Posted by bleauberry on December 14, 2010, at 16:37:47
In reply to Not sure if escitalopram (Lexapro) is working, posted by Franz on December 12, 2010, at 21:16:05
"Motivated" and "outgoing"....these are not typically results seen with any of the SSRIs. Serotonin is more of a calming, serene, everything is ok neurotransmitter. Once in a while someone on an ssri will have an astounding response and feel great, motivated, born again. Those are kind of rare. More common is the apathetic flat line emotion....no lows, but no highs either, flat motivation. Apathy.
Following posts here for many years, and appreciating the writings of Dr Gillman at psychotropical.com, I am in the camp that believes dual-mechanism approaches are best. That is, serotonin and norepinephrine, from two different drugs, not in the same drug, custom balanced for each person. Results are usually faster and more complete. IMO Along those lines, it might make sense to reduce lex to 5mg, or keep it at 10mg, and add 10mg nortriptyline to it. Then play with the doses. The norepinephrine component of Nortriptyline should provide what Lex is not.
Another player in motivation is dopamine. There aren't many drugs that positively impact dopamine. Ritalin qualifies, as does Adderall. Wellbutrin qualifies, though weakly so. Supplements such as DLPA, tyrosine, or SAMe can be combined with Lex, and will all help to bolster the norepinephrine/dopamine side of things.
The only single meds that have balanced serotonin/norepinephrine are MIlnacipran or Clomipramine. Duloxetine and Effexor, while being called mixed serotonin/norepinephrine meds, really are not....the norepinephrine component is very small compared to serotonin.
I think you'll need to add a norepinephrine/dopamine med to the lex to move in the direction you want. Of all the SSRIs, Prozac is usually more stimulating, and Zoloft can be. Lexapro is usually a bit mellow in comparison to those.
> Hello, I am taking 10 mg escitalopram (for 5 weeks approx and I do nos eee clear results.
>
> It seems that I get lethargic as with other SSRIs I tried. I do not feel more motivated or outgoing. At first it seems that I did not stick to sad thoughts, but I am not sure now.
>
> There are no serious side effects.
>
> Maybe I should try 5 mg but the Dr. thinks it is too low. Maybe I should ask again.
>
> Anyone here had any noticeable results with this drug?
>
> Thanks.
poster:bleauberry
thread:973338
URL: http://www.dr-bob.org/babble/20101203/msgs/973564.html