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Starting LEXAPRO / Dosage Issues

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Below are the answers to frequently asked questions about the SSRI antidepressant LEXAPRO (escitalopram oxalate). The answers are provided by HealthyPlace.com Medical Director, Harry Croft, MD, a board-certified psychiatrist.

As you are reading these answers, please remember these are "general answers" and not meant to apply to your specific situation or condition. Keep in mind that editorial content is never a substitute for a visit to a health care professional.

Q: When you first start LEXAPRO, what should that feel like—physically and emotionally?

When first taking LEXAPRO, a patient might feel little change, unless there are some initial side effects (which generally disappear after 7 to 14 days). For most patients, it takes at least a week or two before they feel any improvement. Full antidepressant effect may take 4 to 6 weeks.

In general, emotional improvement is gradual, and realized by looking back over the past several days and noting "you know, I am starting to feel less hopeless, despondent, and depressed." It is also common to begin to have some "good" days only to have them followed by some "not so good" ones. Patients should not feel discouraged by the "blue" days, but rather encouraged by the "good ones", as they indicate that recovery is beginning.

In clinical trials, LEXAPRO was shown to be well tolerated by most people with many of the side effects disappearing in the first few weeks.

The most common adverse events reported with LEXAPRO vs placebo (approximately 5% or greater and approximately 2X placebo) were nausea, insomnia, ejaculation disorder, somnolence, increased sweating, fatigue, decreased libido, and anorgasmia. LEXAPRO is contraindicated in patients taking monoamine oxidase inhibitors (MAOIs) or in patients with a hypersensitivity to escitalopram oxalate or any of the ingredients in LEXAPRO. Lexapro is contraindicated in patients taking pimozide (see DRUG INTERACTIONS - Pimozide and Celexa). As with other SSRIs, caution is indicated in the coadministration of tricyclic antidepressants (TCAs) with LEXAPRO. As with other psychotropic drugs that interfere with serotonin reuptake, patients should be cautioned regarding the risk of bleeding associated with the concomitant use of LEXAPRO with NSAIDs, aspirin, or other drugs that affect coagulation. Patients with major depressive disorder, both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality), whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs. Although no causal role for antidepressants in inducing such behaviors has been established, patients being treated with antidepressants should be observed closely for clinical worsening and suicidality, especially at the beginning of a course of drug therapy, or at the time of dose changes, either increases or decreases.

For more information, see the side effects section.

Q: What if you miss a dose of Lexapro? How will that make you feel and what should you do about it?

A: For most patients, one missed dose of LEXAPRO doesn’t cause many symptoms. If it is the same day when you realize you have missed a dose, take it then. If it is the next day, take the usual dose for that day. In general, it is not necessary to "catch up" by taking extra doses to make up for the one missed. Try not to miss doses of medication. Take them daily and regularly for as long as your doctor prescribes. This may be for several months after recovery from your depressive symptoms. This is to help keep your depression from coming back.

One other word of caution: Always consult with your physician before discontinuing your antidepressant medication.

Q: If you are switching from another antidepressant to LEXAPRO or vice versa, what should you keep in mind? What is entailed in the switchover? Can you switch from Celexa to LEXAPRO without a waiting period?

A: Although several antidepressants work by increasing the effectiveness of the brain neurotransmitter serotonin, these medications do not look alike structurally. Therefore, one SSRI may work in a single patient, whereas another SSRI (working on the same brain "juice," serotonin) may not work for that patient, and thus a switch may be necessary. Studies show that up to 50% of patients not responding to one SSRI may respond to another.

In general, patients can be switched from one SSRI to another without a waiting period in-between. This is no different for patients on Celexa. However, due to serotonin discontinuation symptoms, it is probably best to taper off one SSRI instead of just stopping it abruptly. I generally start patients on LEXAPRO while I taper off the other antidepressant, but other physicians may suggest tapering off the first, before starting the second. There is very little danger in overlapping the drugs for a short time, however.

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