Shown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Colleen D. on March 18, 2006, at 23:42:32
Brief history - I tried 10mg for 6 weeks with a small amount of relief from depression and but gave up on it because I was SOOOOOOOO tired during the day. Dosing at am or pm didn't make a difference. I restarted it about a month later and went straight to 20mg. It's working soooooo well now! My energy level is unbelievable. I think I read on this board that it's manufacturer says 10mg is the standard dosage and that it hasn't found through research that increasing the dosage will help its effectiveness. Does that mean that it's unsafe to take a highr dose? What is the maximum recommended dose? I just can't believe the difference for me between 10 and 20mg! I now need to talk to my GP to get the 20mg prescribed. The pharmacy and dr.'s office gave me a big runaround about getting my last refill filled. It was too soon to have it refilled and they made me wait 24 extra hours before giving me my last refill on the 10mg. So I went 24 hours without it which I got very PO'ed about. My GP wouldn't change it to 20mg and call it in for me when she's never hesitated in the past to increase my AD dosages when I've requestd them.
Does anyone have experience/knowledge that can help answer my question?
Thanks,
Colleen
Posted by med_empowered on March 19, 2006, at 0:11:28
In reply to Lexapro dosage question..., posted by Colleen D. on March 18, 2006, at 23:42:32
antidepressants are strange when it comes to dosing. Usually, manufacturers have set dosage ranges (ex: 20-80mgs/day for Prozac) or even ideal dosages (ex: 60mgs/day for Cymbalta). The beauty of prescription drugs is that docs can rx them for anything, at pretty much any dose. It could be that the extra 10mgs is necessary for you, b/c you rapidly metabolize Lexapro...thats why some people need high doses of stuff (for example, blood levels of antipsychotics can vary wildly from person to person, even at the same dose per day). It could also be that the extra 10mgs did something in your brain above and beyond the usual 10mgs, so you're experiencing something from the "extra" lexapro. Either way, its not necessarily harmful--its just not well-studied. Ex: some docs RX cymbalta at 90, even 120mgs, although 60mgs is currently considered "the dose". And zyprexa is sometimes given at 30+mgs, even though the current max dose (per eli lilly's recommendations) is 20mgs.
As for your GP...GPs tend to prescribe antidepressants too often, but RX them at too low doses--so a shrink might rx 150mgs of, say, Tofranil, but your GP might only go up to 100.
Posted by krybrahaha78 on March 19, 2006, at 1:01:48
In reply to antidepressant dosing, posted by med_empowered on March 19, 2006, at 0:11:28
Just curious--you said some people can get dosages of Zyprexa as high as 30 mgs? My autistic brother was put on 40 mgs. Is that even heard of?
> antidepressants are strange when it comes to dosing. Usually, manufacturers have set dosage ranges (ex: 20-80mgs/day for Prozac) or even ideal dosages (ex: 60mgs/day for Cymbalta). The beauty of prescription drugs is that docs can rx them for anything, at pretty much any dose. It could be that the extra 10mgs is necessary for you, b/c you rapidly metabolize Lexapro...thats why some people need high doses of stuff (for example, blood levels of antipsychotics can vary wildly from person to person, even at the same dose per day). It could also be that the extra 10mgs did something in your brain above and beyond the usual 10mgs, so you're experiencing something from the "extra" lexapro. Either way, its not necessarily harmful--its just not well-studied. Ex: some docs RX cymbalta at 90, even 120mgs, although 60mgs is currently considered "the dose". And zyprexa is sometimes given at 30+mgs, even though the current max dose (per eli lilly's recommendations) is 20mgs.
>
> As for your GP...GPs tend to prescribe antidepressants too often, but RX them at too low doses--so a shrink might rx 150mgs of, say, Tofranil, but your GP might only go up to 100.
Posted by jonquiljo on March 19, 2006, at 1:21:43
In reply to Re: antidepressant dosing, posted by krybrahaha78 on March 19, 2006, at 1:01:48
The 10mg, 20mg thing is (IMO) a marketing thing. I take 30mg, my wife takes 40mg. I've heard even higher than that. It has to do with the cost per dose, and how much the drug company can charge per pill, etc.
Any Dr. that doesn't know that higher than 20mg can be better is an idiot (IMO).
Posted by med_empowered on March 19, 2006, at 1:31:49
In reply to Re: antidepressant dosing, posted by jonquiljo on March 19, 2006, at 1:21:43
hi! OK..antipsychotics for autistic (or just misbehaved) children has been going on forever--pretty much since Thorazine hit the scene in the 50s--and remains controversial. Some people say it does help the kids--other people say its mostly about behavioral control, and the kids really don't get much (if any) benefit. So..I dont know. Its a tough call.
40mgs of zyprexa is A LOT. Maybe your brother metabolizes it quickly, or is on other meds (ex: depakote) that might reduce zyprexa levels and make higher doses necessary (in this scenario, you might need lots more to achieve the same effect, since its getting metabolized so quickly). But..I'd be a little concerned--zyprexa tends to be sedating and cause weight gain/diabetes, and there's still a risk of tardive dyskinesia (although lower than with, say, haldol) that really can't be ignored.
If nothing else, maybe you could try something less sedating? Abilify tends to not-so sedating (sometimes its "activating") and it doesnt seem to cause weight gain or diabetes. Geodon is similar, although its more sedating, is dosed 2X daily, and there are some concerns about cardiovascular risks. I don't know about blood sugar elevation, but it tends to not cause weight gain.
I think some autistic kids also take other stuff--depakote, trileptal, etc.--that can calm them down w/o exposing them to the risks of antipsychotics.
Posted by Racer on March 19, 2006, at 1:49:30
In reply to antidepressant dosing, posted by med_empowered on March 19, 2006, at 0:11:28
>
> As for your GP...GPs tend to prescribe antidepressants too often, but RX them at too low doses--so a shrink might rx 150mgs of, say, Tofranil, but your GP might only go up to 100.GPs rarely prescribe beyond SSRIs, when you come down to it, so I doubt many GPs are prescribing Tofranil at all...
But I agree absolutely with your point: get your drugs set up by a psychiatrist, who has the experience and knowledge to find the best treatment for you. Then, if you need to, you can have your GP continue the prescriptions for you. But for finding the best treatment, absolutely go to a psychiatrist.
That's one thing I really hate about so many insurance plans: you can't go to a pdoc, you have to go to your GP, who may or may not refer you on. Some GPs may benefit from having low referal rates, so they go out of their way not to make those referrals; others may just have the ego to think that they can do just as well; I'm sure there are GPs who think that people won't go to pdocs because of the stigma, so don't bother to refer; and then there are those who just never think to refer. "My patient isn't better on Prozac (or I suppose now it's Lexapro). Well, poor thing, that's too bad. Guess that's as good as it's gonna get..." The big K would be the poster child for GPs who treat depression, I guess. (I know a woman whose K GP put her on Paxil, despite a pre-existing and serious weight problem, and either didn't tell her or didn't know that Paxil can cause weight gain! Now, we all know that weight gain can be depressing, but it's magnified a lot when the doctor tells you that it can't be the drug, because SSRIs don't cause weight loss... She ended up around 150 pounds overweight, and having bariatric surgery. That sort of thing just really disgusts me.)
Sorry. Soapbox for me. Great point, Med. Thanks for making it.
And thanks for making it much more concisely than I...
Posted by Glydin on March 19, 2006, at 8:39:56
In reply to Lexapro dosage question..., posted by Colleen D. on March 18, 2006, at 23:42:32
Everyone being different, a "one size fits all" attitude doesn't seem prudent to me. 20 mgs. works well for me. I began at 10 mgs. and had the increase a few months in after beginning. I know of no specfic "dangers" to the body with a higher dose of Lex.
Posted by Colleen D. on March 19, 2006, at 9:34:45
In reply to Lexapro dosage question..., posted by Colleen D. on March 18, 2006, at 23:42:32
as an aside, I got "kicked out" of the public mental health system here (seeing a pdoc for my prescriptions and a therapist) because I HAD insurance that would cover part of the cost (even though I couldn't afford this cost.) They said that plenty of people needed their services that had no coverage so I should see my GP to maintain my meds. Anyway, I am now on Medicaid, so I may be eligible again, so I am going to see if they'll take me in so there's no no hassle about getting the dosage I need.
Your responses were very informative - thanks sooooooo much again!
Colleen
Posted by Glydin on March 19, 2006, at 10:50:01
In reply to Thanks everyone for your input and..., posted by Colleen D. on March 19, 2006, at 9:34:45
I am very glad to hear you are doing better.
I think therapeudic dosing is variable. On the flip side, my dose of Klonopin was low and below therapeudically accepted levels. I always was cauious to even post it here - as times I did, I actually got posts telling me there was NO way it could be med action but I was experiencing a placebo effect. I knew that wasn't the case. So, see, according to some schools of thought, you can be wrong on either end - even if you know you aren't. Proof is in the response of the individual.
Hope you work out your situation and find an understanding supportive prescriber.
Posted by bassman on March 19, 2006, at 11:38:00
In reply to Lexapro dosage question..., posted by Colleen D. on March 18, 2006, at 23:42:32
I had the same experience-10 mg did nothing, 20 mg worked well. I was attracted to the idea that I was only going to take 10 mg of AD! And I think that was a selling point. But if you look on Remedyfind.com as to what does people are taking of Lexapro, many are taking 20 mg.
Best of luck.
Posted by Emily Elizabeth on March 19, 2006, at 17:01:29
In reply to Re: Lexapro dosage question..., posted by bassman on March 19, 2006, at 11:38:00
Lex comes in 20mg tabs too, so they must have a reason for making them!
I take 40mg rx'ed by my pdoc. Often people w/ anxiety in addition to depression need a higher dose of an SSRI.
Best,
EE
Posted by Phillipa on March 19, 2006, at 20:48:12
In reply to Re: Lexapro dosage question..., posted by Emily Elizabeth on March 19, 2006, at 17:01:29
I wonder why it agitated me. I guess we're all individuals with different body chemistry. Fondly, Phillipa
Posted by Caedmon on March 21, 2006, at 23:31:30
In reply to zyprexa for autistic kids, posted by med_empowered on March 19, 2006, at 1:31:49
I work with a number of kids with autism, most of them on some kind of drug. It is often a low-dose SSRI and/or a neuroleptic such as risperidone. Sometimes a mood stabilizer/antimanic. I would argue that drugs that manage extremely bad behavior is helpful. Some kids can be self-injurious or get into a lot of danger without that touch of olanzapine. But obviously the drug with fewer side effects should be evaluated when possible. I mean, if it's a question of slamming your head into the desk repeatedly, or being drowsy, most everyone will pick the drowsiness. (Sorry, I know this is kind of a tangential topic, it just interested me.)
A LOT of times once the kids have gone through some of the Tx in the Relationship Development Intervention program we have been employing, they get much better w/out meds.
Posted by med_empowered on March 23, 2006, at 2:30:13
In reply to Re: zyprexa for autistic kids » med_empowered, posted by Caedmon on March 21, 2006, at 23:31:30
hi! I am **so** glad you responded. The consisten medication (or recommndation to medicated, at least) of autitistic kids has concerned me for some time (epsecially since it seems that antipsychotics are being used a lot), but I don't really know that much about the day-to-day care for people with autism.
So..when you have kids who are medicated or behaving badly, behavioral interventions can help reduce self-injury and other problematic behavior? that's great. I remember also reading that the antipsychotics were (possibly are) pretty commonly used in "treating" kids who are mentally handicapped. I can't fathom that. I mean, it just seems so risky, especially if you're talking long-term medication. A friend of mine works with mentally handicapped kids and adults, and he says that the number of drugs they're on, and the sheer variety, is astounding: some of them are on massive doses of amphetamines (I guess the stimulation keeps some of them calm), while others are on massive doses of mood-stabilizers (he told me about one case where a guy was on several thousand mgs/depakote daily), and still others are on antipsychotics, even old ones (one guy I met through him has been on Haldol for "behavior issues"--he's already showing signs of Tardive dyskinesia).
What's your take on all this? From my perspective, it seems that SSRIs and benzos would be pretty harmless, but that antipsychotics would probably best be restricted to emergencies, given the risks. Do autistic people often have tardive dyskinesia? How do the drugs impair performance/cognition?
Sorry to ask you so many questions...I just think this is an important issue.
Posted by Caedmon on March 24, 2006, at 22:46:20
In reply to autistic kids and meds, posted by med_empowered on March 23, 2006, at 2:30:13
I haven't seen any of my autistic students develop TD, but then they are usually young so they may not have had the "chance" to. I know one little guy who was put on risperidone .25mg (that's all) and his scores on criterion-referenced problem-solving tests went up a lot. Before the AP, he was throwing almost hourly temper tantrums and would end up having to spend time in confinement until he could calm down. (They can be placed in a smallish padded cell of sorts for 10-15 minutes so that they don't harm themselves or others.)
With this same student, relationship development intervention (RDI) in social reciprocity and communication has further increased his ability to function. It works very well.
Overall, the kids I've seen have benefitted from the medications they've been given, but I am sure that abuses do occur and any time you're giving meds to kids you ought to be extra vigilant.
I have seen low-dose SSRIs (usually Prozac) and Risperdal do the most good. But I don't see a *lot* of students, my n= 20 or so. Different parents swear by different things.
Medications are poor substitutes for quality parents, teachers, and therapists.
Posted by Mandy on March 25, 2006, at 11:27:26
In reply to autistic kids and meds, posted by med_empowered on March 23, 2006, at 2:30:13
I have a 37 year old daughter with autism, classic. We were told to institutionalize her when she was diagnosed. In those days, there was not much. But we preservered and got her in the first public school class in California. I refused to use meds on her in the early days because all they did was major sedate them or cause other adverse reactions. Behavior mod worked the best,although I must say that back then we still did not know what we know now.
I believe that every behavior has a reason--it is just so hard to know the reason because it can be so subtle as a little piece of material out of place in the room.
We have now put her on some medication because she has developed severe OCD and I do think the meds are safer and target the brain chemicals better. What has worked for her is Celexa and Tegretol worked for a long time,but now seems to be getting at toxic level so psych is going to try something else. It is so important to have a doctor who knows autism, and, unfortunately, in these days there are so many people with autism that more doctors are becoming knowledgeable.
I would like to tell you that my daughter lives in supported living which means she has her own place (with help from state monies), has a support day person who takes her to work three days a week--she works at Sports Authority for the past 5 years and recently got an award and a raise!! She loves to ride horses, and I think horses are a great help to people with autism. Melinda has a very normal life now, thanks to some very good support people. Don't ever give up hope. You must always be a strong advocate for your child, but they really can lead happy,productive lives.
Posted by linkadge on March 27, 2006, at 13:21:15
In reply to Re: autistic kids and meds, posted by Mandy on March 25, 2006, at 11:27:26
I think that some of the meds that kids are put on is very disturbing. My brother works for a group home for Children's Aid here in canada, and so he is responsible for med administration.
For starters, these meds are only bandaid solutions in mood disorders so they will only be bandaid solutions for behavioral disorders.
According to my brother, the meds poop-out in these sorts of situations too, all the time. He had a kid start out doing fine on such a dose of prozac, only to have it increase steadily as behavioral problems breakthrough.
The kids are mentally handicapped to begin with, so I don't see how putting them on grams of depakote or other anticonvulsants/antipsychotics is really going improve their long term outlook.
I highly doubt that these medications have any effect on the underlying pathology of such handicaps so I suppose that although the caregivers are happier that their job is easier I don't know if the patients future is improved all that much.
Linkadge
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