Psycho-Babble Medication Thread 666681

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Re: To Those Who Switched From Celexa to Lexapro..

Posted by qbsbrown on July 13, 2006, at 12:12:29

In reply to Re: To Those Who Switched From Celexa to Lexapro.., posted by SLS on July 13, 2006, at 11:34:57

That said, then it is most likely for me, that 60mgs celexa is 20mgs lexapro. PDCO believes 2:1, but says i could try 20 for a while and see if it is more potent and has less side effects, although she seems to believe is all marketing BS.
My GP says, "we just don't know", so try 20, and go up from there if needed.

Thanks for the info. Why is it so hard for them to nail down a definite answer?

Brian

 

Re: To Those Who Switched From Celexa to Lexapro..

Posted by bassman on July 13, 2006, at 12:39:29

In reply to Re: To Those Who Switched From Celexa to Lexapro.., posted by qbsbrown on July 13, 2006, at 12:12:29

Hey! We've been though this before, remember?:>} I still think the ratio is 2:1 and don't buy the inactive isomer is interfering and therefore Lexapro is more "potent" on a mg active basis. I do think it is a good idea to take Lexapro instead of Celexa simply for toxicity reasons: you are taking less drug. Seems like most people need 20 mg, just like they need 40 mg Celexa-but different people certainly react differently, that's for sure.

 

Re: To Those Who Switched From Celexa to Lexapro..

Posted by joslynn on July 13, 2006, at 12:40:22

In reply to To Those Who Switched From Celexa to Lexapro..,,,,, posted by qbsbrown on July 13, 2006, at 11:04:34

I went from 30 Celexa to 10 Lexapro.

As I recall, the reason I switched was because, after I went off of Remeron, I was having trouble sleeping on just Celexa alone. So as an experiment, pdoc said, try this "new" thing called lexapro (it was new at the time) which may have less side effects.

So, on just the lexapro alone, I didn't have trouble sleeping anymore.

But then, a couple years later, I had some mini-relapses of the D and anxiety coming back, so I added back in Remeron.

Now I am on 10 lex, 15 Remeron. This seems like a good combo for me, but I have to be so very careful with my weight. But that is because of the Remeron, not the lexapro, so that's not relevant to your sitch.

I haven't noticed many other differences from lex to celexa...maybe mouth less dry.

 

Re: To Those Who Switched From Celexa to Lexapro..

Posted by qbsbrown on July 13, 2006, at 12:42:17

In reply to Re: To Those Who Switched From Celexa to Lexapro.., posted by bassman on July 13, 2006, at 12:39:29

Yeah, i know we went over it :)
I was looking for some personal experiences from people, celexa to lexapro, and their doses, and how they felt.

But i think you're right, why overshoot it immediately at 30mgs lexapro.

 

Re: To Those Who Switched From Celexa to Lexapro..

Posted by qbsbrown on July 13, 2006, at 12:44:23

In reply to Re: To Those Who Switched From Celexa to Lexapro.., posted by joslynn on July 13, 2006, at 12:40:22

Thanks for the reply. I too after 5 days, am noticing less dry mouth.

Did you take it morning or night?

regards,

Brian

 

Re: To Those Who Switched From Celexa to Lexapro.. bassman

Posted by SLS on July 13, 2006, at 13:58:33

In reply to Re: To Those Who Switched From Celexa to Lexapro.., posted by bassman on July 13, 2006, at 12:39:29

> Hey! We've been though this before, remember?:>} I still think the ratio is 2:1 and don't buy the inactive isomer is interfering and therefore Lexapro is more "potent" on a mg active basis.

Why do you hurt me?

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=15037515&query_hl=27&itool=pubmed_docsum

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=15812262&query_hl=27&itool=pubmed_docsum

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=15812262&query_hl=27&itool=pubmed_docsum

I'm sure there is more.


- Scott

 

Oops - Lexapro versus Celexa potency

Posted by SLS on July 13, 2006, at 14:19:27

In reply to Re: To Those Who Switched From Celexa to Lexapro.. bassman, posted by SLS on July 13, 2006, at 13:58:33

I'm sorry for the duplication and deletion. This is what I meant to post:


http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=15037515&query_hl=27&itool=pubmed_docsum

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=14501259&query_hl=27&itool=pubmed_docsum

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=15812262&query_hl=27&itool=pubmed_docsum


- Scott

 

Re: To Those Who Switched From Celexa to Lexapro..

Posted by bassman on July 13, 2006, at 14:22:02

In reply to Re: To Those Who Switched From Celexa to Lexapro.. bassman, posted by SLS on July 13, 2006, at 13:58:33

Hey, Scott, I respect your opinion and I've seen a couple of the articles you cite. I just don't buy it and could produce a whole set of opinions that the ratio is 2:1 (and did in the first generation of this post). The only thing that bothers me with my prejudice is that I don't understand why some people get so anxious when they switch to Lexapro (?) As you know, AD's have difficulty in trials doing better than placebo, let alone the subtle is it 2 or 2+ for the Lexapro factor that we're talking about here. As I've said before, the remedyfind.com experience that the average Celexa user uses 40 mg and the average Lexapro user uses 20 mg (more or less), is pretty convincing to me as well. I personally found the ratio to be 2:1 subjectively when I went from Celexa to Lexapro. But then, I could be 100% wrong!:>} Keep up your excellent posts, I always seek them out.
bassman

 

Re: To Those Who Switched From Celexa to Lexapro..

Posted by qbsbrown on July 13, 2006, at 14:29:27

In reply to Re: To Those Who Switched From Celexa to Lexapro.., posted by bassman on July 13, 2006, at 14:22:02

AD's have a hard time beating placebos? Are you serious?

Why isn't that well known amongst the general population and/or all the doctors?

 

Re: To Those Who Switched From Celexa to Lexapro.. bassman

Posted by SLS on July 13, 2006, at 15:06:12

In reply to Re: To Those Who Switched From Celexa to Lexapro.., posted by bassman on July 13, 2006, at 14:22:02

> Hey, Scott, I respect your opinion and I've seen a couple of the articles you cite. I just don't buy it and could produce a whole set of opinions that the ratio is 2:1 (and did in the first generation of this post). The only thing that bothers me with my prejudice is that I don't understand why some people get so anxious when they switch to Lexapro (?) As you know, AD's have difficulty in trials doing better than placebo, let alone the subtle is it 2 or 2+ for the Lexapro factor that we're talking about here. As I've said before, the remedyfind.com experience that the average Celexa user uses 40 mg and the average Lexapro user uses 20 mg (more or less), is pretty convincing to me as well. I personally found the ratio to be 2:1 subjectively when I went from Celexa to Lexapro. But then, I could be 100% wrong!:>} Keep up your excellent posts, I always seek them out.
> bassman


The feeling is very mutual.

The thing is, I am beginning to see more and more people settling in on 60mg of Celexa. Numbers higher than that are being thrown around.

I guess this question is more esoteric than anything else, since each person must be titrated clinically anyway. I agree with you that 20mg of Lexapro is the way to go as the initial target dose.

Regarding the appearance of anxiety as a side effect of Lexapro, it is part of the personality of the drug, even when it is given as a de novo treatment. It usually appears about two weeks into treatment and disappears after the third. I am very intrigued that it should also appear upon crossover from Celexa. Sometimes all of the theorization we can muster cannot prepare ourselves for how these drugs act in real life. Perhaps it is the removal of the R- enantiomer antagonism of SERT inhibition that unmasks a pre-response anxiety (dig-dig). Actually, that explanation doesn't sound very plausible, but the observation is fascinating.

I should probably stop by Remedyfind every now and then. My lack of mental energy and focus usually preclude me from doing very much more than hanging out on Psycho-Babble for awhile and doing a few searches on Google or Medline. Nice life. :-(


- Scott

 

Re: To Those Who Switched From Celexa to Lexapro.. qbsbrown

Posted by SLS on July 13, 2006, at 15:22:07

In reply to Re: To Those Who Switched From Celexa to Lexapro.., posted by qbsbrown on July 13, 2006, at 14:29:27

> AD's have a hard time beating placebos? Are you serious?
>
> Why isn't that well known amongst the general population and/or all the doctors?


In my opinion, this is a very complicated issue, and has not yet been explored as thoroughly as it could be. I wish I were more well-read on the topic to be in a position to offer debate. It is my belief that these drugs, when used optimally, are 100% effective for the majority of people who are accurately identified as having an illness for which they have been found effective to treat. We do need more and better drugs, though.


- Scott

 

Re: To Those Who Switched From Celexa to Lexapro.. SLS

Posted by Phillipa on July 13, 2006, at 15:36:27

In reply to Re: To Those Who Switched From Celexa to Lexapro.., posted by SLS on July 13, 2006, at 11:34:57

Scott is that why celexa made me tired all the time and lexapro reved me up? On two weeks of lexapro 20mg my legs wouldn't stop quivering and my head felt like it wanted to explode and couldn't cry. Is this a good or bad sign of a reponse to a med working or not? Maybe I gave up too soon? Still looking for the ad that helps with anxiety and depression at the same time. As Glydin always said it took a few weeks before lexapro kicked in. Thanks, Love Phillipa

 

Re: To Those Who Switched From Celexa to Lexapro..

Posted by qbsbrown on July 13, 2006, at 15:37:45

In reply to Re: To Those Who Switched From Celexa to Lexapro.. qbsbrown, posted by SLS on July 13, 2006, at 15:22:07

So Scott, you are of the opinion that coming over from 60mgs celexa, that 20mg's of lexapro would be a more appropriate start than 30 for anyone?

Any evidence as to benefits of a morning vs night dose? Or completely preferential?

Brian

 

Re: To Those Who Switched From Celexa to Lexapro..

Posted by bassman on July 13, 2006, at 16:20:09

In reply to Re: To Those Who Switched From Celexa to Lexapro.. bassman, posted by SLS on July 13, 2006, at 15:06:12

Scott, from all your very interesting writing I figured you are doing really well. I'm sorry to hear that's not the case and hope that changes very soon. When it happens, though, you have to promise to keep posting and keep some of us radical empiricists at bay! :>}

 

Re: To Those Who Switched From Celexa to Lexapro..

Posted by bassman on July 13, 2006, at 16:32:50

In reply to Re: To Those Who Switched From Celexa to Lexapro.., posted by qbsbrown on July 13, 2006, at 14:29:27

Yes, I'm serious and it is very well known and very embarassing to drug companies. Check it out on the web or if you'd like me to dig up some references to depress you, I will. Recently there was a journal article ref on this board where Celexa was compared to Lexapro and neither were better than placebo, many others...

My theory on why that is (which is worth about 2 cents) is that clinical trials last, say, 8 weeks. During that period, there is a significant number of people that go into remission spontaneously. That makes the math messy: if 50% of the people went into remission of their own accord and the AD was effective for 30% of the people, then the statistics, without error, would be placebo 50%, AD 65%. But there is always a large error in any study involving creatures and 10% error would be great. So the results could look like 55% for placebo to 59% for AD easily. You get the idea: the only way you can get a really good number is to make the placebo group promise they won't get better. :>}

As you can imagine, the anti-AD folks have a picnic with the "no difference between AD and placebo" studies, of which there are many. Oh, check the package insert for any AD you might have and see if you are inpressed with how well the AD did clinically. :>}

 

Re: To Those Who Switched From Celexa to Lexapro..

Posted by SLS on July 13, 2006, at 18:06:03

In reply to Re: To Those Who Switched From Celexa to Lexapro.., posted by bassman on July 13, 2006, at 16:32:50

> My theory on why that is (which is worth about 2 cents) is that clinical trials last, say, 8 weeks. During that period, there is a significant number of people that go into remission spontaneously. That makes the math messy: if 50% of the people went into remission of their own accord and the AD was effective for 30% of the people, then the statistics, without error, would be placebo 50%, AD 65%. But there is always a large error in any study involving creatures and 10% error would be great. So the results could look like 55% for placebo to 59% for AD easily. You get the idea:

I think it is quite a bit more complicated than that.

I wish I were a mathematician.

In most studies, I believe the placebo response is about 30%. That is unacceptably high. I think it needs to be brought down.

Among other things, I believe the inclusion criteria for these studies allows people in who do not have a biologically-driven mental illness. I think we need to define more rigidly what it is we are setting out to treat. I think people with 100% psychological depressions are apt to feel less depressed on a placebo if they believe they are to be helped by it. Even properly-screened people with biological depressions entering the NIMH report feeling better during the first two weeks of their admission because they are so relieved that they are to finally be cured of their illness. These people are given a placebo run-in during this period. If these people with biological depressions report feeling better, even though they really aren't, are our testing implements valid when they rely so heavily on self-reporting? I also think people with psychogenic depressions are far less apt to respond to a somatic treatments like antidepressant therapy. Sure, some of the placebo responders are biogenic spontaneous remitters, but I believe a great many of them, perhaps the majority, are psychogenic remitters. Placebo responders are too high because the number of psychogenic depressives susceptible to suggestion is too high. Active compound responders are too low because psychogenic non-responders are too high. We must more rigidly and narrowly define the illnesses we are investigating and more rigorously select our subjects for our treatment studies to obtain any meaningful results.

If we are going to treat anything that looks grossly like depression with a single class of treatments, we will fail miserably. We will have greater success once we are able to more finely differentiate between the presentations of the various syndromes.

I know this introduction represents to a great degree black-or-white thinking regarding depression as a psychobiological phenomenon. However, it does serve to underscore the reality that there is no standardization of selection criteria for clinical trials for antidepressants or even a definition of what depression is.

These drugs work. We see that this is true with our own eyes, just as we do the sun shining. There must therefore be a problem with the testing.

Oh, yeah. I almost forgot. These drugs suck. They don't work for everyone all of the time. They don't work for me. If you are reading this, they probably don't work for you. Even when they do work, they have side effects. Often, they stop working after some period of time, and you have to look for another one. A lot of times, you have to endure withdrawal syndromes when you discontinue them. They are expensive. The drug companies are taking advantage of us and are concerned only with their profit margins. Etc.


- Scott

 

Re: To Those Who Switched From Celexa to Lexapro..

Posted by SLS on July 13, 2006, at 19:04:11

In reply to Re: To Those Who Switched From Celexa to Lexapro.., posted by SLS on July 13, 2006, at 18:06:03

> In most studies, I believe the placebo response is about 30%.

This number keeps creeping higher and higher it seems.


- Scott

 

Re: To Those Who Switched From Celexa to Lexapro..

Posted by bassman on July 14, 2006, at 5:49:02

In reply to Re: To Those Who Switched From Celexa to Lexapro.., posted by qbsbrown on July 13, 2006, at 14:29:27

This is an interesting general article on antidepressants that mentions that about 50% of all clincial trails don't show any difference between AD and placebo. The opening paragraphs story is very interesting, too.

http://www.motherjones.com/news/feature/2003/11/ma_565_01.html

 

Study sees no difference between Lex and Celexa

Posted by bassman on July 14, 2006, at 6:55:47

In reply to Re: To Those Who Switched From Celexa to Lexapro.., posted by bassman on July 14, 2006, at 5:49:02

Just another point of view:

Escitalopram: superior to citalopram or a chiral chimera?

Psychother Psychosom 2004 Jan-Feb;73(1):10-6 (ISSN: 0033-3190)
Svensson S; Mansfield PR
Department of Clinical Pharmacology, Sahlgren's University Hospital, Gothenburg, Sweden Healthy Skepticism Inc., Willunga, Australia. staffan.svensson@pharm.gu.se.

BACKGROUND: Escitalopram is the active isomer of the antidepressant citalopram. In theory single-isomer drugs may be superior but few have been found to have clinically significant advantages. The manufacturer claims that escitalopram has more efficacy and a faster onset of effect than citalopram. The purpose of this study was to assess how far these claims are justified.

METHODS: Relevant trial reports were requested from H. Lundbeck A/S and the Swedish drug regulatory authority. The trials consisted of a pooled analysis of 1,321 patients from one unpublished, one partly published and one published eight-week trial, as well as a 24-week trial with 357 patients published as a poster. The studies compared escitalopram with placebo and/or citalopram in outpatients aged or=18 years who met specified criteria for depression. The trials' quality was assessed with Moncrieff et al.'s quality assessment instrument and the results compared with the claims from the advertisements.

RESULTS: The advertising claims are not justified because they are based on secondary outcomes, non-intention-to-treat analyses and arbitrarily defined subgroups. The subgroup results are inconsistent. Methodological flaws in the trials could account for the differences found. Even if the differences claimed were real they appear too small to justify higher prices. CONCLUSIONS: On the evidence available to us the manufacturer's claims of superiority for escitalopram over citalopram are unwarranted. The Swedish and Danish drug regulatory authorities reached similar conclusions. This highlights the need for wider dissemination of national authorities' statements to other countries affected by the European Union's mutual recognition procedure. [Copyright 2004 S. Karger AG, Basel].


 

Re: Study sees no difference between Lex and Celex

Posted by SLS on July 14, 2006, at 7:29:52

In reply to Study sees no difference between Lex and Celexa, posted by bassman on July 14, 2006, at 6:55:47

I've tried Lexapro, but not Celexa. Right now, Lexapro is my doctor's SSRI of choice. It did nothing for me. The only other SSRI I haven't tried is Luvox. There have been people here who report responding better to Celexa than to Lexapro. Sometimes different is different enough. So much for in vitro experiments and theories.

You know, it occurs to me that there will probably never be another SSRI to be brought to market in our lifetimes. I find this sad. There have to be better ones floating around in test tubes somewhere.


- Scott


> Just another point of view:
>
> Escitalopram: superior to citalopram or a chiral chimera?
>
> Psychother Psychosom 2004 Jan-Feb;73(1):10-6 (ISSN: 0033-3190)
> Svensson S; Mansfield PR
> Department of Clinical Pharmacology, Sahlgren's University Hospital, Gothenburg, Sweden Healthy Skepticism Inc., Willunga, Australia. staffan.svensson@pharm.gu.se.
>
> BACKGROUND: Escitalopram is the active isomer of the antidepressant citalopram. In theory single-isomer drugs may be superior but few have been found to have clinically significant advantages. The manufacturer claims that escitalopram has more efficacy and a faster onset of effect than citalopram. The purpose of this study was to assess how far these claims are justified.
>
> METHODS: Relevant trial reports were requested from H. Lundbeck A/S and the Swedish drug regulatory authority. The trials consisted of a pooled analysis of 1,321 patients from one unpublished, one partly published and one published eight-week trial, as well as a 24-week trial with 357 patients published as a poster. The studies compared escitalopram with placebo and/or citalopram in outpatients aged or=18 years who met specified criteria for depression. The trials' quality was assessed with Moncrieff et al.'s quality assessment instrument and the results compared with the claims from the advertisements.
>
> RESULTS: The advertising claims are not justified because they are based on secondary outcomes, non-intention-to-treat analyses and arbitrarily defined subgroups. The subgroup results are inconsistent. Methodological flaws in the trials could account for the differences found. Even if the differences claimed were real they appear too small to justify higher prices. CONCLUSIONS: On the evidence available to us the manufacturer's claims of superiority for escitalopram over citalopram are unwarranted. The Swedish and Danish drug regulatory authorities reached similar conclusions. This highlights the need for wider dissemination of national authorities' statements to other countries affected by the European Union's mutual recognition procedure. [Copyright 2004 S. Karger AG, Basel].

 

Re: Study sees no difference between Lex and Celex

Posted by bassman on July 14, 2006, at 7:55:24

In reply to Re: Study sees no difference between Lex and Celex, posted by SLS on July 14, 2006, at 7:29:52

Scott, wow, I never thought of that! I do hope you are wrong (for a change)-I have this hope that someone is going to make an AD that works very well and doesn't have a lot of side effects. Sort of what Gleevac did for some cancers-dramatically put them in remission. The drug worked so well because they did the research first, made the compound second, I think.

You know how in Kramer's book he has people "better than normal" from being on Prozac? That's the type of drug I want-just exactly what happened to me for three years on Paxil. There's a country song that has the line, "and it's a great day to be alive..."-I want some of that in a bottle of pills or from a life-changing experience. Probably that won't happen today. :>}

 

another one...

Posted by bassman on July 14, 2006, at 10:50:51

In reply to Re: To Those Who Switched From Celexa to Lexapro.., posted by qbsbrown on July 13, 2006, at 14:29:27

http://www.epilepsy.com/newsfeed/pr_1136903404.html


The percentages of patients who responded to treatment with Cymbalta, Lexapro or sugar pill (48.7%, 45.3% and 36.9%, respectively) were statistically no different.
-Percentage of patients achieving remission on Cymbalta, Lexapro or sugar pill (40.1%, 33.0% and 27.7%, respectively) were statistically no different in this study.

 

Re: To Those Who Switched From Celexa to Lexapro.. bassman

Posted by MARTY on July 14, 2006, at 11:09:42

In reply to Re: To Those Who Switched From Celexa to Lexapro.., posted by bassman on July 13, 2006, at 12:39:29

> Hey! We've been though this before, remember?:>}

Actually it was with me that you've been tough this before :P

And I you already know I stand behind the same logic as SLS. It also reflect my own experience with it.

People at 60mg CEL should try 20mg LEX before going with an higher dosage. 1:3 Ration first, then if it doesn't quite do it, go for the 1:2 ratio.

Would you agree with this strategy ?

Have a nice day,
Marty


 

Re: To Those Who Switched From Celexa to Lexapro.. bassman

Posted by MARTY on July 14, 2006, at 11:23:59

In reply to Re: To Those Who Switched From Celexa to Lexapro.., posted by bassman on July 13, 2006, at 14:22:02

> As I've said before, the remedyfind.com experience that the average Celexa user uses 40 mg and the average Lexapro user uses 20 mg (more or less), is pretty convincing to me as well.

hmm.. My guess is that some Pdoc haven't even heard about the S competing the R thing. Marketting should have done that job in the last years, but PDOCs aren't neurologist/biochemist and surely classified the thing as a bullshiting marketting thing in the first couple seconds. So the high majority of the PDOCS goes with the 1:2 ratio and that explains what you see on RemedyFind.com. :) that's my theory, and I too may be 100% wrong.


Have a nice day,
Marty

 

Re: To Those Who Switched From Celexa to Lexapro.. qbsbrown

Posted by MARTY on July 14, 2006, at 11:25:47

In reply to Re: To Those Who Switched From Celexa to Lexapro.., posted by qbsbrown on July 13, 2006, at 14:29:27

> AD's have a hard time beating placebos? Are you serious?

I think we should keep in mind that placebo effect alone is already a powerful effect on many individuals: even on depression.

Have a nice day.
Marty


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