![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 10 to 34 of 34. Go back in thread:
Posted by europerep on March 15, 2014, at 17:12:42
In reply to Re: Another step on the Lexapro journey » europerep, posted by phidippus on March 15, 2014, at 15:07:13
>>Have you actually even read her earlier posts?
> Yes, but what does that matter?
For example, she said that higher doses of escitalopram considerably worsened her depression.
> Aren't you being pretentious right now?Not that I'm aware of.
> What assumptions did I make?That there is not a single patient who needs a lower-than-common dosage of an antidepressant. Maybe it would even be possible that she is actually getting to therapeutic drug concentrations in her blood, due to an extremely slow or inhibited metabolism.
But we don't even have to go there: reports of people who need "weird" doses (both higher or lower than the generally prescribed range) exist. And that makes perfect economic sense by the way: why would drug companies produce a dosage that only a fraction of all patients would need?
> I'm not a god, just someone who knows a thing or two.Then maybe you shouldn't act like one?
Posted by merpmerp on March 15, 2014, at 18:02:39
In reply to Re: Another step on the Lexapro journey » merpmerp, posted by phidippus on March 14, 2014, at 18:34:13
I had to think for a while how to respond to your post. Several years ago, I would have agreed with you. I used to scold my brother for taking doses of meds that I believed were too low to be effective.
You said you're working on a master's in neuropsych. I have a master's in science, too, and have gone on to launch a career in science. Therefore, I have become used to looking at what the evidence is telling me, even if it goes against what I expected.
I originally began to take antidepressants (Prozac at first, twice; helped the first time but not the second) for the following symptoms:
Anhedonia
Insomnia
Self hatred
Extreme anger
Suicidal thoughts (vague, unfocused, more escape fantasies like "God I wish I wouldn't wake up tomorrow")You can argue that with the anhedonia, I should not have been given an ssri, but that's not what happened and we can't change history.
In 2009 I was put on what I believe to be too high a dosage of Lexapro for me, despite being the recommended 10 mg. I was to bounce between 5-10 mg, with my doctor's supervision, for the next year and a half.
I experienced:
Extreme lethargy - sleep 10 hrs+ a night and still need a multi hour nap
Complete lack of focus/zero short term memory - a problem in grad school
The first panic attacks I'd ever had in my life - anxiety had never been a big issue with me
Unbelievable restlessness
Extreme diarrhea
The worst- incredibly violent intrusive thoughts aimed at me, my pets, my loved ones and everyone around. These bombarded me for literally every second of every day. I had never experienced anything like that in my life.My doctor believed, of course, that I was worsening. She gave me klonopin, and wanted to put me on beta blockers and Ritalin in addition.
I scoured books and the net for info, as much as I could focus in my state. I very gradually began to suspect my med. I had always just blindly trusted my doctor.
It was here, on Babble, that I got the support I needed to cut my dosage, even against my doctor's advice. I went to 2.5 mg brand name Lexapro.
Within a week, I was feeling better. Within a month, I could tell I was me again. The twitches, diarrhea, panic, and violent thoughts melted away as if by magic. I didn't need to sleep all the time anymore.
I remained well for three years.
Three. Years.
That is the longest I've been stable since my first episode of depression at age 14.
During that time, I finished school and moved cross country, got a job, had my mom attempt suicide and then die unexpectedly (not from suicide), and yet I remained well in spite of this. Not once did I become clinically depressed, and neither did the med side effects return. I paid attention when they switched me to generic, but I remained well.
Until my generic brand changed just now, which coincides with the return of the second group of symptoms. Not the first group. The second.
The evidence is telling me something.
But you don't have to take my word for it. I have an appointment with my doc in a week and a half (could not get in earlier). I will ask about going on the brand name again, because it did work for me before. If it doesn't... I'll try something else.
I'm not scared anymore, since I found that they switched my generic manufacturer. I feel that that is the issue, and if not, I feel confident that I can figure out something that will work for me, as I did before.
I will post updates periodically. It helps me to have a written record of how I felt so I know where I've been.
Posted by merpmerp on March 15, 2014, at 18:05:04
In reply to Re: Another step on the Lexapro journey » merpmerp, posted by phidippus on March 14, 2014, at 18:34:13
Eric - my recent post was for you, but I 'replied' incorrectly. My apologies.
Posted by Phillipa on March 15, 2014, at 19:01:15
In reply to Re: Another step on the Lexapro journey, posted by merpmerp on March 15, 2014, at 18:02:39
So glad you are seeing your doc!!! Only you know your body we are all different. Take 2.5mg also. Phillipa
Posted by SLS on March 15, 2014, at 19:03:31
In reply to Re: Another step on the Lexapro journey, posted by merpmerp on March 15, 2014, at 18:05:04
Perhaps the generic escitalopram isn't being absorbed as well as then name brand Lexapro. I wouldn't really know. If this is the case, perhaps tweaking the dosage upwards a little bit might make things easier until you see your doctor. Regardless, I would still use the name brand if possible. At the very least, you are guaranteed consistency.
Good luck.
- Scott
Posted by phidippus on March 15, 2014, at 22:16:24
In reply to Re: Another step on the Lexapro journey » phidippus, posted by europerep on March 15, 2014, at 17:12:42
>For example, she said that higher doses of escitalopram considerably worsened her depression.
What's she doing taking it?
>reports of people who need "weird" doses (both higher or lower than the generally prescribed range) exist.
I agree, but there are subtherapeutic dosages.
Eric
ps. I am a god
Posted by phidippus on March 15, 2014, at 22:17:55
In reply to Another step on the Lexapro journey, posted by merpmerp on March 13, 2014, at 21:54:02
please stop taking a medication that makes you depressed.
ERic
Posted by Dr. Bob on March 16, 2014, at 17:07:55
In reply to Re: Another step on the Lexapro journey » europerep, posted by phidippus on March 15, 2014, at 22:16:24
Posted by phidippus on March 17, 2014, at 13:01:21
In reply to Re: Another step on the Lexapro journey, posted by merpmerp on March 15, 2014, at 18:02:39
> I experienced:
>
> Extreme lethargy - sleep 10 hrs+ a night and still need a multi hour nap
> Complete lack of focus/zero short term memory - a problem in grad school
> The first panic attacks I'd ever had in my life - anxiety had never been a big issue with me
> Unbelievable restlessness
> Extreme diarrhea
> The worst- incredibly violent intrusive thoughts aimed at me, my pets, my loved ones and everyone around. These bombarded me for literally every second of every day. I had never experienced anything like that in my life.It seems Lexapro was not the right antideppressant for you. Rather thanmask symptoms with Klonopin or go to a lower dose of Lexapro, I would have taken you off it entirely and put you on a different antidepressant.
Eric
Posted by merpmerp on March 19, 2014, at 20:33:16
In reply to Re: Another step on the Lexapro journey » merpmerp, posted by phidippus on March 17, 2014, at 13:01:21
Eric,
I've been spending the last few days re-reading my old posts from 2010/2011 to try and remember exactly what happened. I have a few questions, I'm honestly asking if you or anyone else have any ideas as to why this all happened. Brainstorming and all that.
I'm going to post a condensed timeline.
2006-2007: Generic Prozac (Pliva manufacturer) 20-30 mg. Really felt that it saved my life, as it "cut the bottom out" of my worst depressions. Felt what I thought "normal" should feel like. Forgot to take it over the summer vacation and wound up going off because I felt "cured".
Aug 2008: Took citalopram for about a month for a "transition" to grad school, can't remember it either helping or hurting.
2009 Mar-Sept: Took generic Prozac (Mallinckrodt) and then when it seemed to be making me worse with akathisia/diarrhea/intrusive thoughts (although I thought it just "wasn't working" and I must really be bad off), name brand Prozac, 10-30 mg.
2009 Sept: Switched to Lexapro name brand, 10 mg. Switched from 5 to 10 mg every now and then, corresponding with the seasonal part of my depression. Never felt good. Felt sedated, and at the higher doses akathisia, diarrhea and intrusive thoughts.
Late 2010: Realized the Lexapro was making things worse and dropped to 2.5 mg *against my pdoc's advice*. I wrote in an earlier thread that I also tried 1.25 mg but felt 'edgy', I don't remember this now.
Early 2011-mid Jan 2014: Lexapro name brand, escitalopram Teva brand, then Accord Healthcare brand starting in Oct 2013. Felt good until mid-late Jan. Normal. Not sedated, not restless, just living life with its ups and downs and changes. Then the akathisia, diarrhea, intrusive thoughts started to return a couple of months after they switched my generic manufacturer in Oct 2013. That may or may not be related, but I am posting all info.
-My question is, why did the Prozac help me so much in 2006-2007? Why then was I unable to tolerate it again in March 2009? Why did Lexapro work so well for 3 years?
-Are all SSRIs bad for me now for some inexplicable reason?
These questions have been what really caused my torment for so long. The inability to answer "why" has eaten at me a little bit ever since it happened. This is the reason I stayed so long on the meds even when they seemed to not help, because "Well, it *should* work because Prozac worked like a charm the first time."
The last question is the one that really bothers me. In some ways my scientific training helps me, in some ways it hurts because if I can't answer "why", I have a great deal of trouble just accepting "what is".
Sorry for the long post.
Posted by Phillipa on March 19, 2014, at 21:15:21
In reply to Re: Another step on the Lexapro journey » phidippus, posted by merpmerp on March 19, 2014, at 20:33:16
Same here after being RN you have to show me for me to believe anything. Phillipa
Posted by phidippus on March 20, 2014, at 18:15:28
In reply to Re: Another step on the Lexapro journey » phidippus, posted by merpmerp on March 19, 2014, at 20:33:16
> Eric,
>
> I've been spending the last few days re-reading my old posts from 2010/2011 to try and remember exactly what happened. I have a few questions, I'm honestly asking if you or anyone else have any ideas as to why this all happened. Brainstorming and all that.
>
> I'm going to post a condensed timeline.
>
> 2006-2007: Generic ProzacDo you remember the dose?
>akathisia/diarrhea/intrusive thoughtsThis may have been a reaction to the generic prozac. At this point did you try name brand again?
>Lexapro name brand, 10 mg. Switched from 5 to 10 mg every now and then
Exactly how did you switch from 5 to 10 mg?
>akathisia, diarrhea and intrusive thoughts.
SSRIs don't seem to be agreeing with you. Do you have OCD in the first place?
> Late 2010: Realized the Lexapro was making things worse and dropped to 2.5 mg *against my pdoc's advice*.You should have just stopped it.
>
>Then the akathisia, diarrhea, intrusive thoughts started to return a couple of months after they switched my generic manufacturer in Oct 2013.This tells me you may not have these reactions to all SSRIs.
> -My question is, why did the Prozac help me so much in 2006-2007? Why then was I unable to tolerate it again in March 2009?
Again there's some question as to which you were taking at the time-name bradnd or generic.
>Why did Lexapro work so well for 3 years?
It sounds like you switched to a generic brand that didn't work for you.
> -Are all SSRIs bad for me now for some inexplicable reason?
I wouldn't say that, but perhaps you should try something else like a TCA or Mirtazapine.
>This is the reason I stayed so long on the meds even when they seemed to not help
When medicines have stopped working for me, I immediately stop them and seek treatment with another medication.
Eric
Posted by merpmerp on March 20, 2014, at 22:32:06
In reply to Re: Another step on the Lexapro journey » merpmerp, posted by phidippus on March 20, 2014, at 18:15:28
Thank you, Eric, for taking the time to read and formulate an in-depth reply. That really means a lot to me - these last few months have been pretty awful.
***I put my replies after asterisks, like this, you can find them.
> > Eric,
> >
> > I've been spending the last few days re-reading my old posts from 2010/2011 to try and remember exactly what happened. I have a few questions, I'm honestly asking if you or anyone else have any ideas as to why this all happened. Brainstorming and all that.
> >
> > I'm going to post a condensed timeline.
> >
> > 2006-2007: Generic Prozac
>
> Do you remember the dose?***20-30 mg. This was my first time on any antidepressant of any type. I was 20.
>
> >akathisia/diarrhea/intrusive thoughts
>
> This may have been a reaction to the generic prozac. At this point did you try name brand again?***Had never had name brand or any other manufacturer of it.
>
> >Lexapro name brand, 10 mg. Switched from 5 to 10 mg every now and then
>
> Exactly how did you switch from 5 to 10 mg?***My pdoc and I would adjust the dose as needed to compensate for the seasonal aspect of my depression.
>
> >akathisia, diarrhea and intrusive thoughts.
>
> SSRIs don't seem to be agreeing with you. Do you have OCD in the first place?***No, I don't. I never had intrusive thoughts before the SSRIs. I went around for a year or two thinking I must have developed OCD, but with a lower dose the thoughts finally all went away.
***I have always (until the last few years, with this med ride, considered anxiety secondary to my depression.
>
> > Late 2010: Realized the Lexapro was making things worse and dropped to 2.5 mg *against my pdoc's advice*.
>
> You should have just stopped it.***I did the best I could. I felt powerless, trapped, miserable, muddled. I agree with you now, though.
>
>
> >
> >Then the akathisia, diarrhea, intrusive thoughts started to return a couple of months after they switched my generic manufacturer in Oct 2013.
>
> This tells me you may not have these reactions to all SSRIs.
>
> > -My question is, why did the Prozac help me so much in 2006-2007? Why then was I unable to tolerate it again in March 2009?
>
> Again there's some question as to which you were taking at the time-name bradnd or generic.***I suspect it is a difference with the manufacturers, yes, it's just scary that it made such a difference. 2006-2007 was Pliva brand (I believe Teva has since bought them). Second time was Mallinckrodt brand and then name brand.
>
> >Why did Lexapro work so well for 3 years?
>
> It sounds like you switched to a generic brand that didn't work for you.
>
> > -Are all SSRIs bad for me now for some inexplicable reason?
>
> I wouldn't say that, but perhaps you should try something else like a TCA or Mirtazapine.***To be honest TCA's kind of scare me. Probably undeservedly so. But my mother died from an overdose of a TCA - Elavil, I think - and Valium. (I believe this was accidental and not suicide, after having thought long and hard about the circumstances in which it happened.)
>
> >This is the reason I stayed so long on the meds even when they seemed to not help
>
> When medicines have stopped working for me, I immediately stop them and seek treatment with another medication.***I tried. I was not and am not a very assertive person, although getting better about it. Part of the problem was that I was assigned a pdoc by my grad school - I felt that I had no say in who I got and no recourse to change - a very bad situation. And no finances to go outside the school mental health system. It was this forum that gave me the social support I needed in order to make any changes at all - so for that I am incredibly grateful to everyone here :)
>
> Eric
Posted by phidippus on March 21, 2014, at 14:31:11
In reply to Re: Another step on the Lexapro journey, posted by merpmerp on March 20, 2014, at 22:32:06
> Thank you, Eric, for taking the time to read and formulate an in-depth reply.
I'm happy to help, I hate seeing you struggle with these medications.
>***I did the best I could. I felt powerless, trapped, miserable, muddled. I agree with you now, though.
Don't ever feel trapped with these medications. You have the power to stop them and try different ones.
> > >Then the akathisia, diarrhea, intrusive thoughts started to return a couple of months after they switched my generic manufacturer in Oct 2013.
Can you describe what the akathisia was like. What types of intrusive thoughts did you have?
> ***To be honest TCA's kind of scare me.
I am convinced you would do better on a TCA. I am very sorry about your mother passing, but I think a TCA overdose is a rare thing. As long as you follow proper dosing guidelines you would be perfectly safe.
Also, there's Mirtazapine.
Eric
Posted by Phillipa on March 21, 2014, at 18:18:15
In reply to Re: Another step on the Lexapro journey, posted by merpmerp on March 20, 2014, at 22:32:06
Many moons ago was given what I think could have Elavil with very first panic attack. I couldn't handle it and walked the block at my suburban home the whole night. It was extremely agitating for me. Also skipping forward. After was put on low doses of valium from same doc. I volunteered in a hospital on a psych floor. No SSRI's existed then. And I volunteered one afternoon a week. Patients stayed longer in hospitals then. Weeks at a time. I watched the patients gain huge amounts of weight from the TCA's. So I myself won't and didn't take them. Phillipa
Posted by merpmerp on March 21, 2014, at 20:35:22
In reply to Re: Another step on the Lexapro journey » merpmerp, posted by phidippus on March 21, 2014, at 14:31:11
> > Thank you, Eric, for taking the time to read and formulate an in-depth reply.
>
> I'm happy to help, I hate seeing you struggle with these medications.
>
> >***I did the best I could. I felt powerless, trapped, miserable, muddled. I agree with you now, though.
>
> Don't ever feel trapped with these medications. You have the power to stop them and try different ones.
***Thank you, I do still often feel that I have little to no choice. I just feel somehow like I'll "Get In Trouble" if I don't do exactly what the doctors say. Like be committed to a hospital. (This has never happened, but somehow I'm afraid of it.)
>
> > > >Then the akathisia, diarrhea, intrusive thoughts started to return a couple of months after they switched my generic manufacturer in Oct 2013.
>
> Can you describe what the akathisia was like. What types of intrusive thoughts did you have?
***The akathisia was extreme inner restlessness. I had to be moving, like I was trying to escape something. Had to be exercising, out on a walk, something, or my muscles would just twitch all the time uncontrollably. As for the thoughts: Violent ones. For example, I would look at a knife or scissors and an image would flash into my mind of me deliberately cutting myself. Over and over and over, dozens of times a day. I'd 'see' myself deliberately crashing my car while driving, hurting my pets while playing with them, hurting my boyfriend. It almost felt in my brain that it was a foregone conclusion that I would eventually 'snap' and do the violent things, so I might as well go ahead and just do them and get it over with. (I did not actually do anything violent, to me, animals, or anyone else.) It was terrifying. It felt like it wasn't coming from me - like I was possessed or something.
>
> > ***To be honest TCA's kind of scare me.
>
> I am convinced you would do better on a TCA. I am very sorry about your mother passing, but I think a TCA overdose is a rare thing. As long as you follow proper dosing guidelines you would be perfectly safe.
>
> Also, there's Mirtazapine.
>
> Eric
>
>
Posted by merpmerp on March 21, 2014, at 20:36:59
In reply to Re: Another step on the Lexapro journey » merpmerp, posted by Phillipa on March 21, 2014, at 18:18:15
Ouch! I'm sorry it did that to you, Philippa. :(
> Many moons ago was given what I think could have Elavil with very first panic attack. I couldn't handle it and walked the block at my suburban home the whole night. It was extremely agitating for me. Also skipping forward. After was put on low doses of valium from same doc. I volunteered in a hospital on a psych floor. No SSRI's existed then. And I volunteered one afternoon a week. Patients stayed longer in hospitals then. Weeks at a time. I watched the patients gain huge amounts of weight from the TCA's. So I myself won't and didn't take them. Phillipa
Posted by Phillipa on March 21, 2014, at 22:12:28
In reply to Re: Another step on the Lexapro journey, posted by merpmerp on March 21, 2014, at 20:36:59
Was really bad for sure. The valium and miltown got me right out of it for years. Did ditch the miltown no side effects. Was young didn't know you could get side effects hence I feel they are in my head now. Phillipa
Posted by phidippus on March 23, 2014, at 15:14:28
In reply to Re: Another step on the Lexapro journey, posted by merpmerp on March 21, 2014, at 20:35:22
Did the intrusive thoughts go away when you stopped the medication?
Eric
Posted by merpmerp on March 23, 2014, at 15:44:38
In reply to Re: Another step on the Lexapro journey » merpmerp, posted by phidippus on March 23, 2014, at 15:14:28
Yes.
They went away completely for three years after I lowered the Lexapro dosage to 2.5 mg, until the last few months when they came back but less strongly than before. The reappearance of them corresponds to the time that my generic manufacturer was changed.Nothing else changed in the last few months, with respect to medication or lifestyle.
> Did the intrusive thoughts go away when you stopped the medication?
>
> Eric
Posted by phidippus on March 23, 2014, at 15:47:05
In reply to Re: Another step on the Lexapro journey, posted by merpmerp on March 23, 2014, at 15:44:38
What are you going to do from here? Personally I think you should try Mirtazapine. Something non-ssri.
Eric
Posted by merpmerp on March 23, 2014, at 16:09:55
In reply to Re: Another step on the Lexapro journey » merpmerp, posted by phidippus on March 23, 2014, at 15:47:05
Honestly, I'm not sure. I have appointments in a couple of days with both my doctor and my therapist, so I'll talk it over with them. I'll report back here as I get it figured out.
Wellbutrin is something I've been wanting to try for a while. Considering that my natural depression includes a healthy dose of anhedonia, it seems like that might be good. Mirtazapine... I don't know anything about that one, really. It hits norepinephrine, right?
> What are you going to do from here? Personally I think you should try Mirtazapine. Something non-ssri.
>
> Eric
Posted by phidippus on March 23, 2014, at 17:10:18
In reply to Re: Another step on the Lexapro journey, posted by merpmerp on March 23, 2014, at 16:09:55
Wellbutrin is completely different than SSRIs - it acts as a dopamine/norepenephrine reuptake inhibitor. Chances are you may not have the same problems on it.
Mirtazapine boosts serotonin, norepenephrine and dopamine.
Eric
Posted by merpmerp on March 23, 2014, at 18:22:11
In reply to Re: Another step on the Lexapro journey » merpmerp, posted by phidippus on March 23, 2014, at 17:10:18
Yes, I knew that about wellbutrin; I think I'd do well with it :-)
Over the last few years it's come to annoy me how ssris are handed out like candy. Doctors seem to think they're the answer to everything.
> Wellbutrin is completely different than SSRIs - it acts as a dopamine/norepenephrine reuptake inhibitor. Chances are you may not have the same problems on it.
>
> Mirtazapine boosts serotonin, norepenephrine and dopamine.
>
> Eric
Posted by merpmerp on September 15, 2014, at 18:20:26
In reply to Re: Another step on the Lexapro journey » phidippus, posted by merpmerp on March 23, 2014, at 18:22:11
Hi all,
I'm very sorry to have just left this thread hanging for six months. I wanted to post an update, but I've had tons of computer problems between now and then so it never happened.
Been off the Lexapro since March 13. I was on a dosage of 2.5 mg/day, then cut that to 1.25 mg/day, then went off after two weeks as the intrusive thoughts were too much to bear. I kept in touch with my doctor during this time. The withdrawal was very rough for about 3 weeks. EXTREME fatigue. Dizziness, anxiety, etc. It was very hard on my to keep my normal routine, work, etc., during this time, but I did somehow. During the worst of it, I found that taking a Benadryl on occasion at night would ease the worse symptoms, and exercise also helped with the fatigue and dizziness.
I have not gone back on any med, although I've been taking valerian root on occasion for anxiety. I have been doing counseling and acupuncture. I think the acupuncture helps a little. I have not been exercising enough or eating very healthy, but I know those things would help me.
For now, I am satisfied with how I'm doing. There are extreme stressors in my life right now, and I could be handling them better, but I'm handling them... all right. This is not to say that I will not go back on meds in the future if I feel I need them, but for now, for me, I do not. I think that I need to work through a lot of things on my own. That Lexapro, at least, was not a good fit for me. And I'm not eager to jump back on the med-go-round right at this moment.
I just wanted to post an update in case anyone finds my threads in the future, or was at all curious about how it ended. I hope everyone is well.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.