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Dr. Bob is Robert Hsiung, MD,
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Posted by dr. dave on September 27, 2002, at 6:13:23
In reply to Re: Dosage/see bottom » hawkeye, posted by pharmrep on September 21, 2002, at 23:59:42
Again, the claim has been made that Lexapro has fewer side-effects than Celexa. This has been extensively discussed on this thread and the relevant data have been posted.
http://www.dr-bob.org/babble/20020821/msgs/118023.html
They clearly fail to demonstrate any significant difference. Despite repeated calls for any other research data which might back up the claim, none have appeared. So it is puzzling that this claim is again presented as fact.
The repeated statement of unsubstantiated claims leads to confusion. For instance, it has been said that r-citalopram cannot be inert because it is blamed for side-effects from Celexa. While it is true that this is claimed, there is no evidence to show that it is true. Removing r-citalopram does not cause a significant decrease in side-effects. But if the claim is made often enough, people begin to take it as fact and make deductions which stray further and further from what the research actually shows.
If there is now evidence that Lexapro has significantly fewer side-effects than Celexa, It would be very useful to see it.
> ** great question. 10mg of Lex is at least as efficacious as 40mg of cx...but with less s/e, less drug to drug interactions, and less discontinuation due to adverse events, and will work as fast as 1-2 weeks for most people. It is linear, however...5mg will not work as fast, and is not the recommended starting dose. In general, for most drugs many doctors reduce dosages to avoid side effects, but since Lexapro at 10mg is "comparable to placebo" it shouldnt be needed. In the Dr's I've seen...I would say 95%+ are starting w/ 10mg...only a few have gone to 20mg (only 2 weeks out now) and maybe a few Dr's are just "set in there ways" and are starting with 5mg (for a week or so...then up to 10mg) So far...I have only heard good responses from them, but most of their patients havent been back for their "monthly" visit...I'll hear more in about 2 weeks or so.
> PS...the starting dose for celexa was 20mg (62% of patients stayed there)...40mg was at about 30% (for a total of 92% of all Celexa prescriptions...the last 8% were at 60mg or higher.) I think Lexapro at 10mg will be effective for 80%+ of patients...then 15mg+ will make up the last 20%
Posted by Mr. SadPuppyDog on September 27, 2002, at 12:39:01
In reply to Re: Txment Refract. Maj.Unipolar Depressive Seeks Same » Alice Anne, posted by Geezer on September 24, 2002, at 13:13:03
Geezer, I agree with what you are saying. However I must also say Im VERY skeptical anything like you are talking about will ever occur on a large scale in psychiatry. To have the sort of thing you are talking about occur on a large scale and take over, we really need to formally integrate psychiatry into Neurology and just let Neurologists treat the serious forms of mental illness. Severe mental illness needs to be 100% "medicalised" and people with severe forms of this stuff just need to be given to Neurology to fix. Psychiatry does a poor job of it and Im skeptical psychiatry will ever achieve high tech status in medicine.
Mr. Sad PuppyDog
Posted by IsoM on September 27, 2002, at 13:02:22
In reply to Lexapro side-effects - where's the evidence? » pharmrep, posted by dr. dave on September 27, 2002, at 6:13:23
It's nice to see you post again, Dr. Dave. I like to hear from all sides.
It would be so simple to test to see if r-citalopram causes side effects. In healthy voluteers who have no problem with depression, if they were to take only the inert isomer, it could be judged if it causes side effects.
Another thing that could be tried, is to see if r-citalopram has any agonist or antagonist properties to any receptors in vitro. I realize that there's quite a few recepetors that would need testing this way & that the expensive wouldn't be justified by any possible profit, so it's unlikely to happen.
I think the main problem that people have in knowing whether there's fewer side effects with just Lexapro, as opposed to Celexa, is understanding why side effects occur. Few people understand that an effective medication doesn't just bind to the receptors needed to improve mood but to these same receptors but on different neurons throughout our body, not just the ones in our brain.
Dr. Dave, I have a full write-up by Aimee L McRae on Lundbeck's escitalopram from "Current Opinions In Investigational Drugs". Is she associated with Lundbeck at all, or impartial in your opinion?
Posted by Anyuser on September 27, 2002, at 13:31:14
In reply to Re: Lexapro side-effects - where's the evidence? » dr. dave, posted by IsoM on September 27, 2002, at 13:02:22
Posted by IsoM on September 27, 2002, at 13:50:05
In reply to What does Aimee say? (nm) » IsoM, posted by Anyuser on September 27, 2002, at 13:31:14
There's quite a bit written & copyright laws would prevent me from posting it, but is there any particular thing you're wondering about? If you tell me, I'll check for that in the article.
Much of what's said has already been stated. I noticed that in the diff studies, none involved more than a few hundred patients at a time. I think we'll really need to wait till thousands of patients' reports start coming in to make a better assessment of Lexapro vs ordinary Celexa.
Posted by Anyuser on September 27, 2002, at 14:25:22
In reply to Re: What does Aimee say? » Anyuser, posted by IsoM on September 27, 2002, at 13:50:05
Wouldn't want to break any copyright laws on the internet.
What are her conclusions re efficacy and s/e?
Posted by Geezer on September 27, 2002, at 16:07:14
In reply to Re: merge psychiatry into Neurology is only hope, posted by Mr. SadPuppyDog on September 27, 2002, at 12:39:01
Hi Mr. Sad Puppydog - thanks for the response. It seems you are very aware of the current problems facing people with sever TRD. Historically, I wish the Neurologists had won the battle with the Psychiatrists at the time the "asylums" were still active. There is huge resistance to "medical" treatment (and research) in psychiatry..... note the increased importance of treatment by social scientists (psychologists), the importance of holistic treatments (add seeds & twigs to your diet to improve mental health) - the recent Surgeon Generals report would suggest any bed-wetting do-gooder that cared to should have a go at us. HOWEVER, current drugs do help 70% of the people who take them - at least to some degree for some period of time (that credit goes to the drug companies) - its just us 30%ers left to face ECT or nothing.
It is difficult to manage the logistics of proper care. The psychologist part is easy - they can go the way Freud did - treat the neurotics but stay away from biochemical mood disorders. I would agree the rest of us belong with Neurologists but I can't find one willing to treat.
On the brighter side do a search on Dr. Fuller Torrey. You will find huge attacks against him from the press but he is in the forefront of biomedical research for Bipolar Disorder (Director of The Stanely Foundation - PRIVATE FUNDING; he is a psychopharmacologist).
Good cheer
Posted by IsoM on September 27, 2002, at 16:08:33
In reply to Re: What does Aimee say? » IsoM, posted by Anyuser on September 27, 2002, at 14:25:22
One thing stated that's diff from pharmrep's statements is that 20 mg escitalopram (Lexapro) [not 10 mg] is equivalent to 40 mg citalopram (Celexa).
|| from "A single-dose crossover pharmakinetic study comparing racemic citalopram (40 mg) with the S-enantiomer (escitalopram, 20 mg) in healthy male volunteers."
Drews P New Clinical Drug Evaluation Meeting - Phoenix, AZ 2001 May 28-31 ||She lists a few different studies that compare Lexapro's faster onset of action than imipramine, fluoxetine, & venlafaxine but none that compared it to Celexa even though she mentioned that Lexapro was faster than Celexa. That's one reason I wondered about her affiliation. She states Lexapro is faster than Celexa but the studies don't state that - just the other 3 ADs. The idea that it’s faster is inferred from a study predicted from a rat model only.
It also states that escitalopram is 30-fold more potent than the R-isomer (Celexa).
|| Escitalopram oxalate. Anti-depressant 5-HT reuptake inhibitor.
Sorbera LA, Revel L, Martin L, Castaner J
Drugs Future 2001 26 2 112-120 ||To be honest, I found nothing in the article that states that Lexapro is more effective than Celexa in an equivalent dose. (1:2 equivalency rate)
It didn’t compare side effects but only said that with escitalopram, nausea was the most common side effect (15%), somnolence (7%), ejaculation disorder (9%), & anxiety (no percentage given). As the percentage of s/e with Celexa seem to vary somewhat depending on what study or journal one looks at, this may be true for Lexapro too.
Posted by moxy1000 on September 27, 2002, at 16:52:41
In reply to re efficacy and s/e » Anyuser, posted by IsoM on September 27, 2002, at 16:08:33
Dr. Dave,
I have a question regarding the design of most studies done by drug companies to evaluate the efficacy of anti-depressants. Most study designs evaluate moderate-severe patients (as determined by widely used rating scales), diagnosed with major depression. However, the study designs don't include patients with mild depression or patients with comorbidities.
My question is why do you think these types of patients are excluded from most clinical trials?
I've heard conflicting theories. The first is that many believe if an anti-depressant works for moderate or severe depressed patients, it would be logical to assume that it would work for the milder, easier to treat patients as well. Conversely, I've heard that drug companies are "scared" to evaluate mild depression, because they are fearful that placebo would work as well as the active agent, if not better.
I tend to agree with the first statement, because even if placebo worked better then an active agent, the depression could not have been that debilitating to begin with. It would seem that for many patients, several things other then "placebo-affect" would have a positive impact on depression. Simply the desire to want to feel better, and the constant attention given to patients by clinicians involved in studies, would seem like it would help in improving depressive symptoms.
Anyway, just a question that's been rattling around in my brain for awhile, and I thought I'd get your take on it.
Thanks!
Posted by McPac on September 27, 2002, at 18:14:41
In reply to Re: merge psychiatry into Neurology is only hope » Mr. SadPuppyDog, posted by Geezer on September 27, 2002, at 16:07:14
Did you ever consider going to Dr. Amen's clinic (or one similar elsewhere)?
Posted by Geezer on September 27, 2002, at 18:55:59
In reply to Geezer, posted by McPac on September 27, 2002, at 18:14:41
Hi McPac,
Dr. Amen's clinic has been mentioned to me recently but I must confess I don't know much about it. Could you briefly outline the services? I will do a search. Saw a report recently (don't know where) that hi-frequency MRI was inadequate in picking up neuro brain abnormalities as demonstrated by postmortem studies on depressed suicides. Don't know if this relates to Amen's work.
Thanks
Posted by Dr. Bob on September 27, 2002, at 19:06:07
In reply to Re: merge psychiatry into Neurology is only hope » Mr. SadPuppyDog, posted by Geezer on September 27, 2002, at 16:07:14
> Historically, I wish the Neurologists had won the battle with the Psychiatrists at the time the "asylums" were still active...
I'd like discussion the pros and cons of psychiatry and neurology to be redirected to Psycho-Social-Babble, thanks.
Bob
PS: And follow-ups regarding posting policies to be redirected to Psycho-Babble Administration.
Posted by McPac on September 27, 2002, at 21:18:44
In reply to Re: Geezer » McPac, posted by Geezer on September 27, 2002, at 18:55:59
I used to have a link to Dr. Amen's site....go to a bookstore, like Border's or Barnes & Noble, pull up a chair and read, "Change your brain, Change your life" by Daniel Amen. I think you will be pleasantly fascinated with the technology and its use!
Posted by Geezer on September 27, 2002, at 21:39:27
In reply to Geezer, posted by McPac on September 27, 2002, at 21:18:44
Thanks McPac......will do.
Posted by yeltom on September 27, 2002, at 22:18:05
In reply to Lexapro side-effects , posted by dr dave on August 28, 2002, at 3:15:33
But your conclusion is based on the idea that 10 mg. of Lexapro is equivalent to 20 mg. of Celexa, whereas the company claims that it's equivalent to 40 mg. Am I wrong? I am curious, however, why isolating one of the isomers would make it 4 times stronger. I assumed that the two isomers in celexa were present in a ratio of 1:1, in which case you'd assume (assuming that the less active isomer is not active at all) that the isomer would be twice as strong, not 4 times as strong. Unless the non-active component actually INHIBITS the active component. Or perhaps the assumption that they are present in a ratio of 1:1 is wrong.
> It is repeatedly claimed Lexapro has fewer side-effects than Celexa. What does the data show? In the Burke et al trial 85.6% of those on Lexapro 20mg had side-effects compared to 86.4% on Celexa 40mg (not statistically significant). Not impressive, I would suggest. 10.4% of those on Lexapro 20mg discontinued because of side-effects compared to 8.8% of those on Celexa. So in fact more discontinued Lexapro than Celexa. But the result is not statistically significant and therefore likely to be a chance result.
>
> The incidence of discontinuations on Lexapro 10mg a day was 4.2% compared to 2.5% on placebo. Again, not statistically significant. The overall rate of side-effects on Lexapro 10mg was 79.0% compared to 70.5% on placebo (not statistically significant). The comparison between Celexa 20 mg and placebo is not available as this dose was not used.
>
> So the Burke study provides no data to support the claim that Lexapro has fewer side-effects than Celexa.
>
> Gorman gives discontinuation rates for Lexapro in both doses as being 5.9% versus 2.2% for placebo (not statistically significant). No equivalent rate for Celexa is available. No more detail on side-effects is given in this, the most comprehensive analysis of the data currently available. Myself, I ask why not, if this is such a step forward in terms of side-effects.
>
> These results are entirely consistent with the hypothesis that there is no statistically significant difference in side-effects between Lexapro and Celexa, and provide no evidence of the difference that is so widely claimed as being an established fact.
>
> If there is other evidence to fit into this overall picture, this must be considered, but these results seem to suggest very powerfully that there is no significant difference in side-effects.
>
> Decide for yourself on the basis of actual hard facts.
Posted by pharmrep on September 27, 2002, at 23:41:13
In reply to Lexapro side-effects - where's the evidence? » pharmrep, posted by dr. dave on September 27, 2002, at 6:13:23
> Again, the claim has been made that Lexapro has fewer side-effects than Celexa. This has been extensively discussed on this thread and the relevant data have been posted.
>
***** Nobody has ever said r-cit was inert or is where the side effects are...it just isnt contributing towards treating depressive syptoms (as seen in sanchez study). all of the studies show 10mg to have "s/e comparable to placebo" which is definitely less than celexa or any other AD. I'm not sure who you mean when you say "they"...but it's not just forest stating that claim...it's every study done so far...with the backing of the FDA.
>
> They clearly fail to demonstrate any significant difference. Despite repeated calls for any other research data which might back up the claim, none have appeared. So it is puzzling that this claim is again presented as fact.
>
> The repeated statement of unsubstantiated claims leads to confusion. For instance, it has been said that r-citalopram cannot be inert because it is blamed for side-effects from Celexa. While it is true that this is claimed, there is no evidence to show that it is true. Removing r-citalopram does not cause a significant decrease in side-effects. But if the claim is made often enough, people begin to take it as fact and make deductions which stray further and further from what the research actually shows.
>
> If there is now evidence that Lexapro has significantly fewer side-effects than Celexa, It would be very useful to see it.
>
>
> > ** great question. 10mg of Lex is at least as efficacious as 40mg of cx...but with less s/e, less drug to drug interactions, and less discontinuation due to adverse events, and will work as fast as 1-2 weeks for most people. It is linear, however...5mg will not work as fast, and is not the recommended starting dose. In general, for most drugs many doctors reduce dosages to avoid side effects, but since Lexapro at 10mg is "comparable to placebo" it shouldnt be needed. In the Dr's I've seen...I would say 95%+ are starting w/ 10mg...only a few have gone to 20mg (only 2 weeks out now) and maybe a few Dr's are just "set in there ways" and are starting with 5mg (for a week or so...then up to 10mg) So far...I have only heard good responses from them, but most of their patients havent been back for their "monthly" visit...I'll hear more in about 2 weeks or so.
> > PS...the starting dose for celexa was 20mg (62% of patients stayed there)...40mg was at about 30% (for a total of 92% of all Celexa prescriptions...the last 8% were at 60mg or higher.) I think Lexapro at 10mg will be effective for 80%+ of patients...then 15mg+ will make up the last 20%
>
>
Posted by pharmrep on September 27, 2002, at 23:58:41
In reply to Re: Lexapro side-effects/dosage, posted by yeltom on September 27, 2002, at 22:18:05
*** you are right...Dr Dave wont agree with this point...Celexa is a racemic mixture with "mirror" halves..r-cit. and s-cit (50/50 mix) the r-cit does not contribute towards treating depressive symptoms at all (see sanchez study) and actually inhibits the s-cit (lexapro) from its full potential. it wasnt expected at first...but 10mg is at least as efficacious as 40mg of celexa.
But your conclusion is based on the idea that 10 mg. of Lexapro is equivalent to 20 mg. of Celexa, whereas the company claims that it's equivalent to 40 mg. Am I wrong? I am curious, however, why isolating one of the isomers would make it 4 times stronger. I assumed that the two isomers in celexa were present in a ratio of 1:1, in which case you'd assume (assuming that the less active isomer is not active at all) that the isomer would be twice as strong, not 4 times as strong. Unless the non-active component actually INHIBITS the active component. Or perhaps the assumption that they are present in a ratio of 1:1 is wrong.
>
Posted by curiousguy on September 28, 2002, at 0:14:35
In reply to Re: Lexapro side-effects/dosage » yeltom, posted by pharmrep on September 27, 2002, at 23:58:41
I just switched from celexa to lexapro... on celexa, i had some sexual side effects, mainly less desire and ejac.problems... i switched to lexapro recently - is rash (itchiness really) and/or shortness of breath possible side effects? Are there any ingredients in lexapro that could cause this? I never experienced either on celexa... also, does lexapro REALLY help the sexual side effects? How long to be on it before you notoice a difference?
Posted by pharmrep on September 28, 2002, at 0:56:31
In reply to Re: Lexapro side-effects/dosage, posted by curiousguy on September 28, 2002, at 0:14:35
> I just switched from celexa to lexapro... on celexa, i had some sexual side effects, mainly less desire and ejac.problems... i switched to lexapro recently - is rash (itchiness really) and/or shortness of breath possible side effects? Are there any ingredients in lexapro that could cause this? I never experienced either on celexa... also, does lexapro REALLY help the sexual side effects? How long to be on it before you notoice a difference?
>
> *** rash/itch...very low %, not mentionable, might go away with time/ same with shortness of breath. there are no "new ingrediants" in Lexapro. as for sex s/e...it is an ssri, and they are a class effect for all ssri's. It was listed as 9% for ejac delay...but might be higher. for all side effects and efficacy, you might see its true color in 1-2 weeks, but give it 3-4 for a fair trial for yourself. good luck and keep us posted
Posted by McPac on September 28, 2002, at 1:16:53
In reply to Re: Geezer » McPac, posted by Geezer on September 27, 2002, at 21:39:27
This IS the future! And the future is now!
Posted by IsoM on September 28, 2002, at 1:18:54
In reply to Re: Lexapro side-effects/dosage, posted by yeltom on September 27, 2002, at 22:18:05
Yeltom, see my above post in this thread:
http://www.dr-bob.org/babble/20020922/msgs/121268.html
further to your question.
The info comes from the Aug 2002 issue of Current Opinion in Investigational Drugs
Posted by Dinah on September 28, 2002, at 6:57:07
In reply to Re: Lexapro side-effects/dosage, posted by curiousguy on September 28, 2002, at 0:14:35
> i switched to lexapro recently - is rash (itchiness really) and/or shortness of breath possible side effects? Are there any ingredients in lexapro that could cause this? I never experienced either on celexa...
Hi curiousguy,
I would think that you should mention any new side effects like this to your pdoc and discuss with him whether or not you should continue. It may or it may not be related to the med, but you should still probably discuss it with a doctor.
Posted by Dinah on September 28, 2002, at 6:58:21
In reply to Re: Lexapro side-effects/dosage, posted by Dinah on September 28, 2002, at 6:57:07
Posted by Roman on September 28, 2002, at 10:41:53
In reply to Re: Lexapro side-effects/dosage » curiousguy, posted by pharmrep on September 28, 2002, at 0:56:31
> > It was listed as 9% for ejac delay...but might be higher.
For clarification, was that 9% of the males or 9% of all participants?
Posted by moxy1000 on September 28, 2002, at 13:55:25
In reply to Re: Lexapro side-effects/dosage » curiousguy, posted by pharmrep on September 28, 2002, at 0:56:31
the shortness of breath/itchiness that curious guy mentioned sounds a lot like I feel when my allergies are kicking in. Since neither is listed as being commonly reported s/e's, it's possible that these symptoms are totally unrelated. Also, when I feel stress/anxiety, I do feel short of breath also. Anyway, just my two cents.
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