I want to answer one question about sertraline Vs citalopram with regards to CYP 2D6 inhibition. Citalopram is a very weak CYP 2D6 inhibitor to the point that the interaction is not clinically meaningful. This is one of the reasons if I'm going to use one of these two medications I'll just use escitalopram and avoid citalopram (the other begin dose limits due to QTc prolongation). Likewise, sertraline at doses of 150 mg and less does not have meaningful CYP2D6 inhibition. However, when you go above 150 mg it has meaningful CYP2D6 inhibition. Sertraline is another reasonable option with an excellent safety profile for combination therapy. We are getting into some really detailed points here hope this helps clear things up
Heard a lot of people say they improved after only taking 10mg of Citalopram for anxiety and quickly. When they retake after some time,even on a higher dose,the results are nowhere the same. Any reason to that.? Thanks
I've just found you on youtube now and your videos are very informative. I've been on Citalopram and Escitaopram for 20 years and my Escitalopram dose is 12.5mg. I'm having chronic sweats and hypersensitivity to heat/cold to the point where I can no longer work as I cannot stand aircon or a coll wind as I feel frozen to my bones but yet my t shirts are soaking wet to the point where I have to bring a bag of clothes with me and change 3 t shirts in the space of an hour. I'm frozen to my core but dripping in cold sweat in the shopping mall. My life is hell. The Pneumologist said it's my SSRI and I need to get off it or change it but my local doctor knows very little about how to change and I can't get to a shrink for months as I live in a small town with no real quick access to medical professionals. If I changed SSRI's fro one to another would it stop the sweating or are they all the same? I just want off the meds asap so would it be a good idea just to go a hospital or a clinic as an inpatient and get off the Escitalopram quickly? I've read of a guy who quit Lexapro cold turkey in hospital and was given 2 weeks of Mirtazaoine and then that was stopped and he left hospital and did 30 rTMS sessions and is now med free and feeling great. Could that work? If not can a person switch direct from Lexapro to Prozac as in stop Lex one day and start Prozac the next day and not get withdrawals? All these questions I'm asking are solely for educational purposes and not for medical advice as I will go to my doctor with the info and we can both see what's best for me. Thank you
In general 20 mg is the maximum dose if the person is on 20 mg daily after 4-6 weeks with no response I would consider a change. In cases of some severe anxiety disorders and OCD I will go above the FDA approved recommendation to 30-40 mg daily and with OCD the persons needs to remain on the medication longer 6-12 weeks. I want you to keep in mind 10 mg is a good dose a response should be seen in most cases. Hope this helps
If a patient on Citalopram was reduced from 40mg to 30mg because of palpitations,and were still having them,but were given the O.K in hospital after an ECG to continue,would it be better to swap to escitalopram before choosing another SSRI? Thanks.
I would switch and the basic way to calculate the conversion is just divide by 2. Example patient of 40 mg of citalopram would take 20 mg of escitalopram. Hope this helps
Would you have any concerns with combining Escitalopram and Adderall in a healthy 35 year old patient who has tolerated each medication well on their own. I've done well on both meds, but never combined them. QTC test was normal.
I can’t give any specific medical advice but I have had patients on both stimulants and antidepressants. There are no specific drug interactions and usually can be combined without issue. Hope this helps, if you haven’t subscribed to the channel please do and spread the word about what we are doing here
Hello, Dr Rossi. 👋 my doctor has prescribed me 5 mg of Lexapro. The problem is I do take 100mg of slow release tramadol. I'm worried about serotonin syndrome, and this is why I have not yet started taking the lexapro as yet. What are the chances of me getting serotonin syndrome
I took bupropion 150 mg XL w/ 50 mg sertraline for GAD. I was on sertraline for 6 months prior to adding on bupropion. I felt bupropion made me very very jittery, like a different kind of anxious. Was I experiencing an interaction between sertraline+bupropion like you suggest in this video? And if so, would you expect this same type of reaction if combining bupropion with escitalopram?
Hi I’ve been on citalapram for years for my ocd I’ve literally just heard about escitalapram today ! I’m only on 10 mg now as I hate being on meds anyway but every time I’ve tried completely coming of my ocd flares up bad and I relapse and have to go up higher again , so I’m just sticking to 10 mg , but still worry about being on it long term , so Is this escitalopram safer with fewer side effects and will it still efficiently work for ocd ???? 😊
I'm hearing horror stories of doctors telling their patients to quit maximum dosages of Citalopram cold turkey. It seems to be because they are more worried of QT prolongation from palpitations or the interaction with antibiotics etc. On the request of doctors, people are suffering serious withdrawal or relapse in depression/anxiety for something that's supposed to be very rare. That,along with serious problems from a change of manufacture/generic Citalopram,does it mean that this medication could eventually become redundant or only given at small dosages?
You can just divide the dose of citalopram by 2 and convert the patient to escitalopram. For example 40 mg of citalopram is approximately 20 mg of escitalopram. Most physicians have limited the dose to 40 mg is people at risk. It’s never a good idea to just stop long term medication and there are many ways to do adage conversion. I appreciate this feedback. If you haven’t checked out the Instagram account lately we are doing daily posts now to help combat mental health stigma and provide education.
Think I may know the answer to my own question,generics. In my experience branded Ciprimil is more potent than generic Citalopram. Years ago there was only Ciprimil, now there's generic.
I'm not totally against generic medication but the FDA needs to do a better job with quality control as evidence by recent contamination with carcinogens in metformin
@@brandiepacula5619 I don't have an issue with generic medications but there is some variation in each formula so it's possible to see differences between manufactures but they all have to meet a basic standard set by the FDA
Have a question for educational purposes. If someone has negative reaction to sertraline (bruxism, disassociation, sexual side effects, etc.) is it still possible they will respond fine to another SSRI like escitalopram?
Often people respond and can have good outcomes with respect to depressive symptoms with SRIs but still have the side effects. We should separate out positive response with respect to depressive symptoms and side effects. In general I would say most SRIs carry similar risk for side effects, if there is sexual dysfunction I would consider vortioxetine or bupropion. I would be thinking along similar lines with the other side effects
hey shrinks, ive had 2 seperate cases of severe panic disorder for about 3 years on and off, i used to take lexapro on the smallest dose, 2.5mg and then 5mg and it really helped me overcome my disorder completely the first time (end of 2019 into 2020) but when i got panic disorder a second time (end of 2020) from smoking weed, I noticed not much of an impact on the same dose 2.5mg but i was told multiple times to up my dose for it and i was too scared to so i quit the medication cold turkey, and got insane migraines/headaches (thinking someting in my head was gonna pop it was so bad) as a withdrawal i think and for the past year I’ve been medicine free but I still get panic attacks everyday (heart races everyday nonstop, evil bad thoughts), and I’m ready to get back on something, my doc prescribed me celexa but I’m very unsure about trying it Bc I’ve been so used to take lexapro and I’m just wondering what ur opinion would be, thank u so much for the video also u rock!!
So this is not medical advice and you should always talk to your doctor, I will provide my thoughts for educational purposes only. Now that this is out of the way, Celexa and Lexapro are essentially the same medication. Lexapro is just the isolated S-isomer of Celexa. You can think about dosing by dividing the dose of Celexa in half. For example 20 mg of Celexa is equally to about 10 mg of escitalopram. I do not see any issue with using either one other than there is a cap on the dose of Celexa at 40 mg because of QTc prolongation, I personally never use Celexa because Lexapro is a better option with less risk for QTc prolongation. As far as anxiety disorders go, they usually have good response to medication and specifically SSRIs are better than SNRIs for pure anxiety disorders. The problem is remission (no symptoms at all) only occurs in about 35% of cases and many relapse after stopping medication. I think this is where something like CBT is can help along with medication for s synergistic effect. Hope this helps. Please subscribe to the channel if you haven't and if you have thank you.
@@ShrinksInSneakers yea i subbed thank u so much brother, i just have one question. do u know if ppl taking celexa experience qt prolongation on any dosage or mostly over the prescribed 40mg limit of the drug, im still contemplating on which to pick, i want to give lexapro another shot but my doctor won’t give me a refill and my mother wants me to try celexa but ive been watching a lot of ppl’s experience and im not hooked on it, thank u so much for helping !🙏
@@johnharrison2924 I would say the best thing to do is for people with preexisting heart disease or those over the age of 50 years would be best served to get an EKG at baseline. Yes there is risk at lower doses but it is dose dependent and will be more likely at higher doses. Hope this helps
Dr all due respect, why are any of these meds good You have at best 27% success rate You have fellow psych Dr more and more coming out against psych meds, there are over 13,000 youtubes of people horror studies re use of these meds . AND DR what happen to the oath DO NO harm ? So please explain why are psych meds used?
I want to answer one question about sertraline Vs citalopram with regards to CYP 2D6 inhibition. Citalopram is a very weak CYP 2D6 inhibitor to the point that the interaction is not clinically meaningful. This is one of the reasons if I'm going to use one of these two medications I'll just use escitalopram and avoid citalopram (the other begin dose limits due to QTc prolongation). Likewise, sertraline at doses of 150 mg and less does not have meaningful CYP2D6 inhibition. However, when you go above 150 mg it has meaningful CYP2D6 inhibition. Sertraline is another reasonable option with an excellent safety profile for combination therapy. We are getting into some really detailed points here hope this helps clear things up
Does it decrease libido like Fluoxetine does ?
I love these videos! Thank you for taking the time to share with us 🤗
much appreciated, I'll keep going more to come soon
Heard a lot of people say they improved after only taking 10mg of Citalopram for anxiety and quickly. When they retake after some time,even on a higher dose,the results are nowhere the same. Any reason to that.? Thanks
I really love these videos! Great content! Thanks for the information! :)
I've just found you on youtube now and your videos are very informative. I've been on Citalopram and Escitaopram for 20 years and my Escitalopram dose is 12.5mg. I'm having chronic sweats and hypersensitivity to heat/cold to the point where I can no longer work as I cannot stand aircon or a coll wind as I feel frozen to my bones but yet my t shirts are soaking wet to the point where I have to bring a bag of clothes with me and change 3 t shirts in the space of an hour. I'm frozen to my core but dripping in cold sweat in the shopping mall. My life is hell. The Pneumologist said it's my SSRI and I need to get off it or change it but my local doctor knows very little about how to change and I can't get to a shrink for months as I live in a small town with no real quick access to medical professionals. If I changed SSRI's fro one to another would it stop the sweating or are they all the same? I just want off the meds asap so would it be a good idea just to go a hospital or a clinic as an inpatient and get off the Escitalopram quickly? I've read of a guy who quit Lexapro cold turkey in hospital and was given 2 weeks of Mirtazaoine and then that was stopped and he left hospital and did 30 rTMS sessions and is now med free and feeling great. Could that work? If not can a person switch direct from Lexapro to Prozac as in stop Lex one day and start Prozac the next day and not get withdrawals? All these questions I'm asking are solely for educational purposes and not for medical advice as I will go to my doctor with the info and we can both see what's best for me. Thank you
you could augment mirtazapine to escitalopram. it reduces sweats due to its 5-ht2 antagonism
@@WillKurt702 ok get off the poison all together
Good afternoon...
Is MIRTAZAPINE a good med for chronic panic disorder?
Thank you.
How high would you go on Escitalopram and for how long before you switch your patient to another if there’s no change in mood etc ??? Thanks
In general 20 mg is the maximum dose if the person is on 20 mg daily after 4-6 weeks with no response I would consider a change. In cases of some severe anxiety disorders and OCD I will go above the FDA approved recommendation to 30-40 mg daily and with OCD the persons needs to remain on the medication longer 6-12 weeks. I want you to keep in mind 10 mg is a good dose a response should be seen in most cases. Hope this helps
If a patient on Citalopram was reduced from 40mg to 30mg because of palpitations,and were still having them,but were given the O.K in hospital after an ECG to continue,would it be better to swap to escitalopram before choosing another SSRI? Thanks.
I would switch and the basic way to calculate the conversion is just divide by 2. Example patient of 40 mg of citalopram would take 20 mg of escitalopram. Hope this helps
I wish you explained it so I could understand it better. I don’t know what CYP & QT mean
Dr, I thought the general max dose of citalopram is 40mg, but you mention 60 here?
Would you have any concerns with combining Escitalopram and Adderall in a healthy 35 year old patient who has tolerated each medication well on their own. I've done well on both meds, but never combined them. QTC test was normal.
I can’t give any specific medical advice but I have had patients on both stimulants and antidepressants. There are no specific drug interactions and usually can be combined without issue. Hope this helps, if you haven’t subscribed to the channel please do and spread the word about what we are doing here
Hello, Dr Rossi. 👋 my doctor has prescribed me 5 mg of Lexapro. The problem is I do take 100mg of slow release tramadol. I'm worried about serotonin syndrome, and this is why I have not yet started taking the lexapro as yet. What are the chances of me getting serotonin syndrome
I took bupropion 150 mg XL w/ 50 mg sertraline for GAD. I was on sertraline for 6 months prior to adding on bupropion. I felt bupropion made me very very jittery, like a different kind of anxious. Was I experiencing an interaction between sertraline+bupropion like you suggest in this video? And if so, would you expect this same type of reaction if combining bupropion with escitalopram?
Hi I’ve been on citalapram for years for my ocd I’ve literally just heard about escitalapram today ! I’m only on 10 mg now as I hate being on meds anyway but every time I’ve tried completely coming of my ocd flares up bad and I relapse and have to go up higher again , so I’m just sticking to 10 mg , but still worry about being on it long term , so
Is this escitalopram safer with fewer side effects and will it still efficiently work for ocd ???? 😊
I'm hearing horror stories of doctors telling their patients to quit maximum dosages of Citalopram cold turkey. It seems to be because they are more worried of QT prolongation from palpitations or the interaction with antibiotics etc. On the request of doctors, people are suffering serious withdrawal or relapse in depression/anxiety for something that's supposed to be very rare. That,along with serious problems from a change of manufacture/generic Citalopram,does it mean that this medication could eventually become redundant or only given at small dosages?
You can just divide the dose of citalopram by 2 and convert the patient to escitalopram. For example 40 mg of citalopram is approximately 20 mg of escitalopram. Most physicians have limited the dose to 40 mg is people at risk. It’s never a good idea to just stop long term medication and there are many ways to do adage conversion. I appreciate this feedback. If you haven’t checked out the Instagram account lately we are doing daily posts now to help combat mental health stigma and provide education.
Think I may know the answer to my own question,generics. In my experience branded Ciprimil is more potent than generic Citalopram. Years ago there was only Ciprimil, now there's generic.
I'm not totally against generic medication but the FDA needs to do a better job with quality control as evidence by recent contamination with carcinogens in metformin
@@ShrinksInSneakers is it possible for one generic Escitalopram to work better than another generic brand?
@@brandiepacula5619 I don't have an issue with generic medications but there is some variation in each formula so it's possible to see differences between manufactures but they all have to meet a basic standard set by the FDA
@@ShrinksInSneakers Ok thanks for answering. One brand I previously took felt more potent than the brand I’m currently taking.
Have a question for educational purposes. If someone has negative reaction to sertraline (bruxism, disassociation, sexual side effects, etc.) is it still possible they will respond fine to another SSRI like escitalopram?
Often people respond and can have good outcomes with respect to depressive symptoms with SRIs but still have the side effects. We should separate out positive response with respect to depressive symptoms and side effects. In general I would say most SRIs carry similar risk for side effects, if there is sexual dysfunction I would consider vortioxetine or bupropion. I would be thinking along similar lines with the other side effects
hey shrinks, ive had 2 seperate cases of severe panic disorder for about 3 years on and off, i used to take lexapro on the smallest dose, 2.5mg and then 5mg and it really helped me overcome my disorder completely the first time (end of 2019 into 2020) but when i got panic disorder a second time (end of 2020) from smoking weed, I noticed not much of an impact on the same dose 2.5mg but i was told multiple times to up my dose for it and i was too scared to so i quit the medication cold turkey, and got insane migraines/headaches (thinking someting in my head was gonna pop it was so bad) as a withdrawal i think and for the past year I’ve been medicine free but I still get panic attacks everyday (heart races everyday nonstop, evil bad thoughts), and I’m ready to get back on something, my doc prescribed me celexa but I’m very unsure about trying it Bc I’ve been so used to take lexapro and I’m just wondering what ur opinion would be, thank u so much for the video also u rock!!
So this is not medical advice and you should always talk to your doctor, I will provide my thoughts for educational purposes only. Now that this is out of the way, Celexa and Lexapro are essentially the same medication. Lexapro is just the isolated S-isomer of Celexa. You can think about dosing by dividing the dose of Celexa in half. For example 20 mg of Celexa is equally to about 10 mg of escitalopram. I do not see any issue with using either one other than there is a cap on the dose of Celexa at 40 mg because of QTc prolongation, I personally never use Celexa because Lexapro is a better option with less risk for QTc prolongation. As far as anxiety disorders go, they usually have good response to medication and specifically SSRIs are better than SNRIs for pure anxiety disorders. The problem is remission (no symptoms at all) only occurs in about 35% of cases and many relapse after stopping medication. I think this is where something like CBT is can help along with medication for s synergistic effect. Hope this helps. Please subscribe to the channel if you haven't and if you have thank you.
@@ShrinksInSneakers yea i subbed thank u so much brother, i just have one question. do u know if ppl taking celexa experience qt prolongation on any dosage or mostly over the prescribed 40mg limit of the drug, im still contemplating on which to pick, i want to give lexapro another shot but my doctor won’t give me a refill and my mother wants me to try celexa but ive been watching a lot of ppl’s experience and im not hooked on it, thank u so much for helping !🙏
@@johnharrison2924 It's dose dependent QTc prolongation.
@@ShrinksInSneakers so at any dose qtc prolongation would be possible from celexa?
@@johnharrison2924 I would say the best thing to do is for people with preexisting heart disease or those over the age of 50 years would be best served to get an EKG at baseline. Yes there is risk at lower doses but it is dose dependent and will be more likely at higher doses. Hope this helps
Dr all due respect, why are any of these meds good You have at best 27% success rate You have fellow psych Dr more and more coming out against psych meds, there are over 13,000 youtubes of people horror studies re use of these meds . AND DR what happen to the oath DO NO harm ?
So please explain why are psych meds used?
answer to title: never. List of side effects: Nervous system Very common: Concentration impaired Common: somnolence, insomnia, dizziness, tremor, headache, nervousness, anxiety, paraesthesia, decreased libido, agitation, drugged feeling, myoclonus, CNS stimulation, confusion, impaired concentration, depression, emotional lability, vertigo, abnormal dreams (including nightmares)#, hyperthesia+. Uncommon: abnormal thinking+, akinesia, alcohol abuse, amnesia+, ataxia, convulsion, depersonalisation+, hallucinations, hyperkinesia+, hypertonia+, incoordination, lack of emotion, manic reaction, paranoid reaction. Rare: abnormal electroencephalograph, abnormal gait, antisocial reaction, choreoathetosis, circumoral paraesthesia, delirium, delusions, diplopia, drug dependence, dysarthria, dyskinesia, dystonia, euphoria, fasciculations, grand mal convulsions, hostility+, hyperalgesia, hypokinesia, hysteria, increased libido, manic depressive reaction, meningitis, myelitis, neuralgia, neuropathy, nystagmus, psychosis, psychotic depression, increased reflexes, restless legs syndrome (RLS), stupor, withdrawal syndrome.