Psycho-Babble Medication Thread 1098520

Shown: posts 1 to 21 of 21. This is the beginning of the thread.

 

Celexa anxiety side effect: less than most AD's?

Posted by Mtom on May 4, 2018, at 10:36:56

Hi - I've been avoiding antidepressants because of several past experiences with extreme anxiety/agitation which worsens over time, so had to go off.

Happened with Zoloft many years ago (only took that a few days because was so intense), with very low dose Trazodone (which was actually prescribed for insomnia, wasn't supposed to even have an AD affect at these tiny doses - stayed on it for a couple of months anyway then weaned off, anxiety, tinnitus, continued long after), even 5HTP brings on anxiety/agitation after a week or so. And I suspect so did the very high dose B-Vitamins a Naturopath prescribed.

I've researched and researched and Anxiety/Agitation is listed as a possible side effect of ALL antidepressants of ALL classes. And I'm already experiencing anxiety in addition to depression.

I am obviously hyper-sensitive and there is evidence I may be a poor metabolizer.

But my depression has been worsening (probably at least in part due to some intense situational stresses in recent years) and I have to try something.

I've read limited research, and a number of anecdotal reports that Celexa is less likely to cause anxiety/agitation than other AD's. Including it's newer version "sister" compound Lexapro - same creator, and there is some suggestion out there that Lexapro may have been created more because the patent on Celexa had run out at that time, than any additional benefit (although that's not what the drug company says).

Interested in experiences from those who have had anxiety/agitation syndromes and can comment on comparison Celexa versus other AD's. And any other side-effect/efficacy comparisons. Am starting on very tiny dosage. Thanks!

 

Re: Celexa anxiety side effect: less than most AD's?

Posted by Mtom on May 4, 2018, at 10:38:32

In reply to Celexa anxiety side effect: less than most AD's?, posted by Mtom on May 4, 2018, at 10:36:56

Forgot to tick "notify of follow-ups" so this post is just to add that.

 

Re: Celexa anxiety side effect: less than most AD's?

Posted by Christ_empowered on May 4, 2018, at 14:18:10

In reply to Re: Celexa anxiety side effect: less than most AD's?, posted by Mtom on May 4, 2018, at 10:38:32

hi. im not a big fan of antidepressants, but I did find standard dose (20mgs) celexa helpful for an intense bout of agitated depression. only problem...after 6 months or so, it was a bit too calming, especially with an 'atypical' tranquilizer on board, so I dropped it.

prozac was oddly stimulating. not in a way that made me feel euphoric or even helped with concentration, just...jittery, kind of disconcerting sort of stimulation. having said that, Prozac has a wide dosage range and the long half life often makes tapering a lot easier.

i think i mention Surmontil (trimipramine) in another response to one of your posts. its a tca, but its sedating, calming...I think its chemically somewhat similar to clozapine, but it isn't nearly as toxic.

zoloft was horrible for me, too. i basically had agitation plus frontal lobe syndrome. it wasn't until after i tapered that i realized how horrible it was...the nastiness kind of snuck up on me.

adding buspirone to antidepressants sometimes helps bring about reductions in anxiety plus a more robust response. i didn't think much of it myself, but buspirone is cheaper and less toxic than 'atypical' tranquilizers, so I would think it might be worth a try.

hope this helps.

 

Re: Celexa anxiety side effect: less than most AD's?

Posted by SLS on May 4, 2018, at 18:25:59

In reply to Re: Celexa anxiety side effect: less than most AD's?, posted by Christ_empowered on May 4, 2018, at 14:18:10

> zoloft was horrible for me, too. i basically had agitation plus frontal lobe syndrome.

What were your symptoms of frontal lobe syndrome?


- Scott

 

Re: Celexa anxiety side effect: less than most AD's?

Posted by rjlockhart37 on May 4, 2018, at 19:15:11

In reply to Celexa anxiety side effect: less than most AD's?, posted by Mtom on May 4, 2018, at 10:36:56

i have read celexa has caused anxiety, i was studying about SSRI's about 12 years ago and their differences, celexa does cause anxiety, ill have redo research because it's been a while since i studied about it, but it's child medication is lexepro, it seems to be better in reducing anxiety. There have been posts and reports of similar thing on other sites

celexa does cause anxiety, i've read it many times, some people reported seizures, not as bad a bupropion which is big time seizure threshold reducer

it's the other isomer on celexa that causes anxiety, lexapro is only one isomer, the other isomer on celexa is known to cause anxiety - ill have re research it again to find more info

 

Re: Celexa anxiety side effect: less than most AD's?

Posted by SLS on May 4, 2018, at 22:52:39

In reply to Re: Celexa anxiety side effect: less than most AD's?, posted by rjlockhart37 on May 4, 2018, at 19:15:11

> i have read celexa has caused anxiety, i was studying about SSRI's about 12 years ago and their differences, celexa does cause anxiety, ill have redo research because it's been a while since i studied about it, but it's child medication is lexepro, it seems to be better in reducing anxiety. There have been posts and reports of similar thing on other sites
>
> celexa does cause anxiety, i've read it many times, some people reported seizures, not as bad a bupropion which is big time seizure threshold reducer
>
> it's the other isomer on celexa that causes anxiety, lexapro is only one isomer, the other isomer on celexa is known to cause anxiety - ill have re research it again to find more info

Interesting.


- Scott

 

More research: Celexa versus Lexapro

Posted by Mtom on May 5, 2018, at 11:25:25

In reply to Re: Celexa anxiety side effect: less than most AD's?, posted by SLS on May 4, 2018, at 22:52:39

I have spent many hours researching Lexapro versus Celexa and the information is inconsistent and far from definitive. In general, there seems to be a slight leaning towards Lexapro for efficacy and towards Celexa for less intense adverse affects:

http://www.med.umich.edu/1info/FHP/practiceguides/depress/depress05.pdf states that Celexa may be initially sedating (dose-dependent) or initially increase alertness but also may be the least stimulating SSRI. And it is a minimal inhibitor of CYP 2D6 isoenzymes.
There are a couple of papers hypothesizing whether differences in enantiomers could mean a difference in therapeutic or adverse effects, but without really firm conclusions.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2829184/ states claims about clinically relevant superiority of Lexapro over Celexa are not supported by evidence. It points out that results of antidepressant clinical trials do not reflect the real world due to a number of reasons (design, unpublishsed studies, industry influences, modest generalizability, etc., produces results that do not reflect the real physical world and inflated effect sizes suggest more benefit than really exists.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2950952/pdf/IJPsy-46-333.pdf found greater response and fewer adverse effects for Lexapro than Celexa, but the differences were not huge, especially for anxiety (1% Lexapro, 3% Celexa) and agitation (2% Lexapro, 5% Celexa). And noted most adverse advents were mild in severity. There is discussion regarding evidence that antidepressant benefits have been overestimated and choices of drugs influenced more by marketing than evidence, noting both drugs were developed by the same company and that Lexapro appeared at the time of Celexa patent ending, promoted as being something new and better. This latter point was made in several papers and articles I read.

One article cited agitation and anxiety being common with Lexapro, but did not mention these as side effects with Celexa. Another site specifically stated that side effects of Lexapro that are different from Celexa include agitation or restlessness. As my readings indicate agitation/anxiety are associated with greater serotonin activity, this would seem to correlate with the postulation that Lexapro does enhance serotonin more so than Celexa.

One article did document significantly greater efficacy with Lexapro at initial doses, but similar after dose increase with Celexa.

Lexapro is approved for Generalized Anxiety Disorder where Celexa is not, however it is pointed out that Celexa has not been studied for this while Lexapro has. Some sites state that both Lexapro and Celexa are used to treat despression and anxiety disorders. One says that Celexa is approved in the UK and other European countries for treatment of panic disorder, and is used off-label in the U.S. for anxiety and panic disorder.

The main caveat about Celexa is that high doses have occasionally been linked to heart rhythm abnormalities in, I think, a small and select proportion of patients.

Several websites state Celexa, is reported as having fewer overall side effects than other SSRIs. At least two articles (citations for which I cant find right now) claimed Celexa was the gentlest of the antidepressants. One article showed the same side effects for both with the exception of diarrhea with Celexa but not Lexapro.

One website rated them as practically identical in efficacy and side effects from consumer reviews (1063 for Lexapro and 530 for Celexa) with Celexa being very slightly better.

You could spend days and days researching and not finding definitive answers for these or other drugs!

My own Doctor was ambivalent about the choice, in her experience she has not noted a difference.

 

Re: More research: Celexa versus Lexapro

Posted by rjlockhart37 on May 5, 2018, at 12:56:42

In reply to More research: Celexa versus Lexapro, posted by Mtom on May 5, 2018, at 11:25:25

https://www.ncbi.nlm.nih.gov/pubmed/17675913 - "We then may conclude that R-citalopram antagonizes the antidepressive effects of escitalopram and that its presence limits the therapeutic effect and reduces the speed of action of citalopram. The antagonism of escitalopram by R-citalopram was not expected and one hypothesis is that a direct interaction between the 2 enantiomers may occur on a particular site of the serotonin transporter. Results have shown that R-citalopram has a significant affinity only for the allosteric site of the transporter, which regulates the affinity of the ligand for the active site at the origin of serotonin reuptake inhibition. Unlike citalopram, escitalopram's pharmacologic action is not blocked by R-citalopram explaining its greater therapeutic efficacy and more rapid mode of action"

https://www.ncbi.nlm.nih.gov/pubmed/20730799 - "escitalopram, but not citalopram, improved recognition memory"

https://www.ncbi.nlm.nih.gov/pubmed/17675913 - "Escitalopram is more powerful than citalopram in reducing anxiety but the presence of R-citalopram reduces the positive effects of escitalopram"

these sources repeatedly say that the R-citalopram counter acts escitalopram, and it said many times....."escitalopram" is more potent as an anti-depressant, the "R-citalopram" counter acts, and it has low effect on serotonin re-uptake

after reading all of these, it clearly is saying Lexapro is the better one, because it work better for anxiety and depression because the "R-citalopram" has nearly none AD activity

 

Re: More research: Celexa versus Lexapro

Posted by rjlockhart37 on May 5, 2018, at 13:08:15

In reply to Re: More research: Celexa versus Lexapro, posted by rjlockhart37 on May 5, 2018, at 12:56:42

but i was reading other sources, that say that racemic citalopram has different effects on people than escitalopram (lexapro), some people seem to respond better to citalopram in depression, but read it clearly said lexapro is better for anxiety because its more potent in serotonin reuptake

this is the kinda thing as Provigil and Nuvigil, also Dexedrine and Evekeo - evekeo is racemic amphetamine which it has the levo isomer on it, while as dexedrine or just raw dextroamphetamine which more direct on dopamine reuptake, levoamphetamine is more on norepinephrine, your more kicker and sharp, but it has less psychoactive effects than d-amphetamine. It increases dopamine more than racemic amphetamine

its the same thing with Celexa, its isomer work partly different than the main psychoactive isomer.....some people respond better in some cases i guess to both isomers

 

Re: More research: Celexa versus Lexapro

Posted by Mtom on May 5, 2018, at 13:44:26

In reply to Re: More research: Celexa versus Lexapro, posted by rjlockhart37 on May 5, 2018, at 12:56:42

Hi rjlockhart37 and thank you for your information. I have read the citations you sent I had not previously read. I have also read a lot more papers/articles than the ones I posted above. In part I am expressing frustration with the contradictions between articles and research.

Some additional points:
The dosage of Lexapro is lower than that of Celexa in part to account for the fact that it does not contain the (by some presumably?) inactive enantiomer. I know some papers cite other postulated implications. Yet a good number of papers find negligible differences.

It was pointed out in several papers (not all of which I cited) that most studies have been done on the individual drugs versus placebo, rather than direct comparisons.

Many studies were relatively short term.

I see some papers including your citations note faster onset and greater efficacy of Lexapro (but not all). However, I am hypersensitive to AD's, and therefore a "milder" slower onset one may be indicated for me. I am very concerned about advserse reactions as I have experienced quite intense ones with very small doses of other AD's.

Again, I did not include all I read, just enough to emphasize there are disagreements, unknowns, hypotheses (rather than certainties) and possible biases. I do agree it seems Lexapro may be a "stronger" AD based on some of these papers (although again, others question this).

I know 1 person who has been taking Celexa for years with excellent results who had tried a number of other AD's previously, unsucessfully (either ineffective or adverse effects which they did not experience with Celexa). This person has not tried Lexapro.

I know another who found Lexapro worked wonders for anxiety, but needs Wellbutrin for depression. This person has been on many AD's and other meds for many years, but has not tried Celexa.

> https://www.ncbi.nlm.nih.gov/pubmed/17675913 - "We then may conclude that R-citalopram antagonizes the antidepressive effects of escitalopram and that its presence limits the therapeutic effect and reduces the speed of action of citalopram. The antagonism of escitalopram by R-citalopram was not expected and one hypothesis is that a direct interaction between the 2 enantiomers may occur on a particular site of the serotonin transporter. Results have shown that R-citalopram has a significant affinity only for the allosteric site of the transporter, which regulates the affinity of the ligand for the active site at the origin of serotonin reuptake inhibition. Unlike citalopram, escitalopram's pharmacologic action is not blocked by R-citalopram explaining its greater therapeutic efficacy and more rapid mode of action"
>
> https://www.ncbi.nlm.nih.gov/pubmed/20730799 - "escitalopram, but not citalopram, improved recognition memory"
>
> https://www.ncbi.nlm.nih.gov/pubmed/17675913 - "Escitalopram is more powerful than citalopram in reducing anxiety but the presence of R-citalopram reduces the positive effects of escitalopram"
>
> these sources repeatedly say that the R-citalopram counter acts escitalopram, and it said many times....."escitalopram" is more potent as an anti-depressant, the "R-citalopram" counter acts, and it has low effect on serotonin re-uptake
>
> after reading all of these, it clearly is saying Lexapro is the better one, because it work better for anxiety and depression because the "R-citalopram" has nearly none AD activity
>

 

Re: More research: Celexa versus Lexapro

Posted by SLS on May 5, 2018, at 14:30:02

In reply to Re: More research: Celexa versus Lexapro, posted by Mtom on May 5, 2018, at 13:44:26

I just wanted to mention that with Lexapro, anxiety can emerge around two weeks into treatment and lasts for a few days before disappearing. I don't know if dosage affects this, but you would probably want to start at 10 mg/day for a few weeks before raising it.

There is some conjecture that the r- isomer of citalopram actually takes away from the efficacy of the s- isomer. I don't know the precise mechanism. The following abstract suggests that Lexapro is more effective for anxiety disorders than is Celexa.

https://www.ncbi.nlm.nih.gov/pubmed/17675913

I chose to take Lexapro for depression. I experienced the transient anxiety at day 13, but kept taking it. The anxiety disappeared after 3 days. After this, I was more sedated than I liked, but continued it anyway. Ultimately, Lexapro didn't help me.


- Scott

 

Re: More research: Celexa versus Lexapro » SLS

Posted by rjlockhart37 on May 6, 2018, at 2:04:11

In reply to Re: More research: Celexa versus Lexapro, posted by SLS on May 5, 2018, at 14:30:02

maybe ... some people do better with the r-isomer on citalopram, but i just don't see how because those sources say it's canceling out the more psychoactive part

some people do better on evekeo or provigil, which they both have 2 isomers, where as nuvigil and dexedrine are only one isomer, which are the main psychoactive isomers......some people think provigil works well, and others think armodafinil is better, feel it cleaner in effects

im sure there's alot of people that do well on celexa even over lexapro, but citalopram is not good for anxiety, mostly just depression

 

Re: More research: Celexa versus Lexapro

Posted by Mtom on May 6, 2018, at 12:41:29

In reply to Re: More research: Celexa versus Lexapro » SLS, posted by rjlockhart37 on May 6, 2018, at 2:04:11

Well I'm giving Celexa (Citalopram) a try, starting with very low dose and titrating up (due to my sensitivities). I know it is not "approved" for anxiety treatment, but it is noted in several reports that it is prescribed off-label for this in the U.S. (is approved for anxiety in several other countries). It was pointed out that even though not approved for anxiety in the U.S., this is because it was not submitted for approval for treatment of anxiety (maybe because the drug creator was focusing on Lexapro at that time and more interested in studies that would switch people over to that).

There is one older and small U.S. study which showed patients with Generalized Anxiety disorder responded to Celexa (this may have been before Lexapro appeared on the market): https://www.ncbi.nlm.nih.gov/pubmed/11981350#

 

Re: More research: Celexa versus Lexapro » Mtom

Posted by ed_uk2010 on May 6, 2018, at 13:38:43

In reply to Re: More research: Celexa versus Lexapro, posted by Mtom on May 6, 2018, at 12:41:29

Hi there,

Citalopram undoubtedly has the potential to be useful in multiple forms of anxiety disorder. Approval in individual countries mainly depends on what was submitted to the relevant regulatory authorities in that country. As an example, in the UK, it was submitted and approved for panic disorder.

Given your previous sensitivity to SSRI adverse effects, you're doing exactly the right thing to start with a really low dose. This should reduce the risk of side effects a great deal. You can then increase gradually if tolerated.

Aggravated initial anxiety due to SSRIs certainly isn't inevitable, but it is common.... and usually occurs very early during treatment, or after large dose increases. Most commonly, it will occur during the first two weeks of treatment, or within the first two weeks after changing the dose.

People who experience this initial worsening can still benefit from SSRIs. Just monitor it over time. If citalopram is likely to help, anxiety should start to reduce below baseline after the first month or so. If your anxiety is worse than it was before starting citalopram even after a few weeks of treatment, I would suggest that you ask for a different medication instead.

The starting dose of citalopram recommended by the manufacturer for people prone to panic is 10mg per day. Given your response to sertraline, 5mg per day might be a good starting dose. You could then increase gradually up to 20mg over a period of a few weeks.

Personally, citalopram doesn't make me anxious, even at first. But that's just me. After a few weeks, it starts to help.

 

Re: More research: Celexa versus Lexapro

Posted by Mtom on May 6, 2018, at 14:07:07

In reply to Re: More research: Celexa versus Lexapro » Mtom, posted by ed_uk2010 on May 6, 2018, at 13:38:43

Thank you ed_uk2010. Increased anxiety is the side effect I fear most, it's happened in past attempts with AD's, and at this time I'm already dealing with GAD as well as depression.

I started Citalopram 2 days ago and I have all kinds of commitments scheduled over the next 2 weeks and am extremely concerned whether adverse effects will suddenly hit during this period.

I have started with 5 mg based on Dr recommendation although she wants me to titrate up to 10 after 5 days. I think that's too soon.

I don't know whether I should be cancelling commitments including travel plans for the next couple of weeks.

It appears there is no way to be sure how quickly, or if, adverse effects will set in? They have been variable with past AD attempts (some long ago) - anywhere from the next day to about 7 to 10 days.

> Hi there,
>
> Citalopram undoubtedly has the potential to be useful in multiple forms of anxiety disorder. Approval in individual countries mainly depends on what was submitted to the relevant regulatory authorities in that country. As an example, in the UK, it was submitted and approved for panic disorder.
>
> Given your previous sensitivity to SSRI adverse effects, you're doing exactly the right thing to start with a really low dose. This should reduce the risk of side effects a great deal. You can then increase gradually if tolerated.
>
> Aggravated initial anxiety due to SSRIs certainly isn't inevitable, but it is common.... and usually occurs very early during treatment, or after large dose increases. Most commonly, it will occur during the first two weeks of treatment, or within the first two weeks after changing the dose.
>
> People who experience this initial worsening can still benefit from SSRIs. Just monitor it over time. If citalopram is likely to help, anxiety should start to reduce below baseline after the first month or so. If your anxiety is worse than it was before starting citalopram even after a few weeks of treatment, I would suggest that you ask for a different medication instead.
>
> The starting dose of citalopram recommended by the manufacturer for people prone to panic is 10mg per day. Given your response to sertraline, 5mg per day might be a good starting dose. You could then increase gradually up to 20mg over a period of a few weeks.
>
> Personally, citalopram doesn't make me anxious, even at first. But that's just me. After a few weeks, it starts to help.
>
>
>
>

 

Re: More research: Celexa versus Lexapro » Mtom

Posted by ed_uk2010 on May 6, 2018, at 15:29:03

In reply to Re: More research: Celexa versus Lexapro, posted by Mtom on May 6, 2018, at 14:07:07

>I have started with 5 mg based on Dr recommendation although she wants me to titrate up to 10 after 5 days. I think that's too soon.

I think the 5mg starting dose is a really good choice for you, based on past experience, even though it's lower than most people start on.

I think you will know after five days whether you feel OK to increase. If there is no sign of side effects at all during the first five days, you should be OK to increase. If you think you may have had some side effects, or feel unsure, you could wait a bit longer until they pass.

 

Re: More research: Celexa versus Lexapro

Posted by Tony P on May 19, 2018, at 21:59:46

In reply to Re: More research: Celexa versus Lexapro » Mtom, posted by ed_uk2010 on May 6, 2018, at 15:29:03

A clear case of Your Mileage May Vary!

My personal experience with Celexa was truly horrible. My anxiety was so high I became dissociated and had a sort of out-of-body experience, watching myself try to do normal things from a "safe" corner of my mind. I got off it quickly -- luckily (!) it also affected my liver in combo with trazadone, so I had a good excuse to drop it.

Later my pDoc put me on Lexapro; accepting the early wisdom of the time, he said it had 95% of the antidepressant action of Celexa, and only 5% of the side effects. Later research has questioned this, but my personal experience was absolutely, Yes. We're all different; Effexor, supposed to be good for GAD, also drives me crazy with anxiety.

 

Revisiting Celexa vs Lexapro: effect of r-isomer

Posted by Mtom on July 10, 2018, at 9:38:17

In reply to Re: More research: Celexa versus Lexapro, posted by Tony P on May 19, 2018, at 21:59:46

Earlier posts discussed whether the r-isomer in Celexa is inactive, as most believe, or whether, according to a couple of papers, it might actually interfere with the antidepressant activity of the s-isomer (Celexa has both, Lexapro only the s).

It is commonly stated that Lexapro has twice the AD activity of Celexa per dosage because it contains only the active isomer.

However, if in fact the r-isomer in Celexa does interfere with the AD activity of the s-isomer, it would seem to me that Lexapro would then be "more" than twice as potent per dosage?
Thoughts? Any more research?

Also, how small are the Lexapro pills for cutting? I take very small doses due to hypersensitivity, and I find that small pills tend to crumble, even with a pill cutter or razor knife.

Thanks!

 

Re: More research: Celexa versus Lexapro » SLS

Posted by Tony P on January 13, 2019, at 11:19:02

In reply to Re: More research: Celexa versus Lexapro, posted by SLS on May 5, 2018, at 14:30:02

I too got anxiety early on with Lexapro/Cipralex/escitalopram. I've been off it for 9 months, managing, well, struggling really, on herbals & OTC; I want to go back on it, so I appreciate the reminder to tough the anxiety through. Lamotrigine was much worse, though: serious anxiety when I titrated my dose up to 100 mg had to go on benzos, and I still have post-acute withdrawal anxiety from the latter.

Overall, for me, Lexapro has the best S-E profile of any A-D I have taken, with the possible exception of Cymbalta (unfortunately not covered by my plan).

 

Re: More research: Celexa versus Lexapro » Tony P

Posted by SLS on February 9, 2019, at 19:28:16

In reply to Re: More research: Celexa versus Lexapro » SLS, posted by Tony P on January 13, 2019, at 11:19:02

Hi, Tony.

I am so sorry that I didn't see your post earlier. I hope you were able to reestablish Lexapro treatment. Please let us know how you are doing.


- Scott

 

Re: Celexa anxiety side effect: less than most AD's?

Posted by creepy on April 7, 2019, at 22:13:17

In reply to Celexa anxiety side effect: less than most AD's?, posted by Mtom on May 4, 2018, at 10:36:56

I took citalopram and then escitalopram for a few years. escitalopram was the better of the two and if I took it at a dose lower than 20mg I had some nasty irritability. When I took 20mg that was fixed but I became pretty flat.
You might consider asking about low dose lithium as an augment. like 150-300mg can take the edge off and theres no bloodwork or much in the way of side effects.


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