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Thread: Citalopram to Escitalopram

  1. #1

    Citalopram to Escitalopram

    Just got switched doctor thinks it will be a better option for my anxiety? Iíve been on Cit for a good 10 years, different dose depending of severity.
    Any tips on side effects from changing? Iím on my second day of 5mg feel anxious but Iíve felt constant debilitating anxiety for around 2 weeks so was t expecting to wake up like a new me 🙄.
    Slight headache went for a walk that seemed to clear it. Managed to get the rest of the week off work just incase 🤔🤔

  2. #2
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    Re: Citalopram to Escitalopram

    Quote Originally Posted by Kate1970 View Post
    Just got switched doctor thinks it will be a better option for my anxiety?
    Hmmm. With the possible exception of a couple of ADs for OCD, no antidepressant is intrinsically more effective than the others either generally or for a particular disorder, although 1 or 2 often are for an individual. That said, SSRIs are arguably a little more effective for anxiety disorders than depression.

    The second issue is that citalopram and escitalopram are essentially the same drug sharing the same active chemical, the 'S' isomer of citalopram, aka escitalopram. Citalopram also contains the 'R' mirror image isomer which is a poorer fit biologically and so is mostly inactive. Lexapro (escitalopram) is more refined and only contains the 'S' isomer. There can be subtle differences in the side-effects each med produces because of that 'R' isomer in citalopram, but in terms of effectiveness there is unlikely to be any significant difference, ime.

    Iíve been on Cit for a good 10 years, different dose depending of severity.
    ADs have no direct effect on anxiety in the way say a benzodiazepine has, or aspirin for headaches. They work by stimulating the growth of new brain cells (neurogenesis) to replace cells killed, or prevented from growing by high brain stress hormone levels. The therapeutic response is produced by these new cells and the stronger interconnections they forge, not the meds directly, and they take time to bud, grow and mature. For more detailed explanations see: Depression and the Birth and Death of Brain Cells (PDF) and How antidepressant drugs act. Therefore varying the dose depending on the severity of anxiety that day, or week will have little if any effect, except maybe by the placebo response.

    One additional thing to be aware of is that there is good evidence antidepressants, especially the SSRIs, can be less effective the second time round, and become progressively less so each time they are stopped and restarted requiring higher doses to achieve a good response. They may also produce more severe and/or different, initial side-effects. Two studies, Amsterdam JD, 2016 and Amsterdam JD, 2009, found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Bosman RC, 2018; Amsterdam JD, 2009; Leykin Y, 2007; Paholpak S, 2002). This suggests that if the anxiety (also depression) is chronic then it might be better to remain on ADs permanently.

    Any tips on side effects from changing? Iím on my second day of 5mg feel anxious but Iíve felt constant debilitating anxiety for around 2 weeks so was t expecting to wake up like a new me 🙄.
    Assuming you were switched for 10mg citalopram to the equivalent 5mg of escitalopram there shouldn't be any significant change in anxiety severity, though there might be in the nature, or severity of other side-effects.

    Slight headache went for a walk that seemed to clear it.
    The headache might have been triggered by the med. Serotonin isn't just a brain neurotransmitter. It has many roles in the body, including in the regulation of blood vessel tone, constriction and dilation, and this function can be affected by serotonergic ADs, especially at the beginning. The usual painkillers are generally effective, however, if the headaches are persistent then paracetamol (aka acetaminophen) is a better option than aspirin, ibuprofen, etc, as they are mild anticoagulants as are the SSRIs, SNRIs and some TCAs.
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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.

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