Week 6

Thanks for reply

I'm on 10mg Side effects are gone now I went to doc and he said stay on this dose

Thanks felis

I'm going to stick it out ??

As least I don't feel as bad as when I was on citalopram in going to give this dose at least 12 weeks

How r u doing ?

Hi Don

I'm so glad that you are doing better on escitopram I am due to see my specialist next month and will be tling him that I'm doing well Just very minor anxiety first thing on waking up and only occasionally so this was just readjusting by my body from changing to escitopram from citalopram Even at my stage(two years of SSRIs) there can be glitches but not placing too much importance on it. You have come such a long way and you will reach full recovery and full management of our condition. So pleased for you xx

Thanks felis

Reasureance helps a lot keep in touch 😃

Hi Don, I've spoken to you before on this site, just to let you know I started on escitalopram about 8 weeks ago, 6 on 10mg then about a fortnight ago I increased to 15mg. Gotta be honest and say I'm actually quite low still, I felt better after about 10 days on 10mg but it only lasted a week, then back to feeling low and I still am since the increase, I'm also still suffering from horrible physical symptoms which are rare for me, VERY tight chest, palpitations, butterflies in stomach etc. I managed to see my sister (she lives in Germany) and I thought that might be the catalyst for me to get a more improved mood, I enjoyed out there but as soon as I was back in London I've felt very down again, stay strong fella.

Hi Luke

Nice to here from you again were u on sertraline before ?

I was Don yes, rubbish, all it did was stop me from crying tbh.

hello Luke i had a similar issue when adjusting my dose of escitalopram; 10mg wasnt enough, then 15mg made me feel good for a week or two but it didnt hold and i went back to feeling low again, so i moved up to 20mg, and i am finding that is working better than 15mg could.

i did try 30mg for a week or two but found i was getting daytime sleepiness, so decided to go back down to 20mg.

i still do get low feelings sometimes (tends to be after waking from nights sleep - i tend to feel better as the day goes on), but the low feelings are not bad enough to cause difficulty in doing things/life in general.

do you think it might be worth you trying 20mg instead of 15mg? 

Hi Sparrow, I'll give it a go on 15mg first, 6-8 weeks then try 20mg. You say you tried 30mg? I was told the max dose on escitalopram was 20mg? Thanks for the reply.

although it says in the leaflet that 20mg is the highest dose, there have been official studies regarding higher doses. the studies show that there are people who did not respond adequately to doses of 20mg or lower, but did respond to higher doses. here is some details about one of the tests regarding escitalopram at doses above 20mg:

Background

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Escitalopram is licensed for use at doses up to 20 mg but is used clinically at higher doses. There is limited published data at higher doses and none in the treatment of Major Depressive Disorder.

Methods

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This open-label, pilot study was designed to investigate the efficacy, safety and tolerability of escitalopram in doses up to 50 mg in major depressive disorder. It was conducted in 60 primary care patients with major depressive disorder who had not responded to adequate treatment with citalopram. Patients were treated with escalating doses of escitalopram up to 50 mg for up to 32 weeks until they achieved remission.

Results

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Forty-two patients (70%) completed the study. Twenty-one patients (35%) achieved remission with 8 of the 21 patients (38%) needing the 50 mg dose to achieve remission. Median time to remission was 24 weeks and median dose in remission was 30 mg. No significant safety issues were identified although tolerability appeared to decline above a dose of 40 mg with 26% of patients unable to tolerate 50 mg. Twelve (20%) patients had adverse events leading to discontinuation. The most common adverse events were headache (35%), nausea, diarrhoea and nasopharyngitis (all 25%). Minor mean weight gain was found during the study, which did not appear to be dose-related. Half of the patients who completed the study chose to continue treatment with escitalopram rather than taper down the dose at 32 weeks.

Conclusion

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Dose escalation with escitalopram above 20 mg may have a useful role in the management of patients with major depressive disorder.

 

Wow... That's interesting, thanks sparrow. If need be I will mention what you posted to my psych when I see him next which is about 2 months time.

the history of escitalopram (you can read about it on wikipedia) was that it was developed in a relatively shorter time (3.5 years) over other antidepressants, because it expanded on the already existing research done with its previous incarnation, citalopram.  no doubt its creators were wanting something newer than citalopram, due to citalopram's upcoming patent expiry (meaning other pharmacutical companies could then legally 'copy' the citalopram drug formula and sell it themselves)

it's possible that due to excitaloprams quicker push for release onto the market, the makers may not have had enough time for extensive testing/trials, so instead 'played it safe' and set the maximum dose at 20mg in the leaflet.

however, now that escitalopram has been around for a while, many docotrs have allowed patients to go above the 20mg recommendation, and not encountered problems doing so.  shown in the trial i posted above, it says the (median) dose which seemed to do the best for the patients in the trial was 30mg.

to summarise, personally if i was taking 20mg and my depression/anxiety wasnt being reduced, i wouldnt have any problem going up to 30mg. the problem is side effects, which vary from person to person. for some people, they wouldnt have bothersome side effects on 30mg (or higher), while others are more sensitive at the lower doses so could have a hard time on  20mg, let alone 30mg (or higher). so it's all about finding the right dose for each individual.   ok, i wish you the best of luck. you'll get there in the end, it's that annoying wait which is the problem isn't it (it took me months to feel better when i got started...    certainly well, well worth waiting for though).

just to add one more thing to the above, it's also possible that the makers of escitalopram wanted to market their new 'more modern' SSRI med to be seen as a 'new and improved', better class of antidepressant drug, which works for EVERYONE at lower doses (10mg - 20mg).  this statement really goes against pretty much every other drug out there though doesnt it.    for someone who is quite resistant to SSRI antidepressants, or whos depression/anxiety is deep, well ingrained, and somewhat resistant to meds, it simply makes sense that (like most other drugs), those people might simply need a higher dose than the rest (but of course remembering to go slow, don't rush up in dose too quickly, and pay attention to any side effects due to higher doses).