Lexapro

US Brand Name: Lexapro

Other Brand Names: Cipralex (UK, Ireland and various European countries)

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:

  • Major Depressive Disorder  (a.k.a. feeling like Whale Shit at the Bottom of the Ocean) August 2002
  • Generalized Anxiety Disorder (GAD) December 2003

Some of Lexpro’s Other, Off-Label Uses Include:

    • Panic
    • Social Anxiety Disorder
    • Bipolar Depression
    • OCD
    • Pathological Gambling
    • Premenstrual Dysphoric Disorder (when you take it during your cycle really matters)
    • Pervasive Developmental Disorders incredibly young children (as in three to five years old) given adult dosages to make life easier on their parents.  Uncle Arnie, why don’t they look for you when these kids need you the most?
    • Raynaud’s phenomenon
    • Other off-label uses are likely, as a PubMed search for “escitalopram” automatically brings up both Lexapro and Celexa (citalopram hydrobromide) entries.  Yet if you refine it to “escitalopram oxalate” you wind up with about 10% of the PubMed items at best.  See the comments below for the comparison of Lexapro and Celexa.
    • 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.”

    • 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.

    • 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:

      • Fixed-dose trial of the single isomer SSRI escitalopram in depressed outpatients.
      • Escitalopram 10 mg/day is effective and well tolerated in a placebo-controlled study in depression in primary care.
      • Escitalopram (10-20 mg/day) is effective and well tolerated in a placebo-controlled study in depression in primary care.

      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.

Related Posts