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Dr. Bob is Robert Hsiung, MD,
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Posted by dr. dave on October 29, 2002, at 5:11:46
In reply to Re: Citalopram pharmacology » dr. dave, posted by Malcolm on October 29, 2002, at 2:13:41
> > Although r-citalopram has some affinity to histamine (not 'histomine') receptors this does not mean it is 'inhibiting s-citalopram'. You cannot inhibit a molecule, you can only inhibit a process - which process involving s-citalopram is the r-citalopram/histamine receptor interaction inhibiting?
> >
> > The whole marketing of this drug seems to be based on sloppy science. I have no problem with Celexa, I prescribe it all over the place, but raising desparate people's hopes with woolly and wishful thinking I object to.
>
> Dr. Dave,
>
> Those are "desperate" people, not "desparate" people.
>
> --MalThank you, I stand corrected.
David
Posted by shakingoscar on October 29, 2002, at 5:18:06
In reply to Re: Doesn't anyone like Lexapro » merlin, posted by CuriousJane on October 28, 2002, at 13:54:14
I gave it ten weeks for the lexapro to work after being on 60mg celexa for nearly a year. I really wish I hadnt switched - the full ten weeks I was up and down like a yoyo and unfortunately, mostly very down and anxious and VERY TENSE.
Lexapro? never again!
Posted by dr. dave on October 29, 2002, at 5:41:16
In reply to Re: Citalopram pharmacology » dr. dave, posted by Malcolm on October 29, 2002, at 2:13:41
I was interested to discover in the product monograph (page 22) on www.cipralex.com that one of the two initial US studies of Lexapro/Cipralex showed no statistically significant difference between escitalopram and placebo, nor citalopram and placebo.
What does this mean? I do think that escitalopram and citalopram are both effective, but that they are virtually identical in practice, and their benefit over placebo is a lot less than you might be led to believe by the rather feverishly optimistic marketing. Optimism about treatment for depression is good, but to treat depression realistically and seriously you need to have an accurate idea of what your tools can achieve.
Posted by mudbunny on October 29, 2002, at 6:12:17
In reply to Weighing (mudbunny), posted by bridgette on October 27, 2002, at 6:56:27
It sure is a battle. How is your eating habits? I will only eat 1 full meal a day and then only a snack in the night. I dont like to eat a full meal unless I know I can workout after the same day. I think I will gain weight if I dont. I wish I could stop. My therapist told me to get rid of my scale yea right. My husband got rid of my scale once and I just got a new one.I lost 70 pounds I was heavy my whole life now I am afraid of gainig it back. I want to have a baby but the weght issue is to much right now. Good luck and god bless. mudbunny
Posted by maririp on October 29, 2002, at 8:05:49
In reply to Re: Anyone switched to Lexapro? « ggrrl, posted by Erin on October 28, 2002, at 21:36:10
> I have been on Lexapro for about three to four weeks and feel so much better now. No Side Effects! I don't sleep all day any longer and feel great. After reading some of the responses to Lexapro I am scared that this will not last forever. Just went to my doctor today and raved about this new drug. Is there anyone out there that has experienced good results such as myself? If so could you let me know what your past and present experiences are?
Hi..I have been on lexapro for about two months. I think its one of the best antidepressants I have ever taken. Its my first time back on one in 3-4 years. The first few days I experienced zombie like state and woke up feeling sad. Day 5 I woke up happy and its been great ever since. I do have a hard time with orgasms so we will see how that goes still too eary to tell if this will be a lasting side effect.
Posted by ANXIETY ANN on October 29, 2002, at 9:28:53
In reply to Re: Question., posted by maririp on October 28, 2002, at 20:45:09
> > > > > > I sent an earlier message which doesn't seem to appear asking what you all think of taking drug holidays to see if it alieviates the sexual side effects---I don'tknow if skipping one day would be enough to get it out of your system. Maybe, two? I assume you wouldn't have to rebuild again like when you first start taking it. What do you thinK?
> > > > >
> > > > > Id like to know about that myself..its nice they have viagara for men and forgot about the women. Hormone changes are hard enough. Zoloft was the only med I heard you could skip a day or 2 and I hated zoloft. These companies need to spend their profits coming up with a pill to ehnance your sexual drive and orgasms. It's like a catch 22 with antidepressants...feel better but feel bad about no more orgasms or very few, thats why I struggle with the idea of having to take them again. Sex and orgasms are a huge part of happiness and its annoying to not have them.
> > > > >
> > > > >
> > > > Amen to that sister! I have been taking Lexapro for Anxiety (3wks) and although my anxiety is better, sex is disappointing. It is so frusrating to not complete the job (have an orgasm). Its like whats worse, no anxiety or no orgasim? It seems that there always has to be some trade off. This was one of the reasons I went off Effexor (that ans I gained 20 pounds). I think that all these anti-depressants must be made by people who never have sex! Thats my gripe for the day. Anxiety Ann
> > > > --------------------------------------------------------------------------------------------------------
> > >
> > > I have been taking SSRI's for over two years now and I've been on various forms and other drugs on top of those to combat the sexual side effects, which have been extreme. I have been on Buspar, Wellbutrin, Gingko, etc. Two things were prescribed for me in addition to these others...one is Viagra (yes, I'm female)...I haven't actually taken any yet because in the meantime, my doc prescribed Claritin (see earlier posts) and that has helped. Maybe you can check into these solutions with your docs?? Problem is that Viagra is expensive and most insurance plans don't cover it, but if it helps, it could be worth it! Good luck!
> > >
> >
> > > > hey! i'll tell you what's worse... no sex at all!! at least you all want and are having or attempting to have sex! count yourselves lucky! for the past 10 months i've been dealing with major depression(on top of fibromyalgia et al...) and haven't even wanted to have sex(guess it's lucky i'm single) i've had offers but i just wasn't interested. this is not normal by any means for me! i've been on lexapro now for 3 wks.,instead of prozac. i'm hoping that i will soon get back to my old social self and start having a life, again! instead of staying home alone all the time. and then, hopefully, i'll start being intrested in sex, again!!! :)
> > (i'm gonna cross my fingers and knock on wood and anything else i can think of, too, just in case~!!!) :)
> >
> Hi..Its no fun to want or attempt to have sex only to end up frustrated. I have found that will all the antidepressants i have taken the price to pay was no orgasms or allot of weight gain. It is so nice to feel happy again with the help of lexapro but as Ann said what a trade off your sex life suffers. These are the reasons I usually do not stay on an antidepressant for long, however, as you get older and hormones change I find I may have to stay on them. Not all women can take hormone therapy. Good luck to you, and get out there and enjoy life :-)Hi
I agree with Mari, we may be having sex but believe me its not much fun and terribly frusrating if you can't have an orgasm. maybe you're depression is the reason you don't have much of a sex drive.Give Lexapro a chance to work and go find your self a GOOD man, ENJOY LIFE
Anxiety Ann
Posted by wharfrat on October 29, 2002, at 9:55:20
In reply to Anyone switched to Lexapro? « ggrrl, posted by Dr. Bob on June 11, 2002, at 7:52:48
Is anyone out there taking lexapro for general anxiety disorder?
Posted by bridgette on October 29, 2002, at 10:52:39
In reply to Re: Citalopram pharmacology » Malcolm, posted by dr. dave on October 29, 2002, at 5:11:46
any better than a placebo? Is that what the study says? But, don't they say that about all SSRI's. That they all have a placebo effect. I read that in a study that was in all the newspapers in July.
Posted by Erin on October 29, 2002, at 11:53:40
In reply to Re: Anyone taking lexapro for GAD?, posted by wharfrat on October 29, 2002, at 9:55:20
> Is anyone out there taking lexapro for general anxiety disorder?
I have been taking Lexapro for about 3-4 weeks for major depression and general anxiety disorder. It has been a god-send for me as I do not experience the level of anxiety I once did. This is not to say that there is no anxiety at all, I do experience the normal anxiety. New places, people and things, changes in my life give me a greater level of anxiety but this is true for most people. I will continue my journey with Lexapro and pray that it will help me down the road in recovery.
Posted by johnj on October 29, 2002, at 17:15:50
In reply to Re: Citalopram pharmacology (nm), posted by Malcolm on October 29, 2002, at 14:51:32
Hello,
Does it sound strange to start off with a low dose? I was told to start with 5 mg, but was thinking I would rather start with half that. I am med sensitive and thought that may be better. Anybody with experience out there? Someone mentioned that at low does, Celexa, gave vivid dreams. I didn't know if it is ok to start slow and move up slowly. Thanks
johnj
Posted by chad_3 on October 29, 2002, at 23:21:20
In reply to Re: Doesn't anyone like Lexapro, posted by shakingoscar on October 29, 2002, at 5:18:06
Hi ShakingOscar
I admit your name caught my attention which is why I read your post - I have read almost nothing on this new SSRI except that I heard it blocks 5ht-2 and 5ht-3 somewhat (aka: Remeron) - but has little to no norephinephine effect (kinda like Serzone - except Serzone does have mild NE effects)
Well except that Lexapro supposedly blocks part of 5ht-3, and based on effects on depression (weak effect - sometimes anxiety or tension , etc) - these comments remind me of Serzone - which sounds to me like they are both similar pharacological profiles.
Serzone is now used probably more to augment that anything - as an axiolytic, or to reduce some SSRI sexual side effects since it partially blocks serotonin.
Anyway - long story short - this Lexapro sounds to me more like an augmenting agent than a standalone antidepressant - but I'm just taking a wild guess here on the little bit I've heard.
Chad
> I gave it ten weeks for the lexapro to work after being on 60mg celexa for nearly a year. I really wish I hadnt switched - the full ten weeks I was up and down like a yoyo and unfortunately, mostly very down and anxious and VERY TENSE.
>
> Lexapro? never again!
Posted by dr. dave on October 30, 2002, at 6:20:32
In reply to Lexapro doesn't work???, posted by bridgette on October 29, 2002, at 10:52:39
> any better than a placebo? Is that what the study says? But, don't they say that about all SSRI's. That they all have a placebo effect. I read that in a study that was in all the newspapers in July.
Different studies give you a range of different results, which shows you the dangers of seeing the result of a single trial as 'scientific proof' of anything. Some show greater efficacy, some don't. I think the truth is that Lexapro is more effective than placebo, particularly for more severe depression, but the increase in effectiveness over placebo is such that you can't detect it in some trials.
It's also worth remembering that these trials show averages for a big group of people, and that for an individual the benefit over placebo might be much bigger than the average difference. But then again, sometimes there will be zero advantage.
Posted by Phyl on October 30, 2002, at 6:40:12
In reply to Starting an SSRI Question(lexapro), posted by johnj on October 29, 2002, at 17:15:50
I was told to start with 10 mg of Lexapro but cut it in half. I have been taking 5 for almost four weeks. I notice little difference during the daytime, but am always ready to go to sleep at about 7:00 p.m. I usually sleep for 4-5 hours and then take a Lorezepam to get through to the morning. I think I was prescribed Lexapro for a specific phobia (driving on highways); so far, I'm still afraid to drive, so am not sure what it is doing for me. I go see my internist this morning to clarify a few things. Originally he put me on Trazodone for insomnia but that did a real job on me and I was taken off of it immediately. I think I will stay on 5 mg. I, too, am very sensitive to meds. Good luck!
Posted by SLS on October 30, 2002, at 7:26:31
In reply to Citalopram pharmacology, posted by dr. dave on August 20, 2002, at 15:22:46
> The statement '10mg Lex is 40mg Celexa' doesn't make any sense.
I'm not sure if this refers to my post along another thread, but what I meant by Celexa 60mg = Lexapro 10mg is that they seem to be relatively equivalent therapeutic dosages. This is based upon my memory of the earliest personal anecdotal reports posted by people on PB. Since writing that, I think it looks more like Celexa 60mg = Lexapro 20mg. This is nothing more than my gross observations that I haven't documented. However, this in no way a statement of relative efficacy. Celexa 60mg might be less effective than Lexapro 20mg.> Let's get down to the science here - '10mg lex' is 10mg of s-citalopram. '40mg Celexa' is 20mg s-citalopram plus 20mg r-citalopram. That's different.
Celexa and Lexapro are different. Period.
http://www.dr-bob.org/babble/20021006/msgs/123211.html
http://www.dr-bob.org/babble/20020906/msgs/119448.html
Do you feel you know enough about the brain, physiology, organic chemistry, and the pharmacology of these two drugs to state anything about getting down to science? I admit that I don't (not such a revelation). I just like doing thought experiments - you know - theory. My theories are constructed with great care but with insufficient knowledge for them to be worth a damn.
> A study has been presented claiming 10mg Lexapro is as effective as 40mg Celexa - but Jack Gorman in his meta-analysis of the research states that this study was too small to demonstrate differences in efficacy. The result of one small trial is not necessarily the complete and absolute truth.
I think that empirical observation is essential to help validate the musings of theoreticians.
- Scott
Posted by Amberlin on October 30, 2002, at 9:42:53
In reply to Anyone switched to Lexapro? « ggrrl, posted by Dr. Bob on June 11, 2002, at 7:52:48
Just switched today.
No side effects, of course I didn't think I would experience any. I had been on Effexor for two years previously, went to Celexa for a month, and now on Lexapro. I feel like a guinea pig.But I'll remain positive and hope that Lexapro works.
Posted by dr. justin on October 30, 2002, at 19:34:27
In reply to Anyone switched to Lexapro? « ggrrl, posted by Dr. Bob on June 11, 2002, at 7:52:48
I hope to switch to Lexapro shortly; my physiatrist, whom I am fortunate to have, is the head of my alma mata's psychiatry department and has never steered me wrong (please don't interpret that to mean I haven't had to ride the medicine merry-go-round, I just think my ride may have been shorter because of his talent). He has recommended to me that I shift from Celexa to Lexapro. I'll come back and post with the differences a month or so after I make the switch.
Also, since others have, I wanted to share the combo that really worked for me, for those of you that are just starting your battle. No one falls into any of the seemingly arbitrary categories for these illnesses, but if I was to describe my problem, it would be as follows: Imagine a triangle. Each of the three points are labeled "Depression", "Anxiety", and "OCD." A point describing my condition is in the triangle, and the closer it is to a tip, the more of that condition I experience. My illness "floats" inside this triangle, occasionally drifting closer to one point than the other two, but always on the move. Very hard to combat. If this sounds familiar, I really have had it under control the past 3 years with this “recipe”:
150 mg Wellbutrin SR 2x/day
40 mg Celexa in the morning
4 mg Klonopin in the eveningI hope you all get feeling better; hang in there!
Posted by sjl on October 30, 2002, at 21:10:02
In reply to Anyone switched to Lexapro? « ggrrl, posted by Dr. Bob on June 11, 2002, at 7:52:48
Hi,
I just started on lexapro(10mg) for anxiety and I've gotten some strange side-effects. About 2 hours after I take it, I start twitching, yawning, and feeling like I need to flex my muscles. My jaw also starts to shake a bit. Anyone else get effects like this? Is this normal?Thanks,
sjl
Posted by dr. justin on October 30, 2002, at 22:37:26
In reply to Just started on lexapro...., posted by sjl on October 30, 2002, at 21:10:02
sjl,
I can't comment on Lexapro yet, but I've been taking its "Father", Celexa, for a couple of years now. When I first started taking it, I can clearly remember experiencing facial twitching. Occasionally, the twitching would occur across my back or in my legs. I believe it was somewhat similar to what you described is happening to you. It eventually went away, but when I increased from 20 mg to 40 mg (roughly, the Lexapro 10 mg equivalent) the twitching came back very strong. After 2-3 weeks, it faded again for me. If it really starts to bother you, I'd recommend notifying your physician, but if you're just nervous that you're having some bizarre side-effect, I wouldn't sweat it. Lexapro claims it eliminates or diminishes some of Celexa's uncomfortable side-effects; I guess the twitching isn't one of them. Take care.
~ Justin
Posted by ANXIETY ANN on October 30, 2002, at 22:47:47
In reply to Just started on lexapro...., posted by sjl on October 30, 2002, at 21:10:02
> Hi,
> I just started on lexapro(10mg) for anxiety and I've gotten some strange side-effects. About 2 hours after I take it, I start twitching, yawning, and feeling like I need to flex my muscles. My jaw also starts to shake a bit. Anyone else get effects like this? Is this normal?
>
> Thanks,
> sjl
Sj1,
when I first started taking Lexapro (10mg) I had terrible jaw and back of the neck/head pain. This lasted for about a week. I've been taking Lexapro now for almost a month and the neck and head pain is gone. Sometimes I notice that my jaw is tense but nothing like it was in the beginning. If you haven't been on Lexapro for long, I'd give it a little more time.
Good Luck, Ann
Posted by ANXIETY ANN on October 30, 2002, at 22:54:39
In reply to Re: Anyone switched to Lexapro? My recipe » Dr. Bob, posted by dr. justin on October 30, 2002, at 19:34:27
> I hope to switch to Lexapro shortly; my physiatrist, whom I am fortunate to have, is the head of my alma mata's psychiatry department and has never steered me wrong (please don't interpret that to mean I haven't had to ride the medicine merry-go-round, I just think my ride may have been shorter because of his talent). He has recommended to me that I shift from Celexa to Lexapro. I'll come back and post with the differences a month or so after I make the switch.
>
> Also, since others have, I wanted to share the combo that really worked for me, for those of you that are just starting your battle. No one falls into any of the seemingly arbitrary categories for these illnesses, but if I was to describe my problem, it would be as follows: Imagine a triangle. Each of the three points are labeled "Depression", "Anxiety", and "OCD." A point describing my condition is in the triangle, and the closer it is to a tip, the more of that condition I experience. My illness "floats" inside this triangle, occasionally drifting closer to one point than the other two, but always on the move. Very hard to combat. If this sounds familiar, I really have had it under control the past 3 years with this “recipe”:
>
> 150 mg Wellbutrin SR 2x/day
> 40 mg Celexa in the morning
> 4 mg Klonopin in the evening
>
> I hope you all get feeling better; hang in there!Hi,
I was wondering how you like the Wellbutrin SR? Does it have alot of side effects when you first start taking it? My doc told me that he may put me on Wellbutrin as well as Lexapro. My main problem is generalized anxiety and panic attacks. Any advice?
Posted by dr. justin on October 30, 2002, at 23:56:52
In reply to Re: Anyone switched to Lexapro? My recipe, posted by ANXIETY ANN on October 30, 2002, at 22:54:39
A. Ann,
The Wellbutrin SR has been my rock. The SSRI's have changed over time, as well as the CNS depressants, but good ol' Wellbutrin SR has always been there for me, and always worked. Not so much on its own; it seems to function as an "enhancer" to the other medications I'm on, but in a pinch (i.e., your SSRI starts to give you intolerable side-effects and you need to stop it ASAP) the Wellbutrin SR will hold you over for a while. I can't say enough nice things about it.
However, there is a reason I keep adding the "SR" after Wellbutrin. Until recently, I had lousy health insurance that didn't cover these meds at all. My psychiatrist recommended we use regular Wellbutrin, as it was much cheaper. Well, it was too intense for me-- it gave me panic attacks! This was strange, because I’d never had any type of anxiety-related problem with the sustained-release form.
I also suffer mainly from GAD and panic attacks. Wellbutrin SR has always served me well, and has been the only medication that has remained a constant in my five years of treatment. My only other piece of advice is to watch the dosage-- it was such a good thing I wanted to try 450 mg/day as opposed to 300. The stronger dose made it far less effective. I've found 150 mg when I wake and 150 mg at dinner time does the job. I hope it does for you too. Good luck!
~ Justin
Posted by dr. dave on October 31, 2002, at 8:26:26
In reply to Re: Citalopram pharmacology » dr. dave, posted by SLS on October 30, 2002, at 7:26:31
Dear Scott,
> Do you feel you know enough about the brain, physiology, organic chemistry, and the pharmacology of these two drugs to state anything about getting down to science? I admit that I don't (not such a revelation). I just like doing thought experiments - you know - theory. My theories are constructed with great care but with insufficient knowledge for them to be worth a damn.I'm sorry if anything I've said seems arrogant. The main point I've been trying to make on this board is that claims are being made on very weak evidence about this drug, and there is no clear reason why, pharmacologically, the claims would be true - by which I mean there's no plausible mechanism of action (for any superiority over citalopram) that's been substantiated at all.
I feel qualified to comment on the science as it's what I've been educated in for many years, and it's my job to have an understanding of it - but I'm only commenting, which is not to say I don't get things wrong sometimes.
I couldn't agree more that what matters is what happens in real life, whatever the theories. Obviously Lexapro helps a lot of people and I'm not sure I have ever suggested otherwise. Whether it turns out to be significantly different from Celexa time will tell.
David
Posted by fiddlepuppy on October 31, 2002, at 17:54:02
In reply to Re: Citalopram pharmacology » SLS, posted by dr. dave on October 31, 2002, at 8:26:26
Lexapro at even 5 mg has made my anxiety, restlessness and agitation intolerable. I have been on it for 4 weeks. I am begging my doc to take me off it now.
Posted by SLS on October 31, 2002, at 19:57:13
In reply to Re: Citalopram pharmacology » SLS, posted by dr. dave on October 31, 2002, at 8:26:26
Hi, Dr. Dave.
> > Do you feel you know enough about the brain, physiology, organic chemistry, and the pharmacology of these two drugs to state anything about getting down to science? I admit that I don't (not such a revelation). I just like doing thought experiments - you know - theory. My theories are constructed with great care but with insufficient knowledge for them to be worth a damn.
> The main point I've been trying to make on this board is that claims are being made on very weak evidence about this drug,
I haven't been following the posts closely enough. What are the claims being made? What evidence has been offered to cooraborate these claims? Thanks.
> by which I mean there's no plausible mechanism of action (for any superiority over citalopram) that's been substantiated at all.
How would you critique my hypothesis regarding antagonistic stereochemisty between the enantiomers? How might this relationship be viewed with respect to the actions of partial agonists at neurotransmitter receptors?
> I feel qualified to comment on the science as it's what I've been educated in for many years, and it's my job to have an understanding of it - but I'm only commenting, which is not to say I don't get things wrong sometimes.
What is your background, and how are you applying it today?
I wish I had more. I might be able to help figure out this MF.
Be well.
Sincerely,
Scott
Posted by grace on October 31, 2002, at 21:53:08
In reply to Re: Anyone taking lexapro for GAD?, posted by wharfrat on October 29, 2002, at 9:55:20
> Is anyone out there taking lexapro for general anxiety disorder?
I am diagnosed with anxiety disorder & panic attacks, which I guess is pretty close to GAD. I was recently switched from Celexa to Lexapro due to the side effects I've had on Celexa. So far (week 3) I feel GREAT...actually really great except that I'm still really tired all the time, which was part of my prob with Celexa. Sexual side effects are another prob, but that's another story. A lot of the drugs that are prescribed for depression seem to have a lot of anti-anxiety properties as well and usually are pretty effective. Celexa has worked for me, as has Serzone and now Lexapro. I also take .5mg of Klonopin twice a day. Good luck!
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