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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 749 to 773 of 8406. Go back in thread:
Posted by dr dave on October 10, 2002, at 12:28:02
In reply to Re: Lexapro and Celexa relative side-eff- SLEEP, posted by shakingoscar on October 10, 2002, at 9:18:35
Hi shakingoscar,
I'm glad you're feeling better on the Lexapro. It's difficult to know why you are sleeping better on it than on celexa, but the important thing is that you are, so who cares? If it works, let's not worry too much about it.
People react very individually to antidepressants and there are a whole load of other things going on in most people's lives that will affect that response at any given time. My concern is whether IN GENERAL I can expect people to sleep better on Lexapro than Celexa. The research so far shows that I can't.
It's an important point though to remember that what has been shown to work for a particular patient is more important than what the general research shows.
> Hi Dr Dave,
> I would just like to say one thing.
>
> I find I sleep fine on lexapro, and can take it before bedtime and still sleep well.
>
> With citalopram, I could never take it in the evening because I find it far more stimulating than lexapro.
>
> In fact, I am hoping I can stop taking trazodone which I have always needed with SSRIs because I find them so stimulating (except Paxil/seroxat)
>
> Cheers
>
>
Posted by johnj on October 10, 2002, at 13:22:02
In reply to Re: Lexapro and Celexa relative side-effects » johnj, posted by dr dave on October 10, 2002, at 12:20:11
Thanks Dr. Dave, I appreciate your time and opinion. I do have a few questions in general about AD's. When a person is switching how does one go about doing this? Is there a chart some where that describes how to switch from one class to the another. For ex, I take pamelor and for various reasons need a change. It has not been confirmed and frankly I don't know how it could be, but I have serious s/e after excercise on the TCA.
I have been given some lexapro samples and will not start for another few weeks due to an exam. Is is generally accepted to take the new AD and see if the reaction/remission occurs before reducing the current AD? Or do you titrate down while you titrate up on the new? Lastly, does it matter if one starts at 2.5 mgs, 5 mg or 10 mgs of lexapro, or any other AD for that matter? Could there be higher/harsher s/e at a lower dose?(kind of like you get with remeron). Thanks for any input. I will see my doc again before starting, but I wanted to get another opinion from someone in the field that has seen and has directly worked with such examples. Thank you
johnj
Posted by dr dave on October 10, 2002, at 14:43:23
In reply to Re: Lexapro and Celexa relative side-effects » dr dave, posted by johnj on October 10, 2002, at 13:22:02
There are some guidelines at
http://www.nhslothian.scot.nhs.uk/lothianformulary/appendices/append5.htm#
They are adapted from the Maudsley Prescribing Guidelines, which are my favourite reference. The advice here is, if swapping from tricyclic to citalopram, to halve the dose of tricyclic and introduce citalopram, before gradually withdrawing the tricyclic. This seems sensible to me, but ASK YOUR DOCTOR FIRST! I would continue with this process even if you feel rough and get side-effects, because in a few weeks the side-effects may go and the antidepressant effect kick in.
The higher dose you start on the greater risk of side-effects but the greater probability of an effect. The usual starting dose of Lexapro is 10mg, so I would start on that unless you have a history of being particlarly susceptible to side-effects. Then you could start on five for a week or two and go up to ten.
Best of luck.
> Thanks Dr. Dave, I appreciate your time and opinion. I do have a few questions in general about AD's. When a person is switching how does one go about doing this? Is there a chart some where that describes how to switch from one class to the another. For ex, I take pamelor and for various reasons need a change. It has not been confirmed and frankly I don't know how it could be, but I have serious s/e after excercise on the TCA.
> I have been given some lexapro samples and will not start for another few weeks due to an exam. Is is generally accepted to take the new AD and see if the reaction/remission occurs before reducing the current AD? Or do you titrate down while you titrate up on the new? Lastly, does it matter if one starts at 2.5 mgs, 5 mg or 10 mgs of lexapro, or any other AD for that matter? Could there be higher/harsher s/e at a lower dose?(kind of like you get with remeron). Thanks for any input. I will see my doc again before starting, but I wanted to get another opinion from someone in the field that has seen and has directly worked with such examples. Thank you
> johnj
Posted by dr dave on October 10, 2002, at 15:02:35
In reply to Re: New data » dr. dave, posted by pharmrep on October 9, 2002, at 16:21:04
According to the Lundbeck website, Wyeth are accusing them of cheating in the head-to-head-trial with venlafaxine. I suppose they would, wouldn't they? Allegedly Lexapro was compared to a non-equivalent dose of Effexor. It does mean we ought to reserve judgement until we see the actual data and find out what Wyeth's objections are.
> > A new study has been reported which allegedly shows Lexapro to be more effective than Effexor. This is pretty serious stuff if it is true. There's a link to a story about it in a posting by Anyuser further down the board. If anyone manages to find the study itself I would be very grateful if they could direct me to it.
>
> **** i know the study exists...whether it is done yet or what the results are if done...i dont know, but will see when results are expected
>
Posted by Anyuser on October 10, 2002, at 16:21:49
In reply to Lundbeck accused of cheating in Effexor trial » pharmrep, posted by dr dave on October 10, 2002, at 15:02:35
Do you have access to the following study in full?
European Neuropsychopharmacology
Volume 12, Issue 5, pp. 433-444, October, 2002
Enantiomers' potential in psychopharmacology-a critical analysis with special emphasis on the antidepressant escitalopram
Authors
P. Baumann, D.F. Zullino, C.B. EapAbstract
Stereochemistry is now influencing most areas of pharmacotherapy, with a growing awareness in the field of psychiatry and, more specifically, depression. This is due to the fact that the enantiomers of many chiral drugs may have distinct pharmacological, pharmacokinetic and/or pharmacogenetic profiles. Consequently, in some instances there may be an advantage in using a single enantiomer over the racemic form-thus providing a basis for the development of new therapeutic agents, as well as the potential to improve current treatments. This review highlights some of the potential advantages and disadvantages that using single enantiomers might offer. The principles are exemplified through reference to the stereoselective properties of several established chiral psychotropic drugs, including thioridazine, methadone, trimipramine, mianserin, mirtazapine, fluoxetine and citalopram. Emphasis is given to the treatment of depression and how the potential of one pure enantiomer-escitalopram, the S-enantiomer of the selective serotonin reuptake inhibitor citalopram-appears to be fulfilling its preclinical promise in the clinic.
Keywords: Enantiomer, Depression, Antidepressant, SSRI, Citalopram, EscitalopramPII: s0924977x02000512
© Copyright 1999-2002, Elsevier Science, All rights reserved.
Posted by ZeeZee on October 10, 2002, at 16:33:42
In reply to Re: lexapro and blood pressure » pharmrep, posted by ANXIETY ANN on October 9, 2002, at 21:56:49
Norvasc can cause anxiety and insomnia - I had to stop it for that reason. This may not be the best drug for you if you suffer from anxiety.
Posted by Alan on October 10, 2002, at 18:32:22
In reply to Re: AD's vs. Bzds for Anxiety disorders » Alan, posted by pharmrep on October 9, 2002, at 22:22:18
> ************** what i say is not "company" oriented...just from me. I give a "source" to lend credibility...so as not to be just my opinion. (after all, i did openly identify myself as pharmrep)
> > ============================================
> >
> > I guess that pharmrep is choosing not to answer some very important questions about AD's vis-a-vis their use in treatment of symptoms for anxiety disorders.
> >
> > One would think that a pharmecutical representative would be more than willing to answer these fundamental questions for a very large population of us anxiety sufferers that tried ssri's for many years only to end up on the basic anxiolytic anyway - the lowly benzodiazapine. Or had to augment an ssri with a bzd in the end ....
> >
> > Is that because there are really no legitimate medical answers as to why AD's are presently being promoted as the first line of treatment for the disorder - and not on equal footing with the Benzodiazapines???
> >
> > Why is all of the evidence that the most effective and safe anxiolytic known to medicine - the bzd - brushed aside by the promoting of new AD's in their place rather than along side with the benzodiazapine to give the doctor and patient alike the freedom to choose? Otherwise, isn't freedom being taken away?
> >
> > Would it have anything to do with putting profit before medicine to regain R & D and marketshare?
> >
> > Not meant as just rhetorical questions. Sincerely and honestly wondering...
> >
> > Alan
> >
>
> *** come on alan..if the pharm industry wanted to make money in bzds vs ad's it probably could...it just chooses to focus on ad's because there is more to work with, and more people to aim for...and i believe a proven track record for effectiveness...and why are you attacking me about it? I am here to help not hurt..so be civil=================================================
I'm not attacking you. I'm asking legitimate questions from a pharmecutical authority about specifically why AD's are being pushed in place of BZD's in the treatment of anxiety disorders, that's all.I don't believe the anwers that you are providing are as clearly spelled out for us in the same way that you spell out specifics regarding the single merits of AD's - specifically Lexapro. Certainly the efficacy rates, if they are to be taken at face value, aren't even close to the rates of BZD's.
It's a legitimate question that is important to be addressed for all of us...and I believe that I've asked civily and sincerely several times now.
If you're not sure, an "I'm not sure" will do.
Alan
Posted by Micki on October 10, 2002, at 20:09:47
In reply to Re: Anxiety, depression, indecision » Micki, posted by johnj on October 9, 2002, at 22:24:26
> Hi Micki
> I am also on pamelor(nortryptline) and my pdoc has given me lexapro and told me to take it and get stable on it before lowering my dose of pamelor. I have been on it for 10 years and the s/e are terrible, dry mouth, constipation, urinary retention, etc. What dose of pamelor are you on? Talk to your doc about how to switch the dose since 12 years is a long time! I also take a benzo, and have thought about monotherapy too. It is a tough decision and my pdoc says no. My pdoc didn't want me to lower the pamelor before the lexapro was working AND if it proves to be right for me. If it is not for me I would not have any AD in my system. You could be having some withdrawl symptoms from your lowrering of pamelor. I believe the dose should be lowered over a 2 to 4 week period. Please check all this out. Also, maybe the lack of decision making is just that....maybe you are not sure and that would definately give me some anxiety, which would be normal. take care
> johnjI was taking 50 mg pamelor. My prescription was actually for 75 mg, which probably worked better, but I lowered the dose on my own years ago while I was feeling stable because of the severe dry mouth and constipation. I went down to 25 mg for 5 days, then off for 4 days before starting the Lexapro. The indecision is nothing new, however. As I child I would go to the library and leave with no books, because I couldn't decide which books to take out. Just talked to my psychiatrist who is prescribing a second drug to try to help with the anxiety and what she calls ruminating. Unfortunately, I did not write down the name of it. I won't pick it up till Saturday, will post again when I get it. She says it's not addicting, unlike Xanax, which I took for a while many years ago during a crisis.
Posted by Dr. Bob on October 10, 2002, at 20:31:58
In reply to Re: AD's vs. Bzds for Anxiety disorders » pharmrep, posted by Alan on October 10, 2002, at 18:32:22
> > why are you attacking me about it?
> >
> > pharmrepPlease remember not to post anything that could lead others to feel accused or put down...
> I'm not attacking you. I'm asking legitimate questions from a pharmecutical authority about specifically why AD's are being pushed in place of BZD's in the treatment of anxiety disorders, that's all.
>
> AlanAnd also not to pressure others. (BTW, I don't think he's claimed to be any sort of "authority"...) Thanks,
Bob
PS: Follow-ups regarding posting policies, and complaints about posts, should be redirected to Psycho-Babble Administration; otherwise, they may be deleted.
Posted by ANXIETY ANN on October 10, 2002, at 21:08:47
In reply to Lexapro and Celexa relative side-effects » pharmrep, posted by dr. dave on October 10, 2002, at 8:10:49
does anyone experience intense hot flushing with Lexapro? 4 days on Lexapro and sometimes i get this intense hot feeling throughout my whole body. I don't turn red or anything, but it is very uncomfortable, especially when it wakes you up at night. These flushes last about 20-30 minutes and slowly dissapate. thanks for any help
Posted by Ippopo on October 10, 2002, at 22:12:43
In reply to Re: Anxiety, depression, indecision, posted by Micki on October 10, 2002, at 20:09:47
I thought it was just me but I didn't realize indecission was anything other than just being fussy. As a child my sister and I were given x amount of $ to buy a toy every Friday after Dad came home from work. My sister had no problems finding something. On the other hand my parents and I walked up and down the aisles fo what would seem like an hour til they decided for me. This is been life in not all but many ways.
Could you explain how meds have helped you with this?
Thank you
Posted by Alan on October 10, 2002, at 22:31:14
In reply to Re: AD's vs. Bzds for Anxiety disorders » Alan, posted by pharmrep on October 9, 2002, at 22:22:18
> *** come on alan..if the pharm industry wanted to make money in bzds vs ad's it probably could...it just chooses to focus on ad's because there is more to work with, and more people to aim for...and i believe a proven track record for effectiveness...
===============================================Would you please elaborate further about the need to focus on AD's at the expense of Bzd's in the treatment of anxiety disorders....causing doctors to mistakenly offer only AD monotherapy instead of both BZD monotherapy AND AD monotherapy on equal footing for their patients' clinical trials?
Posted by jane d on October 10, 2002, at 23:28:50
In reply to Re: AD's vs. Bzds for Anxiety disorders » pharmrep, posted by Alan on October 10, 2002, at 22:31:14
> Would you please elaborate further about the need to focus on AD's at the expense of Bzd's in the treatment of anxiety disorders....causing doctors to mistakenly offer only AD monotherapy instead of both BZD monotherapy AND AD monotherapy on equal footing for their patients' clinical trials?
>Alan,
Pharmrep has said he is a sales representative for a company, not a representative of the industry as a whole. It's not reasonable to expect him to be able to answer questions about overall drug development or marketing policies. Probably you and the other posters on this board that have a personal interest in bzds know as much as anybody else.
Jane
Posted by Alan on October 11, 2002, at 0:57:04
In reply to Re: AD's vs. Bzds for Anxiety disorders, posted by jane d on October 10, 2002, at 23:28:50
> > Would you please elaborate further about the need to focus on AD's at the expense of Bzd's in the treatment of anxiety disorders....causing doctors to mistakenly offer only AD monotherapy instead of both BZD monotherapy AND AD monotherapy on equal footing for their patients' clinical trials?
> >
>
> Alan,
>
> Pharmrep has said he is a sales representative for a company, not a representative of the industry as a whole. It's not reasonable to expect him to be able to answer questions about overall drug development or marketing policies. Probably you and the other posters on this board that have a personal interest in bzds know as much as anybody else.
>
> Jane
============================================Why don't we let the parmecutical representative speak for themselves? They are well armed to field any questions about their new medications in relation to others - that's what salesman do.
Someone as well versed in psychotropics and their chemistry in the treatment of anxiety disorders - as I see technical information, statistics, etc cited about how effective Lexapro is - in medical parlance that would make the average consumer's head spin, why would it be unreasonable to ask why they think this medication is more effective for treating anxiety disorders than the well established bzds?
I'm sure that such sophisticated knowledge of the disorder, symptomology, and side effects during treatment would qualify them (if some think only marginally) to comment on why they think their product is more effective in the treatment of anxiety disorders than bzds.
After all, as they have shown, it is their specific area of expertise. No one is asking for a commentary or analysis of the pharm industry in general here as I understand it...
Alan
Posted by shakingoscar on October 11, 2002, at 1:06:19
In reply to Re: Lexapro and Celexa relative side-effects » dr dave, posted by johnj on October 10, 2002, at 13:22:02
Hi Johnj,
PLEASE TAKE MY ADVICE ON THIS POINT.Switching from 60mg citalopram to 30mg lexapro has caused me a month of agony.
Whatever you do, start low on lexapro and work up until you find the right dose.
DO NOT ASSUME THAT YOU TAKE HALF OF YOU CITALOPRAM DOSE.
My doctor has done this and its caused me to be really ill the last few weeks. I am in the process still of adjusting to 15mg lexapro (still not sure if its the right dose), and I changed dose 9 days ago and Im still getting "electric shocks" in the brain as I get used to the new dose.
BE CAREFUL!!!!!!!!!!!!!!!!!!!!!!!!!!
Good luck
Posted by Ippopo on October 11, 2002, at 1:30:29
In reply to Re: Lexapro and Celexa relative side-effects, posted by shakingoscar on October 11, 2002, at 1:06:19
Hi ShakingOscar,
Well this is 30hrs into the dossage of 20mgs of lezapro. I've felt electric shocks to the brain but it may have been with EffexorXR. Since the change of meds started 07/29/02, I don't remember too much. BummerHank, electric shocks to the brain are not very nice.
Anyway, as the 31st hr approaches I want to keep talking but the rest of me wants to sleep. (Late night Pierogis may be the culprit)
It's nice to want to do constructive things again.
I hope this isn't just a here today gone tomorrow s/e. I do have a friend who switched from celexa to lexapro. He spoke of a resurgence of energy. Have you experienced anything like this?
Ippopo
Posted by pharmrep on October 11, 2002, at 1:30:51
In reply to Lundbeck accused of cheating in Effexor trial » pharmrep, posted by dr dave on October 10, 2002, at 15:02:35
** I dont know about lundbeck...just forest studies here in the US...most studies that we use in the US are done here...I dont know why, but thats the case (probably an FDA thing)...Lundbeck and European studies are not always used...maybe due to different methods and variables.
> According to the Lundbeck website, Wyeth are accusing them of cheating in the head-to-head-trial with venlafaxine. I suppose they would, wouldn't they? Allegedly Lexapro was compared to a non-equivalent dose of Effexor. It does mean we ought to reserve judgement until we see the actual data and find out what Wyeth's objections are.
>
> > > A new study has been reported which allegedly shows Lexapro to be more effective than Effexor. This is pretty serious stuff if it is true. There's a link to a story about it in a posting by Anyuser further down the board. If anyone manages to find the study itself I would be very grateful if they could direct me to it.
> >
> > **** i know the study exists...whether it is done yet or what the results are if done...i dont know, but will see when results are expected
> >
>
>
Posted by Ippopo on October 11, 2002, at 1:41:08
In reply to Re: Lexapro and flushing, posted by ANXIETY ANN on October 10, 2002, at 21:08:47
Hi AnxietyAnn,
I did experience something like that but can't remember if it was effexorXR of lexapro. Since 07.29.02 my meds have change a few times and can't remember which one it was or if it was a combo of several. none the less I have had a hot flash though it didn't last long. Maybe 2min.
Posted by pharmrep on October 11, 2002, at 2:00:22
In reply to Re: please be civil » pharmrep » Alan, posted by Dr. Bob on October 10, 2002, at 20:31:58
> > > why are you attacking me about it?
> > >
> > > pharmrep
>
> Please remember not to post anything that could lead others to feel accused or put down...
>
> > I'm not attacking you. I'm asking legitimate questions from a pharmecutical authority about specifically why AD's are being pushed in place of BZD's in the treatment of anxiety disorders, that's all.
> >
> > Alan
>
> And also not to pressure others. (BTW, I don't think he's claimed to be any sort of "authority"...) Thanks,
>
> Bob
********** im not sure what you want from me....i am not a master authority of the pharmaceutical industry, nor do i control what classes of drugs get preference. i do have some insight on the ad market...particularly ssri's (the current 1st line therapy used) and i often post about celexa and lexapro since i work for forest. i will cite my sources when i can, and sometimes speak in generalities if referring to information i've gained from my doctors and their patients. i like to share this info, and gain info from here too...but that is all i do here, let's keep it simple.
Posted by pharmrep on October 11, 2002, at 2:23:53
In reply to lexapro (P.I.) dose dependant adverse events, posted by pharmrep on September 1, 2002, at 0:00:38
*** I dont know what studies dr dave is looking at other than they are from europe...the studies in the usa have different parameters (like separating the mg's and not adding/averaging the #'s) here are the #'s from the US package insert. it is also not realistic to compare the celexa pi to the lexapro pi since they are both different groups (even though lexapro has better #'s, its not a valid comparison) I do stick by my statement (and the FDA'S) that at 10mg lexapro has side effects and discontuation due to adverse events comparable to placebo.
> Some of the more common adverse events (as listed in the package insert) are as follows:
>
> adverse event......Placebo.(311 patients)/...10mg Lexapro.(310 patients)/...20mg Lexapro (125 patients)
> insomnia..............4%.................................7%..........................................14%
> diarrhea..............5%.................................6%..........................................14%
> dry mouth...........3%.................................4%...........................................9%
> somnolence.........1%.................................4%...........................................9%
> dizziness..............2%.................................4%...........................................7%
> sweating increased1%.................................3%...........................................8%
> constipation.........1%.................................3%...........................................6%
> fatigue.................2%.................................2%...........................................6%
> indigestion...........1%.................................2%...........................................6%
>
> The overall incidence rates of adverse events in 10mg Lexapro treated patients (66%) is similar to that of the placebo treated patients (61%), while the incidence rate in 20mg Lexapro treated patients was greater (86%).
Posted by pharmrep on October 11, 2002, at 2:51:39
In reply to Re: Lexapro and flushing, posted by ANXIETY ANN on October 10, 2002, at 21:08:47
> does anyone experience intense hot flushing with Lexapro? 4 days on Lexapro and sometimes i get this intense hot feeling throughout my whole body. I don't turn red or anything, but it is very uncomfortable, especially when it wakes you up at night. These flushes last about 20-30 minutes and slowly dissapate. thanks for any help
*** havent heard of that one before...but having s/e in the 1st week seems to be par for the course...as you have most likely already seen in other posts...these "adjustments" to your new med might go away in the next week or so....i hope you can hang in there....keep us posted
Posted by momof3 on October 11, 2002, at 8:40:54
In reply to Re: Lexapro and flushing » ANXIETY ANN, posted by pharmrep on October 11, 2002, at 2:51:39
UPDATE: I am now at at the end of week two and my dosage is at 10mg Lexapro. I feel great-even laughed last night. I have energy that I have not had in months(maybe longer). Basically, I feel like me again. The only s/e still lingering is maybe a slight tremor. Hang in there. Oh yeah, I actually have a libdo again! The first two weeks were rough but every day got better. I am also wondering what some of you take for "as needed", as I am still having a small anxiety problem.
Posted by johnj on October 11, 2002, at 8:54:20
In reply to Re: AD's vs. Bzds for Anxiety disorders - Pharmrep, posted by Alan on October 11, 2002, at 0:57:04
Alan,
Could you tell me how I know if my disorder is anxiety as the primary under lying issue or depression? They seem to be morphed into one at times and even my doc is not sure. If you know somewhere I could get a clear dx on that I would be very happy. Until that time I will try what is out there and lexapro stands a good chance. If pharmrep knew all the answers to your questions I would go see him for a dx
johnj
Posted by ANXIETY ANN on October 11, 2002, at 10:05:08
In reply to Re: Lexapro and flushing, posted by momof3 on October 11, 2002, at 8:40:54
> UPDATE: I am now at at the end of week two and my dosage is at 10mg Lexapro. I feel great-even laughed last night. I have energy that I have not had in months(maybe longer). Basically, I feel like me again. The only s/e still lingering is maybe a slight tremor. Hang in there. Oh yeah, I actually have a libdo again! The first two weeks were rough but every day got better. I am also wondering what some of you take for "as needed", as I am still having a small anxiety problem.
Hi
thanks for giving me some encouragement. my doc gave me adivan for anxiety. anxiety was my primary reason for going on lexapro but it seems to cause alittle bit more for me but its only been 6 days. im glad you are doing so well, how do you sleep? Lexapro was making me like a zombie so the doc told me to take PM but now i can't sleep, guess I'll go back to mornings.
thanks
Posted by momof3 on October 11, 2002, at 10:40:03
In reply to Re: Lexapro and flushing, posted by ANXIETY ANN on October 11, 2002, at 10:05:08
I was very zombie like in the beginning! I started taking it at night. Now I need to switch to morning because I noticed being very awake, until what is a late hour for me. Thanks for the advice on the anxiety-I will check with my dr. I hope you have the results I seem to be having- I will keep you posted.
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