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Dr. Bob is Robert Hsiung, MD,
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Posted by IsoM on September 27, 2002, at 16:08:33
In reply to Re: What does Aimee say? » IsoM, posted by Anyuser on September 27, 2002, at 14:25:22
One thing stated that's diff from pharmrep's statements is that 20 mg escitalopram (Lexapro) [not 10 mg] is equivalent to 40 mg citalopram (Celexa).
|| from "A single-dose crossover pharmakinetic study comparing racemic citalopram (40 mg) with the S-enantiomer (escitalopram, 20 mg) in healthy male volunteers."
Drews P New Clinical Drug Evaluation Meeting - Phoenix, AZ 2001 May 28-31 ||She lists a few different studies that compare Lexapro's faster onset of action than imipramine, fluoxetine, & venlafaxine but none that compared it to Celexa even though she mentioned that Lexapro was faster than Celexa. That's one reason I wondered about her affiliation. She states Lexapro is faster than Celexa but the studies don't state that - just the other 3 ADs. The idea that it’s faster is inferred from a study predicted from a rat model only.
It also states that escitalopram is 30-fold more potent than the R-isomer (Celexa).
|| Escitalopram oxalate. Anti-depressant 5-HT reuptake inhibitor.
Sorbera LA, Revel L, Martin L, Castaner J
Drugs Future 2001 26 2 112-120 ||To be honest, I found nothing in the article that states that Lexapro is more effective than Celexa in an equivalent dose. (1:2 equivalency rate)
It didn’t compare side effects but only said that with escitalopram, nausea was the most common side effect (15%), somnolence (7%), ejaculation disorder (9%), & anxiety (no percentage given). As the percentage of s/e with Celexa seem to vary somewhat depending on what study or journal one looks at, this may be true for Lexapro too.
Posted by moxy1000 on September 27, 2002, at 16:52:41
In reply to re efficacy and s/e » Anyuser, posted by IsoM on September 27, 2002, at 16:08:33
Dr. Dave,
I have a question regarding the design of most studies done by drug companies to evaluate the efficacy of anti-depressants. Most study designs evaluate moderate-severe patients (as determined by widely used rating scales), diagnosed with major depression. However, the study designs don't include patients with mild depression or patients with comorbidities.
My question is why do you think these types of patients are excluded from most clinical trials?
I've heard conflicting theories. The first is that many believe if an anti-depressant works for moderate or severe depressed patients, it would be logical to assume that it would work for the milder, easier to treat patients as well. Conversely, I've heard that drug companies are "scared" to evaluate mild depression, because they are fearful that placebo would work as well as the active agent, if not better.
I tend to agree with the first statement, because even if placebo worked better then an active agent, the depression could not have been that debilitating to begin with. It would seem that for many patients, several things other then "placebo-affect" would have a positive impact on depression. Simply the desire to want to feel better, and the constant attention given to patients by clinicians involved in studies, would seem like it would help in improving depressive symptoms.
Anyway, just a question that's been rattling around in my brain for awhile, and I thought I'd get your take on it.
Thanks!
Posted by McPac on September 27, 2002, at 18:14:41
In reply to Re: merge psychiatry into Neurology is only hope » Mr. SadPuppyDog, posted by Geezer on September 27, 2002, at 16:07:14
Did you ever consider going to Dr. Amen's clinic (or one similar elsewhere)?
Posted by Geezer on September 27, 2002, at 18:55:59
In reply to Geezer, posted by McPac on September 27, 2002, at 18:14:41
Hi McPac,
Dr. Amen's clinic has been mentioned to me recently but I must confess I don't know much about it. Could you briefly outline the services? I will do a search. Saw a report recently (don't know where) that hi-frequency MRI was inadequate in picking up neuro brain abnormalities as demonstrated by postmortem studies on depressed suicides. Don't know if this relates to Amen's work.
Thanks
Posted by Dr. Bob on September 27, 2002, at 19:06:07
In reply to Re: merge psychiatry into Neurology is only hope » Mr. SadPuppyDog, posted by Geezer on September 27, 2002, at 16:07:14
> Historically, I wish the Neurologists had won the battle with the Psychiatrists at the time the "asylums" were still active...
I'd like discussion the pros and cons of psychiatry and neurology to be redirected to Psycho-Social-Babble, thanks.
Bob
PS: And follow-ups regarding posting policies to be redirected to Psycho-Babble Administration.
Posted by McPac on September 27, 2002, at 21:18:44
In reply to Re: Geezer » McPac, posted by Geezer on September 27, 2002, at 18:55:59
I used to have a link to Dr. Amen's site....go to a bookstore, like Border's or Barnes & Noble, pull up a chair and read, "Change your brain, Change your life" by Daniel Amen. I think you will be pleasantly fascinated with the technology and its use!
Posted by Geezer on September 27, 2002, at 21:39:27
In reply to Geezer, posted by McPac on September 27, 2002, at 21:18:44
Thanks McPac......will do.
Posted by yeltom on September 27, 2002, at 22:18:05
In reply to Lexapro side-effects , posted by dr dave on August 28, 2002, at 3:15:33
But your conclusion is based on the idea that 10 mg. of Lexapro is equivalent to 20 mg. of Celexa, whereas the company claims that it's equivalent to 40 mg. Am I wrong? I am curious, however, why isolating one of the isomers would make it 4 times stronger. I assumed that the two isomers in celexa were present in a ratio of 1:1, in which case you'd assume (assuming that the less active isomer is not active at all) that the isomer would be twice as strong, not 4 times as strong. Unless the non-active component actually INHIBITS the active component. Or perhaps the assumption that they are present in a ratio of 1:1 is wrong.
> It is repeatedly claimed Lexapro has fewer side-effects than Celexa. What does the data show? In the Burke et al trial 85.6% of those on Lexapro 20mg had side-effects compared to 86.4% on Celexa 40mg (not statistically significant). Not impressive, I would suggest. 10.4% of those on Lexapro 20mg discontinued because of side-effects compared to 8.8% of those on Celexa. So in fact more discontinued Lexapro than Celexa. But the result is not statistically significant and therefore likely to be a chance result.
>
> The incidence of discontinuations on Lexapro 10mg a day was 4.2% compared to 2.5% on placebo. Again, not statistically significant. The overall rate of side-effects on Lexapro 10mg was 79.0% compared to 70.5% on placebo (not statistically significant). The comparison between Celexa 20 mg and placebo is not available as this dose was not used.
>
> So the Burke study provides no data to support the claim that Lexapro has fewer side-effects than Celexa.
>
> Gorman gives discontinuation rates for Lexapro in both doses as being 5.9% versus 2.2% for placebo (not statistically significant). No equivalent rate for Celexa is available. No more detail on side-effects is given in this, the most comprehensive analysis of the data currently available. Myself, I ask why not, if this is such a step forward in terms of side-effects.
>
> These results are entirely consistent with the hypothesis that there is no statistically significant difference in side-effects between Lexapro and Celexa, and provide no evidence of the difference that is so widely claimed as being an established fact.
>
> If there is other evidence to fit into this overall picture, this must be considered, but these results seem to suggest very powerfully that there is no significant difference in side-effects.
>
> Decide for yourself on the basis of actual hard facts.
Posted by pharmrep on September 27, 2002, at 23:41:13
In reply to Lexapro side-effects - where's the evidence? » pharmrep, posted by dr. dave on September 27, 2002, at 6:13:23
> Again, the claim has been made that Lexapro has fewer side-effects than Celexa. This has been extensively discussed on this thread and the relevant data have been posted.
>
***** Nobody has ever said r-cit was inert or is where the side effects are...it just isnt contributing towards treating depressive syptoms (as seen in sanchez study). all of the studies show 10mg to have "s/e comparable to placebo" which is definitely less than celexa or any other AD. I'm not sure who you mean when you say "they"...but it's not just forest stating that claim...it's every study done so far...with the backing of the FDA.
>
> They clearly fail to demonstrate any significant difference. Despite repeated calls for any other research data which might back up the claim, none have appeared. So it is puzzling that this claim is again presented as fact.
>
> The repeated statement of unsubstantiated claims leads to confusion. For instance, it has been said that r-citalopram cannot be inert because it is blamed for side-effects from Celexa. While it is true that this is claimed, there is no evidence to show that it is true. Removing r-citalopram does not cause a significant decrease in side-effects. But if the claim is made often enough, people begin to take it as fact and make deductions which stray further and further from what the research actually shows.
>
> If there is now evidence that Lexapro has significantly fewer side-effects than Celexa, It would be very useful to see it.
>
>
> > ** great question. 10mg of Lex is at least as efficacious as 40mg of cx...but with less s/e, less drug to drug interactions, and less discontinuation due to adverse events, and will work as fast as 1-2 weeks for most people. It is linear, however...5mg will not work as fast, and is not the recommended starting dose. In general, for most drugs many doctors reduce dosages to avoid side effects, but since Lexapro at 10mg is "comparable to placebo" it shouldnt be needed. In the Dr's I've seen...I would say 95%+ are starting w/ 10mg...only a few have gone to 20mg (only 2 weeks out now) and maybe a few Dr's are just "set in there ways" and are starting with 5mg (for a week or so...then up to 10mg) So far...I have only heard good responses from them, but most of their patients havent been back for their "monthly" visit...I'll hear more in about 2 weeks or so.
> > PS...the starting dose for celexa was 20mg (62% of patients stayed there)...40mg was at about 30% (for a total of 92% of all Celexa prescriptions...the last 8% were at 60mg or higher.) I think Lexapro at 10mg will be effective for 80%+ of patients...then 15mg+ will make up the last 20%
>
>
Posted by pharmrep on September 27, 2002, at 23:58:41
In reply to Re: Lexapro side-effects/dosage, posted by yeltom on September 27, 2002, at 22:18:05
*** you are right...Dr Dave wont agree with this point...Celexa is a racemic mixture with "mirror" halves..r-cit. and s-cit (50/50 mix) the r-cit does not contribute towards treating depressive symptoms at all (see sanchez study) and actually inhibits the s-cit (lexapro) from its full potential. it wasnt expected at first...but 10mg is at least as efficacious as 40mg of celexa.
But your conclusion is based on the idea that 10 mg. of Lexapro is equivalent to 20 mg. of Celexa, whereas the company claims that it's equivalent to 40 mg. Am I wrong? I am curious, however, why isolating one of the isomers would make it 4 times stronger. I assumed that the two isomers in celexa were present in a ratio of 1:1, in which case you'd assume (assuming that the less active isomer is not active at all) that the isomer would be twice as strong, not 4 times as strong. Unless the non-active component actually INHIBITS the active component. Or perhaps the assumption that they are present in a ratio of 1:1 is wrong.
>
Posted by curiousguy on September 28, 2002, at 0:14:35
In reply to Re: Lexapro side-effects/dosage » yeltom, posted by pharmrep on September 27, 2002, at 23:58:41
I just switched from celexa to lexapro... on celexa, i had some sexual side effects, mainly less desire and ejac.problems... i switched to lexapro recently - is rash (itchiness really) and/or shortness of breath possible side effects? Are there any ingredients in lexapro that could cause this? I never experienced either on celexa... also, does lexapro REALLY help the sexual side effects? How long to be on it before you notoice a difference?
Posted by pharmrep on September 28, 2002, at 0:56:31
In reply to Re: Lexapro side-effects/dosage, posted by curiousguy on September 28, 2002, at 0:14:35
> I just switched from celexa to lexapro... on celexa, i had some sexual side effects, mainly less desire and ejac.problems... i switched to lexapro recently - is rash (itchiness really) and/or shortness of breath possible side effects? Are there any ingredients in lexapro that could cause this? I never experienced either on celexa... also, does lexapro REALLY help the sexual side effects? How long to be on it before you notoice a difference?
>
> *** rash/itch...very low %, not mentionable, might go away with time/ same with shortness of breath. there are no "new ingrediants" in Lexapro. as for sex s/e...it is an ssri, and they are a class effect for all ssri's. It was listed as 9% for ejac delay...but might be higher. for all side effects and efficacy, you might see its true color in 1-2 weeks, but give it 3-4 for a fair trial for yourself. good luck and keep us posted
Posted by McPac on September 28, 2002, at 1:16:53
In reply to Re: Geezer » McPac, posted by Geezer on September 27, 2002, at 21:39:27
This IS the future! And the future is now!
Posted by IsoM on September 28, 2002, at 1:18:54
In reply to Re: Lexapro side-effects/dosage, posted by yeltom on September 27, 2002, at 22:18:05
Yeltom, see my above post in this thread:
http://www.dr-bob.org/babble/20020922/msgs/121268.html
further to your question.
The info comes from the Aug 2002 issue of Current Opinion in Investigational Drugs
Posted by Dinah on September 28, 2002, at 6:57:07
In reply to Re: Lexapro side-effects/dosage, posted by curiousguy on September 28, 2002, at 0:14:35
> i switched to lexapro recently - is rash (itchiness really) and/or shortness of breath possible side effects? Are there any ingredients in lexapro that could cause this? I never experienced either on celexa...
Hi curiousguy,
I would think that you should mention any new side effects like this to your pdoc and discuss with him whether or not you should continue. It may or it may not be related to the med, but you should still probably discuss it with a doctor.
Posted by Dinah on September 28, 2002, at 6:58:21
In reply to Re: Lexapro side-effects/dosage, posted by Dinah on September 28, 2002, at 6:57:07
Posted by Roman on September 28, 2002, at 10:41:53
In reply to Re: Lexapro side-effects/dosage » curiousguy, posted by pharmrep on September 28, 2002, at 0:56:31
> > It was listed as 9% for ejac delay...but might be higher.
For clarification, was that 9% of the males or 9% of all participants?
Posted by moxy1000 on September 28, 2002, at 13:55:25
In reply to Re: Lexapro side-effects/dosage » curiousguy, posted by pharmrep on September 28, 2002, at 0:56:31
the shortness of breath/itchiness that curious guy mentioned sounds a lot like I feel when my allergies are kicking in. Since neither is listed as being commonly reported s/e's, it's possible that these symptoms are totally unrelated. Also, when I feel stress/anxiety, I do feel short of breath also. Anyway, just my two cents.
Posted by sch00lteacher on September 28, 2002, at 14:03:26
In reply to Re: Lexapro side-effects/dosage, posted by moxy1000 on September 28, 2002, at 13:55:25
Dizziness, nausea, the nausea is the worst. If my stomach gets empty I feel close to losing it. I just started the Lexapro a week ago. So I am not used to it yet. I was on Effexor (spelling) for close to six months, maybe more. It just wasn't doing anything anymore.
Posted by Joe U on September 28, 2002, at 14:28:07
In reply to Re: Lexapro side-effects/dosage, posted by Dinah on September 28, 2002, at 6:57:07
I switched from Celexa to Lexapro about 2 weeks ago. I think it's making the Wellburtin ? and Neourtin ? kick in harder. Almost died from the withdrawal of Celexa-- 30Mg. This is the best clinical trial you can have, with real results. Sorry about the spelling, wasn't near the jars.
Posted by johnnylex on September 28, 2002, at 18:13:37
In reply to Anyone switched to Lexapro? « ggrrl, posted by Dr. Bob on June 11, 2002, at 7:52:48
I started on 10mg Lexapro about 2 weeks ago. Prior to this I was taking 150mg of Effexor, which was adequetly relieving my anxiety and depression, but had unwelcome side effects.
I am pleased that I feel no side effects with Lexapro, but I am not feeling much in the way of anxiety/depression relief with it. Is it time to ask my doctor about trying a higher dosage? How long should I give this?
Posted by Mircea on September 28, 2002, at 19:55:56
In reply to The hard, cold facts about Lexapro, posted by ZyprexaNumbTongue on September 6, 2002, at 14:37:39
>
> 4) The studies dont describe the TYPES of depressives in the Lexapro studies.This is not true, you can look at the baseline MADRS CGI and HAMD scores to determine how depressed the population is.
> We need more drug clinical trials where the people recruited are those with SEVERE melancholia type major depression, not dysthymics and moderate depressives.
Gorman did a subanalysis of severe depressives (see Gorman et al., 2002, CNS Spectrums) as part of the Lexapro pooled trial. Also, Gorman did an analysis of severe depressives that was presented at the recent CINP meeting in Montreal.
Posted by pharmrep on September 28, 2002, at 20:00:47
In reply to Re: Lexapro side-effects/dosage » pharmrep, posted by Roman on September 28, 2002, at 10:41:53
> > > It was listed as 9% for ejac delay...but might be higher.
>
> For clarification, was that 9% of the males or 9% of all participants?** good q...i would think just the men...but i will find out (i see how it would be diff)
ultimately it is a class s/e, so dont expect too much.
Posted by pharmrep on September 28, 2002, at 20:04:16
In reply to Re: Lexapro side-effects/dosage, posted by sch00lteacher on September 28, 2002, at 14:03:26
> Dizziness, nausea, the nausea is the worst. If my stomach gets empty I feel close to losing it. I just started the Lexapro a week ago. So I am not used to it yet. I was on Effexor (spelling) for close to six months, maybe more. It just wasn't doing anything anymore.
** you said 1 wk now for lexapro...did you just stop effexor? what dose?...dizziness and nausea can occur from abrupt discontinuation from effexor (and paxil). hopefully you can hang in there...do you see any benefits from lexapro yet?
Posted by pharmrep on September 28, 2002, at 20:06:19
In reply to Re: Lexapro side-effects/dosage, posted by Joe U on September 28, 2002, at 14:28:07
> I switched from Celexa to Lexapro about 2 weeks ago. I think it's making the Wellburtin ? and Neourtin ? kick in harder. Almost died from the withdrawal of Celexa-- 30Mg. This is the best clinical trial you can have, with real results. Sorry about the spelling, wasn't near the jars.
** hang in there...what dose for lexapro? 10mg?..are you noticing less somnolence?
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