![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 353 to 377 of 8406. Go back in thread:
Posted by jane d on September 10, 2002, at 0:33:19
In reply to Re: Fewer s/e with Lexapro - where's the evidence?, posted by moxy1000 on September 9, 2002, at 22:49:59
> I would not think that a direct comparison of Celexa's side effect profile versus Lexapro's side effect profile would be of any value to you, would it? I mean, there are different patient populations involved, different dosages of each agent given. Lexapro's side effect profile was based on a 8 week study, dosed at 10-20 mg (the starting/maintanance dose and the maximum dose.) Celexa's side effect profile was based on a 6 week study, dosed from 10-80 mg (half the starting dose of 20mg to 20mg past the max dose of 60mg.)
Moxy,
As I recall that was exactly the point made near the beginning of this thread. When the company did a study that did include a direct comparison bwtween Celexa, Lexapro and placebo in the same study with the same population, they didn't release the data on the Celexa so that this comparison could not be made. Is this incorrect? If it's true why wouldn't Forest release the numbers? I've always thought that what's missing is just as interesting as what is reported. (see Sherlock Holmes http://www.obtuse.com/juniper-docs/misc/silver_blaze.html :) )
Jane
PS I'm interested in any information you can provide. I don't think I'm in the market for a new SSRI this year but anything's possible.
Posted by dr. dave on September 10, 2002, at 4:42:08
In reply to Re: Fewer s/e with Lexapro - where's the evidence?, posted by moxy1000 on September 9, 2002, at 22:49:59
> Dr. Dave, I believe evidence has already been offered to you but it seems as if the conclusions arrived at in any clinical studies are usually contrary the conclusions you draw for yourself, as far as I can tell from your posts.
>
> I would not think that a direct comparison of Celexa's side effect profile versus Lexapro's side effect profile would be of any value to you, would it? I mean, there are different patient populations involved, different dosages of each agent given. Lexapro's side effect profile was based on a 8 week study, dosed at 10-20 mg (the starting/maintanance dose and the maximum dose.) Celexa's side effect profile was based on a 6 week study, dosed from 10-80 mg (half the starting dose of 20mg to 20mg past the max dose of 60mg.)
>
> If there are is still value to you, even recognizing those vast differences in study design, I would be happy to post the numbers for you. But keep in mind, both studies were sponsored by the manufacturer, and from your prior posts, I know you don't care for those types of studies, either.
>
> I guess what I'm saying is if you will overlook those "flaws" I will go through the work to get the information for you. If those things are too bothersome to get past in the first place, then what's the point? I don't mean to sound cynical, but you've been a tough critic on this board and I guess I just thought you were past convincing at this point. (And that's not necessarily a bad thing.)
>
>
>
>I don't think evidence of a significantly different side-effect profile has been presented. Studies have been done which would answer the question in as unbiased and objective way as possible (randomised double-blind trials, comparing equivalent doses), and these should provide the most reliable data. If these presented evidence that there was a significant difference - well, that would be evidence. But they don't.
I've presented almost all of the available data from these trials, as it is an important question which has a fair amount of research done on it. The data are clear in failing to show any significant difference. Maybe there is a difference - my point is that even if we take the results at face value, they don't support the claim.
Posted by SLS on September 10, 2002, at 7:11:17
In reply to The hard, cold facts about Lexapro, posted by ZyprexaNumbTongue on September 6, 2002, at 14:37:39
> 1) Lexapro is formally classified as an SSRI. Lexapro is not a truly new or novel antidepressant such as a CRF-Antagonist, subsance P drug, an MAOI patch or other drug.
The majority of people posting on PB do not respond equally to all of the SSRIs. It is my impression that the same is true in the general population of depressed individuals. I think the words "truly new or novel" might be interpreted differently by those for whom Celexa has been the only SSRI that they have responded to. There are many of them. Still, it does not seem intuitive that Lexapro would have any advantage over Celexa as far as efficacy is concerned. However, it is conceivable that r-citalopram interferes with the therapeutic action of s-citalopram. If this were the case, Lexapro would be more effective than Celexa.
It doesn't hurt to have more *superficially* similar drugs available for the same illness unless it somehow discourages the development of those that are very dissimilar. I don't know if this is true or not.
- Scott
Posted by IsoM on September 10, 2002, at 12:46:47
In reply to Re: The hard, cold facts about Lexapro » ZyprexaNumbTongue, posted by SLS on September 10, 2002, at 7:11:17
Scott, the nice thing about making Lexapro is it didn't involve any 'development' of a new drug. It just took an already existing drug, citalopram (Celexa) & applied a relatively new technology to it - the separation of isomers of a racemic mixture. So, in theory, this in now way should slow or restrict the developments of new medications.
As far as I can tell, Forest labs do not develop new drugs so much as market those that weren't picked up by other companies. They take ones that show promise & work with those developers to fix them up for use (I'm dumbing their processes way down as I don't know all they do myself).
The inactive isomer of citaprolam should not in theory interfere with the efficiency of the active one but would only bind to certain sites causing an increase of side effects in only those who would be affected. There are many people who take Celexa with no side effects at all - I'm one. I've never noticed anything different in a negative way that I could attribute to Celexa. So presumably, Lexapro wouldn't do anything different for me. The reason that Dr. Dave doesn't believe that the r-isomer of Celexa causes interference with the efficiency of the s-isomer is that (to the best of my knowledge) inactive isomers of other meds have never interfered with the active isomers before. He would be even more aware than me of any other cases where interference resulted previously. All that has resulted from inactive forms before has been an increase of side effects. Mind you, we're still discovering new things in sciences that we never knew about before, which is why I'm still keeping an open mind.
Nice to talk with you again, by the way. I hope you're feeling a little better. I have, at last, found that my new doctor does understand narcolepsy enough to know I have it & has now prescribed Dexedrine for me. Unfortunately, both the adrafinil & modafinil (Provigil) pooped out on me. I've honestly never experienced a drug poop-out before & did NOT expect it.
Posted by moxy1000 on September 10, 2002, at 18:45:51
In reply to Re: Fewer s/e with Lexapro - where's the evidence? » moxy1000, posted by dr. dave on September 10, 2002, at 4:42:08
Overall, Dr. Dave, after doing some extensive research today, I think you are absolutely right in saying that presently that are is a lack of "overwelming" evidence. In all three studies I've found, involving both Celexa and Lexapro, only one presented a table of treatment emergent side effects comparing the two active agents. (This was the table in Clinical Psychiatry, April 2002, included in the study presented by Dr. Burke.) It was a double blind, placebo controlled trial, but I've left out the placebo numbers for space sake. (The placebo rates, as we'd expect, were lower then the two active drugs.)
The table looks like this:
Nausea Celexa 40mg 22% Lexapro 10mg 21%
Diarrhea Celexa 40mg 11% Lexapro 10mg 10%
Insomnia Celexa 40mg 11% Lexapro 10mg 10%
Dry Mouth Celexa 40mg 10% Lexapro 10mg 10%
Ejaculation Dis. Cx 40mg 4% Lexapro 10mg 9%The only major difference in tolerability in the Burke study, was in the drop out rates.
2.5% dropped out on placebo due to side effects
4.2% dropped out on Lex 10mg due to side effects
8.8% dropped out on Cel 40mg due to side effects(Perhaps the rate of side effect occurance potentially the same for both Lexapro and Celexa, but the severity of those side effects differ? That could explain the higher Celexa drop out rate.)
At any rate, I think the biggest difference between Celexa and Lexapro in this study was in the area of efficacy. On every testing instrument used (HAM-D, MADRS, CGI-I) Lexapro at 10 mg was at least as effective as Celexa 40mg. (And how often is it possible to jump into Celexa therapy at 40mg? Starting dose is usually 20mg.) I think that's where the earlier onset of improvement in depressive symptoms comes in for Lexapro.
I think it's standard for all SSRI's to take 4-6 weeks for improvement in depressive symptoms (at least that is what is stated in the package inserts of all available treatments.) Sure, not every patient is the same, some probably respond to therapy sooner (I took wellbutrin and felt it kick in after a couple weeks), some may never respond at all, some may feel better after a month or longer. But, If Lexapro can offer the majority of patients, as it appears that it can from all efficacy studies available, earlier relief at 1-2 weeks, would that not be an improvement over not only Celexa, but some other AD's as well?
Let's say for the sake of argument that the side effect profile is essentially the same. Wouldn't having the ability to offer depressed patients relief sooner be an advantage? After all, from all indications, both Lex and Celexa look like they are pretty well tolerated to begin with.
I hope this info helped.
Posted by moxy1000 on September 10, 2002, at 18:52:07
In reply to Re: Fewer s/e with Lexapro - where's the evidence?, posted by moxy1000 on September 9, 2002, at 22:49:59
Just FYI... a few of you mentioned in replies to my posts topics that were discussed on this board over the past week or longer (that I missed.) My apologies...I can't keep up with this board all the time, and me being uninformed in regards to what's been discussed and what's not been discussed is in no way an indication of my lack of interest, just lack of time to be able to read through everything that's been added each day.
Posted by alan on September 10, 2002, at 22:52:26
In reply to Re: (Long)see bottom » Alan, posted by pharmrep on September 7, 2002, at 2:10:04
Celexa contains two "mirror-image" molecules, one of them active and the other not. Lexapro contains only the active molecule.
The makers knew this in the beginning and they could have produced Lexapro right off the bat. But this way they get to double the length of their patent. First they sell the mixed form (Celexa) until its patent expires. Then they patent the "purified" form (Lexapro) and sell that as superior. To the extent that the inactive molecule really is inactive, the only difference between the medications (besides price!) is that you can take half as much of Lexapro to get the same results.Welcome to the world's most profitable industry.
Posted by IsoM on September 11, 2002, at 1:24:36
In reply to Re:Lexapro marketing (for everyone) » pharmrep, posted by alan on September 10, 2002, at 22:52:26
Alan, Celexa was first marketed in 1998. It took a number of years before that to develop & test it. Separation of racemic mixtures like citaprolam (Celexa) is a fairly new technology. There's more than one way of separating mixtures depending on what the compound is. It's still being finely honed to come up with cheaper ways of doing it. They could NOT have separated Celexa from the start as you suggest. Doesn't mean that drug companies aren't on the band wagon in a big way now, seeing it as a means to boost sales, but it's good to keep all information accurate.
An interesting story from Chemical & Engineering News on the marketing of racemic drugs & the interest by pharmaceutical companies.
Chiral Roundup - http://pubs.acs.org/cen/coverstory/8023/8023chiral.html
Posted by kid47 on September 11, 2002, at 10:59:52
In reply to Re: Fewer s/e with Lexapro - ?, posted by psycHarvard on September 6, 2002, at 23:35:03
>>Yes SSRIs do cause increased Anx in the first few weeks... that is why a lot of psycs now start
there pats off on an SSRI and Wellbutrin... in combination for a few weeks...<<I'm curious. Are you implying that the addition of Wellb to an SSRI will help REDUCE anxiety? This is certainly contrary to my experience.
Posted by Mr.Scott on September 11, 2002, at 11:31:47
In reply to Re:Lexapro marketing (for everyone) » pharmrep, posted by alan on September 10, 2002, at 22:52:26
For some reason people think a depressed son/author and an early release of Lexapro before the U.S. Patent is up on Celexa is something noteworthy. IT'S NOT.
Forest has marketing rights to Celexa only in the U.S.. Only U.S. scripts result in Forest dollars. Also Celexa is no Zoloft or Prozac or even Paxil with regards to revenue here. With Lexapro on the other hand Forest will make dollars from all scripts in the entire world, and have a shot at getting scripts by pushing the "something new BS". It's not really anything new for depressives to be concerned with.
Posted by moxy1000 on September 11, 2002, at 16:46:23
In reply to Re:Lexapro marketing (for everyone) » pharmrep, posted by alan on September 10, 2002, at 22:52:26
I think that's incorrect. Isomer science was only developed in 1998 - the guy that figured out how to single out one isomer of a racemic mixture actually won the noble prize for chemistry that year. Forest started looking into developing Celexa into an isomer at that point - and just recently was Lexapro ready for approval. To say they knew about it all along is in part true - they knew there was potential in developing Celexa into a single isomer. But, they couldn't do it overnight - it took almost five years to get the R&D done and get the drug to market.
Also, the difference b/w lexapro and celexa is not quite as simple as was stated. If Lexapro were truly HALF of Celexa, then to carry that theory forward, 10mg of Lexapro would be equal to 20mg of Celexa. That's not the case - 10mg Lex = 40mg Celexa.
And also, there will be no generic versions of Celexa until probably 2005, so this wasn't released due to a patent emergency.
Posted by Phil on September 11, 2002, at 18:24:25
In reply to Re:Lexapro marketing (for everyone) » alan, posted by Mr.Scott on September 11, 2002, at 11:31:47
>
>
> For some reason people think a depressed son/author and an early release of Lexapro before the U.S. Patent is up on Celexa is something noteworthy. IT'S NOT.>>>Personally, I'm glad it's on the market for whatever reason. If they make money legally by producing meds that can potentially save my ass, I don't care what their motivations are.
Personally, the biggest BS w/ drug companies is charging more in the US than anywhere else.>
> Forest has marketing rights to Celexa only in the U.S.. Only U.S. scripts result in Forest dollars. Also Celexa is no Zoloft or Prozac or even Paxil with regards to revenue here. With Lexapro on the other hand Forest will make dollars from all scripts in the entire world, and have a shot at getting scripts by pushing the "something new BS". It's not really anything new for depressives to be concerned with.>>>What's not anything new for me not to be concerned with? How do you judge who needs to be concerned with what?
So they make money worldwide. Lundbeck is a company that only makes CNS drugs. Forest put $158,000,000.00 back into research last year.
I'm taking Lexapro and glad that I'm able to get it. Judging from a very short trial, it could be an excellent drug and it has more selling points than *new*.
Posted by hawkeye on September 11, 2002, at 20:06:09
In reply to Re: Fewer s/e with Lexapro - where's the evidence?, posted by Phil on September 6, 2002, at 8:27:35
Hi. I have been taking 10mg/day of Lexapro since last Friday.
Here's the result: 110% COMPLETE/TOTAL SEXUAL DYSFUNCTION !!!!!!!!!!!!!!!
In my experience it's WORSE than Celexa and the worst in this regard of any other drug I have taken.
As I mentioned in an earlier post, I have taken Celexa but stopped due to "unacceptable side-efects" , i.e., sexual dysfunction. But with Celexa at 20mg, although there was some, it wasn't total.
My advice: Unless you are a eunuch, forget about this drug.
Posted by Phil on September 11, 2002, at 21:53:06
In reply to LEXAPRO -- USER REPORT -- BAD NEWS, posted by hawkeye on September 11, 2002, at 20:06:09
Well , if it gets me too I'll save it for the cat.
pharmrep's theory that the #'s are high because more people are willing to talk about sex than they were 4 years ago never impressed me but we're all different..we'll see.Sorry Lexapro has killed men's most important organ, hawkeye. That's bad news-that's what Zoloft did to me.
Let's hope it's not going to affect everybody.
Posted by johnj on September 11, 2002, at 23:03:40
In reply to LEXAPRO -- USER REPORT -- BAD NEWS, posted by hawkeye on September 11, 2002, at 20:06:09
PLEASE elaborate on sexual dysfunction. Do you mean no desire? No erection? No ability to orgasm? thanks
johnj
Posted by dr. dave on September 12, 2002, at 3:51:15
In reply to Re:Lexapro marketing (for everyone), posted by moxy1000 on September 11, 2002, at 16:46:23
Isomer science has been known about for a lot, lot longer than that, and Sanchez published a paper demonstrating
s-citalopram was the active isomer of citalopram in 1992. It seems that the s-isomer was patented in the US in 1990, according to this article.http://www.current-drugs.com/CDD/CDD/CDDPDF/NEWS_ANTIDEPRESSANT_HEIR.pdf
What has happened recently is that new technology has allowed separation of stereoisomers to become financially viable - a fantastic thing in general, but of debatable benefit in the case of citalopram.
> I think that's incorrect. Isomer science was only developed in 1998 - the guy that figured out how to single out one isomer of a racemic mixture actually won the noble prize for chemistry that year. Forest started looking into developing Celexa into an isomer at that point - and just recently was Lexapro ready for approval. To say they knew about it all along is in part true - they knew there was potential in developing Celexa into a single isomer. But, they couldn't do it overnight - it took almost five years to get the R&D done and get the drug to market.
>
> Also, the difference b/w lexapro and celexa is not quite as simple as was stated. If Lexapro were truly HALF of Celexa, then to carry that theory forward, 10mg of Lexapro would be equal to 20mg of Celexa. That's not the case - 10mg Lex = 40mg Celexa.
>
> And also, there will be no generic versions of Celexa until probably 2005, so this wasn't released due to a patent emergency.
Posted by Phil on September 12, 2002, at 6:25:19
In reply to LEXAPRO -- USER REPORT -- BAD NEWS, posted by hawkeye on September 11, 2002, at 20:06:09
Got a feeling that it may be closing down shop with me too. After too many years on these drugs it's showing early signs of numbness and well, numbness. I'll give it a fair run but I won't go back to this SE. Patience, damnit.
P
h
i
l
Posted by hawkeye on September 12, 2002, at 7:32:50
In reply to Re: LEXAPRO -- USER REPORT -- BAD NEWS » hawkeye, posted by johnj on September 11, 2002, at 23:03:40
"PLEASE elaborate on sexual dysfunction. Do you mean no desire? No erection? No ability to orgasm?"
ALL OF THE ABOVE
TOTAL WIPEOUT
Posted by sjb on September 13, 2002, at 9:11:12
In reply to Re: Fewer s/e with Lexapro - where's the evidence?, posted by moxy1000 on September 9, 2002, at 22:49:59
You know, I really wish we had more long term studies. My experience, along with many others, proves a BIG difference in the first 6 weeks of treatment, and how one does after months (or years) on the same drug. I know it's expensive, etc, but remember when we heard that Prozac suppresses apetite? Many found this affect short lived and actually could lead to weight gain in the long run. I also caution folks on this board turning to Topomax for weight loss, as I believe that this, too, is short lived for some people.
Posted by Geezer on September 13, 2002, at 10:45:32
In reply to Re: Fewer s/e with Lexapro - where's the evidence?, posted by sjb on September 13, 2002, at 9:11:12
>Hi sjb,
Very good point. The only drug studies carried on over a prolonged period of time, with significant numbers of participants, are conducted in Europe - the results are not admissible here in the US.
I had the experience of weight gain with Prozac (25 lbs over 4 years), D/Ced Prozac at 60mg. (cold turkey with no withdrawal). In a later trial of Remeron 30mg. + Depakote 1000 I only gained 10lbs (quit cold turky no withdrawal). Yet a later trial of Zoloft 200mg., no weight gain or loss and no withdrawal. I recently added Serzone 250 to Wellbutrin 400 and have lost 10 in three weeks (no gain or loss on Wellbutrin - only when Serzone was added).
The real point is I have TRD and would welcome any kind of relief from depression. I am not real concerned about side affects because I don't have any that are sever, probably because nothing works. I think real answers about side effects and efficacy will only come when we have true emperical testing (genetic markers, blood tests, and intracellular ADs). I know current meds. work well for most people, also believe the rest of us make up that 15% mortality figure every year. We get tired of rolling the dice for no benefit.
Prozac was the only AD that ever gave relief but pooped out.
Best of luck,
Geezer
You know, I really wish we had more long term studies. My experience, along with many others, proves a BIG difference in the first 6 weeks of treatment, and how one does after months (or years) on the same drug. I know it's expensive, etc, but remember when we heard that Prozac suppresses apetite? Many found this affect short lived and actually could lead to weight gain in the long run. I also caution folks on this board turning to Topomax for weight loss, as I believe that this, too, is short lived for some people.
Posted by pharmrep on September 14, 2002, at 9:57:47
In reply to LEXAPRO -- USER REPORT -- BAD NEWS, posted by hawkeye on September 11, 2002, at 20:06:09
> Hi. I have been taking 10mg/day of Lexapro since last Friday.
>
> Here's the result: 110% COMPLETE/TOTAL SEXUAL DYSFUNCTION !!!!!!!!!!!!!!!
>
> In my experience it's WORSE than Celexa and the worst in this regard of any other drug I have taken.
>
> As I mentioned in an earlier post, I have taken Celexa but stopped due to "unacceptable side-efects" , i.e., sexual dysfunction. But with Celexa at 20mg, although there was some, it wasn't total.
>
** sorry to hear initial results...I know many people respond differently, but can you tell me how you have done with other AD's in their 1st week of use? Many side effects lessen after a few weeks for people, how do they do for you? Is Lexapro treating the depression?...are you going to discontinue already, or can you stick with it a while longer?
Posted by Mystia on September 15, 2002, at 12:03:34
In reply to Re: LEXAPRO » hawkeye, posted by pharmrep on September 14, 2002, at 9:57:47
I just started taking Lexapro on 9-13-02, after stopping Paxil on my own about a month ago. I suffer from severe migraines and I have had them every time after taking the Lexapro (I usually only have 1-2 migraines/week). Anyone had similar problems? Also does anyone know anything you shouldn't take (esp. herbs) while taking Lexapro?
Posted by hawkeye on September 15, 2002, at 12:55:06
In reply to Re: LEXAPRO » hawkeye, posted by pharmrep on September 14, 2002, at 9:57:47
I have only taken three "modern" ADs for any length of time: Prozac - 3 years; Serzone - 2 years; Celexa - 6 months. I never had any serious side effects with Prozac or Serzone so my experience with them is not instructive here.
I was taking 20mg/day of Celexa. Celexa is one of the few drugs that has worked very well for me. It is one of the few drugs I could actually feel. I wasn't able to take 40 mg of Celexa because of the degree of sexual dysfunction that it caused. At 20mg the SD was present to a degree but it was almost tolerable. But at some point I decided that I couldn't accept even the partial sexual dysfunction that it caused and I stopped it.
Many years ago, I took a tri-cyclic that caused sexual dysfunction. (I don't recall the name-it might have been imipramine, but I am not sure). In that case the sexual dysfunction eventually went away, but this was after several months.
Sexual dysfunction is a side-effect that I now find totally unacceptable. Two other drugs that have caused it for me are Zoloft and Effexor. But with these drugs the onset was not as quick as it has been with Lexapro. In both of those cases I stopped within two weeks of starting them.
Because of the hype and relatively low dosage of Lexapro I was taking, I was not expecting any major problems/side effects. The immediate, sudden onset and totality of the sexual dysfunction was an unpleasant surprise. I was taking 10mgs/day. Correct me if I am wrong, I am under the understanding that 10 mg is the functional equivalent of 20 mg of Celexa. I should note that I am also taking 200mg/day of Lamictal which I have been taking for several months and which has never caused me any sexual problems.
I feel that even after just one week I was getting positive benefits from the Lexapro. I even continued to take it for a couple of more days after my last post before I stopped it. Normal sexual function restored after two days of cessation. Needless to say this has been a disapointment for me. I know Celeza/Lexapro works for me. I am considering continuing with 5mg of Lexapro. If I do I will let you all know. I am not certain that taking less than the recommended therapeutic dose would be worth it.
Posted by pharmrep on September 15, 2002, at 15:39:34
In reply to Re: LEXAPRO hawkeye, posted by hawkeye on September 15, 2002, at 12:55:06
10mg of lex has shown to be at least as effective as 40mg of celexa. I know that 10mg of lex is supposed to have less s/e than 40mg of celexa as well, but as you know..everyone is different...even though 5mg of lex has not been studied...it would seem that your sensitivity would suggest trying that. good luck.
Posted by Phil on September 15, 2002, at 15:40:06
In reply to Re: LEXAPRO hawkeye, posted by hawkeye on September 15, 2002, at 12:55:06
Go to 5mg and work up. Low and slow used to be buzz words here. Try and give it four weeks. If you stop in 2 or 3 weeks, you'll be cycling thru drugs and not find the right one.
Go forward in 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.