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

[LisaS]

Thank you so much PDU,

I was half expecting a blip as I've been here before but I'm a bit thrown this one is lasting so long - the flutterings of anxiety are lasting all day, it's exhausting.

I hope its just the AD weirdness and that it passes soon because it's horrible.

[panic_down_under]

I was half expecting a blip as I've been here before but I'm a bit thrown this one is lasting so long - the flutterings of anxiety are lasting all day, it's exhausting.

Talk to you doctor if it becomes too difficult as the heightened anxiety can be minimised. No one is handing out gold stars for white knuckling anxiety. It's counterproductive.

[LisaS]

Talk to you doctor if it becomes too difficult as the heightened anxiety can be minimised. No one is handing out gold stars for white knuckling anxiety. It's counterproductive.

I went to the doctor this evening and she recommended going up to 20mg.
I’m a bit fed up as this means side effects again and I really want some relief.
She doesn’t agree with Benzodiazapines and would rather I took propranolol in the interim.
Feeling miffed again.

[panic_down_under]

She doesn’t agree with Benzodiazapines and would rather I took propranolol in the interim.

I agree with her on the benzodiazepines (BZDs), though probably not for the same reason. The dependency issue is overblown, imho, however, there is strong evidence¹ BZDs block the neurogenesis mechanism by which antidepressants work.

Propranolol is a beta-blocker which prevents adrenaline binding to its receptors. This can prevent the adrenaline surge of the flight-or-flight response which can help cope with anxiety, but doesn't directly diminish the anxiety itself. It is definitely worth a try, but if it isn't effective ask for *hydroxyzine instead. It is a mild prescription antihistamine with pretty good anti anxiety properties. Not quite as potent as the BZDs, but often potent enough.

*Hydroxyzine comes in two forms, hydroxyzine pamoate (Vistaril) and hydroxyzine hydrochloride (Atarax). Anecdotally, the pamoate form is claimed to be the more effective anxiolytic, but just how true this is remains a matter of debate in forums.

References:

[1]
Boldrini M, Butt TH, Santiago AN, et al. (2014)
Benzodiazepines and the potential trophic effect of antidepressants on dentate gyrus cells in mood disorders.
Int J Neuropsychopharmacol. Dec;17(12):1923-33 (Abstract | Full text)

Nochi R, Kaneko J, Okada N, et al. (2013)
Diazepam treatment blocks the elevation of hippocampal activity and the accelerated proliferation of hippocampal neural stem cells after focal cerebral ischemia in mice.
J Neurosci Res. Nov;91(11):1429-39 (Abstract)

Sun Y, Evans J, Russell B, et al (2013)
A benzodiazepine impairs the neurogenic and behavioural effects of fluoxetine in a rodent model of chronic stress.
Neuropharmacology. Sep;72:20-8 (Abstract)

Song J, Zhong C, Bonaguidi MA, et al (2012)
Neuronal circuitry mechanism regulating adult quiescent neural stem-cell fate decision.
Nature. Sep 6;489(7414):150-4 (Article | Study full text)

Chen J, Cai F, Cao J, et al. (2009)
Long-term antiepileptic drug administration during early life inhibits hippocampal neurogenesis in the developing brain.
J Neurosci Res. Oct;87(13):2898-907 (Abstract)

Wu X, Castren E. (2009)
Co-treatment with diazepam prevents the effects of fluoxetine on the proliferation and survival of hippocampal dentate granule cells.
Biol Psychiatry. Jul 1;66(1):5-8 (Abstract)

Stefovska VG, Uckermann O, Czuczwar M, et al (2008)
Sedative and anticonvulsant drugs suppress postnatal neurogenesis
Ann Neurol. 2008 Oct;64(4):434-45 (Abstract)

[LisaS]

So a quick update, it has been a week on 20mg and its been a rocky road as usual. Headaches, dizzyness, dreamy feeling and of course my old friend increased anxiety. Yesterday I had a really good day but today has been weird again! I also heard on another forum that my clock resets every time I go up a dose and that I can expect another 4-6 weeks of side effects, so that has put a bit of a downer on me again.
The story continues....

[panic_down_under]

I also heard on another forum that my clock resets every time I go up a dose and that I can expect another 4-6 weeks of side effects,

It would be unusual for the side-effects after a dose increase to continue for 4-6 weeks. Around 10-14 days is more likely. It takes about 7 days for citalopram plasma levels to settle to a steady-state after an increase (or decrease) after which side-effects typically begin the diminish. However, as with everything about ADs, YMMV.

[LisaS]

It would be unusual for the side-effects after a dose increase to continue for 4-6 weeks. Around 10-14 days is more likely. It takes about 7 days for citalopram plasma levels to settle to a steady-state after an increase (or decrease) after which side-effects typically begin the diminish. However, as with everything about ADs, YMMV.

Thanks again PDU.
I’m on day 12 of the increase and the past few days as well as the feelings of nervousness, I now feel down and have very little motivation to do anything. I feel like I could just lay in bed all day staring out the window (I don’t).

I know I seem impatient but I seem to be getting worse not better. It’s been 5 weeks on 10mg and 4 on 15mg... I have 2 assignments due and prac to attend next week. Any words or advice would be appreciated...

[Geller]

I had the very same reaction with Lexepro but my doctor gave me a very low dose of Pregabilin 50mg twice a day and now no more anxiety......

[LisaS]

I had the very same reaction with Lexepro but my doctor gave me a very low dose of Pregabilin 50mg twice a day and now no more anxiety......

It took a long time or the side effects?

Do you take the Pregabalin alongside the Lexapro or instead of?