Lexapro or escitalopram may treat depression and anxiety. Actually Lexapro contains the same active component as Celexa. Aggressive marketing promoting the drug as superior to other available options succeeded in boosting total sales well in excess of $14 billion. Unfortunately studies fail to show Lexapro offers any unique advantages over other similar SSRIs such as Prozac, Paxil and Zoloft. Recent investigations suggest not only are antidepressants overprescribed but their effectiveness compared to inactive placebo therapy remains subject to debate.
Hello i’m dr. ken landau thanks for watching let’s talk about lexapro or is generically known as s citalopram the drug was approved by the food and drug administration in 2002 and generic drugs became available after 2012 it’s an ssri a selective serotonin reuptake inhibitor just like prozac or zoloft or paxil it’s used for the acute treatment of word the
Maintenance treatment of depression in adults and in adolescents between the ages of twelve and seventeen it’s also used for the treatment of generalized anxiety disorder for a period of up to about 12 weeks the drug was marketed in the united states by forest laboratories but it was actually discovered by a pharmaceutical corporation in denmark known as london
Back it came on the market in 1998 as celexa and what happened is that forest laboratory started looking at the celexa and they discovered that there were actually two different chemicals mirror images of each other in the celexa one of them the left handed image was active it was a hundred times more active than the other component the right sided or they are
An antemer and that was inactive so what’s the difference between lexapro and celexa the difference is quite simple lexapro got rid of the 50% of the celexa that was inactive so it brought out just the active ingredient that’s the only difference they’re both selective serotonin reuptake inhibitors they both contain the same active ingredient now when we look
At all of the ssris the prozac celexa whether we’re talking about the paxil or does olaf they all work the same way they might have little minor variations on how they work on dopamine how they work on the noradrenaline but basically they are exactly the same kind of molecule now if we look at other areas of the world the drugs are approved for other purposes in
Addition to the anxiety and depression so if we go to europe or if we go to australia drugs also used for panic disorder agra phobia obsessive-compulsive disorder social anxiety off-label for post-traumatic stress disorder fibromyalgia some of the drugs in the united states just prozac approved in addition for treatment of pms premenstrual syndrome can be taken
Either daily or just for the two weeks before the period sometimes people use the drug for treatment of or prevention of migraine headaches doesn’t work it’s used specifically in the united states that say for major depressive disorder but it isn’t the same thing as the colloquial oh boy i’m depressed i need a pill now for the medical definition of depression
You have to have symptoms for at least two weeks they have to be persistent they have to interfere with your normal activities and you have to have at least five symptoms like depressed mood or loss of interest in your usual activities or changing your appetite either increased or decreased change in your sleep either you sleep too much sleep too little change
In your activities either you’re hyperactive or you seem to sit in the chair not do anything increased fatigue feelings of guilt or worthlessness you have to have slowed or impaired concentration maybe even think about suicide that’s how we make the official definition of depression anything less is not depression at least by definition so how does the drug work
Have is lexapro work well okay it’s nothing great actually the four studies were done initially one of them showed it was about the same as a placebo and the other three showed it was a little better than placebo for both the treatment and the maintenance of depression actually if it seemed to work and you took it for a long enough period of time the depression
Might come back and some of the people if we look at the total effect it seemed to be effective and about forty fifty percent of the people in reducing the symptoms not getting rid of the symptoms its reducing the symptoms of depression but placebo seemed to be effective in at least thirty five percent of the people so it’s not a homerun and it doesn’t make any
Difference which one of the many different kind of rating scales we use basically they’re all the same at least as far as the outcome is concerned the drug lexapro is a little bit better than placebo however it’s important to realize that most of the studies that were done were conducted by the drug companies are funded by the drug companies and when looking at
The studies by the unbiased experts we’re thought to be of either low quality or at best modest quality and there’s not a issue you can even have major depressive disorder by itself or sometimes you can have a depression that could be one of the first manifestations of bipolar disorder bipolar disorder where you can have mania manic attacks and depression well
If you treat the depression of the bipolar disorder with this drug or any of the members of the ssri family might precipitate acute attacks of mania obviously not good so caution is required well has it worked for generalized anxiety disorder again you have to have the medical definition so for at least six months you have to have persistent symptoms that are
Difficult to control feeling restless or keyed up or on edge being easily fatigued or difficulty with your mind going blank or irritability of muscle tension sometimes you have sleep disturbance getting multiple studies done and it’s a little better than placebo but again not a homerun medicine comes in either 5 10 or 20 milligram capsules when you look at the
Standard dose it’s 10 milligrams for depression could be increased to 20 milligrams but in those 20 milligrams doesn’t really seem to provide any extra benefit than 10 milligrams and certainly if you have anything wrong with your liver your kidneys 10 milligrams is max 10 milligrams also is the standard dose for anxiety should not be abruptly discontinued if you’ve
Been taking it for a while could some other kind of symptoms and additionally it’s important to periodically reassess the need to be on the therapy you know that the anxiety or the depression may well be situational and conflictual well the good news is the pill lexapro can be taken once a day it can be taken with or without food if you have depression you might
Have to take it for weeks to months before it’s maximally effective and the discontinuation rate of therapy is about the same as if you were taking a placebo drug if you happen to be pregnant you probably shouldn’t take the pill because if you’re pregnant especially if you’re in the third trimester of pregnancy you can have a child with low birth weight autism low
Birth low blood sugar cyanosis apnea seizures respiratory distress and certainly in women who are breastfeeding it’s not recommended to take the drug because there’s some problem with weight loss and fussiness and somnolence and the child decreased feeding and it’s not for children under the age of 12 all drugs associated with some kind of side effects and the
Side effects pretty much standard with all of the drug nausea sweating fatigue feeling tired there’s no change in weight so it’s not a diet pill some people can have the meny or the hypo menial though it’s relatively unusual but it’s not unusual to have sexual dysfunction especially if you’re a man lack of org and decrease in libido or even ejaculatory delay
It’s not a narcotics that we’re not really worried about abuse and dependence but you could overdose on the drug fortunately tends not to be serious unless you happen to be taking other drugs as well shouldn’t take it within two weeks of taking an mao inhibitor more plan or pardal that say for treatment of depression you don’t want to take it with another drug
Called pem aside if you happen to have seizures may worsen the seizures and sometimes the drug can decrease the sodium in the bloodstream and if it does that you could develop headaches or difficulty concentrating or you could have certain unsteadiness or fainting attacks or worse you could go into a coma so do have to be careful about what sodium is well another
Issue is that serotonin is important for platelet function platelets are the things inside your bloodstream that make you a clot and if you take a selective serotonin reuptake inhibitor like lexapro might interfere with the clotting process so if you have a tendency to bleed if you’re taking aspirin or if you’re taking warfarin have to be careful certainly if
You have gastrointestinal bleeding disorders and if you happen to have a narrow angle inside your eye taking the drug can precipitate an acute attack of angle closure of glaucoma and there’s a big black box warning on the drug that it might lead to an increased thought about committing suicide especially if you happen to be less than 24 years of age not so if
You’re an adult not so if you’re a senior citizen but in relative youth it seems there is an increase in the incidence of contemplation and suicides have to be careful sometimes it’s associated with a change to that mania i mentioned a moment ago but other times it might be associated with panic attacks rings xiety irritability aggressiveness not i honestly sure
Why or who is going to suffer the problem another issue with these drugs with lexapro is that it might cause what we call the serotonin syndrome especially if you happen to be taking it with migraine headache drugs the triptans or tricyclic antidepressant or if you’re taking drug like fentanyl or lithium or you’re taking even st. john’s wort well if you’re taking
Any of those drugs or if you’re just taking the lexapro by itself you could suffer education loosen ations delusions you could have increased heart rate your blood pressure can go up you can start flushing and feeling dizzy elevated blood temperature every body temperature you could have some tremors you could have must-go rigidity or seizure disorder you could
Have nausea or vomiting diarrhea fortunately there doesn’t seem to be much interference with metabolism of most drugs when you take this particular compound but interestingly it interferes with metabolism of codeine now if you’re taking codeine for pain coding by itself is what we call a prodrug it’s not active in order for codeine to relieve your pain it has
To be metabolized into morphine and lexapro prevents that conversion so that means that if you’re taking codeine for pain isn’t going work if you’re taking lexapro well there’s another issue that i mentioned and it has to do with this continuation if you stopped taking the drug abruptly you’ve been taking it say for weeks or months and now you just decide to add
On what this drug well you might have the mania that we talked about or lethargy or headaches or confusion or anxiety or dizziness or irritation or agitation sometimes people get what are known as brain zaps feeling like you have electrical shocks or sometimes it’s just acute depression that might come back well in studies before it became marketed to people in
Laboratory animals it was shown to increase the incidence of carcinoma of the small intestine so if you happen to have a history of cancer i’m so sure about this kind of drug well if the drug was a phenomenally successful while it was under patent it brought in about fourteen billion dollars in 2011 the year before it went off patent brought in two billion dollars
Alone and it was it accounted for about half of all of the income of the drug company forest laboratory but now 90% of the drug is generic so how does it rate does it rate any differently than any of the other antidepressants on the market in the family is there anything special about lexapro well the american psychiatric association and what’s known as nice
Or the national institute for clinical health care and excellence in britain says now all of the drugs whether we’re talking about the prozac or the paxil or the zoloft or the luvox all seem to be the same maybe a little bit weaker than effexor or cymbalta according to some people well the company the drug company forest they sort of gotten to a heck of a lot
Of trouble early on they seem to be promoting its off-label use for children even though there was evidence that the company had and hid that the drug didn’t seem to work in kids so as a result they paid the department of justice about three hundred million dollars forest laboratories is known for acquiring compounds and then marketing them here in the united
States and then somehow moving the profits offshore and and that obviously is an issue forest laboratories was bought by another offshore company known as activist it was purchased for about twenty five billion dollars that we’re talking about big money in these companies in 2014 actually interesting when they were in trouble they had to release about 270 pages
Of their marketing agreement or their marketing plan to the senate committee on aging and they released about 88 pages to the public that showed how the company was going to spend about seventy million dollars to fund doctors family doctors and psychiatrists to go out and tell their peers how great the drug was the drug lexapro was launched actually had the sixth
Biggest launch in pharmaceutical history even surpassed viagra according to some people there are about 3540 different drugs in the field to treat depression and this single drug garnered 13% of the market supposedly the drug was superior to the others if you believe the advertising but the advertising was sponsored by the company and as a matter of fact as we
Just mentioned for the american psychiatric association and drug regulatory agency health regulatory agency in europe it’s no different than any of the other drugs in the family it’s just another ssri what’s the current cost well you could go buy lexapro if you put up the cash right now for a month’s supply it’s about three hundred seventy dollars and if you had
A coupons today for instance from good rx it would be about three hundred forty dollars but if you went over to the drugstore and you had again a coupon from good rx and got the generic version instead of three hundred seventy bucks it’s only ten to twenty dollars so what’s the bottom line on the drug the bottom line it’s no better than any of the other ssris
It’s highly overprescribed in america for every single complaint that we have we go to the doctor and what some kind of a pill the question is do we really have depression is the diagnosis correct do we really have generalized anxiety is the diagnosis correct do you really want one of these pills that’s associated with some of the side effects and the answer is
We’re doing it all the time and unfortunately we’re often doing it incorrectly anyway something for you to think about i’m dr. ken landau and thank you for watching you
Transcribed from video
Lexapro By wellnowdoctor
