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Re: Escitalopram after Citalopram failure? » Exisessentialist

Posted by SLS on January 14, 2014, at 6:40:22

In reply to Escitalopram after Citalopram failure?, posted by Exisessentialist on January 14, 2014, at 0:33:32

> Hi, all. I'm currently taking 300 mg Bupropion XL and 200 mg Modafinil, which seems to be working well to return me to a semi-normal state after a period of regression. Question: if citalopram didn't work for me the last time I tried it but it had previously produced a partial response to my depression twice, is it worth trying escitalopram as an add-on? Personally, I've been thinking of trying either viibryd or brintellix in addition but if I can go with something less experimental, why not.

What are the symptoms that you find most problematic?

From what I can see, more people respond to escitalipram (Lexapro) who had failed to respond to citalopram (Celexa) than the reverse. There is some pharmacological evidence that explains this phenomenon.

Escitalopram is probably the most effective SSRI. If you fail to respond to it, I would try a SNRI in combination with bupropion (Wellbutrin) if you haven't yet done so. You never know which SNRI is going to end up working, but I would endorse desvenlafaxine (Pristiq) as a first choice. If this is not an option, venlafaxine (Effexor) would be my second choice followed by duloxetine (Cymbalta). Levomilnacipran might become available soon. I am not very impressed with milnacipran, but the levo- version might work better.

I am not sure how globally effective velazodone (Viibrid) or vortioxetine(Brintellix) are. But then, for every new drug that comes to market - even "me too" drugs, some percentage of previously treatment-resistent illness recover.

Have you tried adding lamotrigine (Lamictal) to bupropion?


- Scott


Some see things as they are and ask why.
I dream of things that never were and ask why not.

- George Bernard Shaw

 

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