Bibliography | LexaproPagesIndex | Comprehensive Rundown Page 2

Table of Contents (hide)

  1. 1. Names, Availability, Brand vs. Generic Issues, Forms
    1. 1.1 US brand name: Lexapro
    2. 1.2 Available as Lexapro in these countries1
    3. 1.3 Other trade name(s) for Lexapro used in these countries1
    4. 1.4 Generic Name and Availability
    5. 1.5 escitalopram is available in these countries2
    6. 1.6 Branded generic names3
    7. 1.7 Specific generics with complaints, or preferred generics manufacturers
    8. 1.8 Generics with independently-tested bioequivalence
    9. 1.9 Forms and Classes
  2. 2. Approved and Off-Label Uses
    1. 2.1 US FDA approved use(s)
    2. 2.2 Lexapro is approved elsewhere for
    3. 2.3 Common off-label uses
    4. 2.4 Less common/experimental off-label uses
    5. 2.5 Failed off-label uses
    6. 2.6 Potentially dangerous off-label uses
    7. 2.7 When / why you should take Lexapro
    8. 2.8 When / why you should not take Lexapro
  3. 3. Chances of Working & Comparisons with Other Meds
    1. 3.1 How long until Lexapro starts working:
    2. 3.2 Likelihood Lexapro will work for its approved indications:
    3. 3.3 For off-label applications:
    4. 3.4 Lexapro versus other Antidepressants for approved treatments:
    5. 3.5 For off-label uses:
  4. 4. Dosage, Titration, and Discontinuation
    1. 4.1 Dosage and doses:
    2. 4.2 Best time / way to take Lexapro:
    3. 4.3 Titration schedule:
    4. 4.4 How to discontinue Lexapro:
    5. 4.5 Discontinuation symptoms:
    6. 4.6 Notes, tips, etc. about discontinuing Lexapro:
  5. 5. Pros, Cons, and Interesting Information
    1. 5.1 Pros
    2. 5.2 Cons
    3. 5.3 Interesting stuff your doctor probably didn’t tell you:
  6. 6. Side Effects and Pregnancy Category
    1. 6.1 Typical side effects
    2. 6.2 Uncommon side effects
    3. 6.3 Potentially dangerous side effects:
    4. 6.4 Freaky rare side effects:
    5. 6.5 Ways to counter / minimize / mitigate / deal with some side effects
    6. 6.6 Pregnancy category

This is essentially everything we know about Lexapro (escitalopram) on two big-ass pages. On this page is brand / trade names to odds of working and comparisons with other meds, or pretty much everything most people want to know. Page two is pharmacokinetics to the bibliography, or: I’m sure somebody wants to about 0.1% of people who read about a med look at it.

The titles for most sections link to the pages for those sections. While all the information is on these two comprehensive pages, the individual section pages go into a little more detail about what it all means.

1.  Names, Availability, Brand vs. Generic Issues, Forms

1.1  US brand name: Lexapro

Just because a drug is available in one country doesn’t mean you can get it everywhere. Even if a medication is available elsewhere, it won’t necessarily have the same brand, or trade name everywhere it is sold.

1.2  Available as Lexapro in these countries1

Argentina, Australia, Brazil, Chile, Colombia, Hong Kong, Ireland, New Zealand, Peru, Philippines, Singapore, Thailand

1.3  Other trade name(s) for Lexapro used in these countries1

  • Cipralex: EU, Iceland, India, Israel, Norway, UK
  • Cipralexia: Finland
  • Cipralexin: Finland
  • Seroplex: France
  • Sipralexa: Belgium, Luxembourg

1.4  Generic Name and Availability

A drug’s generic, or international nonproprietary name (INN) is how it is uniquely identified around the world. Or not. The generic version of a med is are often available in other countries long before they are in the US.

Generic name/INN:escitalopram
US Generic available?Yes

1.5  escitalopram is available in these countries2

Australia, Argentina, Canada, Chile. Either pending in the EU or available in some EU member states, such as Spain.

1.6  Branded generic names3

  • Argentina: Esertia, Meridian
  • Australia: Esipram, Esitalo, Lexam, Loxalate
  • Chile: CELTIUM, ECIPRAX, ECTIBAN, IPRAN, NEOPRESOL, NEOZENTIUS, REPOSIL, ZEPAZ Comprimidos
  • Spain: Esertia
  • essitalopraami is Finnish for escitalopram

1.7  Specific generics with complaints, or preferred generics manufacturers

In theory the generic version of a med is the same as the brand-name version. In practice that is usually, but not always the case. Especially with crazy meds. If we know of any problems with particular generics, or if some generics are better than others, we’ll let you know.

We’re already getting reports of people having problems with Mylan’s generic for Lexapro, one of the two (so far) escitalopram oxalate tablets available on the US market.

Keep an eye on the topic linked above, and any others that may be opened on our Brand vs. Generic forum, for additional details.

1.8  Generics with independently-tested bioequivalence

1.9  Forms and Classes

Available/supplied as:

5, 10, and 20mg tablets and oral solution in the US.
Most EU countries have both tablets and capsules, a 15mg tablet/capsule, and premeasured 1ml, 5ml, 10ml and 20ml dosages of the oral solution. There’s an orally dissoluble (Cipralex orodispersible) tablet available in Sweden and the UK.

Primary Drug Class:Antidepressants
Additional Drug Categories:
 Serotonin-Selective Reuptake Inhibitors, Anxiolytics/Anti-anxiety

2.  Approved and Off-Label Uses

Drugs are officially approved to be used for certain things, and they may be approved for one thing in one country but something else entirely in another.4

2.1  US FDA approved use(s)

  • Major depressive disorder (MDD) in adults
  • MDD in adolescents (Prozac is the only other modern antidepressant approved to treat MDD in adolescents)
  • Generalized anxiety disorder (GAD) in adults.

2.2  Lexapro is approved elsewhere for

  • Everywhere else in the world where you find Lexapro / Cipralex / etc. (escitalopram), it’s approved to treat social anxiety disorder and panic disorder, with or without agoraphobia, along with MDD and GAD.
  • Cipralex / Lexapro is also approved to treat OCD in:
    • Argentina
    • Australia
    • Canada
    • Chile
    • Denmark
    • Sweden
    • Spain
    • New Zealand
    • the UK

2.3  Common off-label uses

Meds are often prescribed for conditions or people they aren’t approved to treat. This is known as off-label prescribing. Some off-label prescribing is so common that lots of people think the medication is a first-line treatment for the condition it’s prescribed to treat.

2.4  Less common/experimental off-label uses

When all else fails and you’ve run out of other options, the experimental use of some drug may be your best chance at treating something. Be careful! Otherwise safe meds can be downright dangerous when used for some things.

  • Impulsive-compulsive Internet Usage Disorder. IC-IUD is better known as “Internet addiction,” and it’s real. The big question is: if you found this page when searching for Internet addiction, Internet usage disorder, or something similar, do you have IC-IUD, cyberchondria, or both? And if it’s both, should you take a medication for it? Lexapro seems to help with IC-IUD, talk therapy combined with workbooks is still your best bet for cyberchondria.

2.5  Failed off-label uses

  • Fear of public speaking. When you have no brain cooties. It didn’t just fail, Lexapro made it worse! Why someone thought taking an SSRI as required would be a good idea is beyond me. But either they don’t know how to write an abstract, or how SSRIs work, as the conclusion contradicts the title.
  • Kleptomania. In all fairness, nothing seems to work for kleptomania. A woman who was in the lock ward with me had been undergoing ECT for a month to treat kleptomania, and she was still stealing stuff.

2.6  Potentially dangerous off-label uses

2.7  When / why you should take Lexapro

Just because a medication is approved or commonly prescribed for a particular condition doesn’t necessarily mean you should be taking it for that condition. There could be a drug that might be better to try first, or at least talk to your doctor about trying first, or the condition you have isn’t bad enough to warrant medication at all.

You haven’t tried any antidepressant before, you and your doctor both think you need one, your symptoms don’t scream Wellbutrin (anhedonia, unable to conceive on how to begin anything), but are still pretty bad and you need something to work sooner than later. And your insurance will pay for it.

2.8  When / why you should not take Lexapro

If Celexa didn’t work for you, or Celexa is working for you with side effects that really aren’t as bad as you think they are.

The only side effects that are less likely to be problems with Lexapro than Celexa are drowsiness and weight gain. The key phrase being less likely. The good news is switching back to Celexa if Lexapro doesn’t work for you is less likely to result in SSRI poop-out or becoming treatment-resistant when neither of those would have happened if you just stayed with Celexa. The bad news is “less likely to” does not equal “won’t.”

3.  Chances of Working & Comparisons with Other Meds

Two of the most important things to know when deciding on which med is the best for a particular condition5: how likely is it to work and how long will it take.
The odds of a med working for a particular condition and how long it generally takes to work should be fairly easy to nail down, and not need to be summed up by the Internet shorthand YMMV (Your Mileage May Vary). Unfortunately because no one is quite sure exactly what causes various conditions - further complicated when everything is a spectrum disorder - and they’re never really sure about how a med works in the first place, especially when there are lots of contradictory and/or questionable studies,6 we can only give you an idea somewhat less vague than support groups and PI sheets, but certainly more accurate than the implied “it fixes everything all the time!” promises of pharmaceutical advertising.
See our page on the tests researchers use to measure the efficacy of medications, including during clinical trials to get FDA approval.

3.1  How long until Lexapro starts working:

Lexapro can start working within one week. As usual there are conflicting data. All the reports from people who’ve taken Lexapro that I’ve read (anecdotal evidence) indicate that Lexapro often starts working in the first week or two.

You should still give it at least three weeks, unless the side effects hit hard, fast, and don’t start getting better within two weeks of reducing the dosage (if there’s any room to reduce the dosage).

3.2  Likelihood Lexapro will work for its approved indications:

Major Depressive Disorder (MDD)

The odds are pretty good that Lexapro will work for MDD, as in you have a 60–75% chance that you’ll respond to Lexapro7 - i.e. it will do something positive - and a 60–70% chance of remission, i.e. your MDD symptoms will more-or-less go away and stay away, although you may have to keep taking your meds to ensure you stay symptom-free.
Keep in mind that:

  1. Serotonin reuptake inhibition, and everything else SSRIs do, is not the answer for everyone, either by itself or at all.
  2. When you pool all the data together (see below) you’ll find that Celexa and Lexapro are better than the other SSRIs. It’s marginally statistically significant for everyone who still takes the other SSRIs. Their real advantage comes from sucking less than the others and being better at preventing relapses, so if you and your doctor think you’re going to be depressed forever without meds, you’re way better off with Celexa or Lexapro than another SSRI or other antidepressant.
  3. We can’t hammer this point home as hard or often enough: antidepressants work only for people who are seriously depressed.8

Like most SSRIs the clinical trials published in the PI sheet used a ridiculously small set of people with vague results. How small? The usually don’t print the number of patients, that’s how small. Things are different in Canada, where some actual numbers are published in the PI sheet. But it tells us only that people felt somewhat better, and not how many of them did.

Unlike most antidepressants I was actually able to find the clinical trials on PubMed, although there are no more data in the abstracts than in the PI sheet. Except for Fixed-dose trial of the single isomer SSRI escitalopram in depressed outpatients. The discrepancies between the PI sheet and the abstract that are really telling. The US PI sheet, which doesn’t allow you to copy any text, has the typically vague result of “statistically significant greater mean improvement compared to placebo on the MADRS.” But when you look at the study:

Clinical response was evaluated by the Montgomery-Asberg Depression Rating Scale (MADRS), the 24-item Hamilton Rating Scale for Depression (HAM-D), the Clinical Global Impressions (CGI) scales, the Hamilton Rating Scale for Anxiety (HAM-A), and patient-rated quality-of-life scales.
RESULTS: Escitalopram, at both doses, produced significant improvement at study endpoint relative to placebo on all measures of depression; significant separation of escitalopram from placebo was observed within I[sic] week of double-blind treatment. Citalopram treatment also significantly improved depressive symptomatology compared with placebo; however, escitalopram, 10 mg/day, was at least as effective as citalopram, 40 mg/day, at endpoint. Anxiety symptoms and quality of life were also significantly improved by escitalopram compared with placebo. The incidence of discontinuations due to adverse events for the escitalopram 10 mg/day group was not different from the placebo group (4.2% vs. 2.5%; p = .50), and not different for the escitalopram 20 mg/day group and the citalopram 40 mg/day group (10.4% vs. 8.8%; p = .83).

Note how more scales are mentioned in the abstract. The PI sheet omits two points that numerous studies will repeatedly prove: while Lexapro usually doesn’t work any better than Celexa, it often does work faster than Celexa, or any other SSRI.

The Australian PI sheet confirmed that the clinical trial about preventing the relapse of depression symptoms I found before is indeed the one in the PI sheet. It, too, is pitifully small (181 taking Lexapro, 93 taking placebo), but at least it had everyone taking their pills for nine months. Close to 75% of the people taking Lexapro after 36 weeks were still not depressed, vs. 60% taking the wonder drug Placebo.

You’re probably a lot less likely to commit suicide when taking Lexapro than taking a placebo. But is that really a big surprise? I guess it is to some people.

There have been studies experimenting with dosages up to 50mg(!) a day. This is the first time I’ve read a Lundbeck-sponsored study of Lexapro where there has been a significant number of people quitting due to side effects (20%). 30mg could be a dosage to consider, especially if you know or suspect you’re a rapid or ultra-rapid metabolizer of drugs cleared by CYP2D6 (substrates), or you take a drug that induces CYP2D6, like Tegretol (carbamazepine). 40mg seems to be the upper limit of real efficacy.

Predicting if a med will work for you is something that can be really useful. What have we got for Lexapro…

Generalized Anxiety Disorder (GAD)

The story for anxiety disorders is a bit better. People in the Panic/Anxiety community love Lexapro. Like MDD efficacy rate is still around 70–75%, but as GAD (and many of the other anxiety disorders for which it’s used off-label) tends to respond at lower dosages than MDD, the side effects tend to suck a lot less than GAD and other treatments.

In regards to GAD, this double-blind study of 158 people taking Lexapro vs. 157 people taking placebo had 68% of the people taking Lexapro responding against 41% taking the placebo. Not too bad for the placebo. In Lexapro’s favor, though, on the Hamilton Rating Scale for Anxiety, those taking Lexapro averaged a 11.3 point drop from a score of 18 points or higher, whereas those taking the placebo dropped only an average of 7.4 points. So you can fool some of the people with GAD into feeling better, but even those you fool won’t feel better than they could have with a real med.

What looks like a follow up to the clinical trials for Lexapro’s approval for GAD has even better numbers than the above. Those who completed the 8-week double-blind trials were given the option of knowing they were taking Lexapro (escitalopram oxalate) 56% of the people made it to the end, so about half in all, or roughly 250 people were still helped by Lexapro (escitalopram oxalate) for generalized anxiety disorder (GAD), and helped a lot.

Just like with MDD, Lexapro helps to prevent the relapse of generalized anxiety disorder. At least when compared with placebo. After taking Lexapro for 8–12 weeks:

3.3  For off-label applications:

Panic-Anxiety Disorders other than GAD

Except for hoarding, where you’ll want Paxil, Lexapro may as well be approved for the rest of them. Oh, wait, Lexapro is approved to treat other anxiety disorders, just not in the US. We really need a way to streamline the approval process for meds when they’re already available here and approved for something else in practically every other country on the planet. In any event…

3.4  Lexapro versus other Antidepressants for approved treatments:

MDD

GAD

3.5  For off-label uses:

  • Lexapro vs. Paxil for Social Anxiety Disorder (SAnD). This Lundbeck-sponsored study isn’t very fair, as it compares 20mg of the older, immediate-release Paxil against 5mg, 10mg, and 20mg of Lexapro. While 20mg of immediate-release Paxil is GSK’s recommendation for SAnD, it’s 25–37.5mg a day for the controlled-release flavor. While 10mg of Lexapro is equal to 10mg of Paxil, 20mg of Lexapro is more like 37.5mg of Paxil CR. So it’s not all that surprising that 20mg of Lexapro was more effective than 20mg of Paxil.
  • Lexapro vs. Celexa vs. Placebo for Panic disorders. Panic disorders are off-label for Celexa as well. The results - Lexapro and Celexa are both really good for panic, and Lexapro sucks less than the placebo. This sort of thing shows up in a lot of Lexapro studies and clinical trials: “The rate of discontinuation for adverse events was 6.3% for escitalopram, 8.4% for citalopram, and 7.6% for placebo.”
  • Lexapro vs. Celexa vs. Placebo for Panic disorders - the sequel. The results - Lexapro kicked Celexa’s ass, which is something you don’t see very often. This was done by DJ Stein, who is one of Lundbeck’s favorite researchers, so he could have set it up to slant things in Lexapro’s favor. The abstract isn’t very forthcoming in results: “Treatment with escitalopram was associated with significant improvement on all 5 subscales of the P&A. Citalopram was significantly different from placebo in 3 subscales. […] Escitalopram was superior to placebo on 12 of 16 items of the Q-LES-Q, while citalopram was superior on 7 items.” Unlike Dr. Stahl’s study above, there’s no hint in the abstract as to what “significant” means.

4.  Dosage, Titration, and Discontinuation

One of the most important aspects of any medication is how to go about taking it. This includes:

  • how much to take (the dosage or dose)
  • when and how often to take it (dosing schedule or doses)
  • how much to start with and how to increase the dose/dosage until you’re taking the target amount (titration or titration schedule).

This information is always in the PI sheet, is usually in the information for patients leaflets, most doctors will give you some idea of what it will be like, and this is what every pharmacist is trained and paid to tell you.
We here at Crazymeds often disagree with the official schedules found in the PI sheets. We usually advocate starting at a lower dosage than recommended. One of our core philosophies is increasing the dosages as slowly as one’s condition allows, and staying at the dosage that works instead of a target dosage9. More and more doctors are agreeing with us10. You and your doctor can always discuss increasing the dosage when you need to in advance.

4.1  Dosage and doses:

One 5–10mg (or 15 or 20mg) tablet once a day.

4.2  Best time / way to take Lexapro:

Like all SSRIs you’ll have to figure out for yourself if taking Lexapro in the morning or at night works better. Start with taking it in the morning and give it at least a week before switching to taking it at night if it makes you too drowsy, as the drowsiness could be a short-term side effect. Most people find Lexapro to be “activating” (i.e. it has a mild stimulant effect) than sedating.

4.3  Titration schedule:

The official titration schedule from Forest for all applications: Start at 10mg once a day, that’s it. There’s no benefit to taking 20mg a day, and there’s no 15mg tablet. At least if you live in the United States.

If you look at some of Lexapro’s PI sheets from other countries you’ll find that Lundbeck (the original developers, or pioneering company) recommends going up to 20mg if required. In Canada they recommend decreasing the dosage to 5mg if the side effects seem to be too harsh, and in Israel they recommend starting at 5mg for panic disorder.

We say: Start at 5mg a day. At least we agree that the dosage should be increased only if needed.

There have been studies experimenting with dosages up to 50mg(!) a day. This is the first time I’ve read a Lundbeck-sponsored study of Lexapro where there has been a significant number of people quitting due to side effects (20%). 30mg could be a dosage to consider, especially if you know or suspect you’re a rapid or ultra-rapid metabolizer of drugs cleared by CYP2D6 (substrates), or you take a drug that induces CYP2D6, like Tegretol (carbamazepine). 40mg seems to be the upper limit of real efficacy.

4.4  How to discontinue Lexapro:

One thing PI sheets and doctors infrequently discuss, and don’t go into enough detail about, is how to discontinue a medication. With some meds it’s not too bad, but with others it can be a nightmare.
Decrease your dosage by 5mg every week. So if you’re taking 10mg a day, take 5mg for a week, then you can stop. If you’re at 5mg a day then you should be OK.
Like Celexa, Lexapro has a long half-life, as far as SSRIs & SNRIs are concerned. So discontinuing Lexapro tends to be a lot easier than most other SSRIs.

If you do have the symptoms of SSRI discontinuation syndrome you can always cut 5mg tablets in half and take one of those each day for a week.

If you’ve been splitting 10mg tablets to save money you and your doctor will have to figure out which is going to suck the least: staying on Lexapro until you can fill a prescription for 5mg tablets or the oral solution, putting up with the discontinuation syndrome, or trying to quarter 10mg tablets.

4.5  Discontinuation symptoms:

The usual for SSRIs/SNRIs. Dizziness, numbness and tingling in your extremities (paraesthesias), electric shock sensations (brain zaps), agitation, anxiety, impaired concentration, headaches (comparable to migraines, actual migraines if you’re susceptible to them), tremors, nausea, vomiting, and excessive sweating.

4.6  Notes, tips, etc. about discontinuing Lexapro:

As mentioned above, the oral solution allows you to taper off as slowly as you need to.

And there’s always the old standby for severe SSRI/SNRI discontinuation syndrome: a prescription for generic Prozac (flouxetine). One to two weeks at 10mg a day is usually enough to take the edge off, if not completely get rid of, the discontinuation symptoms for any med. Prozac also has an oral solution, one that doesn’t taste too bad (it’s like a good, mint-flavored mouthwash with the consistency of cough syrup).

5.  Pros, Cons, and Interesting Information

Every med has its good points and its bad points. This is what we think those are.
Doctors don’t have the time to tell you everything about a drug. Patient information leaflets leave out a lot. Even if the PI sheet covers everything the language is so dense and obtuse that the good stuff is often lost in information overload. Most meds have something interesting about them.

5.1  Pros

Lexapro works faster than other SSRIs. Many people who take Lexapro have reported that it has better effects and lower chances for side effects than other SSRIs (especially weight gain), and when side effects do strike most of them tend to be less harsh. Fewer drug-drug interactions than any other SSRI.

5.2  Cons

Few dosage options with the tablets. Some side effects (teeth grinding, TMJ, anorgasmia) can be way worse than with other SSRIs, and those first two can get really painful.

5.3  Interesting stuff your doctor probably didn’t tell you:

Lexapro is the only true SSRI. All the others affect one or more other neurotransmitters to some extent, although only enough for side effects, off-label uses, or as the reason why only one SSRI works for somebody.

6.  Side Effects and Pregnancy Category

Potential side effects are used as a rationalization to not take a medication. Many people will stop taking an otherwise working drug because of one or more relatively minor, or often temporary side effects. There may even be ways to counter or mitigate side effects.
It all comes down to a very important question: which sucks less?
No matter what crazy med you take, it will probably make you feel spacey and generally out of it for the first few days (i.e. don’t operate heavy machinery), as well as make you drowsy. Even stimulants can make you drowsy. Lexapro will probably affect your dreams as well, and there’s no way to tell if that will be a temporary or permanent side effect. Don’t be surprised if your stomach and/or other parts of your GI system complain for at least the first few days.

6.1  Typical side effects

Most everyone gets at least one or two of these.
The usual for SSRIs:

  • headache
  • nausea
  • dry mouth
  • sweating
  • sleepiness or insomnia (with insomnia more likely)
  • diarrhea or constipation
  • assorted sex problems

Weight gain is a lot less likely than with other SSRIs and all of the typical side effects tend to be milder. The most likely sexual side effect is anorgasmia , i.e. you can’t come, no matter how much romance and/or porn is involved. In the prudish language of PI sheets and clinical trials, anorgasmia affects only women. With men the problem is listed as an “ejaculation disorder .”

6.2  Uncommon side effects

You may or may not get one or more of these.

6.3  Potentially dangerous side effects:

If you have these, call your doctor ASAP. Or now. Or get the hell off of the Internet and go to the ER. NOW!

 and  Heart arrhythmia problems like torsades de pointes (TdP)/prolonged QT interval (QTc).  This happens more often than I had originally thought, as both Celexa (citalopram) and Lexapro are on the list of drugs to totally avoid if you have a history of TdP/QTc/cardiac arrhythmia.

6.4  Freaky rare side effects:

You won’t get these. Unless you already have and that’s why you’re here.

6.5  Ways to counter / minimize / mitigate / deal with some side effects

6.6  Pregnancy category

C-Use with caution Expanded pregnancy category explanation.


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Bibliography | Lexapro Index | Comprehensive Rundown Page 2


1 EU: European Union. Currently Austria, Belgium, Bulgaria, Cyprus, the Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, and the United Kingdom. Not all drugs approved in any one EU country are approved in all, but most crazy meds approved in several EU countries are at least obtainable in all EU countries on the European mainland. I'm not sure about Britain, Cyprus, Ireland, and Malta.
The UK and Ireland are listed separately because we're a primarily English-language site. Plus the UK tends to be more independent on more matters than any other EU member state, so it should probably be listed separately no matter what language a site like this is in.
While the EU is moving toward one brand name for the same med, that's not going to happen overnight. And people will still refer to meds by old brand names. So we'll list old brand names until they vanish.

2 Generic availability isn't fully harmonized in the EU. Sometimes a drug is available everywhere as a generic, sometimes it's available only in a few member states. We'll provide the best information we have.

3 The term "branded generic" has three meanings:
1) A generic drug produced by a generics manufacturer that is a wholly-owned subsidiary of the company that makes the branded version. E.g. Greenstone Pharmaceuticals makes gabapentin**, and they are owned by Pfizer***, who also own Parke-Davis, the makers of Neurontin.
2) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Teva's Budeprion), but otherwise has the same active ingredient as the original branded version (Wellbutrin).
3) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Sanofi-Aventis' Aplenzin, which is bupropion hydrobromide) and uses a salt of the active ingredient that is different from the original branded version and other generics (Wellbutrin, Budeprion and all the others are bupropion hydrochloride). We aren't sure if that really makes a difference or not. The FDA says they're the same thing. As usual, the data are contradictory, but most evidence indicates that the FDA is right and the differences are negligible.
For our purposes a "branded generic name" refers to the second and third definitions. We'll note if any preferred generics are manufactured by the pioneering company's subsidiary.

4 Before Cymbalta (duloxetine) was approved as an antidepressant in the US it was already approved in the EU, but only for stress urinary incontinence and sold under the trade name Yentreve. Duloxetine is now sold in the EU as an antidepressant under the trade name Cymbalta.
A better known, if slightly different example is bupropion. According to the 2007 edition of Mosby's Drug Consult, in the US, Canada and Singapore you can get both Wellbutrin (bupropion) as an antidepressant or Zyban (bupropion) to stop smoking. In Korea, Thailand and most of South America (but not Brazil) you can get bupropion (under various trade names) only as an antidepressant. In Brazil, the EU & UK, Israel, India, Australia and New Zealand it's only available as Zyban to help you stop smoking.

5 Assuming you were correctly diagnosed in the first place.

6 Keep in mind that according to one study, most drug studies will skew in favor of the med made by the company that sponsored the study.***** That's one of my favorite "no shit Sherlock" studies, although it did help in getting conflicts of interest showing up on papers.
Two additional papers along similar lines are Why Current Publication Practices May Distort Science******* and Why Most Published Research Findings Are False********. So in addition to the books we use as source material, this is why we also factor a lot of anecdotal evidence (personal experience, experiences of people we know, case reports, what people have sent us in e-mail, and what is posted all over the Internet) into our conclusions regarding the likelihood of meds working, the prevalence of various side effects, etc.
While the drug companies are getting a lot more transparent and publishing more data in the PI sheets regarding the results of the clinical trials, they still don't publish how many times a drug failed a clinical trial.********

7 The data are often contradictory when compared with Celexa. Celexa averages 60-70% for both response and remission, while Lexapro is often in the neighborhood of 70-75%; hence the big spread on the response rate that seems a bit low given the results of a lot of studies, trials, and anecdotal evidence.

8 Most of the time at any rate. There's always an outlier study or two, as you'll see if you keep reading this page.

9 Although not everyone has the luxury of stopping at a dosage when the symptoms abate and not increasing it unless the return. Sometimes you just have to keep going up until you reach that target dosage. E.g. you have a history of seizures that haven't yet responded to several medications.

10 Most notably Dr. Edward Faught, founder and Director of the Epilepsy Center, and vice chairman of the Department of Neurology, at the University of Alabama School of Medicine in Birmingham. His article on new antiepileptic drugs in Volume 7 issue 1 of Peer Review in Review stressed starting at low dosages, doing a slow titration, and stopping at the dosage where symptoms were under control. In Topiramate in the treatment of partial and generalized epilepsy****, the one free, full-text article I could find (that's not about geriatric patients), he again stresses the low and slow approach to avoid or lessen most side effects, while still achieving seizure control in the same amount of time.

Date created {{$$newlycreated}} Page Creator: JerodPoore Last edited by: JerodPoore on 2013–09–25


Lexapro Comprehensive Rundown Part 1 by JerodPoore is copyright {{$$yearly}} JerodPoore





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Almost all of the material on this site is by Jerod Poore and is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, and 2014 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and something along the lines of following disclaimer, I’m usually cool with it.



All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else.
Know your sources!
Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained through our personal experience and the experiences family, friends, what people have reported on various reputable sites all over teh intergoogles, the medications’ product information / summary of product characteristic (PI/SPC) sheets, and from sources that are referenced throughout the site. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or patient information leaflet (PIL) that comes with your medications and never ever throw them away.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
Very little information about visitors to this site is collected or saved. From time to time I look at search terms used and which pages they bring up in an effort to make the information I present more relevant. And the country of origin, just because I’m geeky like that. That’s about it. Depending on how you feel about Schrodinger, our privacy policy should either assuage or exacerbate your paranoia.
All brand names of the drugs listed in this site are the trademarks of the companies named on the PI/SPC sheet associated with the medication, sometimes on the pages about the drugs, even though those companies may have been acquired by other companies who may or may not be listed in this site by the time you read this. Or the rights to the drug were sold to another company. And any or all of the companies involved may have changed their names.
Crazymeds is optimized for the browser you’re not using on the platform you wish you had. Between you and me, it all looks a lot cleaner using Safari or Chrome, although more than half of the visitors to this site use either Safari or Internet Explorer, so I’m doing my best to make things look nice for IE as well. I’m using Firefox and running Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazymeds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. Use only as directed. Void where prohibited. Contains nuts. Certain restrictions may apply. All data are subject to availability. Not available on all mobile devices, in the 12 Galaxies Guiltied to a Zegnatronic Rocket Society, or in all dimensions of reality. Hail Xenu!

‘Everything is true, nothing is permitted.’ - Jerod Poore


1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazymeds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had a forerunner of QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]

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