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Dr. Bob is Robert Hsiung, MD,
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Posted by dr dave on October 2, 2002, at 12:07:31
In reply to Re: I TAKE 30MG LEXAPRO - ALSO, posted by Cletus2 on October 2, 2002, at 10:31:52
This is really interesting. The '4 to 1' story first emerged from Forest because the Burke study failed to show any difference in efficacy between escitalopram 10mg, escitalopram 20mg and citalopram 40mg. This led to the statement that escitalopram 10mg was at least as effective as citalopram 40mg.
But if escitalopram 10 mg and 20 mg come out the same in this trial, isn't it likely citalopram 20mg and 40mg would as well? There is, it seems, a little added efficacy for 20mg rather than 10mg of escitalopram, which is seen in other studies. This study wasn't sensitive enough to pick it up. There is no reason to think it would have been picked up for citalopram 20mg and 40mg. It's just they didn't collect this data.
No other data supports this '4 to 1' idea. Plenty of data support the much more logical '2 to 1' ratio. Escitalopram is twice as potent as citalopram in several studies. There is no explanation of how this could translate into a 4 to 1 difference in efficacy.
The problem is that if the 2 to 1 ratio is true, which logic and the overwhelming body of evidence points to, it has to be admitted that there is no difference in side-effects. I have received Lundbeck's data on relative side-effects in all comparative studies and I quote '...there were no statistically significant differences for incidences of these events between the escitalopram and citalopram treatment groups.' These data are from 1123 patients treated in trials, and refer to the twelve commonest side-effects. Not one of these was different.
> My doctor told me that he finds the ratio to be 4 to 1 between Celexa and Lexapro.
Posted by Phil on October 2, 2002, at 12:22:35
In reply to I TAKE 30MG LEXAPRO, posted by shakingoscar on October 2, 2002, at 10:04:11
But why are you taking both of them? You can stop the Celexa today and switch to Lex tomorrow.
Maybe I missed something here.
Posted by dr dave on October 2, 2002, at 12:32:21
In reply to Don't know why dr dave didn't address this..., posted by Phil on October 2, 2002, at 12:22:35
> But why are you taking both of them? You can stop the Celexa today and switch to Lex tomorrow.
> Maybe I missed something here.I don't think they are taking both at the same time, are they? You're quite right about just swapping one to the other.
Posted by yeltom on October 2, 2002, at 13:07:26
In reply to Re: I TAKE 30MG LEXAPRO - ALSO, posted by dr dave on October 2, 2002, at 12:07:31
I'm afraid logic doesn't explain everything. If 10 mg of lexapro was found to be equivalent to 40 mg of Celexa (which my and a lot of other people's experience confirms), you need to accept this. Perhaps the inactive isomer affects the absorption or otherwise interferes with the effectiveness of the active isomer. Just because we don't understand the reason does not make it not so. And your comparison is not valid. If 20 mg lexapro is no more effective in the study than 10 mg, that doesnt suggest that 40 mg of celexa would be no more effective than 20 mg. Rather, it suggests (but does not necessarily mean) that 80 mg of Celexa would be no more effective than 40.
Posted by yeltom on October 2, 2002, at 13:21:21
In reply to Re: Don't know why dr dave didn't address this... » Phil, posted by dr dave on October 2, 2002, at 12:32:21
Another thing that does not make sense logically: the idea that the switch from 40 mg of celexa to 10 mg of lexapro would be rocky. But in fact, I totally noticed the change and so have many others. Theoretically, it could be withdrawal from the inactive isomer in Celexa or (under your theory) withdrawal because your moving to a less potent dose, but it's not the withdrawal type of feeling. Rather it's that familiar buzzed feeling of coming on to an antidepressant: heart seeming to beat faster, slightly extra sweating, insomnia, being spaced out. If anything, I would say 10 mg of Lexapro is MORE potent than 40 mg of celexa. In fact, I read a study (funded by Forest) that said 10 mg of lex was "at least" as potent as 40 mg of celex. If you still don't accept this, how do you explain the fact that people who switched from 60 mg of celex to 30 mg. of lex feel totally buzzed out?
Posted by kinikia on October 2, 2002, at 14:33:13
In reply to Re: What is the best time to take, posted by cody on October 1, 2002, at 17:51:56
Cody,
I just started on 5mg Lexapro yesterday too. I'm new here and found the group by searching for lexapro. I was happy to see your post. This is my second try at antidepressants. I had a very tough time on zoloft and now I'm apprehensive about this one too. Since we started the same day maybe we can be lexapro buddies :-)and help each other get through it. It's hard to judge my s/e because I had been feeling pretty bad the last few days. I just feel kind of out of it.> Alaskagirl, thanks for your support. Sometimes I feel like I'm groping in the dark. It's good to hear other's experiences. I started Lexapro at 5mg. this morning. Decided against doing the 2.5mg. Rather get the adjustment over with. So far, so good. Not too many s/e. Mild headache, tightness in chest, some palpatations. Will keep you posted.
>
> Thanks again!
Posted by dr dave on October 2, 2002, at 15:14:56
In reply to Re: I TAKE 30MG LEXAPRO - ALSO » dr dave, posted by yeltom on October 2, 2002, at 13:07:26
No, logic doesn't explain everything but it's pretty useful in trying to sort out complicated issues. I'm sure no-one would advocate deliberately not being logical.
It's difficult to generalise from the individual experience of a relatively few people, which is why scientific trials exist. It's an attempt to answer questions without bias as far as possible. My view is that if research has been done which fails to support a given argument, one should not treat it as proven fact, and I am concerned that this is what is happening. If there were clear evidence for the 4 to 1 argument I would of course accept it, as I accept very many things in psychiatry for which a mechanism is unknown. But the evidence isn't really there.
I'm not sure I really follow your argument about the implications of the results for 10 and 20mg of escitalopram being the same. I compare them with 20 and 40 mg of citalopram because these represent the same amounts of escitalopram, just in the presence of r-citalopram.
80mg of citalopram would be 40mg of escitalopram plus 40mg r-citalopram, and we have no 40mg escitalopram group to compare it to. I'm not sure why one would pick this particular dose to compare with anything.
> I'm afraid logic doesn't explain everything. If 10 mg of lexapro was found to be equivalent to 40 mg of Celexa (which my and a lot of other people's experience confirms), you need to accept this. Perhaps the inactive isomer affects the absorption or otherwise interferes with the effectiveness of the active isomer. Just because we don't understand the reason does not make it not so. And your comparison is not valid. If 20 mg lexapro is no more effective in the study than 10 mg, that doesnt suggest that 40 mg of celexa would be no more effective than 20 mg. Rather, it suggests (but does not necessarily mean) that 80 mg of Celexa would be no more effective than 40.
Posted by cody on October 2, 2002, at 15:46:00
In reply to Re: What is the best time to take, posted by kinikia on October 2, 2002, at 14:33:13
Kinikia,
I'd be happy to be your Lexapro buddie. This is my 2nd try at Lexapro and I really hope it works. So far, I don't feel too bad. A little hyper during the day, but last night around 8 pm I got so sleepy I couldn't keep my eyes open. Still not sure if I'm having withdrawal from the Remeron I was on. What are you taking the Lex for? Depression, anxiety, both? Keep me posted on how your doing.
Posted by yeltom on October 2, 2002, at 15:52:34
In reply to Logic and evidence » yeltom, posted by dr dave on October 2, 2002, at 15:14:56
The study that Forest did and that the FDA oversaw indicated that 10 mg Lexapro was equivalent in antidepressant effect to at least 40 mg. (Are you suggesting that there was no such study and that Forest's claims are fraudulent?) This is why psychiatrists (American ones at least) have been instructed to prescribe at a 1 to 4 ratio. And so far, it seems to be working. It's the patients who've been prescribed at a 1 to 2 ratio that are reporting problems. That's why I'm comparing 10 and 20 mg lex to 40 and 80 celex. I thought it was strange at first as well and certainly did not expect to feel any changes when I switched meds. The hypothesis is that the inactive isomer inhibits the effectiveness of the active one. Have you tried both drugs?
Posted by corrina on October 2, 2002, at 21:46:12
In reply to Logic and evidence » yeltom, posted by dr dave on October 2, 2002, at 15:14:56
Hi all im also new to this board and rather new with depression pills as well, I came to the net trying to get some info on this medicine and found this link! I was put on Lexapro 10mg and started taking it for the first time on sunday, everything was going well untill today and im not sure if its a concern or normal feeling, the dizzyness and feeling like I have to throw up.
should this be a concern I should talk to my doctor about or is this normal? any responce would be very helpful, Thank you
Corrina
Posted by moxy1000 on October 2, 2002, at 23:31:56
In reply to Logic and evidence » yeltom, posted by dr dave on October 2, 2002, at 15:14:56
My understanding of what Dr. Dave is saying is that since Lexapro 10 mg and Celexa 20 mg contain the same amount of the s-isomer, then they would be therapeutically equivalent. But every study done to date shows that Lexapro 10mg is at least as effective as Celexa 40mg, and that is what many people on this board have expressed their experience has been as well.
Just because the s-isomer is proportionally present in both doses, this doesn't make them therapeutically equivalant because that theory does not take into account the presence of the r-isomer in Celexa, which Lexapro dose not possess. The r has been proven to be ineffective in treating depression, but we do not know if it hindered the active agent. (This would probably take a lot of money and time to prove. I don't even know if it's possible to prove scientifically.) No one has clearly proven that it hindered, but many theorize that it must have, since 10mg Lexapro is at least as effective as 40mg Celexa (NOT 20mg) as one would expect.
Posted by pharmrep on October 3, 2002, at 1:36:27
In reply to Re: Logic and evidence, posted by moxy1000 on October 2, 2002, at 23:31:56
> My understanding of what Dr. Dave is saying is that since Lexapro 10 mg and Celexa 20 mg contain the same amount of the s-isomer, then they would be therapeutically equivalent. But every study done to date shows that Lexapro 10mg is at least as effective as Celexa 40mg, and that is what many people on this board have expressed their experience has been as well.
>
> Just because the s-isomer is proportionally present in both doses, this doesn't make them therapeutically equivalant because that theory does not take into account the presence of the r-isomer in Celexa, which Lexapro dose not possess. The r has been proven to be ineffective in treating depression, but we do not know if it hindered the active agent. (This would probably take a lot of money and time to prove. I don't even know if it's possible to prove scientifically.) No one has clearly proven that it hindered, but many theorize that it must have, since 10mg Lexapro is at least as effective as 40mg Celexa (NOT 20mg) as one would expect.
>** hi there...there are studies that show r-cit doesnt work...(sanchez study). the r-cit can attach to receptor sites not allowing the s-cit to attach, therefore inhibiting metabolization.
ps...i dont know where this 4-to-1 ratio thing is coming from...its not forest. Lexapro is twice at potent as celexa (or any other AD). so yes..10mg lexapro is at least as efficacious as 40mg of celexa. does this mean 15mg=60 or 20mg=80? not necessarily...the math seems that way, but patients so far dont always need more...i know of many 80mg celexa pts doing fine on 10mg lexapro, (or higher doses fo prozac, paxil, zoloft, effexor as well)
Posted by pharmrep on October 3, 2002, at 1:38:33
In reply to Re: Logic and evidence, posted by moxy1000 on October 2, 2002, at 23:31:56
sorry been gone for a while...there was a prob with my email address w/ this site...but it's ok now...how is everyone...any good questions or more stories to share?
Posted by pharmrep on October 3, 2002, at 1:46:38
In reply to Re: What is the best time to take, posted by kinikia on October 2, 2002, at 14:33:13
> Cody,
> I just started on 5mg Lexapro yesterday too. I'm new here and found the group by searching for lexapro. I was happy to see your post. This is my second try at antidepressants. I had a very tough time on zoloft and now I'm apprehensive about this one too. Since we started the same day maybe we can be lexapro buddies :-)and help each other get through it. It's hard to judge my s/e because I had been feeling pretty bad the last few days. I just feel kind of out of it.
>
> > Alaskagirl, thanks for your support. Sometimes I feel like I'm groping in the dark. It's good to hear other's experiences. I started Lexapro at 5mg. this morning. Decided against doing the 2.5mg. Rather get the adjustment over with. So far, so good. Not too many s/e. Mild headache, tightness in chest, some palpatations. Will keep you posted.
> >
> > Thanks again!
>
> ********* Celexa seemed to have a "tiring" effect so people took it at night rather that in morning...Lexapro doesnt do that, so take it in the morning, so as not to be as "active" in night. Insomnia occurred is roughly 9% of people in the studies, but that might be you...take in day if you can.
PS the s/e you mentioned...nausea, headache, dizziness...are common in AD's (when taken as a new med)...I am hearing it lasts only 3-4 days, and you feel a lot better at 1 wk...hang in there and keep us posted.
Posted by dr dave on October 3, 2002, at 2:44:58
In reply to Re: Logic and evidence » dr dave, posted by yeltom on October 2, 2002, at 15:52:34
I'm not suggesting there was no such study - that's why I quoted it and discussed the meaning of its results. Nor am I suggesting the study is fraudulent. What I am suggesting is that 'instructing' psychiatrists to treat escitalopram as four times as potent by weight does not bear examination when you look closely at the evidence. If there has been another study apart from the Burke study which indicates this, I would be glad to know of it.
I have used citalopram extensively for many years and it is extremely useful. I am waiting for convincing evidence, or one independent body to review the evidence and state there is a significant difference, before using escitalopram. It is a generally accepted principle (at least with the psychiatrists I know) that you don't start using new drugs unless a case can be made for doing so. I don't think the case has been made. This appears to be the opinion of all four independent bodies that I know of which have reviewed the data.
> The study that Forest did and that the FDA oversaw indicated that 10 mg Lexapro was equivalent in antidepressant effect to at least 40 mg. (Are you suggesting that there was no such study and that Forest's claims are fraudulent?) This is why psychiatrists (American ones at least) have been instructed to prescribe at a 1 to 4 ratio. And so far, it seems to be working. It's the patients who've been prescribed at a 1 to 2 ratio that are reporting problems. That's why I'm comparing 10 and 20 mg lex to 40 and 80 celex. I thought it was strange at first as well and certainly did not expect to feel any changes when I switched meds. The hypothesis is that the inactive isomer inhibits the effectiveness of the active one. Have you tried both drugs?
Posted by dr dave on October 3, 2002, at 2:53:09
In reply to Re: Logic and evidence » moxy1000, posted by pharmrep on October 3, 2002, at 1:36:27
I wonder if you could let us know what the evidence is that r-cit 'can attach to receptor sites not allowing the s-cit to attach, therefore inhibiting metabolization'. The only relevant site with respect to SSRI activity is the serotonin re-uptake transporter, and r-cit has only 1/30th the affinity for it that s-cit has, not enough to significantly compete. I am also not sure why s-cit would have to be bound to a receptor to be metabolised, or what receptor that would be. It sounds like you've seen some important new data, and would be very grateful for details.
> ** hi there...there are studies that show r-cit doesnt work...(sanchez study). the r-cit can attach to receptor sites not allowing the s-cit to attach, therefore inhibiting metabolization.
> ps...i dont know where this 4-to-1 ratio thing is coming from...its not forest. Lexapro is twice at potent as celexa (or any other AD). so yes..10mg lexapro is at least as efficacious as 40mg of celexa. does this mean 15mg=60 or 20mg=80? not necessarily...the math seems that way, but patients so far dont always need more...i know of many 80mg celexa pts doing fine on 10mg lexapro, (or higher doses fo prozac, paxil, zoloft, effexor as well)
Posted by shakingoscar on October 3, 2002, at 3:23:53
In reply to Re: I TAKE 30MG LEXAPRO - ALSO, posted by dr dave on October 2, 2002, at 12:07:31
Hi,
well I have news for you about this matter.I took JUST 10MG this morning instead of the 30MG which has been making me feel really ill. I feel MUCH BETTER...
I dont want to drop from 30 to 15mg in one go, so Im going to move to 20mg as from tomorrow and see how I feel.
But I think I am proof that the 2:1 ratio is not true.
On a couple of occasions, I took a double dose of my 60mg of citalopram (forgot I had taken it, and took it again if you understand). On the two occasions I have made this error, I was really ill both days. Red face, really trembly, jitters, etc etc..
Well, the feeling Ive been getting the last two weeks when taking 30MG lexapro (half my 60mg dose of citalopram) was the same as when I doubled my citalopram dose. I just feel like a fool that I didnt realise earlier that I was on too high a dose of lexapro. I just thought my anxiety had come back!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Well, I will keep you posted on how I get on on 20mg (which if the 4:1 ratio is true), will still be too high and I should move to 15mg... but I want to play it safe.
Cheers
Posted by shakingoscar on October 3, 2002, at 3:25:29
In reply to Don't know why dr dave didn't address this..., posted by Phil on October 2, 2002, at 12:22:35
I AM NOT TAKING BOTH OF THEM!!!!!!!!!!!!!!!!!
I switch directly from 60mg citalopram to 30mg lexapro, then two weeks later started to become really ill.
I thought it was my anxiety returning, but in fact, I am pretty sure now my dose of lexapro was way-to-high.
Cheers
Posted by shakingoscar on October 3, 2002, at 3:29:37
In reply to Re: I TAKE 30MG LEXAPRO - ALSO » dr dave, posted by yeltom on October 2, 2002, at 13:07:26
In my experience DOSE HAS EVERYTHING TO DO WITH IT.
I couldnt quite cope on 40mg citalopram. 60mg citalopram made me feel almost totally well. I tried 80mg citalopram for a month, but I couldnt tolerate the extra amount. When on a couple of occasions I accidentally took my 60mg dose twice in one day (=120mg) I was quite ill.
Since i SWITCHED to lexapro, 30mg has been way to high a dose for me. Im going down to 20mg from tomorrow and leave it there for a while until I know the dose is either too high or right for me.
I have tried all the SSRIs (except Luvox), and citalopram was definitely the best for me.
Im just hoping that on a new lowered dose of lexapro that my sexual side effects will diminish which was the only real problem I had with citalopram.
Cheers
Posted by shakingoscar on October 3, 2002, at 3:32:02
In reply to Re: Don't know why dr dave didn't address this... » dr dave, posted by yeltom on October 2, 2002, at 13:21:21
You are absolutely right.
When I switched from citalopram to lexapro, it was like going on an AD where you're too buzzed up, red faced, sweaty etc... The only problem was for me, that when I went from 60mg citalopram to 30mg lexapro, this "coming-up" was really bad - but I now think that was purely because lexapro is much more potent and 30mg lexapro IS MUCH HIGHER DOSE than 60mg Citalopram
Posted by shakingoscar on October 3, 2002, at 4:02:52
In reply to sorry all, posted by pharmrep on October 3, 2002, at 1:38:33
Hi Pharmrep, we have never spoken, but I have followed many of your conversations on here.
Please see my "I AM TAKING 30MG LEXAPRO" thread if you wouldnt mind, as I would value your views.
Thanks
Oscar
Posted by Phil on October 3, 2002, at 5:17:55
In reply to Re: Don't know why dr dave didn't address this..., posted by shakingoscar on October 3, 2002, at 3:25:29
Oscar, Good. Like I said, I may have misread your post.
Good luck.
Posted by shakingoscar on October 3, 2002, at 5:23:51
In reply to Re: blah blah blah » LostBoyinNC1, posted by pharmrep on September 1, 2002, at 18:39:00
Hi Pharmrep,
I would just like to say that I value your input on this forum as I have found your posts to be useful and informative, and I believe that the reasons for lexapro being a big improvement over celexa may be true.The fact that moving from 60mg citalopram to 30mg of lexapro (and finding the dose way too high) proves to me that lexapro is definitely more potent that citalopram.
Cheers
Posted by Phil on October 3, 2002, at 6:00:35
In reply to Re: blah blah blah, posted by shakingoscar on October 3, 2002, at 5:23:51
Posted by shakingoscar on October 3, 2002, at 6:29:08
In reply to lexapro 10mg, posted by corrina on October 2, 2002, at 21:46:12
Hi Corrina,
my advice to you is that you are likely to suffer some side effects at the start of your course of medication.Try your best to stick with it if it becomes uncomfortable because they do go away.
Dizzyness and sickness are very common, both of which I have suffered myself, but have always gone away after 2-3 weeks (maybe less for lexapro)
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