![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 268 to 292 of 8406. Go back in thread:
Posted by moxy1000 on September 2, 2002, at 15:23:11
In reply to Re: Cheap, Generic Celexa, posted by oracle on September 2, 2002, at 4:01:17
Seems to be a lot of people saying that "lexapro is half of Celexa." Okay...that's true, I guess. But that seems to be over simplifying things a bit.
Let's look at science.
Celexa is a racimic compound that contains the s and r enantiomers in equal proportion (50:50). These means essentially that they are stereoisomers.
There are many stereoisomers in nature - look for instance at carvone - s-carvone it is responsible for the taste and smell of caraway, while r-carvone is responsible for the taste and smell of spearmint.
Not really the same thing at all, is it?
Another example, both lemons and oranges contain a compound called limonene - however Lemons have the enantiomer s-limonene, while oranges have the enantiomer r-limonene. As a result, lemons smell and taste sour, while oranges smell and taste sweet.
Just because isomers are mirror images of eachother, does not mean they are the same thing at all. Science proves that.
In the case of Lexapro, the reason it is more potent comes down to receptor sites in the body.
Ready for more science? Receptor sites are very selective - the correct key is required for binding. However, they are not 100% selective. Similar molecules, or similar "keys" may be able to fit into or bind with the same receptor. The binding may be only partial, but it may be enough to keep another receptor binder from latching on.
This is the case with Celexa. The r-enantiomer was not a perfect fit for blocking the reuptake of serotonin. It fit "partially" with the cells. The s-enantiomer IS a perfect fit, but the presence of the r-enantiomer actually interfered with the ability of the s-enantiomer to increase serotonin levels in the brain.
I have tried to stay away from getting into isomer science, as I found it initially difficult to understand and I didn't want to bore anyone with the specifics, but this discussion seems to warrant a bit more depth in discussion regarding the science behind this isomer called Lexapro.
The point is, like caraway and spearmint, like oranges and lemons, Celexa and Lexapro are not the same. They act totally differently at the receptor sites - one is a perfect fit, and the other is not. The result is Lexapro being over 100 times (or in other words, 100%) more potent then the r-enantiomer in the inhibition of serotonin reuptake.
Do the math. Does logic tell you that one should work more efficiently then the other??
P.S. Dr. Dave, I'm not a scientist or a doctor, but I have done my homework, and contrary to your assumption, I do understand the pharmacodynamics.
Posted by JaneB on September 2, 2002, at 15:24:11
In reply to Re: Lexapro study effects » JaneB, posted by pharmrep on September 2, 2002, at 14:41:51
> > Why don't the study results indicate any positive conclusions about fewer ASE's or daytime sleepiness?
> > Appreciate your info.
> > JaneB
>
> ** Why do you think they dont? There are studies that show reduced s/e with Lexapro...here is a post from a couple days ago that has the FDA approved package insert info.
> Re: Lexapro side-effects » dr dave
> If you have any questions...I'd be glad to help if I can.Pharmrep,
What about antidepressant induced sexual dysfunction? I saw the results you posted. Am I missing something or has this issue not been evaluated with Lexapro? What if 40 mg Celexa causes cycling and 20 mg is used. Can/should 10 mg Lexapro be cut in half to avoid this risk? I know package inserts don't cover these intricate side effects. Just wondered if you have inside information.
JaneB
Posted by winger on September 2, 2002, at 15:46:12
In reply to Re: Lexapro study effects, posted by JaneB on September 2, 2002, at 15:24:11
I missed out.. what is cycling??
> > > Why don't the study results indicate any positive conclusions about fewer ASE's or daytime sleepiness?
> > > Appreciate your info.
> > > JaneB
> >
> > ** Why do you think they dont? There are studies that show reduced s/e with Lexapro...here is a post from a couple days ago that has the FDA approved package insert info.
> > Re: Lexapro side-effects » dr dave
> > If you have any questions...I'd be glad to help if I can.
>
> Pharmrep,
>
> What about antidepressant induced sexual dysfunction? I saw the results you posted. Am I missing something or has this issue not been evaluated with Lexapro? What if 40 mg Celexa causes cycling and 20 mg is used. Can/should 10 mg Lexapro be cut in half to avoid this risk? I know package inserts don't cover these intricate side effects. Just wondered if you have inside information.
> JaneB
>
>
>
Posted by JaneB on September 2, 2002, at 16:22:34
In reply to Re: Lexapro study effects, posted by winger on September 2, 2002, at 15:46:12
You didn't miss out. After being on antidepressants for 5+ years with an unsure diagnosis my pdoc suggested cyclothymia. After research on cyclothymia I discovered and he confirmed that cy. is classified under bipolar2 and can be aggravated by antidepressants which are not stabilized with a mood stabilizer. Someone else could probably explain it better. But I have learned to stay on a low dose of antidepressants to avoid "cycling" which for me is feeling great one day and depressed the next. Hope this helps. I didn't mean to put a glitch in the discussion re. Lexapro. I take Klonopin with an AD to counteract any cycling. If Lexapro would necessitate more Klonopin (.5mg/day now) I won't switch.
JaneB
Posted by pharmrep on September 2, 2002, at 17:15:57
In reply to Re: Lexapro study effects, posted by JaneB on September 2, 2002, at 15:24:11
> > > Why don't the study results indicate any positive conclusions about fewer ASE's or daytime sleepiness?
> > > Appreciate your info.
> > > JaneB
> >
> > ** Why do you think they dont? There are studies that show reduced s/e with Lexapro...here is a post from a couple days ago that has the FDA approved package insert info.
> > Re: Lexapro side-effects » dr dave
> > If you have any questions...I'd be glad to help if I can.
>
> Pharmrep,
>
> What about antidepressant induced sexual dysfunction? I saw the results you posted. Am I missing something or has this issue not been evaluated with Lexapro? What if 40 mg Celexa causes cycling and 20 mg is used. Can/should 10 mg Lexapro be cut in half to avoid this risk? I know package inserts don't cover these intricate side effects. Just wondered if you have inside information.
> JaneB
>
> **good news and bad. As far as cycling...I cant help you there...as far as sex. s/e...here's the scoop...5+ years ago, when Celexa was coming out the sex. s/e was at 6%. Back then (pre Viagra era and others) people were not very willing to mention sexual disfunction (embarrassed?) Anyway, we know that 6% was low...it was more like high-teens, or low 20's (Paxil and others had same problem and are believed to be 30%+.) Since Lexapro study was done in last year, we are hoping for a more "believeable" number since todays responders are more "aware" of the sexual s/e topic, and are more willing to bring it up. Anyway, the Lexapro number is 9%...it is believed to be slightly lower than Celexa, due to its increased Serotonin selectivity (there seems to be a connection to the more selective, the less the sex. s/e.) Ultimately, any AD working with serotonin will affect sex s/e. It's just a question of how much.
PS...the only mg's are 10mg and 20mg (but they are scored...the idea is so you can use 15mg...but of course some people do respond differently and maybe 5mg is good for some, however it has not been tested...10mg is the "normal" starting and maintenance dose. (And this is all in the P.I...read up if you can find it.)
Posted by pharmrep on September 2, 2002, at 17:28:16
In reply to Re: Lexapro effects » JaneB, posted by pharmrep on September 2, 2002, at 17:15:57
Cycling or "poop-out" takes a long time to evaluate. You are right about being on higher mg's to be affected...I have heard that. So if you are on 80+mg of Celexa (after titrating up from 20-40-60 over time) then you might get poop-out eventually...but not necessarily. If you have been on the same mg of something for a long time (low or high mg) then cycling should be less likely to occur. It is not an exact science, so nobody is sure on how or why it happens. Some people have taken prozac for 15 years, no probs...others needed to titrate up 10mg every few years or so, and now take 100+mg of prozac...anyway, you see the picture...hope this helps.
Posted by JaneB on September 2, 2002, at 18:17:30
In reply to Re: poop-out, posted by pharmrep on September 2, 2002, at 17:28:16
> Cycling or "poop-out" takes a long time to evaluate. You are right about being on higher mg's to be affected...I have heard that. So if you are on 80+mg of Celexa (after titrating up from 20-40-60 over time) then you might get poop-out eventually...but not necessarily. If you have been on the same mg of something for a long time (low or high mg) then cycling should be less likely to occur. It is not an exact science, so nobody is sure on how or why it happens. Some people have taken prozac for 15 years, no probs...others needed to titrate up 10mg every few years or so, and now take 100+mg of prozac...anyway, you see the picture...hope this helps.
"Cycling" and "poop out" are not the same at all. If an AD prescribed for depression "poops out" there are no good days. Just old depression and a dr. will up the dosage as you say. However, if there is "cycling" it is a spectrum of bipolar illness and can be induced by AD's. "Cycling" in this sense means highs and lows. Therefore, physicians should not prescribe antidepressants without being aware and following up a patient to watch for and educate patient about potential cycling caused by AD's. I think that some people who see all the ads of people laughing and feeling great may end up asking for an AD and subsequently find themselves worse off because of this potential for cycling and ignorance of the need for a mood stabilizer. (IMO). But you are not a patient or physician and have probably never found it necessary to research something of this nature. If I am wrong I welcome correction re. definition of "cycling", etc.
You are right--"poop out" takes a long time to evaluate. But "cycling" can happen right away with introduction of AD's and increased dosage for someone with bipolar tendencies. That is why I would change to Lexapro cautiously because it seems that I would be receiving more of the active antidepressant. Does this make sense?
Thanks,
JaneB
Posted by Mr.Scott on September 2, 2002, at 20:34:11
In reply to Re: alternatives » Geezer, posted by pharmrep on September 2, 2002, at 12:03:50
I think it's time for a new board that address politics..
Posted by Patson on September 2, 2002, at 20:46:28
In reply to Re: Raines et al, posted by dr dave on September 1, 2002, at 8:23:59
I have to admit I'm a little confused. Maybe I don't understand english all that well....
The investigators observed continued improvement in subjects with further reductions in the MADRS and CGI-S scores. ****The incidence of adverse events declined during escitalopram treatment versus short-term treatment. ****There were no clinically significant mean changes in vital signs, electrocardiogram (ECG), or laboratory values observed during continued escitalopram treatment, regardless of previous treatment. Researchers observed no new clinically significant adverse events in patients switching from citalopram to escitalopram treatment.
"In patients switched from citalopram to escitalopram, there are no safety concerns, and depressive symptoms continue to improve." the researchers concluded.
Hardly sounds like a negative...
> You can find a report by going to http://www.docguide.com and searching for 'escitalopram'. There is a news report dated 08/29/02 on the switching study. If there were any difference between citalopram and escitalopram the side-effects would have decreased and this would have been a major finding. It is noticeable by its absence.
>
>
> > "Indeed new research presented this week (Raines et al) looking at people switching from citalopram to escitalopram did not show any significant reduction in side-effects."
> >
> > That sounds important. Got a link? Or, can you copy and post?
> >
>
>
Posted by Patson on September 2, 2002, at 20:46:32
In reply to Re: Raines et al, posted by dr dave on September 1, 2002, at 8:23:59
I have to admit I'm a little confused. Maybe I don't understand english all that well....
The investigators observed continued improvement in subjects with further reductions in the MADRS and CGI-S scores. ****The incidence of adverse events declined during escitalopram treatment versus short-term treatment. ****There were no clinically significant mean changes in vital signs, electrocardiogram (ECG), or laboratory values observed during continued escitalopram treatment, regardless of previous treatment. Researchers observed no new clinically significant adverse events in patients switching from citalopram to escitalopram treatment.
"In patients switched from citalopram to escitalopram, there are no safety concerns, and depressive symptoms continue to improve." the researchers concluded.
Hardly sounds like a negative...
> You can find a report by going to http://www.docguide.com and searching for 'escitalopram'. There is a news report dated 08/29/02 on the switching study. If there were any difference between citalopram and escitalopram the side-effects would have decreased and this would have been a major finding. It is noticeable by its absence.
>
>
> > "Indeed new research presented this week (Raines et al) looking at people switching from citalopram to escitalopram did not show any significant reduction in side-effects."
> >
> > That sounds important. Got a link? Or, can you copy and post?
> >
>
>
Posted by Patson on September 2, 2002, at 20:47:01
In reply to Re: Raines et al, posted by dr dave on September 1, 2002, at 8:23:59
I have to admit I'm a little confused. Maybe I don't understand english all that well....
The investigators observed continued improvement in subjects with further reductions in the MADRS and CGI-S scores. ****The incidence of adverse events declined during escitalopram treatment versus short-term treatment. ****There were no clinically significant mean changes in vital signs, electrocardiogram (ECG), or laboratory values observed during continued escitalopram treatment, regardless of previous treatment. Researchers observed no new clinically significant adverse events in patients switching from citalopram to escitalopram treatment.
"In patients switched from citalopram to escitalopram, there are no safety concerns, and depressive symptoms continue to improve." the researchers concluded.
Hardly sounds like a negative...
> You can find a report by going to http://www.docguide.com and searching for 'escitalopram'. There is a news report dated 08/29/02 on the switching study. If there were any difference between citalopram and escitalopram the side-effects would have decreased and this would have been a major finding. It is noticeable by its absence.
>
>
> > "Indeed new research presented this week (Raines et al) looking at people switching from citalopram to escitalopram did not show any significant reduction in side-effects."
> >
> > That sounds important. Got a link? Or, can you copy and post?
> >
>
>
Posted by Seamus2 on September 2, 2002, at 22:02:26
In reply to Psycho babble for politics, posted by Mr.Scott on September 2, 2002, at 20:34:11
>
> I think it's time for a new board that address politics..
>
>Amen! "Psycho-Quibblers"
Seamus
Posted by Ritch on September 2, 2002, at 22:20:21
In reply to Psycho babble for politics, posted by Mr.Scott on September 2, 2002, at 20:34:11
>
> I think it's time for a new board that address politics..
>
>Scott,
This discussion definitely brings up POLICY issues for sure. I was certain this was going to wind up being political (socio-politico-economics of psych medication) when I saw a beatup pickup driving through town with a bumper sticker that said "HAVE YOU TAKEN YOUR LAZY PILLS TODAY?".
Mitch
Posted by pharmrep on September 3, 2002, at 0:24:59
In reply to Re: poop-out=cycling. No » pharmrep, posted by JaneB on September 2, 2002, at 18:17:30
Thanks for your clarification...can you have poop-out with or without cycling...or cycling with or without poop-out...I only ask because youre right..I dont know 1st hand and have only gotten this info from some of my Dr's...I heard the terms intermingled, but may be mistaken. Thanks
Posted by pharmrep on September 3, 2002, at 0:58:11
In reply to Re: Raines et al, posted by Patson on September 2, 2002, at 20:47:01
> I have to admit I'm a little confused. Maybe I don't understand english all that well....
>
> The investigators observed continued improvement in subjects with further reductions in the MADRS and CGI-S scores. ****The incidence of adverse events declined during escitalopram treatment versus short-term treatment. ****There were no clinically significant mean changes in vital signs, electrocardiogram (ECG), or laboratory values observed during continued escitalopram treatment, regardless of previous treatment. Researchers observed no new clinically significant adverse events in patients switching from citalopram to escitalopram treatment.
>
> "In patients switched from citalopram to escitalopram, there are no safety concerns, and depressive symptoms continue to improve." the researchers concluded.
>
> Hardly sounds like a negative...
> > You can find a report by going to http://www.docguide.com and searching for 'escitalopram'. There is a news report dated 08/29/02 on the switching study. If there were any difference between citalopram and escitalopram the side-effects would have decreased and this would have been a major finding. It is noticeable by its absence.
> >
> >
> > > "Indeed new research presented this week (Raines et al) looking at people switching from citalopram to escitalopram did not show any significant reduction in side-effects."
> > >
> > > That sounds important. Got a link? Or, can you copy and post?
> > >
> >
************** I run into the same problems with Dr. Dave too, he always seems to reach a different conclusion than what the study finds.
Posted by WINGER on September 3, 2002, at 1:49:04
In reply to Re: Lexapro effects » JaneB, posted by pharmrep on September 2, 2002, at 17:15:57
Does this mean that lexapro will be easier on the body and the liver especially??
None of the doctors I know want to talk about what all of these do taken together to your organs that process them... they all poo poo it and act like you're crazy for worrying about it..
It's like we're all one big long term experiment!!
> > > > Why don't the study results indicate any positive conclusions about fewer ASE's or daytime sleepiness?
> > > > Appreciate your info.
> > > > JaneB
> > >
> > > ** Why do you think they dont? There are studies that show reduced s/e with Lexapro...here is a post from a couple days ago that has the FDA approved package insert info.
> > > Re: Lexapro side-effects » dr dave
> > > If you have any questions...I'd be glad to help if I can.
> >
> > Pharmrep,
> >
> > What about antidepressant induced sexual dysfunction? I saw the results you posted. Am I missing something or has this issue not been evaluated with Lexapro? What if 40 mg Celexa causes cycling and 20 mg is used. Can/should 10 mg Lexapro be cut in half to avoid this risk? I know package inserts don't cover these intricate side effects. Just wondered if you have inside information.
> > JaneB
> >
> > **good news and bad. As far as cycling...I cant help you there...as far as sex. s/e...here's the scoop...5+ years ago, when Celexa was coming out the sex. s/e was at 6%. Back then (pre Viagra era and others) people were not very willing to mention sexual disfunction (embarrassed?) Anyway, we know that 6% was low...it was more like high-teens, or low 20's (Paxil and others had same problem and are believed to be 30%+.) Since Lexapro study was done in last year, we are hoping for a more "believeable" number since todays responders are more "aware" of the sexual s/e topic, and are more willing to bring it up. Anyway, the Lexapro number is 9%...it is believed to be slightly lower than Celexa, due to its increased Serotonin selectivity (there seems to be a connection to the more selective, the less the sex. s/e.) Ultimately, any AD working with serotonin will affect sex s/e. It's just a question of how much.
> PS...the only mg's are 10mg and 20mg (but they are scored...the idea is so you can use 15mg...but of course some people do respond differently and maybe 5mg is good for some, however it has not been tested...10mg is the "normal" starting and maintenance dose. (And this is all in the P.I...read up if you can find it.)
Posted by dr. dave on September 3, 2002, at 5:41:52
In reply to Re: Raines et al/see bottom » Patson, posted by pharmrep on September 3, 2002, at 0:58:11
Let me explain again. I haven't seen evidence to support the claim that escitalopram has fewer side-effects than citalopram. I have presented all the data that are available on relative side-effects in a previous post, and they don't support this claim.
People are now claiming that Raines et al shows escitalopram has fewer side-effects than citalopram. I am not sure how you can come to this conclusion when there was no comparison made. If there is anything in the study that does say it has fewer side-effects than citalopram, I haven't seen it.
All the studies available show no significant difference in side effects between escitalopram and citalopram. If Raines et al does give evidence to contradict this I would be glad if someone could say what that evidence is. Escitalopram having a low level of side-effects is great but unless you know what level of side-effects citalopram would give under the same conditions, you don't know if there's any difference.
It is not enough to read a diffusely enthusiastic tone in a paper and then take this to mean every claim made about the drug must therefore be true. Things can only be taken to be true if there is evidence that they are true. To show that there is a difference in side-effects between escitalopram and citalopram, present the evidence.
> > I have to admit I'm a little confused. Maybe I don't understand english all that well....
> >
> > The investigators observed continued improvement in subjects with further reductions in the MADRS and CGI-S scores. ****The incidence of adverse events declined during escitalopram treatment versus short-term treatment. ****There were no clinically significant mean changes in vital signs, electrocardiogram (ECG), or laboratory values observed during continued escitalopram treatment, regardless of previous treatment. Researchers observed no new clinically significant adverse events in patients switching from citalopram to escitalopram treatment.
> >
> > "In patients switched from citalopram to escitalopram, there are no safety concerns, and depressive symptoms continue to improve." the researchers concluded.
> >
> > Hardly sounds like a negative...
> > > You can find a report by going to http://www.docguide.com and searching for 'escitalopram'. There is a news report dated 08/29/02 on the switching study. If there were any difference between citalopram and escitalopram the side-effects would have decreased and this would have been a major finding. It is noticeable by its absence.
> > >
> > >
> > > > "Indeed new research presented this week (Raines et al) looking at people switching from citalopram to escitalopram did not show any significant reduction in side-effects."
> > > >
> > > > That sounds important. Got a link? Or, can you copy and post?
> > > >
> > >
> ************** I run into the same problems with Dr. Dave too, he always seems to reach a different conclusion than what the study finds.
Posted by Bill L on September 3, 2002, at 9:48:28
In reply to Fewer s/e with Lexapro - where's the evidence? » pharmrep, posted by dr. dave on September 3, 2002, at 5:41:52
The way I see it, a switch from Celexa to Lexapro would be prudent. Celexa has a drug in it (the R-enantiomer) which apparently has NO antidepressant activity. In fact, it may be harmful in terms of making the active ingredient less effecive. And also it might cause side effects. Why would anyone want to take the R-enantiomer? Why put a drug in your body that is not helpfull and that might be harmfull?
Posted by johnj on September 3, 2002, at 11:23:30
In reply to Re: poop-out, posted by pharmrep on September 2, 2002, at 17:28:16
I have never taken an ssri and need to switch. What do you mean when you say sexual side effects? Lack of desire?, feeling?, etc. Also, would it be desirable to titrate up very slowly with lexapro to decrease the chance of initial anxiety? I have heard it can be a problem at the start and I want an AD with anxiety relieving properties. Anybody feel spacey on Celexa? Remeron made me a space cadet. Thank you
johnj
Posted by dr. dave on September 4, 2002, at 4:45:50
In reply to Sexual/anxiety SE question for everyone/pharmrep, posted by johnj on September 3, 2002, at 11:23:30
There are initial reports from people taking Lexapro at
Posted by johnj on September 4, 2002, at 8:27:02
In reply to Reports from people taking Lexapro, posted by dr. dave on September 4, 2002, at 4:45:50
How could they have used Lexapro if it isn't out in the US? One used it a few days at most and said it didn't work? I thought a trial of weeks was needed? Are these for real? Something sounds fishy
Posted by dr. dave on September 4, 2002, at 9:26:23
In reply to Re: Reports from people taking Lexapro » dr. dave, posted by johnj on September 4, 2002, at 8:27:02
It doesn't make a hell of a lot of sense does it? And if you do get side-effects in the first week and no benefit, that means pretty much nothing because the side-effects are likely to go and it hasn't had time to properly kick in yet.
I suppose there's nothing to stop anyone posting anything they like on these boards - maybe every other SSRI manufacturer is posting that they've tried Lexapro and it's awful. You never know what tricks these guys are up to.
> How could they have used Lexapro if it isn't out in the US? One used it a few days at most and said it didn't work? I thought a trial of weeks was needed? Are these for real? Something sounds fishy
Posted by johnj on September 4, 2002, at 11:37:50
In reply to Re: Reports from people taking Lexapro » johnj, posted by dr. dave on September 4, 2002, at 9:26:23
I didn't think about any dirty play from other drug companies. The only thing that bothers me is when I look at a lot of ssri's I see poop out happening(or so it appears) to everyone over time. Why start something if it will just poop out? I would like to change to a new AD since my nortryptline makes my sleep and mood worse when I work out. And I need to excercise to help myself. It might take a few days, but over the last few years all mood and sleep disturbance has occurred when I have tried to work out. My doc doesn't quite buy it, but I have found other people with similiar experience on nortryptline and amitryptline. It is almost like the AD causes depression??? I know it sounds funny, but that is the way it feels sometimes. I have not heard of anybody feeling this way on Celexa or any other ssri's so that is why I am considering Lexapro. I tried remeron, but too powerful, and caused a sponge head feeling. Thanks for your input on ssri poop out if you have had experiences with that.
Johnj
Posted by Ritch on September 4, 2002, at 13:21:06
In reply to Re: Reports from people taking Lexapro » dr. dave, posted by johnj on September 4, 2002, at 11:37:50
> I didn't think about any dirty play from other drug companies. The only thing that bothers me is when I look at a lot of ssri's I see poop out happening(or so it appears) to everyone over time. Why start something if it will just poop out? I would like to change to a new AD since my nortryptline makes my sleep and mood worse when I work out. And I need to excercise to help myself. It might take a few days, but over the last few years all mood and sleep disturbance has occurred when I have tried to work out. My doc doesn't quite buy it, but I have found other people with similiar experience on nortryptline and amitryptline. It is almost like the AD causes depression??? I know it sounds funny, but that is the way it feels sometimes. I have not heard of anybody feeling this way on Celexa or any other ssri's so that is why I am considering Lexapro. I tried remeron, but too powerful, and caused a sponge head feeling. Thanks for your input on ssri poop out if you have had experiences with that.
> Johnj
John,Just an aside here, but I found that nortriptyline and Celexa or nortriptyline and Zoloft work well *together*. The tricyclic didn't do much good by itself, and SSRI by itself doesn't work for me. You might try a lower dose of NT combined with an SSRI.
Mitch
Posted by dr dave on September 4, 2002, at 13:41:42
In reply to Re: Reports from people taking Lexapro » dr. dave, posted by johnj on September 4, 2002, at 11:37:50
I haven't really found that people on SSRIs are more likely to relapse than people on other antidepressants. I do find that people can feel better on an antidepressant for a while and then relapse - which doesn't necessarily mean the drug has stopped working.
Antidepressants can successfully elevate an individuals mood, but it can be the case that the factors that have led to that depressive state in the first place can continue and overwhelm what effect the drug has had. I don't think people's mood state can be permanently elevated by a drug such that other influences cannot have an effect. If someone's life is chronically difficult, be that because of external problems or because of unhelpful ways of thinking or reacting to circumstances, this can lead to depression. Antidepressants can alter the balance of positive and negative influences on that persons mood, but if the difficulties continue they can reverse that shift. If your life has felt devoid of pleasure for six months, that exerts a certain downward pressure on your mood. If your life has felt devoid of pleasure for six years, that is going to depress your mood more strongly. In this situation the pressures that are chronically exerting a negative influence on your mood need to be identified and sorted out, as any medication may be fighting an unwinnable battle.
> I didn't think about any dirty play from other drug companies. The only thing that bothers me is when I look at a lot of ssri's I see poop out happening(or so it appears) to everyone over time. Why start something if it will just poop out? I would like to change to a new AD since my nortryptline makes my sleep and mood worse when I work out. And I need to excercise to help myself. It might take a few days, but over the last few years all mood and sleep disturbance has occurred when I have tried to work out. My doc doesn't quite buy it, but I have found other people with similiar experience on nortryptline and amitryptline. It is almost like the AD causes depression??? I know it sounds funny, but that is the way it feels sometimes. I have not heard of anybody feeling this way on Celexa or any other ssri's so that is why I am considering Lexapro. I tried remeron, but too powerful, and caused a sponge head feeling. Thanks for your input on ssri poop out if you have had experiences with that.
> Johnj
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