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Dr. Bob is Robert Hsiung, MD,
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Posted by pharmrep on October 9, 2002, at 21:46:46
In reply to Re: lexapro and blood pressure, posted by ANXIETY ANN on October 9, 2002, at 21:28:47
> does anyone know if lexapro affects blood pressure? i recently started taking meds for high blood pressure and then 2 wks later started taking lexapro. my blood pressure is still high but my doc says give the bp med time to work. thanks for the help
>
**** what bp med? I know that Lexapro has a very clean p450 system (where meds metabolize in the liver) does your med metabolize in the liver?
As far as bp being high...a new med in your body can do that til you adjust....my other product I carry is tiazac...a calcium channel blocker, I might be able to help you with info if you like.
Posted by Alan on October 9, 2002, at 21:53:18
In reply to Re: marijuana..tough one » Satori, posted by pharmrep on October 9, 2002, at 17:18:02
> Q:
> It seems to me (from this bulletin board and several others)that the preferred option of people suffering from anxiety for a long period seems to be to either take Xanax or another benzo daily, or on an as needed basis. Why is it then that most doctors seem to recommend ADs as the first (and many times only) choice for anxiety? It can't just be marketing by the pharmaceutical companies can it?
>
>
> A:
> Well, it isn't JUST marketing. The makers also performed unprecedented numbers of clinical trials (mostly outside the US) in order to get a handful that were complimentary. They couldn't afford to be satisfied with the first overwhelmingly negative results, as there was too much money already invested. So they persevered and persevered, gradually learning how to design studies with more favorable outcomes. They also changed some data and hid other studies away in company vaults where they weren't "found" until a decade later, and then only under court order.
>
> But yes, antidepressants do seem, according to the little independent research that exists, to be useful against anxiety in maybe 30-50% of cases. Still, it's no coincidence that most manufacturers don't provide data on SSRIs in anxiety that would allow actual percentage calculations to be made. They just say their med was so-and-so % much better than placebo.
>
> Meanwhile, benzodiazapines have proven for 40+ years to be at least 75% - 85% effective by conservative estimates with little side effect comparatively speaking. Plus they are usually added to take with an AD in the end anyway since AD's are most often overstimulating or do not provide adequate releif of symptoms as the anxiolytics do.
>
> You have to understand that the FDA has incestually high employment overlap, among its movers and shakers, with the industries that it regulates. In the pharmaceutical arena, it is common for someone who pushes through an approval at the FDA to then go work for the company that developed the approved product. The financial temptations are nearly irresistible.
>
> There's a rule of thumb in law enforcement that the more highly educated a person is, the more gullible he becomes. You get more Ph.D.s falling for street scams than people whose daily life is closer to the street. Doctors are no exception. They seldom imagine that a drug company would lie and cheat about the information shown to doctors, or that so many of the articles written about SSRIs have been ghost-written by pharmaceutical company hacks who then paid an "independent" MD to put his name on it, or that the respected MD who writes or speaks about a medication neglects to mention that he is earning not only some but the majority of his income from the drug company that makes the medication. They are amazed and outraged when individual cases get exposed, but they don't get it that this is business as usual in the pharmaceutical industry today.
>
>
> Pharmrep:
>
> Besides the "what's your source" company line, any comments? If you dispute it, what are YOUR sources?
>
============================================I guess that pharmrep is choosing not to answer some very important questions about AD's vis-a-vis their use in treatment of symptoms for anxiety disorders.
One would think that a pharmecutical representative would be more than willing to answer these fundamental questions for a very large population of us anxiety sufferers that tried ssri's for many years only to end up on the basic anxiolytic anyway - the lowly benzodiazapine. Or had to augment an ssri with a bzd in the end ....
Is that because there are really no legitimate medical answers as to why AD's are presently being promoted as the first line of treatment for the disorder - and not on equal footing with the Benzodiazapines???
Why is all of the evidence that the most effective and safe anxiolytic known to medicine - the bzd - brushed aside by the promoting of new AD's in their place rather than along side with the benzodiazapine to give the doctor and patient alike the freedom to choose? Otherwise, isn't freedom being taken away?
Would it have anything to do with putting profit before medicine to regain R & D and marketshare?
Not meant as just rhetorical questions. Sincerely and honestly wondering...
Alan
Posted by ANXIETY ANN on October 9, 2002, at 21:56:49
In reply to Re: lexapro and blood pressure » ANXIETY ANN, posted by pharmrep on October 9, 2002, at 21:46:46
parm rep thanks for responding to my question so fast. i am taking norvasc 5mg per day. also,when i take lexapro in AM i am like a zombie all day. but can't sleep at night. do you think i should take it PM and see if that helps. 4days at least my headache and stomach upset is not as bad. thanks for you input
Posted by BarbaraCat on October 9, 2002, at 22:11:04
In reply to Anxiety, depression, indecision, posted by Micki on October 9, 2002, at 21:13:21
Deciding between two loves is HUGE, can affect your entire life, and if you weren't doing major agonizing over it I would suspect SSRI-induced apathy. Our lives are crazed and our 'pathological reactions' are probably appropriate responses to a world gone mad. BTW, be glad you have two loves to choose between vs. none at all! ;o)
>I am currently in a state of extreme stress and anxiety over a situation in my love life--choosing which of two people to get involvoed with. I think about it constantly, think I've made a decision, then change my mind the next hour or day.
Posted by johnj on October 9, 2002, at 22:13:39
In reply to Re: Weird question for anyone concerning lexapro » johnj, posted by Satori on October 9, 2002, at 17:16:23
Hi,
I guess if I could talk to your boyfriend I would tell him how I stubbornly waited to get help because I thought it made me weak and it was embarrassing. However, as soon as I had a panic attack followed by depression I was glad to lay it all out to a doctor. The suffering that could be saved by coming clean is well worth it, although I don't know his total situation. The cool thing is my girlfriend and now wife was there for me and accepted it, I was the one that did and sometimes still does feel like I am weak for going on meds. If your boyfriend does excercise tell him to continue and make sure he eats right and stays away from caffeine. Caffeine is a no no for me. Hope this helps and he recovers soon. Take care
johnj
Posted by emmalie on October 9, 2002, at 22:15:12
In reply to Forest, posted by Mr.Scott on October 9, 2002, at 21:10:12
I have been taking 20 mg of Celexa (10 in the morning, 10 in the afternoon) for about a month. My psychiatrist just switched me to Lexapro. What is the equivalent dose of Lexapro to 20 mg of Celexa? I've heard 10 mg from some sources, and in 5 mg from others. Please advise!
Posted by emmalie on October 9, 2002, at 22:20:39
In reply to Re: Weird question for anyone concerning lexapro » Satori, posted by johnj on October 9, 2002, at 22:13:39
I have been taking 20 mg of Celexa (10 in the morning, 10 in the afternoon) for about a month. My psychiatrist just switched me to Lexapro. What is the equivalent dose of Lexapro to 20 mg of Celexa? I've heard 10 mg from some sources, and in 5 mg from others. Please advise!
Posted by pharmrep on October 9, 2002, at 22:22:18
In reply to Re: AD's vs. Bzds for Anxiety disorders » pharmrep, posted by Alan on October 9, 2002, at 21:53:18
> > Pharmrep:
> >
> > Besides the "what's your source" company line, any comments? If you dispute it, what are YOUR sources?
************** what i say is not "company" oriented...just from me. I give a "source" to lend credibility...so as not to be just my opinion. (after all, i did openly identify myself as pharmrep)
> ============================================
>
> I guess that pharmrep is choosing not to answer some very important questions about AD's vis-a-vis their use in treatment of symptoms for anxiety disorders.
>
> One would think that a pharmecutical representative would be more than willing to answer these fundamental questions for a very large population of us anxiety sufferers that tried ssri's for many years only to end up on the basic anxiolytic anyway - the lowly benzodiazapine. Or had to augment an ssri with a bzd in the end ....
>
> Is that because there are really no legitimate medical answers as to why AD's are presently being promoted as the first line of treatment for the disorder - and not on equal footing with the Benzodiazapines???
>
> Why is all of the evidence that the most effective and safe anxiolytic known to medicine - the bzd - brushed aside by the promoting of new AD's in their place rather than along side with the benzodiazapine to give the doctor and patient alike the freedom to choose? Otherwise, isn't freedom being taken away?
>
> Would it have anything to do with putting profit before medicine to regain R & D and marketshare?
>
> Not meant as just rhetorical questions. Sincerely and honestly wondering...
>
> Alan
>*** come on alan..if the pharm industry wanted to make money in bzds vs ad's it probably could...it just chooses to focus on ad's because there is more to work with, and more people to aim for...and i believe a proven track record for effectiveness...and why are you attacking me about it? I am here to help not hurt..so be civil
Posted by johnj on October 9, 2002, at 22:24:26
In reply to Anxiety, depression, indecision, posted by Micki on October 9, 2002, at 21:13:21
Hi Micki
I am also on pamelor(nortryptline) and my pdoc has given me lexapro and told me to take it and get stable on it before lowering my dose of pamelor. I have been on it for 10 years and the s/e are terrible, dry mouth, constipation, urinary retention, etc. What dose of pamelor are you on? Talk to your doc about how to switch the dose since 12 years is a long time! I also take a benzo, and have thought about monotherapy too. It is a tough decision and my pdoc says no. My pdoc didn't want me to lower the pamelor before the lexapro was working AND if it proves to be right for me. If it is not for me I would not have any AD in my system. You could be having some withdrawl symptoms from your lowrering of pamelor. I believe the dose should be lowered over a 2 to 4 week period. Please check all this out. Also, maybe the lack of decision making is just that....maybe you are not sure and that would definately give me some anxiety, which would be normal. take care
johnj
Posted by ANXIETY ANN on October 9, 2002, at 22:26:18
In reply to Re: Weird question for anyone concerning lexapro » Satori, posted by johnj on October 9, 2002, at 22:13:39
johnj-i think your attitude about meds is great. i also suffer from severe anxiety and panic attacks. i take xanax fot the attacks and adivan for anxiety. just started taking lexapro because docs want me off of bzs.do you take any BZs? how long have you been on lexapro and has it helped the anxiety? panic attacks ?
thanks for your input
Posted by pharmrep on October 9, 2002, at 22:27:22
In reply to Re: Forest, posted by emmalie on October 9, 2002, at 22:15:12
> I have been taking 20 mg of Celexa (10 in the morning, 10 in the afternoon) for about a month. My psychiatrist just switched me to Lexapro. What is the equivalent dose of Lexapro to 20 mg of Celexa? I've heard 10 mg from some sources, and in 5 mg from others. Please advise!
*** 10mg is the starting dose for lexapro. if you had side effects beyond comfortableness w/ celexa...then try 5mg of lexapro for a week, then go to 10mg.
Posted by johnj on October 9, 2002, at 22:36:23
In reply to Re: AD's vs. Bzds for Anxiety disorders » pharmrep, posted by Alan on October 9, 2002, at 21:53:18
HI Alan,
I guess benzo's are best for people with only anxiety disorders, but what about those of us with both? I can feel my benzo helps(tranzene) with anxiety, but it doesn't help with the depression. Sometimes it makes it worse or makes me stupid at times. I am on a TCA, benzo, lithium combo. If I could get on an ssri that would allow me to work out(my TCA screws me up after working out) I would gladly switch. But, I don't think I will ever go off my benzo completely. The guy who mangaes to make a great benzo med that helps with depression would make a fortune. Maybe lexapro will help me with both better than my current TCA. Even if it allowed me to get off the lithium I would be grateful.
Posted by shakingoscar on October 10, 2002, at 1:07:33
In reply to Re: I AM GOING BACK » shakingoscar, posted by pharmrep on October 9, 2002, at 16:26:09
Hi pharmrep,
I was having a bad day yesterday.. Im up and down at the moment like a yo-yo.But I took 15mg lex this morning and dont feel too bad..
Ive decided to give it another week.
No insult intended, but as far as I am concerned, switching to Lex just for sex s/e is VERY WORTHWHILE!!! heheheh
I think I am still adjusting to having dropped from 30mg to 15mg and experience with all the other ssri's does show me that it can take a couple of weeks to adjust to change. I was feeling so miserable yesterday though...
I'll stick with it.
Thanks for your post, much appreciated.
Posted by shakingoscar on October 10, 2002, at 1:12:15
In reply to Re: Weird question for anyone concerning lexapro, posted by Satori on October 9, 2002, at 16:45:06
I too have been a regular pot smoker for years now, and since having depression and anxiety, for the last 2 years, Ive had to really cut down my smoking habits (used to smoke pot daily).
I find that if I smoke pot continually for a few weeks I become very depressed and anxious and it take another few weeks of not smoking pot to recover (about 3 weeks to recover).
Now I only smoke very occasionally to de-stress, but for me, it does have a bad effect on my illness.
Apparently it is because cannabis is associated with lowering of serotonin which is precisely what you dont want when you are depressed!!
Good luck, but my advice is stay away from the pot and give it a few weeks to recover.
Pot can take quite a while to be elimated from your system....
Posted by jane d on October 10, 2002, at 1:13:06
In reply to Re: there is no Lexapro-Toprol interaction /bottom » jane d, posted by pharmrep on October 8, 2002, at 0:43:06
You know I actually re-downloaded the prescribing information from the Lexapro site to see if it had been changed and you were looking at a different version. You aren't. So i'll try to show you what I saw there that you apparently didn't see.
The prescribing information is from: http://www.lexapro.com/home/default.asp under prescribing information.
PHARMREP SAID:
>>Did you read the Package Insert? it states "coadministration of lexapro and metoprol had no clinically significant effects on blood pressure or heart rate." Under the "drug interactions" section...10+ "common" meds are mentioned to show that they were specifically looked at...and none of them had "interactions." So what are you referring too?Sorry Pharmrep. We seem to have some misunderstandings here but I'll try to explain. I'm talking here about the drug interactons section that starts on page 4. One thing I found interesting is that metoprolol was NOT listed alongside that list of drugs that are not supposed to interact significantly (and it actually doesn't always say that if you read closely). They are lumped together and then you get a paragraph explaining that there is some 2D6 inhibition and saying "caution is indicated in coadministration of escitalopram(lexapro) and drugs metabolized by CYP2D6".
(By the way, if you don't really understand the CYP 450 enzyme system this is a great place to ask. There are a lot of posters here who are great at explaining that kind of thing. I'm not one of them unfortunately.)
The drugs metabolized by CYP2D6 include Toprol and, in fact, Toprol now gets it's own section. It does indeed say that there was a study where giving Toprol and Lexapro at the same time did not increase the patients heart rate or blood pressure. But it also says that this raises the level of Toprol found in the blood. And that increased levels of Toprol may effect how the Toprol works. The one thing it does NOT say is that there is NO interaction. It makes me a little nervous that you are taking a position that your own employer was unwilling to (or perhaps not legally permitted) to take.
By the way, the post by JLM also describes a possible interaction of a totally different kind (and a quick check of medline will get you more of the same). Remember the CYP 450 system is only one possible source of interactions.
Please don't take this as an attack on Lexapro or a statement that no one can combine the drugs at all. If I were facing this choice myself I might decide that I cared about the study on heart rate more than the one on blood levels - although I'd want to see the study, how many people were involved, and think about what other drugs I was taking before making that decision. I don't have a problem with you pointing out both facts or even with you giving an explanation for why you would give one more weight than the other. That's not the same as providing only half the facts or saying "there is no interaction" which doesn't help anyone make their own decision.
Jane
PS. Does anyone have an opinion on whether metoprolol should be counted as a CNS drug. I doesn't seem to be listed as one but it seems to me that it should be.
Posted by shakingoscar on October 10, 2002, at 1:18:54
In reply to Forest, posted by Mr.Scott on October 9, 2002, at 21:10:12
Mr Scott,
may I ask what business it is of yours?pharmrep,
I appreciate your presence here, please stay.Cheers
Posted by jane d on October 10, 2002, at 1:19:23
In reply to me » Ippopo, posted by pharmrep on October 8, 2002, at 1:41:13
Pharmrep,
How long have you worked for Forest? Did you start with the Lexapro push? And did you work in the industry before that? I have noticed that you have learned quite a bit since you started posting here.
Jane
> *** I am a pharmaceutical rep for Forest (makers of Celexa and Lexapro). I found this site about 2-3 months ago...
Posted by Ippopo on October 10, 2002, at 1:26:33
In reply to Re: I AM GOING BACK, posted by shakingoscar on October 10, 2002, at 1:07:33
I Knew there was someone on a higher dose of Lexapro but couldn't remember who. I was just about to shut down when...
Anyway, after crying at the Doc's office today because I thought I'd feel more improvement after three weeks and after he told me to up the dossage to 20mgs, he said I should just quick taking medication /go into the hospital/see someone else.
I took 10mg during an early dinner. I'm going to take 20mg with breakfast. After 7hrs of the 10mg I feel no s/e. Is it still going to take a few days to feel anything if it does infact prove to be the proper dossage?
Posted by viridis on October 10, 2002, at 1:33:45
In reply to Re: AD's vs. Bzds for Anxiety disorders » Alan, posted by johnj on October 9, 2002, at 22:36:23
For me, Klonopin (a bzd) greatly reduced depression. I'm sure the causes of depression vary among individuals, but in my case the pattern was typically a period of severe anxiety, followed by a crash into intense depression (often very agitated depression). By stopping the anxiety, it seems that Klonopin (and occasional Xanax) prevent the episodes that precipitate serious depression for me. I did continue to experience some mild depression after starting K, but nothing like before. A low dose of Adderall cleared this up, and has also helped my attention and focus.
By the way, I had a terrible time with the SSRIs I tried, and also Wellbutrin, even at tiny doses -- wild mood swings, agitation, multiple other side effects etc. But I know people who do extremely well on SSRIs and other ADs for depression and anxiety. It just goes to show how differently individuals respond to various meds. The variation in response strongly supports the idea that there are many biological causes of depression and anxiety -- it doesn't all revolve around serotonin, as many doctors still seem to think.
Posted by shakingoscar on October 10, 2002, at 2:38:44
In reply to Re: I AM GOING BACK, posted by Ippopo on October 10, 2002, at 1:26:33
Hi lppopo
Im sorry you are suffering too... I am feeling better today, but as Ive been up and down for the last couple of weeks, I dont have any answers for you.
My situation is different. My supid doctor over-prescribed my dose and STARTED me on 30mg which I took for 4 weeks and became really ill because of.
8 days ago I lowered my dose to 15mg in light of the information I received here. I am still up and down but I think maybe the general direction is improvement...
The only advice I can offer you, from having tried all of the SSRIs, is that patience usually pays dividends, so give it a good shot.
When I first became ill (really severe anxiety) it took me 3 months to settle down on Paxil!!! But the wait was definitely worth it in the end.
Stick with it.
Good luck
Posted by maririp on October 10, 2002, at 7:31:03
In reply to Forest, posted by Mr.Scott on October 9, 2002, at 21:10:12
> Pharmrep,
>
> Does Forest know how much time you spend on this website talking "directly to patients"? I wonder what the legal ramifications are. Hmmm...I'll have to get in touch with some of my med-reg/DDMAC friends who will know.
>LOL!!!! at mr scott...are you bothered by pharmrep? I think its a good thing that he is interested in the how people are reacting to the meds he represents..and after all its a free country :-)
Posted by maririp on October 10, 2002, at 7:41:42
In reply to Re: Weird question for anyone concerning lexapro » johnj, posted by ANXIETY ANN on October 9, 2002, at 22:26:18
> johnj-i think your attitude about meds is great. i also suffer from severe anxiety and panic attacks. i take xanax fot the attacks and adivan for anxiety. just started taking lexapro because docs want me off of bzs.do you take any BZs? how long have you been on lexapro and has it helped the anxiety? panic attacks ?
> thanks for your inputHi..I also suffered from anxiety disorder since 1986..I went through agoraphobia..In time with help of therapist I learned to not be afraid of the attacks..the fear of them was the worst. I still have xanax on hand but do not depend on it on a daily basis. I recently started lexapro and I have noticed a huge change in my anxiety..It has helped me a great deal. I have been on it 3 weeks.
Posted by dr. dave on October 10, 2002, at 8:10:49
In reply to Re: Technical questions /bottom. » JLM, posted by pharmrep on October 9, 2002, at 16:18:08
The relative side-effects of Lexapro and Celexa are as follows
Side effect..........................Lexapro..............CelexaHeadache............................15.8%..............19.9%
Nausea................................15.0%..............17.2%
Ejaculation disorder..............9.3%(of men)...8.8%
Insomnia..............................9.2%................8.6%
Diarrhoea.............................8.0%...............10.8%
Somnolence.........................6.9%................4.7%
Mouth dry............................6.2%...............8.1%
Upper resp tract infection.....6.2%...............3.9%
Dizziness..............................6.0%...............5.6%
Flu-like symptoms................5.0%...............6.1%
Rhinitis.................................4.9%...............5.6%
Sinusitis................................4.3%...............5.1%
'Overall, the type and frequency of TEAEs (treatment-emergent adverse events) reported with escitalopram and citalopram were very similar, and are in line with AEs reported for citalopram previously. For the TEAEs listed (above) there were no statistically significant differences for incidences of these events between the escitalopram and citalopram treatment groups.'
This is the official information from Lundbeck about relative side-effects. I wonder if you still stand by the comments that Lexapro has fewer side-effects than Celexa, and that Celexa causes somnolence while Lexapro does not?
Posted by Anyuser on October 10, 2002, at 8:41:01
In reply to Lexapro and Celexa relative side-effects » pharmrep, posted by dr. dave on October 10, 2002, at 8:10:49
From docguide.com:
"Escitalopram 10 to 20 mg/day for treatment of moderately to severely depressed subjects showed ongoing and increasing efficacy throughout a 12-month, open-label study conducted at 97 sites.
"The study's findings were reported at the 15th Congress of the European College of Neuropsychopharmacology (ECNP).
"'The remission rate among the subjects continuing in the open-label study reached 86 percent by week 52,' said lead investigator Alan Wade, MBChB, director at the CPS Clinical Research Centre, in Glasgow, United Kingdom. 'This long-term, primary care-based data begins to fill out the picture of escitalopram as a drug that raises the bar of expectations for effective and tolerable treatment of this group of patients.'"
This study was funded by Lundbeck.
Do you think this is news? Good science?
I wish we could see the data re clinical experience, but it is not reported.
Posted by johnj on October 10, 2002, at 8:52:42
In reply to Re: Weird question for anyone concerning lexapro, posted by maririp on October 10, 2002, at 7:41:42
HI,
I have been on nortryptline(pamelor) 50 mg for 10 years and tranzene( an ok benzo), and lithium for the same amount of time. My problem is I cannot work out and the culprit seems to point to The TCA. That is why I want to change. I have received 14 days of 10 mg of lexapro, but have not taken it yet. I have an exam in two weeks and cannot afford any side effects that could be harmful. My goal is to find somehting, maybe lexapro, that will allow me a better AD effect without so many s/e. Lexapro looks to be worth a try. I would prefer changing benzo's, but my doc says no. In November I will be giving lexapro a try, not sure if I will go 5 mg or 10 to start with.
johnj
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