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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Janelle on August 23, 2003, at 22:16:36
After 3 months being on Lexapro, now going on 4 weeks at 30 mg/day (she's in her 70's), she is still feeling extremely fatigued, no joy, very negative, very depressed ...
Would anyone out there recommend adding some Wellbutrin to the Lex or switching to EffexorXR (or some other alternative)?
Would love to hear from anyone who is on BOTH Lexapro and Wellbutrin.
Thanks for any feedback/info you can provide.
Posted by Ame Sans Vie on August 26, 2003, at 10:10:45
In reply to Help me help my mother - LEXAPRO ..., posted by Janelle on August 23, 2003, at 22:16:36
Oh wow... we've talked about your mother being on Lexapro before, but I wasn't aware she was in her 70s. With such a high dose (said to be equivalent to 120mg Celexa!!!), it's not the least bit surprising that she feels awful. You said she experiences no joy -- unless this was a prominent symptom of hers before beginning treatment, I'd hazard a guess that she may be experiencing thymoanesthesia ("emotional anesthesia") from the Lexapro.
You know, I've heard great things about using methylphenidate (preferably a long-acting formulation like Ritalin LA, Metadate CR, or Concerta) to treat depression in the elderly. Perhaps this should be discussed with her doctor, whether it's used simply to augment the Lexapro (which is very common) or as an antidepressant on its own.
Posted by Janelle on August 26, 2003, at 19:42:46
In reply to Re: Help me help my mother - LEXAPRO ... » Janelle, posted by Ame Sans Vie on August 26, 2003, at 10:10:45
Oh my gosh, now I'm quite worried about my mother's dose of Lexapro (except that a supposedly good pdoc is behind it) -- equivalent to 120mg of Celexa!! That is scary, because isn't Celexa max'ed out at like 60-80mg?
(in other words, you shouldn't take more than 60-80mg of Celexa?)How do you know/where did you find out that 30mg of Lex = 120mg of Celexa???!??
Before the Lexapro she was more anxious than she is now (but then again, she has also been on Zyprexa), but you could be onto something about the thymoanesthesia ("emotional anesthesia") being caused by the the Lexapro.
I will pass along your suggestion about
using methylphenidate (especially a long-acting formulation like Ritalin LA, Metadate CR, or Concerta) to treat her depression since she is elderly.Thanks for your response and info!
Posted by Ame Sans Vie on August 26, 2003, at 21:04:02
In reply to How do you know Celexa/Lexapro equivalents... » Ame Sans Vie, posted by Janelle on August 26, 2003, at 19:42:46
I believe it's in the Lexapro prescribing information that 10mg Lexapro = 40mg Celexa. How that works out, I have no clue, since Lexapro is basically half of the Celexa molecule.
Posted by Janelle on August 27, 2003, at 17:56:12
In reply to Re: How do you know Celexa/Lexapro equivalents..., posted by Ame Sans Vie on August 26, 2003, at 21:04:02
Thanks for telling me the source of your info regarding Lex and Celexa equivalents. I would have also thought that since Lex has only the supposedly "active" half of Celexa that 10 mg of Lex would be the equivalent of 20 mg of Celexa.
However, I have long been suspicious of Lex being just the "active" half of Celexa because if that is true, then theoretically Lex and Celexa should be basically the same (since Celexa has an inactive half), so why would some people respond to Celexa but not Lex and vice versa. I hope this makes sense!
Posted by Caleb462 on August 27, 2003, at 18:49:38
In reply to Re: How do you know Celexa/Lexapro equivalents..., posted by Ame Sans Vie on August 26, 2003, at 21:04:02
> I believe it's in the Lexapro prescribing information that 10mg Lexapro = 40mg Celexa. How that works out, I have no clue, since Lexapro is basically half of the Celexa molecule.
Eh?? You sure? Cause that makes no sense.
Posted by Janelle on August 27, 2003, at 21:42:42
In reply to Re: How do you know Celexa/Lexapro equivalents..., posted by Caleb462 on August 27, 2003, at 18:49:38
I did a quick search on Lexapro/Celexa equivalency and sure enough a few sites said that 10mg of Lexapro = 40 mg of Celexa. I have no clue how they arrived at this, but that's what I found. Well, it fits my hypothetical gut feeling that there's more to this Lex/Celexa relationship than meets the eye, meaning that I have this weird feeling that there is more to Celexa chemically than has been admitted by the manufacturer. I don't think that half of it is supposedly inactive or whatever. But what do I know?!!!
Posted by Ame Sans Vie on August 28, 2003, at 7:46:09
In reply to I did a quick search and it's true: » Caleb462, posted by Janelle on August 27, 2003, at 21:42:42
I think I understand how this anomaly could be possible... Lexapro is s-citalopram; Celexa is s,r-citalopram. So could it be possible that the r isomer was *not*, in fact, inactive? More specifically, could it be that the r-isomer was in some way *inhibiting* the action of the s-isomer? If so, that would make complete sense, and that's the theory I think I'm going to subscribe to (for now anyway, until I find out for sure). It's just the only thing that seems to make sense -- I definitely found when I took Lexapro that it was about four times as potent as Celexa, with far fewer side effects (especially that horrible somnolence and apathy).
Posted by zeugma on August 28, 2003, at 9:41:34
In reply to Re: I did a quick search and it's true: » Janelle, posted by Ame Sans Vie on August 28, 2003, at 7:46:09
> I think I understand how this anomaly could be possible... Lexapro is s-citalopram; Celexa is s,r-citalopram. So could it be possible that the r isomer was *not*, in fact, inactive? More specifically, could it be that the r-isomer was in some way *inhibiting* the action of the s-isomer? If so, that would make complete sense, and that's the theory I think I'm going to subscribe to (for now anyway, until I find out for sure). It's just the only thing that seems to make sense -- I definitely found when I took Lexapro that it was about four times as potent as Celexa, with far fewer side effects (especially that horrible somnolence and apathy).
Suspicion confirmed: Check out this study: http://www.biopsychiatry.com/escitalopram-lexapro.htm
Posted by Janelle on August 28, 2003, at 21:42:31
In reply to Re: I did a quick search and it's true: » Ame Sans Vie, posted by zeugma on August 28, 2003, at 9:41:34
I clicked on your link, found the study but got lost after the first few sentences! Could you explain BRIEFLY what it says in English! Thanks.
Posted by zeugma on August 29, 2003, at 12:22:17
In reply to Can you translate that into English, please! » zeugma, posted by Janelle on August 28, 2003, at 21:42:31
R-citalopram interferes with the ability of S-citalopram to block the serotonin transporter, so the mixture of R- and S- citalopram is less than half as potent as the S- citalopram by itself. lexapro, according to the abstract, receives much less pharmacological 'static' than Celexa so much lower doses are necessary.
Posted by galkeepinon on August 30, 2003, at 2:20:45
In reply to Re: I did a quick search and it's true: » Janelle, posted by Ame Sans Vie on August 28, 2003, at 7:46:09
Michael!!! I totally agree here!!! It could be very possible that the r isomer was *not*, in fact, inactive!!! I am definately finding out that Lexapro IS about 10X more potent than Celexa with far fewer side effects!!!
Good point!
> I think I understand how this anomaly could be possible... Lexapro is s-citalopram; Celexa is s,r-citalopram. So could it be possible that the r isomer was *not*, in fact, inactive? More specifically, could it be that the r-isomer was in some way *inhibiting* the action of the s-isomer? If so, that would make complete sense, and that's the theory I think I'm going to subscribe to (for now anyway, until I find out for sure). It's just the only thing that seems to make sense -- I definitely found when I took Lexapro that it was about four times as potent as Celexa, with far fewer side effects (especially that horrible somnolence and apathy).
Posted by galkeepinon on August 30, 2003, at 2:21:45
In reply to Re: Can you translate that into English, please!, posted by zeugma on August 29, 2003, at 12:22:17
This is the end of the thread.
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