# Am doing well on Cipralex but...



## OtterB (Jul 24, 2012)

I've been taking Cipralex for about 6 weeks now - the first 10 days at 10 mg and then up to 20 mg since then. My depression has mainly lifted but is still hanging around from time to time. 

The main problem is with anxiety. I'm meditating, exercising and have been back at work for a couple of weeks now but during the mornings and sometimes throughout the day I feel a pronounced tightness in my chest and, sometimes, full on nerves prickling up and down my arms and shoulders. I take the cipralex in the morning when I get up and also take a non-drowsy 24 hr. extra strength antihistimine (Reactin) at the same time because I've had a rough go with allergies and bronchitis early in the spring. 

I have seen some references to possible interactions with antishistimines and AD's - I'm thinking this may be the case with me because I'm usually fine in the evening. Battling through the physical sensations of anxiety also brings the depression around for short periods. 

I'll discuss with my MD but I think I'm going to stop the Reactin tomorrow and if I need something for allergies I'll try to find a milder version and take it later in the day. I also take Crestor 5 mg for cholesteral and trazodone for sleep plus coQ enzyme and vitamins. 

I'd be interested if others have had a similar reaction with an antihistimine (physical tenseness and tingling in the arms). Or can this happen with Cipralex on its own?


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## Retired (Jul 24, 2012)

I would suggest reviewing your current medications, mentioning the Reactine (CETIRIZINE)  with your doctor and/or pharmacist because there is potential for interaction with the combination you have described at several levels.

As you will read in the interaction checker I've pointed to, the nature of the interactions are the combination of CNS depressants (Reactine, trazodone (Desyrel) and Cipralex (Lexapro); however the greater concern is the serotonergic combination of trazodone and Cipralex (Lexapro).

Your doctor would be the best one to guide you, because s/he knows your medical history, the dosage combination and your particular situation.

The interaction checker is only a guideline, which is why you need to follow the advice of your prescribing doctor.


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## OtterB (Jul 24, 2012)

Thanks Steve.  The dosage for the Trazodone is quite low (1 to 1.5 tablets) and is for sleep - supposed to be more restful and natural sleep than imovane.  I'm getting in touch with my doctor to check out all these interactions.  I forgot to add that I take the odd Clonazapem when I get too overthetop anxious like today.


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## Retired (Jul 24, 2012)

Clonazepam too is categorized as a CNS depressant, so caution should be exercised when using it in combination with trazodone and Reactine.

It all cumulative, so your conversation with your doctor should include understanding how and when to use each of your meds to minimize any unwanted adverse reactions.



> supposed to be more restful and natural sleep than imovane



They are quite different compounds with entirely different mechanisms of action.  Unless there is good reason in your particular case, if Imovane is offered to you, consider giving it a try, if ever you need to replace trazodone.  Several years ago my doctor prescribed Imovane for me, and for me, I had the best quality sleep I can remember.  After a few years, though I seemed to develop a tolerance to it, and was unable to continue using it, but during the time it worked, it worked very well for me.


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## Banned (Jul 24, 2012)

I'm on 20mg of Cipralex and 7.5mg of Imovave (Trazadone does not work for me at all) as well, and I know any time I get a cold or flu I always have to check with the pharmacist on what I can take because of the Cipralex and interactions, and my options for cold/flu remedies are quite limited, so definitely have a chat about the interactions as Steve mentioned and hopefully you can see some of those side effects lessen or disappear entirely.


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## OtterB (Jul 25, 2012)

I'm actually thinking of asking my doctor about going back to Zoloft (200 mg). It worked well for me for 20 years and I had no troubles sleeping and really just felt normal with normal anxiety and sadness from time to time. I'm currently working with a psychiatrist on the medicationis because I don't really trust my family doctor - I'm changing to a younger female MD because his listening skills are lacking to say the least. When I weaned myself off of the Zoloft he didn't seem to care one way or the other and didn't advise me either way. And when I crashed into anxiety and depression 3 months later he put me on cipralex (which I know is a good drug and I was willing to try it) but when I queried him a bit more about whether he was sure I shouldn't just go back to Zoloft he said it wasn't working for me any more. It stopped working for me because I had stopped taking it! - it worked fine when I was at 200 mg for over 20 years. So here I am having had some success with Cipralex after 6 weeks but still needing something to help with sleep and something else for anxiety once or twice a week plus some possible drug interactions. I suppose I can give it a full two months and then see whether it makes sense to transition back to Zoloft.


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## Retired (Jul 25, 2012)

> I'm currently working with a psychiatrist on the medications.......So here I am having had some success with Cipralex after 6 weeks but still needing something to help with sleep and something else for anxiety once or twice a week



I believe your choice to consult with a specialist (Psychiatrist) to manage your medications is a good move.  You may require some dosage adjustment with your new prescription of Cipralex, as long you you continue tolerating it well.  It would be in your interest to let the psychiatrist know that you did well with Zoloft, and at what dose, so the doctor can have a good medical history.

It could be that after the Cipralex reaches it full therapeutic action, your anxiety and subsequent sleep difficulty might be relieved.  If not, your doctor may suggest an dose adjustment,  or if your anxiety is triggered by certain situations that occur infrequently and you need help falling asleep only periodically, ask your doctor if a short acting benzodiazepine (minor tranquilizer) might be right for you to use as needed.  Examples of benzodiazepines that fit that description could be Ativan (lorazepam), Klonopin (clonazepam) or Xanax (alprazolam).

As you are in Canada, the first medication I referred to,  Ativan, is available in a sublingual form, that lends itself well to situational use as well as a hypnotic (sleep aid) when needed occasionally.   Furthermore, Ativan has virtually no potential for interaction with other medications you might be taking, because of the way it is metabolized.

Your psychiatrist along with your new family doctor, I am sure, should advise you well.


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## OtterB (Aug 3, 2012)

Well, I met with my psychaitrist on Monday and we discussed the pros and cons of staying on Cipralex or switching to Zoloft. I had a bit of a melt down last week mainly because I took on too much too soon at work and volunteering but when I was on Zoloft in the past I had much better control over anxiety. On Cipralex I seem to be just a hairs breadth away from some serious anxiety and have the physical tingling up and down my arms and a knot in my chest. So we decided I will taper off Cipralex and build up on Zoloft. For the first 7 days I'll go down to 15 mg of Cipralex (from 20 mg) and start 50 mg of Zoloft. The next 7 days it will be 10 mg Cip. and 100 mg Zoloft, then 5 mg C/150 mg Z until after about a month I'll be at 200 mg of Zoloft which was my dosage for about 20 years and worked well. My Dr. said this should go fairly smoothly as the antidepressant effect of the Cipralex is working and the build up to Zoloft should just create some subtle changes. I'm a bit worried about the transition and wonder if others have done this and what to expect. Thanks.


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## Retired (Aug 3, 2012)

Usually switching from one compound to another within the same class of medications is rarely a problem.  Your doctor has prescribed a rational approach to accomplishing the switch, so if you follow the tapered switch over, you should be fine.

Of course, if you do experience anything unusual, it should be reported to the doctor, but otherwise it sounds like you have made a positive move!


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## OtterB (Aug 15, 2012)

I saw my psychaitrist on Monday and told him the switch from Cipralex to Sertraline isn't going quite as smoothly as hoped.  I'm experiencing a lot of anxiety  - the cipralex seemed to make me nervous and hyper at times.  Plus my job is stressful, but on the positive side I'm going to retire soon.  That in itself is causing some anxiety but the more I think about it the more I look forward to it.  I just want to be emotionaly healthy when I walk out the door.  So the good Dr. suggested jumping right to 200 mg of sertraline (the dose I was on for 20 years and did well) and dropping the cipralex (I was taking 10 mg and 100 mg of Sertraline).  Anxiety is still a problem but it's only been a couple of days.  I imagine it will take several days for the cipralex to wash out and several more for the Sertraline to take full effect.  I'm usually one to second guess and wonder if I would have settled down with the 20 mg of Cipralex but it was 2 months and the anxiety was pretty constant.  Anyway, I always value any input from the Psychlinks folks.


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## Retired (Aug 18, 2012)

Thread split to: Retirement Plans


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## betterorworse (Aug 30, 2012)

Hello,

A few ideas occured to me as I read this thread. I have many similar problems that require the same medication that you discuss.

*Allergies: *I find most allergy meds do not work for me, and the 'non drowzy' ones have some kind of stimulant that makes me jittery and tense. A healthy lifestyle and diet that will keep your immune system in good shape is my best defense.

*Retirement:* That is one of the most stressful situation a working person can go through. Happiness and sadness get tangled into huge emotions. Fear of a complete change, which it is going to be. Your anxiety level is normal I feel to this period in your life.

*Age and changing meds:* One of my psychiatrist warned me about this 10 years ago. Switching medications back and forth can be disapointing, because sometimes the effect is no longer the same the second time around. Age also makes a difference in how these prescriptions work. You can metabolize or assimilate the same chemicals with more difficulty 20 to 30 years later. 

*10 mg Cipralex, 7.5 mg Imovane, .5 mg x3 Clonazepam: *This combination has been a great success for me after 2.5 years. My stable level has increased 10 fold, I still have agitated episodes usually triggered by events or conflicts with others but on the whole these peaks don't last 24 hours and I get back to a calm serene state. Sleep helps a lot because I become completely drained and allow myself to just tune out if I need to.

We are all different I realise, hope some of this information is ok for you.


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## OtterB (Aug 30, 2012)

Betterorworse, Thanks for the response.  On the Age and Changing meds topic, I discussed the issue of going back to Zoloft after doing so-so on 20 mg of cipralex with my pdoc and he felt there should be few problems as I have only been off of it for 5 months and am 58.  Of course I ran into problems when he tried to get me up to my original therapeutic dose (of 20 years ago) of 200 mg as I had huge anxiety from such a high dose.  So I'm back at 150 mg for now but need lots of clonazepam to get me over the hump.  I was actually taking 100 mg for the last couple of years I was on Zoloft.  I know these meds are tricky.  I almost wish I had stayed on the cipralex having gone through the ringer the last 2 weeks.  I gave it 2 months but wasn't sleeping without a ton of pills and I also still had quite a bit of anxiety.  Thanks again.


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## betterorworse (Aug 30, 2012)

I understand OtterB.

It's hard to know what to do, there is no road map for any of us. I am considering increasing the Cipralex since it helps with both the depression and anxiety and reduce the Clonazepam. That's my new doctor's inclination, I am very hesitant to change in case things go worse. We will see.

For you, I guess we will never know if you did the right thing by quitting the Cipralex. But you are over the worst in your transition, so I wish you the best. Plus as I said, this is not an easy time for anybody, never mind someone already dealing with so much. Take it easy.


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## OtterB (Aug 31, 2012)

Man, I'm getting discouraged waiting for the Zoloft to start helping. After the cipralex I thought I'd be basically picking up where the cipralex left me which was no to mild depression with some anxiety and difficulty sleeping.  It's like I'm starting all over.  I've been at 150 mg for 2 weeks after building up from 50 and 100 and tapering off the cipralex.  My pdoc (filling in for my regular) felt it would be another 2 weeks before I get relief.  I've had ssome good days and actually made it to work one afternoon but otherwise my anxiety is too extreme.  Sorry, just venting but being on 2 to 3 mg of clon wiping me out.


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