Do I need to increase my dose?

I have been on Lexapro for almost 2 months now. I noticed really positive effects -- depression lifted, no more panic attacks, less anxiety, etc. after about 2 weeks of taking it. I was so pleased.

For the past week, however, my mood has been very low. The panic attacks haven't returned, but I feel like I'm starting to slip back into depression. All week, I have been having trouble focusing at work -- and that's not normal for me.

Starting on Lexapro coincided with starting a new job. So, now I'm wondering if the excitement and happiness of the new job was responsible for my change in mood and now that I'm settling in, I'm slipping back down to the way I felt before. I have also had a really bad cold for the past 10 days, so is it possible that that has something to do with how I'm feeling mentally? I don't know if it's the Lexapro not working as well or if it's situational.

I guess I don't know what to do. Has anyone experienced an SSRI seeming less effective after just a short period of time? Should I be talking to my doctor about increasing my dose? (I'm on 10mg right now.) I'm just really scared of getting terribly depressed again. I want to do well at my new job. It requires me to have some energy and focus, but this past week has been such a struggle. I have no energy. I feel groggy and I'm having trouble concentrating at the office. I can focus for short periods of time, but then I start feeling fidgety and brain-foggy. I'm actually finding myself procrastinating at work. I have always had a problem with procrastination, but only in my home life -- never at work. This is worrying me. I don't want it to get worse. When I get home from work, I have this feeling of overwhelming foreboding and doom. I don't know if it's the Lexapro. I'm confused.

Sorry for rambling. That's just me. I can't blame that on Lexapro.

You may need to contact the presribing pdoc/doc, cause it it is possible an increase may be needed. Don't give up, get in touch with pdoc, explain what you are feeling, and he or she will advise you what next step to take.
Take good care, and lots of luck with this.

(((((((( Juliana ))))))))))

That's a pretty name.

are you certain it isn't because you just met me?

It's possible an increase is what's needed. You should speak to your T about it, in any case. It's also possible something in your diet has caused you more problems lately. Have you consumed more caffeine or sugar or anything than usual lately? I'm no doctor, but I think these things can affect moods and possibly interfere with meds a bit.

I think it takes a few weeks for SSRI's. I've been on Prozac for years off and on and consistently for the past two years.

My depression returned at the end of 2006 and my p-doc added wellbutrin and I tried it for a month 1/2 it made me nuttier. So, we increased Prozac just yesterday to 50mg by alternating 40mg and 60mg every other day...

Prozac is great for me. Maybe your doctor could try that if Lexapro doesn't work...

((((Juliana))))

I'm sorry that you are beginning to feel out of sorts again. A lot of people can go on a high with a new job, and then drop down once they start to settle in. It's rather like when you eat chocolate (yum yum!). It can raise your glucose so high and you're all giddy and talkative and happy.....and then the glucose actually plunges LOWER than before you actually ate the chocolate (so you get tired and things aren't as funny as they were. Lol). It may just be an adjustment reaction to the whole new job situation, and has nothing to do with your meds.

However, I do have a question for you. Where are you getting the Lexapro? Are you in a clinical study? Because we don't have that med in Canada yet, and I even checked the Canadian Drug Database under the generic name. It's not approved here yet. Are you sure it's not Celexa, which is quite similiar to Lexapro? I've just been curious for a little while, and just figured you must be in a clinical study.

Yes, I would talk with your doctor about such things as raising the dose or even augmenting the med with a mood stabilizer. It only helps to ask, right? And the only one hurting by not asking is *you*. We want you to take great care of yourself, Juliana, because we've all come to like you a lot on this Board. You're a nice girl!

God bless,
Sandy

Thanks for all the feedback everyone.

Maybe I am feeling down just cuz I've gotten to know Pat. LOL. Silly Pat.

Sandy, I'm taking escitalopram. It's marketed under the name Cipralex in Canada and the U.K. and Lexapro in the U.S. So the package mine comes in has the brand name Cipralex on it. I've just been referring to it as Lexapro on PC because most people are familiar with that name.

I know what you mean about getting a rush from a new job and then coming back down to reality. I talked to one of my colleagues and my boss this afternoon and both of them were saying what a hellish week it has been. (We're dealing with the volunteer committee from hell. They're totally out of control.) My boss actually said to me, "I feel like I'm having a breakdown." So, maybe it's not me and maybe it's not my medication. Maybe it's just situational. We're so busy at work right now. It was comforting to know that I'm not the only one feeling frustrated and confused and overwhelmed. I had been thinking it was just me -- not being able to handle the pressure. So it was comforting to find out that my colleagues are feeling the same way.

I had also been -- at the same time as being run ragged at the office and then bringing work home in the evenings -- putting a whole lot of pressure on myself to get my flat cleaned up -- and failing -- so that was bringing me down. I think I was just expecting too much of myself this week.

I had to work until 9:30 tonight and I was supposed to go to my boss's housewarming party tonight after we finished at the university, but I just decided I needed to acknowledge my limits. I announced at 9:15 that I wasn't up for a party. I decided I needed to come home, take a bubble bath, relax and get a good night's sleep. I'm worn out and all "peopled out." I've had a bad cold for almost two weeks, haven't been sleeping well, haven't been eating well, etc. I think I just need some "me" time. I have a date tomorrow night, so I'm hoping a good night's sleep and having that to look forward to will cheer me up a bit.

If I'm still feeling down next week, I'll go talk to my doc about it.

Thanks again everyone for listening to me ramble. I'm not good at keeping it brief.

Juliana,

Wow, I just did a search on the Canadian Database and it DOES show Cipralex. This is the first time that I've heard of Lexapro in Canada. It must be fairly recent because nobody else is talking about it anywhere. Wow. It took a long time, but I'm glad it finally made its way up to the Great White North. Now people have another option to choose from.

I hope you are feeling better for your date. Oohhh la la!!! I hope you two hit it off really well!

I'm getting ready for bed, too. Take care of yourself!

God bless,
Sandy

I hope you got some sleep Sandy. I went to my doc back in January specifically to ask about trying Lexapro. I had been talking to a friend in the U.S. about some of the stuff I was going through and all the ADs that hadn't worked for me. Her FIL is a pdoc and he suggested Lexapro. That was the first time I had heard of it. So, I asked my doc about it and she said it's called Cipralex here and it is quite new. She thought it might work well for me because I had done quite well on Celexa and Cipralex/Lexapro is a derivative of Celexa.

Lexapro is supposed to give similar effects to Celexa but at a lower dose... so, fewer side effects. I have found that to be true so far. The lethargy side effect on Lexapro isn't nearly as bad as what I experienced on Celexa... and I'm also not gaining weight like I did on Celexa (in fact, I'm losing weight).

P.S. You mentioned you were on Prozac. That's one of the ADs I have never tried. My sister has been on Prozac off and on for many years and I don't like the way I see it affecting her personality. She is much more temperamental and argumentative and unpredicatable when she's on Prozac. Sometimes, she's her usual self (thoughtful and real and lovely) but other times... OMG! She's so sensitive and easily offended and she responds to those feelings with aggression... going on the attack... being rude to salespeople and waitstaff, etc. She spends a lot of time being SO angry at everyone, but she doesn't realize it's out of character for her and that it only happens when she's on Prozac. She also goes on wild spending sprees and then gets depressed afterwards. Fortunately, she's quite well off financially, so she's not risking financial ruin for her family, but it is a problem that she gets upset about. So, all that behaviour scares me. I didn't want to try Prozac myself because I was afraid it would affect me in the same way. I know it works very well for some people, though.

((((Juliana))))

Oops, you seem to have gotten me mixed up with someone else. I don't take Prozac because my body doesn't tolerate SSRIs. My serotonin levels are just fine. My problem seems to be with norepinephrine. I've been taking Effexor XR.

I am still in shock about the Lexapro here in Canada. I started the psych med roller coaster ride 4 years ago this month, and it certainly wasn't available here then. And I still haven't heard anyone talking about it here, not even any of the docs when they were putting me on one SSRI after another until we figured out that wasn't working. LOL. I remember when Lexapro became available in the US, and everybody was so happy. They were all switching over from Celexa because Lexapro is a much cleaner SSRI than Celexa. And since you said that you did fine on Celexa, then you should do fine on this new med.

What I find baffling is that Canada changed the brand name. How can they do that. In both the US and Canada, the brand name is the brand name: Celexa, Remeron, Advil, Tylenol, Wellbutrin, Valium, Sudafed, Effexor, Benedryl, etc, etc. The only thing I can figure out is that when Canada did its own testing on Lexapro (you know how we have to test even after its already been passed by the US FDA.....just makes us wait a few years longer)....well, maybe they made a tiny change in it and thus it couldn't be called Lexapro because it technically wasn't anymore. I see that the active ingredient in both Lexapro and Cipralex is the same, but *something* must have been changed. Weird.

Let us know all about your date. Is it fun to start seeing guys again? I hope you really enjoy yourself, hon.

God bless,
Sandy

Ooops. I did have you mixed up with someone else. It was Almeda who said she was on Prozac. I'm all discombobulated.

Something I found strange was that, usually, when a new AD is on the market here, the docs tend to really push it. My doc didn't even mention Cipralex/Lexapro to me, though. I had to ask her for it... and then she said it would probably work well for me.

I don't know why the drug has one name in the U.S. and a different name in Canada and the U.K. I did notice that it's manufactured by different companies in Canada and the U.S. I wonder if that's the reason. Weird, huh?

I'm glad you found something that works for you. Effexor was a nightmare for me. It's so frustrating trying to find meds that work because they affect all of us so differently. It feels like a major accomplishment when we finally find something that makes us feel better and not worse.

P.S. Starting to date again is exciting, but kinda scary.

((((Juliana)))))

You will do fine. You are a bright, personable, positive, beautiful young woman, and your date is probably just as nervous as you. Get hopped up on Espressos and chocolate-covered coffee beans.....that should get the conversation rolling. LOL.

ENJOY yourself. You don't have to marry the guy. And if it's not going well, it's easy enough just to say that you haven't been feeling at your best (like you said, you've had a cold recently)....and get your butt back home. But just try to have fun with it. It's not a serious deal. And don't forget those high levels of caffeine!! LOL.

God bless,
Sandy

Thanks Sandy. My problem isn't worrying about getting the conversation going. I'm very outgoing and I'm so damn chatty; I never shut up. LOL. The guy I'm going out with is very shy and quiet. I really like him. I'm just worried about making sure I don't scare the crap out of him or get on his nerves. We have spent quite a bit of time together already -- worked together briefly, socialized as part of a group, and he used to drive me home from work, so he knows how talkative I am... and he agreed to go out with me anyway, so I guess that's a positive sign.

P.S. One of my biggest worries about the date is something that sounds very silly. I have overcome a lot of phobias in the past two years, but I still have a huge phobia of escalators going down... and we're going to the Park Lane cinema. You know how you have to go down that escalator to get to the cinemas? Well, that's scaring me... I'm wondering if he's going to think I'm nuts if I tell him I don't want to take the escalator and insist on using the elevator instead.

Maybe your date is thinking, "She'll have to finally shut up if I take her to a movie!" Hee hee hee!

As for the escalator, you could always say to him, "Would you mind if I hold your hand? I might get a touch of vertigo on this magical moving staircase!"

I'm trying to think of where the stairs are to go down. I know there is a staircase to go upstairs, plus the glassed-in elevators. But there must be stairs to go down. When you walk down the corridor towards the railing at the end of the mall, and if you turn your head to the right there used to be a set of doors there (swinging ones, I think). I haven't been to Park Lane in ages. I used to see people coming out of there all the time like they were just coming in from off the street or coming from a class that was held maybe upstairs. Check over the door to see if there is a sign that shows a staircase. If not, well.....handholding and vertigo works for me. Lol.

By the way, what movie are you seeing?

God bless,
Sandy

I like your suggestion about hand-holding. LOL. He does know about my vertigo. I had severe BPPV (benign paroxysmal positional vertigo) for 3 years, so he knows I still get dizzy spells. He also knows I used to have agoraphobia, but I haven't gone into detail about that... or the panic attacks and specific phobias.

I'll decide what to do when I get there I guess. If you go past the glass elevators and past the escalators, there's another set of elevators in the back corner that go to the parkade and they also go down to the cinema level. Btw, I haven't been to a movie since April of 2000. Yikes. My BPPV started in March of that year and then I developed agoraphobia. I've been back in the "outside world" for a little over two years, but this will be my first time in a theatre since I've gotten better.

I'm not sure what movie we're seeing. We're going for a drink first and then we're going to decide from there. I'm taking a copy of the Coast in my purse so we can go through the movie listings. I want to see Blades of Glory. I think it looks hilarious and he has a goofy sense of humour too. There's also a multi-award-winning documentary about sharks that looks interesting. He's really into travel and nature and stuff so that might appeal to him too.

i want to hear EVERY little detail tonight...........

I promise a full report.

I also took lexapro and it was ok for 2 months, it helped.....then things got very dark for thenext month until i stopped taking them. I felt much better after i stopped.

Thanks Joe. I'm hoping that doesn't happen to me. I thought I had found something that was really working for me. I'm feeling pretty good today, though. I hope it continues.

Have you found something else that works for you -- long-term?

((((Juliana)))))

I think you should stick with the Lexapro for a while longer, although I'm certainly not a doctor to give advice. But you said that the Celexa worked fine, and that Lexapro was even better in terms of side effects. PLEASE don't play the roller coaster game of trying one med after another. It can really mess you up, and make you even worse than when you first started out. It seems pretty obvious that serotonin is the culprit in your body chemistry, so I would definately stick with the SSRIs (if you DO decide to try other meds). As well, you could always add a mood stabilizer to help augment the Lexapro.

Didn't you say that you are only on 10 mg? That's just a starting point. Ask your doctor to increase it to 20 mg and see how that works for you first. I'd hate to see you get all twisted around from the horrors of searching for a new medication.

With love,
Sandy

Thanks for the good advice, Sandy. I'm feeling better today. I think the key for me is making sure that I balance all the work with a little bit of fun. Getting out of the house and socializing with friends and getting some exercise makes a big difference. I had a lovely date last night and then I got up early this morning and went for a long walk. It's kind of chilly out there but it's a beautiful day. So my mood is pretty good. If I start slipping again and the exercise and socializing don't help, I'll talk to my doc about going up to 20mg.

I think I suffer from WAD. I made that up myself -- Weekend Affective Disorder. I usually get much more depressed on weekends and I think it's because I push myself so hard at work all week, don't get enough sleep or relaxation or exercise... and then the weekend comes and I give myself a huge to-do list and instead of doing anything on my list, I sleep a lot (because I'm just worn out) and then feel horrendous when I wake up... and then I feel lousy because I'm wasting my weekend and not doing anything but sleeping and sitting around on my butt. I broke that habit this weekend... went to bed early Friday night and got up early Saturday morning and then again this morning... and my mood is much better. I just have to make sure I continue this... and get enough sleep during the week and find some sort of balance between work and personal life.

i sure am glad it isn't PAD...........

What's PAD?

Peripheal (sp?) Artery Disease?
Used to be PVD, the "v" for vascular.

What other things does, "PAD" stand for?