to start

    Quote Originally Posted by AntsyVee View Post
    I take 20 mg of escitalopram daily. I love it. ITs one of the best things since sliced bread, for me anyway. I’m not sure I’d be here without it.
    +1
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  5. #5
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    Re: Scared to start

    Quote Originally Posted by EmmerLooeez View Post
    My worries are:
    - that Escitalopram will cause me to have long QT syndrome (I've experienced this before, but I was on 40mg Fluoxetine and Venlafaxine at the same time) and/or cause sudden cardiac death
    Firstly, do not ever let the doctor that prescribe fluoxetine and venlafaxine together anywhere near you again, Emma.

    As for escitalopram, yes it may potentially cause long QT in doses higher than the recommended maximum, but this is true of many drugs including some for cardiovascular disease. You can find the full list of medications linked to long QT at the CredibleMeds website (they maintain it for the U.S. FDA), however, free registration is required to access it. But you can use the site's search engine to check on individual meds without registering.

    The case against citalopram and escitalopram in long QT has been challenged by cardiovascular specialists. To quote from van Haelst IMM, 2013 (escitalopram doses are half that of citalopram):

    In a thorough QT/QTc study of citalopram, a mean change in QTc interval of 8.5 milliseconds was found for 20 mg per day and 18.5 milliseconds for 60 mg per day. On the basis of these findings, the FDA stated that citalopram should no longer be prescribed at doses of greater than 40 mg per day and that the maximum citalopram dose is 20 mg per day in elderly patients.12 However, there is still no consensus whether an increase in QTc of this magnitude (< 20 milliseconds) for a dosage of 60 mg is clinically relevant.4, 28 The guidelines of the Committee for Proprietary Medicinal Products (CMPC) suggest that individual changes of QTc interval length need to be at least between 30 and 60 milliseconds from baseline to raise concern for potential risk of drug-induced arrhythmias.23-PDF Another commonly accepted threshold for a clinically significant drug-induced change in QTc length is even higher, with an increase = 60 milliseconds.28, 30.

    - that it will fluff up my arteries (I read once about a link between SSRI's and clogged arteries) even more than they probably are now
    I don't know what you read, but there is a lot of evidence that serotonergic ADs do the opposite, reducing the risk of heart attacks and ischaemic strokes, though slightly increasing it for the much less common haemorrhagic stroke.

    Serotonin isn't only a brain neurotransmitter. It has many roles in the body including in the regulation of blood vessel tone, constriction and dilation and in wound repair. Serotonergic ADs can affect these function usually by slightly dilating arteries and reducing the amount of serotonin held in blood platelets which results in a reduction in blood coagulation, i.e. they 'thin' the blood.

    SSRIs are commonly prescribed to heart attack/stroke survivors who often develop anxiety disorders and/or depression. They may be the largest SSRI/SNRI taking patient cohort.

    BTW-if worry about heart disease is a significant driver of anxiety disorder consider taking Omega-3/fish and N-Acetyl-L-Cysteine (NAC) supplements. Fish oil you probably already know about, NAC is an amino acid analogue mostly used medically to protect the liver in cases of paracetamol, aka acetaminophen, overdose and has other medical uses. It is a potent antithrombic (blood clot reducer) and helps clear arteries. It is often given during and following cardiovascular surgery. As an added bonus it may increase the effectiveness of ADs, especially in OCD and there is also growing evidence that it may significantly lower the risk of dying from the COVID-19 virus (these two Youtube - 26:45m; Youtube - 13:32m; clips explore the science).

    CAUTION: do not take either fish oil, or NAC without discussing it with your GP first. And don't go mad on dose as both are also mild anticoagulants - up to 2,000mg fish oil and 1,200mg NAC daily should be okay, but watch out for increased bruising and/or nose and/or gum bleeding.

    Basically I'm constantly worried I'm going to die. This is exasperated by the current situation. I'm worried that taking these pills will increase the chance of something bad happening to me. I think it's only a small dose.
    SSRIs rarely do harm, much less kill, Emma. It would be bad for business. I can't say whether escitalopram will be the right med for you, but there is a good chance it could be. The only way to know is by taking it. Hopefully, you've only been prescribed a starting dose of 5mg for the first week, or two to reduce the severity of any initial side-effects and not the usual 10mg maintenance dose.
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    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  6. #6
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    Re: Scared to start

    Quote Originally Posted by KK77 View Post
    Yikes Almighty! What the devil were you doing taking Fluox and Ven at the same time? That's enough to give anyone a long ahem

    But I would say you're safe with Escit and Long QT Syndrome is a rare side effect. Also, there have been studies linking SSRIs to improved blood flow and anti-inflammatory properties, so furred up arteries, esp in your age group, is highly unlikely. SSRIs are also believed to promote neurogenesis in the brain, which is more good news. But, as you probably know, you have to give these meds time to work - usually a couple of months minimum.

    Lastly, I've always regarded you as a survivor and certainly no wimp.

    May the Force be with you
    You're an angel Alex, do you know that? I believe it was a psychiatrist that put me on both Fluox and Ven at the same time. Thanks for your reply <3 I have taken 5mg today and feel all spacey.. Which never happens any more when I try new meds, so maybe that means these will work!! I always used to hate the spacey nauseated feeling, but it feels nicer than how I've felt lately so if they do nothing more for me I'll take this.
    __________________
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  7. #7
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    Re: Scared to start

    Quote Originally Posted by panic_down_under View Post
    Firstly, do not ever let the doctor that prescribe fluoxetine and venlafaxine together anywhere near you again, Emma.

    As for escitalopram, yes it may potentially cause long QT in doses higher than the recommended maximum, but this is true of many drugs including some for cardiovascular disease. You can find the full list of medications linked to long QT at the CredibleMeds website (they maintain it for the U.S. FDA), however, free registration is required to access it. But you can use the site's search engine to check on individual meds without registering.

    The case against citalopram and escitalopram in long QT has been challenged by cardiovascular specialists. To quote from van Haelst IMM, 2013 (escitalopram doses are half that of citalopram):
    In a thorough QT/QTc study of citalopram, a mean change in QTc interval of 8.5 milliseconds was found for 20 mg per day and 18.5 milliseconds for 60 mg per day. On the basis of these findings, the FDA stated that citalopram should no longer be prescribed at doses of greater than 40 mg per day and that the maximum citalopram dose is 20 mg per day in elderly patients.12 However, there is still no consensus whether an increase in QTc of this magnitude (< 20 milliseconds) for a dosage of 60 mg is clinically relevant.4, 28 The guidelines of the Committee for Proprietary Medicinal Products (CMPC) suggest that individual changes of QTc interval length need to be at least between 30 and 60 milliseconds from baseline to raise concern for potential risk of drug-induced arrhythmias.23-PDF Another commonly accepted threshold for a clinically significant drug-induced change in QTc length is even higher, with an increase = 60 milliseconds.28, 30.



    I don't know what you read, but there is a lot of evidence that serotonergic ADs do the opposite, reducing the risk of heart attacks and ischaemic strokes, though slightly increasing it for the much less common haemorrhagic stroke.

    Serotonin isn't only a brain neurotransmitter. It has many roles in the body including in the regulation of blood vessel tone, constriction and dilation and in wound repair. Serotonergic ADs can affect these function usually by slightly dilating arteries and reducing the amount of serotonin held in blood platelets which results in a reduction in blood coagulation, i.e. they 'thin' the blood.

    SSRIs are commonly prescribed to heart attack/stroke survivors who often develop anxiety disorders and/or depression. They may be the largest SSRI/SNRI taking patient cohort.

    BTW-if worry about heart disease is a significant driver of anxiety disorder consider taking Omega-3/fish and N-Acetyl-L-Cysteine (NAC) supplements. Fish oil you probably already know about, NAC is an amino acid analogue mostly used medically to protect the liver in cases of paracetamol, aka acetaminophen, overdose and has other medical uses. It is a potent antithrombic (blood clot reducer) and helps clear arteries. It is often given during and following cardiovascular surgery. As an added bonus it may increase the effectiveness of ADs, especially in OCD and there is also growing evidence that it may significantly lower the risk of dying from the COVID-19 virus (these two Youtube - 26:45m; Youtube - 13:32m; clips explore the science).

    CAUTION: do not take either fish oil, or NAC without discussing it with your GP first. And don't go mad on dose as both are also mild anticoagulants - up to 2,000mg fish oil and 1,200mg NAC daily should be okay, but watch out for increased bruising and/or nose and/or gum bleeding.



    SSRIs rarely do harm, much less kill, Emma. It would be bad for business. I can't say whether escitalopram will be the right med for you, but there is a good chance it could be. The only way to know is by taking it. Hopefully, you've only been prescribed a starting dose of 5mg for the first week, or two to reduce the severity of any initial side-effects and not the usual 10mg maintenance dose.
    This reply contained so many things I really needed to hear. Thank you so very much. I am taking 5mg yes, I started today. I wasn't aware this was just a starting dose though! I spoke to my doctor on the phone this morning and she will call me back next week to see how I'm doing on them. She told me that these are more expensive and 'high end' pills and she thought they might be the right ones for me, given the failure of others.. So hopefully my side effect period will not be too bad and I'll begin to feel better.

    Thank you again for your reply, honestly. I will ask my doctor about those vitamins when I speak to her next week. I am especially concerned about Covid-19, with being an asthmatic. I have been taking Vitamin D though following a blood test showing I was deficient, which I believe may be protective in a mild way, still it's something.
    __________________
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  8. #8
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    Re: Scared to start

    Quote Originally Posted by EmmerLooeez View Post
    She told me that these are more expensive and 'high end' pills and she thought they might be the right ones for me, given the failure of others..
    Escitalopram is out of patent so I'd be surprised if it was that much more expensive than other SSRIs and I'm not sure what 'high end pills' means. SSRIs all basically do the same thing with minor variations. It is probably those variations which determine how effective they prove for an individual, however, no AD is intrinsically superior to another, either generally, or for a particular disorder (though clomipramine (Anafranil) and fluvoxamine (Luvox) for OCD may be the exceptions which prove the rule).

    So hopefully my side effect period will not be too bad and I'll begin to feel better.
    Despite the impression support groups like this one tend to give most people have relatively few problems with side-effects. It is the relative few that do who post about them. The other issue is that not all side-effects are necessarily caused by the med. Psychology can be at least as important as chemistry and biology. Believe that you will suffer greatly and an anxious mind is very capable of producing the worst side-effect symptoms it can imagine. One reason why reading about side-effects before first taking a med is rarely a good idea.

    Also be aware that ADs take time to work, up to 12 weeks though most begin seeing an improvement at between 5-8 weeks. It takes time for them to force the brain changes which create the therapeutic response.

    I am especially concerned about Covid-19, with being an asthmatic.
    Me too as I tick all the high risk boxes, male, old, with respiratory issues which also impact the cardiovascular system. Fortunately, I've been taking NAC ever since I had half a lung removed 15 years ago as it controls fluid build up in what remains better than the available medications. So if the theory is right I might survive if I'm unlucky enough to become infected. Fortunately, we seem to have finally eradicated it from my part of the planet for now.
    __________________
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    - - What to know about: Telepsychiatry | Teletherapy - -




    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  9. #9
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    Re: Scared to start

    Quote Originally Posted by EmmerLooeez View Post
    You're an angel Alex, do you know that? I believe it was a psychiatrist that put me on both Fluox and Ven at the same time. Thanks for your reply <3 I have taken 5mg today and feel all spacey.. Which never happens any more when I try new meds, so maybe that means these will work!! I always used to hate the spacey nauseated feeling, but it feels nicer than how I've felt lately so if they do nothing more for me I'll take this.
    I want to take this drug so bad, but I am so f-ing scared, for so many reasons. how are you doing? I would love to hear a good story.

  10. #10
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    Re: Scared to start

    Hi cofo!

    Honestly it's been fine. When I started taking them I took them around midday and felt weird and spacey for a few days, but then I switched to taking them at 10pm, right before bed and I've been absolutely fine ever since. I did have an increase in anxiety at first, but it's subsided now. I wouldn't say they're working fully, but I definitely do feel better than I did last month. I'm having therapy twice a week as well though so it's hard to say which one is working or if it's both, but honestly taking this pill was nowhere near as bad as I thought it would be.

    Best,
    Emma
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