Covers uses of Lexapro, difference between Lexapro and other SSRIs, starting dose of Lexapro and related dosage issues.

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 the advice of a health care professional regarding your personal situation.

• Lexapro Uses and Dosage Issues
• Emotional and Physical Effects of Lexapro Missed Dose, Switching to Lexapro
• Lexapro Treatment Effectiveness
• Side Effects of Lexapro
• Drinking Alcohol and Overdose Issues
• For Women Taking Lexapro

Q: What are the uses for which LEXAPRO is being prescribed?

A: LEXAPRO has been approved by the FDA in the U.S. for the treatment of depression and generalized anxiety disorder (GAD) in adults.

Q: What is the difference between LEXAPRO and other SSRIs and other antidepressants? How does one determine if LEXAPRO or another antidepressant would be best for them?

A: LEXAPRO is very effective in the treatment of depression. Physicians generally choose an antidepressant for a particular patient based upon factors such as side effects for that particular patient, costs, and positive mindset.

In my experience, LEXAPRO has a more favorable side-effect profile, especially regarding sedation and weight gain, than the other SSRIs. However, some patients respond better to one SSRI than another and, as of now, we have no way of knowing in advance which SSRI will work best in a particular patient.

The other advantage of LEXAPRO is "ease of use," which means that most patients seem to respond to the starting dose of 10 mg so that no dose change is necessary in these patients. This is beneficial for most patients because the starting dose is the dose that works over time.

Q: What dose of LEXAPRO should a patient start with and how do you know if the dosage should be increased or decreased? When the dosage is increased or decreased, what does that do to the body and what does it feel like? What are the minimum and maximum dosages?

A: Most patients are started at 10 mg/day. Some patients might be started at 5 mg (especially those with severe anxiety disorder, or who are old or ill from other medical conditions), but most start at one 10 mg tablet. The medication is taken once a day, most commonly in the morning, but some prefer to take it in the evening or at noontime.

For all patients, 10 mg/day is the recommended starting dose of LEXAPRO. 10 mg/day is also the maintenance dose for many patients. If the dose is increased to 20 mg/day, this should occur after a minimum of 1 week. LEXAPRO can be taken morning or evening once daily, with or without food.

Your doctor may suggest a decrease in dosage if you experience side effects that do not go away after approximately 2 weeks. (Most side effects, like nausea, indigestion, diarrhea, headache, slight increase in anxiety, do go away within 2 weeks).

Once the side effects disappear, they usually do not return. However, if your physician recommends increasing your dose, the side effect may return for a brief period of time (usually no more than a day or two).

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 the advice of a health care professional.

• Lexapro Uses and Dosage Issues
• Emotional and Physical Effects of Lexapro,
  Missed Dose, Switching to Lexapro
• Lexapro Treatment Effectiveness
• Side Effects of Lexapro
• Drinking Alcohol and Overdose Issues
• For Women Taking Lexapro

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

A: 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.

next: LEXAPRO FAQS: Treatment Effectiveness of Lexapro

see new important safety information

In addition to the HealthyPlace.com Privacy Policy, Terms of Use and Disclaimer which apply to the entire HealthyPlace.com website including the Lexapro Patient Orientation and Contact Center at HealthyPlace.com ("The Center"), here are some additional things we want you to know.

The following applies to the Lexapro Patient Orientation and Contact Center at HealthyPlace.com:

• The Lexapro™ Patient Orientation and Contact Center at HealthyPlace.com™ is owned, copyrighted and trademarked by HealthyPlace.com, Inc. No one is permitted to use the name, content, or concept without express written permission from HealthyPlace.com, Inc.

• Forest Laboratories, Inc. owns the trademark for Lexapro™.

• Unless otherwise noted on the specific content page, all content is provided by HealthyPlace.com, Inc.

• Forest Laboratories, Inc., the manufacturer of Lexapro, is the exclusive advertiser/sponsor of The Center, but in accordance with our Editorial Policy has no say over specific editorial content, except where noted.

• Any information of a personal nature, such as visitor email addresses, subscriber lists, etc. are the property of HealthyPlace.com, Inc. and are NOT shared with Forest Laboratories, Inc. or anyone else.

It is extremely important for you, the visitor, not to take anything you read, see, or hear in The Center as personally applicable to your situation. HealthyPlace.com, Inc. and Forest Laboratories, Inc. are NOT qualified to provide medical or psychological advice and do NOT provide medical or psychological advice of any sort.

The information provided on this site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician or healthcare provider.

Please keep in mind that Lexapro, as with all medications, has the potential to effect each person differently. The purpose of The Center is to provide you with information and support. If you have any questions or concerns about your own personal medical or psychiatric situation, please talk them over with your medical doctor or mental healthcare provider. Never take medication or make changes to or discontinue treatment or medication without first consulting your physician, clinician or therapist.

bakc to: Lexapro Patient Orientation and Contact Center Homepage

Lexapro®

IMPORTANT SAFETY INFORMATION - Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Antidepressants increased the risk of suicidality (suicidal thinking and behavior) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of antidepressants in children, adolescents or young adults must balance the risk to clinical need. Patients of all ages started on antidepressant therapy should be closely monitored and observed for clinical worsening, suicidality or unusual changes in behavior, especially at the beginning of therapy or at the time of dose changes. This risk may persist until significant remission occurs. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Lexapro is not approved for use in pediatric patients.

Lexapro is contraindicated in patients taking monoamine oxidase inhibitors (MAOIs), pimozide (see DRUG INTERACTIONS - Pimozide and Celexa), or in patients with hypersensitivity to escitalopram oxalate. 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. The most common adverse events with Lexapro versus placebo (approximately 5% or greater and approximately 2x placebo) were nausea, insomnia, ejaculation disorder, somnolence, increased sweating, fatigue, decreased libido, and anorgasmia.

next: Lexapro™ Pharmacology (escitalopram oxalate)

• What is Generalized Anxiety Disorder (GAD)
• Definition, Signs, Symptoms of Generalized Anxiety Disorder (GAD)
• Diagnosis of Generalized Anxiety Disorder (GAD)
• Worry: How Much Is Too Much?
• The Impact of Anxiety Disorders on the Family
• Women and Anxiety: Twice as Vulnerable as Men
• Anxiety Disorders in the Elderly

see new important safety information

When taking LEXAPRO, be sure to keep follow-up appointments with your healthcare professional. He or she needs to track your progress toward recovery. In addition to taking a medication such as LEXAPRO, you may also want to participate in counseling, or psychotherapy. Often called "talk therapy," psychotherapy comes in many forms, but basically it is aimed at helping you develop new ways to cope with problems, and to identify and understand more about your condition and how to avoid it in the future. Psychotherapy may take place in individual, group, or family sessions, and the process itself may take some time before it is effective. There are other things you can do on your own that may help you feel better, such as: exercising; improving your diet; establishing a normal, full-night sleeping schedule; and reducing or eliminating caffeine and alcohol. To find out which of these or other suggestions might be right for you, talk to your healthcare provider.

next: LEXAPRO^® FAQs Starting LEXAPRO / Dosage Issues

(Ed. Note: This is a companion article to the HealthyPlace TV Show on PTSD - that aired live on our website on March 17, 2009. You can watch it here by clicking the "on-demand" button on the bottom of the player.)

According to the textbooks, Post Traumatic Stress Disorder (PTSD) is a condition that can result from exposure to "event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self and others, and during which the person's response involved intense fear, helplessness or horror. Although we usually think of PTSD as resulting from combat situations (such as war), it can also occur as a result of other events such as rape, assault, civilian shootings, fires, hurricanes, or serious automobile accidents, and other such life threatening events. Not all those exposed to these events will develop PTSD, however, and experts are now trying to figure out what background events, or psychological make-up factors determine who will, from similar "stressors," develop the disorder.

PTSD symptoms include three different clusters of emotions or behaviors: Re-experiencing, avoidance, and arousal. To be present someone has to be exposed to a stressor as described above, and to have symptoms from all of the three clusters. Sometimes the symptoms do not show up until months or years after the "stressor" however.

Re-experiencing includes thoughts or recollections of the events that are distressing and reoccurring, nightmares, flashbacks, and distress when exposed to sensory cues that remind the person of the event (such as loud booms, the sight of blood, etc).

Avoidance symptoms include: not wanting to talk or think about the traumas, avoiding places or activities or people that remind the sufferer of the event, decreased interest or participation in social events (like get-togethers or parties), feeling separated or detached from others (even friends or family members), and having a limited (mostly negative) range of feelings (like anger or depression instead of joy, love and intimacy).

Arousal symptoms include: difficulty getting restful sleep, irritability and outbursts of anger (causing problems at home, school or work, being jumpy and easily startled (from loud noises or someone unexpectedly coming up from behind them), being suspicious or paranoid, and having trouble concentrating.

To make the diagnosis of PTSD, the symptoms must have been present for at least a month, and cause problems in everyday life activities. One difficulty is that many people do not recognize the symptoms for what they are -- rather they just accept them as "the way I have become." As a result of the disorder may sufferers turn to drugs or alcohol to cope, or become depressed, isolated or loners.

Treatment for PTSD is available thru psychotherapy (individually or in group), medication, and finding a support group or symptom. But to be helped the sufferer must first recognize the disorder for what it is, a diagnosable psychiatric disorder resulting from extreme trauma, and begin to seek help. I have come up with an acronym for treatment of PTSD called: RESET. To find out more about treatment, tune into the HPTV show on PTSD here on HealthyPlace.com.

Dr. Harry Croft is a Board-Certified Psychiatrist and Medical Director of HealthyPlace.com. Dr. Croft is also the co-host of the HealthyPlace TV Show.

next: The "Why" Behind Self-Injury
~ other mental health articles by Dr. Croft

Dolly Parton once said; "If you want the rainbow, you gotta put up with the rain." How true that is. it seems that no matter what it is in life, you gotta give a little to get a little and sometimes you have to give a lot to get a little back. I went through hell for years fighting with depression, low self-esteem, and  using self injury to cope, all to get to the place I am now. It's a Fabulous place where I am, it's this place I like to call, Sane.  Not to say that before I was insane, or crazy or anything like that, but at time it felt that way. I was so depressed that I never thought I would live to see 30, now I'm almost 36, I even put money in my 401k, which like everyones elses in the country is not doing all that well, but I keep doing it because I have something now that I didn't have way back when... it's a little thing called HOPE. That's right, I have Hope.

Hope is the one thing that you can have and it doesn't cost you anything. But it gives a great return. It helps you to smile when those around you frown. It helps you get out of bed when your brian says turn off the alarm and roll over. It gets you through the day when 10 minutes feels like an hour. It helps you get what you want in life, and cost you nothing. But if you lose it, you have lost a lot, but it is never gone for good. Just like the Rainbow, it sometimes takes a trial or a little rain to fall, but then the Sun comes shining through the drops and bam there it is the sing of a promise that you will make it another day with a little help from your hope.

Here's what's happening on the HealthyPlace site this week:

• "Self-injury: Why I Started and Why It's So Difficult to Stop" on HealthyPlace TV
• TV Show on Bipolar Disorder "On-Demand"
• Depression in Children: It Can Be Trying on Parents Too
• Free? Yes! (the new tools on the site)

We are kicking the week off by announcing that we have over 1000 members who have joined the HealthyPlace Support Network in the last month. We're getting all sorts of positive feedback.  People enjoy being able to keep their own blog/journal, plus get and give advice and support. To join us, simply click the register button in the top right corner of the homepage. It's free and hopefully, you'll get something positive from it. You can invite your friends too.

HealthyPlace TV

Tuesday's HealthyPlace TV Show focuses on "Self-injury: Why I Started and Why It's So Difficult to Stop." Our guest is 35.  She started self-injuring when she was 13. The show airs live at 5:30p PT, 7:30 CT, 8:30 ET. Part of our guest's story is here, where she explains what drove her to self-injury. Other TV Show links:

• TV Show Blog with this week's show info
• Dr. Harry Croft's blog post on self-injury
• How the HealthyPlace TV Show works and how you can participate during the show

Don't forget, the self-injury part of the show is during the first half.  In the second half of the show, you get to ask our Medical Director and Board-Certified Psychiatrist, Dr. Harry Croft, your personal mental health questions.

Also, if you have a website, blog, myspace or facebook page and you would like to put the TV Show player on your site for your friends and visitors to see, simply go to the HealthyPlace TV Show homepage. At the bottom of the player, you'll see a button that says "embed".  Just click that and copy and paste the code into your page.

TV Show on Bipolar Disorder "On-Demand"

And if you missed it, you can catch last week's show on "The Devastation Caused By Untreated Bipolar Disorder", click here for a list of previous HealthyPlace Mental Health TV Shows. Our guest, Ted, shared his story of life with untreated bipolar disorder. A couple of the highlights: Ted discussed the impact bipolar disorder had on his teenage son and wife and the tools his family used to aid in their recovery. HealthyPlace.com Medical Director, Dr. Harry Croft, has a companion post on Bipolar Disorder: Diagnosis and Treatment.

Depression in Children: It Can Be Trying on Parents Too

Depression, like many other disorders such as ADHD and Bipolar Disorder, can affect children too. One of the biggest problems parents face is getting a correct diagnosis.

This week, one of our readers is sharing her personal story of the decade long struggle she had trying to figure out what was going on with her son.  Cathy's story is entitled:  "What's Wrong with My Son?" If you're a parent, I encourage you to read it because first, it'll let you know that you are not alone in your experiences and secondly, there are some valuable lessons to be learned from what Cathy went through.

On the subject of "feeling alone," Amanda, who manages the HealthyPlace Support Network, wrote a piece "Feeling Alone, but Not Being Alone."

Free? Yes!

Following up on last week's newletter about our relaunch, we received some emails asking whether the new tools on the site are free of charge.  Yes, they are. And we hope you find them useful. These features include:

• The HealthyPlace Mental Health Support Network
• The HealthyPlace Mediminder (medication reminder tool)
• The HealthyPlace Mood Tracker (online mood journal)
• HealthyPlace Online Psychological Tests (instantly scored)

back to: HealthyPlace.com Newsletter Index