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Dr. Bob is Robert Hsiung, MD,
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Posted by Ippopo on October 11, 2002, at 1:41:08
In reply to Re: Lexapro and flushing, posted by ANXIETY ANN on October 10, 2002, at 21:08:47
Hi AnxietyAnn,
I did experience something like that but can't remember if it was effexorXR of lexapro. Since 07.29.02 my meds have change a few times and can't remember which one it was or if it was a combo of several. none the less I have had a hot flash though it didn't last long. Maybe 2min.
Posted by pharmrep on October 11, 2002, at 2:00:22
In reply to Re: please be civil » pharmrep » Alan, posted by Dr. Bob on October 10, 2002, at 20:31:58
> > > why are you attacking me about it?
> > >
> > > pharmrep
>
> Please remember not to post anything that could lead others to feel accused or put down...
>
> > I'm not attacking you. I'm asking legitimate questions from a pharmecutical authority about specifically why AD's are being pushed in place of BZD's in the treatment of anxiety disorders, that's all.
> >
> > Alan
>
> And also not to pressure others. (BTW, I don't think he's claimed to be any sort of "authority"...) Thanks,
>
> Bob
********** im not sure what you want from me....i am not a master authority of the pharmaceutical industry, nor do i control what classes of drugs get preference. i do have some insight on the ad market...particularly ssri's (the current 1st line therapy used) and i often post about celexa and lexapro since i work for forest. i will cite my sources when i can, and sometimes speak in generalities if referring to information i've gained from my doctors and their patients. i like to share this info, and gain info from here too...but that is all i do here, let's keep it simple.
Posted by pharmrep on October 11, 2002, at 2:23:53
In reply to lexapro (P.I.) dose dependant adverse events, posted by pharmrep on September 1, 2002, at 0:00:38
*** I dont know what studies dr dave is looking at other than they are from europe...the studies in the usa have different parameters (like separating the mg's and not adding/averaging the #'s) here are the #'s from the US package insert. it is also not realistic to compare the celexa pi to the lexapro pi since they are both different groups (even though lexapro has better #'s, its not a valid comparison) I do stick by my statement (and the FDA'S) that at 10mg lexapro has side effects and discontuation due to adverse events comparable to placebo.
> Some of the more common adverse events (as listed in the package insert) are as follows:
>
> adverse event......Placebo.(311 patients)/...10mg Lexapro.(310 patients)/...20mg Lexapro (125 patients)
> insomnia..............4%.................................7%..........................................14%
> diarrhea..............5%.................................6%..........................................14%
> dry mouth...........3%.................................4%...........................................9%
> somnolence.........1%.................................4%...........................................9%
> dizziness..............2%.................................4%...........................................7%
> sweating increased1%.................................3%...........................................8%
> constipation.........1%.................................3%...........................................6%
> fatigue.................2%.................................2%...........................................6%
> indigestion...........1%.................................2%...........................................6%
>
> The overall incidence rates of adverse events in 10mg Lexapro treated patients (66%) is similar to that of the placebo treated patients (61%), while the incidence rate in 20mg Lexapro treated patients was greater (86%).
Posted by pharmrep on October 11, 2002, at 2:51:39
In reply to Re: Lexapro and flushing, posted by ANXIETY ANN on October 10, 2002, at 21:08:47
> does anyone experience intense hot flushing with Lexapro? 4 days on Lexapro and sometimes i get this intense hot feeling throughout my whole body. I don't turn red or anything, but it is very uncomfortable, especially when it wakes you up at night. These flushes last about 20-30 minutes and slowly dissapate. thanks for any help
*** havent heard of that one before...but having s/e in the 1st week seems to be par for the course...as you have most likely already seen in other posts...these "adjustments" to your new med might go away in the next week or so....i hope you can hang in there....keep us posted
Posted by momof3 on October 11, 2002, at 8:40:54
In reply to Re: Lexapro and flushing » ANXIETY ANN, posted by pharmrep on October 11, 2002, at 2:51:39
UPDATE: I am now at at the end of week two and my dosage is at 10mg Lexapro. I feel great-even laughed last night. I have energy that I have not had in months(maybe longer). Basically, I feel like me again. The only s/e still lingering is maybe a slight tremor. Hang in there. Oh yeah, I actually have a libdo again! The first two weeks were rough but every day got better. I am also wondering what some of you take for "as needed", as I am still having a small anxiety problem.
Posted by johnj on October 11, 2002, at 8:54:20
In reply to Re: AD's vs. Bzds for Anxiety disorders - Pharmrep, posted by Alan on October 11, 2002, at 0:57:04
Alan,
Could you tell me how I know if my disorder is anxiety as the primary under lying issue or depression? They seem to be morphed into one at times and even my doc is not sure. If you know somewhere I could get a clear dx on that I would be very happy. Until that time I will try what is out there and lexapro stands a good chance. If pharmrep knew all the answers to your questions I would go see him for a dx
johnj
Posted by ANXIETY ANN on October 11, 2002, at 10:05:08
In reply to Re: Lexapro and flushing, posted by momof3 on October 11, 2002, at 8:40:54
> UPDATE: I am now at at the end of week two and my dosage is at 10mg Lexapro. I feel great-even laughed last night. I have energy that I have not had in months(maybe longer). Basically, I feel like me again. The only s/e still lingering is maybe a slight tremor. Hang in there. Oh yeah, I actually have a libdo again! The first two weeks were rough but every day got better. I am also wondering what some of you take for "as needed", as I am still having a small anxiety problem.
Hi
thanks for giving me some encouragement. my doc gave me adivan for anxiety. anxiety was my primary reason for going on lexapro but it seems to cause alittle bit more for me but its only been 6 days. im glad you are doing so well, how do you sleep? Lexapro was making me like a zombie so the doc told me to take PM but now i can't sleep, guess I'll go back to mornings.
thanks
Posted by momof3 on October 11, 2002, at 10:40:03
In reply to Re: Lexapro and flushing, posted by ANXIETY ANN on October 11, 2002, at 10:05:08
I was very zombie like in the beginning! I started taking it at night. Now I need to switch to morning because I noticed being very awake, until what is a late hour for me. Thanks for the advice on the anxiety-I will check with my dr. I hope you have the results I seem to be having- I will keep you posted.
Posted by Abacus on October 11, 2002, at 10:47:01
In reply to Re: Lexapro and flushing, posted by momof3 on October 11, 2002, at 10:40:03
I took my lex at night for the first time last night and slept well. I hope this continues, because taking it in the morning seems to make me useless! I'm getting night sweats, too (not bad -- only a time or two each night). Anyone else?
Posted by Raven84 on October 11, 2002, at 11:09:16
In reply to Re: Lexapro and flushing, posted by Abacus on October 11, 2002, at 10:47:01
> I took my lex at night for the first time last night and slept well. I hope this continues, because taking it in the morning seems to make me useless! I'm getting night sweats, too (not bad -- only a time or two each night). Anyone else?
I have the same and recently started to attack myself in my sleep. My legs look like a battlefeild and I am thankful I havent attacked my daughter when she sleeps with me. Any suggestions on how to stop it?
Posted by SMS on October 11, 2002, at 11:18:24
In reply to Anyone switched to Lexapro? « ggrrl, posted by Dr. Bob on June 11, 2002, at 7:52:48
I have switched from a large dosage of Celexa. I now take 60 MG of Lexapro which is considered a mega dosage. I am overall pleased with Lexapro..the only side effect that I get, that is unpleasant, is constipation. I also have some sleep disturbances but I have had that before and can't directly attribute this to Lexapro
I do think Lexapro is helping
Posted by pharmrep on October 11, 2002, at 11:46:56
In reply to Re: Lexapro and flushing, posted by momof3 on October 11, 2002, at 8:40:54
> UPDATE: I am now at at the end of week two and my dosage is at 10mg Lexapro. I feel great-even laughed last night. I have energy that I have not had in months(maybe longer). Basically, I feel like me again. The only s/e still lingering is maybe a slight tremor. Hang in there. Oh yeah, I actually have a libdo again! The first two weeks were rough but every day got better. I am also wondering what some of you take for "as needed", as I am still having a small anxiety problem.
*** glad to hear lexapro is working for you...the anxiety treating effect is supposed to kick in around 2 wks...can you give it another wk before adding something else? you described the "rough" 1st wk or so...like ive heard before...ive also heard a lot of the wk 2 or so of the anxiety getting better...try to wait, good luck/keep us posted
Posted by Alan on October 11, 2002, at 12:08:03
In reply to im not sure? Alan, posted by pharmrep on October 11, 2002, at 2:00:22
>********** im not sure what you want from me....i am not a master authority of the pharmaceutical industry, nor do i control what classes of drugs get preference. i do have some insight on the ad market...particularly ssri's (the current 1st line therapy used) and i often post about celexa and lexapro since i work for forest. i will cite my sources when i can, and sometimes speak in generalities if referring to information i've gained from my doctors and their patients. i like to share this info, and gain info from here too...but that is all i do here....
==============================================
I am not asking you to comment on the entire phar. industry - only about your AD's and anxiety disorders.To a great extent you represent a lobby (as a pharmecutical rep from Forest Labs) for what drugs DO get preference by meeting with them in the form of "face time" as do your colleagues.
Why then is all of the long-known evidence that the most effective and safe anxiolytic known to medicine - the bzd with efficacy rates in the 80 or more percentile - brushed aside by the promoting of new AD's in their place when the AD company's own stats show little improvement over placebo (30 - 50%) specifically in the treatment of anxiety disorders?It seems that someone with your knowledge of psychotropics in the treatment of anxiety disorders would be able to comment on such comparisons in your capacity as a drugrep - whose function it is to show why lexapro or celexa is adventageous over other anxiety treatments when using your "face time" with the doctors that you relate with.
For that matter using "face time" in a consumer forum such as this is also a chance to use those same "comparators" to anwer the same questions that i ask viv-a-vis AD's vs. Bzd efficay rates but in an "everyman's parlance" kind of way if you wish.
Perhaps this is more clearly stated to enable you to comment.
Alan
Posted by Ward on October 11, 2002, at 13:49:35
In reply to Re: Lexapro and flushing, posted by Abacus on October 11, 2002, at 10:47:01
I've been on Lexapro 10mg. for 3 weeks. The night
sweats occurred every night for about the first
2 weeks, but they seem to be diminishing some
now. Hang in there!
Posted by ANXIETY ANN on October 11, 2002, at 18:26:23
In reply to Re: Lexapro for anxiety » momof3, posted by pharmrep on October 11, 2002, at 11:46:56
Does any one know how to adjust the dose of Lexapro if you take it at night and want to switch to mornings? ie.if you take 10mg at night do you again take 10mg the very next am to get on
a regular am schedule? or do you wait until the following morning?
Posted by kimc on October 11, 2002, at 18:36:22
In reply to Re: Lexapro for anxiety » momof3, posted by pharmrep on October 11, 2002, at 11:46:56
I have been on Lexapro for a month now taking 10mg. It has made me more anxious but is getting better. I am alittle concerned about a slight ringing sound in my ears. Only hear if everything else is totally quiet like at night or in a room with no noice. Will this go away
Posted by Alan on October 11, 2002, at 19:06:10
In reply to Re: AD's vs. Bzds for Anxiety disorders - Pharmrep » Alan, posted by johnj on October 11, 2002, at 8:54:20
> Alan,
>
> Could you tell me how I know if my disorder is anxiety as the primary under lying issue or depression? They seem to be morphed into one at times and even my doc is not sure. If you know somewhere I could get a clear dx on that I would be very happy. Until that time I will try what is out there and lexapro stands a good chance. If pharmrep knew all the answers to your questions I would go see him for a dx
> johnj
-------------------------------------------
I wouldn't recommend a pharmecutical representative or any health care professional try to apply the "one size fits all" mentality that seems to gloss over the importance of treating an individual as an individual case. If they were truly interested in you as an individual, they wouldn't use AD's as the default med for anxiety....they would offer anxiolytics (bzds) AND AD's on equal footing...giving you choice....not taking away your freedom to choose.The simplest and most revealing way would be try either an AD or an anxiolytic (bzd) in seperate clinical trials in monotherapy form. This is called "Listening to the Drug" and what many psychopharmocologists use to dignose.
If you receive more symptom relief with the AD then the chances the depression is primary and is driving the anxiety - and vice versa.
Simple tool written about extensively and the basis for Peter Kramer's book "Listening to Prozac" that came out about 10 or so years ago.
Alan
Posted by Abacus on October 11, 2002, at 19:11:26
In reply to Re: Lexapro and flushing » Abacus, posted by Ward on October 11, 2002, at 13:49:35
Thanks for the reply. Glad to know they diminished for you. Now, if I could just regain some energy! Hanging in there. :)
Posted by pharmrep on October 11, 2002, at 19:14:55
In reply to Re: Lexapro for anxiety, posted by ANXIETY ANN on October 11, 2002, at 18:26:23
> Does any one know how to adjust the dose of Lexapro if you take it at night and want to switch to mornings? ie.if you take 10mg at night do you again take 10mg the very next am to get on
> a regular am schedule? or do you wait until the following morning?** I would split the difference...take your last pm dose about mid-day, and your 1st am dose in late morning, then the next at whatever early am you had in mind
Posted by pharmrep on October 11, 2002, at 20:03:20
In reply to Re: im not sure? Alan » pharmrep, posted by Alan on October 11, 2002, at 12:08:03
> >********** im not sure what you want from me....i am not a master authority of the pharmaceutical industry, nor do i control what classes of drugs get preference. i do have some insight on the ad market...particularly ssri's (the current 1st line therapy used) and i often post about celexa and lexapro since i work for forest. i will cite my sources when i can, and sometimes speak in generalities if referring to information i've gained from my doctors and their patients. i like to share this info, and gain info from here too...but that is all i do here....
>
> ==============================================
> I am not asking you to comment on the entire phar. industry - only about your AD's and anxiety disorders.
>
> To a great extent you represent a lobby (as a pharmecutical rep from Forest Labs) for what drugs DO get preference by meeting with them in the form of "face time" as do your colleagues.
>
>
> Why then is all of the long-known evidence that the most effective and safe anxiolytic known to medicine - the bzd with efficacy rates in the 80 or more percentile - brushed aside by the promoting of new AD's in their place when the AD company's own stats show little improvement over placebo (30 - 50%) specifically in the treatment of anxiety disorders?
>
> It seems that someone with your knowledge of psychotropics in the treatment of anxiety disorders would be able to comment on such comparisons in your capacity as a drugrep - whose function it is to show why lexapro or celexa is adventageous over other anxiety treatments when using your "face time" with the doctors that you relate with.
>
> For that matter using "face time" in a consumer forum such as this is also a chance to use those same "comparators" to anwer the same questions that i ask viv-a-vis AD's vs. Bzd efficay rates but in an "everyman's parlance" kind of way if you wish.
>
> Alan** well alan...i got you some face time today...i got the chance to ask 4 doctors how they felt about benz, and why benz. are not used as much as ssri's....i got similar and varied answers, but here are the commonalities.
---feelings on why benz. are not used as much__
1) habit forming
2) short acting
2) the anxiety may be treated, but it may leave the depression even worse...there are some (not all) ssri's that can treat both depression and anxiety.PS If an SSRI like Celexa or Lexapro can reduce a persons score on...lets say the madres scale from 26 (major depression)...by 50% to 13..(mild depression), and also the inner tension items (anxiety subscale), I wouldnt call that "little improvement".
Posted by Alan on October 11, 2002, at 22:40:56
In reply to Re: benz. / vs SSRI's...see bottom » Alan, posted by pharmrep on October 11, 2002, at 20:03:20
> ** well alan...i got you some face time today...i got the chance to ask 4 doctors how they felt about benz, and why benz. are not used as much as ssri's....i got similar and varied answers, but here are the commonalities.
> ---feelings on why benz. are not used as much__
> 1) habit forming
> 2) short acting
> 3) the anxiety may be treated, but it may leave the depression even worse...there are some (not all) ssri's that can treat both depression and anxiety.
>
> PS If an SSRI like Celexa or Lexapro can reduce a persons score on...lets say the madres scale from 26 (major depression)...by 50% to 13..(mild depression), and also the inner tension items (anxiety subscale), I wouldnt call that "little improvement".
================================================Thank you for addressing my question pharmrep.
What I am about to say is not directed specifically to you but is commentary on the content of the answers provided by your sample of 4 selected doctors.
Bzds vs AD's for anxiety disorders:
1)Habit forming?
What specifically is meant? That those with chronic anxiety disorders develop "medical dependence" on a medicine designed to treat a medical condition? (Or do the 4 doctors even make a distinction between addiction and medical dependence?)
Or that there is a typical dependence/withdrawl cycle as now commonly seen in many new AD's, euphemistically referred to as "discontinuation syndrome". Or tolerance similarly referred to as AD "poop-out" (not to mention dosage escalation to treat patients when they do "poop-out")?
As long as doctors are pushing an SSRI at every patient who even looks at them cross-eyed, there's not going to be any opportunity to observe drug-seeking behavior associated with "habit forming" (just another euphemism for medical dependence). In fact, what they see right now is SSRI-avoidant behavior.
But let the doctors start withholding SSRIs and doing all they can to get people off of them (a day that may well come), and then we will see drug-seeking behavior from people who might even prefer to be off but can't even possibly quit over the two week period now recommended as a taper (it took a good long time for there to be an admission that AD's needed to be tapered in the first place, remember?).
2) short acting?
How is keeping up with one or two or three doses of a bzd that much different than taking a once a day AD? Half-life isn't an issue that I know of if bzd's are managed and prescribed properly...at least no less important than keeping up with their dosage regime of an AD.
Or are you talking about short acting in the sense that they are supposedly not meant to be taken for longer than let's say 3 - 4 weeks at a time? That myth was long ago disproven by the "Report on the Rational Use of Benzodiazapines" issued by the World Heath Organisation (independent and hardly a heavily pharmecutically sponsored organisation) that considered 40+ years of studies concluding that short AND long term use of bzds in the treatment of anxiety disorders is not only highly effective but very safe for the general population. The typical panic population does NOT report escalating dosages but rather a level that generally stays the same or DEcreases over time.
3)Huh? I thought the issue was anxiety disorder. Taking away anxiety with a bzd with the result being residual, exacerbated depression shows that the individual doesn't have an anxiety disorder to begin with but has the ubiquitous "mixed anx/depress" dx commonly used when the less skilled clinician (usually the front line physicians like GP's or internists whom these new AD's are the company's largest market by far) can not or are incapable of teasing out which is primary and which is secondary in order to treat effectively...The only known and relatively uncommon side effect of any bzd and depression that I've read about or know of is with klonopin...and decreasing the klon dosage while augmenting with xanax or ativan is the standard antidote and treatment protocol whenever this occurs.
As a matter of fact, there are studies that conclusively prove that xanax has a mild antidepressant effect - probably because it relieves relentless, hopeless depression ABOUT the anxiety...
Which leads to the PS. part.
How are clinicians going to decipher if the relentless anxiety is what is primary - driving the hopelessness of depression, if an AD is going to stimulate and sedate (to use the crudest of layman terms) at the same time? Does this scale take into account whether or not there was any augmentation with a bzd?
As a veteran of 6 AD's that did just that, never treating my anxiety disorder because of the pushing of the AD as the superior and therfore first line of treatment of anxiety disorder, and similar stories from a sizable population on this board and others that have to end up taking a bzd in the end with their AD anyway, and with efficacy rates at very best 40 - 50% by any company's own accounts, perhaps the 4 doctors can answer one key question.
Why aren't bzd's with efficacy rates in the 70 -80 percentile being offered on an equal footing with the new AD's (post 1992) in the treatment of anxiety disorders?
Curious,
Alan
Posted by ZeeZee on October 11, 2002, at 23:05:14
In reply to Re: AD's vs. Bzds for Anxiety disorders - Alan » johnj, posted by Alan on October 11, 2002, at 19:06:10
Alan-
I thoroughly enjoy reading your posts and have found them very helpful. I'm comforted in knowing there is a "champion" here for those of us with anxiety disorders. However, I must disagree with your advice to johnj in regard to how to decide whether anxiety or depression is the primary disorder. My primary and only diagnosis is panic disorder with agoraphobia. Although I agree with you that the AD's have been horribly disappointing for me and many like me (making my panic millions times worse) the MAOI's Nardil and Parnate were the exception and Godsends. You mentioned that if an AD works for your anxiety then maybe it's primary depression driving the anxiety. Both Nardil and Parnate eliminated my panic, anticipatory anxiety, OCD type thoughts, and greatly reduced my phobic avoidance. I was not and am not suffering from depression. I wish I could take Parnate again (Nardil has too many side effects) but unlike my success in the past, I recently had intolerable side effects and could not continue with it.
I do agree that the "currently" prescribed AD's (primarily the SSRI's) do little to help those of us with anxiety disorders and instead make our symptoms worse, with intolerable side effects on top of it all. There are many posts confirming this sad fact as I read about the new Lexapro users reporting "still feeling anxious", or "agitated", or "no longer depressed but more anxious." It's also discouraging to read so much on this site quoting research in support of the use of AD's for depression but little in regard to its efficacy with anxiety.
Yes, I do use Xanax and Klonopin, as needed. However, the effects of these drugs will never compare to the sublime state of "normalcy" found with the use of Parnate.
Just wanted to share my experience and personal opinion since johnj is looking for answers.
Posted by Alan on October 11, 2002, at 23:21:59
In reply to Re: AD's vs. Bzds for Anxiety disorders - Alan, posted by ZeeZee on October 11, 2002, at 23:05:14
Well stated and appreciated! I know of many success stories with the MAOI's in combo with xanax, etc and was on one track with the AD vs. bzd's - this probably considering all of the "face time" we are seeming to be getting free of charge via-a-vis AD's and anxiety disorders (completely unethical no matter how well intended or how one couches it - they're professional salesman after all - but that's just my opinion of course.)
MAOI's and bzd's have indeed saved one of my best friend's and colleague's career and life!
Best to you,
Alan
Posted by ZeeZee on October 12, 2002, at 9:17:32
In reply to Re: AD's vs. Bzds for Anxiety disorders - Alan » ZeeZee, posted by Alan on October 11, 2002, at 23:21:59
I totally agree with you in where you're coming from in regard to the professional salesperson. I have expressed myself before in this regard however have received no support for my position, which is in fact the same as yours. Lest we receive continuous PBC's or ban's our point unfortunately cannot be taken further.
This is LLL.
Posted by BrittPark on October 12, 2002, at 12:44:50
In reply to Re: Lexapro or eqiv. vs. Bzds for anxiety disorder » pharmrep, posted by Alan on October 11, 2002, at 22:40:56
Here, Here. Benzophobia is as common in the treatment of anxiety as Opiophobia is in treating pain. People with chronic anxiety or pain are grossly undertreated in the US.
Britt
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