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Dr. Bob is Robert Hsiung, MD,
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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.
Posted by mills on October 3, 2002, at 15:49:53
In reply to Anyone switched to Lexapro? « ggrrl, posted by Dr. Bob on June 11, 2002, at 7:52:48
So far (one month) on Lexapro, and I am disappointed, but it wasn't until literally after the sixth full week on Paxil that I started feeling less depressed/disoriented (demenitia-like symptoms [anyone else ever experience that? god, i hope so for my sake, hope not for yours)] ocd/panicky/generally angst ridden/socially anxious (let's see, did I cover them all? yep); Paxil saved my life; it was hell getting on, and hell getting off, but while on it, it literally gave me hope to live, especially with the thick-headed/demenitia/inability to focus-concentrate symptoms; the sexual side effects, however, were so bad that I had to try to get off and find something else; I got on Luvox for awhile, until Lexapro came on the market; I was on 10 mg for a week, and was chronically depressed, so, went up to 20, and have been at 20 for 3 more weeks; so far, i've got a chronic medium grade depression, with the other things still hanging on, including the weird thick-headed sense, or like a distortion in my perception (see, that's one of my problems, not being able to identify/articulate what's wrong); oh well, this is my story, and I'm sticking to it; anyone relate? should I hang with Lexapro or go back to Paxil?
Posted by yeltom on October 3, 2002, at 16:16:57
In reply to Paxil to Lexapro--Let's see, salvation or sex??, posted by mills on October 3, 2002, at 15:49:53
Giving it only a week at 10 mg doesn't seem like a fair trial. And then to bump up all the way to 20 mg, without trying 15 mg first, seems unwise. 20 mg is a very large dose for Lexapro, and I would suspect your problem is side effects from too large a dose too fast, as opposed to the drug being ineffective. I would have done 2 weeks at 10 mg followed by 2 weeks at 15 mg. before I even CONSIDERED going to 20 mg
> So far (one month) on Lexapro, and I am disappointed, but it wasn't until literally after the sixth full week on Paxil that I started feeling less depressed/disoriented (demenitia-like symptoms [anyone else ever experience that? god, i hope so for my sake, hope not for yours)] ocd/panicky/generally angst ridden/socially anxious (let's see, did I cover them all? yep); Paxil saved my life; it was hell getting on, and hell getting off, but while on it, it literally gave me hope to live, especially with the thick-headed/demenitia/inability to focus-concentrate symptoms; the sexual side effects, however, were so bad that I had to try to get off and find something else; I got on Luvox for awhile, until Lexapro came on the market; I was on 10 mg for a week, and was chronically depressed, so, went up to 20, and have been at 20 for 3 more weeks; so far, i've got a chronic medium grade depression, with the other things still hanging on, including the weird thick-headed sense, or like a distortion in my perception (see, that's one of my problems, not being able to identify/articulate what's wrong); oh well, this is my story, and I'm sticking to it; anyone relate? should I hang with Lexapro or go back to Paxil?
Posted by kathyj on October 3, 2002, at 16:40:34
In reply to Re: lexapro 10mg, posted by kinikia on October 3, 2002, at 15:15:11
Kinikia, Don't give in to the depression. I know how you feel. Try to focus on positive things. I know it is easier said than done. Give the lexapro a chance. You've only been on it less than a week. I'm told it could take 4-6 weeks before you get relief. I don't know if you are a religious person, but prayer is conforting to me when I get really depressed.
Posted by kathyj on October 3, 2002, at 16:46:20
In reply to Paxil to Lexapro--Let's see, salvation or sex??, posted by mills on October 3, 2002, at 15:49:53
> So far (one month) on Lexapro, and I am disappointed, but it wasn't until literally after the sixth full week on Paxil that I started feeling less depressed/disoriented (demenitia-like symptoms [anyone else ever experience that? god, i hope so for my sake, hope not for yours)] ocd/panicky/generally angst ridden/socially anxious (let's see, did I cover them all? yep); Paxil saved my life; it was hell getting on, and hell getting off, but while on it, it literally gave me hope to live, especially with the thick-headed/demenitia/inability to focus-concentrate symptoms; the sexual side effects, however, were so bad that I had to try to get off and find something else; I got on Luvox for awhile, until Lexapro came on the market; I was on 10 mg for a week, and was chronically depressed, so, went up to 20, and have been at 20 for 3 more weeks; so far, i've got a chronic medium grade depression, with the other things still hanging on, including the weird thick-headed sense, or like a distortion in my perception (see, that's one of my problems, not being able to identify/articulate what's wrong); oh well, this is my story, and I'm sticking to it; anyone relate? should I hang with Lexapro or go back to Paxil?
I can truly relate to the disoriented feelings. However I say give lexapro the same time you gave paxil. I haven't had any sexual s/e> What are you experiencing?
Posted by maririp on October 3, 2002, at 17:03:17
In reply to lexapro 10mg, posted by corrina on October 2, 2002, at 21:46:12
corina Im new here too...I have been on lexapro almost two weeks..the first few days i was fuzzy headed...nauseated..no appetite..and woke up feelin more depressed...by day 4 i was feeling better...now i feel wonderful..dose is 10 mg for me..My biggest concern will be sexual disfunctions..the reason I don't like most antidepressants.
Posted by mills on October 3, 2002, at 17:06:25
In reply to Re: Paxil to Lexapro--Let's see, salvation or sex??, posted by kathyj on October 3, 2002, at 16:46:20
Well, it was mainly under Paxil that I had the horrendous sexual side effects, and the question was more like 'what are you NOT experiencing?' There was just very little feeling in critical areas, if you catch my drift, although the desire and the libido were tolerable to decent. With Lexapro I have had some reduction in sensation, but not nearly as bad as Paxil yet. Even if it's just like Paxil, however, I've just got to have the relief that Paxil gave me, so I guess I do need to give Lex a little more time. It's just all this talk about it supposedly taking only 1-2 weeks for some is discouraging to me when it has been 4 weeks to date. Thanks for responding.
> > So far (one month) on Lexapro, and I am disappointed, but it wasn't until literally after the sixth full week on Paxil that I started feeling less depressed/disoriented (demenitia-like symptoms [anyone else ever experience that? god, i hope so for my sake, hope not for yours)] ocd/panicky/generally angst ridden/socially anxious (let's see, did I cover them all? yep); Paxil saved my life; it was hell getting on, and hell getting off, but while on it, it literally gave me hope to live, especially with the thick-headed/demenitia/inability to focus-concentrate symptoms; the sexual side effects, however, were so bad that I had to try to get off and find something else; I got on Luvox for awhile, until Lexapro came on the market; I was on 10 mg for a week, and was chronically depressed, so, went up to 20, and have been at 20 for 3 more weeks; so far, i've got a chronic medium grade depression, with the other things still hanging on, including the weird thick-headed sense, or like a distortion in my perception (see, that's one of my problems, not being able to identify/articulate what's wrong); oh well, this is my story, and I'm sticking to it; anyone relate? should I hang with Lexapro or go back to Paxil?
>
> I can truly relate to the disoriented feelings. However I say give lexapro the same time you gave paxil. I haven't had any sexual s/e> What are you experiencing?
Posted by yeltom on October 3, 2002, at 18:03:58
In reply to Re: Paxil to Lexapro--Let's see, salvation or sex??, posted by mills on October 3, 2002, at 17:06:25
I still say try a lower dose. You never gave 10 mg much chance or 15 mg any chance. It is possible to take too much
Posted by JLM on October 3, 2002, at 18:10:48
In reply to Re: Logic and evidence » pharmrep, posted by dr dave on October 3, 2002, at 2:53:09
>
> 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)
>
>
I'd like to see this evidence as well.The silence seems deafening thou, doesn't it? ;)
Posted by cody on October 3, 2002, at 18:15:21
In reply to Re: lexapro 10mg, posted by kinikia on October 3, 2002, at 15:15:11
> 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.
>
>
I know what you mean about the anxiety. This is my third day. First two were fine (think I still had some Remeron in my system). Had a really hard time sleeping last night. This morning I woke up really wired. Been taking ativan all day. It seems to help some, but I can really tell when it's wearing off. Is Lexapro supposed to help anxiety (my main problem)? I really don't want to be popping ativan all day. Has the Lex helped anyone with anxiety problems? Please let me know.
Posted by yeltom on October 3, 2002, at 19:46:53
In reply to Paxil to Lexapro--Let's see, salvation or sex??, posted by mills on October 3, 2002, at 15:49:53
Have you read the ealier part of this thread dealing with shakingoscar's post, "I take 30 mg of Lexapro." It appears that his doctor didn't know what s/he was doing and had prescribed too much. He tried 10 mg and felt a million times better. Take a look
> So far (one month) on Lexapro, and I am disappointed, but it wasn't until literally after the sixth full week on Paxil that I started feeling less depressed/disoriented (demenitia-like symptoms [anyone else ever experience that? god, i hope so for my sake, hope not for yours)] ocd/panicky/generally angst ridden/socially anxious (let's see, did I cover them all? yep); Paxil saved my life; it was hell getting on, and hell getting off, but while on it, it literally gave me hope to live, especially with the thick-headed/demenitia/inability to focus-concentrate symptoms; the sexual side effects, however, were so bad that I had to try to get off and find something else; I got on Luvox for awhile, until Lexapro came on the market; I was on 10 mg for a week, and was chronically depressed, so, went up to 20, and have been at 20 for 3 more weeks; so far, i've got a chronic medium grade depression, with the other things still hanging on, including the weird thick-headed sense, or like a distortion in my perception (see, that's one of my problems, not being able to identify/articulate what's wrong); oh well, this is my story, and I'm sticking to it; anyone relate? should I hang with Lexapro or go back to Paxil?
Posted by corrina on October 3, 2002, at 20:33:05
In reply to Re: lexapro 10mg, posted by cody on October 3, 2002, at 18:15:21
this is Day 4 on the lexapro and I have to say I was still a little dizzy today but my feeling sick to my stomach has halted and Dont feel as dizzy as yesterday, I also notice that im doing things a bit slower then I use to, if this is the way im gonna be feeling without the dizziness Im really gonna like these meds, it has me more relaxed and not rush, rush like I am use to doing.
Corrina
Posted by samenewme on October 3, 2002, at 21:56:35
In reply to Re: about insomnia side effect » pharmrep, posted by .tabi.T.ha. on August 3, 2002, at 3:28:08
I just saw this. I'm on 30 mg. Remeron and 20 mg. Celexa. Yes, I'm one of the special people who are wakeful on as little as 30 mg. Remeron. Ambien doesn't work for me.
I take 3 mg of melatonin at night for sleep and it helps a bit. Sometimes I have to stack it with Sonata.
I used to take 1000 mg L-Tryptophan for sleep when I was on nortriptylene, but because I'm on an SSRI now we're avoiding it. Your doctor may be willing to discuss this with you (it's still available by prescription from compounding pharmacies).
> Hi pharmrep,
>
> Saw the note about Phil's combo, can't resist asking a question. For me Celexa is activating and causes insomnia. I take 10mg in the morning, and can't sleep at all unless I take something sedating at night. For now the sedating med is neurontin, but even with that I'm awake til 3am. Do you know of any better way to deal with the insomnia side effect from celexa?
>
> Also, how does lexapro compare on insomnia? Sorry if you've answered this elsewhere, I didn't read the entire thread.
>
> -Tabitha
Posted by pharmrep on October 3, 2002, at 23:46:53
In reply to Pharmrep: A Week On Lexapro..., posted by Alice Anne on October 3, 2002, at 12:38:59
> 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.
** 1-2 wks is the response time for most, but that time starts with the 10mg...so you have 1 wk it sounds like...even then, a fair trial would be 1 month. hang in there and keep us posted.
Posted by pharmrep on October 3, 2002, at 23:51:46
In reply to pharmrep, posted by Phil on October 3, 2002, at 12:56:20
> 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.** sorry bro...it is a class effect...it seems paxil is the worst, then prozac/zoloft/celexa in descending order...I dont think 9% is accurate since it is derived from "volunteered" info...i dont think 50% is right either...even paxil is around 35%...Lex will probably be somewhere in the teens.
Posted by pharmrep on October 4, 2002, at 0:00:03
In reply to Re: pharmrep: Three weeks on Lexapro, posted by nmk on October 3, 2002, at 13:29:24
> 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.
** with 2 AD's in your system...I'm not surprised. Is this your idea or you Dr's? There would still be a serotonergic effect in your body with the addition of Lexapro so as to lessen the effexor discontinuation effects. Can you stop the Effexor completely now?..you will do much better on just Lexapro.
Posted by pharmrep on October 4, 2002, at 0:02:08
In reply to Re: lexapro 10mg, posted by kathyj on October 3, 2002, at 13:49:12
> 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.
* glad to hear its working...i would suggest taking it in the morning so as to avoid the possibility of insomnia (occurred at 9% in studies)
Posted by pharmrep on October 4, 2002, at 0:07:30
In reply to Paxil to Lexapro--Let's see, salvation or sex??, posted by mills on October 3, 2002, at 15:49:53
> So far (one month) on Lexapro, and I am disappointed, but it wasn't until literally after the sixth full week on Paxil that I started feeling less depressed/disoriented (demenitia-like symptoms [anyone else ever experience that? god, i hope so for my sake, hope not for yours)] ocd/panicky/generally angst ridden/socially anxious (let's see, did I cover them all? yep); Paxil saved my life; it was hell getting on, and hell getting off, but while on it, it literally gave me hope to live, especially with the thick-headed/demenitia/inability to focus-concentrate symptoms; the sexual side effects, however, were so bad that I had to try to get off and find something else; I got on Luvox for awhile, until Lexapro came on the market; I was on 10 mg for a week, and was chronically depressed, so, went up to 20, and have been at 20 for 3 more weeks; so far, i've got a chronic medium grade depression, with the other things still hanging on, including the weird thick-headed sense, or like a distortion in my perception (see, that's one of my problems, not being able to identify/articulate what's wrong); oh well, this is my story, and I'm sticking to it; anyone relate? should I hang with Lexapro or go back to Paxil?
** of course im biased, but i would still stay on lexapro...fewer s/e, less sexual s/e, no drug to drug interactions w/ lex...many with paxil, lower protein binding w/ lexapro, and lexapro isnt associated with the discontinuation problems you mentioned you had with paxil. (lex costs less too) there are other benefits...but these are the obvious ones.
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