May 29, 2023

Are you looking to Start a Private Practice as a PMHNP but need some help?

Sike np talks every friday and we talk about certain medications that i like to prescribe give you guys a little more information when i prescribe it why prescribe it the concerns when prescribing it and just little things that i’ve learned from my practice and advocacy that i’ve seen when prescribing it so guys every friday it will be a new medication and today

We’re gonna be talking about a citalopram otherwise known as lexapro let’s get to it all right guys so a citalopram dosing related it goes from five to twenty milligrams that’s the recommended maximum dose is twenty most people will respond to ten milligrams fifteen twenty but you know in some cases you can even try thirty milligrams i have a couple of my patients

On thirty there was a study that went up to fifty milligrams the problem was is that it’s not very well tolerated above thirty i’m generally prescribed from twenty to thirty milligrams as my maximum dose especially if someone has to go ocd or generalized anxiety disorder that’s when i’ll start to try thirty four the depressive you know phase is twenty milligrams

The one thing guys is that it’s one of my favorite ssris to prescribe it’s one of the most selective ssris it doesn’t have many drug to drug interactions if any it’s very well tolerated the half-life is 27 to 32 hours very similar to a lot of the other antidepressants in this drug class other than paxil which is a very fast half-life and prozac which is a very

Long half-life it doesn’t have any of infinity affecting any of these other receptors and for me the most side effects that i’ve seen i see the nausea i’m dead listening the stomach upset some weight gain very minimal but i’ve seen weight gain for sure headaches increased sweating sometimes sexual dysfunction the thing is people ask you what you know who is

The ideal patient to start lexapro generally it’s someone that has never been on any medication before and you know they experience some depression or some anxiety electric was always my first line that’s it’s my favorite medication i’ve seen a really high efficacy it’s very well tolerated that’s a big thing with patients you know you want to not feel have any

Of these side effects if you want to try to take a medication and efficacy wise it’s worked for a lot of my patients for depression and anxiety when dose would i start them on i start pretty quick i go up i start at 10 milligrams i’m depending you know if there’s someone that served it on maybe i’ll start at five milligrams you know initially these three to five

Days when you’ve never been on an antidepressant or if even if you’ve been on an antidepressant before these three to five days initially you know sometimes you have these gi side-effects a lot of serotonin is in your stomach and in your gut that’s why you get a lot of these like nausea stomach upset things like that so you have to be very careful but you have

To let them know that it’s it’s normal to get you know a stomach upset some headaches some nausea and generally three to five days i would say at least 80% these patients will these symptoms will reside or will resolve but if they keep going then you might need to look to a human eye on your medication and try it there’s so many other antidepressants to try maybe

It’s well to better tolerate for that patient it’s different for everybody now if they’re having a sexual side effect that’s a little bit different general even if you you know when you wait a couple of months it doesn’t really change so let’s say they’re having trouble you can also you can you can also be dose related or time related so if a patient is having

Trouble having sex they’d like to do it at night or something like that you can do– see it after they know they do it because generally and that will help with a lot of the sexual sexual dysfunction also you can add wellbutrin sr one to two hours prior to any like sexual engagement and that can also help boost some of the things that they’re doing with sexual

Dysfunction there’s many things and let’s say these two things don’t work you dose it after then you most likely need to try a new medication especially if it’s affecting the quality of life if it’s they can tolerate it and you know it’s not you know a problem in their life then that’s fine they can deal with it but if it’s a problem in that case you should try

To find another medication but for me overall a citalopram is probably my favorite medications to prescribe i’ve seen it worked from a lot of my patients it has it doesn’t work for everybody guys but for the most part it’s well tolerated as a proven to have high efficacy and it’s a medication that should be in your toolbox alright guys ii pete

Transcribed from video
Psych NP Talk Episode 1: Escitalopram & Lexapro By The Psych NP