When should you take lexapro morning or night

• Starts working after 2-4 weeks
• If there is no effect after 6-8 weeks, increase the dose or switch to another drug
• May be taken for many years to prevent relapse.

• Complete remission.
• After the disappearance of symptoms of depression, you should continue taking 1 year if it was the treatment of the first episode. If this is a re-episode treatment, treatment can be extended indefinitely. nine0037
• Use in the treatment of anxiety and chronic pain may be indefinite.

• Change dose, switch to another drug, or add an ancillary drug;
• Connect psychotherapy;
• Review diagnosis for comorbid conditions;
• Patients with undiagnosed bipolar affective disorder may be less effective, in which case switching to a mood stabilizer should be considered [1]. nine0037
• Electroconvulsive therapy should be considered in the acute phase of a severe depressive disorder that is accompanied by psychotic or catatonic symptoms, as well as in patients with actual suicidal ideation [7].

It is not usually necessary to taper off gradually, but taper off gradually to be sure to avoid withdrawal symptoms. Gradual reduction scheme: dose reduced by 50% - 3 days, again reduced by 50% - 3 days, complete cessation. If withdrawal symptoms appear, increase the dose, wait for the withdrawal symptoms to subside, and continue to decrease [1]. nine0016

• For insomnia: trazadone
• For fatigue, drowsiness, loss of concentration: modafinil [3].
• Combinations with other antidepressants may activate bipolar disorder and suicidal ideation
• For bipolar depression, psychotic depression, resistant depression, resistant anxiety disorder: mood stabilizers, atypical antipsychotics
nine0036 For anxiety disorder: gabapentin, tiagabine

Warnings and contraindications

• Use caution if patient has had seizures;
• Use caution if patient has bipolar disorder;
• Do not use if patient is taking pimozide;
• Do not use if allergic to citalopram or escitalopram [1].

Special patient groups

Use caution if patient has severe kidney disease [1].

The recommended dose is 10 mg/day [1].

There are no systematic data on the use of escitalopram in people with pathology of the cardiovascular system. Presumably safe. Useful in recovery after a heart attack [1]. nine0016

A dose of 10 mg is recommended for elderly patients [1].

• Recommended for depression aged 12-17
• It is necessary to regularly and personally check the patient's condition, especially during the first weeks of treatment.
• Use with caution in view of the risk of undiagnosed bipolar affective disorder and suicidal tendencies. nine0037
• Inform adults of the risks.

• There have been no adequate studies in pregnant women [1].
• Not recommended for pregnant women, especially during the first trimester
• All risks should be weighed and compared
• Bleeding can be expected during childbirth

• The drug passes into breast milk. nine0037
• If the infant shows signs of irritation or sedation, stop feeding or taking escitalopram
• However, postpartum treatment may be necessary and the risks should be weighed.

Interaction with other substances

• Tramadol increases the risk of seizures
• Do not use with MAO inhibitors. After the end of taking MAO inhibitors, 14 days should pass. Start treatment with MAO inhibitors 7 days after the end of escitalopram. nine0037
• Together with warfarin, probably increases the risk of bleeding [1].

Tests during treatment

Not required.

Side effects and other risks

Side effects are caused by an increase in serotonin. Most side effects occur immediately after the start of treatment and go away over time.

• Gastroenterological (decreased appetite, nausea, diarrhea, constipation)
• Insomnia, sedation, agitation, tremor
• Sweating
• Urination disorder
• Dry mouth
• Dangerous side effects: convulsions, mania, suicidal ideation
• Weight gain: very rare
• Sedation: very rare
• Sexual dysfunction: yes

1. Wait
2. Switch to another antidepressant [1].
No
◊ Overdose
• There are very few reports of overdose. nine0037
• Very rare cases of fatal overdoses.
• Vomiting, sedation, cardiac arrhythmia, dizziness, tremor.

Benefits

• Good for patients on other medications - very few dangerous interactions;
• Gives relatively fast results [1].

Weaknesses

High price

Expert advice

• Best tolerated antidepressant
• The weakest effect on the sexual sphere compared to other SSRIs
• Lack of response to escitalopram in elderly patients may be indicative of Alzheimer's disease
• In postmenopausal women, escitalopram works better in combination with estrogen [1]
• Escitalopram and fluoxetine show a similar effect in the treatment of depression. The only difference noted is that escitalopram significantly improves microinflammation in the patient's body [6]. nine0015 6. Xiaoling Z, Yunping H, Yingdong L. Analysis of curative effect of fluoxetine and escitalopram in the depression treatment based on clinical observation. Pak J Pharm Sci. May 2018;31(3(Special)) 1115-1118.

  7. American Psychiatric Association. Guideline Watch: Practice Guideline for the Treatment of Patients with Major Depressive Disorder, Second Edition. American Psychiatric Association Practice Guidelines .

  What you need to know about antidepressants

  Ekaterina Kushnir

  treats anxiety disorder

  I have generalized anxiety disorder.

  For a long time I coped without pills and other help, but one day I got tired of constant anxiety and began to interfere with my normal life. As a result, I turned to a private psychiatrist.

  The doctor prescribed an antidepressant from the SSRI group - these are selective serotonin reuptake inhibitors. Such drugs are the first thing prescribed in the treatment of depression and a number of other conditions, including my illness. nine0016

  The doctor immediately warned me about some peculiarities associated with taking the drug. Some of them I then felt on myself. I think everyone who plans to be treated with antidepressants should know about them.

  At the same time, it must be taken into account that most of the negative effects of therapy are temporary and not dangerous, and if they do not go away, one medicine can be replaced with another. Antidepressants help many people with mental disorders and other illnesses get rid of their symptoms and return to a full life, so you definitely should not be afraid of them. The main thing is to take such drugs when they are really needed: as prescribed by a competent doctor and under his control. nine0016

  See a doctor

  Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don't write prescriptions, we make recommendations. Relying on our point of view or not is up to you.

  Fact No. 1

  Antidepressants may make symptoms worse at first

  Antidepressants can increase anxiety in anxiety disorders, as well as cause irritability and agitation - this is the name for causeless motor arousal, the inability to sit still. It's not dangerous, but rather unpleasant. This condition is sometimes referred to as initial anxiety, that is, the anxiety of starting therapy. Up to 65% of people face it. nine0016

  Antidepressant-induced anxiety syndrome - a systematic review in the British Journal of Psychiatry

  There is also evidence that some classes of antidepressants, including SSRIs, may increase suicidal ideation in depression in young people aged 18 to 24 years. These data are not very reliable, and in older people, the risk of suicide no longer increases and even decreases.

  Without treatment, depression is more likely to lead to suicidal thoughts, and in case of anxiety, you just need to prepare for such an effect, then it will be easier to survive the attacks. nine0016

  The doctor told me that in the first two or three weeks there may be an increase in anxiety, but I did not take it too seriously.

  Everything was fine the first week. After about seven days, I became nervous and irritable. And then I woke up at night and after a while I felt an incomprehensible fear. My heartbeat increased, my head was spinning, my throat was constricted. Because of this, I felt a real panic - I spent the rest of the night fighting terrible thoughts, in the morning I got up completely broken. nine0016

  /list/antidepressant-myths/

  8 myths about antidepressants

  I have never had such panic attacks before medication - my anxiety was background, general. I got scared and wrote to the doctor, who reassured me and said that it was not dangerous and would pass soon.

  After that, I already expected these panic attacks, immediately tried to relax, calm down, remember that this was just a temporary effect of the drugs. And they ended faster, and then they completely disappeared.

  My letter to a psychiatrist. I was scared: I expected an increase in background anxiety, but not panic attacks. I even thought about giving up the medicine

  Fact No. 2

  The effect of antidepressant treatment will not be immediate

  Increase the dose of antidepressants gradually to reduce side effects. They usually start with the minimum, and then bring it up to the working one. For example, for SSRIs with the active ingredient "sertraline", the working dose is from 100 mg per day. I started taking such a drug with 25 mg, and then gradually, in several steps, under the supervision of a doctor, raised the dose to 100 mg.

  SSRI dosage - NHS

  What doses of antidepressants will be optimal - an article in The Lancet

  The process of reaching a working dose can take from two weeks to a month or more. It depends on the drug and its tolerance. I turned out to be sensitive to the medicine, it was hard for me to survive every increase in dosage: anxiety increased again, there were other side effects that then stopped. However, this is not the case for everyone, sometimes the process goes faster.

  The full therapeutic effect, that is, the disappearance or a strong improvement in the symptoms of the disease, occurs some time after reaching the working dosage. As a rule, this is a week or two, although some positive changes may be earlier. For some people, this process stretches for a longer period: 6-12 weeks. Minimum initial doses of drugs usually do not work. nine0016

  It is better to get ready for the fact that the symptoms of the disease will not disappear in the first weeks of treatment. And remember - this does not always mean that the drug needs to be changed, sometimes you just need to wait or further increase the dosage under the supervision of a doctor.

  Fact No. 3

  Antidepressants are usually taken in combination with other drugs

  Another way to mitigate the side effects of antidepressants is to prescribe an additional drug along with them: for example, from the group of tranquilizers. Such drugs may have their own side effects, they should not be taken for a long time. Unlike antidepressants, some of them can be addictive. They are usually appointed for a month, but this period may be shorter or longer. nine0016

  Antidepressants together with benzodiazepines work better for depression - BMJ magazine

  My doctor prescribed a rather mild drug for me. However, he did not suit me. At first, it caused increased drowsiness: during the period of increased anxiety, it went away for a while, but then returned - even with half a pill I turned off and could sleep all day. And if I drank at night, I woke up with difficulty in the morning. The psychiatrist prescribed another medicine, but I could not buy it: the drug was not available in any pharmacy nearby. nine0016

  As a result, I simply endured all the side effects of therapy - they were unpleasant, but tolerable. When discussing with the doctor, she called this option acceptable if the side effects of the second medicine only worsen the situation.

  My prescriptions for drugs. I never used one, because there was no such medicine in pharmacies

  Fact No. 4

  Side effects are not always, but they are

  Modern antidepressants, including SSRIs, are mild and have almost no side effects. Older drugs - tricyclic antidepressants and monoamine oxidase inhibitors - cause more side effects. Doctors usually use them when milder first-line drugs don't work or when they can't be prescribed. nine0016

  For the first couple of weeks of taking it, there is a risk that you will not feel well - it's worth thinking about. It may be worth scheduling the start of therapy on vacation.

  I work remotely, and it was easier for me: the first pill was taken on Saturday, I slept through the weekend. Then she continued to work, but refused any additional loads: housework, part-time jobs, training and everything else.

  It was hard to work: I wanted to sleep, then I began to worry and get distracted. I also had diarrhea, nausea, headaches, tremors, i. e. hand trembling, hot flashes, sweating, palpitations. At night, panic attacks began, in the morning I had difficulty getting up because I was in pain and dizzy. nine0016

  There are mixed data on how common the side effects of antidepressants are. If we summarize them, then the numbers look something like this:

  • nausea - about 25% feel it;
  • diarrhea - it happens in 15% of people, and 5%, on the contrary, will have constipation;
  • sweating and a feeling of heat occur in about 20% of people;
  • sexual dysfunction, decreased libido may occur in 80% of cases;
  • insomnia - in 11% of cases;
  • headache and dizziness - in about 10-11% of cases; nine0037
  • weight gain - not all drugs give this effect. Some, on the contrary, can reduce weight. On my medicine, I lost 2 kilograms in the first month, despite the fact that I quit training due to poor health. True, then they returned back.

  It can be seen that most side effects occur in less than half of the cases. In addition, in most cases they pass in the first weeks and are not dangerous.

  Side effects not listed above are very rare. I was "lucky", and I faced one such - a decrease in visual acuity. Once in the morning I noticed that I see worse without glasses. A little later, I realized that something was wrong with the glasses. nine0016

  I wrote to the doctor, she replied that this happens, as a rule, is not dangerous and passes, but it is better to visit an ophthalmologist. I went to the ophthalmologist, everything was fine with my eyes, there was nothing terrible, but my vision really worsened - it was not a subjective feeling. On the right eye, it was -0.5 diopters, it became -0.75, and on the left eye it was -1.5, and it became -3.5.

  I was offered to try changing the drug, but I decided to wait. Vision was then restored. I have not yet gone to the doctor to have it measured, but according to subjective feelings, it is at the same level as before: I am comfortable again in my glasses. nine0016

  Side effects should not be tolerated - if something greatly worries, scares or interferes with life, it is better to tell the doctor right away. The psychiatrist will be able to determine whether the side effect of the drug is dangerous and whether it is worth continuing to take it. There are several antidepressants of the SSRI group, in addition, there are groups of drugs with a slightly different mechanism of action. As a rule, doctors manage to find a medicine that gives a good effect without side effects.

  If there is no danger, the doctor can adjust the dose or increase it more gradually - this often helps to cope with unpleasant effects. nine0016 I wrote to the doctor again when my visual acuity decreased

  Fact No. 5

  Antidepressants need to be taken long term

  Antidepressants are not drugs that you can stop drinking as soon as you get better. They are taken for a long time: usually from several months, less often several years.

  Anxiety Therapy - UpToDate

  For example, for generalized anxiety disorder, the duration of treatment is at least a year. Moreover, the date is not counted from the very beginning, but from the moment when a lasting effect appeared from the pills. In fact, they will have to be drunk for about 1.5 years - it depends on how long it takes to reach the working dosage of the medicine. nine0016

  The cost of a package of the most famous antidepressant "Zoloft" is about 700 R, enough for about a month. That is, a course of therapy will cost about 10,000 R - maybe more or less, depending on which drug is selected.

  Psychotherapy review - UpToDate

  Another drug of the same group already costs more than 2000 R per pack. Source: rigla.ru

  The cost of an appointment with a good psychiatrist in Moscow is 3000-5000 R. At first, you will need to visit him about once every 1-1.5 months, then less often. nine0016

  You can apply to the psycho-neurological dispensary at the place of residence under compulsory medical insurance - it's free. At the same time, they will not put you on psychiatric registration: it was canceled in 1993. People with disorders that do not threaten their lives or those around them are on consultative and diagnostic care. If you stop going to the doctor, he will not find out what happened: a person seeks help at will.

  Psychotherapy, usually cognitive-behavioral, is also commonly prescribed to enhance and consolidate the effect of antidepressants. In many cases, it improves the effectiveness of drugs, including depression and generalized anxiety disorder. An appointment with a psychotherapist in Moscow costs an average of 5000 R. For treatment, you will need about 10 sessions or more. nine0016

  /psychotherapy/

  How psychotherapy works

  Fact No. 6

  Antidepressants should not be stopped abruptly

  Antidepressants are not addictive. However, if you abruptly stop drinking them, there will be a withdrawal syndrome. This is felt as electric current discharges while moving or turning the head, headaches, dizziness, insomnia. Many people experience symptoms similar to the flu or an intestinal virus: low fever, diarrhea, general malaise, chills. Often there is anxiety, there are intrusive images. nine0016

  Withdrawal symptoms after taking serotonin reuptake inhibitors - Journal of Clinical Psychiatry

  How difficult it is to stop taking antidepressants - American Psychological Association

  Stopping antidepressants in adults - UpToDate

  treatment, they should be canceled only under the supervision of a doctor.

  Antidepressant withdrawal occurs as gradually as the start of treatment. The dosage is slowly reduced, usually at this time again a cover-up drug is prescribed to alleviate side effects. As a rule, this is the same medicine that was at the beginning of the intake. nine0016

  Withdrawal is usually harmless and resolves within the first weeks of stopping the drug. Sometimes even within a few days - it still depends on which medicine was prescribed. If severely disturbing symptoms appear during the withdrawal period, you should consult a doctor.

  Fact No. 7

  If you need to change the drug, everything will start over

  It is far from always possible to immediately find the right antidepressant - sometimes the side effects do not go away and you need to take a new one. nine0016

  Changing antidepressants in adults - UpToDate

  Serotonin syndrome - MSD

  Most often it is started again with a small dosage, this delays the process of obtaining the effect of treatment. The new drug may also have side effects - the same or different. We will have to wait again until they pass.

  You won't be able to change the drug on your own, since all antidepressants are sold only by prescription - and that's good. Switching from one drug to another can be dangerous if you do not know the characteristics of different groups of drugs. nine0016

  For example, taking SSRIs is possible only some time after the withdrawal of antidepressants from the group of monoamine oxidase inhibitors - due to the risk of developing serotonin syndrome. This is a potentially fatal condition, accompanied by a change in mental state, high fever, increased muscle tone and other symptoms.

  If the drug is changed correctly, there will be no dangerous negative effects, so consultation with a doctor is required.

  /psychotherapy-search/

  How to choose a psychotherapist

  Fact No. 8

  Among antidepressants there are original drugs and generics

  Preparations may be original or generic. Originals are medicines first released by some pharmaceutical company that have passed all clinical trials and checks. Generics are drugs with the same active ingredient from another pharmaceutical company, that is, copied from the original drug.

  Theoretically, the effect of generic drugs should not differ from the effect of original drugs. However, this is possible, since generics may contain other additional substances or the manufacturer may use other raw materials. nine0016

  Due to my anxiety, I did not read anything in detail about specific drugs before I bought my first antidepressant in a pharmacy, so as not to be scared and not think about taking it. I also didn’t think to ask the doctor about this question.

  /list/covid-depression/

  Psychoneurological complications after covid: memory problems and depression

  As a result, I first bought a generic because it was in stock. Then it turned out that, after all, according to the experience of my psychiatrist, the original drug often gives fewer side effects and is better tolerated. As a result, I changed the generic to the original drug - and, indeed, the side effects softened. nine0016

  In my subjective opinion, which is supported by some data, in the case of antidepressants and other psychotropic drugs, you should always choose the original medicine. Moreover, the cost of originals and generics does not always differ greatly.

  Originals and generics of some SSRIs

  Active ingredient	Original	Original cost	Generics	Cost of generics
  Sertraline	Zoloft	About 700 R, 100 mg tablets	Serenata, Sirlift	500-600 R 100mg tablets
  Escitalopram	Cipralex	3000 R, tablets 10 mg	"Selektra", "Elycea"	500-1300 R, 10 mg tablets
  Fluoxetine	Prozac	About 350 R, 20 mg tablets	Profluzak, Fluoxetine	100-200 R, 20 mg tablets

  CERTRALIN

  Original

  "Zoloft"

  The cost of the original

  about 700 r, tablets 100 mg

  Generiki

  "Serenata"

  , tablets 100 mg

  Escitalopram

  Original

  Cipralex

  Original price

  3000 r, tablets 10 mg

  Generiki

  "Selectra", "Elice"

  The cost of generics

  500-1300 r, tablets 10 mg

  Fluoxetine

  " original

  About 350 R, tablets 20 mg

  Generics

  Profluzak, Fluoxetine

  Cost of generics

  100-200 R, tablets 20 mg

  one remained unclaimed

  Fact No. 9

  Do not take alcohol along with antidepressants

  Drinking alcohol while taking antidepressants may exacerbate unpleasant side effects. Also, alcohol is a depressant, that is, it has the opposite effect, and its intake can adversely affect the results of treatment.

  Why you shouldn't mix antidepressants and alcohol - Mayo Clinic

  Alcohol is strictly forbidden to drink with some groups of antidepressants, for example, tricyclic antidepressants and monoamine oxidase inhibitors: combination with the latter, for example, can lead to an uncontrolled increase in pressure. MAO inhibitors in general require a special diet - it is unlikely that a doctor will prescribe such drugs as the first antidepressants, but if necessary, he will issue a list of what is allowed and prohibited. nine0016

  With other antidepressants, moderate use may not be dangerous and may even pass without consequences, but doctors still recommend abstaining so as not to increase side effects and improve treatment outcome.

  The main thing is not to temporarily stop taking the drug in order to drink. This can lead to the development of a withdrawal syndrome.

  /trevoga/

  How I Treated Generalized Anxiety Disorder under CHI

  Fact No. 10

  Antidepressants are incompatible with certain drugs and have contraindications nine0122

  It is important to tell your doctor what medications you are taking and what chronic illnesses you have. For example, SSRIs may not be suitable for epilepsy and bleeding disorders, and tricyclic antidepressants are usually not prescribed to those who have recently had a heart attack, suffer from glaucoma or porphyria.

  Antidepressant Warnings - NHS

  Drug Compatibility Test - Drugs.com

  It is also important to be careful if you are about to take any over-the-counter medicine. For example, ibuprofen, which people often take on their own to relieve pain and reduce fever. It should not be taken with SSRIs as it increases the risk of gastrointestinal side effects.

  ---

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