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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Baseball85 on February 28, 2013, at 9:59:48
Hey Scott, in my thread about my Lexapro dosage being too high you said this "I would think it more likely that your dose is too low. Instead of languishing for an extended period of time trying to finesse the dosage between 10 - 15 mg/day, perhaps you should do a quick experiment and go to 20 mg/day. I think your tiredness and irritability are the result of the breakthrough of the underlying illness. I could be wrong, but without knowing more about you, I would think it a possibility. Would your doctor allow you to go to 20 mg/day?"
What did you mean by my tiredness an irritability being the result if a breakthrough of my illness?
Sorry, this is my first time on any medication. I started having terrible anxiety about 4 months ago after my first daughter was born. I'm 28 and just trying to figure all this out. I guess I'm scared to try 20 bc I think that means I am really "i'll" and don't want to admit it.
Since dropping to 10 a couple days ago I have felt less tired but anxiety has been back up. Does the tiredness go away with time in these meds?
When I was 15 I think I was mistaking the tiredness, and physical agitation with anxiety. Plus I only gave the 15 4 weeks. I am going to speak with doc again today. Sorry I'd this random, I am typing from my phone. Thanks!!
Posted by brynb on February 28, 2013, at 10:58:52
In reply to SLS...Question, posted by Baseball85 on February 28, 2013, at 9:59:48
hi baseball-
sorry, i'm not sls, but i'm on 20mg of lexapro (and have been for years at different mg). i often get anxiety w/ dose increases and decreases in meds. i'm in agreement w/ scott here that 20 mg is a good dose. the therapeutic range is really 10-20mg, but with anxiety, as it's a pure sri, 20mg is a wise dose.
just my 2 cents.
good luck.
-b
Posted by Baseball85 on February 28, 2013, at 11:09:34
In reply to Re: SLS...Question » Baseball85, posted by brynb on February 28, 2013, at 10:58:52
Thanks, Bryn. I have been on 10mg since October. I was taking 5mg in the morning and 5mg at night. It was working pretty well for about 5 weeks. Then about 5 weeks ago he had me start taking 10mg in morning and then a week after that had me take 15mg in the morning. I had the normal anxiety increase after about a week for about 5 days and then it subsided. At weeks of 15 I started feeling sooooo tired and jittery and irritable. Was this still start up side effects most likely?
Posted by SLS on February 28, 2013, at 11:14:12
In reply to SLS...Question, posted by Baseball85 on February 28, 2013, at 9:59:48
> Hey Scott, in my thread about my Lexapro dosage being too high you said this "I would think it more likely that your dose is too low. Instead of languishing for an extended period of time trying to finesse the dosage between 10 - 15 mg/day, perhaps you should do a quick experiment and go to 20 mg/day. I think your tiredness and irritability are the result of the breakthrough of the underlying illness. I could be wrong, but without knowing more about you, I would think it a possibility. Would your doctor allow you to go to 20 mg/day?"
> What did you mean by my tiredness an irritability being the result if a breakthrough of my illness?I apologize. I should have elaborated. Treatment "breakthrough" describes the phenomenon wherein someone's illness re-emerges, despite previous success at a given dosage of medication. This often happens when an external stressor occurs or even when someone experiences an infection. It sometimes resolves by itself, especially when the stressors resolve.
It is not unusual for someone to experience a transient treatment response at a low dosage early in treatment. However, sometimes a dosage increase is necessary to produce a more reliable improvement.
> Sorry, this is my first time on any medication.
I'm sorry that you should find yourself in such a position as to need treatment. I can understand your trepidations and confusion. I bet your doctor is confused at times. I hope he is right, though. It would be great if a dosage of 10 mg/day were optimal for you, and that you should need a only a short course of treatment.
It is quite possible that the "tiredness" or fatigue you experience is a side effect of Lexapro. It was with me. It may or may not persist. Unfortunately, few if any doctors would be able to predict this for you. If the tiredness does persist, you can change drugs. I don't think Zoloft is as likely to produce the tiredness, but it might not treat the anxiety as well. Perhaps others can offer some insight into this. Again, though, you would be relegated to trial-and-error. Interestingly, insomnia is a possible side effect of Lexapro.
Lexapro is known to produce anxiety and/or agitation briefly, sometimes occurring for a few days between days 14 - 21 of treatment.
> I started having terrible anxiety about 4 months ago after my first daughter was born. I'm 28 and just trying to figure all this out. I guess I'm scared to try 20 bc I think that means I am really "i'll" and don't want to admit it.
Sort of yes and sort of no. You don't necessarily have to be considered more sick if you require higher dosages of a drug. It might depend on how rapidly your body eliminates the drug - how long it stays in the blood stream. I really don't know all of the variables that would contribute to needing higher dosages of Lexapro. However, your anxiety does sound substantial.
In what ways has the anxiety impacted your life?
Is depression a problem?
> Since dropping to 10 a couple days ago I have felt less tired but anxiety has been back up. Does the tiredness go away with time in these meds?
Again, I doubt even your doctor could tell you with certainty. He may have a good idea, though - certainly better than I do. It would be worth asking him how often the tiredness disappears with continued treatment.
So, it is possible that a dosage of 20 mg/day will be necessary to produce a stable improvement, but that tiredness and fatigue become troublesome side effects. They might disappear after a few weeks or they might linger.
> When I was 15 I think I was mistaking the tiredness, and physical agitation with anxiety. Plus I only gave the 15 4 weeks.
That should be a long enough period of time to evaluate the effectiveness of that dosage. If Lexapro is going to be a good match for you, you may find yourself stabilizing at 20 mg/day. That's just my first impression.
Did your doctor offer any other avenues of treatment? Did he discuss benzodiazepine drugs like Klonopin or Ativan?
How long was it that you experienced anxiety before beginning treatment with Lexapro? Perhaps the anxiety will be self-limiting as your hormonal systems reestablish balance.
It is possible that the anxiety you experienced from reducing the dosage from 15 mg/day to 10 mg/day was actually a form of withdrawal.
All of this stuff might be overwhelming at first. As you can see, there is much to consider.
Each person on Psycho-Babble will have his own biases when offering you feedback. My biases incline me to suggest working out with your doctor a trial of Lexapro at 20 mg/day if the 10 mg/day dosage proves worthless.
There are alternatives. However, since you are already taking Lexapro, you might as well explore it fully before changing treatments. Your doctor made a reasonable choice starting with Lexapro.
I wish you the best of luck. You'll be okay.
- Scott
Posted by brynb on February 28, 2013, at 11:25:53
In reply to Re: SLS...Question, posted by Baseball85 on February 28, 2013, at 11:09:34
> Thanks, Bryn. I have been on 10mg since October. I was taking 5mg in the morning and 5mg at night. It was working pretty well for about 5 weeks. Then about 5 weeks ago he had me start taking 10mg in morning and then a week after that had me take 15mg in the morning. I had the normal anxiety increase after about a week for about 5 days and then it subsided. At weeks of 15 I started feeling sooooo tired and jittery and irritable. Was this still start up side effects most likely?
I'm inclined to say yes, but everyone is different. For me, I usually have rocky start-ups with meds.
I read Scott's post and his advice is great.
Also take into account that you're female. (I'm a woman too.) My pdoc is quick to point out that hormones can often alter our reactions to meds.
Also, don't be scared off by what dosage you're on. If anxiety is the biggest issue, I think 20mg of Lexapro at night is you're best bet, and possibly add a benzo (I like Valium, but everyone is different) if need be.
I found that once I got used to Lexapro, the side effects (such as lethargy) subsided. When I experience symptoms such as anxiety and/or lethargy now, it's typically my depression, not the meds, that's causing it.
Good luck.
-b
Posted by SLS on February 28, 2013, at 11:37:13
In reply to Re: SLS...Question, posted by Baseball85 on February 28, 2013, at 11:09:34
> Thanks, Bryn. I have been on 10mg since October. I was taking 5mg in the morning and 5mg at night. It was working pretty well for about 5 weeks. Then about 5 weeks ago he had me start taking 10mg in morning and then a week after that had me take 15mg in the morning. I had the normal anxiety increase after about a week for about 5 days and then it subsided. At weeks of 15 I started feeling sooooo tired and jittery and irritable. Was this still start up side effects most likely?
I think it is possible that it is your illness breaking through as might be incompletely treated. The symptoms might even be exaggerated forms of your original symptoms. You could be caught in between response and relapse. It is a confusing and uncomfortable place to be. I have seen this happen with myself several times. I still think it will be worth going to 20 mg/day if 10 mg/day proves ineffective. However, I would not continue at that dosage if increased anxiety, agitation, and irritability were to continue for more than a week. Some people go to 40 mg/day, so you are not really pushing the dosage too much.
Antidepressants are not ideal treatments, but sometimes they are the best available tools that medical science gives us to work with at this juncture.
If this is your first episode of anxiety, I would consider discontinuing Lexapro after a year or so. You may no longer need it by then.
These illnesses really suck.
Good luck with Lexapro. If it doesn't work out for you, you can bet that people here will shower you with ideas as to what alternative treatments are available so that you can discuss them with your doctor.
- Scott
Posted by Baseball85 on February 28, 2013, at 11:39:08
In reply to Re: SLS...Question » Baseball85, posted by SLS on February 28, 2013, at 11:14:12
> > Hey Scott, in my thread about my Lexapro dosage being too high you said this "I would think it more likely that your dose is too low. Instead of languishing for an extended period of time trying to finesse the dosage between 10 - 15 mg/day, perhaps you should do a quick experiment and go to 20 mg/day. I think your tiredness and irritability are the result of the breakthrough of the underlying illness. I could be wrong, but without knowing more about you, I would think it a possibility. Would your doctor allow you to go to 20 mg/day?"
>
> > What did you mean by my tiredness an irritability being the result if a breakthrough of my illness?
>
> I apologize. I should have elaborated. Treatment "breakthrough" describes the phenomenon wherein someone's illness re-emerges, despite previous success at a given dosage of medication. This often happens when an external stressor occurs or even when someone experiences an infection. It sometimes resolves by itself, especially when the stressors resolve.
>
> It is not unusual for someone to experience a transient treatment response at a low dosage early in treatment. However, sometimes a dosage increase is necessary to produce a more reliable improvement.
>
> > Sorry, this is my first time on any medication.
>
> I'm sorry that you should find yourself in such a position as to need treatment. I can understand your trepidations and confusion. I bet your doctor is confused at times. I hope he is right, though. It would be great if a dosage of 10 mg/day were optimal for you, and that you should need a only a short course of treatment.
>
> It is quite possible that the "tiredness" or fatigue you experience is a side effect of Lexapro. It was with me. It may or may not persist. Unfortunately, few if any doctors would be able to predict this for you. If the tiredness does persist, you can change drugs. I don't think Zoloft is as likely to produce the tiredness, but it might not treat the anxiety as well. Perhaps others can offer some insight into this. Again, though, you would be relegated to trial-and-error. Interestingly, insomnia is a possible side effect of Lexapro.
>
> Lexapro is known to produce anxiety and/or agitation briefly, sometimes occurring for a few days between days 14 - 21 of treatment.
>
> > I started having terrible anxiety about 4 months ago after my first daughter was born. I'm 28 and just trying to figure all this out. I guess I'm scared to try 20 bc I think that means I am really "i'll" and don't want to admit it.
>
> Sort of yes and sort of no. You don't necessarily have to be considered more sick if you require higher dosages of a drug. It might depend on how rapidly your body eliminates the drug - how long it stays in the blood stream. I really don't know all of the variables that would contribute to needing higher dosages of Lexapro. However, your anxiety does sound substantial.
>
> In what ways has the anxiety impacted your life?
>
> Is depression a problem?
>
> > Since dropping to 10 a couple days ago I have felt less tired but anxiety has been back up. Does the tiredness go away with time in these meds?
>
> Again, I doubt even your doctor could tell you with certainty. He may have a good idea, though - certainly better than I do. It would be worth asking him how often the tiredness disappears with continued treatment.
>
> So, it is possible that a dosage of 20 mg/day will be necessary to produce a stable improvement, but that tiredness and fatigue become troublesome side effects. They might disappear after a few weeks or they might linger.
>
> > When I was 15 I think I was mistaking the tiredness, and physical agitation with anxiety. Plus I only gave the 15 4 weeks.
>
> That should be a long enough period of time to evaluate the effectiveness of that dosage. If Lexapro is going to be a good match for you, you may find yourself stabilizing at 20 mg/day. That's just my first impression.
>
> Did your doctor offer any other avenues of treatment? Did he discuss benzodiazepine drugs like Klonopin or Ativan?
>
> How long was it that you experienced anxiety before beginning treatment with Lexapro? Perhaps the anxiety will be self-limiting as your hormonal systems reestablish balance.
>
> It is possible that the anxiety you experienced from reducing the dosage from 15 mg/day to 10 mg/day was actually a form of withdrawal.
>
> All of this stuff might be overwhelming at first. As you can see, there is much to consider.
>
> Each person on Psycho-Babble will have his own biases when offering you feedback. My biases incline me to suggest working out with your doctor a trial of Lexapro at 20 mg/day if the 10 mg/day dosage proves worthless.
>
> There are alternatives. However, since you are already taking Lexapro, you might as well explore it fully before changing treatments. Your doctor made a reasonable choice starting with Lexapro.
>
> I wish you the best of luck. You'll be okay.
>
>
> - ScottThanks Scott, all very helpful!!
I agree that I should explore all dose's before moving on.
I do have some depression. It all started as anxiety but then I started to get depressed about my anxiety and its issues.It's always worse in the mornings. I had it pretty much kicked about a month ago but it has resurfaced since upping the dose. I tend to wake up about 30 min before my alarm goes off and have what I call my anxiety sting and restlessness. That's the absolute WORST part.
My doc did give me klonopin to take as needed but I use that very sparingly. I am speaking with my doc tonight to see if he thinks I should give the 10mg a week or so or try 20mg. At least if it doesn't work I will know I tried everything. Thanks
Posted by Baseball85 on February 28, 2013, at 11:50:43
In reply to Re: SLS...Question, posted by Baseball85 on February 28, 2013, at 11:39:08
Also, can a dosage actually be too much and make anxiety worse or is it just being able to tolerate side effects?
Posted by Phillipa on February 28, 2013, at 12:02:42
In reply to Re: SLS...Question, posted by Baseball85 on February 28, 2013, at 11:50:43
My pdoc was surprised to hear I took my lexapro at night. But it makes me tired. I do take low dose of benzos with only 5mg. But since I'm so much older the docs now don't like high doses. I'm trying now to stop completely the luvox down to 25mg for about a week now. Some have said I seem lonely. When younger lexapro really increased anxiety even with benzos could be at the time that hormones caused this. Will you let us know what your pdoc suggests? Thanks Phillipa
Posted by SLS on February 28, 2013, at 12:09:36
In reply to Re: SLS...Question, posted by Baseball85 on February 28, 2013, at 11:50:43
> Also, can a dosage actually be too much and make anxiety worse
Definitely.
> or is it just being able to tolerate side effects?
With Lexapro, I would think that startup anxiety as a side effect would be limited to a week or so once it first appears or possibly upon dosage increases. You should know pretty quick if Lexapro 20 mg/day is not right for you. I am hoping that your anxiety disappears as soon as you arrive at 20 mg/day.
- Scott
Posted by Baseball85 on February 28, 2013, at 12:20:04
In reply to Re: SLS...Question » Baseball85, posted by SLS on February 28, 2013, at 12:09:36
> > Also, can a dosage actually be too much and make anxiety worse
>
> Definitely.
>
> > or is it just being able to tolerate side effects?
>
> With Lexapro, I would think that startup anxiety as a side effect would be limited to a week or so once it first appears or possibly upon dosage increases. You should know pretty quick if Lexapro 20 mg/day is not right for you. I am hoping that your anxiety disappears as soon as you arrive at 20 mg/day.>
>
> - ScottThanks! I know you can't say with any certainty bc everyone is different. But after a couple weeks, if the anxiety is terrible it's either too much or the wrong med?
Posted by brynb on February 28, 2013, at 13:28:29
In reply to Re: SLS...Question, posted by Baseball85 on February 28, 2013, at 12:20:04
> > > Also, can a dosage actually be too much and make anxiety worse
> >
> > Definitely.
> >
> > > or is it just being able to tolerate side effects?
> >
> > With Lexapro, I would think that startup anxiety as a side effect would be limited to a week or so once it first appears or possibly upon dosage increases. You should know pretty quick if Lexapro 20 mg/day is not right for you. I am hoping that your anxiety disappears as soon as you arrive at 20 mg/day.
>
> >
> >
> > - Scott
>
> Thanks! I know you can't say with any certainty bc everyone is different. But after a couple weeks, if the anxiety is terrible it's either too much or the wrong med?
>
>Again, Baseball, I think the advice Scott gave above is wise. Lexapro is really good for anxiety and I see why it would be a first choice med if you've never been on others before. Try the 20 mg and I think within 10-14 days, you'll know if you're feeling better or worse.
Hang in there. Having a child is a big life-changer.
-b
Posted by jrbecker76 on March 2, 2013, at 11:57:05
In reply to SLS...Question, posted by Baseball85 on February 28, 2013, at 9:59:48
> Hey Scott, in my thread about my Lexapro dosage being too high you said this "I would think it more likely that your dose is too low. Instead of languishing for an extended period of time trying to finesse the dosage between 10 - 15 mg/day, perhaps you should do a quick experiment and go to 20 mg/day. I think your tiredness and irritability are the result of the breakthrough of the underlying illness. I could be wrong, but without knowing more about you, I would think it a possibility. Would your doctor allow you to go to 20 mg/day?"
>
> What did you mean by my tiredness an irritability being the result if a breakthrough of my illness?
>
> Sorry, this is my first time on any medication. I started having terrible anxiety about 4 months ago after my first daughter was born. I'm 28 and just trying to figure all this out. I guess I'm scared to try 20 bc I think that means I am really "i'll" and don't want to admit it.
>
> Since dropping to 10 a couple days ago I have felt less tired but anxiety has been back up. Does the tiredness go away with time in these meds?
>
> When I was 15 I think I was mistaking the tiredness, and physical agitation with anxiety. Plus I only gave the 15 4 weeks. I am going to speak with doc again today. Sorry I'd this random, I am typing from my phone. Thanks!!
I've never been able to handle Lexapro at any dose due to the SEs you mentioned (irritability, increased anxiety, agitation, flattened mood). Surprisingly, I do really well on its predecessor (generic Celexa). It's a lot softer than Lexapro. I would give it a try if you're still experiencing problems.J
Posted by phidippus on March 2, 2013, at 14:29:40
In reply to SLS...Question, posted by Baseball85 on February 28, 2013, at 9:59:48
>I started having terrible anxiety about 4 months ago after my first daughter was born.
It is not unusual for new mothers to incur OCD. Can you tell me about your anxiety?
Eric
Posted by SLS on March 2, 2013, at 15:22:20
In reply to Re: SLS...Question » Baseball85, posted by jrbecker76 on March 2, 2013, at 11:57:05
> I've never been able to handle Lexapro at any dose due to the SEs you mentioned (irritability, increased anxiety, agitation, flattened mood). Surprisingly, I do really well on its predecessor (generic Celexa). It's a lot softer than Lexapro. I would give it a try if you're still experiencing problems.
That's a good idea.
- Scott
Posted by Phillipa on March 2, 2013, at 20:58:27
In reply to Re: SLS...Question » jrbecker76, posted by SLS on March 2, 2013, at 15:22:20
I wonder why it causes tiredness in me strange as years ago couldn't take it due to anxiety from the med? Now is the total opposite? Phillipa
This is the end of the thread.
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