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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by clm2007 on December 20, 2008, at 19:57:56
I have been taking lexapro (10mg) for about 4 years with mostly positive results. The last year or so it hasn't been working as well and I have attempted to wean off (with horrible results) many times. Now, I have a new health insurance company that will not cover this med so my Physician and I have decided to try Zoloft. He says to make the switch immediate, with no overlap. I am to start the Zoloft(25mg)for 2 weeks then up it to 50mg. Is this the best way to do this? I am worried about the withdrawal symptoms of coming off Lexapro so suddenly. Does anyone have any experience making this switch? I am very nervous about this but I have to do it one way or the other.
Posted by raisinb on December 20, 2008, at 23:07:51
In reply to Switching from Lexapro to Zoloft, posted by clm2007 on December 20, 2008, at 19:57:56
I have done the switch in the reverse--Zoloft to Lexapro.
I don't understand why your pdoc would tell you to stop Lexapro immediately, with no taper. Both are SSRIs and are very similar, but that seems reckless to me. If it were me, I'd cut the 10 mg pills into small pieces for a few weeks, stepping down to 7.5, then 5, then 2.5, then stop. That might be a bit over-cautious, but like you, I'm terrified of withdrawal. This type of taper is what my pdoc has prescribed me for every med switch and I have not had any withdrawal symptoms.
Posted by Justherself54 on December 20, 2008, at 23:51:36
In reply to Re: Switching from Lexapro to Zoloft » clm2007, posted by raisinb on December 20, 2008, at 23:07:51
I've switched from Lex to Zoloft with no withdrawals or start up effects. It was way smoother than I expected. I've also done the reverse some time ago, from Zoloft to Lexapro and as I recall there were no really adverse effects. Just eventual poop out on both :-(
Posted by Phillipa on December 21, 2008, at 0:48:31
In reply to Re: Switching from Lexapro to Zoloft, posted by Justherself54 on December 20, 2008, at 23:51:36
Since the same class of meds both SSRI's I'd think it wouldn't be a problem as serotonin should stay stable. It's just a different form of SSRI. If anxious about it think you're pdoc would let you take half of each dose together? I'd think the switch would avoid withdrawal with the just switching. I know with benzos just switching has always been okay for me anyway. Keep us updated. Love Phillipa
Posted by clm2007 on December 21, 2008, at 8:26:30
In reply to Re: Switching from Lexapro to Zoloft, posted by Phillipa on December 21, 2008, at 0:48:31
> Since the same class of meds both SSRI's I'd think it wouldn't be a problem as serotonin should stay stable. It's just a different form of SSRI. If anxious about it think you're pdoc would let you take half of each dose together? I'd think the switch would avoid withdrawal with the just switching. I know with benzos just switching has always been okay for me anyway. Keep us updated. Love Phillipa
Well last night I took 5mg of the Lexapro and this morning I started on the Zoloft 25mg. I'm going to take it in the morning for the time being because I'm worried about not being able to sleep at night. I'll keep you posted on how I feel.
Posted by desolationrower on December 21, 2008, at 14:07:09
In reply to Re: Switching from Lexapro to Zoloft, posted by Phillipa on December 21, 2008, at 0:48:31
> Since the same class of meds both SSRI's I'd think it wouldn't be a problem as serotonin should stay stable. It's just a different form of SSRI. If anxious about it think you're pdoc would let you take half of each dose together? I'd think the switch would avoid withdrawal with the just switching. I know with benzos just switching has always been okay for me anyway. Keep us updated. Love Phillipa
I agree. direct switch is less likely to cause problems.
-d/r
Posted by bleauberry on December 21, 2008, at 17:27:13
In reply to Switching from Lexapro to Zoloft, posted by clm2007 on December 20, 2008, at 19:57:56
I do not like the idea of doing an abrupt switch with a history of being on a med for several years. That is too much of a shock. While the two meds do have the same end result, there are a lot of individual characteristics of each that do not overlap. They are different drugs. Different is different no matter how you look at it.
I switched from longtime Prozac to Lexapro, and then from Lexapro to Zoloft, and then back to Lexapro, and then full circle ended up on Prozac again. So I am well versed in that game.
The way I did it was with cross-tapering. That is, reducing the dose of the med being eliminated while at the same time introducing in low escalating doses the new med. So there is overlap. For example, a switch from 20mg lex to 50mg zoloft could look something like this:
15mg lex + 10mg zoloft for 4 days
12.5 lex + 15mg zoloft for 4 days
10mg lex + 15mg zoloft for 4 days
7.5mg lex + 20mg zoloft for 4 days
5mg lex + 25mg zoloft for 4 days
5mg lex + 35mg zoloft for 4 days
2.5mg lex + 35mg zoloft for 4 days
1mg lex + 50mg zoloft for 4 days
1mg lex every other day + 50mg zoloft for 8 daysNot those exact numbers, but you can see the pattern. One is going up, one is going down, small steps for both, sometimes staying level at one while the other changes, sometimes they both change at the same time.
You need a razor blade so you can cut these pills to custom sizes. They do not have to be exact. Actually, the error you make in trying to get exact sizes is to your benefit. It aids in the whole cross-taper overlap thing. Just get them as close as you can, but base all of it on what you are feeling. You may be able to faster and more aggressive, or you may find you need to go slower and more cautious.
And one final note. Don't fall for the insurance game and end up with generic zoloft. Get the real stuff. The potential for that to make a real difference is very real and worth the cost. If it all works well for you, try switching to a generic later on down the road. But for now, insist on brand name Zoloft.
Posted by Phillipa on December 21, 2008, at 19:19:31
In reply to Re: Switching from Lexapro to Zoloft, posted by bleauberry on December 21, 2008, at 17:27:13
I've had numerous pdocs and all always did a direct switch. I have noticed the starting doses are lower. But why not see first before? I was nuts when found babble as had already cut from 60mg of cymbalta to 30mg and no problem at all. Then read about the tiny reductions my pdoc thought I was nuts but did it anyway. Should have just switched over to another med in retrospect. But that's me. Phillipa
Posted by KarenRB53 on December 21, 2008, at 21:05:48
In reply to Re: Switching from Lexapro to Zoloft, posted by bleauberry on December 21, 2008, at 17:27:13
> I do not like the idea of doing an abrupt switch with a history of being on a med for several years. That is too much of a shock. While the two meds do have the same end result, there are a lot of individual characteristics of each that do not overlap. They are different drugs. Different is different no matter how you look at it.
>
> I switched from longtime Prozac to Lexapro, and then from Lexapro to Zoloft, and then back to Lexapro, and then full circle ended up on Prozac again. So I am well versed in that game.
>
> The way I did it was with cross-tapering. That is, reducing the dose of the med being eliminated while at the same time introducing in low escalating doses the new med. So there is overlap. For example, a switch from 20mg lex to 50mg zoloft could look something like this:
> 15mg lex + 10mg zoloft for 4 days
> 12.5 lex + 15mg zoloft for 4 days
> 10mg lex + 15mg zoloft for 4 days
> 7.5mg lex + 20mg zoloft for 4 days
> 5mg lex + 25mg zoloft for 4 days
> 5mg lex + 35mg zoloft for 4 days
> 2.5mg lex + 35mg zoloft for 4 days
> 1mg lex + 50mg zoloft for 4 days
> 1mg lex every other day + 50mg zoloft for 8 days
>
> Not those exact numbers, but you can see the pattern. One is going up, one is going down, small steps for both, sometimes staying level at one while the other changes, sometimes they both change at the same time.
>
> You need a razor blade so you can cut these pills to custom sizes. They do not have to be exact. Actually, the error you make in trying to get exact sizes is to your benefit. It aids in the whole cross-taper overlap thing. Just get them as close as you can, but base all of it on what you are feeling. You may be able to faster and more aggressive, or you may find you need to go slower and more cautious.
>
> And one final note. Don't fall for the insurance game and end up with generic zoloft. Get the real stuff. The potential for that to make a real difference is very real and worth the cost. If it all works well for you, try switching to a generic later on down the road. But for now, insist on brand name Zoloft.
My pdoc wants to switch me from Prozac (been taking over 10yrs)but has stopped working...to Lexapro. Noticed you had done that switch also. How did you find the difference between Prozac and Lexapro? Did you stay on the Lexapro for any length of time? I've read some of your other postings and really appreciate them as I know you've been on Prozac for a long time like I have. Very informative.
Thanks, Karen
Posted by bleauberry on December 22, 2008, at 17:05:34
In reply to Re: Switching from Lexapro to Zoloft, posted by KarenRB53 on December 21, 2008, at 21:05:48
>
> My pdoc wants to switch me from Prozac (been taking over 10yrs)but has stopped working...to Lexapro. Noticed you had done that switch also. How did you find the difference between Prozac and Lexapro? Did you stay on the Lexapro for any length of time? I've read some of your other postings and really appreciate them as I know you've been on Prozac for a long time like I have. Very informative.
> Thanks, KarenHI Karen,
I did about 2 months on Lexapro. For depression, it was ok. I had a few moments of feeling pretty darn good, but for the most part it was the same blah empty anhedonic life of ssris. I'm trying to recall the difference between lex and prozac, but it is all kind of fuzzy. I do remember lex caused stronger anorgasmia than prozac did. Prozac was a bit more stimulating, lex a bit more sedating.
If you do try lex or another med and it doesn't go well, you might consider going back to prozac and see if it works again. For some people it does. If it doesn't, you could maybe add something to it, such as Ritalin or Zyprexa, depending on what types of symptoms you need to address.
Posted by KarenRB53 on December 22, 2008, at 17:52:46
In reply to Re: Switching from Lexapro to Zoloft » KarenRB53, posted by bleauberry on December 22, 2008, at 17:05:34
>
> >
> > My pdoc wants to switch me from Prozac (been taking over 10yrs)but has stopped working...to Lexapro. Noticed you had done that switch also. How did you find the difference between Prozac and Lexapro? Did you stay on the Lexapro for any length of time? I've read some of your other postings and really appreciate them as I know you've been on Prozac for a long time like I have. Very informative.
> > Thanks, Karen
>
> HI Karen,
>
> I did about 2 months on Lexapro. For depression, it was ok. I had a few moments of feeling pretty darn good, but for the most part it was the same blah empty anhedonic life of ssris. I'm trying to recall the difference between lex and prozac, but it is all kind of fuzzy. I do remember lex caused stronger anorgasmia than prozac did. Prozac was a bit more stimulating, lex a bit more sedating.
>
> If you do try lex or another med and it doesn't go well, you might consider going back to prozac and see if it works again. For some people it does. If it doesn't, you could maybe add something to it, such as Ritalin or Zyprexa, depending on what types of symptoms you need to address.
>
>Hi: What meds are you on now if you don't mind my asking? I did try adding the Zyprexa to Prozac and it made the agitation worse. I don't think its supposed to but it did. The Prozac for years worked so well but all along its caused agitation but it was worth it because it helped me so much but now it doesn't do much for the depression and the agitation is still there. Did you mention Zoloft also? How did that work for you? What do you think of Luvox? I've read that Prozac affects more than seratonin, that it could actually be considered an atypical SSRI, thats why its stimulating and probably thats why it causes my agitation, whereas Lexapro is strictly seratonin. Do you agree or have any opinion on that?
Karen
This is the end of the thread.
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