73 replies to this topic

[dunbar]

Yes but I havent started yet. Somehow 20mg lexapro scare me this is the MAX dose because of the possible dangerous heart rhythm disorders
which it could cause. I am not sure if you can prevent this by getting routine ECGs and then see if the QT interval has changed
or if this also doesn't offer security.

Edited by dunbar, 05 February 2014 - 05:49 AM.

[nupi]

Yes but I havent started yet. Somehow 20mg lexapro scare me this is the MAX dose because of the possible dangerous heart rhythm disorders
which it could cause. I am not sure if you can prevent this by getting routine ECGs and then see if the QT interval has changed
or if this also doesn't offer security.

That's why any sane person starts with 5mg, to see if there are any major side effects (there's always the off chance that you could be allergic to a compound so you rather do not take a big dose of it for the very first time...

And no, I have never heard of people getting routine ECGs because of Lexapro. And I am certain that your GAD does have worse impact on your health than anything but the most severe side effects of any commonly used anti depressant. Actually, in your case I would probably bundle an AD with a benzo.

[dunbar]

Lexapro can cause life threatening heart rhythm disorders so getting a routine ECG to rule out QT changes is very much indicated.

I won't get a benzo for daily use because of the risk of addiction. Doctors usually don't want to prescribe benzos in huge quantities.

Besides this I have taken ativan 1mg and it wasn't strong at all it was disappointing.

[nupi]

Contrary to what you might believe, frequent ECGs are NOT common protocol for Escitalopram.

There's like 4 or 5 more commonly used benzos and a whole bunch of not so commonly used ones, so the fact that single use of one of them (at a relatively low dose to start with) did not do what you want is kind of irrelevant here.

[Tom_]

There is no evidence that Escitalopram can cause arrhythmias in healthy individuals (apart from those caused by serotonin syndrome, which is extremely rare in normal doses and rare in mild overdose), those with severe cardiac problems are recommended to undergo ECG. ECG's are not recommend in the case of non cardiac patients/at risk of arrhythmias.

No prescription guideline suggests routine ECG monitoring in SSRI use, for good reason. The only antidepressants recommended for routine ECG are tricylic ADs as they carry a 0.1 risk of inducing tacky-arrhythmias.

[Keizo]

Ativan (lorazepam) seems in my experience and according to some user-reports to be rather strange. I think it can be hard to notice, while at the same time have strong effects. Same with clonazepam. I will not try and remember the finer details of my experience with benzodiazepines, but I think Diazepam (Valium, etc) is the most valuable one for all purposes. Now I would not advise anyone to use these things for more than a couple of weeks, if at all.

I looked at your previous posts dunbar and I saw you apparently had low testosterone... You should get that in order. I might be in the same boat, but hopefully not, am waiting for test results. Doctors here are very annoying as well.


I would just like to say that Cerebrolysin has a marked anti-depressant effect, and anti-anxiety. Considering there does not seem to any issues with dependence or withdrawal, in fact effects seem to last for a long time, I would regard this higher than currently available drugs for anxiety and depression. Possible unknowns aside.

[Tom_]

I never actually asked the question of the post. Its quite likely the best drug is Clomipramine, it is the strongest SRI (I think), mild NRI (enough to potentate SRI effects without worsening anxiety) and has potent sedative qualities due to antihistamine, anticholinergic (also theraputic in depressive/anxiety disorders) and alpha 1 antagonism. Its also an antagonist at various Seroternergic receptors.

This isn't a first line drug by any means but it is an effective one.

[hani]

There is no evidence that Escitalopram can cause arrhythmias in healthy individuals (apart from those caused by serotonin syndrome, which is extremely rare in normal doses and rare in mild overdose), those with severe cardiac problems are recommended to undergo ECG. ECG's are not recommend in the case of non cardiac patients/at risk of arrhythmias.

No prescription guideline suggests routine ECG monitoring in SSRI use, for good reason. The only antidepressants recommended for routine ECG are tricylic ADs as they carry a 0.1 risk of inducing tacky-arrhythmias.

Tom what's the difference between Citalopram & Escitalopram?

[Tom_]

Citalopram is the first drug that was made. Escitalopram is a S-Stereoisomer, which means its the same chemical exactly with the same atoms in the same order but its 3d shape is different.

Escitalopram is a stronger SSRI than Citalopram and it is arguably 'purer' in that Citalopram has weak antihistamine properties, it also appears to somewhat counteract its SSRI effect. However Escitalopram has another trick up its sleeve. Escitalopram may be an allostoric positive moderator makes serotonin bind better. Escitalopram also appears to increase its binding potential to SERT. Overall making Escitalopram the purest Serotoninergic drug. It appears to be more tolerable than Citalopram as well as more effective.

[BlueCloud]

Overall making Escitalopram the purest Serotoninergic drug. It appears to be more tolerable than Citalopram as well as more effective.

The difference is mainly a commercial one. A variation on a theme.. The main reason being that citalopram's patents expired, and a lot of generics began cutting into their profit, so Lundbeck rushed escitalopram with just enough variations to justify a new patent and they took again the very profitable market that they had with citalopram. They worked very aggressively to convince doctors to prescribe newly patented escitalopram ( and more profitable) rather than citalopram , despite feeble proofs of any real advantages.
Their management seems to be decided to milk the cow even more, since they managed to get an extension on the patent ( wich were supposed to run out in 2011 ) and kill any attempt for cheaper generic options to cut into their profits : http://www.mondaq.co... Patent And SPC

NEVER forget that pharma companies are BUSINESSES FIRST. Huge businesses, that generate fortunes for their shareholders. Sometimes the financial interests of the shareholders and that of public's health align, and it's all good. Sometimes they don't really align and you get all sorts of inneficient drugs whose existence is mainly to keep generating dollars for the company, despite weak efficiency or even safety.

[Tom_]

This is true, apart from feeble prove. It was only marketed for money, however it turned out to be a good medication. Citalopram is barely statistically strong enough to differentiate significantly from placebo, escitalopram manges to quite successfully. It wouldn't surprise me if Lundbeck released Citalopram and then Escitalopram in that order aware of the potential for Escitalopram to be more effective there by allowing them to market as 'new and improved' - which it is.

I've seen enough to convince me that Fluoxetine, Escitlopram and Sertraline are effective in a range of disorders and of roughly equal efficacy while maintaining a reasonable side effect profile and happily recommend any one of them as a first line treatment for there indications.

[dunbar]

But what if you have already had heart rhythm disorders in the past?
Then maybe it's different. I have had hundreds of SVES every day for months once.
That was scary.

[nupi]

But what if you have already had heart rhythm disorders in the past?
Then maybe it's different. I have had hundreds of SVES every day for months once.
That was scary.

Then you should mention that to the doctor. Also, it's not like Lexapro is the ONLY antidepressant that could be used (personally I actually hated it far more than any other I tried).

[hani]

What about Paxil?