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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 27 to 51 of 71. Go back in thread:
Posted by Phillipa on February 8, 2012, at 20:55:44
In reply to Re: Thyroid levels and Serotonin, posted by Maisey on February 8, 2012, at 19:37:49
Luvox generic is approved for OCD I take it with low dose of lexapro 5mg. Never ever a side effect with luvox. I do take benzos also low dose. Got the thyroid also. But it's at l.5 now so can't blame it on that. Also used a compounding pharmacy an anti-aging doctor who completed tested all hormone levels and then prescribed the ratios of estrogen to progesterone and testosterone. Might look into this Phillipa
Posted by Maisey on February 8, 2012, at 21:26:38
In reply to Re: Thyroid levels and Serotonin » Maisey, posted by Phillipa on February 8, 2012, at 20:55:44
Phillipa, thanks - I've never heard of Luvox.
I'm a "thin PCOSer" which is like a whole other sub-catagory of PCOS. Many people actually call it ballerina syndrome now because the reasons for getting to irregular cylces/cysts are usually different than the average PCOSer. Though, some thin women do have insulin resistance. It is harder in thin women to sort out the root cause esp because it can be that the estrogen/testosterone balance is fine today, but could've been off at some point in her life - thus starting a pattern of irregularity. I got too underweight when I was 18. I was working and going to school, and just didn't eat enough. That's the time my cycles went awry. I doubt I have a sizable testosterone/estrogen imbalance since the symptoms are not there.
Like I said earlier, I don't have the money for specialists. It's not an option for me. I have done poorly on combination pills. I'm 30, so I'm a little old for the pill or estrogen/progesterone supplementation. That stuff gets risky as one ages (well you prolly already know that!).
I'm pretty convinced that I've found a good remedy for my PCOS - and as long as I have a period at least every 2 months, I don't really need anything. (I've never skipped more than 2 mons at a time.) I tend to better w/nothing on that - I've tried metformin, bc pills, maca root. All made me feel worse.
Thanks for your input. :) Your combination of meds is interesting, though not sure what benzos are!
Posted by ed_uk2010 on February 9, 2012, at 13:18:14
In reply to Re: Thyroid levels and Serotonin, posted by Maisey on February 8, 2012, at 19:37:49
Hi again,
>Ugh! My whole post just did not show up! Maybe it is how I formatted it.
It must be because you clicked on the box where it says 'no message, just post above subject'. That's why it says nm (no message) after your subject line. It's easy to click the box by accident when you're typing a post.
>My doctor knew about this too so it makes me mad but only $10 down the drain.
Given the price difference and the similarity to Lexapro, it's good that you tried citalopram. It's a shame it didn't work out.
>I thought it may be good to be on Paxil for this reason; its the only SSRI approved for OCD.In the US, fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox) and paroxetine (Paxil) are all FDA approved for OCD. Escitalopram (Lexapro) is approved for OCD in the UK and elsewhere but not in the US, presumably because the manufacturer hasn't yet submitted the necessary data to the FDA. In practice, all SSRIs can be effective for OCD, including citalopram - which is not approved. Some patients may respond better to one than another but efficacy in OCD is a 'class effect' of the SSRI group of antidepressants. Another drug used for OCD is clomipramine (Anafranil), which is chemically related to amitriptyline.
Like you said, trichotillomania is not OCD, but might be related in some way, at least in some cases. It is sometimes referred to an an impulse-control disorder. SSRI drugs are sometimes tried but their effectiveness is less well established than in OCD. The recommended treatment is usually CBT, cognitive behavioural therapy. CBT can be expensive but there are various self help books you can buy and a lot of information on the internet. You can do most of the exercises at home. If you search for CBT, or CBT for trichotillomania you should find some good websites.
>It is amitriptyline HCL. I think one has an anti-histamine, and one doesnt? Ive been taking it for 10 years. Ive taken as much as 50mg and as little as 12.5, but Ive done 25mg for the past 2 years or so. Im sure my doctor said its ok to take it with Lexapro, though with Citalopram, I read they shouldnt be mixed.
Amitriptyline hydrochloride (HCl) is the form of amitriptyline used in all tablet formulations, but it's usually just called amitriptyline. Amitriptyline has a strong antihistamine effect, which is part of the reason it causes drowsiness.
Amitriptyline was one of the earliest antidepressants to be discovered. It can work well if you can tolerate the side effects. For depression, higher doses are needed eg. 75mg to 150mg per day, adjusted according to response. The dose is always increased gradually. You could try a higher dose of amitriptyline instead of trying an SSRI.
>Thats another reason why Ive balked about SSRIs. I know ones like Paxil.
Amitriptyline is more likely to cause weight gain than any of the SSRIs. If you can take amitriptyline without gaining weight it is probably a good sign!
Paroxetine (Paxil) does sometimes causes weight gain, possibly slightly more frequently than other SSRIs, but not everyone is affected by any means. Weight gain rarely occurs early in treatment. Some patient lose weight initially and then put it on after several months. With SSRIs, metabolic problems (eg. high cholesterol) are mainly a problem in patients who gain a lot of weight, and not otherwise. Most of the western population has borderline high cholesterol, so I wouldn't worry about that particularly. If you are a healthy weight, your BP is normal and you don't smoke you should be fine. Mildly elevated cholesterol in the absence of any other cardiac risk factors is not very important.
The main issue with paroxetine (Paxil) is that it interacts with amitriptyline. Fluoxetine (Prozac) also interacts with amitriptyline. Both drugs block a liver enzyme called CYP 2D6 which is needed for the metabolism of amitriptyline. Taking Paxil or Prozac with amitriptyline can substantially increase the level of amitriptyline in your blood. This can cause an adverse reaction.
Among the SSRIs, citalopram, escitalopram (Lexapro) and sertraline (Zoloft) interact minimally with amitriptyline. These drugs can be used with amitriptyline unless the amitriptyline dose is very high, which yours is not. Since you don't respond well to citalopram and Lexapro is too expensive, generic sertraline (Zoloft) might be a good choice. Since you've had side effects with SSRIs before, you could start with half a 50mg tablet before going up to a full tablet.
Although it's reassuring that you didn't have any major side effects with Lexapro, it doesn't sound like it was very effective for you... but it was very expensive. This is why I think generic sertraline is worthy of consideration. It's up to you and your doctor of course. All antidepressants can aggravate bipolar disorder in some cases, but I know you don't have a diagnosis. Some people get manic on antidepressants, or become agitated and experience rapid changes in mood. Have you had any manic symptoms in the past? Examples include elevated mood, excitement, talking quickly, racing thoughts, reduced need for sleep, impulsive behaviour....
If you decide to try Paxil, you will need to reduce your amitriptyline dose, but the extent of the reduction is basically trial and error. You could reduce your dose from 25mg to about 10mg initially. Paxil causes more severe withdrawal symptoms than other SSRIs, and needed to be tapered gradually if you decide to stop.
>Thanks for your responses. I really appreciate them. :)
You're welcome.
Posted by Maisey on February 9, 2012, at 17:30:28
In reply to SSRIs etc. » Maisey, posted by ed_uk2010 on February 9, 2012, at 13:18:14
Naw, I checked that box later on, right before posting my last message to you. I wasn't sure what it meant - now I know! I'm not sure what happened the one time, but I hope it doesn't happen again b/c that was a thorough message and I didn't remember it all in my last message to you that got through. I'm making sure to save all my messages to my computer from now on, though.
One thing I forgot in my last post was I have mitral valve prolapse so there is a greater risk with that in picking my mouth. Though they've stopped giving antibiotics w/dental cleanings b/c the risk is so low, my picking habit is bad b/c hands are germier than sterile instruments, for ex. I always try to wash my hands beforehand but sometimes I will do it in public if the compulsion is really strong. I'd love to stop doing it (the habit). I'm sure I read that Paxil is the only one (SSRI anyway) to be approved for OCD, but they could be wrong. It seems as if medicines in general aren't much good for this. I've tried therapy - not this type - but I just hated it. It was $$$$ and I felt like I wasn't getting anywhere. I only did 2 visits at the most to two different therapists, BUT I've read that short-term therapy or accelerated is most effective by far. I couldn't find therapists nearby who do that kind, so I gave up. IDK about therapy for these conditions. If they were more severe, like dermotillmania can be pretty bad, I'd consider it. I was thinking about therapy today because I said something really mean to my mom today - basically called her stupid - and I was instantly shocked that I said. Of course, I'm a mess with this cold so I take that into consideration. I had some funky affects from Delsym last night (heart rate changes and shakiness) and later read that it can cause mental changes. So I'm trying to dismiss it, but it still bothers me. I'm thinking about buying a cognitive therapy book. I got one from the library once, but didn't get to read it enough to get an impression if it would help. I'm seriously just not the type of person who does writing exercises and junk, though. I think if it's chemical, it's chemical.
I've had what I thought was mania at times, but I'm not sure. Mania lasts weeks. It's more like phases... whereas mine was more a short high of sorts from coming off a bad mood. Cyclomania (sp) is a milder form of bipolar disorder. Could be that, I guess. I don't get super excited or happy or anything. One night, I did exercise for 3 hours (well I sat on and off through it). That is the most severe instance I can think of.
I wonder why my doctor prescribed Paxil if it cannot be taken with elavil? I'm not saying I doubt you - I don't - but, you would think he would at least have indicated when to take it. I haven't heard back from him on my letter, which probably would've been received Tues. He could be on vacation - IDK. It is rare to not get a response like this, but I've never sent a letter before. Not sure what to do, but it's probably good to wait until I'm back to normal from this cold to make a decision. My thinking has been hazy lately, though I'm just now feeling a lot better.
I did take Zoloft, but only for 2 or 3 days. I was 18, and my doctor (different one than my current doctor) suspected an eating disorder in me because I got to a danger zone low weight (81 lbs at 5'2). I actually didn't get that low until later on - I was at 87 when I first went to see her - her making a big point about it worried me into eating less until I had no appetite at all. I stopped seeing her and my appetite came back almost instantly. I also changed jobs. I was at Wal-mart working in a physically laboring job + going to school. I have a hard time eating when I'm busy or tired. I don't think it was an eating disorder or depression as she suspected. My new doctor (my doctor now) agreed. Anyway, I did try the anti-depressant at that time. I don't remember much about it as it was so long ago. It wouldn't have been enough to get anything out of it, though I don't remember grogginess or anything.
Posted by ed_uk2010 on February 9, 2012, at 18:42:42
In reply to Re: SSRIs etc., posted by Maisey on February 9, 2012, at 17:30:28
Hello,
>I'm sure I read that Paxil is the only one (SSRI anyway) to be approved for OCD, but they could be wrong.
You probably did read it, but it's not true :) There is quite a lot of incorrect information out there on psych meds. This is even more of a problem with psych meds than with meds in general. You can see the FDA approved uses of drugs on the website RxList, or on the manufacturer's websites.
>It seems as if medicines in general aren't much good for this.
They might be, but there's not a great deal of research to say one way or another, or to show which meds are most effective.
>I've tried therapy - not this type - but I just hated it. It was $$$$ and I felt like I wasn't getting anywhere. I only did 2 visits at the most to two different therapists, BUT I've read that short-term therapy or accelerated is most effective by far.
The thing about therapy is that the type of therapy and the personality of the therapist are extremely important. You could hate one therapist but really benefit from another.
>I had some funky affects from Delsym last night (heart rate changes and shakiness) and later read that it can cause mental changes.
Very high doses of dextromethorphan (in cough suppressants) can cause severe psychiatric disturbances, so I assume that milder symptoms can occur when it's taken at therapeutic doses. It is not recommended to take dextromethorphan in combination with antidepressants.
>I've had what I thought was mania at times, but I'm not sure.
You could be somewhere on the bipolar spectrum, rather than having full blown bipolar disorder. This is often the case when there's a family history.
>I wonder why my doctor prescribed Paxil if it cannot be taken with Elavil?
Paxil could be used cautiously in combination with amitriptyline (under close medical supervision), but the dose of amitriptyline would need to be kept very low.
Here is what the manufacturer of Paxil says...
'Co-administration of PAXIL (paroxetine hydrochloride) with other drugs that are metabolized by this isozyme (CYP2D6), including certain drugs effective in the treatment of major depressive disorder (e.g. amitriptyline....) should be approached with caution.'
Here is an extract from a medical journal...
http://www.ncbi.nlm.nih.gov/pubmed/8968657
'Due to its (Paxil's) potent CYP2D6 inhibiting properties, comedication with this SSRI can lead to an increase of tricyclic antidepressants in plasma, as shown with amitriptyline....'
>I'm not saying I doubt you - I don't - but, you would think he would at least have indicated when to take it.
Perhaps he didn't think it was significant since you're only on 25mg of amitriptyline. Personally, I would want to be cautious and reduce the amitriptyline dose down to 10mg or less initially. Still, it would be easier just to use a different SSRI.
>It wouldn't have been enough to get anything out of it, though I don't remember grogginess or anything.
Good to know that you don't recall a bad reaction to sertraline (Zoloft). It gives you an extra option.
Take care!
Posted by Maisey on February 10, 2012, at 13:35:33
In reply to Re: SSRIs etc. » Maisey, posted by ed_uk2010 on February 9, 2012, at 18:42:42
>Very high doses of dextromethorphan (in cough suppressants) can cause severe psychiatric disturbances, so I assume that milder symptoms can occur when it's taken at therapeutic doses. It is not recommended to take dextromethorphan in combination with antidepressants.
That is my issue with starting another anti-d because I didn't read anything about Delsym/elavil interactions. I know Benadryl I'm not supposed to do. But, I took Robitussin DM with elavil last night. Later on at night when I was stopped up, I took a 1/2 a pill of Kroger Allergy and Sinus PE. It is Chlorpheniramine maleate and Phenylephrine HCL. Then, I stayed awake until 4pm because I worried about taking all of those together, though I'd taken a 1/2 dose of Robitussin at 9pm with Elavil, and the next 1/2 dose at 11pm. The Allergy & Sinus I took at 1:30 pm. I've taken Robitussin and elavil before with no probs, though I've taken Delysm + elavil together before too and not had a problem.
I guess next time I have a bad cold like this, I'll just not take elavil. Because I can't fall asleep if I'm stuffed up at all, anyway. Once, I had surgery done on my nose, and had it packed. I woke up feeling like I couldn't breathe and started hyperventilating. I need an anti-histamine when congested. That is my fear with adding anything else on, because I think SSRIs are like tricyclics in their interactions.
I also watch my cholesterol b/c my doctor started talking about statins. Another medicine. I think less medicine is usually better, though he said he wanted to wait and make sure I didn't want to have kids before putting me on that.
Posted by Maisey on February 10, 2012, at 16:49:43
In reply to Re: SSRIs etc. » Maisey, posted by ed_uk2010 on February 9, 2012, at 18:42:42
Are there cough and cold medicines that CAN be taken safely with anti-d's? I always thought the biggest concern is that they up each other's chance of side effects. Generally, I haven't had problems. Even with Benadryl - it't just an anti-histamine. I don't take it with elavil b/c you're not supposed to go overboard on HCLs. Though, I take such a small dose of elavil. That's why I didn't worry last night until I read the Allergy&Sinus label, and discovered it was more than just an HCL like I had thought...
Posted by ed_uk2010 on February 11, 2012, at 7:50:28
In reply to Re: SSRIs etc., posted by Maisey on February 10, 2012, at 13:35:33
>I didn't read anything about Delsym/elavil interactions.
There might not be an interaction. Some dextromethorphan medicines in the UK come with a vague warning to avoid when taking antidepressants. This is probably because of the interaction with MAOI antidepressants. Amitriptyline is not an MAOI so I wouldn't expect any serious interaction with dextromethorphan. The warning to avoid it 'with antidepressants' is probably overcautious.
>I know Benadryl I'm not supposed to do.
This is because many of the side effects of Benadryl overlap with amitriptyline eg. dry mouth. There are other antihistamines which are more suitable, although amitriptyline already has an antihistamine effect on its own.
>But, I took Robitussin DM with elavil last night.
Robitussin contains dextromethorphan, the same drug used in Delsym.
>I guess next time I have a bad cold like this, I'll just not take elavil.
You don't need to do that. Next time, ask a pharmacist for advice on what to take.
>I think SSRIs are like tricyclics in their interactions.
Not really, but the interactions vary from drug to drug. For example, Paxil and Prozac have more interactions than Zoloft and Lexapro.
Posted by ed_uk2010 on February 11, 2012, at 8:08:26
In reply to Also, wanted to ask, please..., posted by Maisey on February 10, 2012, at 16:49:43
>Are there cough and cold medicines that CAN be taken safely with anti-d's?
Yes. For a blocked nose you can use a decongestant nasal spray for a few days. For a fever or aches and pains you can take acetaminophen. Cough medicines are not very effective, there is not much point in taking them.
>I always thought the biggest concern is that they up each other's chance of side effects. Generally, I haven't had problems. Even with Benadryl - it's just an anti-histamine.
You could take a small dose of Benadryl at night if you need to, just don't take a lot. If you need an antihistamine for allergies, you could take cetirizine (Zyrtec) or fexofenadine (Allegra).
>I don't take it with elavil b/c you're not supposed to go overboard on HCLs. Though, I take such a small dose of elavil. That's why I didn't worry last night until I read the Allergy&Sinus label, and discovered it was more than just an HCL like I had thought...
I'm not sure what you mean. A large number of drugs are given as the hydrochloride/HCl eg. amitriptyline hydrochloride. The hydrochloride/HCl refers to the atoms which are bonded to the drug to make it into a form which can be used in medicines. There is *no* problem taking different medicines containing HCl at the same time. When looking at the ingredients in a product, just look at the drug names, don't worry whether they are HCl or not, it's not relevant.
As an example, Benadryl + amitriptyline might cause a dry mouth. This is because diphenhydramine (the drug in Benadryl) and amitriptyline can both cause a dry mouth, and the effect is increased if they are taken together. It is nothing to do with HCl.
Hope this helps.
Posted by Maisey on February 11, 2012, at 16:38:56
In reply to Re: Also, wanted to ask, please... » Maisey, posted by ed_uk2010 on February 11, 2012, at 8:08:26
Thank you - that cleared up several things for me. I wish my head would clear up now, lol. Ever since I took those cold medicines the night before last, I've been in a fog. I don't think it's the cold. I hope this effect is not long-lasting or permanent. :-(
Posted by ed_uk2010 on February 12, 2012, at 12:54:25
In reply to Re: Also, wanted to ask, please..., posted by Maisey on February 11, 2012, at 16:38:56
>Thank you - that cleared up several things for me. I wish my head would clear up now, lol. Ever since I took those cold medicines the night before last, I've been in a fog. I don't think it's the cold. I hope this effect is not long-lasting or permanent. :-(
It's the combined effects of lack of sleep and the cold. You will get better for sure, but it could take a few more days. If you get ill again, ask a pharmacist for advise on what to take for your symptoms. They can also check for interactions with your medication. You will feel much better knowing that what you're taking is safe, and you will get the most effective treatment for whatever is wrong with you.
Posted by Maisey on February 13, 2012, at 16:58:19
In reply to Re: Also, wanted to ask, please... » Maisey, posted by ed_uk2010 on February 12, 2012, at 12:54:25
Can you also tell me, in your opinion (Nobody has responded to my new thread about Lexapro yet.), would it be better to take Lexapro with a multivitamin in the morning, or at night with elavil? Those are the only times I would be able to work it in. I went ahead and purchased generic Lexapro online, but I am waiting until I get a T3 test done (tomorrow) to make sure I don't need more thyroid hormone supplementation. I plan to start Lexapro as soon as I know the results of that test (assuming it comes out ok). Thanks.
Posted by ed_uk2010 on February 14, 2012, at 17:07:24
In reply to Re: Also, wanted to ask, please..., posted by Maisey on February 13, 2012, at 16:58:19
>Can you also tell me, in your opinion (Nobody has responded to my new thread about Lexapro yet.), would it be better to take Lexapro with a multivitamin in the morning, or at night with elavil? Those are the only times I would be able to work it in.
The standard time to take Lexapro is in the morning. If you feel tired after your dose, you can try taking it at night instead, so long as it doesn't interfere with your sleep. Most people continue to take it in the morning.
>I went ahead and purchased generic Lexapro online
I hope it's from a reputable pharmacy. Some online medicines are counterfeit. There is no generic version of Lexapro in Europe because it is still patent protected. I believe that a generic version will be launched in the US relatively soon.
Posted by Phillipa on February 14, 2012, at 21:30:21
In reply to Re: Also, wanted to ask, please... » Maisey, posted by ed_uk2010 on February 14, 2012, at 17:07:24
I take it at night. Phillipa
Posted by Maisey on February 15, 2012, at 23:11:30
In reply to Re: Also, wanted to ask, please..., posted by Phillipa on February 14, 2012, at 21:30:21
Thanks, you two. I haven't heard back from my thyroid test so I assume it's normal. That means I'll go on Lexapro.
I have yet another question. My doctor added a liver function test when I started taking mefformin (I don't take it any more.) and when I was taking Lexapro. I don't think he does one regularly any more but he stated when I was on those medicines he was doing it because... I was on those medicines. Does Lex have any long-term effect on the liver or does it up the risk of liver probs?
I know taking cinnamon does, and I still take that. Should I not take it if I go on Lex, or should I just take them at different times? There is an enzyme in cinnamon that can affect the liver at large doses but I don't take much which is why I didn't care before.
What is Lexapro's effect on the liver and if I add it on, should I subtract something? I take a multivitamin daily, though I alternate b/w a women's multivitamin and gummy vitamins. I take a calcium supplement (chewable) at dinner along with either flaxseed oil capsules or cinnamon (about 1000 mg). I take synthroid in the morning, 12.5 mg. I take elavil at night (25mg), and occasionally asprin at night if I have trouble sleeping. I can cut out flaxseed/cinnamon - those are just for lowering cholesterol and helping with PCOS symptoms - but, I have a ton of each and want to use them up.
Posted by ed_uk2010 on February 16, 2012, at 15:31:39
In reply to Re: Also, wanted to ask, please..., posted by Maisey on February 15, 2012, at 23:11:30
Hi,
>Does Lex have any long-term effect on the liver or does it up the risk of liver probs?
No, Lexapro is not a high-risk medication for the liver.
>I know taking cinnamon does, and I still take that. Should I not take it if I go on Lex, or should I just take them at different times?
Cinnamon may be good for you in small amounts. Like most foods, it may be bad in very large quantities.
>aspirin at night if I have trouble sleeping.
Aspirin is not a sedative. It is not likely to be effective for insomnia.
Take care!
Posted by Phillipa on February 16, 2012, at 19:30:19
In reply to Re: Also, wanted to ask, please..., posted by Maisey on February 15, 2012, at 23:11:30
Maisey the synthroid is in mcg. So it could be l.25 or .125both mcg. 12.5mg would be an overdose. Just thought I'd add. Phillipa
Posted by Maisey on February 16, 2012, at 20:10:28
In reply to Re: Also, wanted to ask, please... » Maisey, posted by ed_uk2010 on February 16, 2012, at 15:31:39
Yeah, I have very dry, itchy skin that I notice more at night so aspirin helps me sleep, as an anti-inflammatory.
Phillipa, strange I never noticed that. I think it's b/c my other meds are in mg and my 25 mcg Levothyroxine tablet (I half them.) doesn't look much smaller than my 50mg Elavil tablet. I changed it on my meds list, though - thanks.
Posted by Phillipa on February 16, 2012, at 21:18:28
In reply to Aspirin, posted by Maisey on February 16, 2012, at 20:10:28
Maisey just trying to help. Important though for someone reading your list of meds. Phillipa
Posted by Maisey on February 25, 2012, at 18:49:54
In reply to Thyroid levels and Serotonin, posted by bulldog2 on September 27, 2008, at 19:11:43
Anyone else can join in - I had a lot of discussion on this thread with ed_uk2010, so I'm hoping he'll respond.
I opted to buy generic Lexapro from an online pharmacy site - Cipralex 20 (made in India). I'd heard good things about buying meds this way, esp from India. I've been on this for 4 days at 5mg, and I feel BAD. I recently read about someone else who'd taken another generic Lexapro from India (called something different), and he felt similarly. I just wonder if it's possible that, even though I've been on Lexapro before, I can get a different reaction when re-starting. I don't want to believe that I got ahold of something bad tho that is prolly the most logical answer. I feel hazy, very like when I took Citralopram. I'm also going through bad moodswings, though IDK if that has to do with the med. I feel like I should be feeling better, though, as I did when I originally started Lexapro (in 2006). I guess I'm looking for advice - any advice - it's the weekend, or I'd call my doctor. He is aware that I'm taking this.
Posted by ed_uk2010 on February 26, 2012, at 6:35:52
In reply to Ed_uk2010 - are you there?, posted by Maisey on February 25, 2012, at 18:49:54
Hi,
>I opted to buy generic Lexapro from an online pharmacy site - Cipralex 20 (made in India).
Cipralex isn't a generic, it's the brand name for escitalopram in many countries. The problem with buying online from that type of site is that it's very difficult to know whether the medicine is genuine or counterfeit. Some websites sell very sophisticated counterfeits which can make it difficult to tell. I'm not saying that your medicine is a counterfeit, just that it's a possibility. I really can't say.
>I'm just wonder if it's possible that, even though I've been on Lexapro before, I can get a different reaction when re-starting.
Yes, it's possible. We often hear people report that.
>I feel hazy, very like when I took citalopram.
This can happen when starting citalopram or escitalopram, to be fair.
Hope you're OK until you see your doc.
Posted by Maisey on February 26, 2012, at 11:37:31
In reply to Re: Ed_uk2010 - are you there? » Maisey, posted by ed_uk2010 on February 26, 2012, at 6:35:52
>
> Cipralex isn't a generic, it's the brand name for escitalopram in many countries. The problem with buying online from that type of site is that it's very difficult to know whether the medicine is genuine or counterfeit. Some websites sell very sophisticated counterfeits which can make it difficult to tell. I'm not saying that your medicine is a counterfeit, just that it's a possibility. I really can't say.
>I also read that in generics in the U.S., the generic formulation can have up to 20% variance to the original's formulation. And, in tests of some drugs, 30% variance was found! So, that worries me a little bit - not knowing India's standards.
>
> This can happen when starting citalopram or escitalopram, to be fair.
>
I didn't feel this way, I don't think, when I began Lexapro before - maybe a little bit. I started out on 10mg at that time, too, which is 2x what I've been taking.> Hope you're OK until you see your doc.
>
>
I think I'll be ok going off this cold turkey since it's only a 5mg dose. I def don't feel like taking it again! Yesterday evening, I was very weepy and upset over things in the past. I *can* get that way, but usually not that bad. I got strange brain twitches toward evening, and felt almost jerky. I've heard of people getting that way going off an AD, but never experienced it myself.Thanks for your response - I do feel better today.
Posted by ed_uk2010 on February 27, 2012, at 1:25:15
In reply to Re: Ed_uk2010 - are you there? » ed_uk2010, posted by Maisey on February 26, 2012, at 11:37:31
>I also read that in generics in the U.S., the generic formulation can have up to 20% variance to the original's formulation. And, in tests of some drugs, 30% variance was found! So, that worries me a little bit - not knowing India's standards.
India has a substantial pharmaceutical industry. A lot of generics and branded medicines are made (for the rest of the world) in India. The problem isn't where your medication was made, it's the issue of whether it's actually a genuine product. Some medicines sold over the internet are fakes.
Assuming your medicine is genuine, Cipralex is not a generic. Cipralex is the brand name used by the manufacturer, Lundbeck, in many countries, including the UK.
US generics do not differ from the brand by 20% in terms of formulation. The quantity of drug contained in the tablets is exactly the same as the brand. The 20% figure is part of a statistical bio-availability calculation, and is often misquoted.
>I think I'll be OK going off this cold turkey since it's only a 5mg dose.
I think you'll be OK to just stop. To be honest, I think you would feel much safer taking something from your doctor. You could try generic sertraline (Zoloft), starting at a low dose initially. Sometimes people get worse before they get better, but it's generally a useful medicine. Alternatively, you could ask your doctor about taking a higher dose of amitriptyline, since you are already used to this medication.
Posted by Maisey on February 28, 2012, at 17:04:43
In reply to Re: Ed_uk2010 - are you there? » Maisey, posted by ed_uk2010 on February 27, 2012, at 1:25:15
But, could the variance from generic to original matter in terms of side effects? With metformin, for example, I had terrible emotional side effects. I was told to try the brand name, Glucophage, because some people had better luck with it. They even said try met from a different manufacturer because a lot of people who took metformin from Teva had problems with it when they'd never had probs from metformin before. I never tried the brand name metformin b/c I reacted so badly to met, I doubted it would make a difference. But, I wonder if it WOULD make a difference in a medication like an anti-depressant?
When I took Zoloft before, I didn't have any issues, but I don't want to take something that will make me feel worse before I feel better -something that has a reputation of doing that. I'm hesitant to get back on an anti-d now because I really felt unstable on Cipralex, and if I'd felt any more unstable, I probably would have put myself and other people in danger. It is common for me to have passing suicidal feelings and visions, on a normal day, and if I'm going through a bad spell, the feelings are much more frequent and much more real. The difference is, normally when something goes wrong and I have the vision, I'm able to logically think thorugh it and get it out of my mind. If I'm going through a "bad spell," or less commonly, when I take a medication that doesn't agree with me (metformin and birth control pills were ones), I get an inclination to commit this act. I obviously haven't done it or I'd be dead, but the feelings are quite strong. I feel if the right provocation came along when I already felt badly, I would do it. It used to be drowning that I'd think about. Now, it is ramming my car into a semi. I logically thought it through and at some point decided this would be an easier, quicker way, but there is more alarm b/c it possibly puts other people at risk. That is why it's important to me to have the "right" medication - it's why I was so intent on getting Lexapro. It did so well for me before. Now, the problem is I don't know if Cipralex was an exact Lexapro equivalent and I no longer agree with the medicine OR did I get some phony drug and Lexapro prescribed by my doctor is still the best solution? OR, it could be I was going through a bad spell anyway, and the drug had no effect. Lexapro, in the past, though, did seem to help me work out of the bad spells faster. I tend to have the bad spells at the end of my cycle, though I mentally note when they arrive, and I don't see a definite trend.
Anyway, I've been having a pretty stable last couple of days, so I'm taking this time to think about what I want to do.
Posted by Maisey on February 28, 2012, at 19:18:11
In reply to Re: Ed_uk2010 - are you there? » Maisey, posted by ed_uk2010 on February 27, 2012, at 1:25:15
Have you heard anything about elavil working for OCD? I know it's not approved for it. From what I've read, it doesn't sound like it would help (my skin and hair picking issues) - it hasn't at this dose. I like the idea of using elavil for an AD rather than sleep aid, but I actually cut its dose down even more just before adding the Cipralex on. I've still kept it at that dose - I may go back to 25mg. I'm not sure I could function at a higher dose than that, even if I split up the dose b/w day and night.
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