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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 49. This is the beginning of the thread.
Posted by Franz on December 12, 2010, at 21:16:05
Hello, I am taking 10 mg escitalopram (for 5 weeks approx and I do nos eee clear results.
It seems that I get lethargic as with other SSRIs I tried. I do not feel more motivated or outgoing. At first it seems that I did not stick to sad thoughts, but I am not sure now.
There are no serious side effects.
Maybe I should try 5 mg but the Dr. thinks it is too low. Maybe I should ask again.
Anyone here had any noticeable results with this drug?
Thanks.
Posted by Phillipa on December 12, 2010, at 21:19:34
In reply to Not sure if escitalopram (Lexapro) is working, posted by Franz on December 12, 2010, at 21:16:05
Franz doing the same and have tried 2.5 to 5mg with 50mg luvox notice nothing at either dose so it's just not me? Wierd. Phillipa
Posted by Christ_empowered on December 12, 2010, at 21:39:12
In reply to Re: Not sure if escitalopram (Lexapro) is working » Franz, posted by Phillipa on December 12, 2010, at 21:19:34
antidepressants aren't all that effective...sometimes, they don't even beat placebo in drug trials. You might do well with a different dose, an additional drug, or a different drug.
Posted by Franz on December 12, 2010, at 21:54:52
In reply to Not sure if escitalopram (Lexapro) is working, posted by Franz on December 12, 2010, at 21:16:05
Thanks for the replies.
I had good expectations for escitalopram. I was also interested in what I read here by peter Kramer about AD:
http://www.doublex.com/section/health-science/real-depression-story?page=0,1Based on my own clinical observations, I suggested that certain antidepressants might make patients less socially anxious and more assertive. At the same time, I wrote that psychotherapy remained the most important intervention for minor depression. (Later, in Against Depression, I supported vigorous treatment, often including medication, for serious bouts of depression.)
If we look only at the two recent studies, we might draw puzzling conclusions about antidepressants. They help with acute severe depression. They help with chronic minor depression. And yet they do little for acute, isolated bouts of minor mood disorder. Still, overall, they make patients resilient in a general fashion having to do with personality traits.
Posted by Conundrum on December 13, 2010, at 0:03:16
In reply to Re: Not sure if escitalopram (Lexapro) is working, posted by Franz on December 12, 2010, at 21:54:52
Lethargy is common with lexapro. Try being assertive with your pdoc and try to get wellbutrin, an SNRI, Remeron, or a tricyclic.
Lexapro appeals to some because it is such a clean SSRI, well i think a lot of people are starting to realize thanks to lexapro, they need to do more than just increase serotonin. Cleaner isn't necessarily, for all, better.
> Thanks for the replies.
>
> I had good expectations for escitalopram. I was also interested in what I read here by peter Kramer about AD:
> http://www.doublex.com/section/health-science/real-depression-story?page=0,1
>
> Based on my own clinical observations, I suggested that certain antidepressants might make patients less socially anxious and more assertive. At the same time, I wrote that psychotherapy remained the most important intervention for minor depression. (Later, in Against Depression, I supported vigorous treatment, often including medication, for serious bouts of depression.)
>
> If we look only at the two recent studies, we might draw puzzling conclusions about antidepressants. They help with acute severe depression. They help with chronic minor depression. And yet they do little for acute, isolated bouts of minor mood disorder. Still, overall, they make patients resilient in a general fashion having to do with personality traits.
>
Posted by Glydin50 on December 14, 2010, at 11:51:14
In reply to Not sure if escitalopram (Lexapro) is working, posted by Franz on December 12, 2010, at 21:16:05
> Anyone here had any noticeable results with this drug?
>
> Thanks.~~~ Huge positive results for me.
Posted by herpills on December 14, 2010, at 13:44:53
In reply to Not sure if escitalopram (Lexapro) is working, posted by Franz on December 12, 2010, at 21:16:05
I have used Lexapro in doses between 5mg and 15mg.
5mg is the best dose for me, helps with depression. I didn't get any additional benefits with a higher dose, just more side effects. Fatigue was especially prominent at 15mg.
Posted by bleauberry on December 14, 2010, at 16:37:47
In reply to Not sure if escitalopram (Lexapro) is working, posted by Franz on December 12, 2010, at 21:16:05
"Motivated" and "outgoing"....these are not typically results seen with any of the SSRIs. Serotonin is more of a calming, serene, everything is ok neurotransmitter. Once in a while someone on an ssri will have an astounding response and feel great, motivated, born again. Those are kind of rare. More common is the apathetic flat line emotion....no lows, but no highs either, flat motivation. Apathy.
Following posts here for many years, and appreciating the writings of Dr Gillman at psychotropical.com, I am in the camp that believes dual-mechanism approaches are best. That is, serotonin and norepinephrine, from two different drugs, not in the same drug, custom balanced for each person. Results are usually faster and more complete. IMO Along those lines, it might make sense to reduce lex to 5mg, or keep it at 10mg, and add 10mg nortriptyline to it. Then play with the doses. The norepinephrine component of Nortriptyline should provide what Lex is not.
Another player in motivation is dopamine. There aren't many drugs that positively impact dopamine. Ritalin qualifies, as does Adderall. Wellbutrin qualifies, though weakly so. Supplements such as DLPA, tyrosine, or SAMe can be combined with Lex, and will all help to bolster the norepinephrine/dopamine side of things.
The only single meds that have balanced serotonin/norepinephrine are MIlnacipran or Clomipramine. Duloxetine and Effexor, while being called mixed serotonin/norepinephrine meds, really are not....the norepinephrine component is very small compared to serotonin.
I think you'll need to add a norepinephrine/dopamine med to the lex to move in the direction you want. Of all the SSRIs, Prozac is usually more stimulating, and Zoloft can be. Lexapro is usually a bit mellow in comparison to those.
> Hello, I am taking 10 mg escitalopram (for 5 weeks approx and I do nos eee clear results.
>
> It seems that I get lethargic as with other SSRIs I tried. I do not feel more motivated or outgoing. At first it seems that I did not stick to sad thoughts, but I am not sure now.
>
> There are no serious side effects.
>
> Maybe I should try 5 mg but the Dr. thinks it is too low. Maybe I should ask again.
>
> Anyone here had any noticeable results with this drug?
>
> Thanks.
Posted by Minsc22 on December 14, 2010, at 17:21:59
In reply to Re: Not sure if escitalopram (Lexapro) is working, posted by bleauberry on December 14, 2010, at 16:37:47
Hello, does a serotonin med can boost the action of a noradrenagic med ie more energy, motivation?
For example, if the action of wellbutrin decreases or stop, does a small dose of zoloft can boost the action of wellbutrin ?
Posted by linkadge on December 14, 2010, at 18:58:36
In reply to Re: Not sure if escitalopram (Lexapro) is working, posted by bleauberry on December 14, 2010, at 16:37:47
>"Motivated" and "outgoing"....these are not >typically results seen with any of the SSRIs.
Not necessarily true. See the thread above re paxil studies. The most pronounced effect of paxil was in turning introverts to extroverts - little effect on core depression, however.
Linkadge
Posted by morgan miller on December 14, 2010, at 21:27:50
In reply to Re: Not sure if escitalopram (Lexapro) is working, posted by bleauberry on December 14, 2010, at 16:37:47
>"Motivated" and "outgoing"....these are not typically results seen with any of the SSRIs. Serotonin is more of a calming, serene, everything is ok neurotransmitter. Once in a while someone on an ssri will have an astounding response and feel great, motivated, born again. Those are kind of rare. More common is the apathetic flat line emotion....no lows, but no highs either, flat motivation. Apathy.
Have to been to Revolutionhealth or Ask a Patient or any other medication review sites? There are plenty of people reporting uplifting feel good responses from SSRIs. This response does not just happen rarely or once in a while. The apathetic reaction is focused so much on sites like babble because this is the place people go to when they are not responding well to medication and need some help and support. I have said it before here, I personally know enough people that are kinda loving their SSRI. I have a hard time believing that all the people I have known to do well on SSRIs are just part of this small population that has a rare positive reaction.
I do believe some SSRIs are more likely to leave someone feeling numb and apathetic, without feeling warm happy and vigilant. I think Zoloft is one SSRI that is much less likely to leave someone feeling numb and apathetic and much more likely to have an overall positive antidepressant response.
Posted by morgan miller on December 14, 2010, at 21:34:29
In reply to Re: Not sure if escitalopram (Lexapro) is working, posted by linkadge on December 14, 2010, at 18:58:36
> >"Motivated" and "outgoing"....these are not >typically results seen with any of the SSRIs.
>
> Not necessarily true. See the thread above re paxil studies. The most pronounced effect of paxil was in turning introverts to extroverts - little effect on core depression, however.
>
> LinkadgeI have both experienced, read about, and been told of people feeling more outgoing and also less inhibited on SSRIs. Some people that I talked to that experienced this were not comfortable with it.
That's interesting about Paxil. It was one of the few drugs I would not stick out the side effects with, it turned me into a complete Zombie for 10 days.
We all obviously know that everyone responds so much differently to medications due to unique brain chemistry's. There are few antidepressants that we can just say have a specific response in most people.
Posted by Phillipa on December 14, 2010, at 22:29:27
In reply to Re: Not sure if escitalopram (Lexapro) is working, posted by morgan miller on December 14, 2010, at 21:34:29
SSRI's do work for people I know Daughter included whos on prozac 20mg and she's not only lost weight but for her anxiety is gone and she takes things in stride. Now she did go through six weeks of anxiety on the way. But gone now. Phillipa
Posted by linkadge on December 17, 2010, at 18:28:14
In reply to Re: Not sure if escitalopram (Lexapro) is working, posted by morgan miller on December 14, 2010, at 21:34:29
At first I liked the SSRI effect, now I realize its just not me.
I don't like to be a "social butterfly".
I go home and think about how foolish social butterflys are for wasting so much mental energy on just trying to be liked.
Linkadge
Posted by morgan miller on December 24, 2010, at 1:00:48
In reply to Re: Not sure if escitalopram (Lexapro) is working, posted by linkadge on December 17, 2010, at 18:28:14
>I go home and think about how foolish social butterflys are for wasting so much mental energy on just trying to be liked.
Maybe some people are simply more social and have realized that they are much happier and life is much fuller if they are connected with people. Being very social and extroverted can be fun, stimulating, and therapeutic.
Being a bit of a social butterfly does not mean you are starved for attention or you need others to like you. Besides, who doesn't need SOMEONE to like them. If one claims to be free of this need, they are in complete denial. It's like when someone says they don't need to be around people in order to be happy. That person is lying to themselves and likely has something quite wrong going on.
Posted by roscopeeco on December 26, 2010, at 3:03:42
In reply to Re: Not sure if escitalopram (Lexapro) is working, posted by Phillipa on December 14, 2010, at 22:29:27
> SSRI's do work for people I know Daughter included whos on prozac 20mg and she's not only lost weight but for her anxiety is gone and she takes things in stride. Now she did go through six weeks of anxiety on the way. But gone now. Phillipa
Prozac did wonders for my father. If Parnate proves to be a failure to me then that might be the SSRI I turn to.
Posted by Franz on January 11, 2011, at 9:57:17
In reply to Not sure if escitalopram (Lexapro) is working, posted by Franz on December 12, 2010, at 21:16:05
Thanks to all for the comments.
For some days the effect get better but now I am getting sleepy or lethargic again. Ias escitalopram supposed to make you feel more energetic?
What I notice is that I do not feel so down when I think in my problems.
I asked the Dt if I can take 0.5 mg instead of 10 mg but he says it is not an effective dose. I am not sure if he is right. Is anyone here taking 0.5?
A side effect I notice is in the ears, difficult to explain, like numb.
Today I took only 0.5 mg and I feel more alert.
Posted by Franz on January 11, 2011, at 10:07:14
In reply to Re: Not sure if escitalopram (Lexapro) is working, posted by Franz on January 11, 2011, at 9:57:17
> Thanks to all for the comments.
>
> For some days the effect get better but now I am getting sleepy or lethargic again. Ias escitalopram supposed to make you feel more energetic?
>
> What I notice is that I do not feel so down when I think in my problems.
>
> I asked the Dt if I can take 0.5 mg instead of 10 mg but he says it is not an effective dose. I am not sure if he is right. Is anyone here taking 0.5?
>
> A side effect I notice is in the ears, difficult to explain, like numb.
>
> Today I took only 0.5 mg and I feel more alert.
>
>Where I wrote 0.5 I should have written 5 mg, sorry.
Posted by Phillipa on January 11, 2011, at 18:42:48
In reply to Re: Not sure if escitalopram (Lexapro) is working, posted by Franz on January 11, 2011, at 10:07:14
Franz I'm also on 5mg can't really say if working or trying to a lot of external stresses at the time. But I'd say yes it can work for some as we all are different. Phillipa
Posted by Franz on January 12, 2011, at 15:45:10
In reply to Re: Not sure if escitalopram (Lexapro) is working » Franz, posted by Phillipa on January 11, 2011, at 18:42:48
> Franz I'm also on 5mg can't really say if working or trying to a lot of external stresses at the time. But I'd say yes it can work for some as we all are different. Phillipa
It seems 5 mg is effective in some cases for SAD:
Efficacy and tolerability of escitalopram in 12- and 24-week treatment of social anxiety disorder: randomised, double-blind, placebo-controlled, fixed-dose study.
Lader M, Stender K, Bürger V, Nil R.
Institute of Psychiatry, University of London, London, SE5 8AF, UK. m.lader@iop.kcl.ac.uk
AbstractSelective serotonin reuptake inhibitors are the pharmacological treatment of choice for the treatment of social anxiety disorder (SAD). The efficacy and tolerability of fixed doses of escitalopram were compared to those of placebo in the long-term treatment of generalised SAD, using paroxetine as an active reference. Patients with a DSM-IV diagnosis of SAD between 18-65 years of age were randomised to 24 weeks of double-blind treatment with placebo (n = 166), 5 mg escitalopram (n = 167), 10 mg escitalopram (n = 167), 20 mg escitalopram (n = 170), or 20 mg paroxetine (n = 169). Based on the primary efficacy parameter, Liebowitz Social Anxiety Scale (LSAS) total score at Week 12 (LOCF), a significantly superior therapeutic effect compared to placebo was seen for 5 and 20 mg escitalopram and for all doses for the OC analyses. Further improvement in LSAS scores was seen at Week 24 (OC and LOCF), with significant superiority over placebo for all doses of escitalopram, and 20 mg escitalopram was significantly superior to 20 mg paroxetine. Response to treatment (assessed by a Clinical Global Impression-Improvement score < or = 2) was significantly higher for all active treatments than for placebo at Week 12. Clinical relevance was supported by a significant decrease in all the Sheehan disability scores, and the good tolerability of escitalopram treatment. It is concluded that doses of 5-20 mg escitalopram are effective and well tolerated in the short- and long-term treatment of generalised SAD.
PMID: 15274173 [PubMed - indexed for MEDLINE]
Posted by Phillipa on January 12, 2011, at 21:39:22
In reply to It seems 5 mg is effective in some cases for SAD, posted by Franz on January 12, 2011, at 15:45:10
Franz anything about Gad or PTSD latest diagnosis from pdoc?
Posted by Franz on January 13, 2011, at 8:22:45
In reply to Re: It seems 5 mg is effective in some cases for SAD » Franz, posted by Phillipa on January 12, 2011, at 21:39:22
> Franz anything about Gad or PTSD latest diagnosis from pdoc?
He did not give me a diagnose. I was always prone to worry with some social phobia and obsessive traits in my opinion. Lately I think due to these tendencies and life events (health problems in the family, work problems, girlfriend breakup) I have been feeling depressed.
He started me on clonazepam (which I do not like very much) but as mood was not better we talked about an antidepressant and he gave me escitalopram 10 mg. This is my second month approx. I notice I do not get so low and that I can switch from bad thoughts more easy but I do not feel much more energy and many times I am lethargic. No bad side effects except from ear discomfort.
I am seeing a therapist too.
Thanks Phillipa for your interest.
Posted by Phillipa on January 13, 2011, at 20:06:21
In reply to Re: It seems 5 mg is effective in some cases for SAD » Phillipa, posted by Franz on January 13, 2011, at 8:22:45
Franz since also taking and at 5mg it's of great interest to me. Phillipa
Posted by Franz on January 13, 2011, at 20:30:46
In reply to Re: It seems 5 mg is effective in some cases for SAD » Franz, posted by Phillipa on January 13, 2011, at 20:06:21
> Franz since also taking and at 5mg it's of great interest to me. Phillipa
I took 5 mg only for two days.
Today I took 5 mg in teh morning and 5 in the evening.
I feel better today. The difference:
1) Last night I took 0.2 mg clonazepam.
2) I slept well.
3) Exposure to intense sun.
4) I went out of my house, walked.
4) No vitamins today but yesterday I took vitamin C.
5) I talked to people, no discussions: parents, the therapist
Posted by Phillipa on January 13, 2011, at 21:47:13
In reply to Re: It seems 5 mg is effective in some cases for SAD » Phillipa, posted by Franz on January 13, 2011, at 20:30:46
Franz I would take the full l0mg if not already on luvox 50mg for many years. Afraid of serotonin syndrome. I do take vitamins. You feel better without them? Intense sun in a warm climate? That surely would help. Phillipa
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