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I am going to paste something I had written a few days ago have been taking Lexapro 40 mg and Lamictal 300mg with success for a few years. about a year ago My Psychiatrist tried changing my Lexapro to celexa 40mg and lexapro 20 mg after i felt like results were not as good as they once were. During this time i started talk therapy which proved to be very successful. So successful that From there we eventually went down to 15, than 10 mg of Lexapro while staying on 40 mg Celexa and 300 Lamictal.Needless to say in January my therapist is no longer covered on my insurance plan, and 3 weeks ago i had a horrible panic attack and 2 days later ended up in the hospital due to a feeling of anxiety that was not going away for 8 hours straight. like a constant adrenaline rush. (I blame the reduction of medication, and possibly the switch of medication) Of course medically speaking I am as healthy as can be. However now for the past 3 weeks, my GP has changed me back to 40 mg Lexapro and cut out Celexa. then he knocked my Lamictal down to 50 mg (from 300!) and added 25 mg Seroquel. That was the worst 5 days of my life and i stopped the Seroquel 2 days ago. Yesterday he told me to just go back to Lexapro 40 mg and Lamictal 300 mg to get back on some stable ground.I am in an emotional roller coaster now. I rely on Klonopin to get me through my days (never did have to use a benzo) I have a 4 year old and a fiance (been together 10 years supposed to be married in the fall) and I can barely function as a father, husband (fiance), or even employee. Thankfully I work from home, but basically my whole life has been put on hold. Does anyone have any advice, positive experiences, or expectations of how long this medication can take to balance out and give me some positive results so i start feeling closer to myself again? Thanks. as an update it seems that im still not quite myself... i still have some depression and extreme difficulty leaving my house

Doctor's Assistant: How long have you been dealing with this? Is there anything in particular that seems to make the symptoms better or worse?

Originally lexapro gave me my life back, but recently after reducing my doses then going back up to my original dose it doesnt feel the same anymore

Doctor's Assistant: Anything else in your medical history you think the Psychologist should know?

Only that in 2009 I had a complete breakdown where i had to withdraw from school and i was confined to my apartment. Lexapro fixed that, but now many years later it just doesnt seem to do the trick

Submitted: 2 months ago.Category: Mental Health
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Answered in 52 minutes by:
3/27/2018
Mental Health Professional: Dr. Kaushik, Psychiatrist replied 2 months ago
Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4,769
Experience: MD Psychiatry
Verified
Greetings.
Welcome to the site.
I am a Psychiatrist and I believe that I can help you with your query.
Well, you see if you had sustained on the same combination which you have been taking for quite some time now then this situation of a random panic attack and subsequent Anxiety would not have occurred in the first place since you tolerating these medications quite well and they were producing benefits to you in terms of keeping you out of the clutches of depression and anxiety.
However having said that I feel you shall start responding to the same combination of lexapro and Lamictal a week to 10 days but I do feel that the benefits this time around would not be as effective as last time since it seems like your body has developed tolerance against these medications and hence they have become less effective.
So I would suggest that you ask your gp to add another augmenting agent to this two drug regime such as modafinil or provigil at dose of 50 mg to begin with In the morning and after 1 week you may further up the dose to 100 mg per day. This drug will help you elevate your mood and infuse enthusiasm within your body.
Make sure before starting modafinil that your present and earlier doctors have ruled out bipolar depression in your case since using this drug in a potential bipolar patient can precipitate manic spell.
I hope this helps.
Wish you all the best
Please kindly leave a POSITIVE RATING if you are satisfied with the answer.
Regards
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Customer reply replied 2 months ago
I should add that i took a genesight test, and Lexapro is said to only be effective in high doses for me, which would explain why I have been on 40 mg. I was recommended to switch to Pristiq, but I am worried the switch may cause unfavorable symptoms from discontinuing the lexapro.I also have to say that while the lexapro was getting me by, I feel like i could be "better" than i was. Although my panic attacks seemed to be under control, I would still get triggered by places such as grocery stores, department stores, malls, etc. do you think switching the Lexapro completely could help? Currently I sort of feel like I am just existing, the lexapro has left me with depersonalization, which has been a disruption in my abilities to leave the house. I don't think I was able to give my full story in my original message to you.Basically, I am looking to have emotions, feel in my own body (no more depersonalization) and enjoy things I once did. Lexapro was perfect when I was on the namebrand, but I think its effectiveness has steadily declined since I was put on the generic 3 years ago. Do you have anything to add with this information?
Mental Health Professional: Dr. Kaushik, Psychiatrist replied 2 months ago
Thanks for the valuable inputs.
Well, i personally would not endorse the idea of switching to another anti depressant drug like pristiq or any other in place of lexapro because I feel your body has become quite well adapted to the drug's presence and any attempt to replace this drug may lead to worsening of your condition.
So according to me what you can do is that you can augment the action of lexapro and Lamictal by adding a new augmenting agent either in the form of modafinil or bupropion. Either of these options are capable of lifting your mood and help in preventing depersonalization.
So for me lexapro and Lamictal should stay as it is while you shall ask your doctor to add either bupropion or modafinil for the reasons discussed above.
Klonopin shall be continued as and when required.
I hope this helps.
Wish you all the best.
Please kindly leave a POSITIVE RATING if you are satisfied with the answer.
Regards
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Customer reply replied 2 months ago
My psychiatrist recommended adding 20mg of celexa to 40mg Lexapro and 300mg lamictal. Although they are similar he explained in his experience celexa helps better with panic and Lexapro is good with generalized anxiety. We are going to assess how I feel after 7 days on this group at this dosage. He believes increasing the lamictal could help my depersonalization. Right now it seems to be at it's peak. Do you think this is just my body adjusting to the celexa, or do you think more lamictal could help? Also, do you think there is an advantage with either drug you mentioned over lamictal for depersonalization? I'm starting therapy again on Monday and I'm sure it will at least help a little bit but I'm equally concerned with finding the right medication combination to get me to my best possible self. Thanks.
Mental Health Professional: Dr. Kaushik, Psychiatrist replied 2 months ago
Thanks for the valuable inputs.
Well, i do not support your doctor's decision to add celexa because the two drugs are almost similar in their mechanism of action so adding celexa would not bring any significant difference in your symptoms as it would be just like further raising the dose of lexapro which is already falling short in delivering the benefits at a high dose. That is why I suggested addition of another genre anti depressant or stimulant medication so that the body reacts to it positively and does not think of the new drug redundant just like it shall happen with the newly introduced celexa. I hope your doctor sees the reason in my comments and gets ready to try any one of the drugs suggested such as either modafinil or bupropion. Also do not discount the fact that that addition of celexa on top of already in use lexapro may result in a serious side effect called as Serotonin syndrome.My goal is to give you the best experience possible! I hope I have earned a 5 star rating today! Please remember to rate my service by selecting the 5 stars at the top of the screen. Please note that rating me now does not close your question. We can continue until you are satisfied. If you need more assistance, please use the reply box and let me know.Thank you.
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