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Author Topic: Might be time to switch off the lexapro :/  (Read 401 times)

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Online AncientMelody

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Might be time to switch off the lexapro :/
« on: January 09, 2014, 09:41:45 AM »
Well, I've been really hoping to avoid this. I love what the lexapro has done for me mentally. Depressive symptoms essentially nil, and I've actually noticed the anxiety symptoms start to lift in the last week too. I had my physical yesterday and I wasn't nearly as nervous as I usually am, so that was a big test for me. More motivation and energy for my family in the evenings.

But the GI symptoms haven't gotten better. I'm having to hydrate like crazy, I work out quite regularly, and one wrong meal or one day with not enough exercise and I'm in trouble again. I'm just debating if I should give it three more weeks, and talk about changing at follow-up, or call her this week and request a change (we've already been discussing/dealing with this for a month now so she knows it's a possibility)

Again, so frustrating because it's clicked extremely well for my symptoms, but if the side effect hasn't cleared up with me being on it for 6 weeks, I don't expect that it will change.
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Offline beast216

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Re: Might be time to switch off the lexapro :/
« Reply #1 on: January 09, 2014, 11:08:54 AM »
How bad are the GI symptoms....I have been on for almost a month and the GI symptoms I was having (really poor appetite, vomiting, nausea), have started to subside.

Sounds like the medication is really working...so it would be a shame to have to swithc.  Any chance teh doc can give you something to treat the GI symptoms?
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Online AncientMelody

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Re: Might be time to switch off the lexapro :/
« Reply #2 on: January 09, 2014, 11:51:01 AM »
I'm having slowed bowel movements, with 2-3 pretty significant episodes of constipation lasting a few days. I'm pretty much doing a lot of lifestyle management trying to keep them at bay: I exercise vigorously at least twice a week (swimming and kickboxing) and do yoga or calisthenics for at least 10 minutes most other days, so there's really probably only one day a week I'm not active. Lots of water, bran cereal and fruit for breakfast, veggies.  I even drink a particular herbal tea on a fairly regular basis that should help. Even with all of that I've had to resort to stool softeners or laxatives (temporarily) on a couple of occasions.

I put in a call to her just now. My last ditch effort, I think, is that with her approval I'll be starting a hormonal birth control pill because I've had a lot of hormonally driven issues recently.....and I've noticed these symptoms worsening right before my period as well. I'm HOPING that maybe starting this will alleviate some of the bowel trouble. So, I just wait for her response and if she agrees we'll see how this goes. *fingers crossed*
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Offline Julie A. Cook

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Re: Might be time to switch off the lexapro :/
« Reply #3 on: January 09, 2014, 02:19:39 PM »
Just saw my doctor today and she has upped me to 20 mg. of Lexapro, after 4 weeks on 10 mgs..  I get a lot of stomach upset with this medication, but going to give it a while longer.  She did explain that there were other meds that could be used in combinatopn with the Lex. to lessen the symptoms of the stomach distress.  Remarin?  I can't remember the name, but you might want to ask about it.  Best regards,
Julie
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Online AncientMelody

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Re: Might be time to switch off the lexapro :/
« Reply #4 on: January 09, 2014, 04:23:11 PM »
Thanks for the suggestion Julie. I'm going to start the Seasonique (hormonal birth control pill) today, so I'm hoping THAT will give me a slight nudge of improvement. We'll see in a few weeks :), hopefully by follow-up visit ***** the end of the month I'll know where I'm at..
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Offline insights

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Re: Might be time to switch off the lexapro :/
« Reply #5 on: January 09, 2014, 04:33:07 PM »
But the GI symptoms haven't gotten better. I'm having to hydrate like crazy, I work out quite regularly, and one wrong meal or one day with not enough exercise and I'm in trouble again. I'm just debating if I should give it three more weeks, and talk about changing at follow-up, or call her this week and request a change (we've already been discussing/dealing with this for a month now so she knows it's a possibility)

I've very recently been told that green tea extract supplements at around 200-500mg/day may help. It apparently begins to have a stool firming effect within 2-3 days.

If that doesn't help then small doses of Remeron (mirtizapine ) or one of the tricyclic antidepressants should. Nortriptyline would be my pick as it has very low serotonergic activity with relatively strong action at the acetylcholine muscarinic receptors which induces constipation, dry mouth, etc. The extra boost from its norepinephrine reuptake inhibition could help with anxiety and depression too.

There is also a possibility that switching to Celexa (citalopram) may solve the problem despite it being essentially the same drug. For some reason the mostly inactive isomer of the drug present in Celexa, but not Lexapro, can vary the side-effects profile. But I'd try the green tea and TCA first.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline BusuB

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Re: Might be time to switch off the lexapro :/
« Reply #6 on: January 09, 2014, 05:13:18 PM »
TRUST IAN, THE TCA'S WORK VERRRY WELL... to my chagrin.  :spineyes:
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Offline Abraham2007

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Re: Might be time to switch off the lexapro :/
« Reply #7 on: January 09, 2014, 05:15:30 PM »
Nortriptyline would be my pick as it has very low serotonergic activity with relatively strong action at the acetylcholine muscarinic receptors which induces constipation, dry mouth, etc. The extra boost from its norepinephrine reuptake inhibition could help with anxiety and depression too.

Ian,

If Ancient Melody (AM) were to take both the Lexapro(Escitaloprom) at 20mg and the Notriptyline (Pamelor) together (which leads me to ask how much Notriptyline would you recommend, would it be a starting dose of 50mg), would it be better to settle on this SSRI/Tricyclic combination for a few months (such as three to four months), and if things were stable after a few months, then have AM slowly taper off the Lexapro, so she only has the Notriptyline (Pamelor) in her body?  For me, that would be preferable, because she would only be working with one psychiatric medication in the long run.

However, if she were to switch from Lexapro 20mg (by tapering off it in two weeks), and then getting on Notriptyline (Pamelor) full time at (say) 100mg, without the Lexapro, this action would probably be riskier,  because 1) her body would have already adjusted to the Lexapro, but the sudden loss of loosing the Lexapro in her system could cause more side effects, since the body has to readjust quickly and  2) her body would have to relearn to adapt to a new antidepressant too quickly, like two weeks, by this sudden shift to the new medication, Notriptyline(Pamelor)?  For me, this would be less preferable then the first choice, because although both options lead to one psychiatric medication to handle the anxiety, the second option seems riskier and harder on the body, given its short time to adjust.

Of course, AM, this is all conjecture.  If anything, your psychiatrist should be determining the final outcome of how she prescribes your medication.

Steve
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Offline BusuB

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Re: Might be time to switch off the lexapro :/
« Reply #8 on: January 09, 2014, 06:05:12 PM »
TBH, Abraham, my wife, who suffers IBS took a very low dose of Amitriptyline daily for years (currently off as she and I are prepping for pregnancy).  I myself have taken it at a low dose (10 mg) for a short time for sleep - though I prefer Trazodone - along with other antidepressants.  I'd imagine that AM could possibly keep up w/ the lex and a very low dose of a TCA indefinitely with minimal risk.  Of course again, standard disclaimer to take the advice of a medical professional.
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Offline insights

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Re: Might be time to switch off the lexapro :/
« Reply #9 on: January 09, 2014, 06:23:23 PM »
If Ancient Melody (AM) were to take both the Lexapro(Escitaloprom) at 20mg and the Notriptyline (Pamelor) together (which leads me to ask how much Notriptyline would you recommend, would it be a starting dose of 50mg

The minimum dose that solves the diarrhea issue without turning it into a constipation issue. I'd start on 25mg with the last meal of the day, but it may require 50mg, or 12.5mg could be enough.

Quote
if things were stable after a few months, then have AM slowly taper off the Lexapro, so she only has the Notriptyline (Pamelor) in her body?  For me, that would be preferable, because she would only be working with one psychiatric medication in the long run.

I'm not a fan of poly pharmacy either Steve, but sometimes it is the lesser of evils. In this case the nortriptyline dose is likely to be small and probably won't contribute much in terms of anxiety and depression reduction. While switching to nortriptyline would have the advantage of only needing one med, it could trigger other issues and I wouldn't be advocating the switch as long as both Lexapro and nortriptyline were working well in their respective roles.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Online AncientMelody

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Re: Might be time to switch off the lexapro :/
« Reply #10 on: January 09, 2014, 06:32:45 PM »
Sorry for the confusion insights, the Lexapro is giving me constipation not diarrhea
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Offline BusuB

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Re: Might be time to switch off the lexapro :/
« Reply #11 on: January 09, 2014, 06:45:30 PM »
Sorry for the confusion insights, the Lexapro is giving me constipation not diarrhea

Ahh, I'm the same way... I'll go days w/o a BM even though I've upped my roughage, take a fiber supplement and hydrate like crazy (TMI?). I swear, I strain so much it feels like I'm gonna rupture a blood vessel at times. :P It's amazing how much you miss the small things in life.
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Offline insights

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Re: Might be time to switch off the lexapro :/
« Reply #12 on: January 09, 2014, 07:16:08 PM »
Sorry for the confusion insights, the Lexapro is giving me constipation not diarrhea

Oops, my mistake. Constipation usually isn't as significant a problem with SSRIs as diarrhea, especially with Lexapro which is the 'cleanest' SSRI having little impact on other neurotransmitter systems known to trigger constipation.  Unfortunately, apart from what you're doing now there is little you can do except to switch to another SSRI. Celexa might still be a possibility, but Prozac and Zoloft are likely to be better bets with Paxil usually being more prone to cause constipation that those two, though YMMV.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline Abraham2007

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Re: Might be time to switch off the lexapro :/
« Reply #13 on: January 09, 2014, 09:58:37 PM »
TBH, Abraham, my wife, who suffers IBS took a very low dose of Amitriptyline daily for years (currently off as she and I are prepping for pregnancy).  I myself have taken it at a low dose (10 mg) for a short time for sleep - though I prefer Trazodone - along with other antidepressants.  I'd imagine that AM could possibly keep up w/ the lex and a very low dose of a TCA indefinitely with minimal risk.  Of course again, standard disclaimer to take the advice of a medical professional.

Hi BusuB,

Just out of curiosity, since your wife is off the Amitriptyline (Elavil) for now, does she take any medication to manage the IBS, or did she change her diet intake instead, by limiting the amount of fiber?  (I thought that question may add more meaningful discussion to this thread.)

And one other quick question, when you took the Amitriptyline(Elavil) as a sleep aid, were you also on Lexapro like AM?

And .... (ahem) just one more question, sorry  :goofy:..... did you benefit from the antidepressant combination of a SSRI and Elavil?  :-*

Thanks.  :action-smiley-065:
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Offline BusuB

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Re: Might be time to switch off the lexapro :/
« Reply #14 on: January 10, 2014, 10:57:19 AM »
Hi BusuB,

Just out of curiosity, since your wife is off the Amitriptyline (Elavil) for now, does she take any medication to manage the IBS, or did she change her diet intake instead, by limiting the amount of fiber?  (I thought that question may add more meaningful discussion to this thread.)



And one other quick question, when you took the Amitriptyline(Elavil) as a sleep aid, were you also on Lexapro like AM?

And .... (ahem) just one more question, sorry  :goofy:..... did you benefit from the antidepressant combination of a SSRI and Elavil?  :-*

Thanks.  :action-smiley-065:


To be honest, since she discontinued the amitriptyline, the problem hasn't resumed, although over the years we've adjusted our diets to more of a bland one.  We still enjoy thai, pizza and the like, but more often than not it's lean protein, brown rice and veggie (or similar combinations).  We're both ethnically Japanese, so our typical diet is naturally appropriate for IBS.

As for me.  I found the combo of lexapro and amitriptyline too much, as in, it worked too well.  No anxiety, no depression... but also no happy, no laughter, etc.  I know others who have had good success with this combo.  I think it was because I found lexapro to be flattening to begin with, the amitriptyline on top of it only compounded the issue.  Perhaps if I did the combo w/, say Zoloft (which I found more activating), I would've had a better result.
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