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Thread: Escitralopram 15mg to 20mg to 15mg

  1. #1

    Escitralopram 15mg to 20mg to 15mg

    Hi all,

    I have been on escitralopram for quite some time.

    My anxiety and depression have increased a lot (my husband is terminally ill so there is a lot of stress at home).

    My doctor suggested increasing my dosage to 20mg which I did but I felt really irritable and angry (not even sure if this is related?) So I have now reduced back to 15mg and feeling really anxious and on edge (is this normal?)

    I'm at such a loss as to what to try next?. My doctor suggested diazpam 2mg to try whilst I'm feeling like this (but I'm feeling too scared to try these) there's a lot of pressure on me to be 'at my best' for my hubbie and family.

    I would like a better medium term approach med wise. I'm too scared to try diazapam, knowing they can be addictive.

    Please help with some suggestions (over the years I have tried citralopram, prozac, Sertraline).None of these have helped previously.

    Thanks in advance x

  2. #2
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    Re: Escitralopram 15mg to 20mg to 15mg

    Quote Originally Posted by welshdory View Post
    Hi all,

    I have been on escitralopram for quite some time. My doctor suggested increasing my dosage to 20mg which I did but I felt really irritable and angry (not even sure if this is related?) So I have now reduced back to 15mg and feeling really anxious and on edge (is this normal?)
    It may be a withdrawal symptom. Depends on how long you were on 20mg.

    As for the irritability and anger, you could try switching to citalopram. It contains the same active chemical as escitalopram, the 'S' isomer of citalopram, but citalopram also has the 'R' mirror image form which is a poorer fit biologically and so is mostly inactive. The minor difference can vary the side-effects produced. No guarantees, but it's an easy overnight switch which shouldn't create any issues.

    I'm at such a loss as to what to try next?. My doctor suggested diazpam 2mg to try whilst I'm feeling like this (but I'm feeling too scared to try these) there's a lot of pressure on me to be 'at my best' for my hubbie and family. I'm too scared to try diazapam, knowing they can be addictive.
    You are already dependent on diazepam. Have been since before you were born. Benzodiazepine receptors in the brain require benzodiazepines to activate them. There are no processes within the brain capable of producing them, and while there has been much speculation about how they might be synthesized in the body, gut flora was once thought to be the most likely source, nothing has ever been found despite much research. So it is now generally accepted that we derive all the benzodiazepines we need from food.

    It has been known since the 1980s that plants make benzodiazepine compounds, and that it is also found in animal flesh and organs [1]. Diazepam (Valium) and its metabolites seem particularly prevalent in plants. My guess is that that benzodiazepines are a plant poison to which animal life, Homo sapiens included, have become so adapted to that we can no longer function without them. While the quantities we get from food are small, they are not insignificant. Benzodiazepine levels can reach pharmaceutical levels in patients with some liver diseases [2]. So much so that medical intervention is sometimes necessary [3].

    That said, benzodiazepines are not a good long-term option as they trigger the brain changes which produce the anxiety disorders and depression. Used sparingly they can be a great help.

    Please help with some suggestions (over the years I have tried citralopram, prozac, Sertraline).None of these have helped previously.
    It seems the SSRIs are not a good fit with your biology so if a switch to citalopram doesn't work your best bet would be a non SSRI, either a SNRI, or TCA. Imo, the TCAs are the better option as the SNRIs have short half-lives which can make them difficult to discontinue.

    References:
    [1]
    Muceniece R, Saleniece K, Krigere L, et al. (2008)
    Potato (Solanum tuberosum) juice exerts an anticonvulsant effect in mice through binding to GABA receptors.
    Planta Med. 2008 Apr;74(5):491-6. (Abstract)

    Kavvadias D, Abou-Mandour AA, Czygan FC, et al (2000)
    Identification of benzodiazepines in Artemisia dracunculus and Solanum tuberosum rationalizing their endogenous formation in plant tissue.
    Biochem Biophys Res Commun Mar 5;269(1):290-5 (Abstract)

    Sand P, Kavvadias D, Feineis D, et al. (2000)
    "Naturally occurring benzodiazepines: current status of research and clinical implications."
    Eur Arch Psychiatry Clin Neurosci vol 250(4) p 194-202 (Abstract)

    Kotz U, (1991)
    Occurrence of "natural" benzodiazepines.
    Life Sci;48(3):209-15 (Abstract)

    Unseld E, Krishna DR, Fischer C, et al (1989)
    Detection of desmethyldiazepam and diazepam in brain of different species and plants.
    Biochem Pharmacol Aug 1;38(15):2473-8 (Abstract)

    [2]
    Baraldi M, Avallone R, Corsi L, et al (2000)
    Endogenous benzodiazepines.
    Therapie Jan-Feb;55(1):143-6 (Abstract)

    [3]
    Zeneroli ML, Venturini I, Stefanelli S, et al, (1997)
    Antibacterial activity of rifaximin reduces the levels of benzodiazepine-like compounds in patients with liver cirrhosis.
    Pharmacol Res , Jun;35(6):557-60 (Abstract)
    __________________
    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.

  3. #3

    Re: Escitralopram 15mg to 20mg to 15mg

    Thank you so much for such an informative reply. I reply appreciate your time and advice.

    What med in the SNRI would you suggest.

    I have the diazpam but scared to try it. I don't want to cause further problems

  4. #4
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    Re: Escitralopram 15mg to 20mg to 15mg

    Quote Originally Posted by welshdory View Post
    What med in the SNRI would you suggest.
    Your GP will likely recommend venlafaxine (Effexor). Though the box says it's a SNRI it is really only a SSRI having only a weak effect on noradrenaline (NA), aka norepinephrine, neurotransmission and then only at the upper end of its dose range. Some of the other SSRIs are actually more potent NA reuptake inhibitors, albeit still only weak ones. Venlafaxine can also be the most difficult AD to quit, often more so than benzodiazepines.

    Duloxetine is a true SNRI and pretty effective, but the initial side-effects can be rough and quitting can be difficult as like all the SNRIs it has a short half-life and the limited dose range it comes in makes it impossible to wean off in small steps. The old SNRI milnacipran might be worth a shot as might the newer levomilnacipran (as with citalopram and escitalopram, the new med was more about extending the patent than improving effectiveness), if they are available on the NHS. I haven't seen either mentioned here much so they may not be.

    I have the diazpam but scared to try it. I don't want to cause further problems
    You could try mirtazapine at low doses for its sedative effects, plus maybe a beta-blocker if you're experiencing adrenaline surges.
    __________________
    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.

  5. #5
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    Re: Escitralopram 15mg to 20mg to 15mg

    Quote Originally Posted by welshdory View Post
    Thank you so much for such an informative reply. I reply appreciate your time and advice.

    What med in the SNRI would you suggest.

    I have the diazpam but scared to try it. I don't want to cause further problems

    Diazepam taken appropriately and sparingly can be really helpful though. 2 mg is a tiny dose.

    I would also consider carer burnout which meds can't fix sadly. Is there any way you could get a short break away from your carer duties.. with cover at home of course?

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