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Dr. Bob is Robert Hsiung, MD,
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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)
Posted by corrina on October 3, 2002, at 8:38:33
In reply to Re: lexapro 10mg, posted by shakingoscar on October 3, 2002, at 6:29:08
Thank you all for the advice im gonna try and stick with it and see what happens, I was also put on some sleeping pills and thinking I was getting dizzy from that but now I know its the lexapro. im hoping this works for me cause my depression is very bad and actually I found when I first started this Lexapro my depression was even worse the first couple days but that no longer is the fact, I found that this is making me kinda mellow which is good for me cause im always Ms. Speedy at everything I do and im kinda feeling a little relaxed.
I will keep everyone informed on my progress with this med. And Thank you again for the feedback!Corrina
Posted by pharmrep on October 3, 2002, at 10:35:10
In reply to Re: I TAKE 30MG LEXAPRO - ALSO, posted by shakingoscar on October 3, 2002, at 3:23:53
> 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
**** 4 to 1 ratio? that is wrong...Lex 10mg vs celexa 40mg is a 2 to 1 ratio not 4 to 1 (dont forget to subtract the r-isomer). anyway...forest is not promoting 4 to 1 either...10mg is 40 yes...but 15=60 and 20=80 is not exact...10mg has been fine for many 60mg+ people (not just celexa...all high doses of AD's). if you already got to 30mg fine, then dropping to 20mg over 2 days or so, then 10 should be fine (not associated w/ discontinuation syndrome) keep us posted.
Posted by yeltom on October 3, 2002, at 10:49:02
In reply to Re: 30MG LEXAPRO » shakingoscar, posted by pharmrep on October 3, 2002, at 10:35:10
What do you mean 40 celexa and 10 mg of lexapro isn't a 4 to 1 ratio? I'm not comparing the strength of the isomers. I'm comparing the amount of drugs needed to achieve given antidepressant effect. I guess what you're saying is that the s isomer when given alone is twice as potent as the s isomer when given in combination with the r isomer. Seems like a strange point to focus on. People want to know how much lexapro to take if they're on Celexa, and for that purpose, the key a ratio is 4 to 1 (at least roughly).
> > 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
> **** 4 to 1 ratio? that is wrong...Lex 10mg vs celexa 40mg is a 2 to 1 ratio not 4 to 1 (dont forget to subtract the r-isomer). anyway...forest is not promoting 4 to 1 either...10mg is 40 yes...but 15=60 and 20=80 is not exact...10mg has been fine for many 60mg+ people (not just celexa...all high doses of AD's). if you already got to 30mg fine, then dropping to 20mg over 2 days or so, then 10 should be fine (not associated w/ discontinuation syndrome) keep us posted.
Posted by shakingoscar on October 3, 2002, at 11:26:39
In reply to Re: 30MG LEXAPRO » pharmrep, posted by yeltom on October 3, 2002, at 10:49:02
Yeltom,
I WAS NOT saying anything about the 4:1 ratio. The comment at the end of my post was not mine.ie: I did not write the following:
> **** 4 to 1 ratio? that is wrong...Lex 10mg vs celexa 40mg is a 2 to 1 ratio not 4 to 1 (dont forget to subtract the r-isomer). anyway...forest is not promoting 4 to 1 either...10mg is 40 yes...but 15=60 and 20=80 is not exact...10mg has been fine for many 60mg+ people (not just celexa...all high doses of AD's). if you already got to 30mg fine, then dropping to 20mg over 2 days or so, then 10 should be fine (not associated w/ discontinuation syndrome) keep us posted.
Posted by shakingoscar on October 3, 2002, at 11:34:59
In reply to Re: 30MG LEXAPRO » shakingoscar, posted by pharmrep on October 3, 2002, at 10:35:10
Thanks Pharmrep. Im grateful for your help. I will drop to 20mg for a couple of days and then to 15mg.
I was worried about withdrawal symptoms to drop straight down to 15mg from 30mg.
Its amazing how IN ONE SINGLE DAY dropping from 30mg to 10mg stopped me from feeling ill - but I only dropped to 10mg for today because Ive been on so high a dose...
Cheers
Posted by pharmrep on October 3, 2002, at 11:52:02
In reply to Re: 30MG LEXAPRO » pharmrep, posted by yeltom on October 3, 2002, at 10:49:02
Alright then...if you are looking for a basic ratio, not the scientific or therapeutic rationale, but just simple math...I see where 4-to-1 comes from (ie 10mg Lexapro = 40mg Celexa). But lets be clear, that is not the potentcy or efficacy ratio. See the Sanchez study to learn more about r-cit, s-cit (lexapro), and r-cit + s-cit (celexa) to see how they really work. It isnt such a strange point, because the "ratio" isnt exact...only 10mg lex = 40mg celexa has been studied, in reality, there are many people who were on higher than 40mg of celexa (and equivilant doses of other AD's) that have tried 10mg of Lex and dont need to go to 15mg or more. Dont assume you need more. Doctors have been told that the starting dose is 10mg...if needed, after at least 1 wk...go higher...I would guess that only 20% or less of people will need higher that 10mg (since about 80% of people taking celexa used 40mg or less) Of course time will tell, but jumping to higher doses because of math isnt right...try 10mg...give it a fair trial for a few weeks before determining if you need more...it is twice as potent as celexa or any other AD so this is different than what's been available before. Good luck to all, and keep us posted.
Posted by yeltom on October 3, 2002, at 12:13:46
In reply to Re:lexapro dosage » yeltom, posted by pharmrep on October 3, 2002, at 11:52:02
Can you give me a link to the Sanchez study? Thanks
> Alright then...if you are looking for a basic ratio, not the scientific or therapeutic rationale, but just simple math...I see where 4-to-1 comes from (ie 10mg Lexapro = 40mg Celexa). But lets be clear, that is not the potentcy or efficacy ratio. See the Sanchez study to learn more about r-cit, s-cit (lexapro), and r-cit + s-cit (celexa) to see how they really work. It isnt such a strange point, because the "ratio" isnt exact...only 10mg lex = 40mg celexa has been studied, in reality, there are many people who were on higher than 40mg of celexa (and equivilant doses of other AD's) that have tried 10mg of Lex and dont need to go to 15mg or more. Dont assume you need more. Doctors have been told that the starting dose is 10mg...if needed, after at least 1 wk...go higher...I would guess that only 20% or less of people will need higher that 10mg (since about 80% of people taking celexa used 40mg or less) Of course time will tell, but jumping to higher doses because of math isnt right...try 10mg...give it a fair trial for a few weeks before determining if you need more...it is twice as potent as celexa or any other AD so this is different than what's been available before. Good luck to all, and keep us posted.
Posted by pharmrep on October 3, 2002, at 12:25:17
In reply to Re:lexapro dosage » yeltom, posted by pharmrep on October 3, 2002, at 11:52:02
> Alright then...if you are looking for a basic ratio, not the scientific or therapeutic rationale, but just simple math...I see where 4-to-1 comes from (ie 10mg Lexapro = 40mg Celexa). But lets be clear, that is not the potentcy or efficacy ratio. See the Sanchez study to learn more about r-cit, s-cit (lexapro), and r-cit + s-cit (celexa) to see how they really work. It isnt such a strange point, because the "ratio" isnt exact...only 10mg lex = 40mg celexa has been studied, in reality, there are many people who were on higher than 40mg of celexa (and equivilant doses of other AD's) that have tried 10mg of Lex and dont need to go to 15mg or more. Dont assume you need more. Doctors have been told that the starting dose is 10mg...if needed, after at least 1 wk...go higher...I would guess that only 20% or less of people will need higher that 10mg (since about 80% of people taking celexa used 40mg or less) Of course time will tell, but jumping to higher doses because of math isnt right...try 10mg...give it a fair trial for a few weeks before determining if you need more...it is twice as potent as celexa or any other AD so this is different than what's been available before. Good luck to all, and keep us posted.
**Cant find online...but will try... it is called .."Escitalopram: A comparative study of in vitro and in vivo 5-ht uptake inhibitory activity"...study was presented at the XXIII CINP Congress, June 23-27, 2002 in Montreal, Canada
It was done by A. Mork, M. Kreilgaard, C. Sanchez, L.T. Brennum and O. Wiborg (Dept Neurochemistry and Discovery ADME, Dept. Neuropharmacology and Dept. Molecular Pharmacology, Psychiatric Hospital of Aarhus University, Denmark.
Posted by yeltom on October 3, 2002, at 12:25:52
In reply to Re:lexapro dosage » yeltom, posted by pharmrep on October 3, 2002, at 11:52:02
Do you know of any evidence re: the effectiveness of lexapro for OCD? I have some OCD symptoms, and though Celexa doesn't seem to be the best SSRI for OCD, I've used it because of the relative lack of sexual side effects. I'm wondering if there's any reason to believe Lexapro might be any more effective for OCD than Celexa. Perhaps at higher doses?
Posted by Alice Anne on October 3, 2002, at 12:38:59
In reply to sorry all, posted by pharmrep on October 3, 2002, at 1:38:33
Hello Pharmrep, I've managed a week now at 10 mgs. Lexapro. I started at 2.5 for a week and then went to 5 for a few days. Most of the side effects (queasiness, muscle tension-- although I'm still a little spacey feeling) are dissipating, but my depression is not. My question for you is when do the anti-depressant, anxiety effects "usually" kick in? Thanks for the info.
Posted by Phil on October 3, 2002, at 12:56:20
In reply to Re:lexapro dosage/see bottom » pharmrep, posted by pharmrep on October 3, 2002, at 12:25:17
Does your company offer chemist a huge bonus if they can cure the sexual SE or do they really believe their numbers?
I'm at 15 mg and my unit only does one function..it ain't the fun one. I'll wager at least 50% will run into this. Too bad, pretty good drug otherwise.
Posted by nmk on October 3, 2002, at 13:29:24
In reply to pharmrep, posted by Phil on October 3, 2002, at 12:56:20
This is my 3rd week of 10 mg Lexapro and the nausea has not let up. I am also weaning off Effexor xr (am down to 16 mg) simultaneously so I don't know which is the culprit. If it is the Lex, shouldn't the s/e's have lessened at this point. I don't want to give up so soon on this but I am losing weight fast. Please help.
Posted by kathyj on October 3, 2002, at 13:49:12
In reply to Re: lexapro 10mg, posted by corrina on October 3, 2002, at 8:38:33
This is my first time on anti-depressants. I took 5 mg for 2 days and then went to 10mg which I have been taking for 5 days now. Prior to the Lexapro I was taking sleeping pills. I hoped that the lexapro would eliminate the sleeping pills. I take the dosage at 5pm and I don't get sleepy. I still have to take my sleeping pill. Does lexapro increase insomnia? On a brighter note, I was more depressed the first couple of days but now I feel much less depressed.
Posted by kinikia on October 3, 2002, at 15:15:11
In reply to Re: lexapro 10mg, posted by kathyj on October 3, 2002, at 13:49:12
I'm glad to hear you're feeling less depressed. I started 5mg on Monday and I am totally depressed, but that started on Sunday. I would also be interested to know when I should start to feel better. Don't know if it's the lexapro but I am definitely feeling more anxious. It never really stops. Took some xanax but it doesn't really help so I just have to take more. I used to take half of a .25mg xanax and be fine, now no amount seems to help. I'm getting quite despondent. If anyone has anything positive to say about lexapro or anything, It would definitely be appreciated. Thanks,
- kinikia
> This is my first time on anti-depressants. I took 5 mg for 2 days and then went to 10mg which I have been taking for 5 days now. Prior to the Lexapro I was taking sleeping pills. I hoped that the lexapro would eliminate the sleeping pills. I take the dosage at 5pm and I don't get sleepy. I still have to take my sleeping pill. Does lexapro increase insomnia? On a brighter note, I was more depressed the first couple of days but now I feel much less depressed.
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