[BETosca]

Okay. The quick background story: I started Lexapro 10 mg in September for depression and anxiety (but anxiety being my real, ongoing thing, kwim?). It started to work at about 5 weeks. I felt normal again, for the entire month of October and into November. Then, I had the blues set in mid month, for no obvious reason. Family doc upps me to 20 mg. After a week or so at 20, I start to feel normal again, then some major stuff in my family hits the fan that is quite devastating. Really, really bad timing. Still, a week or so after the stuff hits the fan, I feel myself going back on an even keel.

Then, just a few days before my long awaited appt. with a psychiatrist, I feel myself getting down and anxious again, for no obvious reason. By the time of my appt. with him, I'm a wreck. Fortunately, I took a liking to him and had a really good session. He felt that Lexapro was providing me with *some* benefit, but I was probably one of many for whom a good therapeutic dose was more like 30 or 40 mg, rather than 10 or 20. The teaching hospital he is affiliated with is doing major research on this which is backing this up.

His advice was this: He suggests I up to 30 mg. Wait a week, watch for side effects. I started 30 mg the day I saw him, Dec. 16. He said that if I feel better by week's end and am not having s/e, to stay at 30 mg until my follow-up with him. If I wasn't feeling better and not having side effects at the end of that week, then to up to 40 mg. It seemed clear and simple.

So, here's what happened. I did feel better in a week at 30 mg. This lasted up until new year's day, when I woke up feeling an unspecified "off." Over the last three days it's evolved into full blown blues and anxiety.

Now, do I go ahead and *now* up to 40 mg? Or do I try to hang on (with the help of the odd Ativan) until Thursday when I see him for me scheduled follow-up?

I don't want to jump the gun, if you kwim, but at the same time I have a feeling he's going to tell me to up it to 40 mg anyway, so why not sooner rather than later???

Unfortunately he's out of the country and I can't call him. Argh.

Suggestions?

[tarabug922]

If it were me...I would up it to 40. You do have his permission to do so and you haven't experienced any side effects so i think it would be proactive.

Love and Hugs,
Tara

[Berries]

If it were me, I'd DEFINITELY up it to 40mg. That's what it sounds like he'd say if you were able to call him. To me anyway.

But, usually when a pdoc goes out of town (or country), they leave you with someone else to call. Someone who's covering his/her patients.

If you'd feel more comfortable, I'd give that person a call.

[BETosca]

Thanks for both of your replies.

I decided shortly after posting this morning to go ahead with the increase. I'm sure that's what he would advise me to do over the phone- it's just me second guessing the fact that I *did* respond well to 30 mg, and then went down...we hadn't discussed that specific contingency. But this is me probably just splitting hairs.

I'm just grateful that I don't have to wait too much more time before seeing him again- four more days.

[(JD)]

I think you did the right thing also, by upping the dose again as he said. Now, when you see him, you can move on from this point, rather than him saying, ok now try 40 mg... you know what I mean? Glad it's helping!