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Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2253
Experience:  MBBS ; M.D Psychiatry, MS. Health Informatics
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How to switch from 20mg of Lexapro, which was first 10mg for

Resolved Question:

How to switch from 20mg of Lexapro, which was first 10mg for 3 wks, to Effexor . He then has taken 10 mg. for 2 weeks. Little reult. Can he change to the equivalent dose of Effexor or does he need to go through the "washout period?"
Submitted: 5 years ago.
Category: Mental Health
Expert:  Dr. Vikas replied 5 years ago.
Hello Madam,

Since both of these medicines acts on Serotonin neurotransmitter, while switching from a SSRI antidepressant such as Lexapro to Effexor we usually ask our patients to taper down Lexapro first and then start Effexor to avoid risk of serotonin syndrome.

Serotonin syndrome
Most patients can tolerate 50% dose reduction of Lexapro for 3-5 days followed by another 50 % reduction for next 3-5 days , then discontinuation.

So in my view, he should first taper down Lexapro and then start effexor.

I hope this helps.

Best wishes,

Vikas

Please feel free to ask if you need clarification/more information. Kindly click the GREEN ACCEPT BUTTON if you are satisfied with the answer. POSITIVE FEEDBACK and BONUS are warmly appreciated
Customer: replied 5 years ago.
Hw will not agree to taper off Lexapro as he is having such a horrible time tapering off the xanax. He was given no ifo on the horrors of benzo's, i was very, very ill and could not participate in his medical stuff so was unaware of the xanax consumption. He is not a junkis, a a professional who has had it-with doctors, with xanax, with tapering. Will it be dangerous to go straight to Lexapro? Would a higher dose of Lexapro be better
Expert:  Dr. Vikas replied 5 years ago.
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.

Best wishes,

Vikas

Please feel free to ask if you need clarification/more information. Kindly click the GREEN ACCEPT BUTTON if you are satisfied with the answer. POSITIVE FEEDBACK and BONUS are warmly appreciated
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