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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by cornfedboy on May 26, 2007, at 20:00:43
I'm writing on behalf of a friend, a 30-year-old woman who's been diagnosed with mild to moderate depression.
About her: usually a pillar of strength; even when unhappy in the past, never been clinically depressed. Last year she lost her father and is also devoid of a real support network close by; financial difficulties; a mean mother; loneliness and a sense of being overwhelmed with responsibilities that others in the family won't shoulder.
After a lot of thinking and a little psychotherapy, she went to a psychiatrist, who prescribed her Lexapro. 5 mg for a week, then 10 mg. Transient side effect: nausea. Unexpected side effect: she got her period two weeks early (she's on the pill). Bad and continuing side effect: generalized anxiety.
My questions are: (1) Is the mentrual irregularity common with SSRIs? Is it something to be concerned about? (2) What about the anxiety? Will it wane in a week or two (it seems definitely med-related and dose-related)? (3) My friend is highly susceptible to benzos. Even 0.25 of alprazolam (Xanax) makes her drowsy. And she has a stressful 10-hour-a-day job to perform. Is Xanax SR, at bedtime or in the morning, one possible solution? Are there any other benzos or anxiolytics which are longer lasting and without the side effect of somnolence? She's told me that the anxiety is occasionally unbearable and if it doesn't go away or can't be dealt with, she'll quit the Lexapro. (4) Would another SSRI or SNRI (like Effexor EX) have been a better first choice?
I'm worried about her; never seen her like this. Any answers or suggestions would be appreciated. Thanks.
Cornfedboy
Posted by Phillipa on May 26, 2007, at 20:12:11
In reply to Lexapro and anxiety, posted by cornfedboy on May 26, 2007, at 20:00:43
Don't believe menstrual irregularity a part of antidepressants. She sounds extremely med sensitive and even that dose of lexapro may be too high for her. Can she take a small amount of a benzo for awhile at bedtime? And call the doc and explain whats going on with her. Love Phillipa
Posted by jflange on May 26, 2007, at 21:36:54
In reply to Re: Lexapro and anxiety » cornfedboy, posted by Phillipa on May 26, 2007, at 20:12:11
Hi!
I had problems taking Zoloft and the pill at the same time. It seemed to make me much more anxious. And the combination seemed to make my period come at an unpredictable time for one month or two.
So Lexapro could be a contributing factor for menstrual irregularity. My PDoc, who is considerate and trustworthy said he had not heard of much incidence of it however. Still he told me to quit the combo, and so I ditched the pill, but not the Zoloft.
As for your friend, she should know anxiety is a common startup symptom of any SSRI and if it does not subside within a couple of weeks give or take, she needs to ditch it or find something to take with it. Why take on the burden of anxiety when you are trying to relieve depression? There are other choices out there. In the end, I chose to take Buspar with Zoloft to take the anxious edge off of Zoloft, the latter which I really did need to take. The combo has worked for me.
Best of luck, jflange
Posted by Denise190466 on May 27, 2007, at 13:41:56
In reply to Lexapro and anxiety, posted by cornfedboy on May 26, 2007, at 20:00:43
I've never found SSRI drugs have messed up my menstrual cycle, however, they can help with PMT.
As far as the anxiety goes, it might be that she is actually on too low a dose for it to actually be doing any good anxiety or depression wise. Either way it definately sounds like she needs to be taking something else in addition to the lexapro to offset the start up anxiety. It would be a shame if she gave up on lexapro too early or at too low a dose.
Denise
Posted by cornfedboy on May 27, 2007, at 14:20:33
In reply to Re: Lexapro and anxiety, posted by Denise190466 on May 27, 2007, at 13:41:56
Thanks for the input, genuinely appreciated. Spoke to my friend this morning and turns out her Pdoc has taken her off the pill too -- something about the possibility of the AD messing with the estrogen levels. (She's on one of those newer pills, which deliver different dosages during the 28 day menstrual cycle.) Since she won't be meeting her boyfriend until late July, I guess it's more important to get the depression and anxiety under control first.
I, too, have considered the possibility that the dose might be, paradoxically, too low, given that Lexapro treats GAD too -- at doses above 10 mg I think. But I'm hesitant to suggest increasing the dose just yet. I've suggested the Xanax SR low-dose option; also suggested Buspar. Crossing my fingers and hoping that the start-up anxiety will just go away on its own.
Thanks!
Cornfedboy
Posted by Bonnie_CA on May 28, 2007, at 1:27:00
In reply to Re: Lexapro and anxiety, posted by cornfedboy on May 27, 2007, at 14:20:33
The only medicine I had that seriously messed up my cycle was Effexor XR. But, that medicine messed a lot of things up. :)
Maybe she could try a longer acting benzo at a low dose. BuSpar takes a long time to start working, and IMO, doesn't work very well.
Hope she gets to feeling better!
-Bonnie
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