Dealing with Lexapro side effects
March 6, 2016 8:24 PM Subscribe
I've been taking Lexapro for about nine months for generalized anxiety disorder and depression. Overall, the experience has been very good. I'm no longer nervous all the time. But in the past couple of months, I've grown concerned about two side effects: fatigue and apathy/lack of motivation. I talked to my psychiatrist about this and she laid out three options. I'm having trouble deciding which one would be best.
I know you are not my doctor/psychiatrist.
The fatigue isn't that bad. I'm a tiny bit drowsy most of the day but I can handle it. It's worst in the morning and night. I find it really hard to get up in the morning and I'm ashamed to say that sometimes I turn off my alarm and sleep an extra hour or two (I'm a grad student so I don't always have to be somewhere first thing in the morning). Also, I find that it's nearly impossible to think straight after about 9PM (thanks to deadlines, sometimes I have to work late so this is annoying). I'll also note that I exercise regularly and eat somewhat healthily, b/c I know those are important to one's energy levels.
But if it was just the fatigue I think I could live with it. The motivation thing is more difficult. The Lexapro is great in that I don't feel anxiety about my work, but now it's hard to rustle up the motivation to do anything, even things I like to do. I'm not falling behind on my work, but I could easily see that happening if this goes on. I've become much more content to stay at home as well, which isn't good for my social life. Furthermore, I identified with this question. I've tried to watch movies and read novels in my free time, but at some point, I get bored with them and it seems like a chore to finish them.
I brought all this up with my psychiatrist last week, and she gave me 3 options:
1. Stay on the Lexapro and try to cope with these issues through other means
2. Reduce the Lexapro dose (I'm currently on 10mg so it would be down to 5mg)
3. Supplement the Lexapro with Wellbutrin.
There are good and bad aspects of all of these, of course. Right now, I'm leaning toward #2 because right now I feel very little anxiety and (I can't believe I'm saying this, since anxiety turned me into a virtual zombie for 2 years) maybe I could handle it if the Lexapro was a little less effective. I've also looked into Wellbutrin and it seems like it would take care of these two issues I have, but I'm worried about the emergence of new side effects.
I hope that's clear enough. I'd appreciate any comments from others who may have had similar experiences or know more about these things than I do.
I know you are not my doctor/psychiatrist.
The fatigue isn't that bad. I'm a tiny bit drowsy most of the day but I can handle it. It's worst in the morning and night. I find it really hard to get up in the morning and I'm ashamed to say that sometimes I turn off my alarm and sleep an extra hour or two (I'm a grad student so I don't always have to be somewhere first thing in the morning). Also, I find that it's nearly impossible to think straight after about 9PM (thanks to deadlines, sometimes I have to work late so this is annoying). I'll also note that I exercise regularly and eat somewhat healthily, b/c I know those are important to one's energy levels.
But if it was just the fatigue I think I could live with it. The motivation thing is more difficult. The Lexapro is great in that I don't feel anxiety about my work, but now it's hard to rustle up the motivation to do anything, even things I like to do. I'm not falling behind on my work, but I could easily see that happening if this goes on. I've become much more content to stay at home as well, which isn't good for my social life. Furthermore, I identified with this question. I've tried to watch movies and read novels in my free time, but at some point, I get bored with them and it seems like a chore to finish them.
I brought all this up with my psychiatrist last week, and she gave me 3 options:
1. Stay on the Lexapro and try to cope with these issues through other means
2. Reduce the Lexapro dose (I'm currently on 10mg so it would be down to 5mg)
3. Supplement the Lexapro with Wellbutrin.
There are good and bad aspects of all of these, of course. Right now, I'm leaning toward #2 because right now I feel very little anxiety and (I can't believe I'm saying this, since anxiety turned me into a virtual zombie for 2 years) maybe I could handle it if the Lexapro was a little less effective. I've also looked into Wellbutrin and it seems like it would take care of these two issues I have, but I'm worried about the emergence of new side effects.
I hope that's clear enough. I'd appreciate any comments from others who may have had similar experiences or know more about these things than I do.
I am just going to tell you that if you have anxiety, Wellbutrin can make that go through the roof. Maybe Lexapro will moderate that, but I had depression with mild anxiety and being on Wellbutrin ended up with me so agoraphobic I couldn't leave my house for 6 months. (Totally out of the blue, I am not a recluse or anything close to it.)
I also vote for #2 and maybe look in to alternative medications if that doesn't work.
posted by ananci at 8:39 PM on March 6, 2016 [1 favorite]
I also vote for #2 and maybe look in to alternative medications if that doesn't work.
posted by ananci at 8:39 PM on March 6, 2016 [1 favorite]
I had the same side effects when I tried Lexapro (albeit worse, or I hated them more than you do), as well as the amazing effect on my anxiety. I felt zero anxiety, but I couldn't function. I couldn't tolerate the side effects. After adjusting the dose and time I took the Lexapro without any change in side effects, what worked for me was to switch to a different medication entirely (Zoloft). The downside was that, whereas with Lexapro I felt "cured" of my anxiety, with Zoloft I felt like I could see it coming and relate to it differently. It works well for me, it just doesn't feel as miraculous as the Lexapro. A subsequent doctor had me try Lexapro again, and even a small dose knocked me out and erased my motivation.
I'm not saying you must try a different drug. Maybe you want to keep trying to get the right balance with Lexapro. This was my experience, and yours may well be different. However, I'm surprised that there isn't an option #4, to try a different medication entirely, one with a different set of side effects that might be more tolerable.
posted by Meg_Murry at 8:55 PM on March 6, 2016
I'm not saying you must try a different drug. Maybe you want to keep trying to get the right balance with Lexapro. This was my experience, and yours may well be different. However, I'm surprised that there isn't an option #4, to try a different medication entirely, one with a different set of side effects that might be more tolerable.
posted by Meg_Murry at 8:55 PM on March 6, 2016
I have done both #2 and #3 in my past. Ultimately what works best is keeping the full dose of Lexapro and taking 300mg of Wellbutrin which has eliminated the fatigue issue. Maybe it has helped the motivation issue as well, but I can't say for certain.
You might want to start with an entry-level dose of Wellbutrin and see how it works for you. If you don't like it, try another option. If it works out well, up yourself to a full dose. Basically Wellbutrin has eliminated any negative aspects of Lexapro that made me dislike the drug and Wellbutrin itself doesn't seem to have any other side effects for me and blunts the side effects of Lexapro.
posted by bright colored sock puppet at 8:59 PM on March 6, 2016
You might want to start with an entry-level dose of Wellbutrin and see how it works for you. If you don't like it, try another option. If it works out well, up yourself to a full dose. Basically Wellbutrin has eliminated any negative aspects of Lexapro that made me dislike the drug and Wellbutrin itself doesn't seem to have any other side effects for me and blunts the side effects of Lexapro.
posted by bright colored sock puppet at 8:59 PM on March 6, 2016
Personally, here's what I'd do:
#2
-> If that works, super!
-> If not, determine why not.
----> If it's because your anxiety is back to non-manageable levels, titrate back to your current dose of Lexapro, then try #3.
----> If it's because you're still not motivated but your anxiety is manageable, stay at the smaller dose of Lexapro and try #3.
--> If either of those work, super!
--> If not, as Meg_Murry said above, try #4, a new drug entirely.
(I'd do #2 before #3 because that's the simplest thing - you're adjusting the dose of a drug you're already taking, that you know works, with known side effects, rather than adding in a new drug that's an unknown. I'd do #3 before #4 for the same reason. I think in this situation, it might be best to adjust what you already have first, add second, switch third.)
I spent about two years feeling like a lab rat while the OCD department at a nearby university ran me through the gamut of different meds, different dosages, etc. One of the meds was Lexapro, and it definitely did not work for me, but for different reasons (I actually had increased anxiety on it, I think). Lots of other meds didn't either. Prozac did, at a specific dose.
The takeaway for me (besides a med that works, of course) was that it's totally worth it to deal with adjustments and annoying side effects to find the right drug and right dose for you, which includes managing your side effects so they're not getting in the way of what you need to do.
Personally, I'd take option #1 off the table for now. If it were a case of "eh, it's kind of annoying to be sleepy in the morning," then maybe it wouldn't be worth messing with. Since it's a case where you're talking to your doctor about your side effects, it's probably worth messing with.
After a while of trying different meds, it became very clear for me at what points I was willing to try new doses and meds and deal with possible side effects for the hope of a better mix and fewer side effects, and at what point I was ready to stop adjusting and deal with the few side effects I still have because they were better than many of the other alternatives.
As a side note, make sure you are clear (maybe get your doctor to write it down for you) on how fast you should titrate up or down, when you should add the new drug, etc. It can be easy to feel like "oh, this med is awful, I can't deal with this" when really the initial side effects are more a function of titration and titration speed, etc., and may change radically when you get to a proper dose. It's super frustrating, but a lot of the time you have to just hang in there for awhile (or as long as you can stand) and see if things ease up. It seems to me that it's especially true if you're adjusting multiple things (like dose and drug) within the same one-to-two-month window.
Hang in there and good luck!
posted by bananacabana at 9:45 PM on March 6, 2016
#2
-> If that works, super!
-> If not, determine why not.
----> If it's because your anxiety is back to non-manageable levels, titrate back to your current dose of Lexapro, then try #3.
----> If it's because you're still not motivated but your anxiety is manageable, stay at the smaller dose of Lexapro and try #3.
--> If either of those work, super!
--> If not, as Meg_Murry said above, try #4, a new drug entirely.
(I'd do #2 before #3 because that's the simplest thing - you're adjusting the dose of a drug you're already taking, that you know works, with known side effects, rather than adding in a new drug that's an unknown. I'd do #3 before #4 for the same reason. I think in this situation, it might be best to adjust what you already have first, add second, switch third.)
I spent about two years feeling like a lab rat while the OCD department at a nearby university ran me through the gamut of different meds, different dosages, etc. One of the meds was Lexapro, and it definitely did not work for me, but for different reasons (I actually had increased anxiety on it, I think). Lots of other meds didn't either. Prozac did, at a specific dose.
The takeaway for me (besides a med that works, of course) was that it's totally worth it to deal with adjustments and annoying side effects to find the right drug and right dose for you, which includes managing your side effects so they're not getting in the way of what you need to do.
Personally, I'd take option #1 off the table for now. If it were a case of "eh, it's kind of annoying to be sleepy in the morning," then maybe it wouldn't be worth messing with. Since it's a case where you're talking to your doctor about your side effects, it's probably worth messing with.
After a while of trying different meds, it became very clear for me at what points I was willing to try new doses and meds and deal with possible side effects for the hope of a better mix and fewer side effects, and at what point I was ready to stop adjusting and deal with the few side effects I still have because they were better than many of the other alternatives.
As a side note, make sure you are clear (maybe get your doctor to write it down for you) on how fast you should titrate up or down, when you should add the new drug, etc. It can be easy to feel like "oh, this med is awful, I can't deal with this" when really the initial side effects are more a function of titration and titration speed, etc., and may change radically when you get to a proper dose. It's super frustrating, but a lot of the time you have to just hang in there for awhile (or as long as you can stand) and see if things ease up. It seems to me that it's especially true if you're adjusting multiple things (like dose and drug) within the same one-to-two-month window.
Hang in there and good luck!
posted by bananacabana at 9:45 PM on March 6, 2016
I also vote for number 2, and if number 2 doesn't work, as suggested above, I would go with option 4, try a different SSRI. Have you taken any other SSRIs or psych meds aside from Lexapro? As dancing leaves mentions, you may want to look into exploring sleep disorders.
FWIW, I took Wellbutrin for roughly 3-4 years. I took Celexa (similar to Lexapro) for the first 5 months, then switched to Lamictal. Although Wellbutrin definitely helped me with motivation, focus, and energy, it also pushed my anxiety levels through the roof. Anxiety wasn't even the thing I was being treated for; I would say that I'm prone to situational anxiety and am kind of a high strung person, but I was a never ending ball of anxiety on Wellbutrin. The only reason I took it for so long was that I really benefited from the other effects. I was taking 300 mg XL; I did try cutting down, but when I went down to a low enough dose to relieve the anxiety (150 mg XL), I lost the positive benefits. (Ultimately I ended up getting diagnosed with ADHD, went off Wellbutrin, got on a stimulant which bizarrely decreases my anxiety rather than amplifying it.)
It sounds like we have different diagnoses, and I do know SSRI + Wellbutrin is a pretty popular combo so I'm not intending to scare you off of Wellbutrin. This is just one personal anecdote; as they say, the plural of anecdote isn't data. I also should add that aside from the anxiety, I didn't have any noticeable side effects from the Wellbutrin. The Lexapro + Wellbutrin combo would be enough to keep your anxiety under control. I just wanted to share my personal experience in case it helps you as you weigh your options.
tl;dr: I would start with #2, then consider trying out a different SSRI if #2 fails. If both those options don't work, then I would give the Wellbutrin a shot, just be aware of the potential for increased anxiety.
Good luck! I know the trial and error of psych meds can be very frustrating.
posted by litera scripta manet at 6:21 AM on March 7, 2016
FWIW, I took Wellbutrin for roughly 3-4 years. I took Celexa (similar to Lexapro) for the first 5 months, then switched to Lamictal. Although Wellbutrin definitely helped me with motivation, focus, and energy, it also pushed my anxiety levels through the roof. Anxiety wasn't even the thing I was being treated for; I would say that I'm prone to situational anxiety and am kind of a high strung person, but I was a never ending ball of anxiety on Wellbutrin. The only reason I took it for so long was that I really benefited from the other effects. I was taking 300 mg XL; I did try cutting down, but when I went down to a low enough dose to relieve the anxiety (150 mg XL), I lost the positive benefits. (Ultimately I ended up getting diagnosed with ADHD, went off Wellbutrin, got on a stimulant which bizarrely decreases my anxiety rather than amplifying it.)
It sounds like we have different diagnoses, and I do know SSRI + Wellbutrin is a pretty popular combo so I'm not intending to scare you off of Wellbutrin. This is just one personal anecdote; as they say, the plural of anecdote isn't data. I also should add that aside from the anxiety, I didn't have any noticeable side effects from the Wellbutrin. The Lexapro + Wellbutrin combo would be enough to keep your anxiety under control. I just wanted to share my personal experience in case it helps you as you weigh your options.
tl;dr: I would start with #2, then consider trying out a different SSRI if #2 fails. If both those options don't work, then I would give the Wellbutrin a shot, just be aware of the potential for increased anxiety.
Good luck! I know the trial and error of psych meds can be very frustrating.
posted by litera scripta manet at 6:21 AM on March 7, 2016
Oh, one other thing: Have you tried experimenting with the time of day you take the lexapro? It's probably a long shot, but if you take it in the morning, maybe try taking it at night, or vice versa.
And I forgot to add: IANAD, IANYD, YMMV; I'm just a psych patient who has taken my share of psych meds.
posted by litera scripta manet at 6:23 AM on March 7, 2016
And I forgot to add: IANAD, IANYD, YMMV; I'm just a psych patient who has taken my share of psych meds.
posted by litera scripta manet at 6:23 AM on March 7, 2016
I don't have a specific recommendation, but I'll share my experience with option 2. I was on 5 mg Lexapro for two years, and had similar issues. Before decreasing my dosage, I tried changing the time of day I took the pill and changing some of my life workflows to deal with the motivation issue (more lists, automate whatever I could, etc.) but those things didn't cut it. My biggest problems were weight gain, spending too much money, and sleeping in as often as I could. I missed more work than I should have due to the combination of fatigue and not caring enough to be responsible. I could sleep 14 hours or more on days I didn't have to work.
I tried quitting cold turkey (BAD IDEA!) because I was fed up with the situation and was so laid back I didn't care about all the good internet advice to not quit cold turkey. I spent a week feeling miserable and really dizzy, in addition to having what they call brain zaps, so I went back on the full dose, stabilized, then talked to my doctor. He suggested a few options, including changing meds, adding another med to the list, or cutting the dose. I chose to cut the dose, and it's been working pretty well for me. I'm still a little anxious and still a little too careless about what I eat, what I spend, and how much I sleep, but it's a workable balance for me. I can't believe 2.5 mg is enough to do anything, but I still get dizzy if I forget to take it, so it must be doing something.
Those two years on the full dose were wonderful in terms of getting me back out into the world, but I'm glad I cut back. I'm still working to rebuild my savings account, lose weight, and get out of the sleep-too-much habit (because it's more habit now than response to fatigue.) I'm also putting more effort into taking care of my anxiety (diet, exercise, occasionally pushing myself to do something difficult just for the experience) which was something I didn't care enough to do while on the full dose (but also didn't really need to do, I guess.) That said, if I feel the anxiety getting out of control again, I will look into one of the other options.
Whatever you do, please continue working with your doctor, as long as she listens to you and understands that you know your body and life better than she does. Good luck, and feel free to memail me if you want to chat more.
posted by ruemonkey at 11:41 AM on March 7, 2016
I tried quitting cold turkey (BAD IDEA!) because I was fed up with the situation and was so laid back I didn't care about all the good internet advice to not quit cold turkey. I spent a week feeling miserable and really dizzy, in addition to having what they call brain zaps, so I went back on the full dose, stabilized, then talked to my doctor. He suggested a few options, including changing meds, adding another med to the list, or cutting the dose. I chose to cut the dose, and it's been working pretty well for me. I'm still a little anxious and still a little too careless about what I eat, what I spend, and how much I sleep, but it's a workable balance for me. I can't believe 2.5 mg is enough to do anything, but I still get dizzy if I forget to take it, so it must be doing something.
Those two years on the full dose were wonderful in terms of getting me back out into the world, but I'm glad I cut back. I'm still working to rebuild my savings account, lose weight, and get out of the sleep-too-much habit (because it's more habit now than response to fatigue.) I'm also putting more effort into taking care of my anxiety (diet, exercise, occasionally pushing myself to do something difficult just for the experience) which was something I didn't care enough to do while on the full dose (but also didn't really need to do, I guess.) That said, if I feel the anxiety getting out of control again, I will look into one of the other options.
Whatever you do, please continue working with your doctor, as long as she listens to you and understands that you know your body and life better than she does. Good luck, and feel free to memail me if you want to chat more.
posted by ruemonkey at 11:41 AM on March 7, 2016
I just rode the Lexapro roller coaster for 8 months. The side effects for me, were awful. I stuck it out as long as I could, but eventually the medicine seemed to stop working for me. I have dysthymia and anxiety, so Wellbutrin wasn't an option for me.
Have you tried any other SSRIs? When I was on Zoloft, I only had the sexual side effects (not great, but preferable to sleeping ALL THE TIME and a headache and crushing migraines ALL THE TIME). Maybe something different might work? I failed two SSRIs, so I switched to a tricyclic, and I'm doing SO MUCH BETTER with my therapy sessions and time management and mood and sleep cycle that I feel like I'm out of the tunnel and I'm going to discuss stopping the Elavil soon.
One last thing, if you decide to change dosages or medications, be aware of the withdrawals of Lexapro. It affects everyone differently, but I had rage issues, dreams that were more violent than normal, and suicidal ideation. It was almost as bad as before I had even taken the damn drug in the first place. After about 3 weeks, however, I felt amazing! Like a new person!
Just make sure to have your GP/psych/counselor work with you regarding whichever path you decide is right for you. Good luck!
posted by sara is disenchanted at 4:39 PM on March 7, 2016
Have you tried any other SSRIs? When I was on Zoloft, I only had the sexual side effects (not great, but preferable to sleeping ALL THE TIME and a headache and crushing migraines ALL THE TIME). Maybe something different might work? I failed two SSRIs, so I switched to a tricyclic, and I'm doing SO MUCH BETTER with my therapy sessions and time management and mood and sleep cycle that I feel like I'm out of the tunnel and I'm going to discuss stopping the Elavil soon.
One last thing, if you decide to change dosages or medications, be aware of the withdrawals of Lexapro. It affects everyone differently, but I had rage issues, dreams that were more violent than normal, and suicidal ideation. It was almost as bad as before I had even taken the damn drug in the first place. After about 3 weeks, however, I felt amazing! Like a new person!
Just make sure to have your GP/psych/counselor work with you regarding whichever path you decide is right for you. Good luck!
posted by sara is disenchanted at 4:39 PM on March 7, 2016
I have supplemented Lexapro with Wellbutrin for the exact same issues: the combo works fabulously. I feel much more awake now.
posted by Dressed to Kill at 11:09 AM on March 8, 2016
posted by Dressed to Kill at 11:09 AM on March 8, 2016
« Older Help me fill in the gaps in my photography setup | My mom found my brother's adderall tablets Newer »
This thread is closed to new comments.
Can you switch the time you take the drug to experiment with drowsiness?
Anyway, I vote for 2 as well. Have you tried some cbt to help you manage your feeling I parallel with the drug? It may be just as good without the side effects....
posted by Kalmya at 8:29 PM on March 6, 2016 [1 favorite]