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US Brand Name:
Lexapro
A link here will take you to the official website for the drug.Other Brand Names:
Cipralex
(Austria, Denmark, Finland, Germany, Greenland, Holland [the Netherlands]
Iceland, Ireland, Italy, Norway, Portugal, Spain, Sweden)
Seroplex (France)
Sipralexa (Belgium, Luxembourg)
Generic Name: escitalopram oxalate
Other Forms: Oral solution
What is Lexapro: Lexapro
(escitalopram oxalate) is an
Antidepressant, specifically Lexapro is a Selective
Serotonin Reuptake Inhibitor (SSRI).
Read up on these sections if you
haven't done so already, because they cover a lot of information about multiple
medications that I'm not going to repeat on many pages. I'm just autistic
that way about not repeating myself.
What are FDA Approved Uses: Lexapro (escitalopram oxalate) is approved
and used for:
Some of Lexpro's Other, Off-Label Uses Include:
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Lexapro's pros and cons:
Pros:
Lexapro is
the most selective of all the
Selective
Serotonin Reuptake Inhibitors (SSRIs).
Many people who take Lexapro have reported that it has better effects and lower chances for side effects than other SSRIs. When side
effects do strike they tend to be less harsh. Lexapro gets rave reviews from the Panic/Anxiety
community.
Cons: The dosage of Lexapro is such that discontinuation can be more difficult than with other
SSRIs. Not because Lexapro is more addictive, it's not. Paxil
(paroxetine hydrochloride)
holds that honor (for true SSRIs that is, Effexor (venlafaxine hydrochloride)
is not a true SSRI). It's just that you don't have many dosage options with Lexapro. The same
goes with its use in bipolar, making it way too easy to trigger mania.
Although to be fair, fewer people in the bipolar community reported manias when
starting Lexapro (escitalopram oxalate) than with other SSRIs.
What are Lexapro's Typical Side Effects:
Pretty much the usual for SSRIs
- headache
- nausea
- dry mouth
- sweating
- sleepiness or insomnia
- diarrhea or constipation
- weight
gain
- loss of libido
Most everything but the weight gain and loss of libido usually goes
away within a couple of weeks. The odds are just lower than the other SSRIs and the
effects less severe, even the weight gain and sexual problems tend to be not as bad with
Lexapro (escitalopram oxalate). When Lexapro (escitalopram oxalate) does hit you sexually it tends to be anorgasmia, i.e. you can't cum,
no matter how much romance and/or porn is involved. In the prudish
language of PI
sheets and clinical trials, anorgasmia affects only women.
With men the problem is listed as an "ejaculation disorder."
For tips on how to cope with these side effects, please see our
side effects page.
These aren't all the side effects
possible, just the most popular ones.
Lexapro's Not So Common Side Effects include:
- lethargy
- apathy
- generally not giving a damn
The above may all read as interchangeable, but there are subtle
differences. And while they are also common to other SSRIs,
with Lexapro these tend to be less common, but when they do hit they
hit hard. I'm talking
antipsychotic
hard. Rarely have I read complaints of the zombification
effect with other antidepressants, except the usual whining of the
bipolar who miss their
manias. Fortunately, just as with the antipsychotics, the
zombie-like feeling passes within a couple weeks, at most.
I've also read several accounts of jaw tightening and clenching.
To the point of
temporomandibular joint syndrome (TMJ). Sometimes dental
appliance intervention is required (e.g. wearing a mouth guard at
night).
These may or may not happen to you don't, so don't be surprised one way or the
other.
Lexapro's Freaky Rare Side Effects: Lexapro (escitalopram oxalate) hasn't been on the
market long enough for the really freaky side effects to come out, so we're stuck with
uncontrolled eye movement and excessive discharge of breast milk when there shouldn't be
any breast milk at all. As in for both men and women. It's noted that in the clinical
trials someone on Lexapro (escitalopram oxalate) complained that their muscle tone increased. There's no pleasing
some people. The
Israeli
package insert warns of "exaggerated gaiety." But I thought one was
either born flaming or it came from watching too many episodes of "Queer Eye for
the Straight Guy" and getting a Carmen Miranda toaster oven during the
recruitment period. Or something like that.
You aren't going to get these. I promise.
For all side effects, read the PI sheet.
Hell, read all of them below and really indulge your
cyberchondria.
Interesting Stuff About Lexapro Your Doctor Probably Won't Tell You: Lexapro
(escitalopram oxalate) hasn't been on the
market long enough for anything really interesting to come to the surface yet.
Again, in spite of it being
much more potent and selective than
Celexa (citalopram hydrobromide)
, PubMed keeps returning Celexa for all my searches.
Even the PI sheet points out stuff on Celexa. Probably for good reason,
as this pooled analysis of over 1,600 people in double-blind studies
comparing Lexapro with either placebo or
Celexa (citalopram hydrobromide)
concludes. The hypothesis: "Escitalopram
is the active isomer of the antidepressant citalopram. In theory single-isomer
drugs may be superior but few have been found to have clinically significant
advantages." And what did they find? "On the evidence
available to us the manufacturer's claims of superiority for escitalopram over
citalopram are unwarranted. The Swedish and Danish drug regulatory authorities
reached similar conclusions." So if you're paying full retail for
Lexapro (escitalopram oxalate) and
Celexa (citalopram hydrobromide)
is cheaper, you may want to try the Celexa first.
One thing I did find, which
makes Lexapro stand out among all the meds we discuss here:
if the early side effects suck, just move on. Really, don't stick it
out. Apparently Lexapro (escitalopram oxalate) turns out to be no better
than placebo with bad side effects. Not mild side effects, just
really suck-ass ones.
Lexapro's Dosage and How to Take Lexapro: For both
Major Depressive Disorder
and
Generalized Anxiety Disorder (GAD) the initial dosage for Lexapro
(escitalopram oxalate) is the same. 10mg a day that can be increased to 20mg a day after at
least one week. That's it!
A lot of people are starting out at 5mg a day (splitting the
tablets in half, or getting the new 5mg tablets) and increasing the dosage in 5mg increments for better control over
effects and side effects, as well as discontinuation.
I recommend starting at 5mg and
waiting at least two weeks before taking more than 10mg a day. The folks in
the bipolar community who started at 5mg a day reported fewer issues with manias
being triggered that way. Hmm, I wonder why they started making 5mg
tablets? The only I could find backing up my go-slow approach
was for social anxiety disorder. In that one 5mg a day turned out to
be good enough, period.
As for all the off-label uses, as always it's going to be up to your doctor.
Check the studies in the links above.
Days to Reach a Steady State: About a week,
per the PI sheet.
When you're fully saturated with the medication and less prone to peaks and valleys of
effects. You still might have peaks of effect after taking many meds, but with a lot of
the meds you'll have fewer valleys after this point. In theory anyway.
How Long Lexapro Takes to Work: Like all SSRIs Lexapro
starts to work anywhere from a couple days to over a
month, but many who have tried other SSRIs report that Lexapro (escitalopram oxalate) kicks in faster than the
competition, with about one to two weeks being reported frequently. One large
meta-analysis (pooling data of published studies) concluded that
Lexapro (escitalopram oxalate) pretty much works in a week. The
standard line with SSRIs is the if you don't feel any positive benefit after six weeks, then you should talk
to your doctor about either another SSRI or trying a med that hits another
neurotransmitter. With Lexapro cut that down to three weeks to a month.
Lexapro's Half-Life: 27-32 hours.
How Long Lexapro Takes to Clear Out of Your System: On
average Lexapro (escitalopram oxalate) is out of your system in 6-8 days.
It has a couple of marginally active metabolites, so especially sensitive people
may have it lingering around for a day or two longer.
How to Stop Taking Lexapro: Your doctor should be recommending that
you reduce your dosage by 5mg a day every 6-8 days if you need to stop taking
it, if not more slowly than that. Based on the 27-32 hour half-life.
For more information, please see the page on how to
safely stop taking these crazy meds. Because of it's super-selectivity
Lexapro is more of a coin-toss when it comes to
SSRI
discontinuation syndrome. Somewhat fewer people than average are
subject to it, but there is a symptom that is especially bad with Lexapro
(escitalopram oxalate) - the sensation of electric shocks. Sometimes felt
in your body, or sometimes the standard
brain shocks & shivers
of SSRI discontinuation. At least Forest & Lundbeck included warnings
specifically about this in the PI sheet. I
don't know who spanked them into that, but I'm glad it happened.
If you've worked your way up to a particular dosage, it's usually best to spend this
many days at the next lowest dosage before going down the next lowest dosage before that
and so forth. This is the least sucky way to avoid problems when stopping any psychiatric
medication. Presuming you have the option of slowly tapering off them.
Chances that Lexapro Will Work:
If you read the PI sheet you'll just see that for
Major Depressive Disorder
Lexapro (escitalopram oxalate) showed significantly greater mean
improvement compared to placebo. But no hard numbers are given. Why? Because
"significant" means somewhere in the neighborhood of 20%. On top
of that drug companies love using
the Montgomery-Asberg Depression Rating Scale (MADRS) because
MADRS scores improve regardless of the antidepressant used. That doesn't
look too good. So you have about a 1 in 5 chance of it, or any SSRI, doing
its job. Part of the problem is that serotonin isn't always the issue with
someone's depression.
I've looked for the clinical trials themselves, and there aren't any numbers
in the abstracts either. Take a look for yourselves:
We'll head down to our local medical library, which has a buttload of
journals, and let you know if we find anything. One of these days.
In any event here's what I could find.
I could find
a study indicating that Lexapro (escitalopram oxalate) is good to prevent relapses of major
depressive disorder when compared to a placebo. Close to 75% of the people
taking Lexapro (escitalopram oxalate) after 4-6 months were still not depressed, vs. 60% taking the
wonder drug Placebo. Unfortunately we don't get to see how their MADRS
scores were. I suspect this was the fourth trial mentioned in the PI
sheet.
In regards to GAD,
this double-blind study of 158 people taking Lexapro (escitalopram
oxalate) vs. 157 people
taking placebo had 68% of the people taking Lexapro (escitalopram oxalate) responding against 41%
taking the placebo. Not too bad for the placebo. In Lexapro's favor,
though, on the Hamilton Rating Scale for Anxiety, those taking Lexapro averaged
a 11.3 point drop from a score of 18 points or higher, whereas those taking the
placebo dropped only an average of 7.4 points. So you can fool some of the
people with GAD into feeling better, but even those you fool won't feel better
than they could have with a real med.
What looks like a follow up to the clinical trials for Lexapro's approval for
GAD has even better numbers than the above. Those who completed the
8-week double-blind trials were given the option of knowing they were taking
Lexapro (escitalopram oxalate) 56% of the people made it to the end, so about
half in all, or roughly 250 people were still helped by Lexapro (escitalopram
oxalate) for generalized anxiety disorder (GAD) , and helped a lot.
Furthermore, following patients 24-76 weeks
this study found that Lexapro (escitalopram oxalate) helped prevent the
relapse of generalized anxiety disorder (GAD) for 75% of the people taking
Lexapro (factoring in the 7% of people who had to stop taking it because of
adverse effects).
How Lexapro Compares to Other Meds:
Lexapro vs. Effexor Compared with
Effexor (venlafaxine hydrochloride), Lexapro
(escitalopram oxalate) is about equally effective, provided one can stand taking
the Effexor. Lexapro certainly sucks less. And as more and more
people were able to take the Lexapro longer, it wound up working better in the
end.
Lexapro vs. Effexor, European Style As above, compared with
Effexor (venlafaxine hydrochloride), Lexapro
(escitalopram oxalate) is about equally effective, provided one can stand taking
the Effexor. In this study it's pointed out that Lexapro not only sucks
less, but works faster.
Lexapro vs. Celexa vs. Placebo
This review pools the results of studies comparing Lexapro (escitalopram
oxalate),
Celexa (citalopram hydrobromide)
and good old Placebo. So not much in hard numbers, other than 56% of the
people taking Lexapro responded to it, vs. 41% of the people taking Celexa.
Lexapro vs. Celexa for suicidal ideation (thoughts). You know you're
really depressed as fuck when you're sitting around all day thinking about
offing yourself. So what's the better drug for you, Lexapro (escitalopram
oxalate) or
Celexa (citalopram hydrobromide)?
And how much of either should you be taking? Fortunately someone decided
to do a study on just that. Well, they just wanted to do the study on how
much of either was more effective and sort of stumbled on the suicidal ideations
as the best way of measuring how well things were working. In the end the
data are kind of weird. Compared with Celexa, Lexapro works better right
aware and in the long-run (after 8 weeks). But between two and eight weeks
there doesn't seem to be much difference between 20mg of Lexapro and 40mg of
Celexa.
Lexapro vs. Celexa for
old people's panic attacks. They're messing with Social Security!
The supermarkets rearranged all the aisles! Everyone over 70 has to live
in a home whether they want to or not! Those kids won't get off the lawn!
Every day Matlock is on at a different time! OK, enough with the old
jokes. Studying the effects on geriatric patients is actually important
science. The result of this study - Lexapro (escitalopram oxalate) works
in half the time. Surprised? Otherwise there's no appreciable
difference.
Lexapro vs. Paxil for generalized anxiety disorder (GAD). Compared
with Paxil (paroxetine),
Lexapro (escitalopram oxalate) is more effective in treating GAD and certainly
sucks a lot less. At least for these 120 people after six months.
A review of cost and quality of life comparing Lexapro with other SSRIs and
Effexor (venlafaxine hydrochloride) in Europe
had it coming out as Lexapro being cheaper to use with fewer side effects.
As I already noted in the section on interesting stuff your doctor won't tell
you,
this European pooled analysis of over 1,600 people in double-blind studies
comparing Lexapro with either placebo or
Celexa (citalopram hydrobromide)
concludes you may want to try
Celexa (citalopram hydrobromide)
if your insurance company insists upon it, or Lexapro just
seems too potent.
A STEPS review
(Safety, Tolerability, Effectiveness, Price, and Simplicity) conducted by highly
respected Baylor College of Medicine found 10mg a day to be as effective, if not
more so, than 40mg of Celexa. Plus at 10mg a day Lexapro comes out
as actually cheaper than brand name and some generic versions of other SSRIs of
comparable dosages. But it doesn't come out as significantly
better. So this is in line with the European study above.
In spite of the above two reviews, I still think there is enough difference
between Celexa and Lexapro that if Celexa seemed to almost work, that
Lexapro is worth a shot. But if Celexa was an utter failure, don't bother
with Lexapro. The other studies I'm citing show that, all other things
being equal, Lexapro (escitalopram oxalate) works in one or two weeks, instead
of the four weeks that is typical with most other
Selective
Serotonin Reuptake Inhibitors (SSRIs).
Lexapro vs. desipramine vs. placebo for after-dinner dyspepsia Uh, OK.
From the study, "Antidepressants are widely used to treat functional
gastrointestinal disorders but their effect on postprandial symptoms remains
unstudied." So someone thought to put Lexapro (escitalopram oxalate)
head to head with Norpramin (desipramine). About as
potent and selective as one can get with serotonin vs. as potent and selective
as one can get with norepinephrine. The result? Not much.
Lexapro vs. Paxil vs. Effexor - whose discontinuation syndrome sucks more?
Finally, somebody looking into the question a lot of people want answered, which
med is easiest to stop taking? And does it make a difference if you have
major depressive disorder (MDD), generalized anxiety disorder (GAD) or social
anxiety disorder? So they compared Lexapro (escitalopram oxalate) with
Paxil (paroxetine)
and
Effexor (venlafaxine hydrochloride) to see
which med was the easiest to quit. The results - Lexapro (escitalopram
oxalate) showed "significantly" fewer problems with discontinuation than either
Paxil (paroxetine)
and
Effexor (venlafaxine hydrochloride),
regardless of your brain cooties.
How Lexapro Works In Your Brain: Lexapro (escitalopram oxalate)
is the most potent and most selective of all
Selective
Serotonin Reuptake Inhibitors (SSRIs) on the
market.
According to this study it's 30 times more potent and selective than Celexa.
Dr. Stahl in
Essential Psychopharmacology of Depression and Bipolar Disorder,
and Dr. Preskorn in
Clinical Pharmacology of Selective Serotonin Reuptake Inhibitors
both list Celexa as the post potent and selective of SSRIs. N.b. in
reading the numbers on Dr. Preskorn's site, sometimes it's the lower
number that means it's more potent. That's why Celexa is the most
selective, it barely touches anything else. Only
Luvox (fluvoxamine maleate) has a slighter lighter touch on dopamine.
So regardless of the pooled analysis
cited above comparing Lexapro with Celexa, I think there is a significant
difference between the two. Just that Celexa is probably the better to try
first unless severity of symptoms warrants the super potency of Lexapro.
Like all
Selective
Serotonin Reuptake Inhibitors (SSRIs)
Lexapro (escitalopram oxalate) doesn't make you
produce more serotonin, rather it makes your neurons soak for a longer period of
time in the serotonin you already produce. Serotonin is one of the big
three neurotransmitters responsible for depression, along with norepinephrine
and dopamine. My wild-ass guess / rule of thumb is that imbalances of one
or more of the three are responsible for 80% of the depression issues.
It's all just a matter of figuring out exactly the extent of the tweaking and
what neurotransmitters you exactly need to tweak.
|
|
Comments: Be sure to read the sections on
antidepressants and especially SSRIs if you haven't done so already.
Approved by the FDA to treat depression in August
2002,
Lexapro (escitalopram oxalate) is the new & improved version of
Celexa (citalopram oxalate).
Because it is so new, there's not much literature on it! It's all
anecdotal evidence, folks. I can't find much in the way of
studies. None of the books have anything. Most of the
off-label uses above are from Remedy Find, and mainly reflect what
Celexa (citalopram oxalate) is used for off-label, and if
Celexa (citalopram oxalate) works for it, then Lexapro
(escitalopram oxalate)
is just tried! Lexapro is one of the few antidepressants that
Mouse and I have no personal experience with.
Still, if you do move from Celexa (citalopram
oxalate) to Lexapro (escitalopram oxalate), expect few, if any of
the common side effects. Many people have reported making the switch with
little or no side effects. However if you move from any other SSRI to
Lexapro, expect some adjustment period and a brief return of common side effects
you thought you were done with.
If you are looking at your first SSRI, or switching to another SSRI
because of side effects, Lexapro seems to
be a good choice. I've found one reference to
a single case study where someone overcame the sexual side
effects of Prozac (fluoxetine hydrochloride)
by switching to Lexapro (escitalopram oxalate). Many people have reported that the sexual
side effects, along with all of the common SSRI side effects in general,
are just less harsh with Lexapro (escitalopram oxalate). Plus it tends to work faster
than other SSRIs. So if you're going to start anywhere with an
SSRI, Lexapro (escitalopram oxalate) seems like the best first choice, as the anecdotal
evidence indicates (i.e. what the users of the drug say) that it sucks
less than all the others. At least if you're going for a med that
works quickly and has fewer side effects and you and your doctor are
pretty sure that serotonin is the problem in the first place. If
you're not that sure it's serotonin, you'll probably want to go with the Prozac
(fluoxetine hydrochloride) first. While Prozac
(fluoxetine hydrochloride) has more side effects, it will generally mess
with you less because it is the weakest of SSRIs. There's a bit of
a difference.
It may be too new to know if Lexapro (escitalopram oxalate) is any
better than the others at controlling symptoms, but if it's as good as
the others and sucks less, that's a huge plus.
|
Have questions about Lexapro? Want to read about experiences other
people have had with Lexapro? Check out
our
Lexapro
Board.
Who Makes Lexapro:
Forest Pharmaceuticals,
Who Makes Cipralex: H. Lundbeck A/S
Sample US Cost of Lexapro: $71 for 30 10mg tablets
As of 11/03/2003. Full retail for the uninsured. Go ahead and gloat, citizens of
civilized countries and all of you with full medical coverage.
Sample Canadian Cost of Lexapro:
$165 for 90 tablets in either 10mg or 20mg.
As of 05/16/2004. In US dollars, for re-importation to the US. Does not
include any shipping charges.
Remedy Find Rating for
Depression
Remedy Find Rating for
Panic/Anxiety
Check
for Drug-Drug Interactions
Full
Patient/Prescribing/Physician Information Sheet
UK
Cipralex PI Sheet (what patients get)
UK Cipralex SPC Sheet (what doctors get)
New
Zealand Lexapro data sheet (for doctors)
Swedish Cipralex SPC / PI Sheet
Finnish
Patient Information Leaflet
Danish Cipralex PI Sheet
Italian Cipralex PI Sheet
Israeli Cipralex Package Insert for patients, in Hebrew & English
Israeli Cipralex Prescribing Information for doctors, in English
Please see the section on how to read these sheets. Don't freak out about every potential side effect. Look at the odds of
something having happened during the clinical trials.
Lexapro's Wikipedia Entry
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Take care, and keep taking your crazy meds!
Jerod
If you still have unanswered questions about this or other medications,
including which one is, or combination of meds are the best for you, your best
bet is to ask on Crazy
Meds Talk. Better yet, if you want to let the world know how they
worked out for you and want to help out others in their quest for the correct
meds, join the party.
If you want to discuss your issues, I suggest checking out one of
the various
support groups online.
Otherwise, if you're letting me know about how much you like or hate the site,
or need to let me know about medication effects in private, then just drop
a note to jerod23 at gmail dot com Honestly, I usually don't have a
lot of time to answer e-mail these days. The snide autoresponse
message that may or may not hit your mailbox is going to tell you the same
thing.
Another problem is that you may not get a response even if I wanted to send you
one. You see, so many dickweeds with malicious intents and too much time
on their hands have appropriated the crazymeds.org domain name to use for their
spam, viruses and the like. Subsequently some lazy-ass e-mail protection
software authors just go by the domain name, and not the IP address. So
I've been blacklisted because of the actions of others. Or the software
just doesn't like the domain name because of the "crazy" and/or "meds." Or
your question about a particular medication will set off spam flags. So
the e-mail just wouldn't go through regardless. Sorry.
Hey, did you find this page all by itself through Google or some other search engine?
Great! But to really appreciate the entire site, you need to start here.
Dead tree references:
Physicians' Desk Reference Edition 59
Min Ko and Greg Tallis, Drug
Information Specialists, et al. © 2005. Published by
Thomson PDR.
Mosby's 2004 Drug Guide David Nissen PharmD, Editor.© 2004. An
imprint of Elsevier. The
edition we're using isn't listed on Amazon.
Essential Psychopharmacology The Prescriber's Guide Stephen M. Stahl, M.D., Ph. D. © 2005.
Published by Cambridge University Press
End of books used for this article.
Created Saturday, November 08, 2003
Last updated
Saturday, May 15, 2010
Copyright © 2003 - 2010 Jerod Poore. All rights
reserved.
Almost all of the material on this site is copyright © 2003, 2004, 2005,
2006, 2007, 2008, 2009 and 2010 Jerod Poore. Except, of
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All rights reserved. No warranty is expressed or implied in this information.
Consult one or more doctors and pharmacists before taking, or changing how you take any
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Know your sources! As such the information
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Very little information about visitors to this site is collected or
saved. And from time to time I do look at search terms used to find it in an effort
to make the information I present more relevant. Use only as directed. Void where
prohibited.
"Everything is true, nothing is permitted." - Jerod Poore
