How can you manage nausea caused by antidepressants. What strategies help with weight gain associated with antidepressant use. How to deal with fatigue and insomnia as side effects of antidepressants. What are effective ways to combat dry mouth and constipation from antidepressant medications.

Understanding Common Antidepressant Side Effects

Antidepressants are crucial medications for managing depression, but they can come with a range of side effects that may be bothersome for some individuals. While most side effects are not dangerous, they can impact quality of life and treatment adherence. It’s essential to understand these potential issues and learn effective coping strategies.

The most frequently reported side effects of antidepressants include:

• Nausea
• Weight gain
• Fatigue and drowsiness
• Insomnia
• Dry mouth
• Constipation

It’s important to note that many of these side effects tend to improve within the first few weeks of starting an antidepressant as your body adjusts to the medication. However, in some cases, they may persist and require additional management strategies.

Combating Nausea: Strategies for Relief

Nausea is often one of the first side effects experienced when starting antidepressant treatment. How can you manage this unpleasant symptom? Here are some effective strategies:

• Take your medication with food (unless otherwise directed by your doctor)
• Eat smaller, more frequent meals throughout the day
• Suck on sugarless hard candy
• Stay hydrated by drinking plenty of cool water
• Try over-the-counter antacids or bismuth subsalicylate (Pepto-Bismol)

If nausea persists or becomes severe, consult your healthcare provider. They may consider adjusting your dosage or switching to a slow-release form of the medication to help alleviate this side effect.

Managing Weight Gain and Increased Appetite

Weight gain is a common concern for many people taking antidepressants. While not all antidepressants cause weight gain, some are more likely to do so than others. What can you do to manage your weight while on antidepressant treatment?

1. Monitor your calorie intake by keeping a food diary
2. Choose nutrient-dense, lower-calorie foods like fruits and vegetables
3. Reduce consumption of sweets, sugary drinks, and foods high in saturated and trans fats
4. Engage in regular physical activity
5. Consult a registered dietitian for personalized nutrition advice

If weight gain becomes a significant issue, discuss the possibility of switching to a different antidepressant with your doctor. However, it’s crucial to weigh the pros and cons of changing medications, as the benefits of your current treatment may outweigh the drawbacks of weight gain.

Overcoming Fatigue and Drowsiness

Feeling tired or drowsy is a common side effect, especially in the early weeks of antidepressant treatment. How can you combat this fatigue and maintain your daily activities?

• Take short naps during the day if possible
• Incorporate light exercise, such as walking, into your routine
• Avoid operating heavy machinery or driving until the drowsiness subsides
• Consider taking your medication at bedtime (with your doctor’s approval)

If fatigue persists and significantly impacts your daily life, your doctor may consider adjusting your dosage or exploring alternative medications that are less likely to cause this side effect.

Tackling Insomnia and Sleep Disturbances

While some antidepressants can cause drowsiness, others may lead to insomnia. How can you improve your sleep quality when dealing with this side effect?

• Take your medication in the morning if approved by your doctor
• Limit caffeine intake, especially in the afternoon and evening
• Establish a consistent sleep schedule
• Practice good sleep hygiene, such as avoiding screens before bedtime
• Engage in regular exercise, but not too close to bedtime

For persistent insomnia, your doctor may recommend additional strategies, such as cognitive behavioral therapy for insomnia (CBT-I) or the use of a low-dose sedating medication at bedtime.

Alleviating Dry Mouth: Practical Solutions

Dry mouth is a common and often uncomfortable side effect of many antidepressants. How can you find relief from this persistent dryness?

• Sip water regularly throughout the day
• Chew sugar-free gum or suck on sugar-free hard candies to stimulate saliva production
• Use a humidifier in your bedroom to add moisture to the air
• Avoid tobacco, alcohol, and caffeinated beverages, which can worsen dry mouth
• Practice good oral hygiene to prevent dental issues associated with reduced saliva flow

If dry mouth continues to be problematic despite these measures, consult your doctor about over-the-counter or prescription medications designed to alleviate this symptom.

Dealing with Constipation: Dietary and Lifestyle Approaches

Constipation is often associated with certain types of antidepressants, particularly tricyclic antidepressants. What strategies can help alleviate this uncomfortable side effect?

• Increase your fluid intake, aiming for at least 8 glasses of water per day
• Consume a high-fiber diet rich in fruits, vegetables, whole grains, and legumes
• Engage in regular physical activity to promote bowel movements
• Consider taking a fiber supplement after consulting with your healthcare provider
• Use over-the-counter stool softeners or laxatives if recommended by your doctor

If constipation persists or becomes severe, it’s important to discuss this with your healthcare provider, as they may need to adjust your treatment plan or recommend additional interventions.

The Importance of Open Communication with Your Healthcare Provider

While managing side effects is crucial for successful antidepressant treatment, it’s equally important to maintain open communication with your healthcare provider. Why is this ongoing dialogue so vital?

• Your doctor can help determine if side effects are related to your medication or indicate another health issue
• They can suggest personalized strategies to manage side effects based on your individual health profile
• Your provider can adjust your dosage or consider alternative medications if side effects become intolerable
• Regular check-ins allow for monitoring of your overall treatment progress and mental health status

Remember, never stop taking your antidepressant or adjust the dosage on your own, as this can lead to withdrawal symptoms or a recurrence of depression. Always consult your healthcare provider before making any changes to your treatment plan.

Monitoring Blood Levels: A Potential Tool for Optimizing Treatment

In some cases, monitoring blood levels of certain antidepressants can be helpful in managing side effects and ensuring optimal treatment. How does this work?

• Blood tests can determine if the concentration of the medication in your system is within the therapeutic range
• This information can guide dosage adjustments to minimize side effects while maintaining effectiveness
• Not all antidepressants require blood level monitoring, but it can be particularly useful for certain medications like tricyclic antidepressants

Discuss with your healthcare provider whether blood level monitoring might be beneficial in your specific case.

The Role of Lifestyle Modifications in Managing Side Effects

While medication adjustments are sometimes necessary, lifestyle modifications can play a significant role in managing antidepressant side effects. What lifestyle changes can be particularly helpful?

• Regular exercise can help combat fatigue, improve sleep quality, and manage weight gain
• A balanced diet rich in fruits, vegetables, and whole grains can support overall health and help manage weight and digestive issues
• Stress reduction techniques like meditation or yoga can improve sleep and overall well-being
• Limiting alcohol and caffeine intake can help manage sleep disturbances and dry mouth

Incorporating these lifestyle changes alongside your medication regimen can lead to better overall treatment outcomes and improved quality of life.

Alternative and Complementary Approaches to Side Effect Management

In addition to conventional strategies, some individuals find relief from antidepressant side effects through alternative or complementary approaches. What are some options to consider?

• Acupuncture: May help with nausea, insomnia, and other side effects
• Herbal supplements: Some herbs may help with specific side effects, but always consult your doctor before using any supplements
• Mindfulness practices: Can aid in managing stress and improving sleep quality
• Aromatherapy: Certain essential oils may help with nausea or sleep issues

It’s crucial to discuss any alternative treatments with your healthcare provider to ensure they don’t interact with your antidepressant medication or other aspects of your treatment plan.

The Potential for Side Effect Reduction Over Time

While dealing with side effects can be challenging, it’s important to remember that many side effects tend to diminish over time. How does this process typically unfold?

• Initial side effects are often most pronounced in the first few weeks of treatment
• As your body adjusts to the medication, many side effects may gradually subside
• Some side effects may persist but become less bothersome as you develop coping strategies
• In some cases, side effects may resolve completely after several months of treatment

Patience and persistence are key when starting antidepressant treatment. However, if side effects remain severe or intolerable after several weeks, it’s essential to consult your healthcare provider for further guidance.

The Impact of Individual Factors on Side Effects

It’s important to note that antidepressant side effects can vary significantly from person to person. What factors can influence an individual’s experience with side effects?

• Genetic variations can affect how your body metabolizes medications
• Age and overall health status can impact your susceptibility to certain side effects
• Other medications you’re taking may interact with antidepressants, potentially exacerbating side effects
• Your specific mental health condition and its severity may influence how you respond to treatment

Understanding these individual factors can help you and your healthcare provider tailor your treatment plan for the best possible outcomes.

The Role of Support Systems in Managing Side Effects

Having a strong support system can be invaluable when dealing with antidepressant side effects. How can friends, family, and support groups help?

• They can provide emotional support and encouragement during the adjustment period
• Loved ones can help monitor for any concerning changes in your behavior or mood
• Support groups can offer practical tips and coping strategies from others with similar experiences
• A supportive network can help you stay motivated to continue treatment despite challenges

Don’t hesitate to lean on your support system and communicate openly about your experiences with antidepressant treatment.

The Importance of Long-Term Perspective in Antidepressant Treatment

While managing side effects is important, it’s crucial to maintain a long-term perspective on your antidepressant treatment. Why is this broader view so important?

• The full benefits of antidepressants often take several weeks to become apparent
• Initial side effects may be challenging, but they often improve with time
• The potential long-term benefits of successful treatment can far outweigh temporary discomfort from side effects
• Premature discontinuation of treatment can lead to relapse of depressive symptoms

By keeping the big picture in mind, you can stay motivated to work through challenges and give your treatment the best chance of success.

The Future of Antidepressant Treatment: Personalized Medicine

As research in psychiatry and pharmacology progresses, the future of antidepressant treatment looks promising. What developments are on the horizon?

• Pharmacogenetic testing may help predict which medications are likely to be most effective and cause the least side effects for each individual
• New classes of antidepressants with potentially fewer side effects are in development
• Advanced brain imaging techniques may help tailor treatments more precisely
• Combination therapies involving medication and targeted psychotherapies may improve outcomes

While these advancements are exciting, it’s important to work with your current treatment plan and healthcare provider to manage your depression effectively in the present.

Remember, managing antidepressant side effects is a collaborative process between you and your healthcare provider. By staying informed, communicating openly, and being proactive in your approach, you can optimize your treatment experience and improve your overall quality of life. With patience, persistence, and the right strategies, many individuals find that the benefits of antidepressant treatment far outweigh the challenges of managing side effects.

Antidepressants: Get tips to cope with side effects

Antidepressants: Get tips to cope with side effects

Most antidepressant side effects aren’t dangerous, but they can be bothersome. Here’s what to do.

By Mayo Clinic Staff

Introduction

Antidepressants can cause unpleasant side effects. Signs and symptoms such as nausea, weight gain or sleep problems can be common initially. For many people, these improve within weeks of starting an antidepressant. In some cases, however, antidepressants cause side effects that don’t go away.

Talk to your doctor or mental health professional about any side effects you’re having. For some antidepressants, monitoring blood levels may help determine the range of effectiveness and to what extent dosage can be adjusted to help reduce side effects. Rarely, antidepressants can cause serious side effects that need to be treated right away.

If side effects seem intolerable, you may be tempted to stop taking an antidepressant or to reduce your dose on your own. Don’t do it. Your symptoms may return, and stopping your antidepressant suddenly may cause withdrawal-like symptoms. Talk with your doctor to help identify the best options for your specific needs.

Nausea

Nausea typically begins early after starting an antidepressant. It may go away after your body adjusts to the medication.

Consider these strategies:

• Take your antidepressant with food, unless otherwise directed.
• Eat smaller, more-frequent meals.
• Suck on sugarless hard candy.
• Drink plenty of fluids, such as cool water. Try an antacid or bismuth subsalicylate (Pepto-Bismol).
• Talk to your doctor about a dosage change or a slow-release form of the medication.

Increased appetite, weight gain

You may gain weight because of fluid retention or lack of physical activity, or because you have a better appetite when your depression symptoms ease up. Some antidepressants are more likely to cause weight gain than others. If you’re concerned about weight gain, ask your doctor if this is a likely side effect of the antidepressant being prescribed and discuss ways to address this issue.

Consider these strategies:

• Cut back on sweets and sugary drinks.
• Select lower calorie nutritious foods, such as vegetables and fruits, and avoid saturated and trans fats.
• Keep a food diary — tracking what you eat can help you manage your weight.
• Seek advice from a registered dietitian.
• Get regular physical activity or exercise most days of the week.
• Talk to your doctor about switching medications, but get the pros and cons.

Fatigue, drowsiness

Fatigue and drowsiness are common, especially during early weeks of treatment with an antidepressant.

Consider these strategies:

• Take a brief nap during the day.
• Get some physical activity, such as walking.
• Avoid driving or operating dangerous machinery until the fatigue passes.
• Take your antidepressant at bedtime if your doctor approves.
• Talk to your doctor to see if adjusting your dose will help.

Insomnia

Some antidepressants may cause insomnia, making it difficult to get to sleep or stay asleep, so you may be tired during the day.

Consider these strategies:

• Take your antidepressant in the morning if your doctor approves.
• Avoid caffeinated food and drinks, particularly late in the day.
• Get regular physical activity or exercise — but complete it several hours before bedtime so it doesn’t interfere with your sleep.
• If insomnia is an ongoing problem, ask your doctor about taking a sedating medication at bedtime or ask whether taking a low dose of a sedating antidepressant such as trazodone or mirtazapine (Remeron) before bed might help.

Dry mouth

Dry mouth is a common side effect of many antidepressants.

Consider these strategies:

• Sip water regularly or suck on ice chips.
• Chew sugarless gum or suck on sugarless hard candy.
• Avoid tobacco, alcohol and caffeinated beverages because they can make your mouth drier.
• Breathe through your nose, not your mouth.
• Brush your teeth twice a day, floss daily and see your dentist regularly. Having a dry mouth can increase your risk of getting cavities.
• Talk to your doctor or dentist about over-the-counter or prescription medications for dry mouth.
• If dry mouth continues to be extremely bothersome despite the efforts above, ask your doctor the pros and cons of reducing the dosage of the antidepressant.

Constipation

Constipation is often associated with tricyclic antidepressants because they disrupt normal functioning of the digestive tract and other organ systems. Other antidepressants sometimes cause constipation as well.

Consider these strategies:

• Drink plenty of water.
• Eat high-fiber foods, such as fresh fruits and vegetables, brans, and whole grains.
• Get regular exercise.
• Take a fiber supplement (Citrucel, Metamucil, others).
• Ask your doctor for advice on stool softeners if other measures don’t work.

Dizziness

Dizziness is more common with tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs) than with other antidepressants. These medications can cause low blood pressure, resulting in dizziness.

Consider these strategies:

• Rise slowly from sitting to standing positions.
• Use handrails, canes or other sturdy items for support.
• Avoid driving or operating machinery.
• Avoid caffeine, tobacco and alcohol.
• Drink plenty of fluids.
• Take your antidepressant at bedtime if your doctor approves.

Agitation, restlessness, anxiety

Agitation, restlessness or anxiety can result from the stimulating effect of certain antidepressants. Although having more energy can be a good thing, it may mean you can’t relax or sit still even if you want to.

Consider these strategies:

• Get regular exercise, such as jogging, biking or aerobics, or some type of physical activity, such as walking. Talk to your doctor first about what would be a good type of exercise or physical activity for you.
• Practice deep-breathing exercises, muscle relaxation or yoga.
• Consult your doctor about temporarily taking a relaxing or sedating medication or switching to an antidepressant that isn’t as stimulating.

Be alert for racing or impulsive thoughts along with high energy. If these develop, talk to your doctor right away because they may be signs of bipolar disorder or another serious disorder.

Sexual side effects

Many antidepressants cause sexual side effects. They can include reduced sex drive and difficulty reaching orgasm. Some antidepressants may cause trouble getting or keeping an erection (erectile dysfunction). Selective serotonin reuptake inhibitors (SSRIs) are more likely to cause sexual side effects than other antidepressants are.

Consider these strategies:

• Consider a medication that requires only a once-a-day dose, and schedule sexual activity before taking that dose.
• Talk to your doctor about switching to an antidepressant that may have fewer of these effects, such as bupropion (Wellbutrin, SR, Wellbutrin XL, others), or adjusting your medication to ease sexual side effects.
• Talk to your partner about your sexual side effects and how they change your needs. Adjusting your sexual routine may be helpful. For example, you may need a longer period of foreplay before having sexual intercourse.
• Talk with your doctor about options for medications, such as sildenafil (Viagra), that may temporarily ease sexual side effects or treat erectile dysfunction and any associated risks. Avoid over-the-counter herbal supplements that promise increased sexual desire and function — these are not regulated by the Food and Drug Administration (FDA) and some could be dangerous to your health.

Heart-related effects

Depending on your heart health and the type of antidepressant you take, you may need an electrocardiogram (ECG) before or periodically during treatment. The ECG is used to monitor what’s called the QT interval to make sure it’s not prolonged. A prolonged QT interval is a heart rhythm condition that can increase your risk of serious irregular heart rhythms (arrhythmias).

Certain antidepressants should not be used if you already have heart problems or if you’re taking an MAOI. Talk with your doctor about your heart health and any heart medications or other medications that you take.

Genetic variations

Some studies indicate that variations in genes may play a role in the effectiveness and risk of side effects of specific antidepressants. So your genes may, at least in part, determine whether a certain antidepressant will work well for you and whether you’re likely to have certain side effects.

Some locations already provide limited genetic testing to help determine antidepressant choice, but testing is not routine and it’s not always covered by insurance.

More studies are being done to determine what might be the best antidepressant choice based on genetic makeup. However, genetic testing is a part of — not a replacement for — a thorough psychiatric exam and clinical decisions.

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Chronic fatigue syndrome Information | Mount Sinai

CFS is a stressful disease. It is important to get emotional support, as well as treat your symptoms. Studies show that psychological support, including cognitive behavioral therapy, can help treat symptoms of chronic fatigue syndrome.

Although there is no cure, physicians may treat symptoms with medications, such as antidepressants and anti-anxiety drugs. Pain relievers and anti-inflammatory drugs help relieve muscle and joint aches. Support groups and stress management techniques can help you cope with the disease.

Drug Therapies

Antidepressants. In addition to relieving depression, these drugs can reduce fatigue and muscle tension, and improve sleep. Side effects vary. Antidepressants often prescribed for chronic fatigue include:

• Tricyclics: amitriptyline (Elavil), desipramine (Norpramin), notriptyline (Pamelor)
• Selective serotonin reuptake inhibitors (SSRIs): citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft)

Anti-anxiety medications (benzodiazepines). Side effects vary. Alprazolam (Xanax) or lorazepam (Ativan) are among those prescribed.

Antihistamines. Relieve allergy like symptoms. Side effects include drowsiness and headache.

Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs help relieve pain. These drugs include naproxen (Aleve) and ibuprofen (Advil, Motrin). Side effects can include stomach bleeding when used for a long period of time.

Acetaminophen (Tylenol). Another pain reliever. Side effects can include kidney and liver damage when taken in large doses.

Stimulants. Improve fatigue and concentration. These drugs include methylphenidate (Ritalin, Concerta). People whose fatigue is less chronic tend to respond better.

Complementary and Alternative Therapies

Eating a healthy diet, and using herbs and homeopathic remedies as recommended, may help reduce the debilitating symptoms of CFS, and may improve overall energy. Counseling, support groups, meditation, yoga, and progressive muscle relaxation are stress management techniques that may help as well.

Lifestyle

• Save your energy. Your doctor may suggest that you slow down and pace yourself, so that you do not overdo it one day and pay for it the next. The goal is to maintain a steady, moderate amount of activity that includes regular exercise.
• Get regular exercise. Your doctor may suggest that you see a physical therapist to create an appropriate exercise program. At least one study shows that people with CFS who exercise have fewer symptoms than those who do not exercise.
• Reduce stress. Stress can make CFS symptoms worse. Guided meditation or deep breathing may help you relax. Studies show Qigong, in particular, helps reduce symptoms of fatigue and poor mental functioning.

Nutrition and Supplements

Avoid refined foods, sugar, caffeine, alcohol, and saturated fats. Eat more fresh vegetables, legumes, whole grains, protein, and essential fatty acids found in nuts, seeds, and cold-water fish.

The following supplements may help reduce symptoms of CFS. Supplements may not be appropriate for every patient, and some may have side effects and/or interact with other medications. Ask your doctor before taking a supplement and work with someone knowledgeable in complementary and alternative medicine therapies.

• Magnesium may help reduce fatigue. But studies show mixed results. Too much magnesium causes diarrhea. To correct this problem, gradually reduce the amount you are taking. It is sometimes combined with malic acid (600 mg, twice per day) to boost energy. Magnesium can alter blood pressure and interfere with certain medications.
• Omega-3 fatty acids, such as those found in fish oil may also help reduce fatigue. Studies show that people with CFS have lower ratios of omega-3 to omega-6 fatty acids. Omega-3 fatty acids may increase the risk of bleeding, especially if you also take blood thinners such as clopidogrel (Plavix), warfarin (Coumadin), or aspirin.
• NADH, a naturally-occurring chemical involved in energy production in the body. One small study showed it might help reduce symptoms of CFS. But more research needs to be done.
• DHEA, a hormone produced by the body that may improve energy levels. Your body uses DHEA to make testosterone and estrogen. It is truly a hormone rather than a supplement, and should never be taken without a doctor’s prescription. DO NOT use DHEA if you have or are at risk for breast cancer, prostate cancer, or any other hormonally-influenced illness. DO NOT take DHEA if you are pregnant or breastfeeding. People with diabetes, high cholesterol, liver disease, or bipolar disorder should not take DHEA. DHEA interacts with many medications, including antidepressants and ant-anxiety medications.
• Vitamin B12 has been shown to improve energy in people who are not getting enough B12. It is not clear whether it will help in cases of CFS. Oral supplements do not work as well as injections.
• Beta-carotene to strengthen immune function. Some studies suggest that smokers should not take beta-carotene. Beta-carotene may interact with some drugs used to treat high cholesterol.
• L-carnitine may support energy production in the cells. L-carnitine may alter blood pressure. Tell your doctor about any kidney issues you may have, or if you have a history of seizures. People who take thyroid hormone or blood thinners should ask their doctor before taking L-carnitine.
• Vitamin D. Although vitamin D is not used specifically to treat CFS, not getting enough vitamin D may make symptoms worse. Vitamin D can be toxic in extremely high doses.
• Melatonin has been shown to improve fatigue symptoms among people with CFS. Melatonin may interact with certain medications, including some psychiatric medications. Speak to your physician.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. However, herbs can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, take herbs only under the supervision of a health care provider.

Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.

Herbs that may help with symptoms of chronic fatigue include:

• Ginseng (Panax ginseng) may help improve energy. One test tube study found that ginseng and echinacea increased the immune response in cells taken from people with CFS. However, no studies have been done where people took ginseng for CFS. Ginseng can increase the risk of bleeding, especially if you already take blood thinners, such as clopidogrel (Plavix), warfarin (Coumadin), or aspirin. Ginseng also may interact with several drugs, including those taken for diabetes or to suppress the immune system. People with heart disease, schizophrenia, diabetes, or those with hormone-sensitive cancers, including breast, uterine, ovarian, or prostate cancer, should not take ginseng. There are many types of ginseng, and they are best prescribed by an experienced practitioner who can closely match the patient’s needs. The wrong type of ginseng may be exacerbate your condition.
• Echinacea (Echinacea species) may help boost the immune system. However, studies have not looked at echinacea as a treatment for CFS. People with autoimmune disease, such as lupus or rheumatoid arthritis, should not take echinacea. Echinacea can interact with certain medications, including caffeine.

Essential oils of jasmine, peppermint, and rosemary may help reduce stress when used in aromatherapy. Place several drops in a warm bath or atomizer, or on a cotton ball.

Homeopathy

The appropriate homeopathic treatment for CFS depends on your constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for each individual. Some remedies commonly used by professional homeopaths to treat CFS include:

• Arsenicum. For restlessness and fatigue accompanied by chills and burning pains that are worse at night.
• Gelsemium. For mental exhaustion, including drowsiness and indifference, and physical weakness, such as heaviness of the limbs and eyelids.
• Pulsatilla. For people who are moody and emotional, although usually with a calm and gentle disposition.
• Sulphur. For people who feel fatigue, but are usually not as emotionally sensitive as those requiring Pulsatilla.

Acupuncture

Several studies in China have indicated acupuncture may help treat CFS. Western studies have found that acupuncture may help conditions with similar symptoms, such as fibromyalgia, depression, headache, and irritable bowel syndrome.

Evidence also suggests that acupuncture may help boost your immune system. It may also help people with CFS get a more restful night’s sleep, which is often key to turning the condition around.

Acupuncturists treat people with CFS based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In the case of CFS, a qi deficiency is usually detected in the spleen or kidney meridians, but a deficiency may also be found in the lung or liver meridians. CSF does not have to be caused by a deficient condition. It can also be a symptom of an excess in certain meridiens.

Acupuncturists may use moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) in addition to needling therapy, as it is thought moxibustion helps to provide a deeper and stronger treatment. Practitioners with herbal training may recommend specific herbal remedies, as well as dietary changes.

Chiropractic

Although no well-designed clinical trials have looked at chiropractic treatment for CFS, some chiropractors suggest that spinal manipulation may boost energy and reduce pain in some people with the condition.

Physical Therapies

Therapeutic massage can reduce stress-related symptoms, improve circulation, and increase your overall sense of well being. Physical exercise and exercise therapy have also been shown to improve symptoms.

Escitalopram (Lexapro): Dosage, Uses, Side Effects

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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Escitalopram, or Lexapro, has been on the market since 2002. It’s one of several prescription drugs used to treat depression, anxiety, or both. Before starting this medication, you should be aware of Lexapro’s uses, side effects, and other information to ensure you are making the right treatment choice. 

Escitalopram (brand name Lexapro; see Important Safety Information) is a prescription drug known as a selective serotonin reuptake inhibitor or SSRI. These drugs raise your serotonin levels and help in the treatment of depression and anxiety. Serotonin is a neurotransmitter in the brain and nervous system essential for a healthy mood. 

SSRIs are one of the first-line options for treating depression symptoms. Lexapro and generic escitalopram are also used to treat anxiety. Other SSRIs include citalopram (brand name Celexa), fluoxetine (brand name Prozac; see Important Safety Information), paroxetine (brand name Paxil), and sertraline (brand name Zoloft; see Important Safety Information) (Chu, 2021). 

Lexapro vs. Zoloft: differences and similarities

Escitalopram is FDA-approved to treat (FDA, 2017):

• Major depressive disorder (MDD) in adults and adolescents over age 12: MDD or unipolar depression is a mental health condition where you have symptoms of persistently sad moods, a lack of desire to do anything, a sense of hopelessness or guilt, and other symptoms that affect your ability to function. Escitalopram is approved for both short-term and long-term depression treatment (Bains, 2021).
• Generalized anxiety disorder (GAD) in adults: With GAD, people feel excessive worry about many things, to the point where it can interfere with aspects of daily life. Escitalopram is approved for short-term anxiety treatment (Munir, 2021).

Healthcare providers often use medications to treat conditions other than the FDA-approved ones—this is called using a drug “off label.” Many of these “off-label” uses of escitalopram are widely researched and include (UptoDate, n.d.):

The U.S. Food and Drug Administration (FDA) has a black box warning for both generic escitalopram and brand name Lexapro, indicating that people taking this drug and their families should watch for any behavioral or mental health changes. Concerning changes include worsening depression, panic attacks, and suicidal thoughts when starting escitalopram or after a dose change. Adolescents are at an increased risk of these side effects when taking antidepressant medications (FDA, 2018).

If you or someone in your family experiences these symptoms, get medical help right away.

Most of the common side effects of Lexapro appear to be dose-dependent, meaning there’s a higher chance of experiencing these side effects if you’re on 20 mg than 10 mg. Some of the most common side effects include (FDA, 2017): 

• Diarrhea
• Nausea
• Ejaculation problems
• Drowsiness
• Headache 
• Trouble sleeping
• Decreased sex drive (libido)

Less often, people may experience other adverse effects like weight gain, blurry vision, muscle stiffness, and joint pain (FDA, 2017).

SSRIs have a reputation for causing weight changes—studies show that they may increase your risk of weight gain. The association between SSRIs, including Lexapro, and weight gain, is most significant during the second and third years of treatment (Gafoor, 2018).

SSRIs: everything you need to know

Sexual side effects can also occur in men and women taking escitalopram. Men may experience ejaculatory disorder (delayed ejaculation), lower sex drive, impotence, and priapism (a painful and persistent erection). Women may experience lower sex drive as well as an inability to orgasm (FDA, 2017). Tell your healthcare provider about any sexual side effects you may be having—alternative treatments, like bupropion (see Important Safety Information), mirtazapine (see Important Safety Information), and serotonin-norepinephrine reuptake inhibitors (SNRIs) like duloxetine (brand name Cymbalta; see Important Safety Information) and venlafaxine (brand name Effexor; see Important Safety Information) may be potential options for you (Jing, 2016).

If you’re experiencing side effects on Lexapro, it’s important to talk to your healthcare provider before discontinuing the medicine. If you stop taking it suddenly, you may experience Lexapro withdrawal symptoms such as nightmares, irritability, headache, nausea, feeling dizzy, or vomiting (Hirsch, 2020).

Lexapro and generic Lexapro are available in three different tablet strengths: 5 mg, 10 mg, and 20 mg. They’re also both made as an oral solution with a concentration of 1 mg/mL. Both adults and adolescents typically start at a dose of 10 mg once daily. For adults, this dose may be increased after a minimum of one week, depending on symptoms, side effects, etc. (FDA, 2017). 

That waiting window is longer for young adults, though—they need to take their starting dose for at least three weeks before making changes to dosage. Though providers may use generic Lexapro for the long-term management of MDD, it’s generally not prescribed for long-term or maintenance use when treating GAD. Although escitalopram is approved for adolescents with major depression, its safety has not been established for anyone younger than 12 years old (FDA, 2017).

How long does it take for Lexapro to take effect?

Tell your healthcare provider about any medications or over-the-counter supplements you may be taking to avoid potential drug interactions. Drug interactions can lead to serious side effects. One of the most severe drug interactions with escitalopram is serotonin syndrome. With this condition, too much serotonin builds up in the body, leading to shivering, high blood pressure, elevated heart rate, fever, and diarrhea. Serotonin syndrome can even cause more severe symptoms like seizures, coma, or death (Simon, 2021). 

Since escitalopram increases serotonin levels in the body, you should not take it with other drugs that do the same thing. Other medications that affect serotonin levels (serotonergic drugs) include triptans, tricyclic antidepressants (like amitriptyline), fentanyl, lithium, tramadol, tryptophan, buspirone (see Important Safety Information), amphetamines, and even over-the-counter supplements containing St. John’s Wort (Simon, 2021). 

A build-up in serotonin can also happen because your body isn’t breaking down the neurotransmitter appropriately. Certain prescription medications affect how your body metabolizes serotonin, especially monoamine oxidase inhibitors (MAOIs) such as linezolid, phenelzine, isocarboxazid, selegiline, and tranylcypromine. Combining MAOIs with SSRIs like escitalopram increases your risk of serotonin syndrome; avoid taking escitalopram within 14 days of using MAOI medications (FDA, 2017).

You should also be careful when taking Lexapro with any medication with a blood-thinning effect, whether prescription blood thinners such as warfarin (brand name Coumadin) or over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen. Taking these medications with Lexapro may put you at an increased risk of bleeding (FDA, 2017).

Avoid combining alcohol with escitalopram. 

Alcoholism: signs, causes, and treatments

This SSRI antidepressant is known for making you feel tired and interfering with your ability to make decisions. It may take some time to feel the full effects of escitalopram and figure out how it affects you. For that reason, avoid driving or operating heavy machinery until you understand just how this antidepressant affects you. Alcohol has similar effects on your ability to make decisions and react to events. Clinical trials have not shown that Lexapro makes these alcohol effects worse, but standard medical advice is to avoid alcohol while taking escitalopram (FDA, 2017).

As mentioned, escitalopram carries a black box warning from the FDA. Some people taking this medication, especially children, teenagers, and young adults up to 24, can develop worsening depressions and suicidal thoughts or tendencies. If you are having suicidal thoughts, consult a healthcare professional immediately.

There are times when you should avoid escitalopram or use it with caution, including: 

• Do not take escitalopram if you have had an allergic reaction to the medication or any other SSRI.
• Use with caution if you are prone to seizures or have a history of a seizure disorder.
• If you are pregnant, plan to become pregnant, or are breastfeeding, talk to your healthcare provider about the risks of taking this medication. 

This list is not exhaustive. Consult with your healthcare provider regarding any medical conditions you have before starting treatment with escitalopram.

1. Bains, N. et al. (2021). Major depressive disorder. [Updated Apr 20, 2021]. In StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK559078/
2. Chu, A. & Wadhwa, R. (2021). Selective serotonin reuptake inhibitors. [Updated May 10, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK554406/
3. Food and Drug Administration (FDA). (2017, Jan). Lexapro (escitalopram oxalate). Retrieved June 21, 2021 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021323s047lbl.pdf
4. Food and Drug Administration (FDA). (2018). Suicidality in children and adolescents being treated with antidepressant medications. Retrieved June 21, 2021 from https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/suicidality-children-and-adolescents-being-treated-antidepressant-medications
5. Gafoor, R., Booth, H. P., & Gulliford, M. C. (2018). Antidepressant utilisation and incidence of weight gain during 10 years’ follow-up: population based cohort study. BMJ (Clinical Research Edition), 361, k1951. doi: 10.1136/bmj.k1951. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29793997/
6. Hirsch, M. & Birnbaum, R. J. (2020). Discontinuing antidepressant medications in adults. In UptoDate. Roy-Byrne, P.P. & Solomon, D. (Eds.). Retrieved from https://www.uptodate.com/contents/discontinuing-antidepressant-medications-in-adults
7. Jing, E., & Straw-Wilson, K. (2016). Sexual dysfunction in selective serotonin reuptake inhibitors (SSRIs) and potential solutions: A narrative literature review. Mental Health Clinician, 6(4), 191-196. doi: 10.9740/mhc.2016.07.191. Retrieved June 21, 2021 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007725/
8. Munir, S. & Takov, V. (2021). Generalized anxiety disorder. [Updated May 8, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK441870/
9. Simon, L. V., & Keenaghan, M. (2021). Serotonin syndrome. [Updated Jul 22, 2021]. In StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK482377/
10. UptoDate. (n.d.). Escitalopram: drug information. Retrieved on June 21, 2021 from https://www.uptodate.com/contents/escitalopram-drug-information

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Common and Rare Side Effects for Lexapro oral

COMMON side effects

If experienced, these tend to have a Severe expression i

Sorry, we have no data available. Please contact your doctor or pharmacist.

If experienced, these tend to have a Less Severe expression i

• problems with ejaculation
• dry mouth
• drowsiness
• dizziness
• difficulty sleeping
• low energy
• excessive sweating
• nausea
• diarrhea
• orgasm problems

INFREQUENT side effects

If experienced, these tend to have a Severe expression i

Sorry, we have no data available. Please contact your doctor or pharmacist.

If experienced, these tend to have a Less Severe expression i

• abnormal sexual function
• altered interest in having sexual intercourse
• a stuffy and runny nose
• inflammation of the tissue lining the sinuses
• a toothache
• indigestion
• constipation
• the inability to have an erection
• flu-like symptoms
• decreased appetite
• gas
• stomach cramps
• a feeling of pins and needles on skin

RARE side effects

If experienced, these tend to have a Severe expression i

• low blood sugar
• a disorder with excess antidiuretic hormone called syndrome of inappropriate antidiuretic hormone
• low amount of sodium in the blood
• low amount of potassium in the blood
• anemia
• a decrease in the blood clotting protein prothrombin
• decreased blood platelets
• very low levels of granulocytes, a type of white blood cell
• low levels of white blood cells
• mental problems from taking the drug
• manic behavior
• suicidal thoughts
• aggressive behavior
• extrapyramidal disease, a type of movement disorder
• neuroleptic malignant syndrome, a reaction characterized by fever, muscle rigidity and confusion
• serotonin syndrome, a type of disorder with high serotonin levels
• high blood pressure
• a heart attack
• a clot in the lung
• rapid ventricular heartbeat
• torsades de pointes, a type of abnormal heart rhythm
• atrial fibrillation
• slow heartbeat
• prolonged QT interval on EKG
• blood clot in a deep vein of the extremities
• low blood pressure
• bleeding
• inflammation of the lining of the stomach and intestines
• liver tissue death
• liver failure
• inflammation of the liver called hepatitis
• acute inflammation of the pancreas
• bleeding of the stomach or intestines
• kidney failure
• priapism, a prolonged erection of the penis
• a skin disorder with blistering and peeling skin called toxic epidermal necrolysis
• a skin disorder with blistering and peeling skin called Stevens-Johnson syndrome
• a condition with muscle tissue breakdown called rhabdomyolysis
• hallucinations
• seizures
• muscle tremors
• a feeling of restlessness with inability to sit still
• high blood sugar
• a type of allergic reaction called angioedema
• secondary angle-closure glaucoma, a type of eye disorder

If experienced, these tend to have a Less Severe expression i

• a high prolactin level
• high cholesterol
• agitation
• a migraine headache
• double vision
• blurred vision
• ringing in the ears
• bruising under the skin
• stuffy nose
• bronchitis
• pain in the jaw area
• blood coming from anus
• urinary tract infection
• pain with menstruation
• abnormally long or heavy periods
• a problem with menstrual periods
• hives
• joint pain
• muscle pain
• cramps
• difficulty concentrating
• sensation of spinning or whirling
• fever
• abnormal manner of walking
• loss of muscle coordination
• a skin rash
• weight gain
• increased hunger
• nosebleed
• heart throbbing or pounding
• cough
• heartburn
• an increased need to urinate often
• low energy and weakness
• hematoma, a collection of blood outside of the blood vessels
• inflammation of a vein
• a feeling of general discomfort called malaise
• irritability
• chest pains unrelated to heart problems
• drug-induced hot flashes

Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Lexapro (escitalopram) and Zoloft (sertraline) are SSRIs (selective serotonin reuptake inhibitors) indicated for the treatment of depression and other psychological conditions. An SSRI works by increasing serotonin levels in the brain, which helps improve symptoms. Both prescription drugs are approved by the Food and Drug Administration (FDA). Other drugs in the SSRI class of medications are  Prozac (fluoxetine), Celexa (citalopram), and Paxil (paroxetine). Although Lexapro and Zoloft are similar, they have notable differences in their indications as well as cost.

RELATED: About Lexapro | About Zoloft | About Prozac | About Celexa | About Paxil

What are the main differences between Lexapro vs. Zoloft?

Conditions treated by Lexapro and Zoloft

Lexapro is an SSRI indicated for acute and maintenance treatment of major depressive disorder (MDD) in adolescents aged 12-17 years and adults, and acute treatment of generalized anxiety disorder (GAD) in adults.

Zoloft is an SSRI indicated for the treatment of major depressive disorder (MDD), obsessive-compulsive disorder (OCD), panic disorder (PD),  post-traumatic stress disorder (PTSD), social anxiety disorder (SAD), and premenstrual dysphoric disorder (PMDD).

Is Lexapro or Zoloft more effective?

Lexapro was shown in clinical studies to be significantly more effective than placebo in the treatment of Major Depressive Disorder and Generalized Anxiety Disorder.

Zoloft was shown in clinical studies to be significantly more effective than placebo in the treatment of major depressive disorder, panic disorder, PTSD, OCD, SAD, and PMDD.

A 2014 study published in International Clinical Psychopharmacology suggested that Lexapro may be more effective and better tolerated than Zoloft or Paxil. Lexapro has different binding site interactions which may lead to better efficacy and tolerability. However, another study found that Zoloft led to outcomes that were at least as good as or better than patients using Lexapro or Celexa in terms of adherence, drug costs, and medical spending.

The most effective medication, though, should only be determined by your doctor taking into account your medical condition(s), medical history, and other medications you are taking.

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Coverage and cost comparison of Lexapro vs. Zoloft

Lexapro is typically covered by both insurance and Medicare Part D, the generic will have a much lower copay, whereas brand name may have a much higher copay or may not be covered at all. Lexapro is available in 5, 10, or 20 mg tablets (brand or generic) and as a liquid in 5 mg/5 ml oral solution (generic). Lexapro costs about $379 for 30 tablets of 10 mg brand name tablets; the Medicare Part D copay for generic (10 mg, 30 tablets) typically ranges from $0-30, and with a SingleCare card you can expect to pay $9 to $45 depending on your pharmacy.

Try the SingleCare prescription discount card

Zoloft is typically covered by both insurance and Medicare Part D, generic will have a much lower copay, whereas brand may have a much higher copay or not be covered at all. Zoloft is available in 25, 50, or 100 mg tablets (brand or generic) and as a liquid in 20 mg/ml oral solution (generic). Zoloft costs about $365 for 30 tablets of 100 mg brand name tablets; the Medicare Part D copay for generic (100 mg, 30 tablets) typically ranges from $0-13, and with a SingleCare card you can expect to pay $9 to $31.

Common side effects of Lexapro and Zoloft

Both drugs have a long list of serious warnings, which are included in the warning section below. Additionally, you may experience other, more common adverse effects from Lexapro or Zoloft.

The most common adverse reactions of Lexapro are headache, upset stomach/nausea, sexual dysfunction/ejaculatory delay, insomnia, fatigue, and sleepiness.

The most common adverse reactions from Zoloft are nausea, diarrhea, sexual dysfunction/ejaculatory delay, dry mouth, insomnia, and sleepiness.

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Side effects vary; this is a partial list. A medication guide will be given to you with a new or refill prescription of Lexapro or Zoloft with information about side effects and other warnings. Consult your healthcare professional for a complete list of side effects.

Source: DailyMed (Lexapro), DailyMed (Zoloft)

Drug Interactions of Lexapro vs. Zoloft

Because both drugs are in the same category, they have similar drug interactions.

MAO inhibitors such as selegiline should not be used within 14 days of Lexapro or Zoloft; the combination may increase the risk of serotonin syndrome, a life-threatening medical emergency due to a buildup of serotonin.

Triptans used to treat migraines, such as Imitrex (sumatriptan), as well as other antidepressants, such as Elavil or Cymbalta, should not be used in combination with Lexapro or Zoloft due to the risk of serotonin syndrome.

Other drugs that may interact with Lexapro or Zoloft include macrolide antibiotics such as Zithromax, NSAIDs (non-steroidal anti-inflammatory drugs) such as Mobic, or painkillers such as Ultram.

Alcohol should not be used with Lexapro or Zoloft.

This is not a complete list of drug interactions. Consult your healthcare provider for medical advice.

Warnings of Lexapro and Zoloft

Both Lexapro and Zoloft come with an FDA black box warning for antidepressants and suicidality. Children, adolescents, and young adults (up to age 24) taking antidepressants have an increased risk of suicidal thoughts and behavior. All patients on antidepressants should be carefully monitored.

Other warnings with both drugs include:

• Risk of serotonin syndrome: A life-threatening medical emergency caused by the buildup of too much serotonin. Patients should be carefully monitored for symptoms including hallucinations, seizures, and agitation.
• Discontinuation: When discontinuing one of these medications, symptoms such as agitation may occur; patients should taper off the drug very slowly.
• Seizures: In patients who have seizures, Lexapro or Zoloft should be used with caution.
• Hyponatremia (low sodium) due to syndrome of inappropriate antidiuretic hormone secretion (SIADH): Patients may experience headache, difficulty concentrating, memory impairment, confusion, weakness, and unsteadiness, which may lead to falls. More serious cases can occur. Patients should seek emergency treatment if symptoms occur, and the SSRI should be stopped.
• Angle-Closure Glaucoma: SSRIs should be avoided in patients with untreated anatomically narrow angles.
• Bleeding: SSRIs may increase bleeding risk; risk increases with concomitant use of aspirin, NSAIDs, or warfarin.
• Activation of mania or hypomania: In patients with bipolar disorder, an antidepressant may precipitate a mixed/manic episode.

Lexapro or Zoloft should only be used in pregnancy if the benefit to the mother is greater than the risk to the baby. Stopping the medication may cause a relapse of depression or anxiety. Therefore, patients should be evaluated on a case-by-case basis.

If you are already on Lexapro or Zoloft and find out you are pregnant, contact your healthcare provider immediately. Lexapro or Zoloft should be used with caution in breastfeeding mothers, and the baby should be evaluated for any adverse reactions.

Zoloft oral solution contains 12% alcohol and should not be used while pregnant or breastfeeding, because of the alcohol content.

Frequently asked questions about Lexapro vs. Zoloft

What is Lexapro?

Lexapro (escitalopram) is an SSRI  indicated for acute and maintenance treatment of major depressive disorder (MDD) in adolescents aged 12-17 years and adults, and acute treatment of generalized anxiety disorder (GAD) in adults.

What is Zoloft?

Zoloft (sertraline) is a selective serotonin reuptake inhibitor indicated for treatment of major depressive disorder (MDD), obsessive-compulsive disorder (OCD), panic disorder (PD),  post-traumatic stress disorder (PTSD), social anxiety disorder (SAD), and premenstrual dysphoric disorder (PMDD).

Are Lexapro vs. Zoloft the same?

Lexapro and Zoloft are both SSRI medications, but their indications vary (see above). Because they are in the same category, they have many of the same drug interactions and side effects.

Is Lexapro vs. Zoloft better?

It depends. Each medication has different indications; one may be more appropriate for your condition(s). Consult your healthcare provider to help you determine which medication is better for you.

Can I use Lexapro vs. Zoloft while pregnant?

It depends. Consult your healthcare provider for advice. Your doctor will weigh the benefits of taking an antidepressant vs. the risk to the baby. Some doctors will prescribe a low dose of antidepressant while pregnant. If you are already on Lexapro or Zoloft and find out that you are pregnant, consult your OB/GYN immediately for advice. If you are breastfeeding, consult your OB/GYN as well.

Can I use Lexapro vs. Zoloft with alcohol?

No. Combining antidepressants with alcohol can worsen symptoms of depression or anxiety, impair your thinking and alertness, and increase sedation and drowsiness.

Which is the best SSRI for anxiety?

SSRIs can be very useful in the treatment of anxiety, but it is best to consult with your healthcare provider about which one is best for you, taking into account your medical history, medical condition(s), and other medications you are taking.

Does Lexapro or Zoloft cause more weight gain?

Everyone has a different experience; some people have no change in weight, and some may gain or lose some weight while on these medications.

Escitalopram – StatPearls – NCBI Bookshelf

Continuing Education Activity

Escitalopram is a medication used in the management and treatment of major depressive disorder and generalized anxiety disorder. It is in the selective serotonin reuptake inhibitor class of drugs. This activity will highlight the mechanism of action, adverse event profile, and other key factors (e.g., off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, relevant interactions, adverse events) pertinent for members of the healthcare team in the management of patients with depression, anxiety, and other related conditions.

Objectives:

• Identify the mechanism of action of escitalopram.

• Describe the potential adverse effects of escitalopram.

• Review the appropriate monitoring for therapy with escitalopram.

• Summarize interprofessional team strategies for improving care coordination and communication when initiating escitalopram to improve patient outcomes.

Access free multiple choice questions on this topic.

Indications

Escitalopram, a selective serotonin reuptake inhibitor (SSRI) and the S-enantiomer of racemic citalopram, is known to be the most selective of SSRIs. SSRIs are widely known for their use in the treatment of depression, anxiety, and other related disorders.[1] Escitalopram (and SSRIs) are also known for their off-label use for the treatment of social anxiety disorder, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder, premenstrual dysphoric disorder, and vasomotor symptoms of menopause.[2][3][4][5]

Mechanism of Action

SSRI’s mechanism of action is exerted by binding to the sodium-dependant serotonin transporter protein (SERT), also known as 5-HTT, which is located in the presynaptic neuron. SERT works by re-uptaking serotonin from the synaptic cleft back to the presynaptic neuron. As SSRIs bind to SERT they inhibit the re-uptake of serotonin and thus increase the amount of serotonin in the synaptic cleft. [6] This activity potentiates the effect of serotonin in the central nervous system. Serotonin or 5-hydroxytryptamine (5-HT) modulates a wide range of human behavioral processes which include mood, perception, memory, anger, aggression, fear, stress response, appetite, addiction, and sexuality. For these to happen, brain regions like cortical, limbic, midbrain, and hindbrain regions express multiple serotonin receptors. [7] There are 5 main serotonin receptors; 5-HT1A, 5-HT1B, 5-HT4, 5-HT6, 5-HT7 located in the brain. [8] In total there are 15 known serotonin receptors, and all of them can also be found outside the central nervous system. [7]

Administration

Escitalopram is administered via the oral route (OR). It is available as a 1 mg/mL oral solution as well as 5 mg, 10 mg, or 20 mg tablets. It is taken once daily, either with or without food. The typical starting dose for escitalopram is 10 mg, and after one week, the dose can be increased to achieve proper symptoms control.[9] A 4-week dose reduction is recommended when trying to switch escitalopram for another SSRI. The half-life of escitalopram is 27 to 32 hours (1.5 days), and it takes 7 to 10 days for it to reach a steady-state in the blood. [10] 

Adverse Effects

Escitalopram and SSRIs have a lower toxicity profile than older antidepressants. Despite this, they have been associated with significant adverse effects. [11]The most commonly observed adverse effects reported are; insomnia, sexual dysfunction (primarily decreased libido, anorgasmia, and male ejaculatory delay), nausea, increased sweating, fatigue, and somnolence. [12] Escitalopram can potentially cause withdrawal symptoms like dizziness, nausea, lethargy, and dizziness if abruptly stopped.  [10]

Escitalopram can cause SSRI-induced syndrome of inappropriate antidiuretic hormone secretion (SSRI-induced SIADH) leading to hyponatremia, especially in the elderly population.[13] Depending on the severity of hyponatremia, symptoms can range from anorexia, nausea, vomiting, fatigue, headache, to more severe conditions like; altered mental status, seizures, and even coma. [14][13]

QT prolongation and serotonin syndrome are amongst the rare but serious adverse effects caused by Escitalopram. QT prolongation is defined as a corrected QT interval on an EKG of greater than 500 ms or an increase from a baseline interval of more than 60 ms.[15] QT prolongation can cause potentially fatal cardiac arrhythmias, including torsade de pointes.[16] The mechanism by which escitalopram causes QT prolongation is a poorly understood phenomenon.[15] However, it is known to be a dose-dependent relationship.[17] 

Serotonin syndrome, a potentially life-threatening side effect results from an excess amount of serotonin in the peripheral and central nervous systems. This medical condition can lead to symptoms of neuromuscular excitation and autonomic stimulation. Serotonin syndrome is more likely to occur in patients taking high-dose SSRIs, who have overdosed, or patients taking more than one serotonergic drug, especially if they work by different mechanisms (an SSRI plus a monoamine oxidase inhibitor, for example). [18] Symptoms of serotonin syndrome may include autonomic instability such as tachycardia, hypertension, dizziness, diaphoresis, flushing, mydriasis, and increased temperature (above 38 degrees celsius). It can also include nausea, vomiting, diarrhea, and mental status changes like agitation, delirium, hallucinations, somnolence, and coma. Neuromuscular symptoms can also present, including incoordination, rigidity, clonus, hyperreflexia, tremors, and hypertonicity. [18] There are reports of severe cases presenting with EKG changes and seizures.[19] [18] A 4 weeks weaning off period before trying another antidepressant therapy is advised to avoid causing serotonin syndrome. [20]

Contraindications

In order to prescribe escitalopram, a proper risk assessment for hypersensitivity reactions to other medications (especially antidepressants and SSRIs), possible QT prolongation, and serotonin syndrome is indicated for all patients.  If the patient has a history of hypersensitivity reactions to escitalopram or citalopram this is considered an absolute contraindication.[11]

Co-administration of a monoamine oxidase inhibitor (MAOI) is also contraindicated with escitalopram due to the risk of causing serotonin syndrome. MAOIs include phenelzine, selegiline, isocarboxazid, and selegiline. [21] Other medications contraindicated due to the possibility of inducing serotonin syndrome include; antidepressants, triptans, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, St. John’s Wort. Drugs that impair the metabolism of serotonin, such as intravenous methylene blue, linezolid, MAOIs, and other psychiatric medications are also contraindicated. [18]

Although it is a relative contraindication, the risk of QT prolongation is another consideration when starting escitalopram. A family history of long QT syndrome, or sudden, premature cardiac death, should be evaluated. Concomitant use of other drugs that can cause prolonged QT syndrome, including antipsychotics (especially older typical antipsychotics) should also be carefully assessed. [16]

In recent years, liver enzyme CYP2C19 activity has been evaluated in pharmacogenetics as a determinant in contraindicating escitalopram use. CYP2C19 metabolizes escitalopram, and it is now possible to evaluate an individual patient’s activity of this enzyme via genetic testing. Poor metabolizers, or those with decreased activity of this enzyme, are shown to have higher concentrations of escitalopram in their bloodstream and are therefore at higher risk of adverse drug reactions.[17] If a patient’s CYP2C19 status is known and is weak, it is reasonable to evaluate whether escitalopram use is necessary or whether adjustments should be made to the dose to avoid serious adverse drug reactions.[22] 

Monitoring

Patients taking escitalopram should be monitored for mood or behavioral changes, including suicidality. An increase in suicidal thoughts and self-destructive behavior in pediatric and adolescent patients taking SSRIs have been documented in the past. [1] Electrolyte disturbances (SSRI-induced SIADH), EKG changes (QT prolongation), should also be assessed in subsequent visits with a basic metabolic panel and EKG, especially in patients 65 years or older or with a family history of arrhythmias. [11] In patients with a history of arrhythmias, follow-up EKGs after escitalopram has reached therapeutic levels are also recommended to evaluate for prolongation of the QT interval. A QT interval greater than 500 ms or a change from baseline of more than 60 ms should merit consideration of changing to another antidepressant. [23]

Toxicity

Currently, the highest recommended dose of escitalopram is 20 mg PO daily. Management for out-of-hospital isolated SSRI overdose in patients who are experiencing minor symptoms (regularly less than 5 times their treatment dosage) is recommended at-home observation and close conjunction with a local poison control center. [19]

In an overdose of escitalopram, the most concerning clinical aspect is QT prolongation and a subsequent torsade de pointes arrhythmia, as this could be fatal. In reported ingestions of 300 mg or more of escitalopram, single-dose activated charcoal demonstrably decreased the fraction of absorption by 31% and decreased the risk of abnormal QT interval by 35%. Therefore, the recommendation is to administer a single dose of activated charcoal to patients who have ingested at least 300 mg of escitalopram in an attempted overdose. Cardiac monitoring of patients who receive activated charcoal (overdose of 300 mg or greater) is recommended for 12 hours.[24] In the event of the development of torsade de pointes, administer magnesium sulfate.[25]

In patients with more severe hyperexcitability symptoms, supportive treatment is the mainstay. Besides discontinuing all serotonergic drugs, measures for adequate temperature and blood pressure control should be initiated, agitation control can be achieved with benzodiazepines.  In severe cases of serotonin toxicity patients may require endotracheal intubation and ventilatory support. [19]  For refractory cases to supportive care, medications that are known to have anti-serotonergic properties like cyproheptadine a histamine-1 receptor antagonist, and nonspecific 5-HT1A and 5-HT2A antagonist can be used. Despite this antagonistic effect, it is still unclear its effect on patient clinical outcomes. [26]

Enhancing Healthcare Team Outcomes

Management of depression and anxiety requires an interprofessional team, including physicians, nurses, therapists, and pharmacists. When treating depression and anxiety with escitalopram, the interprofessional healthcare team should communicate and collaborate to achieve the best outcome for the patient. This collaboration can include a thorough review of the patient’s medications to avoid drug interactions and adverse events. Furthermore, pharmacists may monitor the drug level in the blood in cases of overdose, and serum electrolyte levels will be necessary to monitor for disturbances. These coordinated activities and open communication strategies will result in more effective therapeutic outcomes when using escitalopram while minimizing adverse effects. [Level 5]

References

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Sanchez C, Reines EH, Montgomery SA. A comparative review of escitalopram, paroxetine, and sertraline: Are they all alike? Int Clin Psychopharmacol. 2014 Jul;29(4):185-96. [PMC free article: PMC4047306] [PubMed: 24424469]

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Baldwin DS, Asakura S, Koyama T, Hayano T, Hagino A, Reines E, Larsen K. Efficacy of escitalopram in the treatment of social anxiety disorder: A meta-analysis versus placebo. Eur Neuropsychopharmacol. 2016 Jun;26(6):1062-9. [PubMed: 26971233]

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Bandelow B, Reitt M, Röver C, Michaelis S, Görlich Y, Wedekind D. Efficacy of treatments for anxiety disorders: a meta-analysis. Int Clin Psychopharmacol. 2015 Jul;30(4):183-92. [PubMed: 25932596]

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Stubbs C, Mattingly L, Crawford SA, Wickersham EA, Brockhaus JL, McCarthy LH. Do SSRIs and SNRIs reduce the frequency and/or severity of hot flashes in menopausal women. J Okla State Med Assoc. 2017 May;110(5):272-274. [PMC free article: PMC5482277] [PubMed: 28649145]

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Marjoribanks J, Brown J, O’Brien PM, Wyatt K. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev. 2013 Jun 07;(6):CD001396. [PMC free article: PMC7073417] [PubMed: 23744611]

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Kasper S, Sacher J, Klein N, Mossaheb N, Attarbaschi-Steiner T, Lanzenberger R, Spindelegger C, Asenbaum S, Holik A, Dudczak R. Differences in the dynamics of serotonin reuptake transporter occupancy may explain superior clinical efficacy of escitalopram versus citalopram. Int Clin Psychopharmacol. 2009 May;24(3):119-25. [PubMed: 19367152]

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Berger M, Gray JA, Roth BL. The expanded biology of serotonin. Annu Rev Med. 2009;60:355-66. [PMC free article: PMC5864293] [PubMed: 19630576]

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Yohn CN, Gergues MM, Samuels BA. The role of 5-HT receptors in depression. Mol Brain. 2017 Jun 24;10(1):28. [PMC free article: PMC5483313] [PubMed: 28646910]

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Rao N. The clinical pharmacokinetics of escitalopram. Clin Pharmacokinet. 2007;46(4):281-90. [PubMed: 17375980]

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Keks N, Hope J, Keogh S. Switching and stopping antidepressants. Aust Prescr. 2016 Jun;39(3):76-83. [PMC free article: PMC4919171] [PubMed: 27346915]

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Dodd S, Malhi GS, Tiller J, Schweitzer I, Hickie I, Khoo JP, Bassett DL, Lyndon B, Mitchell PB, Parker G, Fitzgerald PB, Udina M, Singh A, Moylan S, Giorlando F, Doughty C, Davey CG, Theodoros M, Berk M. A consensus statement for safety monitoring guidelines of treatments for major depressive disorder. Aust N Z J Psychiatry. 2011 Sep;45(9):712-25. [PMC free article: PMC3190838] [PubMed: 21888608]

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Cipriani A, Santilli C, Furukawa TA, Signoretti A, Nakagawa A, McGuire H, Churchill R, Barbui C. Escitalopram versus other antidepressive agents for depression. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD006532. [PMC free article: PMC4164382] [PubMed: 19370639]

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Kirpekar VC, Joshi PP. Syndrome of inappropriate ADH secretion (SIADH) associated with citalopram use. Indian J Psychiatry. 2005 Apr;47(2):119-20. [PMC free article: PMC2918297] [PubMed: 20711296]

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Rondon H, Badireddy M. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jan 25, 2021. Hyponatremia. [PubMed: 29262111]

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Hasnain M, Howland RH, Vieweg WV. Escitalopram and QTc prolongation. J Psychiatry Neurosci. 2013 Jul;38(4):E11. [PMC free article: PMC3692726] [PubMed: 23791140]

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Beach SR, Celano CM, Sugrue AM, Adams C, Ackerman MJ, Noseworthy PA, Huffman JC. QT Prolongation, Torsades de Pointes, and Psychotropic Medications: A 5-Year Update. Psychosomatics. 2018 Mar – Apr;59(2):105-122. [PubMed: 29275963]

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Cooke MJ, Waring WS. Citalopram and cardiac toxicity. Eur J Clin Pharmacol. 2013 Apr;69(4):755-60. [PubMed: 22996077]

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Scotton WJ, Hill LJ, Williams AC, Barnes NM. Serotonin Syndrome: Pathophysiology, Clinical Features, Management, and Potential Future Directions. Int J Tryptophan Res. 2019;12:1178646919873925. [PMC free article: PMC6734608] [PubMed: 31523132]

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Bruggeman C, O’Day CS. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 10, 2021. Selective Serotonin Reuptake Inhibitor Toxicity. [PubMed: 30521236]

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Haddad P. The SSRI discontinuation syndrome. J Psychopharmacol. 1998;12(3):305-13. [PubMed: 10958258]

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Sabri MA, Saber-Ayad MM. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 3, 2021. MAO Inhibitors. [PubMed: 32491327]

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Petry N, Lupu R, Gohar A, Larson EA, Peterson C, Williams V, Zhao J, Wilke RA, Hines LJ. CYP2C19 genotype, physician prescribing pattern, and risk for long QT on serotonin selective reuptake inhibitors. Pharmacogenomics. 2019 Apr;20(5):343-351. [PMC free article: PMC6562837] [PubMed: 30983508]

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Sheeler RD, Ackerman MJ, Richelson E, Nelson TK, Staab JP, Tangalos EG, Dieser LM, Cunningham JL. Considerations on safety concerns about citalopram prescribing. Mayo Clin Proc. 2012 Nov;87(11):1042-5. [PMC free article: PMC3532688] [PubMed: 23018033]

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van Gorp F, Duffull S, Hackett LP, Isbister GK. Population pharmacokinetics and pharmacodynamics of escitalopram in overdose and the effect of activated charcoal. Br J Clin Pharmacol. 2012 Mar;73(3):402-10. [PMC free article: PMC3370344] [PubMed: 21883384]

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Thomas SH, Behr ER. Pharmacological treatment of acquired QT prolongation and torsades de pointes. Br J Clin Pharmacol. 2016 Mar;81(3):420-7. [PMC free article: PMC4767204] [PubMed: 26183037]

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Graudins A, Stearman A, Chan B. Treatment of the serotonin syndrome with cyproheptadine. J Emerg Med. 1998 Jul-Aug;16(4):615-9. [PubMed: 9696181]

Lexapro Side Effects – Common & Serious Complications

Quick Summary

Lexapro Common Side Effects

Lexapro (escitalopram) is an SSRI antidepressant medication which works by affecting serotonin levels in certain areas of the brain. Like all medications it may cause side effects, most of which are not serious and will go away with time.

Common side effects of Lexapro include:

• Dizziness
• Drowsiness or fatigue
• Insomnia
• Headache
• Nausea
• Constipation
• Weight changes
• Sexual dysfunction

Lexapro Serious Side Effects

Lexapro may also cause side effects or complications which are more severe or may be serious or life-threatening.

Serious side effects or complications of Lexapro include:

• Increased suicide risk
• Birth defects
• Serotonin Syndrome
• Withdrawal effects

Severe side effects of Lexapro should be reported to a health care professional right away. Sudden or severe symptoms such as changes in level of consciousness should treated as a medical emergency as they may be life-threatening.

Lexapro Side Effects Overview

Lexapro is the brand name of generic escitalopram. It is a serotonin-specific or selective serotonin reuptake inhibitor (SSRI) antidepressant which only affects serotonin levels in the brain. Lexapro is approved for depression and anxiety disorder, but it is also used for other conditions such as obsessive-compulsive disorder, post-traumatic stress disorder and bipolar disorder.

Lexapro is manufactured by Forest Laboratories who has been accused of failure to warn about severe side effects and serious risks and is has faced numerous lawsuits for injuries caused by its use.

Common Lexapro Side Effects

Like all medications, Lexapro may cause a number of side effects. In most cases, side effects are mild to moderate and will go away with time. In other cases, however, side effects may be more severe, result in serious injury or may be life-threatening.

Common side effects include:

• CNS effects:
  • Dizziness
  • Drowsiness
  • Fatigue
  • Insomnia
  • Headache
• GI complaints:
  • Nausea
  • Diarrhea
  • Constipation
  • Weight Loss or Gain
  • Dry Mouth
• Weight changes
• Sweating
• Sexual difficulties (both males and females)

Bothersome or persistent side effects should be reported to a health care provider.

Severe Lexapro Side Effects

In addition to the common side effects of Lexapro, the medication may cause side effects or complications which are more severe or may be serious or life-threatening.

Lexapro Suicide Risk

Lexapro has been linked to an increase in suicide risk, especially in patients under 25 or have a history of suicidal thoughts or behaviors and in those with bipolar disorder.

Since 2004, the FDA has required that Lexapro and other SSRIs include information about increased suicide risk at the top of prescribing information. This information must be enclosed in a box with a thick, black border. It is the most severe notice that the FDA issues and is known as a “black box warning”

Lexapro Birth Defects

When SSRIs were introduced to the market, they were believed to be safer than older antidepressants which were rarely given during pregnancy. Lexapro has been widely used during pregnancy but has been linked to a number of birth defects. Some of these effects are severe, permanently debilitation or may cause death.

Because of the risk of birth defects, the medication has been classified as Pregnancy Category C. Category C medications have been shown to cause birth defects in humans and should not be used unless the benefits outweigh the risks.

Lexapro birth defects affect may affect vital organs and have included:

• Hypoplastic Left or Right Heart syndrome (HLHS or HLRS), a medical emergency which is up to 70% fatal
• Persistent pulmonary hypertension (PPHN), a medical emergency that is 10% fatal
• Spina Bifida (underdeveloped vertebra and exposed spinal cord), often 15% fatal by age 4
• Anencephaly (malformation of brain and skull), usually fatal shortly after birth
• Omphalocele (abdominal organs grown on outside of abdomen), requires surgery and is sometimes fatal
• Cleft Palate or Lip (malformation of roof of mouth or upper front jaw), may require surgery
• Scoliosis (curved spine), may require surgery or be permanently disabling
• Club feet (feet curl inwards), may require surgery or be permanently disabling
• Autism Spectrum Disorder (ASD) or Delayed Development Disorder (DDD)
• Withdrawal symptoms or Serotonin Syndrome in infants

A 2006 FDA safety alert warned of the risks of SSRI medication use during pregnancy and the Agency required manufacturers to strengthen warnings.

Lexapro and Serotonin Syndrome

“Serotonin syndrome” occurs when serotonin levels in the brain become too high. Other medications which affect serotonin levels can increase the risk. These medications may include cough remedies, herbal supplements and migraine treatments.

Symptoms of serotonin syndrome should be reported to a doctor immediately and may include:

• Sudden or unexpected high fever
• Increased heart rate, irregular heartbeat
• Loss of balance, lack of coordination
• Confusion, hallucinations
• Seizures

Lexapro Discontinuation or Withdrawal Syndrome

Some evidence shows that Lexapro and other SSRIs may cause result in a withdrawal syndrome if the medication is suddenly discontinued. A gradual reduction of the dose is recommended rather than abrupt discontinuation.

Symptoms of withdrawal may include:

• Irritability
• Nausea
• Dizziness
• Nightmares
• Headache
• Odd or unusual skin sensations

In most cases, withdrawal will subside over a short period of time and are lessened by gradual tapering, but some patients may find symptoms bothersome for months. Severe or bothersome withdrawal symptoms should be reported to a health care professional.

The FDA has issued numerous warnings about the dangers of Lexapro and has recently requested that certain changes to some SSRI warnings. Forest Laboratories was accused of hiding negative information about the medication and promoting unapproved uses of the mediation. They paid $313 million in 2009 but are facing a number of lawsuits.

Patients who have been harmed by severe Lexapro side effects may be eligible for compensation for medical costs, lost wages and pain and suffering. People or loved ones of those affected by suicide, birth defect, required hospitalization or who died after using Lexapro should seek expert legal advice.

Notwithstanding claims relating to this product, the drug/medical device remains approved by the U.S. FDA. 

[e-lek] FDA approves first generic Lexapro to treat depression and anxie

 FDA NEWS RELEASE

[Many thanks to Ruslan Dzhukaev for the information and translation. Subscribers,
it will probably be interesting to discuss this event in light of the lack of
escitalopram of any advantages over citalopram, which has long been released in
generics, and therefore reiterate the emphasis that FDA approval is in no way
is a rational basis for rational use in clinical
practice.This example is also a good illustration of the quality debate.
generic / generic drugs and their use for
Refining Our Submissions FDA Resource - Orange Book That Subscribers
e-lek was actively discussed some time ago (see archives!):
http://www.accessdata.fda.gov/scripts/cder/ob/docs/tempai.cfm
Your moderator LE]

* For Immediate Release: * March 14, 2012
* Media Inquiries: * Sandy Walsh, 301-796-4669, [email protected]
* Consumer Inquiries: * 888-INFO-FDA

Center for Food and Drug Administration
US drugs approved the use of the first generic Lexapro for the treatment of
depression and anxiety.*
Food Control Center and
drugs of the United States today approved the use of
the first generic Lexapro (escitalopram tablets) for the treatment of depression and
generalized anxiety disorders in adults.

Signs and symptoms of depression include
yourself: depressed mood, loss of interest in normal life
activity, significant changes in weight and appetite, insomnia, or
drowsiness, restlessness / anxiety (psychoactive agitation),
increased fatigue, feelings of guilt or worthlessness, delayed
thinking, impaired concentration and attention, suicidal attempts or thoughts
about suicide.)

People with generalized anxiety disorder (GAD) have a feeling
exaggerated anxiety and tension, although events provoking
these are small or none at all. They anticipate trouble and are overly concerned with questions.
health, money, family problems and difficulties at work. GAD
diagnosed when a person is overly worried about various life
problems for at least six months.)
Lyuli with GAD cannot relax, are easily frightened and have difficulty with
concentration of attention."These psychiatric
conditions make a person unable to carry out normal daily activities
activities, "says Janet Woodcock, MD, director of the FDA center
for the evaluation and research of medicinal products. This drug is widely
used by people who need to manage their condition during
for a long time, and therefore it is important to have affordable treatment regimens.

Teva Pharmaceutical Industries / IVAX Pharmaceutical Receives Approval From
FDA to market the generic escitalopram in dosages of 5 mg, 10 mg and
20 mg.In Lexapro clinical trials, the most commonly observed
adverse reactions were: insomnia, ejaculation disorders, nausea,
increased sweating, feeling tired and sleepy, and also decreased
sexual desire (decreased libido).

Escitalopram and all other antidepressants contain in
packaging, a warning and instructions for the patient describing the
the possibility of increasing the risk of suicidal thoughts and behavior in children,
adolescents and young people between the ages of 18 and 24 in the initial period
treatment.The warning also says the data does not show an increase in risk.
thoughts of suicide and behavior change in people who
over 24 years old, also over 65 years old, taking antidepressants.
These warnings also indicate that depression and other serious
psychiatric disorders themselves are the most important causes
suicide and that close monitoring of patients who have started
treatment with these drugs.
Teva obtained an exclusive right
for a 180-day period, for the release of a generic drug, which means that
FDA cannot approve another generic version of escitalopram tablets before
the end of this period.FDA Approved Generic Drugs
have the same quality and effectiveness as drugs with branded
names. Manufacturing and
packaging of generic drugs must pass such quality standards,
as branded drugs.
Generic escitalopram availability information can be obtained from
from Teva.

for details:

FDA: Understanding Generic
Drugs 

National Institute of Mental Health:
Depression 

National Institute of Mental Health: Anxiety
Disorders 

Information on specific drug products,
Drugs @ FDA 

 Translated by Ruslan Dzhukaev, infectious disease doctor, clinical pharmacologist.
Kislovodsk infectious diseases hospital. 

23 answers about depression from the professional psychiatrist Maxim Malyavin (dpmmax) / Habr

In the morning, neither raise your hand, nor write a line of code.There is no appetite, no mood, no opportunity to enjoy what used to please. Yes, anhedonia, sir, she is. Plus self-esteem below the plinth – already knocking to the neighbors downstairs through the chandelier. It is difficult to concentrate, constant fatigue, thoughts with difficulty toss and turn in my head. And even at night there is no relief – insomnia.

It was at a bad hour that the classic “depressive triad” visited you.

We have already seen how it happens from the point of view of an ordinary patient. What circles of earthly hell do you have to go through in order to recover and become yourself again.

Now it would be useful to hear the opinion of a specialist psychiatrist. Because he has more than a dozen years of experience and more than one thousand patients.

Maksim Malyavin – local psychiatrist at the neuropsychiatric dispensary in Togliatti
He has already communicated with the readers of Habr in an interview “Professional burnout of IT specialists: 15 answers of psychiatrist Maxim Malyavin.”

Psychiatrist maintains the very famous Blog of Good Psychiatrists (dpmmax), and writes incredibly funny psychiatric tales that can ward off the autumn-winter blues.He published many books: from “Notes of a Psychiatrist, or to All Haloperidol at the expense of the institution” and “New Notes of a Psychiatrist or Barbukhayka, on the road!” before “Thrust to the Lord of the Galaxy.”

In addition, Maxim runs the Find Your Psychiatrist project especially for those who do not know who to contact and how to find a really good specialist.

But let’s not endlessly pull the syringe by the plunger and proceed to the interview itself …

1. Psychiatrists in the United States, I don’t know exactly how we are, are knocking on the alarm rail with might and main – the frequency of borderline mental disorders is growing, especially depression …Moreover, in the United States, cases of resistant depression are even more frequent, since patients are accustomed to drinking blood pressure like vitamins. Or they run for an appointment with any decrease in mood – from “a guy left me” and “my boss looked at me askance” to “my neighbor turns on Black Sabbath every evening and keeps three black cats at home” – and with insurance medicine, as I understand it, it is easier for an American physician to write a prescription than to beat a demanding patient with a stethoscope. What is the reason for the increase in the incidence of depression in the modern world?

Probably, our psychiatrists managed to learn Zen Husim.And where foreign colleagues offer to sound the alarm, they agree to just sound the alarm. But in fact, this tendency is taking place. True, an important clarification needs to be made here. An increase in the number of subdepressive states is noticeable, that is, they do not reach the strength of an extended, psychotic depression, which in many cases requires both hospitalization and saving the patient’s life in the literal sense of the word.

Just this extended, major depression hasn’t changed much in percentage terms. As for subdepressive states (or neurotic depression, or minor, call it what you want) – there are a number of reasons for its growth.

The first is the increased information load. I suppose there is no need to decrypt. The second is a decrease in physical activity against this background. I think there is also no need to explain why: a side effect of scientific and technological progress. The third is, oddly enough, an increase in the quality of life. Life has become better, life has become more fun, accordingly, the requirements of the person himself to how he should ideally feel have increased. Especially (referring to the first point) when there is someone to compare with. The fourth is also paradoxical, but it is precisely the emergence of the market for antidepressants and a wide range of psychotherapeutic services.

Let me explain. If, before the era of antidepressants (and this is the end of the 50s of the last century), the same poor American simply had nowhere to go – not to go to the madhouse forever – then, as soon as there was an opportunity to somehow improve his condition, and not just work, endure , drinking or sniffing cocaine – this niche quickly filled. Moreover, it has become fashionable. Fifth. As old Freud used to say, sitting down in the smoking room, sometimes a cigar is just a cigar. So, many began to forget that sometimes a bad mood is just a bad mood.And they got worse to keep up with the frustration’s blow to their overestimated expectations. After all, a healthy bad mood, in contrast to depression and subdepression, arises quite naturally, as a response to objective external circumstances, and plays the role of correction stars and initiating pundels from the body itself: once it has arisen, then you did something wrong, and you need to carry out work on mistakes, and not reach for a magic pill. The main thing is to understand where it is and where the depression is.

2. The older generation, he himself met more than once in conversations, claims that under dear Leonid Ilyich no one had any depression – this is all inventions and conspiracy of pharmaceutical companies.Was the incidence of depression really lower in the past, or was it just being diagnosed less frequently? Or the average person did not really hear the statistical indicators, while the average person “successfully” suppressed depression with alcoholic products of their own manufacture?

Actually, here we are not very different from our foreign friends. The points are the same. One need only add that both in our country and abroad, the number of major depressions was the same as a percentage per thousand of the population. As for minor depressions, you and I survived longer, and began to live much later.Accordingly, they got to the bows with ruffles, like the same quality of life, relatively recently. And they also immediately began to complain about depression. In addition, Russian psychiatry (I confess, and I had a hand in this) ceases to be a bogeyman, becoming a little more transparent, more subtle and without far-reaching conclusions.

3. Is there any relationship between the growth of depression manifestations depending on the size of the city – more patients with depression in megacities and fewer in provincial cities N? Or is there no special statistical dependence?

This is true only for the same small depressions.And for all the same reasons listed in the answer to the first question.

4. What professions are most susceptible to borderline mental disorders, the same depression? Is there such a list? For example, IT specialists, who often work remotely, may not leave their homes at all and order anything from pizza to schoolgirls from the nearest hostel of ignoble girls to their cozy abodes? Or is there really no such dependence?

And again we recall all the same points.The greatest risk is for those who have a high information load with low physical activity. Throw in professions with a high risk of burnout and a rough picture will emerge.

5. How to determine in yourself – is it a slight Russian blues about autumn and rains, a slight depression or even an average one? We are not talking about a severe clinical one – a patient who has buried his nose in a wall and eats porridge in a tube or a nutrient solution intravenously, indirectly guesses that he has depression.

Mild to moderate depression are the most common affective disorders encountered in outpatient practice. Traditionally, several people a day come with such symptoms. Subjectively, it is always heavier than it really is. So when at the reception they talk about the “severe depression” suffered in the past – this is just it, mild or moderate.

Depression can occur in any type of neurotic disorder, can develop as a reaction to stress, as decompensation of psychopathy, is a frequent companion of chronic somatic pathologies, encephalopathies of any genesis serve as a good ground for it.Mild to moderate depressive episodes are also possible with bipolar or recurrent disorder. A patient with schizophrenia may have depression, a patient with epilepsy – as much as you like, a patient with mental retardation or dementia – maybe. Simply put, no one is insured, but the main suppliers are listed at the beginning of the paragraph.

Anxiety and asthenic are the undisputed leaders among the many types of depression.

Importantly, depression is not just a bad mood.This is a disease with its own symptoms, a persistently low mood for at least two weeks, anhedonia, sleep disturbances (often early awakening), a decrease in appetite, objectively confirmed by weight loss, are required. Usually they feel worse in the morning.

If depression is reactive – constant painful thoughts about a traumatic event, which is very difficult to get away from. If the alarm is the same, did not have time to open his eyes in the morning, she, darling, is already there. With asthenic depression, short flashes of irritability and tearfulness occur.

In case of mild depression, they may remain able to work, but household chores are no longer delayed. Sometimes they are drawn to work in order to escape from their worries at least for a while. With moderate performance, performance decreases markedly.

Visually, with mild depression may appear as usual, others do not always notice changes in behavior. With moderate, the diagnosis can be made right away. A woman in a state of moderate depression will never come to an appointment with makeup and styling, her face is a frozen mask of suffering, her voice is quiet, weakly modulated, her movements are somewhat slowed down.Or, on the contrary, he fusses, is in a hurry to tell, breaks down to tears, but facial expressions are just as poor.
Often accompanied by a headache, discomfort in the sternum, in the epigastrium, difficulty breathing, constipation, women may have menstrual irregularities.

Current depression can stimulate the onset or exacerbation of many somatic pathologies, primarily diseases of the cardiovascular system and gastrointestinal tract.

How to diagnose yourself.With mild depression, self-diagnosis does not present any particular difficulties, on the basis of the above complaints, a person often goes directly to a psychiatrist, nevertheless, the literacy of the population has grown. With moderate self-diagnosis is unlikely. Here, either a person does not have the strength to think over and assess his condition, or the thought process is densely occupied by painful, anxious experiences and it is difficult for something rational to break through them.

In this regard, the episode that happened with one of the colleagues is very indicative.A psychiatrist with more than 20 years of experience, while on vacation, is exposed to severe and prolonged stress, against which a moderate depressive episode develops. As she herself told later, she made the diagnosis to herself only by the end of the third week of the disease, when she suddenly realized for herself that she had spent the last few hours for a methodical choice of the method of suicide.

People with moderate depression are more likely to be referred by relatives, friends or colleagues, or referred by a therapist or neurologist.

The outlook is generally good. Most mild to moderate depressive disorders are quickly and well treated on an outpatient basis. When the condition improves, such a pattern is often observed – first, anxiety decreases and strength appears, then sleep and mood normalize, the latter restores appetite. A protracted or recurrent course of depression can acquire in chronic psychotrauma, against a somatically burdened background, persistence of symptoms is characteristic of hysterical-hypochondriacal disorders, there is persistent depression in dementia.

What happens if you don’t treat? Mild depression usually resolves on its own within 1 to 2 months. Moderate – longer, but also often goes away on its own.

Why treat then? Reducing the risk of suicide. Reducing the risk of chronicity. We improve the quality of life during illness. We reduce the risk of onset or exacerbation of somatic pathology.

6. What then does a severe depression look like, if even a moderate one is such a debilitating “pleasure”, unless you wish it to the enemy?

If mild and moderate depressants are taken in the hundreds, then here the count is per unit.And thank God. Severe depression is something that God forbid anyone to experience.

Major providers of bipolar and recurrent disorder.

The most difficult – those who fell ill for the first time, relatives did not figure out in time where to drag, and started well. The patient himself does not want to go anywhere at the beginning of the disease, and then he cannot.

The classic sight of a neglected depressive patient – an emaciated, unwashed, overgrown person, lies facing the wall, does not really react to the speech addressed, in well-neglected cases the bed underneath is saturated with feces.Sometimes relatives only catch themselves when it is no longer possible to force feed, and death from hunger and thirst looms before a person.

The patients themselves subsequently describe their condition as unbearable mental pain, tearing the soul with longing, which often fill everything with themselves, leaving no room for other thoughts. These sensations are so painful that patients are sometimes ready to endure arbitrarily intense physical pain, if only for a moment to be distracted from the all-consuming mental.

Afterwards, sometimes you hear the bewilderment of patients who sincerely do not understand how they managed to endure these sensations and not die, how it is generally possible for a person to survive while doing this.There is no more fear of death, death is perceived as deliverance. But there is no strength for suicide either. Sometimes there is no strength no matter what. They are indifferent to everything that happens around them. The fire will start – they will burn. The child will climb into the open window – they will not move. Sometimes, in the relatively early stages of the formation of depression, a depressive raptus can develop, this is for the best, because the relatives will sooner realize to call an ambulance, and they will get treatment earlier.

It is clear that all this does not develop within a couple of days, therefore, transitional states from a moderate to a severe episode are more often recorded – and few get to such a nightmare.

May be combined with delirium, with hallucinations. Moreover, delirium and hallucinosis can both precede the development of depression and develop against its background.

If a person who has had a mild or moderate depressive episode later on at the reception willingly and in detail tells about them, then it is difficult to pull something out of these. They prefer not to remember. In severe depression with psychotic symptoms, amnesia is not uncommon for part of the experience.

Typically their surprise after being discharged, when everything is already fine: why didn’t I apply right away, but why did I suffer so much? The most grateful patients.

Repeated patients in most cases come in the first week of deterioration of health, without waiting for the full development of symptoms.

When the condition improves, the same pattern can be traced – first, anxiety and melancholy decrease, strength appears, then sleep and mood normalize, the latter restores appetite.

Treatment is only inpatient, with rather long outpatient follow-up treatment after discharge and subsequent prevention of relapse.

7.Should you take tests yourself, such as the Zang Scale and the Beck Depression Scale, for self-assessment? As prevention and control? Or is it no less harmful than self-medication?

We always know how to intimidate ourselves. I don’t think it’s worth it like that, just in case. Now, if everything is bad with the mood for a couple of weeks, and there is a solid hopeless on the horizon, and it is not clear where it came from, and there are no ideas what can be done with it – then try it. Better to let the specialist take a look.By the way, it is in terms of such quantitative diagnostics that the role of clinical psychologists is greatly underestimated: it is they who, without attracting the attention of psychiatrists to you, can quantitatively assess the depth of depression.

8. If a person sees or suspects the onset of a primary depressive episode (because after a second episode, the patient himself already knows what is wrong with him) in a loved one, what should he do? Is it ethical to insist on seeing a psychiatrist? Consult a specialist yourself? Ask to pass the same Beck and Zang scales? What is the most ethical option in such cases? Or to expect that the person himself will be so pressed that he will jump like a sad hare to the kind doctor psychiatrist?

Ethical.Indeed, sometimes (after all, you will not take the responsibility to determine whether it is a big or a small depression), it is no longer about the quality of life, but about its safety. Again, there is always the possibility of anonymous admission if anyone is afraid of the consequences.

9. What is the first aid kit now if a psychiatrist diagnoses depression? SSRI (SSRI) or other drugs?

There are standards of medical care, including in psychiatry. And there is the personal skill of the doctor. The first set of help is, perhaps, just one of the standards.And they are based on the principle “it helped more often.” Personal skill is to discern shades, estimate status and try to predict how “our word will respond.” Rather, a pill. And this – at the moment, is not even so much following the letter as personal experience. Who reacted how and to what. Compared to computer games, it’s like a lock picking skill. Only in the role of a lock – a biochemical, neurotransmitter set of a particular patient, and in the role of a master key – an antidepressant. And the closer it is to the authentic key, to the missing neurotransmitters in this particular case, the better the effect.

10. How do you feel about the fact that the drug Bupropion has been banned in Russia since August 22, 2016? As far as I understand, it was a fairly effective drug, both in monotherapy and in addition to SSRIs. In addition, it did not cause weight gain or sexual dysfunction, which is often reported by patients on SSRIs. What is the reason for this decision?

How can I tell you, without obscene vocabulary. I have a bad attitude. I am perplexed. Discouraged.Frappy. Apparently, someone up there, decided to cut it out. And then the all-Russian struggle against precursors. And here are indications of the stimulating effect of bupropion. For me, this is another manifesto of the watchman’s syndrome – alas, performed by those who can make decisions.

11. If the patient is not helped by selective antidepressants, what is left for him? ECT or the miracle nasal esketamine spray that American pharmacologists pulled from the past?

You are a kind person. There are also classic antidepressants, there is sleep deprivation, there are methods aimed at treating neurodegenerative inflammation (as one of the causes of depression).Well, you yourself probably remember the verse about the white mouse.

Poem about a white mouse

If an adult mouse
Take and, carefully holding,
Stuff needles in it
You will receive a hedgehog.

If this hedgehog,
Stopping his nose to stop breathing,
Where deeper, throw it into the river
You will receive a Ruff.

If this ruff,
Clamping his head in a vice,
Pull the tail harder
You will get a snake.

If this snake,
Preparing two knives …
However, he will probably die,
But the idea is good!

12. What does the mechanism of depression look like? What kind of violations are occurring? Has the serotonin theory been popular for a long time? Has it remained – or is the search for a more detailed and explanatory theory still underway?

Let’s not try to cram the unpushy into one interview. Yes, the main theory at the moment is the disruption of the work of serotonin and receptors that are sensitive to it.But they are already looking at dopamine and GABA, and they groped for a genetic predisposition to suicide, and discovered NMDA receptors for bad mood, and neuroinflammation is increasingly being talked about. But there is no unified theory, while we are at the stage of data collection, the next (after the serotonin hypothesis) step in building a model of depression is still ahead.

13. Resistant depression – what is it? What does it look like at the neurochemical level? Why do antidepressants stop helping? Is this a rather dangerous condition, since patients often have a high risk of suicide?

This is a depressive state when the response to most antidepressants used is absent or miserable.But fig knows what he really looks like. With addiction to benzodiazepines and opiates, everything is more or less clear, but here, again, everything is at the stage of information accumulation. Comprehension will come later.

14. And by the way, why is there an increased risk of suicide at the initial stage of SSRI treatment? What is the reason for this?

The question is not quite correctly formulated. In general, this is observed in severe depression. And it works for all antidepressants, any group.Just imagine: the depression was so severe that it was hard for a person to even crawl to a hinge or window. Everything is so bad that there is no strength to sleep or eat, the soul is already tired of hurting. And we reduced the depth of depression with an antidepressant. Some forces appeared to act, but suicidal thoughts have not passed yet. And the prospects are still not visible, but the thought has not gone anywhere that he himself is to blame for everything. I think the result is easy to predict. Glory to the universe that this does not happen often.

15.If we have touched on this unpleasant topic, what should be the actions if suicidal thoughts are formed right in your head and there is a desire to embody them? Likewise, what if a loved one was caught trying to commit suicide – theatrical or real – it doesn’t matter?

Run to the doctor. Or by the collar – and run to the doctor.

16. When is hospitalization indicated for depression?

With severe depression, especially with suicidal tendencies – definitely.Moreover, according to the Law on Psychiatric Care – even if the person is against it. In other cases, they are guided by the severity, duration, and the effect of treatment.

17. How to distinguish endogenous from exogenous depression? Or how long can the remission of endogenous and exogenous depression be after the end of antidepressant therapy?

Not for a specialist – in any way. No, if you know for sure that this episode is clearly tied to a powerful traumatic situation, and the person has no history of spontaneous depressive periods, then yes, you can assume that this is exogenous depression.Or, on the contrary, you are aware that once a year (six months, two years, it does not matter) a person has such periods, and he either goes to be treated, or toils until everything passes – you can think about an exacerbation of the endogenous process. But these will all be just your assumptions. As well as assumptions about the duration of remission.

18. If a person has already had several episodes of depressive disorder, can this indicate that this is an endogenous depression, and not a complete bad luck in life, when traumatic environmental factors that cause episodes of exogenous depression are repeatedly poured on him.

But everything can be, although the specialist would be on his guard.

19. Is there a risk of emergence as a result of resistant depression in case of recurrent episodes of depression? And is it worth changing drugs with a new episode? Or if you are lucky to have earned paroxetine, then it is better not to skip to conditional escitalopram?

There is a risk, but not so great as to give up what helped last time.

20. In 2018, the Lancet medical journal published a meta-analysis of studies on the efficacy of 21 antidepressants in the treatment of recurrent depressive disorder.Taking amitriptyline as the basis for efficacy, the scientists eventually ranked antidepressants according to the ratio of “efficacy-severity of side effects.” As a result, agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine and vortioxetine were found to be the most effective. And for patients, agomelatine, citalopram, escitalopram, fluoxetine, sertraline, and vortioxetine were identified as the most tolerable with minimal side effects. As a result, escitalopram, mirtazapine, paroxetine, agomelatine, and sertraline were statistically selected for the effectiveness-to-harm ratio.How do you feel about these drugs in your practice? And based on your experience, what are your main choices?

I use an even wider range. Each of them has its own niche. Remember the lock-pick principle

21. Depression can sometimes lead to disability. What are the indications for such an appointment?

As in all cases of definition of disability for mental illness: severity, duration, frequency and persistence of painful manifestations, degree of mental dysfunction and social adaptation, rehabilitation potential.Everything is assessed as a whole.

22. For which activities may depressive disorder be an obstacle? Getting rights? Weapon permit? Joining the power structures of the state?

And it depends on what kind of disorder (after all, the syndrome and the disease that leads to it are still two big differences), as well as what group of observation it requires. For dispensary restrictions, almost all of the above, for consultative and medical ones – are already much less.

23. When I raised a rather urgent and complex topic of suicide: what to do in such cases, where to call and how to act – then from the harsh readers of HabraKhabr comments that such topics should be published in Cosmopolitan. Because the stern bearded administrator grunts any depression with a server – and the ailment ran away. And willpower, nurtured by bugs, downtime and disgruntled users, will drive away any suicide with one sneeze. In your opinion, IT industry specialists are 100% protected from depression and suicide by temperament and willpower, or are they no less susceptible than Cosmopolitan readers?

No, they are also at risk – think of burnout if we are talking about minor depressions.As for major depressions, including within the framework of the TIR (BAR), then the distribution in the population is truly democratic and does not depend on profession, gender, race, material wealth or confession. We can only console ourselves with the fact that both Pushkin and Churchill …

What are the most common side effects of Lexapro?

Disclaimer

If you have any medical questions or concerns, please contact your doctor. Articles in the Health Guide are based on peer-reviewed research and information gleaned from medical societies and government agencies.However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Common Lexapro side effects appear to be dose dependent, which means that you are more likely to get these side effects if you are taking 20 mg than 10 mg. In clinical trials With regard to the efficacy of Lexapro for the treatment of major depressive disorder (MDD) and generalized anxiety disorder (GAD), the incidence of potential side effects did not differ significantly, but the most common side effects were largely the same.In people with MDD, the most common side effects (and their frequency) were (FDA, 2017):

• Nausea (15%)
• Sleep problems (9%)
• Ejaculation disorder (9%)
• Diarrhea ( 8%)
• Drowsiness (6%)
• Dry mouth (6%)
• Increased sweating (5%)
• Dizziness (5%)
• Flu-like symptoms (5%)
• Fatigue / tiredness (5%) )
• Loss of appetite (3%)
• Low sex drive (3%)

Vitals

• Lexapro, the generic name for escitalopram oxalate, is a prescription drug in a group of drugs called selective serotonin reuptake inhibitors SSRI.
• Common Lexapro side effects include fatigue, sleep problems, sexual dysfunction, and dizziness.
• Potential side effects occur when Lexapro is suddenly stopped.

Other possible side effects of Lexapro were noted, although they were not observed in more than 2% of participants in these studies. These symptoms included weight gain, blurry vision, muscle stiffness, and joint pain (FDA, 2017).

In clinical trials, 8% of participants taking Lexapro for GAD and 6% of participants taking a prescription drug for MDD discontinued the drug due to side effects.This study also showed that side effects increased with higher dosages. This was reflected in the discontinuation rate, with more people taking 20mg stopped taking Lexapro than those taking 10mg.

If you experience side effects from Lexapro, it is important to talk to your doctor before stopping your medication. If you stop taking Lexapro suddenly, you may experience withdrawal symptoms such as nightmares, irritability, headache, nausea, dizziness, or vomiting (NAMI, 2016).

SSRIs have a reputation for causing weight gain, and there is evidence that this is true for many of these drugs (Gafoor, 2018). Some studies have found short-term initial weight loss in people taking Lexapro, but long-term studies do not reflect this finding (Walke, 2011). Participants who took Lexapro gained weight similar to many other drugs studied in one study. The association between SSRIs, including Lexapro, and weight gain is highest during the second and third years of treatment (Gafoor, 2018).

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Sexual side effects are also of concern to Lexapro and have been found in both men and women who have taken this medication. Men may have impaired ejaculation (delayed ejaculation), decreased sex drive, impotence, and priapism (painful and persistent erection).Women may experience decreased sex drive as well as an inability to orgasm. There may be alternative therapies available for those struggling with sexual dysfunction while taking Lexapro, including drug switching (Jing, 2016).

What is Lexapro used for?

Lexapro is a prescription drug from a group of antidepressants called selective serotonin reuptake inhibitors or SSRIs. These medications are considered the first line of treatment for depression, although they are also used to treat anxiety and other mood disorders (Bauer, 2009).Lexapro is specifically approved for the treatment of MDD and GAD, but it may be misused by healthcare providers to treat obsessive-compulsive disorder (OCD) (Zutshi, 2007). This has also been studied about patients receiving treatment for overeating (Gerdzhikova, 2007).

Generic Lexapro has the same active ingredient as its branded version. Although previously it could only be produced by Forest Laboratories Inc. (in partnership with the pharmaceutical company Lundbeck), their patent expired in 2012 (Lamy, 2013).This has enabled other companies to apply for FDA approval to manufacture and market Lexapro generics. To earn this approval, companies must prove that their generic Lexapro has the same potency, safety, potency, dosage and form as the brand-name version (FDA, 2018a).

Lexapro dosage and drug interactions

Lexapro and Lexapro generic are available in three different tablet dosages: 5 mg, 10 mg and 20 mg. For both adults and adolescents, a starting dose of 10 mg is usually given in tablet form, which should be taken once a day.For adults, this dose can be increased at least after a week. However, this waiting window is longer for young people. They need to take the starting dose for at least three weeks before any dosage changes are made, although 20 mg can also be used for teens. Lexapro is not usually prescribed for long-term use in the treatment of GAD.

Lexapro should not be taken with certain other medicines, including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and even over-the-counter supplements containing St. John’s wort.Prescription drugs that interfere with the breakdown of serotonin in the body should also be avoided, especially monoamine oxidase inhibitors (MAOIs) such as rasagiline and tranylcypromine.

Combining these drugs increases your risk of a serious illness called serotonin syndrome, which occurs when you have a build-up of actively available serotonin. Serotonin syndrome can cause mild symptoms such as tremors and diarrhea, but can also cause seizures and be life-threatening (Volpi-Abadie, 2013).

You also need to be careful when taking Lexapro with any blood thinning medications, from real-life prescription blood thinners like warfarin to over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, and naproxen. Taking these drugs with Lexapro may increase the risk of bleeding (FDA, 2017).

Warnings Lexapro

Lexapro can cause more serious side effects, although they are less common. Patients and their families should watch for any changes in behavior, including worsening depression, panic attacks, and suicidal thoughts, while starting Lexapro or after changing the dose.These serious side effects are more common.Brief studies have shown that in children, adolescents, and young adults under the age of 18 (FDA, 2018b).

This medicine is known to make people feel tired. It may take a while to feel the full effects of Lexapro and to understand how it affects you. Lexapro may cause drowsiness and may affect your ability to make decisions or react to events. For this reason, it is advised not to drive or operate heavy equipment until you understand how this antidepressant is affecting you.

Alcohol similarly affects your ability to make decisions and react to events. Clinical trials have not shown Lexapro to worsen these effects of alcohol, but standard medical advice is to avoid alcohol while taking Lexapro (FDA, 2017).

When to seek medical attention

You should also see your doctor immediately if you experience (FDA, 2017):

• Changes in mood or behavior, such as increased depression or suicidal thoughts.
• Any symptoms of serotonin syndrome, including coordination problems, hallucinations, heart palpitations, sweating, nausea, vomiting, muscle stiffness, or high or low blood pressure.
• Any symptom of an allergic reaction, including swelling of the face, lips, or tongue, difficulty breathing, rash, or hives.
• Seizures
• Abnormal bleeding
• Manic episodes, which may include jumping thoughts, increased energy, reckless behavior, and talking more or faster than usual.
• Changes in appetite or weight, especially in children and adolescents.
• Vision problems including eye pain, swelling or redness around the eyes.

Lexapro Conclusion

You should not suddenly stop using Lexapro as it is associated with side effects. Withdrawal of Lexapro may include symptoms such as irritability, agitation, dizziness, anxiety, confusion, headache, lethargy, and insomnia. It is generally recommended that you and your doctor reduce your Lexapro dose gradually to reduce the risk of withdrawal symptoms when you stop taking the medication.

How can you enlarge your penis

In some cases, these side effects occur even with a slow dose reduction. If this happens, your healthcare provider may temporarily revert to the previous dose and begin the decline even more slowly (FDA, 2017).

Recommendations

1. Bauer, M., Bshor, T., Pfennig, A., Wybrow, P.K., Angst, J., Versiani, M.,. … … WFSBP Working Group on Unipolar Depres. (2007). The World Federation of Biological Psychiatric Societies (WFSBP) Guidelines for the Biological Treatment of Unipolar Depressive Disorders in Primary Care.World Journal of Biological Psychiatry, 8 (2), 67-104. DOI: 10.1080 / 15622970701227829 Retrieved from https://www.tandfonline.com/doi/full/10.1080/15622970701227829
2. Food and Drug Administration (FDA). (2017, January). Lexapro (escitalopram oxalate). Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021323s047lbl.pdf
3. Food and Drug Administration (FDA).(2018a, 01 June). Generic Facts. Retrieved from https://www.fda.gov/drugs/generic-drugs/generic-drug-facts
4. Food and Drug Administration (FDA). (2018b, February 5). Suicidality in children and adolescents receiving antidepressant treatment. Retrieved from https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/suicidality-children-and-adolescents-being-treated-antidepressant-medications
5. Ghafoor R., Booth H.P. and Gulliford M.K. (2018). Antidepressant use and frequency of weight gain over 10 years of follow-up: a population-based cohort study. Bmj, 361, K1951. Doi: 10.1136 / bmj.k1951. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5964332/
6. Gerdzhikova A.I., Makelroy S.L., Kotval R., Velge J.A., Nelson E., Lake K.,. … … Hudson, J.I. (2007). High-dose escitalopram in the treatment of obese binge eating: a placebo-controlled monotherapy study.Human psychopharmacology: clinical and experimental, 23 (1), 1-11. doi: 10,1002 / hup 899 Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1002/hup.899
7. Jing, E., Straw-Wilson, K. (2016). Sexual dysfunction in selective serotonin reuptake inhibitors (SSRIs) and possible solutions: a review of the narrative literature. Psychiatrist, 6 (4), 191-196. DOI: 10.9740 / mhc.2016.07.191. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007725/
8. Lamas, M.(January 21, 2013). Lexapro is struggling with patent expiration and lawsuits are escalating. Retrieved from https://www.drugwatch.com/news/2013/01/21/lexapro-manufacturer-struggles-as-patent-expires-lawsuits-grow/
9. National Mental Illness Alliance (NAMI). (2016, January). Escitalopram (Lexapro). Retrieved from https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Escitalopram-(Lexapro)
10. Volpi-Abadi, J., Kay, A.M., and Kay, A.D. (2013). Serotonin syndrome. Ochsner Journal, 13 (4), 533-540. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865832/
11. Walke, Y., and Pereira, Y. (2011, August). Changes in weight and body mass index during therapy with amitriptyline, fluoxetine and escitalopram. Retrieved from https://www.priory.com/psychiatry/Weight_gain_antidepressants.htm
12. Zutshi, A., Mathematics, S.B., and Reddy, Y.K. (2007). Escitalopram for obsessive-compulsive disorder.Primary Care Assistant to the Journal of Clinical Psychiatry, 09 (06), 466-467. Doi: 10.4088 / pcc.v09n0611c. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2139927/

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Difference between Celexa and Lexapro (Health)

Celexa vs. Lexapro
Celexa and Lexapro are common drugs used to treat symptoms of depression in patients who are showing severe symptoms.Both drugs are prescription drugs that inhibit the reuptake of serotonin. Chemically, they are both very similar in ingredients, however there are important differences between them and they cannot be used interchangeably, so it is important to disclose all the medications you are taking before you receive your prescription. Patient statements seem to lead to the belief that if one of the two drugs works for you, the other will not, and vice versa.

Both recipes should be stored in a cool, dry area out of the reach of children, as accidental overdose can cause serious injury and even coma.These medicines should not be used if you intend to drive cars or vehicles. Plus, they can be harmful if you are pregnant or breastfeeding. Both medicines are approved by the Food and Drug Administration (FDA).

Celexa is also known as citalopram hydrobromide. One of the main advantages of prescribing Celexa is that a generic prescription is available for purchase, which can save the patient money. This drug comes in pill form and it can take up to 4 weeks for a person to feel the drug’s effects.Some of the side effects may include sweating, dry mouth, vomiting, diarrhea, and loss of appetite. The worst side effects are less common, but include hallucinations and seizures. Celexa is a serious drug and should be taken with caution.

Lexapro is known as escitalopram hydrobromide. Lexapro is very similar to Celexa, however it also has the ability to treat anxiety problems. But unlike the Celexa, there is no universal Lexapro shape. Lexapro is available in both tablet and liquid form, and it can take up to 4 weeks before it becomes effective in a patient’s system.Symptoms of this medication include vomiting, dry mouth, fatigue, heartburn, and diarrhea. Some felt the side effects of Lexapro were lighter than Celexa, as there was no association with seizures. However, patients may still experience hallucinations, severe muscle stiffness, and unusual agitation.
While both of these drugs are intended to treat the same nerve problems in the brain, they still have some important differences in why a doctor might prescribe one over the other.
Summary

1. Celexa and Lexapro are prescribed antidepressants. These drugs are designed to inhibit the reuptake of serotonin.
2. Celexa is known as citalopram hydrobromide and can also be found in generic form. Lexapro is known as escitalopram hydrobromide and is not available in generic form, but it is also prescribed for anxious patients.
3. Side effects of both drugs include vomiting and diarrhea, but Celexa is also associated with seizures.
4. Both are available in tablet form, but Lexapro is also available in liquid form.

Escitalopram (Escitalopramum) – PsyAndNeuro.ru

10 mg tab

20 mg tab

Trade names in Russia

Cipralex, Elicea, Lenuxin, Selektra, Escitalopram, AISIPI, Elicea Ku-tab

Form of issue

Tablets: 5 mg, 10 mg, 20 mg

Capsules: 5 mg, 10 mg, 20 mg

Pharmacological group

Antidepressant

Nomenclature NbN

Serotonin reuptake inhibitor [2].

Readings

◊ Recommendations of the Ministry of Health of Russia

F32 Depressive episode

F33 Recurrent depressive disorder

F40.0 Agoraphobia

F41.0 Panic disorder (episodic paroxysmal anxiety)

◊ FDA recommendation

• Major depressive disorder (in adults and children over 12 years old)
• GTR

◊ Recommendations UK Medicines and Healthcare Products Regulatory Agency

• Major depressive episode
• Panic disorder with / without agoraphobia
• Social phobia
• GTR
• OKR

◊ Use Off-label

• Vasomotor symptoms during menopause
• Insomnia
• Dysmorphophobia
• Bulimia [5].

Target symptoms

• Depressive mood
• Anxiety
• Panic attacks, avoidance behavior
• Sleep disorders

Mechanism of action and pharmacokinetics

Escitalopram is the S-isomer of citalopram. Selectively inhibits serotonin reuptake, increasing the concentration of this neurotransmitter in the synaptic cleft. Escitalopram, like other antidepressants from the SSRI group, practically does not bind to dopamine (D ₁ and D ₂ ) receptors, α-adreno-, m-cholinergic receptors, as well as benzodiazepine and opioid receptors [4].Long-term use of escitalopram leads to desensitization of somatodendritic 5-HT1A and terminal autoreceptors.

• Bioavailability – 80%.
• Half-life 27-32 hours
• Stable blood concentration is maintained for one week
• Metabolized by CYP3A4, CYP2C19; inhibits CYP2D6

Treatment regimen

◊ Dosage and dose selection

• Optimal dose for depression, OCD and GAD: 10-20 mg / day
• Start at 10 mg / day if necessary increase to 20 mg
• Take once a day, morning or evening
• Escitalopram 10 mg is comparable to citalopram 40 mg, but no side effects
• A dose of 30-40 mg is suitable for some patients [1]
• To relieve vasomotor symptoms during menopause, 10 mg / day is sufficient, but if ineffective within 4 weeks, the dose may be increased to 20 mg / day
• If anxiety, insomnia, agitation, akathisia appear at the beginning of treatment or after interruption of treatment, consider the possibility of bipolar disorder and switch to a mood stabilizer or atypical antipsychotic

◊ How quickly does it work

• Effective after 2-4 weeks
• If there is no effect after 6-8 weeks, you need to increase the dose or switch to another drug
• May be used for many years to prevent relapse.

◊ Expected Result

• Complete remission.
• After the disappearance of the symptoms of depression, you should continue taking it for 1 year if it was the treatment of the first episode. If this treatment is a recurrent episode, the treatment can be extended indefinitely.
• Use in the treatment of anxiety and chronic pain may be indefinite.

◊ If not working

• Change dose, change to another drug, or add ancillary drug;
• Connect psychotherapy;
• Reconsider the diagnosis after finding out comorbid conditions;
• In patients with undiagnosed bipolar disorder, the effectiveness of treatment may be low, in which case a mood stabilizer should be considered [1].
• In the acute phase of severe depressive disorder accompanied by psychotic or catatonic symptoms, as well as in patients with actual suicidal ideation, electroconvulsive therapy should be considered [7].

◊ How to stop taking

Gradually tapering is usually not necessary, but to be sure to avoid withdrawal symptoms can be tapering off gradually. The scheme of gradual reduction: the dose, reduced by 50% – 3 days, again reduced by 50% – 3 days, complete cessation.If withdrawal symptoms appear, increase the dose, wait for the withdrawal symptoms to disappear and continue decreasing [1].

◊ Treatment Combinations

• For insomnia: trazadone
• For fatigue, drowsiness, loss of concentration: modafinil [3].
• Combinations with other antidepressants may activate bipolar disorder and suicidal ideation
• For bipolar depression, psychotic depression, refractory depression, refractory anxiety disorder: mood stabilizers, atypical antipsychotics
• For anxiety disorder: gabapentin, tiagabine

Warnings and contraindications

• Use caution if patient has had convulsions;
• Use caution if patient has bipolar disorder;
• Do not use if patient is taking pimozide;
• Do not use if allergic to citalopram or escitalopram [1].

Special patient groups

◊ Patients with kidney problems

Use caution if patient has severe kidney disease [1].

◊ Patients with liver disease

The recommended dose is 10 mg / day [1].

◊ Patients with heart disease

There are no systematic data on the use of escitalopram in people with pathology of the cardiovascular system.Presumably safe. It is useful in recovering from a heart attack [1].

◊ Elderly patients

A dose of 10 mg is recommended for elderly patients [1].

◊ Children and adolescents

• Recommended for the treatment of depression aged 12-17
• The patient should be monitored regularly and personally, especially during the first weeks of treatment.
• Use with caution, bearing in mind the risk of undiagnosed bipolar disorder and suicidal tendencies.
• Inform adults about risks.

◊ Pregnant

• There were no appropriate studies of pregnant women [1].
• Not recommended for pregnant women, especially in the first trimester
• All risks should be weighed and compared
• Bleeding may be expected during childbirth

◊ Breastfeeding

• The drug passes into breast milk.
• If the infant shows signs of irritation or sedation, stop feeding or taking escitalopram
• However, postpartum treatment may be necessary and the risks must be weighed.

Interaction with other substances

• Contraindicated (!) Use with: ziprasidone, selegiline, procarbazine, phenelzine, isocarboxazid
• Tramadol increases the risk of seizures
• Cannot be used with MAO inhibitors.After you stop taking MAO inhibitors, 14 days should pass. Start treatment with MAO inhibitors 7 days after the end of escitalopram.
• Together with warfarin, it probably increases the risk of bleeding [1].

Analyzes during treatment

Not required.

Side effects and other risks

◊ Mechanism of side effects

Side effects are caused by increased serotonin levels.Most side effects occur immediately after starting treatment and go away over time.

◊ Side effects

• Gastroenterological (decreased appetite, nausea, diarrhea, constipation)
• Insomnia, sedation, agitation, tremor
• Sweating
• Urinary Disorder
• Dry mouth
• Dangerous side effects: seizures, mania, suicidal ideation
• Weight gain: very rare
• Sedation: very rare
• Sexual dysfunction: yes

◊ What to do with side effects

1. Wait
2. Switch to another antidepressant [1].

◊ Long-term use

Safe

◊ Addictive

No.

◊ Overdose

• Very few overdose reports.
• Very rare cases of fatal overdoses.
• Vomiting, sedation, cardiac arrhythmias, dizziness, tremors.

Benefits

• Good for patients taking other medications – very few dangerous interactions;
• Gives a relatively fast result [1].

Weakness

High price

Expert Advice

• Best tolerable antidepressant
• Weakest effect on the sexual sphere in comparison with other SSRIs
• Failure to respond to escitalopram in elderly patients may indicate Alzheimer’s disease
• In postmenopausal women, escitalopram works better when combined with estrogen [1]
• Escitalopram and fluoxetine show similar effects in the treatment of depression.The only difference noted is that escitalopram significantly improves the parameters of microinflammation in the patient’s body [6].

Footnotes

1. Stephen Stahl “Prescriber’s Guide”, 6th edition, 2017

2. Neuroscience-Based Nomenclature (https://www.nbn2.com/taskforce)

3. In Russia, modafinil is included in the “List of narcotic drugs and psychotropic substances, the circulation of which is limited and in respect of which control measures are established” (List II)

4.Escitalopram dragbank.ca

5. Escitalopram medscape.com

6. Xiaoling Z, Yunping H, Yingdong L. Analysis of curative effect of fluoxetine and escitalopram in the depression treatment based on clinical observation. Pak J Pharm Sci. 2018 May; 31 (3 (Special)) 1115-1118.

7. American Psychiatric Association. Guideline Watch: Practice Guideline for the Treatment of Patients with Major Depressive Disorder, Second Edition. American Psychiatric Association Practice Guidelines .

What factors affect an adequate dose of escitalopram?

Escitalopram, marketed under the brand names Lexapro®, Cipralex®, Seroplex®, Lexamil® and Lexam®, is a member of a group of drugs that selectively inhibit serotonin reuptake. This class of drugs includes popular psychiatric drugs such as Prozac® and Paxil®, which began to be phased out in 2008 as treatments for depression, but have gained popularity for treating anxiety and obsessive-compulsive disorder.The dosage recommendations for escitalopram are relatively similar for patients of different ages and weights, although caution should be exercised when prescribing the drug to elderly patients or patients with reduced levels of kidney or liver function.

Although escitalopram has sometimes been used controversially for the treatment of depression in pediatric patients, since 2011 the FDA has not explicitly approved the use of the drug in this population.Adults who are being treated for an underlying depressive disorder should first receive an oral dose of escitalopram 10 mg once daily. Higher doses have not been shown to be more effective in treating depression. Although the drug is intended for use in acute depressive episodes, it can sometimes be used for longer periods to maintain positive clinical results in patients who respond well to the drug.

Patients with generalized anxiety disorder may also benefit from treatment with this drug. You can use the same starting dose of escitalopram that is used for depression. If after two to four weeks control of the condition is not achieved, the dose of escitalopram can be increased to 20 mg per day. Although considered to be an effective treatment for chronic anxiety, as of 2011, no longitudinal studies have been conducted to conclude that escitalopram is effective after an initial eight-week treatment period.When using this medication to treat generalized anxiety disorder, the patient must be retested every three months to determine if it continues to be effective.

When you stop using the drug, the daily dose of escitalopram should be gradually reduced over several weeks. Patients over 65 years of age who suffer from decreased liver or kidney function should be prescribed daily escitalopram, the dose of which should not exceed 10 mg per day.Other risks of escitalopram include the possibility of a fatal hypertensive crisis when taken within 14 days after stopping antidepressant therapy with a drug that inhibits monoamine oxidase.

With similar pharmacological properties, clinical uses and spectrum of side effects, escitalopram followed roughly the same trajectory as Prozac® and Paxil®. The most common side effects of escitalopram are insomnia, pupillary constriction, anhedonia, dry mouth, drowsiness, sweating, dizziness, constipation, indigestion, fatigue, decreased libido, delayed ejaculation, genital anesthesia, and inability to reach orgasm.Although most side effects resolve soon after the drug is discontinued, the sexual side effects of the drug may persist for months or years after use.

OTHER LANGUAGES

TIPS ON HOW TO STOP TAKING LEXAPRO – MEDICAL

Contents:

Lexapro, a brand name for a prescription selective serotonin reuptake inhibitor, or SSRI, is used to treat depression and anxiety. Lexapro, like any SSRI medication, can cause serious withdrawal effects if the drug is stopped too abruptly 1. People wishing to stop taking Lexapro must follow a specific process to reduce or eliminate the likelihood of these withdrawal effects 1.

Is this an emergency?

If you experience severe medical symptoms, seek emergency help immediately.

Get medical approval. Sometimes people want to stop taking a medicine as soon as they feel better, but it can be dangerous to do so without a doctor’s approval.People who stop taking Lexapro should gradually stop taking the medication under the supervision of a doctor.

Discuss the weaning process with your doctor. A doctor will be able to explain in detail the possible effects of Lexapro withdrawal, which typically include irritability, dizziness, anxiety, headaches, insomnia, agitation, fatigue, confusion, and a burning or tingling sensation, health website eMedTV.com explains 12.

Reduce the amount of Lexapro you are taking by carefully following your doctor’s instructions. Although it may be tempting to speed up the weaning process by lowering the dosage above the recommended dosage or stopping the medication altogether, this increases the likelihood of withdrawal symptoms and can be dangerous.

Tell your doctor about any unpleasant consequences of withdrawal. Although most people will experience only mild withdrawal effects if they follow a doctor’s recommended weaning plan, some people will experience severe or unpleasant effects. If this is the case, ask your doctor if another weaning plan would work.The doctor may re-prescribe the original dosage before introducing a new weaning plan, or may continue with the current dosage but at a more gradual rate, explains the drug website RxList.com 2.

Tips

Since the drugs must not be thrown away, ask the doctor what to do with Lexapro tablets left after the completion of the weaning process.