Posted by Peter on October 31, 2003, at 7:14:37
Hi all:
Well, 8 weeks of lexapro 10mg, and my pdoc is finally telling me it's a 'no-go' for me. In all these 2 months, it has not produced any significant or lasting therapeutic effects. In addition, it is the first anti-depressant that I have taken without a mood-stabilizer, and I've experienced a lot of heightened agitation and evening hypomania. My doc always said I had atypical, 'soft' bipolar disorder underlying all my other symptoms. But after going thru hell coming off of my last medication 'cocktail' (lamictal, prozac, trazadone, adderall, straterra, ambien, temazepam,klonopin), we decided to ditch the mood stabilizer and just see how the lexapro would work for my depression and anxieties, while still taking klonopin for sleep/anxiety and dexedrine for comorbid ADHD.
But, seeing my lack of therapeutic response to the lexapro and the worsening of my agitation and mood swings, he said his theory of my mood disorder had been verified: basically, he told me that the type of bipolar disorder I have can be thought of as an underlying 'engine' to which all of my other comorbid disorders (social anxiety, GAD, ADHD symptoms, etc.) are tied. When the engine gets 'revved-up,' either naturally or from anti-depressant 'kindling,' my hypomania becomes manifest as heightened anxieties, impulsiveness, and all my other symptoms get worse. So it is important to stabilize that underlying engine.
So now wants me to just come off the lexapro and has given me depakote (which, although not the ideal med, is the most tolerable for me out of all the mood stabilizers I've tried) so that my 'underlying bipolar engine' will stabilize. Meanwhile, he said I should continue the dexedrine spansules. After I am more stabilized, we will discuss other routes of treating my depression/anxiety - either with another SSRI, or a traditional MAOI (which I have not yet tried).
Here's my question:
He has told me to cut my lexapro dose in half, and take 5mg each day for a week, and then 5mg every other day until I receive further instructions from him. Because of the high-potency of lexapro (10mg=40mg celexa, etc.), I am scared about withdrawal symptoms, even though my doc said he really doesn't 'think' I will experience any. All I know is that the worst hell I've ever been through was zoloft withdrawal which resulted from my tapering it a bit too quickly. Is tapering the lexapro like I stated above a good way to taper it? Or will I experience withdrawal?
I can understand why he would want to get me off the lexapro completely so I can 're-stabilize' before going on to another antidepressant, but I wonder the following:
If we are going to end up treating me with another SSRI ANYWAY, there seem to me to be advantages of switching immediately over to another SSRI instead of waiting until the lexapro is 100% out of my system: Firstly, this would avoid SSRI-discontinuation symptoms; secondly, the onset of action of the new SSRI will probably begin much more quickly than if I started it after all the lexapro was out of my system. I think this is because (correct me if I'm wrong) my brain is already used to the whole seratonin reuptake inhibition mechanism, and if I switch to, let's say Prozac, the Prozac will sort of continue from where the lexapro left off. Whereas, if I waited until all the lexapro was out of my system, my brain would sort of have to re-learn and re-adjust to the SRI mechanism, which could take many months.
On the other hand, if we decide to start me up on an MAOI, then switching to prozac would pretty much exclude that possibility, or at least stall it for many more months, as you need to wait at least 5 weeks after stopping prozac to begin an MAOI.
I've taken prozac before and it worked in much more noticeable, positive ways for me than lexapro, even though I only took it for a few weeks, combined with many different meds; that leads me to think that it COULD work even better taken just with depakote, dexedrine, and klonopin.
On the other hand, I've been battling with the idea of trying an MAOI for years; I've heard they are extremely effective, but I have a lot of trouble getting over my phobias about MAOI interactions and Side-effects.
I don't know: do you think I should taper the lexapro in the way that he said and stabilize on depakote before we decide on trying me on another AD?
Or should I introduce Prozac while tapering lexapro to avoid withdrawal and make a smooth transition?
Or should I just get off the lexapro as instructed, endure any hellish withdrawal, say good-bye to SSRI's (I've tried 'em all), and go the MAOI route in a few weeks?
thanks,
Peter
poster:Peter
thread:275182
URL: http://www.dr-bob.org/babble/20031030/msgs/275182.html