Posted by Peter on October 6, 2003, at 19:39:48
In reply to Anyone switched to Lexapro? « ggrrl, posted by Dr. Bob on June 11, 2002, at 7:52:48
Hi all:
Well, today marks my day 32 total on lex - day 26 on 10mg (started on 5mg for first 6 days). It's been a rough journey, and, honestly, I can't say for sure that I've had any 'breakthrough' succesful response(s) yet.
But I think I'm feeling better; it's harder to notice since it's really a process, and it's easy to forget how lousy I felt before beginning lex in the first place.
I think it's been proven to me that my pdoc was correct in saying that my moderate/high 40mg adderall dose that I was already taking when I began lex might have had some wierd synergistic effects with the lex, causing some kind of 'masking' of the lex therapeutic effects. His instructions for me to reduce the adderall 5mg every 4th day were very practical, in that the ultimate goal of such a reduction would at least give me a better, more accurate assesment of whether I was responding well to the lexapro, and, for that matter, whether many of the SE's were being caused by a synergy between the adderall+lexapro or the lex alone. I'm down to 20mg adderall daily now, and I must say I have less overall anxiety, social phobia, and mood lability (I'm crossing my fingers). But I have yet to really put the lex to the test by actively going out to parties or meeting new people, etc. This is as much a psychological problem for me as a biological one, so it might take some time to get over some of these hurdles that were formed through my years of depression and anxiety. Mind you, again, I don't consider myself (yet!) to have experienced the full benefits of the lex, but the very fact that the SE's that were really bothering me before are gone is an attestment to the lex somewhat working, as, all in all, my mood seems better - at least in terms of my no longer (thank God) falling into such awful depths of depression during which I am rendered utterly debilitated and paralyzed in every area of my life. But in terms of the comorbid problems of social anxiety, anticipatory anxiety, etc.. for these there is still room for improvement. And I gotta say that although I'm not falling into those horrible, deep depressive states, my mood in general can use some improvement.
My next pdoc appt. is on Wednesday; we finished our last session with hs telling me to reduce the adderall, and I have. He said that if my mood is not recognizably improved, we would take the next step of increasing the lex dose. However, I'm concerned about doing this. The lexapro prescribing info that describes the outcomes of the various placebo-controlled trials state that those groups who took 20mg lexapro experienced DOUBLE the SE's than the placebo and 10mg lex groups; it also states that there was no real evidence that the 20mg group experienced more therapeutic effects than did the 10mg group. But, on the other hand, I've heard from many posters that they increased from 10mg and experienced a profound increase in therapeutic effects. But if the stats are correct, do I really want to, by increasing the dose, risk double the side-effects (the ones I just recently got over were bad enough in and of themselves) with a chance of not experiencing any increase in therapeutic effects? I'm confused as to what to do. I liked the news on the lex site from September that lex was proven as effective for major depression as Effexor, with a much lower incidence of SE's and dropout. This was encouraging, as it was really a toss up between lex and effexor, and once I began lex, I sort of regretted not going the route of a dual-NT med like effexor (SNRI). So this news was encouraging; but the stats in the lex prescribing info on the 20mg group vs. the 10mg group was not encouraging, and I'm even wondering if I've given the lex a long anough trial as it is (4-5 weeks) and that maybe I should just switch to another AD. Even with other SSRI's, I not only experienced therapeutic effects within the first 3 weeks, but I noticed these effects even through mountains of other meds, including adderall, that I took simultaneously with the SSRI's. For instance, I began prozac when I was already taking adderall, strattera, and lamictal, and, once the therapeutic effects kicked in (improved mood, lessened anxiety, better sleep/wake cycles, etc.), I noticed them very profoundly even though I was taking all those other meds at the same time. Yet now my pdoc has had me reduce the adderall to see if I notice the lex benefits any better - so you see? It just seems iike, if the lex were REALLY working, I would have noticed it regardless of the dose of adderall I was taking with it. So I'm just wandering if me and my pdoc are really kidding ourselves and denying that lex just isn't working for me as well as it should. I don't know - stick with the lex even longer, increase the dose in spite of the discouraging prescribing info stats, or switch AD's? What do you all think?
much appreciated,
Peter
poster:Peter
thread:109458
URL: http://www.dr-bob.org/babble/20031004/msgs/266101.html