Escitalopram to duloxetine

[smogie]

Hi all I’ve been on 20mg escitalopram for about a year and really don’t think they’ve helped as my health anxiety has been on a whole new level these past months I’m also getting passed around the mental health service like an unwanted parcel anyway spoke with a cpn that s morning who wants me to switch from escitalopram to duloxetine 60mg has anyone else had experience of this I’m quite worried about switching thanks

[panic_down_under]

Hi all I've been on 20mg escitalopram for about a year

Is this the first antidepressant (AD) you've been on?

spoke with a cpn that s morning who wants me to switch from escitalopram to duloxetine 60mg has anyone else had experience of this I'm quite worried about switching thanks

Switching ADs is fairly common as while no AD is intrinsically better than the others one or two are likely to be for an individual and it often takes a few switches to find the most effective.

Moving from a SSRI (except fluoxetine) to another, or a SNRI, is usually done by a direct overnight switch, or a short cross taper (see: NHS Primary Care Guide to Antidepressants, from page 12, PDF). A direct swap is probably the better choice for duloxetine, imo, but the CPN is better placed to make that call.

[smogie]

I’ve had lots of ssri s over the years but never a snri why ch seems strange?

[panic_down_under]

I've had lots of ssri s over the years

Did any of them work well and if so which and why did you stop taking it/them?

but never a snri why ch seems strange?

Switching to a SNRI is indicated if there is no response to SSRIs in the prescribing by the numbers manual. It's usually either that, or mirtazapine and SNRIs are the better of the two options, imo.

There's not much difference between SSRIs and duloxetine in terms of their effect on serotonin, but duloxetine is also a potent inhibitor of noradrenaline, aka norepinephrine, transporters which may make a significant difference, although, as with everything about ADs, there are no guarantees. The dual action ADs are usually less prone to pooping out too.

[smogie]

No I don’t think the escitalopram is doing anything for me I’m just a bit anxious about starting something new do you think I will see any big changes as soon as I start them side effects? Thanks for your input it’s appreciated

[panic_down_under]

No I don't think the escitalopram is doing anything for me

What about the other SSRIs you've been on? Did any of them work well for you?

I'm just a bit anxious about starting something new do you think I will see any big changes as soon as I start them side effects?

There are likely to be some side-effects for a few days. It is impossible to say which, or how severe they may be as it all depends on individual biology. But any side-effects will almost certainly be less severe and shorter than from quitting escitalopram and then starting on duloxetine (or another AD).

[smogie]

Other ones have helped but all to do with circumstances I think I’ve been on a downward spiral since last year had other health stuff going on which was resolved but the anxiety has stayed this time

[panic_down_under]

Other ones have helped

How long were you usually on the ADs which worked?

but all to do with circumstances I think I've been on a downward spiral since last year had other health stuff going on which was resolved but the anxiety has stayed this time

An effective AD should be able to greatly lower anxiety levels. If you're not getting good results within 12 weeks of being on a therapeutic dose then it's time to switch to another med, imho.

[smogie]

Usually a couple of months but like I said usually other factors have also played a part have been on escitalopram 14months and don’t think is doing anything for me so I am wanting to try something else but because I’ve not had this type before I’m worrying about the effects ect

[panic_down_under]

Usually a couple of months

So your anxiety levels would flare up and you'd take an AD daily for a couple of months and then stop until the next time? If so, that isn't the best way of managing anxiety disorders (or depression). Ideally, one should take an AD for about a year the first time, 18 months the second time and arguably permanently thereafter if the disorder reoccurs a third time.

The problem is that there is now good evidence antidepressants, especially the SSRIs, may become progressively less effective every time they are stopped and restarted, often requiring higher doses to achieve the previous level of control, or not working at all. They may also produce more severe, and/or different, initial side-effects. Two studies, Amsterdam JD, 2016 and Amsterdam JD, 2009 a, found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Bosman RC, 2018; Amsterdam JD, 2009 b; Leykin Y, 2007; Paholpak S, 2002).

but like I said usually other factors have also played a part have been on escitalopram 14months and don't think is doing anything for me

Were you on escitalopram before and if so was it effective then?

so I am wanting to try something else but because I've not had this type before I'm worrying about the effects ect

It probably won't be much different than what you experienced with SSRIs.