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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by dozy35 on January 8, 2005, at 17:12:09
I have been on Lexapro for almost 3 months now (for OCD and mild depression), and, while I feel it's helped me become more spontaneous and relaxed about things in general, I feel that at the same time I am turning into a COMPLETE ZOMBIE (comparable to my old Paxil days)! Some days I cannot get out of bed for anything! I have no motivation to get anything done, especially when it comes to housework and other mundane tasks. I feel like such a slacker, I just can't seem to get my act together, and I think it's driving my hubby crazy! I have a 2-year-old daughter and feel like a terrible Mom these days! I just don't seem to care about anything anymore - plus I want to eat more and crave alcohol more, which I think is affecting my weight and making me feel even worse! I'm thinking of switching back to Prozac, but that didn't help so much with my anxiety. It doesn't seem to matter what time of the day/evening I take the Lex - I'm still a zombie! Not sure what I should do - help!
Posted by ed_uk on January 8, 2005, at 17:31:15
In reply to Lexapro - no motivation!, posted by dozy35 on January 8, 2005, at 17:12:09
Hi!
Just a few questions.....
How much is the Lexapro helping your OCD and depression?
What dose are you on? How long have you been on that dose? Have you tried a lower dose?
Why did you stop the Paxil?
Have you been managing to resist your alcohol cravings?
Ed.
Posted by dozy35 on January 9, 2005, at 15:42:58
In reply to Re: Lexapro - no motivation!, posted by ed_uk on January 8, 2005, at 17:31:15
Hi Ed,
I've been on 10 mg of Lexapro for a little less than 3 months now. (For the six months prior to that, I'd been taking Prozac, which worked fine for depression, but did nothing for my anxiety and OCD). I started at 5 mg Lexapro the first week (just to introduce it gradually to my system) - since then, I've been taking 10 mg per day. For the first month or so I felt pretty good, but as the medication built up in my system, the feelings of fatigue and lethargy became worse. I still struggle daily with OCD; however, my urges to perform compulsions have become less intense (much better than with Prozac) and I experience far less anxiety while attempting to resist the compulsions. It does a fairly good job of helping with my depression (although I don't quite have the "high" that I had while taking Prozac); however, now that I'm lacking so much in energy (in addition to putting on some weight), I'm not so sure how much it's really helping with the depression anymore - especially premenstrually. Back in November, my pdoc suggested taking 15 mg (instead of 10 mg) a week or so before my period. Unfortunately the higher dosage caused some stomach upset, so I immediately went back to taking 10 mg.
A couple of years ago I was on Paxil CR for OCD, anxiety, and mild depression. I was on an extremely high dose (for OCD). In some aspects it really helped my OCD, but of course it did not completely eliminate it. And I must say it did WONDERS for general feelings of anxiety and social phobia type stuff; however, it eventually turned me into a zombie and caused weight gain, to the point where I felt it was more important to stop the medication and and try to lose weight than to treat my OCD, etc. (and oh, what a joy it was discontinuing Paxil - or "Puxil", shall I say? - took me several weeks to get off the stuff, being on such a high dose & everything - but that's a whole other story)!
My alcohol cravings aren't as intense as they were when I was on Prozac. They do tend to get worse premenstrually. They mainly just hit me in the early evening ("happy hour"), as that tends to be a more stressful time of day for me (dinner time, dealing with my hubby when he comes home from work, bath and bedtime for the little one, picking up messes, cleaning the kitchen, etc). I'll make myself a cocktail or two because it "takes the edge off" and makes everything else I have to do much less boring. Once I start thinking about having that cocktail or glass of wine or whatever, it's hard to get the thought out of my head. I never do it before I have to drive anywhere, though. I think that once I start exercising again, it will be easier to manage my cravings. Perhaps I'll try some tea or something in lieu of the gin. My pdoc also prescribes Ativan for me, but even taking half of a 0.5-mg tablet tends to make me feel too sleepy. Anyway, sorry to be so long-winded! If you have any suggestions, let me know. Thanks!
Posted by ed_uk on January 9, 2005, at 16:07:18
In reply to Re: Lexapro - no motivation!, posted by dozy35 on January 9, 2005, at 15:42:58
Hi!
I used to take Paxil 40-60mg/day for OCD and anxiety. It made my very lazy and I ended up dropping out of college. I was on Celexa 60mg/day up until recently, Celexa also made me lazy.
I think that you should try reducing the dose down to 5mg/day. Hopefully, you'll still get the benefit but with less side effects. Alternatively, you could try Zoloft instead of Lexapro. It seems a little less likely to cause laziness than Lexapro. Some people do find Zoloft good for anxiety although it does seem to be a little more Prozac-like than the other SSRIs.
Regards,
Ed.
Posted by dozy35 on January 9, 2005, at 16:45:43
In reply to Re: Lexapro - no motivation!, posted by ed_uk on January 9, 2005, at 16:07:18
I think I'll try reducing the dose to 5 mg per day, like you suggested. I'll let you know how it goes. Thanks so much for your advice - I really appreciate it!
Was just wondering if you're currently taking anything for your OCD? Are you familiar with "exposure and response prevention" therapy? There's also a pretty good book out there ("Brainlock", I believe it's called) by Jeffrey Schwartz (not sure if I spelled the author's name correctly).
Take care!
Posted by ed_uk on January 9, 2005, at 17:03:14
In reply to Re: Lexapro - no motivation!, posted by dozy35 on January 9, 2005, at 16:45:43
Hi!
>Thanks so much for your advice - I really appreciate it!
You're welcome!
I don't have OCD at the moment. It generally affects me for a few months and then goes.... then it comes back later- you get the picture.
>Are you familiar with "exposure and response prevention" therapy?
I don't know much about it to be honest. I once went to a cognitive behavioural therapist but he said he didn't know how to help me!
Regards,
Ed.
Posted by lars1 on January 10, 2005, at 2:07:07
In reply to Lexapro - no motivation!, posted by dozy35 on January 8, 2005, at 17:12:09
> I have been on Lexapro for almost 3 months now (for OCD and mild depression), and, while I feel it's helped me become more spontaneous and relaxed about things in general, I feel that at the same time I am turning into a COMPLETE ZOMBIE (comparable to my old Paxil days)! Some days I cannot get out of bed for anything! I have no motivation to get anything done, especially when it comes to housework and other mundane tasks. I feel like such a slacker, I just can't seem to get my act together, and I think it's driving my hubby crazy! I have a 2-year-old daughter and feel like a terrible Mom these days! I just don't seem to care about anything anymore - plus I want to eat more and crave alcohol more, which I think is affecting my weight and making me feel even worse! I'm thinking of switching back to Prozac, but that didn't help so much with my anxiety. It doesn't seem to matter what time of the day/evening I take the Lex - I'm still a zombie! Not sure what I should do - help!
Hi dozy,
Some people find dopaminergics helpful for apathy. Have you tried Wellbutrin, Ritalin, or Adderall?
Re the alcohol cravings, I enjoy a drink now and then, and I often crave alcohol the next day after I have one. If I don't drink, then pretty soon I don't crave it any more. I wonder if you stopped if the cravings might go away? On the other hand, if you enjoy it and it doesn't cause you any problems, there's no reason you need stop.
Lars
Posted by dozy35 on January 10, 2005, at 14:15:44
In reply to Re: Lexapro - no motivation!, posted by lars1 on January 10, 2005, at 2:07:07
Hi Lars,
I actually haven't tried any of the dopaminergics you mentioned. Apparently there are quite a few people who combine Lexapro with Wellbutrin ("WellPro"). From what I gather, though, I wouldn't be able to drink at all on Wellbutrin, with the seizure risk being much higher than that of other antidepressants. I think it's a good idea that I cut back on the drinking...however, considering my lifestyle, I don't think I'd be able to abstain completely (unless I became pregnant or something). It doesn't seem to cause me any problems, unless I drink wine in the evening, which makes me feel drowsy the next day, so I try to cut back on it. What you said about the cravings makes sense, though, just as with things like chocolate - the less you have, the less likely you are to crave.
For the time being, I've reduced my dose of Lex to 5 mg/day, per Ed's suggestion. I'll let you know how that works out! Hopefully it will - if not, I may be talking to my pdoc about dopaminergics. Thanks for your suggestion!
Posted by flmm on January 10, 2005, at 21:21:34
In reply to Re: Lexapro - no motivation!, posted by dozy35 on January 10, 2005, at 14:15:44
Dozy, I reduced to 5 mg of lex for exact reasons as you. Week 1 was easy,at about day 8 started feeling really bad for 3-4 days, then started having rushes of old emotions that felt good and bad. Now at 3 weeks feel stable and better than ever. All sexual side fx and lack of motivation side fx are all but gone. I have been combining with good cbt program and working on changing my thought process and really improving!But at 5 mg I think it still blocks panic attacks and you can work on recovery.A pill will never completely cure you, only help with symptoms. Try to work thru the withrawall, there is some even reducing, you will feel better in the end on 5 mg! Much better enjoyement, less emotion blunting. I think many people take too high a dose. When you eliminate all anxiety thru medication, you dilute emotions, and hence all motivation!Stick it out!
Posted by flmm on January 10, 2005, at 21:31:35
In reply to Re: Lexapro - no motivation!, posted by flmm on January 10, 2005, at 21:21:34
I think people think the pills are supposed to make them happy, I did. I have been fighting panic and depression for 10 years and only now does it all make sense.The pills keep you from getting depressed not make you happy,that can only be found within!I think that they compress emotions in a way that makes happiness impossible. They are great when needed, but I feel the key is to take the lowest dose possible, to keep youself as functional as possible, even if there is some anxiety. Some anxiety is needed to feel excitement, happiness etc. Then work on positive thinking thru cbt and someday maybe get off drugs altogether!
Posted by lars1 on January 11, 2005, at 12:07:45
In reply to Re: Lexapro - no motivation!, posted by dozy35 on January 10, 2005, at 14:15:44
> I actually haven't tried any of the dopaminergics you mentioned. Apparently there are quite a few people who combine Lexapro with Wellbutrin ("WellPro"). From what I gather, though, I wouldn't be able to drink at all on Wellbutrin, with the seizure risk being much higher than that of other antidepressants. I think it's a good idea that I cut back on the drinking...however, considering my lifestyle, I don't think I'd be able to abstain completely (unless I became pregnant or something). It doesn't seem to cause me any problems, unless I drink wine in the evening, which makes me feel drowsy the next day, so I try to cut back on it. What you said about the cravings makes sense, though, just as with things like chocolate - the less you have, the less likely you are to crave.
> For the time being, I've reduced my dose of Lex to 5 mg/day, per Ed's suggestion. I'll let you know how that works out! Hopefully it will - if not, I may be talking to my pdoc about dopaminergics. Thanks for your suggestion!
Hi dozy,I think Ed's suggestion is a good one. If for some reason it doesn't work out, please don't let the seizure thing discourage you from trying Wellbutrin. I think it's a very useful drug that has been unfairly maligned due to some early problems. If you use one of the time-release formulations and don't exceed 300mg/day, the seizure risk is comparable to other antidepressants (0.1%) and less than Zoloft or Celexa. It's also one of the very few AD's that don't tend to cause sexual problems. (It may even be pro-sexual.)
You wouldn't necessarily need to abstain from all alcohol. My understanding of the issue with Wellbutrin and alcohol is this: alcohol has an anti-seizure effect, somewhat like the benzodiazepines. After the alcohol is gone from your body, there is a rebound/withdrawal effect, where the seizure threshold is lowered. (This is similar to benzo withdrawal.) For alcoholics (heavy drinkers) who abruptly stop drinking, the rebound can be very strong and will sometimes be enough to trigger a seizure even without Wellbutrin. However, if you just had a single glass of wine, the withdrawal effect would be very mild and would be unlikely to cause any problem.
FWIW, here's what the Wellbutrin XL label says: "Patients should be told that the excessive use or abrupt discontinuation of alcohol or sedatives (including benzodiazepines) may alter the seizure threshold. Some patients have reported lower alcohol tolerance during treatment with WELLBUTRIN XL. Patients should be advised that the consumption of alcohol should be minimized or avoided."
There's a good article on Wellbutrin at http://bupropion.com/wonderwell/. In any case, I don't mean to say that Wellbutrin is necessarily right for you, but I also don't want anybody to be discouraged from trying it based on misinformation.
Lars
Posted by dozy35 on January 11, 2005, at 22:06:59
In reply to Re: Lexapro - no motivation!, posted by flmm on January 10, 2005, at 21:21:34
Hi flmm,
Thank you so much for sharing your experience with me - you are certainly an inspiration! I've been on 5 mg/per day for about 3 days now, and so far, nothing too harsh in terms of withdrawal, but of course, the worst is probably yet to come (I haven't forgotten those good ol' days of going off Paxil)! I'm definitely going to stick it out, though! I should really think about CBT myself. (I think finding a good therapist is half the battle)! I'm gearing up to start exercising again, too, which hopefully will help in combination with the 5 mg Lex per day. Thanks again for everything!
Posted by dozy35 on January 11, 2005, at 22:19:06
In reply to Re: Lexapro - no motivation! » dozy35, posted by lars1 on January 11, 2005, at 12:07:45
Hi Lars,
Thank you so much for your information on Wellbutrin. I haven't had much time to read up on it recently, so I really appreciate it! It is so helpful to know that I don't necessarily have to rule that out as an option. I also remember hearing that weight gain is not a problem with Wellbutrin, which is a good thing! I will definitely try to read the article you mentioned as soon as I get a chance! For now, I'm on 5 mg of Lex per day (third day now) and will keep you & the others posted on how that works out (of course right now, it's too early to tell)! Thanks again for your help - I appreciate it so much!
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