Increasing the dose will not of be much help in my view because the usual dose range of Lexapro is from 10 -20 mg per day and he is already taking it.
When a patient is not responding to an antidepressant, there are two possible options. Either the patient is switched over to another antidepressant or that medicine is augmented with another medicine.
Cross tapering is a method in which one medicine is gradually taper down while the dos e of another medicine is gradually increased. In this method, from the day one - Lexapro is taper down slowly while starting the Venlafaxine at 37.5 mg per day. This should be done under his doctor supervision. His doctor will slowly reduce the dose of Lexapro while cautiously increasing the dose of Venlafaxine. By following this method, chances of withdrawal are comparatively very low and slowly Lexapro can be stopped while increasing the dose of Effexor.
I am also suggesting you a new option below.
Since according to you, he will not agree to taper off Lexapro, instead of tapering down Lexapro and starting Effexor, one possible option could be to augment Lexapro with another antidepressant in low dose such as Bupropion (Wellbutrin) or Mirtazapine (Remeron).
Combination of Lexapro 20 mg with Mirtazapine (7.5 / 15 mg) will be very useful if he is having associated Insomnia
. Mirtzapine will augment the antianxiety and antidepressant effect of Lexapro and may also reverse the sexual and gastrointestinal side effect because of Lexapro.
Similarly, combination of Lexapro with Bupropion (Wellbutrin) could be useful if he is having associated increased sedation, lethargy, and fatigue. Wellbutrin will augment the antidepressant effect of Lexapro and may also reverse the sexual and gastrointestinal side effect because of Lexapro.
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