Dr James Schaller
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Escitalopram (Lexapro) in Adolescent Major Depression

Dr. Schaller has recently published one of the first international articles on Lexapro use in youth. It was published in the highly respected journal, Medscape General Medicine, and examines the experience of five youth who had unacceptable experiences with antidepressants. All had experienced errors in prescribing that are common, particularly with non-child psychiatrists, like family doctors, internists, pediatricians, neurologists and adult psychiatrists pretending to know adolescent psychiatry.

Lexapro is the purified active part of Celexa. Lexapro is available in 26 countries. The five youth and their parents wanted a Lexapro trial because of depression that had a poor response and side effects from other medications.

  • Lexapro seemed to cause less obesity than Paxil (paroxetine).
  • Lexapro caused less restlessness or akathisia than Prozac (fluoxetine).
  • Lexapro seemed to have more stable blood levels over years than Zoloft (sertraline).
  • Lexapro is reported to have very low drug interactions
  • Lexapro appears to have low anxiety at onset, as long as the starting dose is not over 5 mg. We start with 2.5 mg the first day, and 5 mg the second day if comfortable.

Lexapro is derived from Celexa, which is used in 89 countries and in approximately 40 million patients. So I have thought that many youth have been "exposed" to Lexapro when it was part of Celexa.

Dosing of Lexapro and Other Antidepressants

If your doctor prescribes based on limited PDR data that is fairly sad.

Why?

Lexapro dosing can be a single mg in "very sensitive" patients who are also "sensitive" to different drug classes. Often they have an underlying inflammation or other medical trouble that is being missed. And yet, other pateints need very high doses. Perhaps they metabolize it fast, have less sensitive or fewer receptors, suffer with major irritation to the brain, or other body trouble.

So in folks with significant allergy problems with fatigue and "sensitivity to medications," we found nausea and headaches at doses of only 5 mg. They did better on 1-2.5 mg and did not always need an increase, even after 6 months.

Other adolescent patients needed massive doses. And we found some labs that are not routinely ordered that may explain why they needed such high doses. In individuals with an elevated tumor necrosis factor-alpha, an elevated sensitive C-reactive protein, an elevated matrix metalloproteinase-9, or a decreased alpha-melanocyte stimulating hormone, they generally needed doses higher than those FDA-approved, e.g., 50-60 mg/day.

These later folks needing high doses had a wide range of problems: severe chronic sinus infections without pain, deep multiple tooth cavities, mild American Babasia or Bartonella (cat scratch fever which is not commonly acquired from cats). Some had the number one vector illness in the US, specifically neurological Lyme infection confirmed by a bulls eye, special laboratory results, a clinical history, and positive single photon emission computerized tomographic scans (SPECT). Others had exposure to a toxic pond, toxic algae from a lake or other source. One had a contaminated well. With treatment of the offending disease, dosages were universally lowered to common ranges, e.g., 5-20 mg/day. But sometimes finding the inflammatory cause took up to 8 months.

To read the full article and not just some of the summarized sample points, please go to: www.medscape.com/viewarticle/497492?src=search

You may need to take 2 minutes to register, but the journal is free.



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