300 replies to this topic

[ScienceGuy]

Hi ScienceGuy.

My girlfriend is psychiatrist. Yesterday we talked about escitalopram. She told me that she has been prescribing this substance many years. In her opinion it is one of the more efficients SSRIs and one of the best substances for treat anxiety. Very few side effects are reported in comparison with others SSRIs and it is very safe.

She told me that other SSRIs produce a more letarghic effect so they must be taken in the night (before going bed) but the escitalopram doesn´t produces this effect. In fact it produces a more "euphoric" effect and that´s the reason of taking it at the beginning of the day (maybe it will depend on the person and the quantity because I read in forums people suggesting that they feel very tired after taking it).

Regarding to the dose, she told me that she prescribes to her patients minimum 10 mg. 5 mg. is only an "attack dose" for the first days but 10 mg. is the minimum "therapeutic dose". In fact, the suggested minimum dosage according to the laboratories is 10 mg.

Everyone is different and maybe some people could expect benefits with 5 mg. dose (or maybe it could be a placebo effect). In your personal experience 5 mg. have effect??

Thanks

Your girlfriend is a very smart lady

Firstly, please kindly note that 10mg is NOT "the minimum therapeutic dose", and please also note that the only reason why the majority of physicians (including psychiatrists ) prescribe ESCITALOPRAM at 10 - 20mg dosage range is because that is what you are instructed to do at medical school, and that is what the physician prescribing information for the drug recommends. This does NOT mean that 10 - 20mg is exclusively the "therapeutic dosage range" but simply the 'recommended' dosage range.

There is conclusive substantiated clinical evidence that 100% demonstrated the 5mg dosage to be "therapeutic"; which is further supported by clinical practice. And YES in my personal professional experience, both in treating my own patients, and also discussions with medical colleagues with regards the treatment of their patients (which somewhat ironically happens to include a psychiatrist) is as I have already stated regards the 5mg dosage.

Please kindly note that FATIGUE is common SIDE EFFECT of ESCITALOPRAM when administered at the 10 - 20mg dosage range; however, when administered at the 5mg dosage range FATIGUE is UNCOMMON and if experienced tends to be MILD, and when balanced against the positive therapeutics effects, by no means a deal breaker.

For a variety of reasons I strongly advise against increasing the dosage above 5mg.

Physicians are not lemmings. They need to use their own brains and not follow advice blindly. Furthermore, the have a sworn responsibility to "DO NO HARM" and hence should be interested in treating their patients EFFECTIVELY and SAFELY without SIDE EFFECTS (where possible).

Just because the Physician Prescribing Information Sheet RECOMMENDS that ESCITALOPRAM be administered at 10 - 20mg does not in fact mean it is CORRECT that that is the BEST dosage to prescribe for the majority of people. 5mg is that dosage.

IN SUMMARY REGARDS ESCITALOPRAM DOSAGE:

5mg = EFFECTIVE with MINIMAL chance of SIDE EFFECTS

10 - 20mg = Vast majority of patients experiencing SIDE EFFECTS

Hope this helps!

Edited by ScienceGuy, 17 March 2012 - 03:45 PM.

[LazarusMan]

For anxiety powdered kava kava root did wonders for me... There's always benzos of course, Klonopin worked very well for me when suffered from particularly bad anxiety...

Hey LazarusMan,

I strongly recommend that you read THIS thread on: TREATING ANXIETY SAFELY & EFFECTIVELY

As you will see, that's an absolute NO regards KAVA KAVA and especially any and all BENZODIAZEPINES, with regards to treating ANXIETY which entails prolonged administration for the medium long-term use.

Those are absolutely fine for short-term use only; but NOT for prolonged administration for the medium long-term use.

Point well taken as I only take benzos short term as my anxiety seem to be season and I understand hey are very habit forming. Kava was more recreational in the alcohol sort of way, but at the same time more therapeutic than intoxicating for me.

[choqueiro]

Thanks for the information ScienceGuy.

Right now I´m taking the Uridine + DHA + Choline stack with no benefit. I´m trying to treat anxiety, depression, memory issues, poor verbal fluency etc.

I´m going to try (if the experiment with uridine is not succesful) the escitalopram at the suggested dose of 5 mg. day.

I think that my brain fog, headaches (migraines), and memory issues are a consequence of anxiety and depression. I´ve been trying differents supplements and nootropics (ginkgo, bacopa, piracetam, alcar, choline...) with no positive results. Do you think that my memory will also improve with escitalopram?? Did you experiment any improve in memory and general cognition??

Thanks

[LazarusMan]

Thanks for the information ScienceGuy.

Right now I´m taking the Uridine + DHA + Choline stack with no benefit. I´m trying to treat anxiety, depression, memory issues, poor verbal fluency etc.

I´m going to try (if the experiment with uridine is not succesful) the escitalopram at the suggested dose of 5 mg. day.

I think that my brain fog, headaches (migraines), and memory issues are a consequence of anxiety and depression. I´ve been trying differents supplements and nootropics (ginkgo, bacopa, piracetam, alcar, choline...) with no positive results. Do you think that my memory will also improve with escitalopram?? Did you experiment any improve in memory and general cognition??

Thanks

Hey Choqueiro, if you're willing to give racetams another shot I would recommend aniracetam (studies show is has anxiolytic effects) or oxiracetam. I found oxiracetam to clear my brain fog, improved fluidity of speach, and prevented anxiety at 600-700mg. Or you could try one of the more potent racetams but some are harder to find and more expensive.

[ScienceGuy]

Thanks for the information ScienceGuy.

Right now I´m taking the Uridine + DHA + Choline stack with no benefit. I´m trying to treat anxiety, depression, memory issues, poor verbal fluency etc.

I´m going to try (if the experiment with uridine is not succesful) the escitalopram at the suggested dose of 5 mg. day.

I think that my brain fog, headaches (migraines), and memory issues are a consequence of anxiety and depression. I´ve been trying differents supplements and nootropics (ginkgo, bacopa, piracetam, alcar, choline...) with no positive results. Do you think that my memory will also improve with escitalopram?? Did you experiment any improve in memory and general cognition??

Personally, for a variety of reasons, I am not a huge fan of the "Uridine + DHA + Choline stack"; and I am not unsurprised that you have found no benefit with it.

Yes, IMPAIRED COGNITION can be symptoms of ANXIETY and DEPRESSION; and yes, in effectively treating your ANXIETY and DEPRESSION you will likely find that your IMPAIRED COGNITION somewhat improves.

I think you are wise to give the ESCITALOPRAM 5mg a go.

To specifically help to address your IMPAIRED COGNITION I would recommend you also immediately start taking the following:

1) HYDERGINE 1mg OD (upon waking); N.B. To achieve the 1mg dosage either have it supplied as 1mg via a COMPOUNDING PHARMACY or cut a 4.5mg tablet into quarters and take 1/4 tablet.

2) PRAMIRACETAM 100mg OD (with breakfast)

3) CHOLINE 100mg (that's 100mg of the actual CHOLINE, not the respective source raw material); N.B. in your particular instance you specifically want to take 100mg, and no more, no less (I can elaborate why if you wish)

You should find that after 1 WEEK on the ESCITALOPRAM 5mg and all of the above, that your ANXIETY, MOOD and COGNITIVE IMPAIRMENT should improve, at the very least to an extent.

After the 1 week, you can then try adding in the following individually one-at-a-time to your 'stack' (to further improve your COGNITIVE IMPAIRMENT) such that you can gauge how you respond to each:

1) PIRACETAM at dosage of 5 GRAMS twice daily (TOTAL: 10 GRAMS); N.B. You might need to fiddle with your CHOLINE dosage when you do this - e.g. if you get a headache or the PIRACETAM one day gives brilliant mental clarity but brainfogged the next day, then take an extra 100mg CHOLINE; you want the minimum CHOLINE dosage that eliminates the PIRACETAM INDUCED CHOLINE DEFICIENCY symptoms.

2) OXIRACETAM at dosage of 300mg (DAY 1); then increasing dosage each day by 500mg increments to ascertain what dosage you respond well to; N.B. For many people 300mg is the 'sweet spot' regards OXIRACETAM and find more than that causes OVERSTIMULATION effects. However, others can quite happily take 800mg TID. You will need ascertain what is the best dosage for YOU.

3) ANIRACETAM at dosage of 300mg (DAY 1); then increasing dosage each day by 500mg increments (i.e. as per the OXIRACETAM) - N.B. Be aware that ANIRACETAM is one of the most unpredictable of the RACETAMS, in that some people respond well to it, but other respond badly to it, in that the ANIRACETAM in fact produces an ANTI-NOOTROPIC effect wherein one becomes STUPIFIED and BRAIN-FOGGED. You will need to establish whether you are an ANIRACETAM 'Positive-Responder' or 'Negative-Responder'

4) Increasing the PRAMIRACETAM dosage by 500mg increments each day up to a maximum of 2,500mg daily, to establish what dosage is right for YOU.

If you do decide to follow my advice, please do post feedback regarding your progress

Also happy to answer any questions

[choqueiro]

Hi ScienceGuy.

There´s a lot of interesting information in your posts.

First of all. I also think that if my memory issues are caused by anxiety and depression, escitalopram could improve my memory, but this is the theory. In practice, most SSRIs cause memory loss. What do you think about it?? Could I combat brain fog "effectively" with escitalopram or my memory issues could get worse??

Regarding to nootropics, I must say that I´m not a huge fan. One year ago I tried for the first time piracetam + alcar + alpha gpc with no effect. Since three weeks (more or less) I tried different quantities and combinations with no response. I only increased my brain fog and my headaches with them.

Even though I haven´t tried pramiracetam (the most potent and expensive of all the racetams), it is said that pramiracetam increases nitric oxide synthase (NOS) activity. There are a lot of studies supporting that NO is involved in neuron death. Researchers believe that excess NO creates nicks and breaks in the DNA of neurons which depletes energy sources in the cell, causing cell death.The question is, is the increase of NO caused by Pramiracetam sufficient enough to induce neuronal death?

According to this information and taking in account my unsuccessful experience with piracetam, I think that I prefer other options. There´s another big problem with racetams. The improves you made dissapear after stop his consumption. I don´t imagine taking racetams the whole life. In oposition, a correct treatment with escitalopram could raise serotonin to the basal level and this one might be kept even though you stop the consumption of escitalopram.

The next problem I´ll find in the stack, is choline. Right now, as you know, I´m taking the "Uridine + Choline + DHA stack". At the moment no benefits. I´m "playing" with different combinations trying to find any improve. One of the discoveries that I have done is that maybe I´m not a "good responder" to choline (Alpha GPC). When I avoid it, I have less brain fog or headache (It is something very subtle because I "always" feel brain fogged). I´ll continue experimenting. I also have doubts abot the convenience of fish oil (or a high DHA fish oil if you suffer from depression).

I´m curious about the exact dose of choline you suggest (100 mg.). Why?? What type of choline?? Choline CDP?? I only tried Alpha GPC with the results that I explained previously.

[JChief]

I think someone with the name of "Science Guy" should respect recent research and science-based clinical studies that indicate uridines potential effectiveness for those with mental health concerns. I also think Lexapro (or you called it "ESCITALOPRAM") should be used only if more natural nutrition-based efforts fail for whatever reason. I also think your racetam combinations are pretty extreme. This is only my opinion..

Edited by JChief, 08 February 2012 - 03:56 PM.

[choqueiro]

Hi JChief.

I agree with you. Natural supplements is the way, but what do you recommend me to raise serotonin levels?? 5-htp or Trytophan are natural but not safe. Studies suggested that they can damage heart valves. Any natural and safe option to raise serotonin with efficiency if you suffer from depression and anxiety??

Thanks

[rg8032]

I think someone with the name of "Science Guy" should respect recent research and science-based clinical studies that indicate uridines potential effectiveness for those with mental health concerns. I also think Lexapro (or you called it "ESCITALOPRAM") should be used only if more natural nutrition-based efforts fail for whatever reason. I also think your racetam combinations are pretty extreme. This is only my opinion..

Recent research and science-based clinical studies indicate, in fact, that uridine MAY have an ANTIDEPRESSANT-LIKE effect (N.B. I prefer scientific studies as I imagine science-based studies lose some of the rigor in translation (joke)). I am a hardcore believer in the scientific method and I believe the jury is still out. I thought that uridine was total BS, but after researching it I came to the conclusion that it may or may not be BS. The evidence is intriguing at best. Small populations, no replication, and mostly rodents.

Some have gone over-the-top in their uridine advocacy and some pretty outrageous claims have been made. Advocating uridine treatment for serious medical conditions in place of proven, conventional, evidence-based treatment is incredibly irresponsible. For example, someone recommended dropping conventional Parkinson's Disease treatment to pursue uridine (N.B. in their defense, consulting a doctor was recommended). Claims were made that those on long-term treatment with ADHD drugs could reduce their dose by as much as 60% if they started uridine.

An insidious transformation of conjecture, anecdote, and a semblance of fact into cold, hard, specious-argument-parading-as-fact has been occurring. Dangerous.

ScienceGuy has the right idea and puts his money where his mouth is. Like everyone else under the sun, he has not reviewed all literature on all topics and his experience lacks that breadth as well. His recommendations for the racetams are not extreme (e.g. doses of piracetam well in excess of 10g have been used with no noted ill effects and the combination of racetams is not uncommon). He recommends a tiered-introduction approach with titration and allows for stabilization.

I think ScienceGuy would be the first to admit that he does not know everything; however, he is one of the logical few and that should be respected.

Edited by rg8032, 08 February 2012 - 05:08 PM.

[ScienceGuy]

I think someone with the name of "Science Guy" should respect recent research and science-based clinical studies that indicate uridines potential effectiveness for those with mental health concerns.

Hey JChief,

You are absolutely right. Please note that my comments regarding URIDINE are only my personal opinion, which is why I stated "personally". You are absolutely right for nailing me to the wall on this point, in that the research and studies behind URIDINE are substantial. The problem is that I personally was hugely underwhelmed with both my own personal experience with it, and that of my friends; however, I acknowledge that this is purely anecdotal, and does not necessarily mean that URIDINE is not fantastic stuff.

However, I should add that since the topic of this thread is "Anxiety, OCD and depression reommendations" I believe the OP is seeking recommendations for treating MEDICAL DISORDERS, for which I do believe URIDINE is lacking in conclusive substantiated evidence regards being effective in treating; i.e. I am not aware of any clinical studies existing that demonstrate URIDINE to be an effective treatment for ANXIETY and DEPRESSIVE DISORDERS

I also think Lexapro (or you called it "ESCITALOPRAM") should be used only if more natural nutrition-based efforts fail for whatever reason.

I also think your racetam combinations are pretty extreme. This is only my opinion..

Well, I think it is very clear from your comments that my negative personal opinion regarding URIDINE has irritated you, so for that I can only apologise. I normal do my best to maintain positivity within my posts, so in my haste I appear to have made the mistake of posting a personal view, which I clearly should have kept to myself. So again, my apologies.

With regards to my "racetam combinations" I am not sure whether you are referring to my own personal stack, or my recommendations that I just posted; if it is the former, then you are quite correct that my personal dosage for PIRACETAM is at the upper end of the dosage range, however I feel the need to point out that this dosage has in fact been used in clinical studies, and my personal dosages for both OXIRACETAM and PRAMIRACETAM are small; if it is the latter, then perhaps you are misunderstanding my recommendations in that I am not suggesting that everything be taken in combination, but that the respective individual RACETAMS should be tried one-at-a-time to ascertain how one personally responds to each before then considering which (if any) to combine into a stack.

With regards to your opinion on the ESCITALOPRAM, please kindly note that NATURAL does not always = SAFE; and 'UNNATURAL' does not automatically = 'UNSAFE'. For example, given the choice between ST JOHN'S WORT versus ESCITALOPRAM, ESCITALOPRAM wins hands down every time with regards to both SAFETY and EFFICACY; which hopefully is something with which we can both agree. If not, then let's agree to disagree and leave it there.

Edited by ScienceGuy, 08 February 2012 - 08:21 PM.

[ScienceGuy]

I think someone with the name of "Science Guy" should respect recent research and science-based clinical studies that indicate uridines potential effectiveness for those with mental health concerns. I also think Lexapro (or you called it "ESCITALOPRAM") should be used only if more natural nutrition-based efforts fail for whatever reason. I also think your racetam combinations are pretty extreme. This is only my opinion..

Recent research and science-based clinical studies indicate, in fact, that uridine MAY have an ANTIDEPRESSANT-LIKE effect (N.B. I prefer scientific studies as I imagine science-based studies lose some of the rigor in translation (joke)). I am a hardcore believer in the scientific method and I believe the jury is still out. I thought that uridine was total BS, but after researching it I came to the conclusion that it may or may not be BS. The evidence is intriguing at best. Small populations, no replication, and mostly rodents.

Some have gone over-the-top in their uridine advocacy and some pretty outrageous claims have been made. Advocating uridine treatment for serious medical conditions in place of proven, conventional, evidence-based treatment is incredibly irresponsible. For example, someone recommended dropping conventional Parkinson's Disease treatment to pursue uridine (N.B. in their defense, consulting a doctor was recommended). Claims were made that those on long-term treatment with ADHD drugs could reduce their dose by as much as 60% if they started uridine.

An insidious transformation of conjecture, anecdote, and a semblance of fact into cold, hard, specious-argument-parading-as-fact has been occurring. Dangerous.

ScienceGuy has the right idea and puts his money where his mouth is. Like everyone else under the sun, he has not reviewed all literature on all topics and his experience lacks that breadth as well. His recommendations for the racetams are not extreme (e.g. doses of piracetam well in excess of 10g have been used with no noted ill effects and the combination of racetams is not uncommon). He recommends a tiered-introduction approach with titration and allows for stabilization.

I think ScienceGuy would be the first to admit that he does not know everything; however, he is one of the logical few and that should be respected.

Thank you very much for your kind words. I am in wholehearted agreement with every single thing that you have posted...

...especially the fact that I do not know everything

[ScienceGuy]

"5-htp or Trytophan are natural but not safe. Studies suggested that they can damage heart valves."

"Natural supplements is the way"

Am I the only one who is baffled by this logic?

Surely in any particular circumstance which substance you opt for should be determined by individual assessment of substances in question with regards to their own merit, irrespective of which category (e.g. PHARMACEUTICAL DRUG or NUTRITIONAL SUPPLEMENT) that they fall into?

[choqueiro]

Hi ScienceGuy.

First of all my english is not as good as yours so maybe in certain ocassions I have difficulties to express my ideas correctly.

Yes, you could take two sentences of my argumentation put them together and make a post extracting a conclusion (or saying: "Am I the only one who is baffled by this logic?").

Yes, in my post I say that "5-htp or Trytophan are natural but not safe according to the studies" and I also say that "Natural supplements is the way". For me both ideas aren´t incompatible (sorry if you are "baffled"). What I´m trying to say is that in equality of conditions between a natural supplement and a pharmaceutical drug, if both are effective and both are safe I will choose the natural supplement (I think that they are a lot of examples and substances in which the natural supplement is so effective and safe as the pharmaceutical drug). I think that this is not incompatible with the affirmation that "5-htp or Trytophan are natural but not safe according to the studies". Not all the natural supplements are safe (5-htp or trytophan are a good example) but that doesn´t mean that every natural supplement is unsafe. It is necessary to analyze every case.

Yes, I prefer natural supplements (personal option and personal opinion) but not in every case. If natural supplements carry risks, are harmful or ineffective, then the pharmatheutical drugs are an option (or the first option).

[ScienceGuy]

Hi choqueiro,

Thank you for taking the time to explain.

What I´m trying to say is that in equality of conditions between a natural supplement and a pharmaceutical drug, if both are effective and both are safe I will choose the natural supplement (I think that they are a lot of examples and substances in which the natural supplement is so effective and safe as the pharmaceutical drug).

I myself agree with this philosophy; however, I believe that they will be very few instances where there would be absolute equality between a natural supplement and a pharmaceutical drug or vice versa; in other words, in some instances the natural supplement will be superior regards safety and/or efficacy over the pharmaceutical drug, and in other instances it might be the other way around.

Just to clarify a little more exacty where my opinion stands in this regard, IMO with regards to substances that are completely free from SIDE EFFECTS there are considerably LESS pharmaceutical drugs than there are natural supplements; i.e. there are many more natural supplements that will yield a beneficial therapeutic effect without any side effects than there are pharmaceutical drugs.

However, there are some, albeit fewer, instances where there are pharmaceutical drugs that when compared against the natural supplement alternatives are the best choice for the particular instance. You asked "So the question is, if anyone knows of some substance that could raise serotonin levels but without any risk?" and my opinion is that in this particular instance, after weighing up both the pharmaceutical drugs and natural supplements whose endgame is to raise serotonin levels, it is in fact the pharmaceutical drug, namely ESCITALOPRAM, that is the best choice (again in this particular instance only). For something else the natural supplement might be the best choice

It is necessary to analyze every case.

I wholeheartedly agree. This is what I have done in this instance, and after analyzing this particular case it is my professional opinion that ESCITALOPRAM at the 5mg dosage is the best choice

Yes, I prefer natural supplements (personal option and personal opinion) but not in every case. If natural supplements carry risks, are harmful or ineffective, then the pharmatheutical drugs are an option (or the first option).

I wholeheartedly agree. I should add that if there exists a natural supplement that does not carry risks, is not harmful and is more effective than the pharmaceutical drug, then the natural supplement is the best choice (for example, in treating OPIOID ADDICTION)

[nupi]

If both are equally safe and effective, why would it matter if its natural or not? [if anything, pharmaceuticals generally have more research behind them than natural supplements which should make it easier to decide on their safety]

[JChief]

Perhaps I misread and I apologize if so because I thought the recommendation was to combine all of those racetams together. Stacking them one by one. I went back and re-read. Piracetam at those doses are not extreme - it was the combination that took me by surprise. People of course do it on these boards but the responses are all over the place. Racetams are not consistent performers for me but exhibit very interesting effects. Piracetam is my favorite of the racetams I've tried. And no doubt that St John's Wort cannot hold a candle to potent controlled substances. I've found that racetams can cause hypomanic-like reactions so I just get nervous when the suggestion was to combine with Lexapro with them. A natural cure should make you feel normal. Not euphoric. I believe Lexapro is a band-aid. And only masks symptoms. One could argue uridine may be doing the same thing. People many times look for an acute euphoric effect and if they don't get it they think its not working. Depression could be caused by a variety of reasons and multiple pathways are being studied to treat depression (glutamate pathway is one). Serotonin is only one approach to treating depression. 5-HTP carries some risk. I just wanted to mention (since I recently came across it) the book "Mood Cure" (which I've not read) recommends a variety of amino acids which are only taken for a certain amount of time and then stopped with the impression that it corrects imbalances and there are people that swear by it just as I swear by the effectiveness of uridine in the form of TAU combined with DHA. But if serotonin is the sole focus the options are quite limited if 5-HTP or tryptophan are not desired. St John's Wort didn't do much years back (other than dilate my pupils ha). I understand that uridine is not proven but I'm happy with the results. I do not advocate taking any advice on this board without checking with your doctor if you are clinically depressed. At the same time, just because a doctor hands you a prescription for an antidepressant doesn't mean you require them to improve your well being.

Over the counter supplements I think, in general, tend to carry a lower toxicity risk but of course they are usually not as potent as pharmaceuticals and is why certain people ditch those efforts in favor of stronger and more potent drugs. I am opposed to those drugs if at all possible. That's just me. Side effects, withdrawals, you name it are more common to those drugs. And they should be a last resort. Why not start with diet?

[hippocampus]

diet and lifestyle changes depression is in my opinion a lifestyle disease (in most cases) like obesity or high blood pressure are.

Edited by hippocampus, 09 February 2012 - 11:28 AM.

[JChief]

diet and lifestyle changes depression is in my opinion a lifestyle disease (in most cases) like obesity or high blood pressure are.

The reason why I lean that way is because I highly doubt most of us are born depressed. It "sets in" so-to-speak. Just like cancer can be reversed as most cancers arise from epigenetic influences (see the work of Dr. Ajay Goel, Ph.D., Director of Epigenetics and Cancer Prevention at the Gastrointestinal Research Center at Baylor University Medical Center in Dallas, TX for instance) I believe mental health disorders can be corrected if given the proper nutrition and we take measures to reduce our exposure to toxins. MIT trained scientist Raymond Francis, M.Sc. in his books Never Be Sick Again and Never Fear Cancer Again argue that there is only one disease (malfunctioning cells), only two causes of disease (deficiency and toxicity) and to avoid the Big Four: sugar, white flour, processed oils, and dairy/excess animal protein (less than 10% of your overall diet), replacing processed, highly toxic foods with organic, unprocessed fresh fruit and vegetables, legumes, sprouts, raw nuts, seeds, and gluten free grains (quinoa, brown rice, amaranth, buckwheat, millet etc). Sounds simple. But most people do not do so. It's a good place to start anyway.

[choqueiro]

Hi ScienceGuy.

I have been searching information about escitalopram low dose benefits for memory. I find only these articles: http://www.medconnec...ry/Default.aspx and http://pnhw.psychiat.../45/7/12.1.full

I'd love to see specific references for memory improvement, as the only ones I came across are in direct relation to stroke patients. There is some limited evidence that suggests escitalopram in very low doses (5-10mg) improved memory loss in this specific population, but I couldn't find anything relating to otherwise healthy individuals?

Any personal experience in this way?? Is there any evidence that treating anxiety with SSRIs I could improve my memory and avoid brain fog??

Thanks

[choqueiro]

I have just found more information: http://www.wisegeek....memory-loss.htm

Any personal experience or opinion about it??

Thanks

[choqueiro]

This article for example talks about the opposite: impairment caused by escitalopram (at a high dose of 20 mg.). This is what I am afraid. I don´t want to take the risk of treat my depression with a substance that could increase my memory issues.

[choqueiro]

Sorry, here it is the link with the article that talks about memory imparment caused by escitalopram: http://jop.sagepub.c.../5/477.abstract

[owtsgmi]

Sorry, here it is the link with the article that talks about memory imparment caused by escitalopram: http://jop.sagepub.c.../5/477.abstract

Choqueiro,
I understand your reluctance to take 5htp because of some evidence of heart damage in the literature. Do you know of any PubMed articles that support this view? I am no scientist but I do give scientific studies added weight when reaching conclusions about a supplement/drug. if you know of or have any links to scientific studies that specifically implicate 5htp, I would be grateful if you posted them. From what I understand, it is high levels of serotonin, not 5htp, that have been implicated as contributing to heart valve damage. See this link:
http://www.life-enha...plate.asp?ID=46

Also, the study about escitalopram doesn't sound that bad when you consider that with just escitalopram alone the memory impaired respondants didn't even show a statistical difference from the control. And, remember that the doses were much higher than the 5mg ScienceGuy talks about.

Sounds to me like you need more serotonin in your brain (like me). One way to get it is 5-HTP; one way is escitalopram. It might pay-off for you to accept calculated, tolerable side effects and/or "withdrawal symptoms" to achieve a reduction in anxiety and depression. I think you need to look at the enormous benefits of having a healthy brain and outlook, not just the potential negatives a new supplement can bring. I mean, you need to do your due diligence and follow the best advice, but sometimes you have to experiment a bit.

Look at it the other way around. Say you had absolutely NO anxiety and NO depression, but slightly impaired memory. Would you even consider taking something that would fix your memory, but would give you bad anxiety and depression. I bet you wouldn't! You are probably over-worrying because of your depression. Once you start to pull out of it, you may wonder what took you so long to take a stand and fix your situation.

That being said, I understand you are trying to get all the info you can before you make a choice on your supplementation. I love this forum because we are all pushing for new answers and keep looking for the perfect cure.

Good luck and keep us posted!

Edited by owtsgmi, 10 February 2012 - 07:35 AM.

[ScienceGuy]

Sorry, here it is the link with the article that talks about memory imparment caused by escitalopram: http://jop.sagepub.c.../5/477.abstract

...remember that the doses were much higher than the 5mg ScienceGuy talks about.

You should listen to this FINE gentleman

There is no evidence whatsoever that ESCITALOPRAM causes any MEMORY IMPAIRMENT when taken at the 5mg dosage

I should add that CLINICAL PRACTICE further supports this fact; and to hopefully nip the matter in the bud once and for all I wish to point out that I practice what I preach, in that I presonally take ESCITALOPRAM at 5mg dosage myself. I have never experienced any side effects whatsoever, and only positive beneficial therapeutic effects, including those relating to COGNITION

Whereas I believe that there does indeed exist substantiated evidence that links 5HTP to increased risk of CARDIOVASCULAR DISEASE

Furthermore, there does also exist substantiated evidence that ESCITALOPRAM does indeed IMPROVE COGNITION; see the follow for example:

Arch Gen Psychiatry. 2010 Feb;67(2):187-96.

Escitalopram and enhancement of cognitive recovery following stroke.

Jorge RE, Acion L, Moser D, Adams HP Jr, Robinson RG.

Source
Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA 52242-1000, USA. ricardo-jorge@uiowa.edu

Abstract

CONTEXT:
Adjunctive restorative therapies administered during the first few months after stroke, the period with the greatest degree of spontaneous recovery, reduce the number of stroke patients with significant disability.

OBJECTIVE:
To examine the effect of escitalopram on cognitive outcome. We hypothesized that patients who received escitalopram would show improved performance in neuropsychological tests assessing memory and executive functions than patients who received placebo or underwent Problem Solving Therapy.

DESIGN:
Randomized trial.

SETTING:
Stroke center.

PARTICIPANTS:
One hundred twenty-nine patients were treated within 3 months following stroke. The 12-month trial included 3 arms: a double-blind placebo-controlled comparison of escitalopram (n = 43) with placebo (n = 45), and a nonblinded arm of Problem Solving Therapy (n = 41).

OUTCOME MEASURES:
Change in scores from baseline to the end of treatment for the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Trail-Making, Controlled Oral Word Association, Wechsler Adult Intelligence Scale-III Similarities, and Stroop tests.

RESULTS:
We found a difference among the 3 treatment groups in change in RBANS total score (P < .01) and RBANS delayed memory score (P < .01). After adjusting for possible confounders, there was a significant effect of escitalopram treatment on the change in RBANS total score (P < .01, adjusted mean change in score: escitalopram group, 10.0; nonescitalopram group, 3.1) and the change in RBANS delayed memory score (P < .01, adjusted mean change in score: escitalopram group, 11.3; nonescitalopram group, 2.5). We did not observe treatment effects in other neuropsychological measures.

CONCLUSIONS:
When compared with patients who received placebo or underwent Problem Solving Therapy, stroke patients who received escitalopram showed improvement in global cognitive functioning, specifically in verbal and visual memory functions. This beneficial effect of escitalopram was independent of its effect on depression. The utility of antidepressants in the process of poststroke recovery should be further investigated. Trial Registration clinicaltrials.gov Identifier: NCT00071643.

PMID: 20124118

Edited by ScienceGuy, 10 February 2012 - 07:55 AM.

[owtsgmi]

Whereas I believe that there does indeed exist substantiated evidence that links 5HTP to increased risk of CARDIOVASCULAR DISEASE

ScienceGuy,
Could you post some evidence/studies concerning the dangers of 5htp? Not that I doubt you, but I would like to read them. I am thinking about getting checked out by a doctor for valve damage but don't know what type of test to ask for. Also, I am considering switching from 5 htp to the 5mg escitalopram, but I want to get all the info I can. Also, what would be the best way to do the switch from my thrice daily 200mg 5htp TR doses to the 5mg escitalopram?

Great info ScienceGuy...I appreciate your insights!

[choqueiro]

Hey ScienceGuy

I know that in the study that suggests memory impairment caused by escitalopram dosage was bigger than the 5 mg. Read my post another time and you will see that I do specific mention to that point when I say: "at a high dose of 20 mg."

My doubts come because it is said that in general SSRIs caused memory impairment. Some people in forum depressions talk about side effects such as memory impairment at dosages of 10 mg. In addition I can´t find a specific study made with 5 mg. that suggests improves in memory issues. In this point, your personal experience using 5 mg. with succesful is very important. What I don´t want is to worsen my cognition situation and your opinion is really valuable.

The study that you put, in which people who suffer strokes improve after escitalopram treatment is the one linked by me. Yes I have seen that study. That´s the reason of my comment in post #229: "I'd love to see specific references for memory improvement, as the only ones I came across are in direct relation to stroke patients. There is some limited evidence that suggests escitalopram in very low doses (5-10mg) improved memory loss in this specific population, but I couldn't find anything relating to otherwise healthy individuals?"

Thanks for all the information and for taking time to explain everything.

[ScienceGuy]

Whereas I believe that there does indeed exist substantiated evidence that links 5HTP to increased risk of CARDIOVASCULAR DISEASE

ScienceGuy,
Could you post some evidence/studies concerning the dangers of 5htp? Not that I doubt you, but I would like to read them. I am thinking about getting checked out by a doctor for valve damage but don't know what type of test to ask for. Also, I am considering switching from 5 htp to the 5mg escitalopram, but I want to get all the info I can. Also, what would be the best way to do the switch from my thrice daily 200mg 5htp TR doses to the 5mg escitalopram?

Great info ScienceGuy...I appreciate your insights!

L-5HTP increases risk of CARDIOVASCULAR DISEASE via two mechanisms; firstly, by significantly increasing PLASMA RENIN ACTIVITY; and secondly, by significantly elevating levels of SYSTEMIC SEROTONIN.

See the following:

Pharmacol Biochem Behav. 1981 Jun;14(6):895-900.

Effects of serotonin and L-5-hydroxytryptophan on plasma renin activity in rats.

Barney CC, Threatte RM, Kikta DC, Fregly MJ.
Abstract
The effects of dipsogenic doses of l-5-hydroxytryptophan (5-HTP) and serotonin on plasma renin activity (PRA), blood pressure, and body temperature were determined in unanesthetized female rats. Both serotonin (2 mg/kg, s.c.) and 5-HTP (25 mg/kg, s.c.) induced six-fold increases in PRA measured 1 hr after drug administration. The central and peripheral decarboxylase inhibitor, benserazide (30 mg/kg, s.c.), as well as the peripheral decarboxylase inhibitor, carbidopa (6.5 mg/kg s.c.), prevented the increase in PRA associated with administration of 5-HTP. This suggests that 5-HTP must be converted to serotonin peripherally to increase PRA. At the doses used, serotonin decreased mean blood pressure and colonic temperature of unanesthetized rats while 5-HTP was without effect. The increase in PRA induced by 5-HTP does not appear, therefore, to be a response to either hypotension or a decrease in colonic temperature. Since 5-HTP must be converted to serotonin to initiate both a drinking response and an increase in PRA, the results suggest that the decrease in blood pressure and colonic temperature following administration of serotonin may not be important in induction of the drinking response and the increase in PRA. The mechanism by which activation of the renin-angiotensin system occurs following peripheral administration of either 5-HTP or serotonin remains for further study.

PMID: 7019933
-------------------------------------------------------------------------------------------------------------------------------

Am J Cardiol. 2011 Jul 15;108(2):246-51. Epub 2011 May 3.

Prognostic value of plasma renin activity in heart failure.

Vergaro G, Emdin M, Iervasi A, Zyw L, Gabutti A, Poletti R, Mammini C, Giannoni A, Fontana M, Passino C.

Source
Division of Cardiovascular Medicine, Fondazione Toscana G. Monasterio, Pisa, Italy.

Abstract
The prognostic role of specific biomarkers of the renin-angiotensin-aldosterone system and sympathetic activation pathways in heart failure has never been investigated in populations with current evidence-weighted treatment. To establish whether the plasma renin activity (PRA), among several neurohormonal biomarkers, is able to predict cardiac events in a population of patients with heart failure on up-to-date treatment, we selected 996 consecutive patients with systolic left ventricular dysfunction (ejection fraction <50%, mean age 65 ± 13 years), who underwent a complete clinical and humoral characterization and were then followed up (median 36 months, range 0 to 72) for cardiac death and appropriate implantable cardioverter device shock. We recorded 170 cardiac deaths and 27 shocks. On Cox multivariate analysis, only ejection fraction (hazard ratio 0.962, 95% confidence interval 0.938 to 0.986), N-terminal pro-brain natriuretic peptide (NT-proBNP; hazard ratio 1.729, 95% confidence interval 1.383 to 2.161) and PRA (hazard ratio 1.201, 95% confidence interval 1.024 to 1.408) were independent predictors of cardiac death. Receiver operating characteristic curve analysis identified a cutoff value for PRA of 2.30 ng/ml/hour that best predicted cardiac mortality. Independent predictors of PRA were ejection fraction, functional class, sodium, potassium, NT-proBNP, norepinephrine, aldosterone, C-reactive protein, and medical therapy. The association of high NT-proBNP and high PRA identified a subgroup (22% of the study population) with the greatest risk of cardiac death. In conclusion, PRA resulted an independent prognostic marker in patients with systolic heart failure additive to NT-proBNP level and ejection fraction. PRA might help to select those patients needing an enhanced therapeutic effort, possibly targeting incomplete renin-angiotensin-aldosterone system blockade.
-------------------------------------------------------------------------------------------------------------------------------

Circulation. 2005 Mar 29;111(12):1517-22. Epub 2005 Mar 21.
Long-term [systemic] serotonin administration induces heart valve disease in rats.

Gustafsson BI, Tømmerås K, Nordrum I, Loennechen JP, Brunsvik A, Solligård E, Fossmark R, Bakke I, Syversen U, Waldum H.
Source

Department of Internal Medicine, St Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway. bjorn.gustafsson@medisin.ntnu.no
Abstract

BACKGROUND:

The purpose of this study was to investigate whether rats dosed with serotonin develop changes similar to those seen in human carcinoid heart disease.
METHODS AND RESULTS:

Ten Sprague-Dawley rats were given serotonin injections subcutaneously once daily for 3 months; controls were given saline. A long-lasting hyperserotoninemia with a >10-fold increase in both platelet-poor plasma and dialysate from the femoral muscles appeared. The animals developed clinical signs such as flushing and loose stools. After 3 months, 6 of 10 rats given serotonin had pathological echocardiographs. Two animals had a combination of aortic and pulmonary valve insufficiency, 1 had isolated aortic valve insufficiency, and 3 had isolated pulmonary valve insufficiency. Histopathological examination revealed shortened and thickened aortic cusps and carcinoidlike plaques characterized by a collection of myofibroblasts within an extracellular matrix of collagen ground substance. Immunostaining for Ki-67 demonstrated an increased number of proliferating subendocardial cells. In the control group, no pathological changes were seen. With the use of reverse-transcription polymerase chain reaction, normal rat aortic cusps were shown to express mRNA for serotonin receptors 5-HT1A, 5-HT2A, and 5-HT2B and the serotonin transporter 5-HTT.
CONCLUSIONS:

For the first time, long-term [systemic] serotonin administration was performed in rats. Morphological and echocardiographic changes similar to those seen in human carcinoid heart disease developed. This study demonstrates that [systemic] serotonin most likely is involved in the pathogenesis of carcinoid heart disease.

PMID: 15781732

[ScienceGuy]

Hey ScienceGuy

I know that in the study that suggests memory impairment caused by escitalopram dosage was bigger than the 5 mg. Read my post another time and you will see that I do specific mention to that point when I say: "at a high dose of 20 mg."

My doubts come because it is said that in general SSRIs caused memory impairment. Some people in forum depressions talk about side effects such as memory impairment at dosages of 10 mg. In addition I can´t find a specific study made with 5 mg. that suggests improves in memory issues. In this point, your personal experience using 5 mg. with succesful is very important. What I don´t want is to worsen my cognition situation and your opinion is really valuable.

The study that you put, in which people who suffer strokes improve after escitalopram treatment is the one linked by me. Yes I have seen that study. That´s the reason of my comment in post #229: "I'd love to see specific references for memory improvement, as the only ones I came across are in direct relation to stroke patients. There is some limited evidence that suggests escitalopram in very low doses (5-10mg) improved memory loss in this specific population, but I couldn't find anything relating to otherwise healthy individuals?"

Thanks for all the information and for taking time to explain everything.

Apologies. In my haste due to insufficient time I obviously did not read everything that you posted comprehensively.

However, please kindly note the following:

1) The studies demonstrating ESCITALOPRAM to in fact IMPROVE COGNITION in individuals suffering ILLNESS, such as recovering from STROKE, are very much relevant.

2) 99.9% of studies are conducted with regards to treating ILLNESS as opposed to HEALTHY individuals, because MEDICINE is primarily focused on treating ILLNESS as opposed to HEALTHY individuals; hence seeking studies relating to healthy individuals is somewhat futile, and since this does not mean that the particular substance will not have the same effect for HEALTHY individuals, potentially unnecessary. Take PIRACETAM for example; I am not aware of any studies carried out on HEALTHY individuals demonstrating its NOOTROPIC effects on HEALTHY individuals; this does not mean that it does not, and I am sure you will be aware that other evidence most certainly supports the fact that it does.

Incidentally, any COGNITIVE IMPAIRMENT resulting from ESCITALOPRAM usage at high doses is almost certainly INDIRECTLY caused due to DISRUPTION of the SLEEP CYCLE due to the high dose; this is exactly the same mechanism through which high dose CAFFEINE intake causes long-term COGNITIVE IMPAIRMENT. There is NO such DISRUPTION of the SLEEP CYCLE when ESCITALOPRAM is taken at the 5mg dosage

Edited by ScienceGuy, 10 February 2012 - 09:04 AM.

[JChief]

OK 5-HTP was used because it raises serotonin. Got that. But how do those dosages convert to humans? Just as you said low-dose Lexapro doesn't carry much of the reported side effects.. how about 100mg of 5HTP 2-3 times daily? Perhaps 5-HTP isn't as bad as we are all making it out to be.. I'm just playing devils advocate here. Let's have it Science Guy.

[JChief]

The act of smiling may be more powerful then what we think . In a journal article in Pediatrics (2008 Jul;122(1):40-51), dopaminergic reward-related brain regions in mothers were activated specifically in response to happy, but not sad, facial experesions by their own infant. Dopamine centers are the part of the brain that makes us feel like we are doing something right. There have been several studies stating when you smile (and of course lauging), your brain will release both serotnin and dopamine. Seems like a great daily exercise to me.