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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 26. This is the beginning of the thread.
Posted by qbsbrown on July 1, 2006, at 3:06:04
Seems to be some confusion here. At first everything i saw said it was 4:1. Now, i've seen many other docs, including my own, thinking that it's closer to 2:1.
What is the evidence? Why is it so hard to measure?
Brian
Posted by Phillipa on July 1, 2006, at 12:24:07
In reply to what's latest consensus Lexapro:Celexa ratio 2:1??, posted by qbsbrown on July 1, 2006, at 3:06:04
I don't have evidence but the posters say that celexa is half as strong as lexapro. Love phillipa
Posted by bassman on July 1, 2006, at 16:55:54
In reply to what's latest consensus Lexapro:Celexa ratio 2:1??, posted by qbsbrown on July 1, 2006, at 3:06:04
I think the answer is 2:1 based on being a pharmaceutical chemist for 25 years and stuff like this:
The editors of The Medical Letter on Drugs and Therapeutics concluded in their September 30, 2002, review of the drug that: “Escitalopram (LEXAPRO), the active enantiomer [one of the two mirror images] of citalopram (CELEXA), is effective for treatment of depression, but it has not been shown to be more effective, more rapid-acting or less likely to cause adverse effects, including sexual dysfunction, than citalopram or any other SSRI.”1
I also finding it very telling that the Remedyfind.com site, with 1500 users evaluating Celexa versus Lexapro for depression, end up with them being equally effective and the average Celexa user uses twice the dose of the average user of Lexapro.I find the case very compelling for Lexapro simply being the bioactive of the two isomers of Celexa, which are each present at 50%- and therefore the efficacy ratio is 2:1.
For a completely different opinion, see (on this site):
Posted by qbsbrown on July 3, 2006, at 23:52:14
In reply to Re: what's latest consensus Lexapro:Celexa ratio 2:1??, posted by bassman on July 1, 2006, at 16:55:54
Ok, so there is obviously a debate. One thing that i did notice, especially from remedyfind.com, is that noboby was above 20mgs lexapro for ocd, same as 40mg celexa.
I've seen many times 60mgs celexa being prescribed for ocd, but hardly ever is 30 mgs for lexapro. What explains this?
If i am taking 60mgs celexa, what seems to be the closest lexapro dose?
Posted by bassman on July 4, 2006, at 7:22:01
In reply to so 60mg celexa would roughly be _ lexapro?, posted by qbsbrown on July 3, 2006, at 23:52:14
That's a good question. The "normal range" for dosage of Lexapro is 10-20 mg and it is 20-40 mg for Celexa. But Celexa has a max dosage of 60 mg. Since many people respond to 20 mg Celexa, I think Forest Labs really wanted to sell the idea of a 10 mg, one-size-fits-all, apparently low dosage AD-which would be inconsistent if they had recommended a max dose of 30 mg Lexapro. It would have looked too much like Celexa prescribing info, just divide by 2. I think that docs are reluctant to prescribe above the recommended max dose, hence the lack of 30 mg on Remedyfind.com. That may not make sense to everyone.
When I took Celexa, 40 mg was just a bit too little and so I'd go up to 60 mg occasionally. When I switched to Lexapro, 20 was that same on-the-edge feeling of 40 mg Celexa. ANYWAY, to answer your question. :>} -I'd start with 20 mg Lexapro and not be afraid to go to 30 mg if necessary.
Posted by qbsbrown on July 4, 2006, at 22:36:08
In reply to Re: so 60mg celexa would roughly be _ lexapro?, posted by bassman on July 4, 2006, at 7:22:01
Ya know what bassman, i was looking wrong on remedyfind. I was only seeing the 20mg lexapro, not noticing the 2 times daily.
There were about 11-12 out of 52 for OCD on 40mgs lexapro. So now i am not as in shock that my doc has recommended that i switch from 60mgs celexa to 30mgs lexapro.
Posted by bassman on July 5, 2006, at 5:40:07
In reply to Re: so 60mg celexa would roughly be _ lexapro?, posted by qbsbrown on July 4, 2006, at 22:36:08
Great news and good job of looking at the data! Nothing like seeing what people actually do (as opposed to armchair comments) that works! And that fits well with the 2:1 ration of Celexa: Lexapro, so it is reasuring that you are taking a reasonable dose. Best of luck!!
Posted by qbsbrown on July 5, 2006, at 20:46:52
In reply to Re: so 60mg celexa would roughly be _ lexapro?, posted by bassman on July 5, 2006, at 5:40:07
I've been on 60mgs of celexa. I have improved greatly. I am moving to lexapro in hopes of fewer side effects, namely sexual.
My PDoc believes that it is a 2:1 ratio, and that 30mgs is more appropriate. My family doc thinks try 20, and go up if needed. My PDOC agrees that I can always go up if needed.
Only problem is that i am worried of losing any benefit that i've experienced if i take 20.
Would you say 20 and go up, or do 30, and go down later when feeling better?
Pretty severe OCD, amongst all the other anxiety disorders.
I appreciate your input.
Brian
Posted by Phillipa on July 5, 2006, at 21:01:05
In reply to last call! 20 or 30 mg of lexapro????????, posted by qbsbrown on July 5, 2006, at 20:46:52
I'd take the 20 you can always go up. And I didn't know you were male. Love Phillipa
Posted by bassman on July 6, 2006, at 5:17:14
In reply to last call! 20 or 30 mg of lexapro????????, posted by qbsbrown on July 5, 2006, at 20:46:52
It is a tough call. I don't think you'll seee difference in sexual side effects, from my own experience, but let's hope so. Pretty damn discouraging.
The problem, as I see it, is that if you start at 20 mg-your point is well taken-not only might you lose the benefits of the AD, they might not come back by increasing to 30 mg. OTOH, you give yourself a better chance of decreasing the sexual side effects at 20 mg.
Probably if you start at 20 mg, you'll see a difference in sexual side effects within days (my own experience)-if things aren't better, might as well go to 30 mg. Maybe try 150 mg Wellbutrin to counter the side effects if this doesn't work (?) Just a couple thoughts..
Best of luck!
Posted by qbsbrown on July 6, 2006, at 6:40:52
In reply to Re: last call! 20 or 30 mg of lexapro????????, posted by bassman on July 6, 2006, at 5:17:14
Well, the 40mg celexa sexual side effects weren't existant. Actually seemed to improve functioning and drive. But 60 has deadend everything (no pun intended), not necisarily drive.
Perhaps 20mg lexapro will have same benefit as 60mg celexa (ocd wise), w/ less sexual SEs.
I guess there's only one way to find out, trial.
One would think, that the ammount of $$$$ going in to Lexapro, they would be able to come up with an accurate, or near accurate measure of the conversion. I mean come on, the difference between 1/4 and 1/2 is ridiculous, considering how delicate of a balancing system the brain and chemicals are.
If you go to their site, they obviously want you to switch to Lex instead of Celexa, but don't give you great guidelines for switching.
Baffling to say the least.
Brian
Posted by bassman on July 6, 2006, at 8:30:52
In reply to Re: last call! 20 or 30 mg of lexapro????????, posted by qbsbrown on July 6, 2006, at 6:40:52
Generic Celexa is 90 tabs for $50 and Lexapro is $210. I wonder if that is the reason....:>}
(generic Lexapro can be purchased on the internet for $38 for 90 tabs)
Posted by qbsbrown on July 7, 2006, at 16:26:39
In reply to Re: last call! 20 or 30 mg of lexapro????????, posted by bassman on July 6, 2006, at 5:17:14
So my PDOC doesn't care 20 or 30mgs Lex, totally my choice. I can always go down, i can always go up.
So, i was going to go for 30mg. So i am/was doing 20mg celexa + 20mg Lexapro for a couple days, then go to 30mg lexapro solo.
Well after day one, i slept great, but today i went to lunch w/ my friends, and i was literally shaking, hands, arms, legs etc.
I am very med sensitive, and can usually tell w/ in one dose if a med is good for me or not, i don't know, it just clicks or not.
I think it was a good indication to simply start at 20mg lexapro. Just felt like too much.
You concur?
Posted by bassman on July 7, 2006, at 18:17:42
In reply to well bassman,,.., posted by qbsbrown on July 7, 2006, at 16:26:39
Wow! There's that initial intense anxiety thing with Lexapro again, which happens a lot on this board. I really like your idea of 20 mg Celexa plus the Lexapro-damn well thought out! You can't subject yourself to that level of anxiety, owing to the fact that anxiety is in part what you are trying to get rid of! :>} You've got some time to do a quick adaptation to the Lexapro due to the somewhat long half-life of Celexa that is already in your system. So maybe no Celexa but 10 mg Lexapro for a couple days to make sure the stuff isn't going to give you too many side effects, going up to 20 over the period of a week or so? Because of your sensitivity to meds, I'd be more worried about getting very discouraged at this point than with the Lexapro not working because of the "drug holiday" thing. Don't be a hero with the side effects...the Celexa you have in your system should hold you for awhile. Sorry to hear about the anxiety, but best of luck. I'll bet everything will be fine if you taper up, so to speak. Again. best of luck and tell us how you make out!
Posted by qbsbrown on July 8, 2006, at 8:51:44
In reply to Re: well bassman,,.., posted by bassman on July 7, 2006, at 18:17:42
Do most take Lex in the morn? I've been taking mine in the evening for 7 weeks now, and i wake up very early 5-630am, no matter how early or late i go to bed. Quite bothersome.
I don't find them sedating at all. The only worry i have is this; derealization has been the most bothersome of all symptoms for 5 years, and i'm worried that it'll be aggrivated by taking a morning dose.
You think just switch and give it a shot?
To switch, do i just skip my evening dose and take in morning, or is it usually a gradual transfer?
Thanks,
Brian
Posted by bassman on July 8, 2006, at 9:05:55
In reply to Re: well bassman,,.., posted by qbsbrown on July 8, 2006, at 8:51:44
If the Lex wakes you up and you feel like you have to get out of bed (not just awake), that's usually a good sign, in my experience. When to take it is important and seems to be different for everyone-people that are bothered in terms of stimulation and sleep often like to take the Lex in the morning to get the serum max (and one assumes, the max also of side effects) over with during the day-so they can sleep better. There is the opposite school of thought that basically says, "let's sleep through the side effects" and they take it at night.
Being very med sensative (like most panic disorder folks), I like to take a new med twice a day at a reduced dose to start with-the reasoning being to keep the drug blood concentration as constant as possible. I've found time of the two doses doesn't have to be 12 hours apart for it to reduce side effects-so if I were you, I might take half to 3/4 at your usual time and the rest maybe at noon, esp. if you're concerned about the morning. After awhile, you can take the entire dose whenever it is less bothersome and most effective. I think you need at least a few days at a lower dose, maybe a much lower dose-taking it two times a day to minimize side effects-until you feel comfortable with the med. At least for me, there is a point at which I think, "this med isn't going to do anything nasty to me :>)" and then I can relax and just move the timing around without much concern. That has worked for me-I hope it is of help to you.
Posted by qbsbrown on July 8, 2006, at 9:09:41
In reply to Re: well bassman,,.., posted by bassman on July 8, 2006, at 9:05:55
I hear ya. I think that i'll give it a shot in the morn. My doc doesn't care when i take it, just that i do everyday. I was having sleep troubles before i started it, so it's nothing new.
But yes, i do pop-up very early, wide awake (no wake up cycle), and the obsessions are running rampant.
Posted by Phillipa on July 8, 2006, at 20:35:03
In reply to Re: well bassman,,.., posted by qbsbrown on July 8, 2006, at 9:09:41
What would happen if you took half in the am and half at night? I don't know just thinking. Love Phillipa
Posted by Phillipa on July 8, 2006, at 20:37:38
In reply to Re: well bassman,,.., posted by Phillipa on July 8, 2006, at 20:35:03
Sorry should have read the whole thread first. Love Phillipa
Posted by elanor roosevelt on July 9, 2006, at 22:48:52
In reply to well bassman,,.., posted by qbsbrown on July 7, 2006, at 16:26:39
the overly wired feeling calms a fair amount
i found lexapro to be the best drug as far as no sexual side-effects
i can't imagine how anyone sleeps taking these drugs at night
i'm all for splitting the total dosage by 3 or 4 hours if it is too much all at once
like celexa, it can set you up for sudden digestive surprises
lexapro worked well for me at one time and allowed me to enjoy some great times and get through some tough stuff
i found it to help with a positive outlook and that it smoothed the edges of fear.
good luck
ask doctors for samples
Posted by qbsbrown on July 11, 2006, at 10:33:28
In reply to Re: well bassman,,.., posted by Phillipa on July 8, 2006, at 20:37:38
Can 30mgs, or raising doses, actually increase obsessive thoughts? I do know that raising doses can and does often increase anxiety.
I think 30mgs is too much for me right now. But sexual functioning is improving from the crossover from 60mg celexa.
Sleep wise; first night of 30mgs, did my regular wake up at 530 am w/ racing thoughts, but this time i was able to fall back asleep, a rarity.
Then i was to cross over to morning, so i skipped the next nights dose, and coincedentally, i slept beautifully.
Yesterday, took 30 in the morning, and i was up at about 7am w/ racing thoughts, not too bad.
For me, when i take the dose in the morning, derealization is increased very much, and it's difficult for me to eat. I notcie that i calm down around 8hrs later, which leads me to think of taking before bedtime.
My doctor, who is great, thinks i should be on 30mgs lexapro, but is ok w/ me giving 20 a trial. Plus, she does not care when i take it. In her experience, people on celexa, taking at night, seemed to do a little better.
Let me know what you think.
Regards,
Brian
Posted by bassman on July 11, 2006, at 11:58:07
In reply to Re: well bassman,,.., posted by qbsbrown on July 11, 2006, at 10:33:28
I think it would be interesting to take an benzo/increase benzo dose for a few days and see if the thoughts decrease in the morning (because I wonder how much of it is not OCD, but garden-variety anxiety). With panic, the racing thoughts are there in the morning for me during the intense stage, but a bit of benzo at night helps a lot. I also found about 0.3 mg melatonin was helpful.
Maybe, as I mentioned before, you should try 10 mg just for a couple days and see what happens; let your body adjust. You might be surprised...
Posted by qbsbrown on July 11, 2006, at 12:03:55
In reply to Re: well bassman,,.., posted by bassman on July 11, 2006, at 11:58:07
Funny you mention. I've been on benzos for 2 years, only now am on an extremely slow WD from valium. I'm on 8 mgs. After 2-3 failed WD's, i am taking this one very slow ala Dr Ashton style. I'm sure it equates into my anxiety.
I was on 10mgs lexapro for a 1.5 yrs, with little help, and perhaps only 1 month or less on the 20mgs. This was before my recent CBT though.
On 40mgs of celexa, it was like a light switch went on, a complete 180 degree turn for the better. That faded away w/ in a week or two. I know that much of it revolves around me not working full time as well. Much time to obsess!
I was in agreeance to go up to 60mgs, after the great feelings i had on 40mgs celexa.
Posted by bassman on July 11, 2006, at 12:24:10
In reply to Re: well bassman,,.., posted by qbsbrown on July 11, 2006, at 12:03:55
A problem with the Ashton site is it's extreme anti-benzo slant. Some people do themselves into trouble by taking large doses of benzos, getting nasty side-effects, and then have trouble withdrawing. And we have Dr. Ashton with her opinion as to how such WD's should be handled (I personally don't agree with her). For the vast majority of people, benzos represent a safe way to reduce anxiety-and people tend to decrease, not increase their use of benzos with time, at least that's what the medical literature says. But I would think this would be a bad time to even think about WD-especially on such a very low dose. For many people, Valium doesn't do much for intense anxiety-I know it does nothing for me at all. I'd be interested in how you'd feel after just a couple days of Xanax; just as a measure of how much of your suffering is due to anxiety vs. OCD.
Posted by Phillipa on July 11, 2006, at 19:41:12
In reply to Re: well bassman,,.., posted by bassman on July 11, 2006, at 12:24:10
Believe it not a poster here saw a renouned Dr. in Boston who said that benzos are on their way back in. Maybe cause so many docs were substituting atypical antipsychotics for them. And look at the lawsuits for diabetes. Benzos are safe and you tend to reduce the doseage on your own as your anxiety goes down. At least that's what happens with me. Love Phillipa
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