If you’ve already been prescribed LEXAPRO, you’ve taken the all-important first step toward improving your depression.

Now you may be wondering what to expect from treatment with LEXAPRO and what you can do to get the best results.

What to expect from LEXAPRO treatment

With LEXAPRO, many patients begin to feel improvement in their depression beginning in 1 or 2 weeks, although full antidepressant effect may take 4 to 6 weeks.

To get the greatest benefit, always take LEXAPRO exactly as prescribed by your healthcare professional or doctor, who may ask you to keep taking LEXAPRO even if you are feeling better. This is to help keep your depression from coming back.

LEXAPRO is well tolerated by most people. In fact, patients in clinical trials who took 10 mg of LEXAPRO experienced overall rates of side effects comparable to patients who took a placebo (sugar pill).

Overall, the most common side effects reported with LEXAPRO vs. placebo were nausea, insomnia, problems with ejaculation, somnolence, increased sweating, and fatigue. Most of the side effects experienced by patients treated with LEXAPRO are mild to moderate and tend to go away with continued treatment, and usually do not cause patients to stop taking LEXAPRO. For more complete information about side effects, look in the adverse events section of the LEXAPRO prescribing information.

If you have any concerns about side effects when taking LEXAPRO, you should talk with your healthcare professional or doctor promptly.

Treatment advice for LEXAPRO patients

Here are some additional steps you can take to feel better as you move forward with your therapy.

If you are taking LEXAPRO:

• Remember you are not alone and you have nothing to be ashamed of. In any single year, 19 million Americans suffer from depression. Depression is a real medical illness, like kidney disease or heart disease. It is simply a different part of the body that is affected.
• Avoid making major decisions (about a job, a divorce, a move, or a relationship) until your treatment with LEXAPRO takes effect.
• Avoid alcohol while taking LEXAPRO.
• You should also consult you healthcare professional or doctor about the use of other nonprescription drugs, herbal remedies, nutritional supplements, diet preparations, etc., during your LEXAPRO therapy.
• Try to exercise. Even mild exercise, like walking as little as 30 minutes a day, may have a positive effect on depression. If you miss a day, don’t get down on yourself. Simply do it the next day.
• Try to get out of the house and be around people, even if you’re not feeling up to it. Remember it is your illness that is making you feel withdrawn. Don’t let it govern your behavior. Go to a movie, go to the mall, call a friend. In time, taking pleasure in activities will return.
• Follow through on your treatment. You can’t benefit by taking LEXAPRO or attending therapy on a hit-or-miss basis. You must consistently take your LEXAPRO and follow your treatment as prescribed by your healthcare professional or doctor in order to feel better. Make sure to speak with your healthcare professional or doctor before you stop taking LEXAPRO.
• Keep follow-up appointments with your healthcare professional or doctors. They need to know how your treatment is going, if you’re feeling better, and if you’ve had any side effects. Keep a journal and take it with you to your appointment, so you’ll remember to mention everything you want to.
• Take advantage of the resources available in your community and online, such as support groups, chat rooms, and educational materials. Click here for a list of suggested resources.

Advice for friends and family of LEXAPRO patients

If someone you care about has been prescribed LEXAPRO, here are some ideas to help you support your friend or family member as they go through treatement.

• Take an active role in making sure the person with depression takes their LEXAPRO and keeps appointments with their healthcare professional or doctor.
• Sometimes people with depression have trouble functioning, and even simple, everyday tasks overwhelm them. Offer practical help, like cooking a meal or doing some laundry, whenever you can.
• Don’t just encourage the person with depression to go out; arrange outings to ensure they don’t become withdrawn.
• People with depression may lose interest in sex. If this happens, don’t take it personally. Remember that the situation may improve as the depression lifts. In the meantime, remain affectionate and connected in other ways, because affection is a very important way to support recovery.
• Take advantage of any resources available in your community or online, such as support groups for friends and family members, group counseling, or chat rooms. Click here for a list of suggested resources.

This will be a stressful time for you, too. Your friend or loved one will require additional patience, support, and encouragement from you. You may get tired of reassuring and encouraging. That’s natural. But your support is crucial, so don’t give up.

Fortunately, it’s very easy to seek treatment for depression today. And in most cases, treatment with medications like LEXAPRO can effectively restore quality and enjoyment to the life of the person with depression. Here are 3 easy steps to follow if you think you or someone you care about may be suffering from depression.

First: Recognize the symptoms

The first step in solving any problem is recognizing that one exists. Depression is a real medical condition, and just like other illnesses, depression has symptoms that can help you identify it. To find out if you may be experiencing symptoms of depression, click here to take a self-assessment on the Depression Screening Tool.

Second: Make an appointment

If you have 5 or more symptoms of depression and they have persisted for a period of 2 weeks or more, then you should make an appointment with a healthcare professional or doctor. There are many healthcare professionals or doctors who are qualified to give an initial depression screening, including family doctors, general practitioners, nurse practitioners, clinical psychologists, as well as psychiatrists.

You could feel depressed, but the first thing you want to do is rule out other possibile causes. Sometimes a viral infection or other medications can cause symptoms similar to those of depression. Your healthcare professional or doctor should give you a checkup to make sure there is no other physical cause for your depressive symptoms.

Once a physical cause is ruled out, you should then have a psychological evaluation. Your involvement will play an important role getting a good diagnostic evaluation, so here are some things to talk to your healthcare professional or doctor about:

• History of your symptoms — how you’ve been feeling; how long you’ve felt this way; how severe the symptoms have been; if you have experienced them before, and if so, if you sought treatment.
• At-risk traits — tell your healthcare professional or doctor how often you drink alcohol or use drugs. Also, if you have frequent thoughts of death or suicide, tell your healthcare professional or doctor.
• Family — has anyone else in your family ever seemed depressed; have they been treated for depression; what treatment did they receive and was it effective?

Third: Get treated

If your healthcare professional or doctor diagnoses you with depression, don’t be upset. Instead, feel good that you have done something to make a positive difference in your life.

There are many options available for you. Either medication like LEXAPRO, talk therapy, or both can make a great improvement in depression. Take an active role in deciding what options you would like to pursue.

If your healthcare professional or doctor is considering an antidepressant medication, you may ask about LEXAPRO. For many patients, LEXAPRO has provided well-tolerated therapy that has been proven effective. If you are prescribed LEXAPRO, here are a few additional guidelines for you to follow:

• Make sure you tell your healthcare professional or doctor (again) about any medications you’re taking; this includes prescription and over-the-counter medicines, herbal remedies, as well as dietary supplements.
• Follow your healthcare professional’s or doctor’s instructions exactly.
• Refill your LEXAPRO prescriptions ahead of time to avoid missing a dose.
• You should take your LEXAPRO as long as your healthcare professional or doctor instructs, even if you start feeling better, because otherwise your depression could return or worsen. Your healthcare professional or doctor may ask you to keep taking LEXAPRO even if you are feeling better, to help keep your depression from coming back.
• Keep track of your progress and let your healthcare professional or doctor know if you’re experiencing side effects from treatment.
• Keep your follow-up appointments with your healthcare professional or doctor.
• Ask questions and click here to start learning about LEXAPRO and depression.

Remember that you are the most important part of your depression therapy. To have the greatest impact, it’s very important that you get involved and follow through with treatment. It’s difficult to say how long therapy should last, because each person may be different. Keeping follow-up appointments with your healthcare professional or doctor and discussing your progress is how you will determine your length of treatment.

Question. I am veteran of SSRI poop-out. After more than four successful years on Zoloft, it stopped working. When tyrosine was added, it was effective for another nine months. My doctor and I then tried various strategies that didn’t work, usually because of my hypersensitivity to side effects. Wellbutrin made me jittery even at low doses and caused insomnia. Desipramine made me so jumpy, dumb and uncomfortable that I couldn’t take another dose. I have had similar reactions to approximately 10 other tricyclics. I have also tried all of the other SSRIs which I couldn’t tolerate. I think augmentation is the way to go at this point. What do you think?

Answer. I admire your tenacity, after all these complications with your treatment. So, let’s go through each of your questions and see if it leads to some treatment options to discuss with your doctor. First, I think buspirone augmentation can be helpful, particularly if there is an anxiety component to the depression. In fact, there are studies showing that buspirone alone, and in high doses (at least 50 mg/day) has antidepressant properties. Pindolol studies have yielded mixed results, and this may vary from SSRI to SSRI, but I think the risks are so minimal that it might be worth trying in your case. Other medications to consider as augmenters to SSRIs would include methylphenidate (Ritalin), which works well, in my experience, but could be overstimulating to you (if it were used, I’d start with 2.5 mg per day and hold it there for a week). Alternatively, you (with your doctor’s approval, of course) could try stopping the tyrosine for a week or two, then re-starting it. Sometimes this strategy works with the SSRIs as well, though some patients may experience mild-to-moderate withdrawal symptoms (flu-like symptoms) when a short-acting SSRI (Paxil, Zoloft) is suddenly stopped–so a tapering period might be better, followed by 1-2 weeks off, then a restart.

Another option would be to add a dopamine agonist, such as pergolide. I have seen this help in one case of very resistant depression. Here, too, I’d start low, and go slow with the dose. The combination of the MAO-B inhibitor selegiline (L-deprenyl) in combination with phenylalanine (another amino acid precursor) has been reported helpful. To use L-deprenyl, you must be off Zoloft for at least two weeks. You did not mention Serzone…if you haven’t tried this, it could be used in low doses in combination with the Zoloft, or as a single agent in much higher doses. Or, Serzone could be used in combination with most of the other agents mentioned above, except an MAOI. I don’t know if you’d consider treatment in Canada, but they do have a unique MAOI up there–moclobemide–that is not available in the States. It might work for you, even though two previous MAOIs did not. Moclobemide can usually be obtained via a cooperative arrangement between your doctor and one up in Canada. Then, there’s always St. John’s Wort, but we know so little about how well this works, or if it can be combined safely with standard antidepressants, that I can’t really recommend it.

Since you have been through the pharmacologic ringer, I think you should at least consider something that we know does work, and that is ECT. This is a safe and very effective treatment for major depression, and can be used on a maintenance basis.

As to the mechanism of “poop-out” – the undignified name says a lot about our state of knowledge. It doesn’t really fit the usual definition of tolerance since dosage increases may or may not help (with tolerance, an increase in dose virtually always – by definition – brings about a renewed response). Dopamine depletion from the SSRI is plausible, and goes along with the observation that some patients who experience this fading out of SSRI effects also experience a sort of emotional flattening and decreased response to rewarding stimuli (e.g., sex, good times, etc.). Since the reward system is mediated in large part by dopamine, this all hangs together. That may be why methylphenidate (Ritalin), which has dopamine enhancing properties, sometimes restores the SSRI response. On the other hand, the apparent success of pindolol – which basically unlocks the valve on the neuron that produces serotonin – suggests that serotonin slow down may underlie this loss of SSRI effect. I don’t think it is a pharmacokinetic effect in most cases. I do wish you and your doctor the best in dealing with your problem, and don’t give up!

Question. I take Luvox 150 mg per day for chronic depression and obsessive anger problems. My psychiatrist is concerned about my sleep habits, which have basically been the same all my life; I cannot sleep at night, I only sleep soundly in the mid-morning hours. He prescribed Ambien to be taken at bedtime and it put me to sleep right away. I was delighted with that result, however, for two or three days after taking even just one dose, all the obsessive anger and intense depression symptoms would reappear, as if the Ambien negated all the beneficial effects of the Luvox. The psychiatrist prescribed trazodone as a sleeping agent, only to be taken as needed. Well, it works occasionally, but when it does work, I sleep not only through the night but most of the next day as well. But it doesn’t detract from the positive effects of the Luvox. I want to know how drugs such as Ambien and over-the-counter decongestants interfere with SSRIs like Luvox, if such interference is common and if these medications have any property that might cause these problems. Can you offer any insight?

Answer. I wish I had some insight that could unify all the various elements of your case, but I’m afraid I don’t. This is partly because of the complexity of your question, and partly because the circumstances as you’ve described them don’t permit a neat pharmacologic “dissection” of the facts, a result of the way you were taking the medications.

First of all, I would have to say that the reactions you describe strike me as uncommon, but that may be because few such interactions have been published, rather than because they don’t occur. However, my guess is that your nervous system is unusually sensitive to either the single agents you list or to some interaction between them. Let’s start with the Ambien. Ambien itself (i.e., taken without any concomitant medications) can, in less than 1% of cases, cause unusual reactions, including visual distortions, aggressive reactions, manic states and panic attacks. We don’t know whether Ambien alone might have given you some problems. Could it have “negated” the effects of the Luvox? I doubt that a single dose of Ambien could have had any significant effect on the total amount of Luvox in your system; however, since both Ambien and Luvox are bound to “carrier proteins” in the blood, it is theoretically possible that the Ambien displaced a large amount of the Luvox from its carrier proteins, caused a sudden (very brief) surge of “free” Luvox in your brain and somehow negated its own beneficial effects.

Something similar can sometimes be seen in patients with obsessive-compulsive conditions, in which the neurotransmitter serotonin is thought to be deficient (as it is in some depressive states). When we give such individuals chemicals that stimulate serotonin receptors in the brain, they sometimes, at first, get worse; perhaps because their serotonin receptors are overly sensitive. Over longer periods of time (i.e., 6-12 weeks) agents like Prozac and Luvox, which also boost serotonin, are thought to gradually “down regulate” the oversensitive serotonin receptors and restore them to their natural state.

So, thinking very theoretically, it is possible that the Ambien displaced the Luvox from its carrier proteins, caused a sudden, brief surge in your nervous system, which overstimulated your serotonergic system for a few days. However, it is also possible that the Luvox and Ambien interfered with each other’s metabolism (elimination) in some way that led to elevated levels of one or both agents. Now, as to antihistamines and decongestants, it is not clear to me whether these agents have caused intense anger and social withdrawal in you when taken alone or only in combination with Luvox. If the former is the case, I would guess that you have an unusual sensitivity to these agents. More specifically, if you have this reaction to medications such as Actifed and Sudafed – but not to diphenydramine – you may have an unusual sensitivity to pseudoephedrine, a stimulant/decongestant found in Actifed and Sudafed. (Diphenhydramine is an antihistamine). Actifed is actually a combination of pseudoephedrine and the antihistamine tripolidine, so it is possible that you react to the tripolidine. I am not aware of any of these antihistamines or decongestants interacting adversely with Luvox; however, two non-sedating prescription antihistamines (terfenadine and astemizole) may have adverse interactions with Luvox, since Luvox may reduce metabolism of these agents.

My suggestion would be to keep a careful record of your reactions to medications and discuss them with a psychopharmacologist; in the mean time, you might want to avoid use of pseudoephedrine-containing medications. By the way, it may be better for your sleep-wake cycle to use the trazodone on a regular basis, in very small doses (e.g., 25 mg), rather than sporadically; it is not habit-forming and the regularity may help stabilize your sleep-wake cycle.

Question. I am attempting to research the area of male depression. Through my experience of working with clients and my current reading it, would seem clear that men do not express their depression along the lines of the symptoms presented in the DSM-IV. It appears to be particularly “feminine” symptomology or a societal expectation of feminine expression. I wish to explore how men tend to act out their emotions or hide their emotion through actions such as violence, substance abuse or workaholism. I would appreciate your comments and perhaps some comment on where to find more information.

Answer. I am not sure I entirely agree with the premise of your question, though I do think you are on to something. In my experience as a psychiatrist, most severely depressed men, like most severely depressed women, satisfy most of the typical DSM-IV criteria for major depression. There are exceptions, of course, so-called “atypical” depression with its anxious, phobic, somatizing features; hypochondriacal forms of depression; depressive states expressed as chronic pain, etc. But in the main, I have always found the DSM criteria a very useful starting point for diagnosing depression in men or women.

There is some evidence that women experience more depressive symptoms for a longer period of time than do men. But at least one large study found men and women with major depression (Research Diagnostic Criteria) to have quite similar symptom profiles, on the whole.

That said, I do think that men may show some differences in the way they express depression, perhaps reflecting the divergent cultural influences on men and women in Western society. (I can’t rule out inherent biological differences, either). I think men more often fit Peter Sifneos’ description of alexithymia than do women; i.e., the men are often woefully unable to recognize or at least verbalize their feelings. At times, this seems to be part of the macho culture of the “strong, silent type” epitomized by John Wayne. So, as I’m sure you’ve found, when you ask some men if they are depressed, they may shrug their shoulders and say, “No way, Doc! I just wanna kill myself.”

Even the Frank et al study found some differences between men and women; e.g., women reported more appetite and weight increase, more somatization, and showed greater levels of expressed anger than men. The women also took longer to respond to treatment. Re: alcoholism and sociopathy, there is a school of thought that views these conditions as “the man’s way of expressing depression”. However, I don’t think there is compelling empirical evidence for this; e.g., most studies of alcoholism and depression have found that these are independent disorders. For more details on this interesting issue, you may want to see the chapter by Wolk & Weissman in the American Psychiatric Press Review of Psychiatry, volume 14, 1995. Good luck with your research!

Results from several clinical studies designed to assess the effectiveness and tolerability of Reboxetine (Edronax), a new antidepressant agent, were announced recently at the annual meeting of the American Psychiatric Association.

Reboxetine, produced by Pharmacia & Upjohn, is the first of a new class of antidepressant medications known as selective norepinephrine reuptake inhibitors. It works through a novel mechanism of action, affecting the norepinephrine system of the body. Researchers have long suspected that the neurotransmitter norepinephrine plays a major role in depression. In fact, reduced levels of this brain chemical have been linked to several specific symptoms that characterize this disorder, including diminished energy, interest, and motivation.

More specifically, reboxetine works by selectively inhibiting the reuptake process, whereby norepinephrine is drawn back up into the brain. By impairing reuptake, there is an increased supply of norepinephrine available for use. Transmission is concomitantly enhanced in various brain areas.

The results from two eight-week clinical trials of 549 patients with major depression in Europe, Latin America, and Australia demonstrated greater reductions in depression scores (as measured by the Hamilton Depression Scale) with reboxetine versus placebo. When compared to fluoxetine (Prozac®), reboxetine showed larger reductions in depressive symptoms, despite a similar rate of adverse events. Additionally, reboxetine treatment enabled more patients to achieve a normal score on a scale measuring social functioning by the end of the two studies. Social functioning encompasses active social behavior in both personal and occupational settings, as well as self-perception.

Although generally well tolerated in both studies, the most commonly reported side effects of reboxetine are dry mouth, insomnia, constipation, increased sweating, hypotension, urinary hesitancy/retention, paresthesia, tachycardia, and impotence.

Study author Juan Massana, M.D., concludes that these studies provide valuable information on the role of norepinephrine in depression and a possible new treatment option for patients suffering from this disease.

A recent study sought to examine the risk of depression among young women. Researchers at the University of California, Los Angeles, studied the psychiatric health of 155 female high school students, aged 17 to 18 years at the beginning of the study, over a period of five years to collect data. It was found that 47 percent of the participants had at least one episode of major depression within five years after high school graduation and that the risk peaked at about 18-19 years of age; bouts of depression during the study period were the first such episodes in about 37 percent of women. Authors note that the risk of depression was greatest in those women with a prior history of depression and that both academic pressure and relationships were strongly associated with the risk. The study is in “The Journal of the American Academy of Child and Adolescent Psychiatry”

Sexual dysfunction associated with antidepressants may be more prevalent than previously believed, according to researchers at Case Western Reserve University School of Medicine.

The American Psychiatric Association reports that depression, a serious mental health problem affecting more than 17 million Americans, is a highly treatable condition. Unfortunately, many of the medications used to provide relief from symptoms are linked to orgasm dysfunction (the absence or delay of orgasm).

This study, published in the journal “Clinical Therapeutics,” reveals that sexual dysfunction caused by antidepressants affects more people than previously expected, and the problem may be more common in patients taking certain types of drugs than others. In this placebo-controlled comparison of sertraline (Zoloft) and bupropion SR (Wellbutrin SR) in 355 patients with moderate to severe clinical depression, investigators found that orgasm dysfunction was more prominent in patients taking sertraline than in those taking bupropion SR or placebo.

In fact, after only one week of treatment, more patients taking sertraline reported orgasm dysfunction compared with bupropion SR or placebo. By the end of the study, 41 percent of patients taking sertraline reported orgasm problems. There was no significant difference in orgasm dysfunction between bupropion SR (15 percent) and placebo (eight percent).

Sertraline is a selective serotonin re-uptake inhibitor (SSRIs). Previous research has identified an association between SSRIs and sexual problems, including lack of orgasm, impaired erection, and delayed ejaculation. Researchers suggest that the serotonin effect of SSRIs might account for the negative effects on sexual function. Unlike sertraline, bupropion SR is not an SSRI and has no appreciable effect on serotonin.

The authors assert that depression itself can take a toll on relationships, and sexual dysfunction caused by some antidepressant treatments may further affect intimate relationships and adversely influence recovery. They suggest that the under-reporting of adverse sexual side effects may be due to shame or lack of knowledge on the part of patients, as well as reluctance by health-care providers to broach the subject. They stress that side effects should be acknowledged, and that open communication about any adverse medication effects is critical to successfully treating depression.

Having epilepsy seems to increase the likelihood that you’ll suffer from chronic depression and multiplies the risk for suicide by five times. Researchers from the University of California Los Angeles don’t believe it results from dealing with the stress of having epilepsy, but may simply be a part of the disease process.

As many as 35 percent of epileptics suffer from some type of depression. Women seem particularly susceptible, but the statistics may be misleading because women are more willing to seek help for health problems.

For some people, depressive symptoms may be part of the prodromal stage, the symptoms experienced before a seizure. For others, the depression may occur during, after, or in between seizures. In many cases, the depression becomes chronic, lasting more than six months.

Historically, studies have shown that if the seizure-causing lesion(s) can be located in depressive epileptics, it’s usually in the left temporal lobe. However, one recent study at the University of Pennsylvania found that in two specific types of epilepsy, gelastic and dacrystic, the lesion was usually found in the right temporal lobe.

In people who experience a psychological aura, rather than one of sensation or movement, the lesion(s), if located, tends to be in the temporal lobe–limbic system area of the brain. The limbic system is associated with emotional responses triggered by a stimulus. For example, if you have joyful memories of your grandmother baking you gingerbread cookies when you where a child, simply smelling gingerbread later in life may produce a feeling of happiness and well-being.

Hormones also influence the limbic system. Estrogen has an antidepressant effect but contributes to seizure activity. Too much estrogen may promote panic attacks or obsessive compulsive disorder. Progesterone tends to decrease seizure activity and anxiety, but excessive levels may induce sleepiness and depression. Testosterone is believed to have an antiseizure and energizing influence, but in excess it causes aggressive and hypersexual behaviors.

To complicate this delicate interplay, hormonal effects are unpredictable in those with temporal/limbic epilepsy. The effects may be exaggerated or they may be the exact opposite of what is expected.

Recent studies indicate that depression precedes Type II diabetes in 90 percent of people with both illnesses. What does that really mean to you?

Researchers from the University of Oregon Health Sciences Center conducted a study of 10,000 people, 5,000 with Type II diabetes and 5,000 without it. The two groups were similar in other ways such as age and gender. The team hoped to answer three questions:

· Are diabetics more likely to be depressed than those who don’t have diabetes?
· What types of medications are depressed diabetic people likely to be taking?
· What are the costs of treating a person with diabetes, depression, or both?

They found that 62 percent of diabetics are more likely to be depressed than people without the disease. Among diabetics, those who are depressed are more likely to be taking insulin than managing their diabetes through diet and oral medications.

Diabetics are less likely to be taking antidepressant drugs. Of those who are being treated, most are on the same medications as any depressed patient—serotonin re-uptake inhibitors, such as Prozac, Zoloft, or Paxil. They also were taking more tricyclic antidepressants, such as Elavil. However, the researchers were uncertain if they were taking the antidepressants at the higher doses needed to treat depression or at the lower doses used to treat peripheral neuropathy, a common complication of diabetes.

As for costs, depressed people use more services and spend more money than average, whether or not they also have diabetes. In fact, it costs about the same amount to treat a diabetic without depression as it does to treat a depressed person without diabetes. Having both diseases increases costs considerably.

Treating the depression was shown to increase an individual’s adherence to his or her treatment plan, improve blood glucose control, as well as improve the individual’s psychological outlook.

From any perspective, untreated depression in Type II diabetes carries a high cost, financially, physically, and mentally.