Lexapro not my panacea, apparently..... now what?

To recap, I was on Celexa for a month, starting at 5mg and titrating up. It was working great to wipe out the vertigo, but when I hit 20mg, I got a symmetrical rash under my arms, crotch, and inner forearms. It also gave sexual sides, so I was willing to quit it.

They switched me to Lexapro for another month, starting at 5mg and titrating up. I am now on 7mg. My dizziness is quite reduced – almost eliminated on some days – and I have much lower sexual side effects. However, I feel very activated/jittery and have been feeling like a buzzing in my head, almost like pressure in my ears. I suspected that my blood pressure was suddenly elevated. I also noticed that I needed 2mg of valium to sleep when on Lexapro (often it doesn’t work), whereas on Celexa I was taking 1mg and was trying to eliminate it altogether. The Celexa seemed to have a sedative effect, but the Lexapro makes me jittery.

When I was at the Mayo clinic for diagnosis two months ago, my blood pressure was 118/70, and was also normal while laying down, sitting, and standing.

Today my father (a doctor) took my blood pressure many times and it was consistently 150/72.

Oddly, my pulse is in the 40s. I am a lifelong runner who also takes Atenolol. I have always been a white-coat reactor, but when I go to the doctor, I tell them to take my blood pressure three times, and by the third time it is always back down to normal. Yet when my father took my blood pressure today it never went down. He said, “Don’t worry, the diastolic is the key and if that is still low, you are ok, this is probably just anxiety caused by the Lexapro.”

Everyone in my family has high cholesterol but no one has had a heart attack and no one has died before their late 70s (some live well into their 90s). But I don’t want to walk around with high cholesterol and high blood pressure, let alone a buzzing in my head and pressure in my ears.

I am worried that this is the start of the A-D merry-go-round – that I am destined to whip from one to the next, trading one set of side effects for another. I have proof that an SSRI or SNRI can help me, obviously they are working to eliminate the vertigo. But the side effects are troubling. And they want me on this stuff for at least a year.

Any ideas would be greatly appreciated!

Hey Doug
Sorry you’re getting hyped up from the lexapro. The same thing happened to me. I had to take Ativan to sleep. You might want to try Paxil? It is the most serotonergic of the ssri’s. It is really supposed to be great for anxiety disorders. And that seems to be one of ur biggest concerns.
What do you think?
Kelley

— Begin quote from "rockyksmom"

Hey Doug
Sorry you’re getting hyped up from the lexapro. The same thing happened to me. I had to take Ativan to sleep. You might want to try Paxil? It is the most serotonergic of the ssri’s. It is really supposed to be great for anxiety disorders. And that seems to be one of ur biggest concerns.
What do you think?
Kelley

— End quote

That’s a logical suggestion, but my fear over Paxil is, first, it was not on the list of SSRI/SNRIs that they gave me, and second there is weight gain often reported with Paxil. The one good thing about the Celexa/Lexapro is the weight loss of about 3-5 lbs, which doesn’t seem like much but those were my stubborn last few pounds that were hard to get rid of, so now I look better.

The next anti-depressant on the list is Effexor, then Zoloft, but my GP says Cymbalta is better.

Does the fact that I lost weight on Celexa/Lexapro mean that I will also lose weight on any other anti-depressant, or is it a case-by-case situation?

I wonder if I should just try to go really low on Celexa/Lexapro and see if I can get results without triggering the sides…

Good points,
Yes, Paxil is known for the weight gain…I think because it is so serotonergic, and it also is a tough one to get off of. Effexor in low doses is basically an SSRI, as it doesn’t kick into the norephinphrine until the higher doses (I’m thinking 150mg). Cymbalta, on the other hand, is more 50/50 with the sero/NE at any dose. I take it and have done well with it. It is an newer med, and many docs get stuck in their meds that work without trying the newer ones. If I were you, I would probably do a lower dose of Lex (5mg?) Or go back to Celexa and stay lower on it. I find it interesting/odd that these meds are so similar, and yet so many people do well on one and not the other…other than Lex being more potent. I think I mentioned here that I"ve read at least 2X and up to 4X stronger than Celexa.
Kelley

Hi Doug,
Sorry to hear that you are having some issues with side effects. I wondered if Nori was on you list from Mayo at all? I also wondered if when you were there you had any of the testing to see how your body would react to the medication. I can’t remember what the name of the test was, but it showed how your body would break down some different medications. I think it is really a positive sign that you noticed relief with the CSD symptoms. That in itself it hopeful.

Kat

Have you tried a tricyclic like amitriptyline or prothiaden? I saw a doctor who is a neurochemist and he thinks it was cipralex (lexapro) kicked off my mav 5 years ago. However with mav one mans medicine is another’s poison

Doug,

I was thinking the same thing as Becks. Nortryptaline (another tricyclic) is pretty well tolerated and it has kicked the dizziness for a lot of people. I wonder if you could do a lower dose of lex and add in a small dose of Nort. to fill in the rest.

Good luck with your Bears today. But I think if they lose, they’re done. On the flipside I think the Lions will make the playoffs if they win today. So this game means more for the Bears than the lions, so on that thought, I think the Bears will win. They’ve been playing good lately and they’re at home.

Greg

Hi Doug,

My thoughts: both Cipramil and Lexapro can pile the pounds on many people who use them. When I was on 15 mg of Cip I shot up to 90 kg from 75. The first time in my life I ever had “man boobs”. Not happy. When I dumped Cip the weight fell off. When I tried Lex the same thing happened as you report. It was like I had a rocket up my ass all the time. Totally jacked and couldn’t sleep. The point about ANY SSRI is that you cannot generalise about side effects. That you lost weight on Cip and Lex means you’ll probably do the same on another one.

I would strongly suggest trying either Zoloft or Paxil next. I had to go through all of them before I found the best one for me and that was a low dose of Paxil. There’s a clinical trial being run right now in Atlanta for MAV by Dr Tusa’s group and they are using his drug of choice which is Paxil. You may get by on a lower dose of this stuff because of its high affinity for serotonin receptors.

Anyway, the take home message is to not worry about a particular side effect of a med that “others” say may cause this or that. It’s different for everyone, especially the SSRIs.

Re your blood pressure. To get an accurate take on your BP, it should be taken 3 times at different times of the day, preferably after you’ve sat relaxed for about 10 min. This is the standard in a clinical trial. It may be that you just had a one off bad day. You could buy your own cuff and monitor it at your leisure to be certain.

It’s great that you have found something that works! Now to get around the side effects.

S

— Begin quote from "scott"

Anyway, the take home message is to not worry about a particular side effect of a med that “others” say may cause this or that. It’s different for everyone, especially the SSRIs.

S

— End quote

Right, I am beginning to think it is highly variable like the sense of taste. I like peppermint ice cream and you hate it; you like mango sorbet and I hate it. Why? Just a difference in chemistry, I guess. Same for these: one pill that makes me jumpy can make another person relaxed, and vice versa. I wish it was more scientific than that!

My vanity is a stumbling block: I won’t take anything that makes me gain weight, lose hair, or become unable to perform.

— Begin quote from "beatles909"

Doug,

I was thinking the same thing as Becks. Nortryptaline (another tricyclic) is pretty well tolerated and it has kicked the dizziness for a lot of people. I wonder if you could do a lower dose of lex and add in a small dose of Nort. to fill in the rest.

Good luck with your Bears today. But I think if they lose, they’re done. On the flipside I think the Lions will make the playoffs if they win today. So this game means more for the Bears than the lions, so on that thought, I think the Bears will win. They’ve been playing good lately and they’re at home.

Greg

— End quote

What a game today – great for me, bad for you. Plus I am 7-2 in fantasy football so far this year, and this week is looking good too.

During the games I am too amped up to notice any dizziness, it’s a wonderful distraction!

Update: went to internist this morning and my blood pressure readings were 122/84 and then 115/65. That was after a half dose of Lexapro and prior to breakfast/coffee.

He said that the reason I am jittery on Lexapro is that I am taking TOO LOW a dose. He said that I should ramp up to 10-15mg Lexapro, or else go back to 10-15mg Celexa (pre-rash levels).

Whaaa? Too low of a dose? Geez I never heard of that one.
Guess you have to give it a try? That doessn’t sound too bad with your blood pressure…mine is around 85/60…super low…so I can’t take Verapamil etc…
what are you going to do?
Kelley

Sorry that it’s not doing the trick Doug, that stinks. I found that Prozac was very stimulating and I felt very jittery on that one, but we all react differently.

I wonder if adding another migraine med to your mix might help rather than changing SSRIs? Would you and/or your doctors consider that? I found that while an SSRI gave me good relief, nothing has come close to the combination of Lexapro and Topamax. Maybe you need a little drug cocktail to get you above 70%. Just a thought.

— Begin quote from "rockyksmom"

Whaaa? Too low of a dose? Geez I never heard of that one.
Guess you have to give it a try? That doessn’t sound too bad with your blood pressure…mine is around 85/60…super low…so I can’t take Verapamil etc…
what are you going to do?
Kelley

— End quote

I don’t know what to do.

I am not sure his logic makes sense. He said that I am on baby doses anyway and that my anxiety is making me notice side effects. He wants me to put decent sized doses into my brain till I get an “a-ha” moment. He thinks my anxiety (which is high) is preventing me from taking the dosage I truly need. He said, this stuff won’t hurt you – you might get this or that side effect, but you will be fine in the end, so just load up and see what happens.

Add this to the mix: my wife says that when I was on Celexa I was too blase, didn’t care about stuff and was too carefree, too patient with the kids, with being late, etc. She said, “It didn’t seem like You.” I told this to my doctor and he got really mad at her, and said, “That is bullshit, I hate when my patient’s spouses say stuff like that. Just let the person have some relaxation and enjoy the new You that has less anxiety.” Not sure how I feel about that, which side I am on.

More confused than ever. Might go back to Celexa but on the brand and not generic.

Doug,
My brother in law is one of those type A personalities…he started having panic attacks and went on a low dose of Celexa. LIke 5mg. My sister says he’s so much better in that he can sleep in a little on the weekends, he’s not racing around trying to get everything done RIGHT NOW…he laughs more, unfortunatley, his sex drive isn’t as high, but she prefers his more laid back self. I would say that going through life in a state of anxiety puts a lot of stress on the body…floods the body with cortisol and the flight or fight hormones etc…can’t be good for you. I’d rather see someone who can stop and smell the roses and live more in the moment. It may not be how that person always WAS, but in the long run I think it’s better for the brain…
Just a thought…
Kelley

Hi Doug,

I have heard this before from more than one GP. Sometimes when the dose is too low the side effects from the SSRI are worse until you hit an efficacious dose. It’s entirely possible.

I know the rash thing freaked you out on Cip but would you consider a retrial if you decide Lex is out? As I mentioned before, some get the rash and it just goes. It’s a start up symptom. Chat to Emma about this.

Scott

— Begin quote from "scott"

Hi Doug,

I have heard this before from more than one GP. Sometimes when the dose is too low the side effects from the SSRI are worse until you hit an efficacious dose. It’s entirely possible.

I know the rash thing freaked you out on Cip but would you consider a retrial if you decide Lex is out? As I mentioned before, some get the rash and it just goes. It’s a start up symptom. Chat to Emma about this.

Scott

— End quote

Thanks Scott. It is good to know that my doctor is not entirely crazy.

Now that I think about it, I wonder if the rash was caused by a vitamin I was taking, which was GNC’s Nourishair, which is hair and nails vitamins. I stopped taking it, it had a lot of weird stuff in it.

Why did you quit the Celexa/Lexapro, was it the weight gain or the headaches, or sexual sides?

Hi Doug,

It could have been the other stuff you were on causing the rash but SSRIs can definitely do this – and it goes away.

Cip caused me to have much MORE pain in all of my muscles. Full blown myalgia that would hit in waves weekly. Migraine headaches were far worse on it too. Apart from that it was good initially when I was on 10 mg. It was when I hit 15 mg the problems began and never left until I got off of it completely. Paxil is the only SSRI that has not increased headaches, though it does initially as a start up symptom.

S