Question:
Should I have stayed on the Lex longer? Has anyone else had this
problem with SSRIs? I know I don't want to go back to the Effexor
because of the way it made my heart so erratic, but I'd still be
willing to try the Lexapro. However, I'd like to take an even smaller
dose. Can you get smaller doses than 5mg? I've heard you can buy it in
bottled liquid form.
Another thing I wondered about was if I went on and off the Lexparo on
a schedule. For instance, I seem to feel great going on or coming off
an SSRI, but in the middle I'm in hell. So I was wondering if it's
possible to set up a schedule where I take the Lex two days out of
three, or something similar.
The other thing to consider with all this is that I can't take benzos
regularly because we're trying to get pregnant with our second child.
I've been hoping that I could find a good SSRI that would carry me
through the pregnancy, but I'm starting to lose hope. Any advice out
there?
Answer:
I'm wondering if you guys can help me sort out a problem I seem to
have with SSRIs. I've tried Effexor XR and Lexapro for my severe panic
disorder.
The Effexor was great in that it totally erased my general anxiety,
but my panic attacks increased to practically three a day, and they
were much worse and more physically intense than I'd ever experienced
them before. For example, normally when I'm unmedicated and I have a
panic attack, my heart rate will increase slightly, but doesn't race.
With the Effexor, I was dealing with my heart rate jumping from the
100's to the 150's or 160's. It was very scary, and I ended up in the
ER once. After five weeks of this getting steadily worse, I stopped
taking it.
I moved to the Lexapro (5mg). Once again, it started out great, and
then within a few days the panic attacks began again. They started to
get worse, and after two weeks I stopped the Lexapro.
Should I have stayed on the Lex longer? Has anyone else had this
problem with SSRIs? I know I don't want to go back to the Effexor
because of the way it made my heart so erratic, but I'd still be
willing to try the Lexapro. However, I'd like to take an even smaller
dose. Can you get smaller doses than 5mg? I've heard you can buy it in
bottled liquid form.
Another thing I wondered about was if I went on and off the Lexparo on
a schedule. For instance, I seem to feel great going on or coming off
an SSRI, but in the middle I'm in hell. So I was wondering if it's
possible to set up a schedule where I take the Lex two days out of
three, or something similar.
The other thing to consider with all this is that I can't take benzos
regularly because we're trying to get pregnant with our second child.
I've been hoping that I could find a good SSRI that would carry me
through the pregnancy, but I'm starting to lose hope. Any advice out
there?
I don't take an SSRI either, but your news is great to hear, Vanessa. I
have specifically avoided getting pregnant again b/c of being on Xanax and
Remeron. For some reason, I worry that the meds will hurt an unborn child
(Can you believe that? Sounds like anxiety ; ), even though my pdoc told me
it would be ok. It's good to know that you were successful. I know others
have been too. Of course, I think the Remeron is still a wild card. Not
many are on it, so who knows?
You could put your next (i.e. 2nd) pregnancy on hold for awhile. Taper onto
the Lexapro very slowly. If you remain on a theraputic (i.e. effective) dose
of Lexapro for several weeks you will become tolerant to the temporary side
effects of increased anxiety and panic attacks. While tapering onto the
Lexapro use a benzodiazepine (for example Xanax) to decrease anxiety and
block panic attacks. After you have been on, say, Lexapro 10 mg/day for
several weeks without any increased anxiety or panic attacks, then do a slow
taper off the benzodiazepine.
After you are off the benzodiazepine, attempt to get pregnant.
Alternatively:
Benzodiazepines are category D for pregnancy, which means there is positive
evidence of human fetal risk *but the benefits (of benzos during pregnancy)
may outweigh the risks*.
In other words, one should not just look at the possible adverse effects of
a med on a pregnancy, but also consider and weigh the potential adverse
effects of an untreated medical or mental condition (eg panic disorder) in
the mother on a pregnancy. And to the best of my knowledge the effects of
untreated panic disorder on a fetus is unknown.
As a general rule of thumb, medical and mental disorders in a woman should
be under control before she becomes pregnant. A sick mother can adversely
affect a fetus.
Back to the Lexapro:
The smallest Lexapro tablet is 10 mg and it is *scored*. So you could break
it in half and have 5 mg. Lexapro also comes in an oral solution formulation
of 1 mg per cc. (5 cc's equals a teaspoon) Therefore you might have to
obtain a dropper that is capable of measuring CC's. (If one isn't already
supplied with the container of Lexapro solution).
You could start on, say, 2 or 3 mg/day of Lexapro oral solution if 5 mg in
tablet form is too much Lexapro for you to tolerate.
