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Dr. Bob is Robert Hsiung, MD,
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Posted by pharmrep on September 3, 2002, at 0:24:59
In reply to Re: poop-out=cycling. No » pharmrep, posted by JaneB on September 2, 2002, at 18:17:30
Thanks for your clarification...can you have poop-out with or without cycling...or cycling with or without poop-out...I only ask because youre right..I dont know 1st hand and have only gotten this info from some of my Dr's...I heard the terms intermingled, but may be mistaken. Thanks
Posted by pharmrep on September 3, 2002, at 0:58:11
In reply to Re: Raines et al, posted by Patson on September 2, 2002, at 20:47:01
> I have to admit I'm a little confused. Maybe I don't understand english all that well....
>
> The investigators observed continued improvement in subjects with further reductions in the MADRS and CGI-S scores. ****The incidence of adverse events declined during escitalopram treatment versus short-term treatment. ****There were no clinically significant mean changes in vital signs, electrocardiogram (ECG), or laboratory values observed during continued escitalopram treatment, regardless of previous treatment. Researchers observed no new clinically significant adverse events in patients switching from citalopram to escitalopram treatment.
>
> "In patients switched from citalopram to escitalopram, there are no safety concerns, and depressive symptoms continue to improve." the researchers concluded.
>
> Hardly sounds like a negative...
> > You can find a report by going to http://www.docguide.com and searching for 'escitalopram'. There is a news report dated 08/29/02 on the switching study. If there were any difference between citalopram and escitalopram the side-effects would have decreased and this would have been a major finding. It is noticeable by its absence.
> >
> >
> > > "Indeed new research presented this week (Raines et al) looking at people switching from citalopram to escitalopram did not show any significant reduction in side-effects."
> > >
> > > That sounds important. Got a link? Or, can you copy and post?
> > >
> >
************** I run into the same problems with Dr. Dave too, he always seems to reach a different conclusion than what the study finds.
Posted by WINGER on September 3, 2002, at 1:49:04
In reply to Re: Lexapro effects » JaneB, posted by pharmrep on September 2, 2002, at 17:15:57
Does this mean that lexapro will be easier on the body and the liver especially??
None of the doctors I know want to talk about what all of these do taken together to your organs that process them... they all poo poo it and act like you're crazy for worrying about it..
It's like we're all one big long term experiment!!
> > > > Why don't the study results indicate any positive conclusions about fewer ASE's or daytime sleepiness?
> > > > Appreciate your info.
> > > > JaneB
> > >
> > > ** Why do you think they dont? There are studies that show reduced s/e with Lexapro...here is a post from a couple days ago that has the FDA approved package insert info.
> > > Re: Lexapro side-effects » dr dave
> > > If you have any questions...I'd be glad to help if I can.
> >
> > Pharmrep,
> >
> > What about antidepressant induced sexual dysfunction? I saw the results you posted. Am I missing something or has this issue not been evaluated with Lexapro? What if 40 mg Celexa causes cycling and 20 mg is used. Can/should 10 mg Lexapro be cut in half to avoid this risk? I know package inserts don't cover these intricate side effects. Just wondered if you have inside information.
> > JaneB
> >
> > **good news and bad. As far as cycling...I cant help you there...as far as sex. s/e...here's the scoop...5+ years ago, when Celexa was coming out the sex. s/e was at 6%. Back then (pre Viagra era and others) people were not very willing to mention sexual disfunction (embarrassed?) Anyway, we know that 6% was low...it was more like high-teens, or low 20's (Paxil and others had same problem and are believed to be 30%+.) Since Lexapro study was done in last year, we are hoping for a more "believeable" number since todays responders are more "aware" of the sexual s/e topic, and are more willing to bring it up. Anyway, the Lexapro number is 9%...it is believed to be slightly lower than Celexa, due to its increased Serotonin selectivity (there seems to be a connection to the more selective, the less the sex. s/e.) Ultimately, any AD working with serotonin will affect sex s/e. It's just a question of how much.
> PS...the only mg's are 10mg and 20mg (but they are scored...the idea is so you can use 15mg...but of course some people do respond differently and maybe 5mg is good for some, however it has not been tested...10mg is the "normal" starting and maintenance dose. (And this is all in the P.I...read up if you can find it.)
Posted by dr. dave on September 3, 2002, at 5:41:52
In reply to Re: Raines et al/see bottom » Patson, posted by pharmrep on September 3, 2002, at 0:58:11
Let me explain again. I haven't seen evidence to support the claim that escitalopram has fewer side-effects than citalopram. I have presented all the data that are available on relative side-effects in a previous post, and they don't support this claim.
People are now claiming that Raines et al shows escitalopram has fewer side-effects than citalopram. I am not sure how you can come to this conclusion when there was no comparison made. If there is anything in the study that does say it has fewer side-effects than citalopram, I haven't seen it.
All the studies available show no significant difference in side effects between escitalopram and citalopram. If Raines et al does give evidence to contradict this I would be glad if someone could say what that evidence is. Escitalopram having a low level of side-effects is great but unless you know what level of side-effects citalopram would give under the same conditions, you don't know if there's any difference.
It is not enough to read a diffusely enthusiastic tone in a paper and then take this to mean every claim made about the drug must therefore be true. Things can only be taken to be true if there is evidence that they are true. To show that there is a difference in side-effects between escitalopram and citalopram, present the evidence.
> > I have to admit I'm a little confused. Maybe I don't understand english all that well....
> >
> > The investigators observed continued improvement in subjects with further reductions in the MADRS and CGI-S scores. ****The incidence of adverse events declined during escitalopram treatment versus short-term treatment. ****There were no clinically significant mean changes in vital signs, electrocardiogram (ECG), or laboratory values observed during continued escitalopram treatment, regardless of previous treatment. Researchers observed no new clinically significant adverse events in patients switching from citalopram to escitalopram treatment.
> >
> > "In patients switched from citalopram to escitalopram, there are no safety concerns, and depressive symptoms continue to improve." the researchers concluded.
> >
> > Hardly sounds like a negative...
> > > You can find a report by going to http://www.docguide.com and searching for 'escitalopram'. There is a news report dated 08/29/02 on the switching study. If there were any difference between citalopram and escitalopram the side-effects would have decreased and this would have been a major finding. It is noticeable by its absence.
> > >
> > >
> > > > "Indeed new research presented this week (Raines et al) looking at people switching from citalopram to escitalopram did not show any significant reduction in side-effects."
> > > >
> > > > That sounds important. Got a link? Or, can you copy and post?
> > > >
> > >
> ************** I run into the same problems with Dr. Dave too, he always seems to reach a different conclusion than what the study finds.
Posted by Bill L on September 3, 2002, at 9:48:28
In reply to Fewer s/e with Lexapro - where's the evidence? » pharmrep, posted by dr. dave on September 3, 2002, at 5:41:52
The way I see it, a switch from Celexa to Lexapro would be prudent. Celexa has a drug in it (the R-enantiomer) which apparently has NO antidepressant activity. In fact, it may be harmful in terms of making the active ingredient less effecive. And also it might cause side effects. Why would anyone want to take the R-enantiomer? Why put a drug in your body that is not helpfull and that might be harmfull?
Posted by johnj on September 3, 2002, at 11:23:30
In reply to Re: poop-out, posted by pharmrep on September 2, 2002, at 17:28:16
I have never taken an ssri and need to switch. What do you mean when you say sexual side effects? Lack of desire?, feeling?, etc. Also, would it be desirable to titrate up very slowly with lexapro to decrease the chance of initial anxiety? I have heard it can be a problem at the start and I want an AD with anxiety relieving properties. Anybody feel spacey on Celexa? Remeron made me a space cadet. Thank you
johnj
Posted by dr. dave on September 4, 2002, at 4:45:50
In reply to Sexual/anxiety SE question for everyone/pharmrep, posted by johnj on September 3, 2002, at 11:23:30
There are initial reports from people taking Lexapro at
Posted by johnj on September 4, 2002, at 8:27:02
In reply to Reports from people taking Lexapro, posted by dr. dave on September 4, 2002, at 4:45:50
How could they have used Lexapro if it isn't out in the US? One used it a few days at most and said it didn't work? I thought a trial of weeks was needed? Are these for real? Something sounds fishy
Posted by dr. dave on September 4, 2002, at 9:26:23
In reply to Re: Reports from people taking Lexapro » dr. dave, posted by johnj on September 4, 2002, at 8:27:02
It doesn't make a hell of a lot of sense does it? And if you do get side-effects in the first week and no benefit, that means pretty much nothing because the side-effects are likely to go and it hasn't had time to properly kick in yet.
I suppose there's nothing to stop anyone posting anything they like on these boards - maybe every other SSRI manufacturer is posting that they've tried Lexapro and it's awful. You never know what tricks these guys are up to.
> How could they have used Lexapro if it isn't out in the US? One used it a few days at most and said it didn't work? I thought a trial of weeks was needed? Are these for real? Something sounds fishy
Posted by johnj on September 4, 2002, at 11:37:50
In reply to Re: Reports from people taking Lexapro » johnj, posted by dr. dave on September 4, 2002, at 9:26:23
I didn't think about any dirty play from other drug companies. The only thing that bothers me is when I look at a lot of ssri's I see poop out happening(or so it appears) to everyone over time. Why start something if it will just poop out? I would like to change to a new AD since my nortryptline makes my sleep and mood worse when I work out. And I need to excercise to help myself. It might take a few days, but over the last few years all mood and sleep disturbance has occurred when I have tried to work out. My doc doesn't quite buy it, but I have found other people with similiar experience on nortryptline and amitryptline. It is almost like the AD causes depression??? I know it sounds funny, but that is the way it feels sometimes. I have not heard of anybody feeling this way on Celexa or any other ssri's so that is why I am considering Lexapro. I tried remeron, but too powerful, and caused a sponge head feeling. Thanks for your input on ssri poop out if you have had experiences with that.
Johnj
Posted by Ritch on September 4, 2002, at 13:21:06
In reply to Re: Reports from people taking Lexapro » dr. dave, posted by johnj on September 4, 2002, at 11:37:50
> I didn't think about any dirty play from other drug companies. The only thing that bothers me is when I look at a lot of ssri's I see poop out happening(or so it appears) to everyone over time. Why start something if it will just poop out? I would like to change to a new AD since my nortryptline makes my sleep and mood worse when I work out. And I need to excercise to help myself. It might take a few days, but over the last few years all mood and sleep disturbance has occurred when I have tried to work out. My doc doesn't quite buy it, but I have found other people with similiar experience on nortryptline and amitryptline. It is almost like the AD causes depression??? I know it sounds funny, but that is the way it feels sometimes. I have not heard of anybody feeling this way on Celexa or any other ssri's so that is why I am considering Lexapro. I tried remeron, but too powerful, and caused a sponge head feeling. Thanks for your input on ssri poop out if you have had experiences with that.
> Johnj
John,Just an aside here, but I found that nortriptyline and Celexa or nortriptyline and Zoloft work well *together*. The tricyclic didn't do much good by itself, and SSRI by itself doesn't work for me. You might try a lower dose of NT combined with an SSRI.
Mitch
Posted by dr dave on September 4, 2002, at 13:41:42
In reply to Re: Reports from people taking Lexapro » dr. dave, posted by johnj on September 4, 2002, at 11:37:50
I haven't really found that people on SSRIs are more likely to relapse than people on other antidepressants. I do find that people can feel better on an antidepressant for a while and then relapse - which doesn't necessarily mean the drug has stopped working.
Antidepressants can successfully elevate an individuals mood, but it can be the case that the factors that have led to that depressive state in the first place can continue and overwhelm what effect the drug has had. I don't think people's mood state can be permanently elevated by a drug such that other influences cannot have an effect. If someone's life is chronically difficult, be that because of external problems or because of unhelpful ways of thinking or reacting to circumstances, this can lead to depression. Antidepressants can alter the balance of positive and negative influences on that persons mood, but if the difficulties continue they can reverse that shift. If your life has felt devoid of pleasure for six months, that exerts a certain downward pressure on your mood. If your life has felt devoid of pleasure for six years, that is going to depress your mood more strongly. In this situation the pressures that are chronically exerting a negative influence on your mood need to be identified and sorted out, as any medication may be fighting an unwinnable battle.
> I didn't think about any dirty play from other drug companies. The only thing that bothers me is when I look at a lot of ssri's I see poop out happening(or so it appears) to everyone over time. Why start something if it will just poop out? I would like to change to a new AD since my nortryptline makes my sleep and mood worse when I work out. And I need to excercise to help myself. It might take a few days, but over the last few years all mood and sleep disturbance has occurred when I have tried to work out. My doc doesn't quite buy it, but I have found other people with similiar experience on nortryptline and amitryptline. It is almost like the AD causes depression??? I know it sounds funny, but that is the way it feels sometimes. I have not heard of anybody feeling this way on Celexa or any other ssri's so that is why I am considering Lexapro. I tried remeron, but too powerful, and caused a sponge head feeling. Thanks for your input on ssri poop out if you have had experiences with that.
> Johnj
Posted by IsoM on September 4, 2002, at 14:32:36
In reply to Re: 'Poop out' » johnj, posted by dr dave on September 4, 2002, at 13:41:42
Dr. Dave, you seem willing to discuss different factors regarding depression. If you wouldn't mind, could you please email me at isomorphix at hotmail dot com (in the normal mode - this is to hopefully stop my email add from showing up in searches). I will not be a bother but wish to privately ask a question regarding ADs, self-esteem, & life style. Promise that there would be no 'hounding' you with many further questions.
Posted by johnj on September 4, 2002, at 14:34:56
In reply to Re: 'Poop out' » johnj, posted by dr dave on September 4, 2002, at 13:41:42
Thanks for responding. I do agree with what you said about overwhelming factors. And I have had that this past year. But, not working out doesn't allow me to help myself.
Ritch, I will have an overlap when I start (maybe) lexapro while trying to change over.
Posted by dr dave on September 4, 2002, at 15:12:33
In reply to Re: Raines et al/see bottom » Patson, posted by pharmrep on September 3, 2002, at 0:58:11
You have mentioned the Sanchez paper which shows Lexapro raising brain serotonin more than an equivalent dose of Celexa. This seems to show r-citalopram impeding the action of s-citalopram.
But there is another side to this. Another paper by Sanchez compares the potency of Lexapro and Celexa. The results are in terms of IC50 - the concentration required to inhibit serotonin re-uptake by 50%.
2.1 nM of Lexapro inhibits re-uptake by 50%, whereas 3.9 nM of Celexa is required. So Lexapro is about twice as potent. But let's think about this. Once Celexa is absorbed, you end up with 36% s-citalopram and 64% r-citalopram in the circulation. So the concentration of s-citalopram needed to achieve 50% inhibition, when r-citalopram is also present, is 36% of 3.9nM - only 1.4nM!
So from these results, r-citalopram helps s-citalopram with serotonin re-uptake inhibition! This is pretty definitely not true, but it demonstrates how unreliable individual results can be, and if you pick out the right results you can make them say all sorts of improbable things. This is why I feel it is so important to look at all the data.
I think we should be able to examine the trials which have been done comparing Celexa and Lexapro. Currently (as far as I am aware) the comparisons from only one of three trials has been disclosed (Burke et al). The study written up by Lepola et al and Montgomery et al has had the citalopram data removed, for no apparent reason. The third trial has not been disclosed at all.
I think we should be able to have access to all the information so we can make up our own minds.
Posted by Patson on September 4, 2002, at 22:39:44
In reply to r-citalopram impedes s-citalopram?, posted by dr dave on September 4, 2002, at 15:12:33
Hey,
I just read an article on the Nobel Prize in Chemistry for the scientists that created the technology allowing scientists to "cleve" a molecule and isolate the single isomer of a racemic compound. Just thought that was kind of an interesting addition to the current discussion of isomer science.
Posted by pharmrep on September 4, 2002, at 23:33:31
In reply to Re: Lexapro effects » pharmrep, posted by WINGER on September 3, 2002, at 1:49:04
Lexapro has the cleanest cyp450 system (liver metabolization) of all AD's. Celexa was the cleanest before, only mild inhibitions in the 2d6 and 1a2...Lexapro has 0 (negligible) inhibitions in all the pathways..3a4,2d6,1a2,2c19,and 2c9
(In otherwords...it is nearly impossible to get a drug-to-drug interaction with Lexapro...which is good news for anybody on multiple meds.)
> Does this mean that lexapro will be easier on the body and the liver especially??
> None of the doctors I know want to talk about what all of these do taken together to your organs that process them... they all poo poo it and act like you're crazy for worrying about it..
> It's like we're all one big long term experiment!!
>
>
> > > > > Why don't the study results indicate any positive conclusions about fewer ASE's or daytime sleepiness?
> > > > > Appreciate your info.
> > > > > JaneB
> > > >
> > > > ** Why do you think they dont? There are studies that show reduced s/e with Lexapro...here is a post from a couple days ago that has the FDA approved package insert info.
> > > > Re: Lexapro side-effects » dr dave
> > > > If you have any questions...I'd be glad to help if I can.
> > >
> > > Pharmrep,
> > >
> > > What about antidepressant induced sexual dysfunction? I saw the results you posted. Am I missing something or has this issue not been evaluated with Lexapro? What if 40 mg Celexa causes cycling and 20 mg is used. Can/should 10 mg Lexapro be cut in half to avoid this risk? I know package inserts don't cover these intricate side effects. Just wondered if you have inside information.
> > > JaneB
> > >
> > > **good news and bad. As far as cycling...I cant help you there...as far as sex. s/e...here's the scoop...5+ years ago, when Celexa was coming out the sex. s/e was at 6%. Back then (pre Viagra era and others) people were not very willing to mention sexual disfunction (embarrassed?) Anyway, we know that 6% was low...it was more like high-teens, or low 20's (Paxil and others had same problem and are believed to be 30%+.) Since Lexapro study was done in last year, we are hoping for a more "believeable" number since todays responders are more "aware" of the sexual s/e topic, and are more willing to bring it up. Anyway, the Lexapro number is 9%...it is believed to be slightly lower than Celexa, due to its increased Serotonin selectivity (there seems to be a connection to the more selective, the less the sex. s/e.) Ultimately, any AD working with serotonin will affect sex s/e. It's just a question of how much.
> > PS...the only mg's are 10mg and 20mg (but they are scored...the idea is so you can use 15mg...but of course some people do respond differently and maybe 5mg is good for some, however it has not been tested...10mg is the "normal" starting and maintenance dose. (And this is all in the P.I...read up if you can find it.)
>
>
Posted by pharmrep on September 4, 2002, at 23:47:12
In reply to Sexual/anxiety SE question for everyone/pharmrep, posted by johnj on September 3, 2002, at 11:23:30
You need to ask your Dr about Lexapro...Forest is going to start giving the Dr's samples and studies starting 9/5...there can be sexual s/e with AD's that affect serotonin. Lexapro showed a 9% possibility of have ejaculatory delay (not always a problem). But it was not enough to discontinue treatment (only 6% dropout rate for various reasons.) As far as titrating goes...couldn't be easier...everyone starts at 10mg...most patients should see a difference in 1-2 weeks, and if necessary go to 20mg, but that should be necessary for a minority of patients...most will do fine at 10mg. As far as anxiety...Lexapro will help that, not contribute to problems. Look for the Burke, Gorman, and Lydiard studies for proof-sources.
> I have never taken an ssri and need to switch. What do you mean when you say sexual side effects? Lack of desire?, feeling?, etc. Also, would it be desirable to titrate up very slowly with lexapro to decrease the chance of initial anxiety? I have heard it can be a problem at the start and I want an AD with anxiety relieving properties. Anybody feel spacey on Celexa? Remeron made me a space cadet. Thank you
> johnj
Posted by pharmrep on September 4, 2002, at 23:52:36
In reply to Re: Reports from people taking Lexapro » dr. dave, posted by johnj on September 4, 2002, at 8:27:02
> How could they have used Lexapro if it isn't out in the US? One used it a few days at most and said it didn't work? I thought a trial of weeks was needed? Are these for real? Something sounds fishy
** I agree...I am positive that no early sample studies were done...perhaps they got it from UK? Anyway...there will be more feedback starting soon since it's in US now.
Posted by pharmrep on September 5, 2002, at 0:06:31
In reply to Re: Fewer s/e with Lexapro - where's the evidence?, posted by Bill L on September 3, 2002, at 9:48:28
> The way I see it, a switch from Celexa to Lexapro would be prudent. Celexa has a drug in it (the R-enantiomer) which apparently has NO antidepressant activity. In fact, it may be harmful in terms of making the active ingredient less effecive. And also it might cause side effects. Why would anyone want to take the R-enantiomer? Why put a drug in your body that is not helpfull and that might be harmfull?
>** Of course it is a guess, but Forest is anticipating Lexapro getting its prescriptions from about 1/3 of patients on Celexa and about 2/3's of patients on other AD's. Remember..Lexapro is for patients who feel their current AD is not working or the s/e are not tolerable...not just switching because its "new."
Posted by dr dave on September 5, 2002, at 2:31:05
In reply to Re: Fewer s/e with Lexapro - where's the evidence?, posted by Bill L on September 3, 2002, at 9:48:28
Anybody?
Any evidence? If it's going to be repeated and repeated that Lexapro has fewer side-effects than Celexa, can anyone provide the evidence to back it up?
Things seem to have gone a bit quiet with regards to this question.
Posted by Anyuser on September 5, 2002, at 9:56:45
In reply to Re: Fewer s/e with Lexapro - where's the evidence?, posted by dr dave on September 5, 2002, at 2:31:05
"Evidence" for you is something different than "evidence" for a potential user of Lexapro and also different, I'll bet, for most practitioners. I'm not trying to win a scientific argument. I am trying to make reasonable and, I hope, effective decisions about which medicine to take for a mood disorder. "Evidence" for me means "useful information." For the moment, the best such evidence about Lexapro is the FDA-approved prescribing information that says that the incidence of adverse effects associated with a therapeutic dose of 10mg Lexapro is the same as placebo. That's pretty good reason to believe that Lexapro is worth a try, as compared to the FDA-prescribing info for the alternative SSRIs. In a couple of months we'll have additional "evidence" in the way of the reported experience of Lexapro users and prescribers.
Posted by pharmrep on September 5, 2002, at 10:17:28
In reply to Re: Fewer s/e with Lexapro - where's the evidence?, posted by dr dave on September 5, 2002, at 2:31:05
> Anybody?
>
> Any evidence? If it's going to be repeated and repeated that Lexapro has fewer side-effects than Celexa, can anyone provide the evidence to back it up?
>
> Things seem to have gone a bit quiet with regards to this question.** I do agree with Anyuser's statement...the FDA has approved the statement "Lexapro 10mg/day had an overall incidence of side effects comparable to placebo" and "Lexapro 10mg/day showed no significant diference in drop-rates due to adverse events vs. placebo." (As written in the Lexapro package insert)
I have to ask you something DR. Dave...has any representative from Lundbeck seen you? I am thinking you have not gotten any input/presentation from them, posters of studies or samples....or have you?
Posted by dr. dave on September 5, 2002, at 10:34:28
In reply to Re: evidence » dr dave, posted by pharmrep on September 5, 2002, at 10:17:28
> > Anybody?
> >
> > Any evidence? If it's going to be repeated and repeated that Lexapro has fewer side-effects than Celexa, can anyone provide the evidence to back it up?
> >
> > Things seem to have gone a bit quiet with regards to this question.
>
> ** I do agree with Anyuser's statement...the FDA has approved the statement "Lexapro 10mg/day had an overall incidence of side effects comparable to placebo" and "Lexapro 10mg/day showed no significant diference in drop-rates due to adverse events vs. placebo." (As written in the Lexapro package insert)
> I have to ask you something DR. Dave...has any representative from Lundbeck seen you? I am thinking you have not gotten any input/presentation from them, posters of studies or samples....or have you?I've seen a Lundbeck rep and I have also had several lengthy conversations with Dr Joubert Gama, Medical Affairs Officer for Lundbeck UK. I've seen all the papers and posters available, to my knowledge - certainly Lundbeck say they've sent me everything that's available.
Posted by Dinah on September 5, 2002, at 10:34:59
In reply to Re: evidence » dr dave, posted by pharmrep on September 5, 2002, at 10:17:28
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