Lexapro - increasing dosage? - Anxiety and Depre...

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Lexapro - increasing dosage?

Hidden
Hidden

Hello

I’m on Lexapro (Escitalopram) 10 mgs and have been for 4 months. One aspect of the benefits was that my sleeping was much better. However for the last week or two I have been waking up very early again and a bit down. I’m wondering if this is because my brain has got used to the dosage I’m on and if this means that I need to increase the dosage? Does this happen? That the dose you’re on stops working as well? If so does this mean that you have to increase to a higher and higher dose? This worries me!!

Any thoughts/comments welcomed!

Thanks 😊

17 Replies
oldestnewest

It’s happening to me as well! Been on 10mg for 3 months and now feeling low again, my doc advised me to increase the dose to 15mg!

Hidden
Hidden in reply to Vectron

Hi there

Thanks for your response. What I’m cogitating on is that will I need to continually increase the dose to feel stable? Do the meds stop being so effective every few months because the brain gets used to the dose you’re on or will I reach ‘peak performance’ on a specific dosage?. I’m not clear how it works, are you? I know everyone reacts differently but I don’t like the idea of having to take more and more to feel the same!!

😊

Vectron
Vectron in reply to Hidden

I was on Lexepro in 2009 until 2014 remember going on 10mg then eventually 20mg, the drug worked very well it stopped my anxiety and depression, but it did stop working in 2014 so my doctor switched me to Zoloft 75mg which was ok but I decided to go back to Lexepro again.

I dont know. Thats a good question! So it seems like when your body gets used to medication, you have to increase the dosage. So does that mean the dependency is stronger or the medication is weaker? I can understand why you are starting to get nervous. My doctor prescribed that for me yet I never started it because I was nervous about those same areas.

Hi to slf and friend.

I can help you a bit on this question from my experience on Venlafaxine, a different antidepressant but they work in a similar way really. This will probably be long so be warned but I feel you will understand it better with more detail. I would have liked someone to write this for me when I first started as I had exactly the same worries as you.

In a nut shell, incase you do not want to read all of this:

How well, or not so well antidepressants work for me tends to depend so much on what is happening in my life and my attitude of mind to my illness and my antidepressants.

I decided how high I wanted to go with the dosage and with the doctors support have stuck to that and most of the time I feel really great and really do carry on improving. But I do have set backs as I will explain.

I started on 75 mg of Venlafaxine. It is the usual dose to start on. I was very ill with GAD and depression when I started following two life traumas. I had not been ill before and had seen myself as a happy, largely fulfilled, non anxious person.

After around a month I felt worse rather than better but certain crucial aspects had improved, for example I could now eat and enjoy meals though smaller quantities. I had put back a little weight, the constant nausea had largely gone. I was however now feeling scared of a lot more things, seeing friends, going in shops, going on car journeys sometimes even driving which I always loved. I had never experienced anything like it before. I did however make myself do all these things however bad I felt. I even had friends in small numbers over for meals, keeping the occasion short, my friends understood, and I felt great for a few days each time I accomplished this. I knew I would feel better after a glass of wine at the dinner party, which my doc said was fine.

I continued to improve slightly even though I also developed new symptoms, e.g.; a constant pain in my stomach for example. That went on for about a month then suddenly disappeared.

I went back to my doctor and said that although better in some ways I was nothing like back to normal. I could still hear my heart pounding all the time etc. I have a very mild heart problem of getting palpitations for physical not psychological reasons as well, so before he did another dose increase I had an ECG, which came back normal.

I therefore increased by another 37.5 to take me up to 150 mg

I knew at this level considered an average dose, the drug would work to increase noradrenaline in my system as well as serotonin. I felt I did not want to have to ever go higher than this.

After this dose increase I saw the most dramatic change at 4 months. I suddenly knew the depression had lifted as well as most of the anxiety symptoms. I was really enjoying life again and it felt wonderful. I had a slight set back a month later after Christmas because I got flu. Some of the symptoms returned for a while and I felt a bit down but not depressed. I improved again one over the flu and carried on feeling good but not quite as good as I had done suddenly after the dose increase a few months earlier.

It then, and now feels that how I feel on my drug depends largely on keeping a positive attitude, setting myself little challenges, not worrying about symptoms and what is going on around me in my life in general. I feel good most of the time but small life crises set me back a little.

I could still see progress for about 6 months but the remaining symptom in my case is a bit of breathlessness and feeling out of sorts in the morning carried on. When I reached the year point I was getting fed up with this minor symptom and so went back for a small final increase to 187.5 which is a fairly high dose but not the maximum. I decided I did not want to reach the maximum of 375mg or even 225mg, unless I really need to.

If I get a major relapse which is most likely to do with a life crise I would ask to increase again but very gradually still.

So 2 years down the line I am still very well and I would also say still improving but in a much slower less perceptible way. I was disappointed after that final increase by the way, as at first it did not seem to help with the breathlessness at all. I still am a little breathless perhaps half the time, mostly in the first part of the day. If I go on holiday and really enjoy myself it goes completely for a week. But you can't have non stop holidays. It disappears also on nearly all social occasions which I am no longer nervous about at all and can stay away for a few days after these. It also goes completely if I do my wild swimming, which in the summer I do around 3 times a week and then can stay away for the rest of the day.It is the effect of cold water on your body apparently. I do find though hard to get in, the colder the water the better I feel at the time and afterwards. Try it if you can. I did a post about how to get in safely by the way.

If I have an amazing day, it will go away for a few days. I therefore try to lead very full days and enjoy myself amap. I am lucky as I am retired now so have time to do this. I also work a few days a month and it will go then as I am fully occupied. I also eat healthy food,regular meals, rest as much as possible between activities and make sure I get good sleep. Getting tired always makes me worse.

I can see general continuing improvements, such as I can do more new challenges and enjoy life to the full and am more sociable now even than before I became ill. If I have the odd few hours moping around or worrying about symptoms I always feel worse. If anything upsets me I will feel a little ill again and it will take my nerves longer to settle down again than it ever did before. So you can see, attitude of mind and setting yourself challenges are crucial I find. If ever I started to worry my antidepressants had stopped working so well, I always felt worse. They can and will carry on improving for you if you work with them and increase your dose if you need to, but perhaps leave room to not reach the maximum unless you have a major relapse or life crisis to set you back.

I make sure I excercise as many days as I can with short runs or at least an hour's fast walking even though breathless and nearly always feel so much better afterwards.

Some people do find antidepressants are less effective after a period of time but with a positive attitude and setting yourself little challenges daily I think you can carry on improving. That was confirmed by my doctor.

You basically have to work with them to benefit fully.

Very good luck with it.

Kim

Bluetj
Bluetj in reply to Kkimm

Thx for the info. You made mention about increasing the dosage of the medication, this is one thing I'm concerned with. I have never been a medicine person, taking medicine already scares me but the thought of increasing the dosage horrifies me. I always worry about taking to much. How did you manage to push thru & take the higher dosage? I guess if it helps uts worth it. Calling my dr's office now to see about increasing dosage. Maybe if I increase my dosage, this thing will get under control.

Kkimm
Kkimm in reply to Bluetj

Hi

I think I tried to reply to you and it went to slf.

Read those replies in this thread if you like.I too felt the same but it is not at all difficult increasing your dose. Nothing like as bad as starting in my case. Just title bit of return if symptoms and increase in anxiety.

Much more detail below on this, how to decide on the dose etc.

All the best

Kim

Hidden
Hidden

Thanks very much for sharing your story! With me, I did have major depression many years ago following a life threatening illness but I recovered from this without medication after about 6 months. This was triggered by massive weight loss (28 lbs in 2 weeks) following typhoid so I am sure it was this that triggered it. What I’ve had though and why I sought treatment was not deep depression but GAD. I woke up every day with a feeling of dread, nightmares, generally feeling pretty joyless, being overly critical, angry and worrying excessively about small things. I always put this down to life issues of which there’s been a few so thought it normal. However when I really didn’t have any life issues or problems at all, I realised this wasn’t normal and my doctor diagnosed GAD 4 months ago when I started on Escitalopram. After the first couple of weeks I started basically getting my life back - other than yawning too much and a few small but manageable side effects it’s been brilliant. I don’t want to stop but I obviously don’t want the meds to stop working. As I think it has a bit. I would say my attitude is positive and I am happy in my life so it seems to me that it’s not my attitude but the fact that I may need to consider upping the dosage which I’d be happy to do but I don’t want to get to the highest dosage and then that to stop working!

Thanks for all the feedback. 😊

Kkimm
Kkimm in reply to Hidden

Hi

From what I have read there is a dose level that will probably be needed for most people to be effective for GAD. I had heard that in the case of Venlafaxine, the drug I have you are likely to need from 150 to 225 to be effective. Most psychiatrists seem to put people up to the effective dose very quickly. GPs do not do this so often and tend to be more cautious and let patients ask for an increase before they will give one. I asked my doctor why this is and he said that it is because psychiatrists in the UK at least only see the most severe cases that have not really responded to antidepressants.

Mine certainly let me set the pace.

Like you I was very nervous about a dose increase although I did feel that I needed it after a month. Often the increase for my med is 75 mg at a time but because I was so nervous he suggested suggested to go in increments of 37.5 mg.

I can honestly say in my case the dose increases were fine. I had a little bit of increase of symptoms but nothing like the start of getting onto the drug. I read that the dose increase can take up to 8 weeks to be really reach its maximum effectiveness. However I also read it takes around 2 to 4 weeks.

My doctor's view is that it will just carry on improving if you work with it. He has suffered from GAD himself and uses the same medication.

Be guided by your doctor but it may be if you are on a low dose for GAD you need an increase and in my experience this was no problem. I certainly needed my increases. The one that really helped for me was reaching 150, the average dose after that it did not make much difference but I am still definitely improving, but very slowly. You already ready view that I want to leave room to be able increase if I really need to.

Sometimes it seems whatever you do the drug does stop working for you. I do not know why this happens in which case they seem to either change you to another antidepressant or add another.

I do not want to temp fate but I think I have had a big improvement over the last week or so which I think is to do with being able to cry and express relationship difficulties with my partner. I had a similar step change when airing some difficulties with my sister. In each case these were difficult not happy periods but may have lead to some positive changes. However I will have to see if they are lasting or not.

Very good luck with it.

Kim

Hidden
Hidden in reply to Kkimm

Thanks for this Kkimm. Really helpful. I shall be seeing my GP in a few weeks so will see if he thinks I should up the dosage. In the UK, according to the product information, they say 10mgs is the usual dosage for GAD whereas most people taking Lexapro in the USA seem to think that 20 mgs is the best dosage. I’m glad you are doing well. I am certainly doing better than pre medication but the lovely feeling of slight euphoria that I definitely felt after the meds kicked in after 8-10 weeks has diminished sadly 😞! The euphoria was an unexpected upside - would be nice to get it back!😊

Kkimm
Kkimm in reply to Hidden

Hi slf

I will comment on your point of reduction of slight euphoria in a minute but first want to ask you some questions about side effects etc of escitalopram because I think it may be the best antidepressant for my husband Pete to take.

We are experiencing a very difficult time in our relationship at present and yes, even so, I am improving. I think I am improving because we are finally finding the cause of his difficulties which always seem to manifest as verbal attacks etc on me, he is also suffering from anxiety but more social anxiety and not severe or sudden in onset.

I therefore am thinking from what you and others have said about lack of side effects for escitalopram that this may be an antidepressant he could take if he and the doctor think this is possible for him.

He has finally accepted he has a problem and that it is the reason that we have serious relationship problems. His problem of social anxiety and anger/stress management have always been there but have become so much worse over the last 2 or 3 years. Yes I became ill 2 years ago and perhaps this made it worse but I am pretty sure it was developing about a year before that. If you want to read more about his problem and how it presents it is covered in my most recent post, about the holiday in Spain and has a photo if a gorge. Posted about 11.9.19

It is certainly not GAD as unlike in my case it is not present all the time.

I think escitalopram could really help him as it seems alot milder and with less side effects than the one I took. I am however still worried it may be too much for him at first while he gets used to it. He gets so stressed and verbally aggressive that I fear he could be pushed over the edge by any antidepressant. You may be aware that people, particularly young or vulnerable people become more likely to commit suicide whilst first getting used to antidepressants.

So my questions to you are:

1 Could you tell me your starting dose and how you felt in detail after the first tablet for the first few days, for example, did it create nausea, diarrhoea etc increase in anxiety or anger or feeling stressed or more anxious at all and at what point?

2 I think you said you did get a few manageable side effects after a few days, what were they if not the above and how long did they last?

3 I think you said that you started to feel good after a fortnight, I do not know if that was when you felt a bit of Euphoria then or if it was just that you felt normal again

4 If the euphoria was not then when did it start and how long did it last. Did it also increase your irritability or not?

5 Have you felt dizzy or spaced out at all since on it and if so did you ever feel that beforehand.

6 How long did it take to start to feel the drugs are not working so well?

7 Does your feeling of not working just mean your euphoria has gone or does it mean you feel worse in yourself and are not much better than before.

8 Finally, sorry so many questions!!

I read your description of how you had depression following typhoid and then the development of GAD and I really feel for yoy. Some of your GAD symptoms I definitely had, for example the extreme dread on waking in the morning.

However, unless you are missing alot of your symptoms it does sound as if it is possible my GAD at least started out alot more severely. I was so lucky in that I did not get your severe depression. Just moderate depression I think in my case.

My anxiety symptoms of complete loss of appetite, weight loss, nausea, heart pounding, completely unable to concentrate on any task, spaced out and a constant feeling of lack of safety in my own skin, afraid of having to see anyone even my daughter and close friends etc were constant for months, just giving me a few hours relief within a week, then perhaps a full day now on then after a month of starting antidepressants and so on until 4 months when the dark veil lifted and normality crept back.

Am I right in thinking therefore that you had a much milder version of the illness than me? Could you give me a more detailed description of how you were feeling before which led you to take antidepressants and what if any of it got worse after you took them?

My husband Pete has normality and lack of stress, anger and difficult behaviour nearly all the time. Even social anxiety is almost as a very rare occurrence so I am very worried starting antidepressants, even mild ones could make him worse. Possibly he is more in need of anger management and CBT for social anxiety if he is prepared to do this. This Medication however may reduce his anxiety such alot that the other stuff falls into place but the last thing I want us to make matters worse. Clearly we will talk it all through with our GP but it is a very hard decision because out of his comfort zone he reacts so badly, often toward me but is very violent, in his comfort zone which is most of the time he is lovely kind and gentle and we have a wonderful life together. The bad side us very bad and ruins all holidays with him so most of mine are not taken with him but travel is so central to our relationship and why we married it is now presenting huge problems for us.

Really sorry I know I am writing and asking asking for an essay😅 but I think it will help me to decide if we should risk escitalopram with Pete and approach the doctor to discuss it now Pete says he is prepared to have help.

With regard to your comment on euphoria, My experience was similar. The euphoria for me was largely after the second dose increase after 4 months. Down side of making sleeping difficult also.

I still get it after very good experiences but nothing like as strong as at the beginning.

However it is not reality. It should just be seen as a lovely bonus at the beginning that probably will not last. It is also not something you should have a dose increase to try to recreate. That certainly could become a slippery slope and would lead to disappointment and worse. It would lead to never being satisfied, then really feeling worse and possibly a real decline.

If you tell some doctors or psychiatrist s you get it some people have the difficult experience if being taken off the antidepressant causing it and having to start another one. It is seen as a side effect that is not encouraged because it can have uninhibited behaviour and risk taking associated with it as well as bad temper and irritability than impacts on relationships.

When I get mild euphoria now as I do if having a very good holiday or social time etc I get all of the bad side with it and sleeplessness. I have zoplicone given by my doctor to cope with this and that is a whole different ball game with very serious risks if you take them for too long or increase the dose etc. My doctor knows me well enough to know that I am very careful to manage these high periods and zoplicone which I use so rarely.

Therefore euphoria is great and like you I wanted to chase it at first but means that you are a bit high and in my case if I got higher could also get bad temper, risk taking and sleeplessness. In some ways it means that within your body you are sometimes exceeding your required dose. But doses are static things and our bodies, minds and lives are not fixed in anyway. In my experience my dose will be too high for me on days I am on holiday having a wonderful time and too low for me once I return to everyday life.

Then far too low for me when I have a life trauma. I therefore decided to go just a bit above the recommended dose for severe GAD in my case. When I tried to increase it was to rid myself of a final slightly distressing symptom of feeling off in the morning and slight breathlessness which can persist all day sometimes. I should not want to increase to achieve ongoing mild euphoria however understandable that is. Trying to feel how you were before you became ill or better than before ill if you were always over anxious is what you want. You do not want to try to Chase the dragon if you know what that means🤔

There is a very much more rewarding dragon which by alot of work I am beginning to find . It involves a deeper understanding of myself and others and a more challenging and rewarding life which my journey through anxiety depression and the right medication for me have taken me on.

However like you I feel it is great to get it, I love art and nature and my appreciation of that is really enhanced when I do get it so for me it can be really magical and lead to increased creativity, connection and understanding with my writing and photography but I try never to chase it. I just try to keep positive so I am working with my medication.

It would really help me alot if you could answer these questions fully about escitalopram. I will ofcourse read up on it but your experience in detail will tell me alot so I can try to help Pete and try to improve or even save our relationship

Anyone new to this site should read this post and replies. It is a perfect example of how we help each other. It fills my heart with gratitude to be a part of this community. AND I identified and learned something. I am afraid of the same thing (meds working less). It’s scary to think about diving back into that black hole. You’ve lightened the fear. Thank you. Lynne

Kkimm
Kkimm in reply to LilyAnnepuppy

Hi Lynne.

Thanks for your lovely comments. I have just done a further reply to slf in this which could be of help also.

I like the way you describe your fear, yes I feel the same at times and was very worried about this at one point.

In my case with the drug and dose I am on I do not have to try hard not to worry about most things. Worries most of the time seem to sort of slide away from me and are not held onto.

I used to have quite a deep fear of death but that has become really reduced to something somehow fluid and insubstantial. I would possibly have it back if facing death but even having that is hard to imagine. I think it is also partly because I now feel that there are much worse things than death, having once been "in the black hole" as you say.

I did have mild health anxiety and would have worried alot about cervical smear test results, mammogram etc but I recently sent in a routine stool sample for over 60s bowel cancer screening and because of holidays and so many drama's with my partner and wider family members whilst on holiday with them I completely forgot I was expecting them!!!! Got a nice surprise of all clear yesterday.

Previously even before I was ill I would be dreading them. While I was really ill they would have created ongoing and overwhelming anxiety, spending all day obsessed not only about post arriving but thinking the results might be so bad I might get a telephone call. This would then cause high anxiety all through office hours until I knew I could not be rung until the next working day.

I still have anxiety about my daughter for all the usual small things and my caring and love has in no way reduced for worrying less. I am however better able to put unnecessary worry about her to the back of my mind and not bother her with over worry the way I used to at times.

Possibly a down side in my case is reduction of caution and possibly risk taking sometimes. This is good in some ways, largely making me more sociable etc and more prepared to try new things. It is bad in that I am a bit adventurous anyway and could possibly take risks in certain physical activities. That is how my partner sees it and I am thinking he may be right.

Anyway enough pondering on things you have not asked about, you will be getting bored reading this.

Very best wishes.

Kim

LilyAnnepuppy
LilyAnnepuppy in reply to Kkimm

No boredom here in fact the daughter worry is an ongoing issue for me. But I really believe the fear is warranted. I’m her mother and will always want her to be safe and secure and happy. She’s 52 and I’m still waiting. 😱. Sometimes I wish I could turn off the mother thing, but that’s impossible.

Hidden
Hidden in reply to Kkimm

Hi Kkimm

I wondered how you were feeling? 😊

Hidden
Hidden

Hi there Kkimm

I’ve tried to answer below in the same order:

1 Starting dose 5 mgs for 2 weeks. Side effects kicked in between days 4-9. Excessive yawning, felt spaced out, couldn’t get off the sofa or think straight. No nausea or diarrhoea and no additional anxiety. I did push through and went to work but I was totally unproductive and was ready to quit and would have done had it not been for support on this website. I would recommend starting meds mid week so the worst side effects hit at weekend so you/he can rest and take it easy.

2 Around day 10 I started to feel okay/quite relaxed. Each day I think I felt a bit better. I can’t recall You can look at my posts where I detailed as much as I could. I then increased dosage to 10 mgs. I didn’t get additional side effects following the increase. Of course everyone reacts differently. My sleep was massively improved almost from day 1. I took meds with my lunch following advice on here. The manageable side effects was still feeling a bit ‘can’t be bothered’ and difficulty getting going in the morning. Coffee helped as did throwing myself in the shower and lively music!

3 As above. No euphoria, just felt more levelled out, less irritated by things. The only ongoing side effect has been yawning but not as much as in the beginning, dryish mouth and some itching of arms and legs. All manageable.

4 Euphoria probably around 4 - 6 weeks. Nothing excessive but found myself smiling and generally feeling perky.

5 Not felt dizzy. Occasionally a bit spaced out/high but eating something helped. Never felt spaced out beforehand or dizzy beforehand either.

6 It took a good 8 weeks before I properly knew they were working and I generally felt really well, happy and levelled out.

7 My feeling of not working so well is mainly that my sleeping has been slightly less good. Not terrible but waking up a bit more but not as bad as before I started.

8 It does sound that your anxiety was worse than mind. As I said, I thought my symptoms of dread, not wanting to do much and nightmares and early waking were just due to hassle at work and with family but when these hassles were no more and I still felt same that’s when I went to GP. None of these symptoms got worse, everything better. Just those side effects in the beginning and the yawning, dry mouth. I would add that we recently had a holiday and for the first time EVER I was really happy and enjoyed it so much. The depression I had after the typhoid was something else though. I couldn’t eat, get out of bed and was completely out of it. The old black dog effect. The GAD was not stopping me from functioning but, as I think I said, my life was okay but rather joyless before taking the meds. When I had depression I was prescribed Zopiclone for insomnia (I was sleepless for around 6 weeks only getting 1-2 hours a night) and got addicted! Horrible time. Went cold turkey. Not to be recommended...

I know what you mean by chasing the dragon! That’s not me though. I’m not addictive by nature. I was feeling worried by the thought of having to take more and more of the meds to feel the same, that’s all really. I am currently feeling pretty good. Nice day at work and chilling out with a G&T and some chocolate and looking forward to reading my book when I go to bed!!

I wish you and Pete all the best. Hope this helps a bit 😊

Hi slf

Thanks this is amazingly helpful, I really appreciate the time you took to answer all my questions. Helpful information for me and for others I believe also.

I remain well thanks. Pete and I just had a good weekend with our daughter. He got a bit stressed on the way down, anxious about the visit I expect but great at times whilst there and generally things have improved since our time in Spain a week or so ago. Spain, was very very difficult.

When I re read my reply to you I saw there was a typo saying he could be very violent, it was meant to say never violent by the way.

I have concluded that any antidepressants would be too difficult and risky for Pete and he agrees with me. I was coming to that conclusion before I was able to read your reply from doing my own research also. Your email reply link would not open for me by the way but found it through replies on my profile page.

Probably CBT could help him so I will look into that a bit more. He really hates the idea of seeing a therapist face to face so an online course could be good if he could stick to it. May be obtained through NHS Health online free in my area if they decide he is ill enough. I think however they may not decide that and I think he will refuse to pay for a course so only an outside chance of help really.

However I also have some lifestyle changes in mind I feel could help us both.

Really hope you continue to do well. I think you are doing very well and will continue to do so as you have a great positive attitude.

Do keep me up dated if you feel like it, I think others will benefit if you do as well as me being interested. It is just so hard for many people with anxiety to get onto and stick to antidepressants as I know you are aware.

Very best wishes.

Kim

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