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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on October 18, 2002, at 14:31:54
In reply to Re: Careful with that T, was Re: orgasms... » SLS, posted by Seamus2 on October 18, 2002, at 10:28:13
Posted by SLS on October 18, 2002, at 14:52:30
In reply to Is Lexapro helping anyone with anxiety, posted by cody on October 18, 2002, at 12:43:43
> I've been on Lexapro about 2 1/2 weeks now. Started at 5mg for 10 days, then 7.5 for 10 days. I haven't gotten any relief from my anxiety yet. In fact, it seems to make me more anxious and I think I'm starting to get depressed over it. I'm thinking about going back to Remeron, although I don't like the s/e, it at least seems to help more with the anxiety. Any thoughts on this would be helpful.
Hi Cody.Anxiety is very often a start-up side effect of SSRI antidepressants. I have seen people complain about every one of them. Fortunately, this side effects seems to go away for most people, although I can't say what the average length of time is. Certainly, don't get depressed about things so soon. If things go well, perhaps the anxiety will begin to disappear after another week, and you will begin to see some positive improvements within another month. Perhaps your doctor can make you more comfortable in the meantime using a mild anxiolytic. Try to stick it out for at least another week with the anxiety.
Best wishes.
- Scott
Posted by cody on October 18, 2002, at 15:24:30
In reply to Re: Is Lexapro helping anyone with anxiety » cody, posted by Alan on October 18, 2002, at 13:39:53
Not really sure what my dx is. It started 3 years ago, after what was to me a taumatic experience. My symptoms began with nausea, dizziness and progressed into a constant state of extreme anxiety. I thought and still think that I was on the verge of a breakdown. I can't concentrate, very anxious and my heart pounds 24/7. Was put on Remeron and ativan and have been on them ever since. It has allowed me to function but I don't think I have felt any kind of happiness in 3 years, which is why I think my doc wanted me to try Lexapro. Right now I feel worse than before and I don't think I can take it much longer. I have a husband and 4 young children and I'm barely managing to cope. I was hoping that the Lex would be my answer, to make me feel "normal" and "happy" again. I'm starting to think that's never going to be possible. I'm sorry to ramble and give you my life history, but I don't know what to do right now. This board has been a big help, and I appreciate all of your advice.
Thanks,
Posted by Alan on October 18, 2002, at 16:02:55
In reply to Re: Is Lexapro helping anyone with anxiety, posted by cody on October 18, 2002, at 15:24:30
> Not really sure what my dx is. It started 3 years ago, after what was to me a taumatic experience. My symptoms began with nausea, dizziness and progressed into a constant state of extreme anxiety. I thought and still think that I was on the verge of a breakdown. I can't concentrate, very anxious and my heart pounds 24/7. Was put on Remeron and ativan and have been on them ever since. It has allowed me to function but I don't think I have felt any kind of happiness in 3 years, which is why I think my doc wanted me to try Lexapro. Right now I feel worse than before and I don't think I can take it much longer. I have a husband and 4 young children and I'm barely managing to cope. I was hoping that the Lex would be my answer, to make me feel "normal" and "happy" again. I'm starting to think that's never going to be possible. I'm sorry to ramble and give you my life history, but I don't know what to do right now. This board has been a big help, and I appreciate all of your advice.
>
> Thanks,
============================================
A form of Post Trumatic Stess has been known to bring to the surface an underlying, prexisting type of anxiety...not that you necessarily have PTSD.Is there a reason that your doctor hasn't offered you the option of a benzodiazapine like ativan or klonopin taken in single form (monotherapy)? The same way they have offered an AD (Leaxapro) as monotherapy? Or have they offered bzds in monotherapy at all?
The best anxiolytic or anti-anxiety medications for the general population has been bzds for the last 40+ years. There are trade off's for both types of drugs but if you have overriding anxiety, seems that you might want to bring this up with your doctor.
I tried all of the AD's and in combo with bzd's and finally found that the bzd klonopin + ativan PRN was by far the most effective.
The success treating anxiety disorders with bzds and even MAOI's are in the 78 - 80% range while the AD's are in the drug co's own stats merely 30 - 50% effective - hardly above pacebo rates.
Of course statistics don't necessarily apply to individual cases but I bring this up because what you are doing now seems not in need of modification, but a rethinking of how to go about treating your symptoms effectively. Especially one with your responsibilities...
Best,
Alan
Posted by sweets on October 18, 2002, at 16:06:56
In reply to Re: Is Lexapro helping anyone with anxiety, posted by cody on October 18, 2002, at 15:24:30
I have just been prescribed with lexapro. Although I have only been on it for 2 days, I feel a lot better than I have in the past year. After having a "break down" my doctor prescribed it. I am in a better mood and don't feel so anxious or depressed. I have noticed that for about 2 hours after I take it, i feel a little bit buzzed. Other than that, I think, so far, it is really helping. Hope this helps!
Posted by Alan on October 18, 2002, at 16:10:07
In reply to Re: Is Lexapro helping anyone with anxiety, posted by cody on October 18, 2002, at 15:24:30
If your doc is one that is not listening to you when you tell them that your symptoms are not treated fully - and they want to try one commercially driven AD after another because they bring up the "A" word (addictive)in regards to bzds alike ativan or klonopin, you may want to print this article out and show it to them. Perhaps you may need a second opinion if they dismiss it. It is common knowledge and accepted treatment amongst those doctors that specialise in the treatment of anxiety disorders and who know these medicines:
http://panicdisorder.about.com/library/weekly/aa031997.htm
Best,
Alan
Posted by Grace on October 18, 2002, at 16:33:01
In reply to Re: Benzodiazapines vs. AD's for anxiety disorder » cody, posted by Alan on October 18, 2002, at 16:10:07
I am diagnosed with panic/anxiety disorder and mild
depression (mostly because of the effect the panic/
anxiety has had on my life).I have tried MANY different meds and am currently taking:
30 mg celexa (at night)
.5 mg 2x day klonopin
10 mg claritin (for sexual side effects)my doctor recently added the claritin to my meds
because of the sexual side effect problem, which
nothing else fixed (buspar, ginko, wellbutrin, etc.).
She had a study that another doctor had done with his
own practice of 9 patients on SSRI's and sexual side
effects. Of those 9, 7 reported their sexual s/e went
away with the claritin and 2 had some improvement.
I figured it was worth a try and amazingly it has
had some effect.I now have some desire for sex (which was non-existent before)
and am able to orgasm without it taking 2 hours and more work
than it was worth. I figure I'm a tough case, so maybe you
can bring this up with your docs.Also, I've just been switched today to Lexapro because of
being very sleepy for the whole time I've been on Celexa.
I'm starting out with 10mg (anytime) and moving up to
15....we'll see.
Posted by maririp on October 18, 2002, at 16:38:28
In reply to Re: Is Lexapro helping anyone with anxiety, posted by cody on October 18, 2002, at 15:24:30
> Not really sure what my dx is. It started 3 years ago, after what was to me a taumatic experience. My symptoms began with nausea, dizziness and progressed into a constant state of extreme anxiety. I thought and still think that I was on the verge of a breakdown. I can't concentrate, very anxious and my heart pounds 24/7. Was put on Remeron and ativan and have been on them ever since. It has allowed me to function but I don't think I have felt any kind of happiness in 3 years, which is why I think my doc wanted me to try Lexapro. Right now I feel worse than before and I don't think I can take it much longer. I have a husband and 4 young children and I'm barely managing to cope. I was hoping that the Lex would be my answer, to make me feel "normal" and "happy" again. I'm starting to think that's never going to be possible. I'm sorry to ramble and give you my life history, but I don't know what to do right now. This board has been a big help, and I appreciate all of your advice.
>
> Thanks,
I went through the same thing in 1986..why not just try lexapro and xanax? I have tried them all and lexapro has been the best for me. I have been on it just one month and it has worked wonderfully, I use xanax but rarely now. Once you find the right medications that work together you should start to feel like yourself again. Its a long road but getting the right combination of meds is the key.
Posted by maririp on October 18, 2002, at 17:19:19
In reply to Re: Benzodiazapines vs. AD's for anxiety disorder, posted by Grace on October 18, 2002, at 16:33:01
> I am diagnosed with panic/anxiety disorder and mild
> depression (mostly because of the effect the panic/
> anxiety has had on my life).
>
> I have tried MANY different meds and am currently taking:
> 30 mg celexa (at night)
> .5 mg 2x day klonopin
> 10 mg claritin (for sexual side effects)
>
> my doctor recently added the claritin to my meds
> because of the sexual side effect problem, which
> nothing else fixed (buspar, ginko, wellbutrin, etc.).
> She had a study that another doctor had done with his
> own practice of 9 patients on SSRI's and sexual side
> effects. Of those 9, 7 reported their sexual s/e went
> away with the claritin and 2 had some improvement.
> I figured it was worth a try and amazingly it has
> had some effect.
>
> I now have some desire for sex (which was non-existent before)
> and am able to orgasm without it taking 2 hours and more work
> than it was worth. I figure I'm a tough case, so maybe you
> can bring this up with your docs.
>
> Also, I've just been switched today to Lexapro because of
> being very sleepy for the whole time I've been on Celexa.
> I'm starting out with 10mg (anytime) and moving up to
> 15....we'll see.Isnt claritin a sinus medication? how does that help sexual side effects of antidepressants?
Posted by cody on October 18, 2002, at 18:23:44
In reply to Re: Is Lexapro helping anyone with anxiety » cody, posted by Alan on October 18, 2002, at 16:02:55
Alan,
Thank you for the helpful information. No, I have not been offered bzd as monotherapy. In addition to the Remeron, I have also been asked to try Paxil and Celexa, but was unable to tolerate either. My doctor has always seemed willing to prescibe the ativan and has told me to increase the dosage while adjusting to the Lexapro. As hard as I try, I just don't seem to be able to tolerate any AD except Remeron. I don't know why, but I have always tried to avoid taking any bzd. After reading the info on the subject, I now have a better understanding of my illness and ways to treat it. Thank you so much for your help.
Posted by pharmrep on October 18, 2002, at 18:24:51
In reply to Re: Benzodiazapines vs. AD's for anxiety disorder, posted by Grace on October 18, 2002, at 16:33:01
> I am diagnosed with panic/anxiety disorder and mild
> depression (mostly because of the effect the panic/
> anxiety has had on my life).
>
> I have tried MANY different meds and am currently taking:
> 30 mg celexa (at night)
> .5 mg 2x day klonopin
> 10 mg claritin (for sexual side effects)
>
> my doctor recently added the claritin to my meds
> because of the sexual side effect problem, which
> nothing else fixed (buspar, ginko, wellbutrin, etc.).
> She had a study that another doctor had done with his
> own practice of 9 patients on SSRI's and sexual side
> effects. Of those 9, 7 reported their sexual s/e went
> away with the claritin and 2 had some improvement.
> I figured it was worth a try and amazingly it has
> had some effect.
>
> I now have some desire for sex (which was non-existent before)
> and am able to orgasm without it taking 2 hours and more work
> than it was worth. I figure I'm a tough case, so maybe you
> can bring this up with your docs.
>
> Also, I've just been switched today to Lexapro because of
> being very sleepy for the whole time I've been on Celexa.
> I'm starting out with 10mg (anytime) and moving up to
> 15....we'll see.*** why go to 15mg? 10mg of lexapro is very potent and demonstrating efficacy compared to 40mg of celexa...dont titrate just to "see" (ps...try taking lex in morning...since you probably wont have that tired feeling you got from celexa...i hear mornings work better for most)
Posted by pharmrep on October 18, 2002, at 18:27:27
In reply to Is Lexapro helping anyone with anxiety, posted by cody on October 18, 2002, at 12:43:43
> I've been on Lexapro about 2 1/2 weeks now. Started at 5mg for 10 days, then 7.5 for 10 days. I haven't gotten any relief from my anxiety yet. In fact, it seems to make me more anxious and I think I'm starting to get depressed over it. I'm thinking about going back to Remeron, although I don't like the s/e, it at least seems to help more with the anxiety. Any thoughts on this would be helpful.
*** 10mg is the starting dose...can you try it?
Posted by cody on October 18, 2002, at 18:46:17
In reply to Re: why only 5, then 7.5mg? » cody, posted by pharmrep on October 18, 2002, at 18:27:27
> > I've been on Lexapro about 2 1/2 weeks now. Started at 5mg for 10 days, then 7.5 for 10 days. I haven't gotten any relief from my anxiety yet. In fact, it seems to make me more anxious and I think I'm starting to get depressed over it. I'm thinking about going back to Remeron, although I don't like the s/e, it at least seems to help more with the anxiety. Any thoughts on this would be helpful.
>
> *** 10mg is the starting dose...can you try it?>>>I seem to be very chemical sensitive. It's not only the physical s/e that bother me. I feel like I'm in a fog, can't think straight, have a harder time just functioning. Also, the Lexapro seems to make me nervous on top of the anxiety.
Posted by pharmrep on October 18, 2002, at 19:17:51
In reply to Re: why only 5, then 7.5mg?, posted by cody on October 18, 2002, at 18:46:17
> > > I've been on Lexapro about 2 1/2 weeks now. Started at 5mg for 10 days, then 7.5 for 10 days. I haven't gotten any relief from my anxiety yet. In fact, it seems to make me more anxious and I think I'm starting to get depressed over it. I'm thinking about going back to Remeron, although I don't like the s/e, it at least seems to help more with the anxiety. Any thoughts on this would be helpful.
> >
> > *** 10mg is the starting dose...can you try it?
>
> >>>I seem to be very chemical sensitive. It's not only the physical s/e that bother me. I feel like I'm in a fog, can't think straight, have a harder time just functioning. Also, the Lexapro seems to make me nervous on top of the anxiety.*** for most people...1-2 wks is all they need...and for others 4-6...why, i dont know, everyone responds differently...perhaps it might take a little longer for you but lexapro does help with anxiety too...hang in there and keep us posted
Posted by Phil on October 18, 2002, at 19:28:19
In reply to Re: adjustment time » cody, posted by pharmrep on October 18, 2002, at 19:17:51
Posted by pharmrep on October 18, 2002, at 19:49:48
In reply to pharmrep..Ever been on meds for depression? (nm), posted by Phil on October 18, 2002, at 19:28:19
Posted by Phil on October 18, 2002, at 20:53:12
In reply to nope (nm) » Phil, posted by pharmrep on October 18, 2002, at 19:49:48
I feel like you understand what patients are feeling. When did you get the ability to empathize but also be aware of where people are on the steps out of hell? People don't usually have that ability if they've never been around suffering.
That's a compliment pharmrep. : ^ )
Posted by momof3 on October 18, 2002, at 20:53:13
In reply to Re: adjustment time » cody, posted by pharmrep on October 18, 2002, at 19:17:51
Cody,
Hi-I am the mother of three children and have suffered depression and anxiety for several years now. I am on 10mg lexapro and felt the fog and sleepiness,sick,headache etc. This lasted for about two weeks and I thought I could not continue. I know how it feels to feel as though you are barely hanging on and these children are looking to you and you have nothing to give. I am at three plus weeks now and am up at 6:30 in the morning and not in bed till a "normal time". This is the first time in a long time I feel like I can be there for my family. If you can work through the icky feeling at 10mg, you may just feel like there is hope. I also can hardly tolerate most meds. Hang in there!Laura
Posted by CuriousJane on October 18, 2002, at 20:59:25
In reply to Anyone switched to Lexapro? « ggrrl, posted by Dr. Bob on June 11, 2002, at 7:52:48
I switched from 30mg of Celexa (which worked fine aside from the total lack of sex drive) to 10mg Lexapro about 7 days ago, and for the last few days I have noticed myself becoming increasingly impatient and frustrated (no one seems to be able to drive right! :). Today I was so frustrated at work I started to cry, which hasn't happened in ages. I have also noticed tension headaches the past few days. No new stresses in my life, so I can only imagine its the meds.
called my doc and he said, "Well, you could need less, or more." Great. So he suggested dropping to 5mg for a few days, and then if that doesn't work, going to 15mg.
Anyone have any similar problems switching?
Posted by lmblec on October 18, 2002, at 21:12:31
In reply to Re: Is Lexapro helping anyone with anxiety » cody, posted by SLS on October 18, 2002, at 14:52:30
i am at 20 mg 2 weeks helps with anxiety but not completely - i tend to sleep much to much and makes tired. anyone have a suggestions. did i go up to fast
i went to twenty mg after one week on ten
lmblec
Posted by Dr. Bob on October 18, 2002, at 21:35:37
In reply to Re: raw boy/see bottom » Phil, posted by pharmrep on October 17, 2002, at 10:27:40
> why are you ripping on me? Im here to help, not be your punching bag.
Please don't post anything that could lead others to feel accused. The last time you were blocked, it was for 1 week, so this time it's for 2.
Bob
PS: Follow-ups regarding posting policies should be redirected to Psycho-Babble Administration; otherwise, they may be deleted.
Posted by Abacus on October 18, 2002, at 22:07:01
In reply to dosing » Grace, posted by pharmrep on October 18, 2002, at 18:24:51
Mornings may work better for most, but for me, evenings are the time to take the lex since it makes me so sleepy and dull. I wake refreshed.
> > I am diagnosed with panic/anxiety disorder and mild
> > depression (mostly because of the effect the panic/
> > anxiety has had on my life).
> >
> > I have tried MANY different meds and am currently taking:
> > 30 mg celexa (at night)
> > .5 mg 2x day klonopin
> > 10 mg claritin (for sexual side effects)
> >
> > my doctor recently added the claritin to my meds
> > because of the sexual side effect problem, which
> > nothing else fixed (buspar, ginko, wellbutrin, etc.).
> > She had a study that another doctor had done with his
> > own practice of 9 patients on SSRI's and sexual side
> > effects. Of those 9, 7 reported their sexual s/e went
> > away with the claritin and 2 had some improvement.
> > I figured it was worth a try and amazingly it has
> > had some effect.
> >
> > I now have some desire for sex (which was non-existent before)
> > and am able to orgasm without it taking 2 hours and more work
> > than it was worth. I figure I'm a tough case, so maybe you
> > can bring this up with your docs.
> >
> > Also, I've just been switched today to Lexapro because of
> > being very sleepy for the whole time I've been on Celexa.
> > I'm starting out with 10mg (anytime) and moving up to
> > 15....we'll see.
>
> *** why go to 15mg? 10mg of lexapro is very potent and demonstrating efficacy compared to 40mg of celexa...dont titrate just to "see" (ps...try taking lex in morning...since you probably wont have that tired feeling you got from celexa...i hear mornings work better for most)
Posted by ANXIETY ANN on October 18, 2002, at 22:27:36
In reply to Re: dosing, posted by Abacus on October 18, 2002, at 22:07:01
Hi Cody,
I too suffer from severe anxiety and panic attacks. I had my first panic attack in 1996 and suffered from anxiety since I was a little girl. I have tried almost every anti-depressant out there and took xanax daily. I've been in counseling twice a month for four years. Right now I take 10mg of Lexapro in the morning and adivan as needed. (usually twice a day). I am also very sensitve to meds and when I first started talking Lexapro I was extremely anxious and could'nt sleep. Ive been on Lexapro for two weeks now, and I feel so much better.(aside fron the sexual s/e). Hang in there, it will get better. Try taking the Lexapro in the am if your not already and give yourself a break, it sounds like your too hard on yourself.
stay in touch
Posted by Alan on October 18, 2002, at 23:16:48
In reply to Re: Is Lexapro helping anyone with anxiety, posted by cody on October 18, 2002, at 18:23:44
> Alan,
> Thank you for the helpful information. No, I have not been offered bzd as monotherapy. In addition to the Remeron, I have also been asked to try Paxil and Celexa, but was unable to tolerate either. My doctor has always seemed willing to prescibe the ativan and has told me to increase the dosage while adjusting to the Lexapro. As hard as I try, I just don't seem to be able to tolerate any AD except Remeron. I don't know why, but I have always tried to avoid taking any bzd. After reading the info on the subject, I now have a better understanding of my illness and ways to treat it. Thank you so much for your help.
============================================You're welcome.
There is a distinctive trend amongst anxiety sufferers - those that respond best to bzds and those to AD's (the AD' as I mentioned before are in the distinct minority).
Both drugs have tolerance ("poop-out" is the euhpemism used by the pharmecticals for AD's) and withdrawal ("discontinuation syndrome" used by AD co's.) so it's a wash.
So, if you've run a sufficient amount of clinical trials with the new AD's sounds like it's time to try the bzds in monotherapy. Remember that each of them will give you a different response so your doctor should give you the latitude to try any one of them either as a single type or combining a long acting (klonopin or Valium) with a shorter one PRN (xanax or ativan) for breakthrough panic or anxiety attack. Either way, it sounds like you are a good candidate.
Remember that there are sedating side effects at first but that will wear off over the course of the first week or so. DO NOT confuse the decrease of the sedating side effect with the med losing any of it's anti anxiety effect. Keep upping the dose (under the docs supervision of course) until either the med has enough benefit without too much side effect to enable you to stick with it.
If one type doesn't work, go to the next one....that's the beauty of it, the med works right away so you can go from one to the other until you find the one that YOU feel best on. DON'T feel bound to some arbitrary starting dose that's on some chart or is preconceived that is not individual to you. Only YOU will know by listening to your body what med at what dose works for you and in what situation. The dose may fluxuate too to trace the waxing and waning of the underlying anxiety disorder.
Leave the commercial interests standing between you and a good doc that understand these meds behind. YOU are the boss and the doc is YOUR employee. As long as you remember that, you'll be in control of your health and the hopelessness of things being out of control will lessen.
Second and third opinions are sought after on a daily basis in medicine. Why should psychiatry be immune to these standard practices? Find someone that is not benzophobic and beyond that understands and has experience treating with these very safest of drugs for anxiety disorders!
Best,
Alan
Posted by Alan on October 18, 2002, at 23:22:50
In reply to Went from Celaxa to Lexapro, notice irriatbility, posted by CuriousJane on October 18, 2002, at 20:59:25
> I switched from 30mg of Celexa (which worked fine aside from the total lack of sex drive) to 10mg Lexapro about 7 days ago, and for the last few days I have noticed myself becoming increasingly impatient and frustrated (no one seems to be able to drive right! :). Today I was so frustrated at work I started to cry, which hasn't happened in ages. I have also noticed tension headaches the past few days. No new stresses in my life, so I can only imagine its the meds.
>
> called my doc and he said, "Well, you could need less, or more." Great. So he suggested dropping to 5mg for a few days, and then if that doesn't work, going to 15mg.
>
> Anyone have any similar problems switching?
=============================================
No but a close friend did...I posted some reasons why I thought it was happening up earlier in this thread. It may be worth looking into. It's only a little technical but seems especially apropos to your situation....http://www.dr-bob.org/babble/20021012/msgs/123451.html
Alan
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