Guest Guest_unregistered_* Posted January 23, 2007 Share Posted January 23, 2007 So i'm for another ride on the med-go-round, this time with ADs for reactive depression. I don't pick up the script till tomorrow, but from memory, it will be Lexapro AM and Celexa PM. Now seeing as they are mostly the same thing, does anyone have any explanantion? Link to comment Share on other sites More sharing options...
HaloGirl66 Posted January 23, 2007 Share Posted January 23, 2007 Seems strange to me too. Link to comment Share on other sites More sharing options...
Loon-A-TiK Posted January 23, 2007 Share Posted January 23, 2007 i'm not a psychopharm expert, so i'm not going to be able to give you the brain chemical names for these things, however, i'll try to answer. cymbalta is a multiple reuptake inhibitor, whereas lexapro is a selective seratonin reuptake inhibitor. i don't think cymbalta works on seratonin. i could very, very easily be wrong about this. however, i think it works on the other ones. your pdoc may want to cover the full spectrum to make sure that everything possible is addressed. Link to comment Share on other sites More sharing options...
lemonflavor Posted January 23, 2007 Share Posted January 23, 2007 cymbalta is a multiple reuptake inhibitor, whereas lexapro is a selective seratonin reuptake inhibitor. i don't think cymbalta works on seratonin. i could very, very easily be wrong about this. however, i think it works on the other ones. your pdoc may want to cover the full spectrum to make sure that everything possible is addressed. She mentioned celexa as opposed to cymbalta you silly goose. (smiley would here if I was smiley) This is strange because Lexapro is the new and improved celexa and is very similar. celexa is available generic but that's not really an issue. Are you sure it's celexa? If so maybe the doc has something in mind and wants to cover all the bases with that drug. BTW Cymbalta is like the next generation Effexor which does affect serotonin along with norepinephrine and possibly a little dopamine. Link to comment Share on other sites More sharing options...
null0trooper Posted January 24, 2007 Share Posted January 24, 2007 BTW Cymbalta is like the next generation Effexor which does affect serotonin along with norepinephrine and possibly a little dopamine. Effexor is primarily a serotonin reuptake inhibitor until the dose is ramped up to around 225 mg, when the noradrenaline reuptake inhibition kicks in. I don't recall what plateau dopamine reuptake inhibition is supposed to start becoming noticeable, but DA can hitch a ride on the NA transporter so YMWV. I'd guess that if you can't handle Effexor above 150 mg, you're probably better off with an SSRI. I'm fairly certain that Cymbalta inhibits reuptake of both serotonin and noradrenaline throughout the normal dosing range, as does Milnacipran. From what little I've dug up about the relative affinities of either one, both have a greater effect on serotonin than NA (but if NA-driven anxiety is a problem, the NA effects may be far more apparent). Celexa and Lexapro are basically the same chemical, complex enough to have two mirror-image forms even with the same basic atoms-stuck-together-with-sticks structure. Apparently one of the two forms provides more AD effect with less side-effects, so the parent company figured out how to separate the two from the production stream (not as easy as it sounds) and markets that as Lexapro. I can actually think of a good reason to prescribe the two separately - sometimes an insurance company decides that a medication at a given dose/formulation is 1/day, period, who cares what the patient needs! So you prescribe a second med that does the same thing, and try to balance the two out. Instead of 2 oranges twice a day (which isn't on the formulary, and therefor verboten) you prescribe 2 oranges in the AM, 2 tangelos in the PM, and still get 4 fruits' worth of Vitamin C in by the end of the day. Link to comment Share on other sites More sharing options...
Libby Posted January 24, 2007 Share Posted January 24, 2007 I'm guessing that a GP prescribed this, not a psychiatrist. I think they're too similar to be prescribed together. Link to comment Share on other sites More sharing options...
Unregistered Posted January 24, 2007 Share Posted January 24, 2007 OK, so I heard wrong. I'm now on citalopram hydrobromide (Celexa?) AM and trimipramine (Surmontil/Rhotrimine) PM. Anyone got any experience of trimipramine? Crazymeds has nothing. Link to comment Share on other sites More sharing options...
Spanophile Posted January 24, 2007 Share Posted January 24, 2007 I think Surmontil is a tricyclic, but I could be wrong. Link to comment Share on other sites More sharing options...
Unregistered Posted January 24, 2007 Share Posted January 24, 2007 I think Surmontil is a tricyclic, but I could be wrong. Yeah, it is but aside from the generic TCA crap I can't find out a thing. Just trying to find out what to expect. Link to comment Share on other sites More sharing options...
null0trooper Posted January 24, 2007 Share Posted January 24, 2007 I think Surmontil is a tricyclic, but I could be wrong. Yeah, it is but aside from the generic TCA crap I can't find out a thing. Just trying to find out what to expect. If SSRIs are a silver bullet, TCAs are a shotgun shell with a random load of shot. The stuff goes everywhere. It is used in treating peptic ulcers, but the effect does not appear related to an antihistamine (H2) action (PubMed abstract), although it is supposed to have some antihistamine effect (usually assumed for all TCAs, but the reality is that the effect ranges from "gee, I'm a little zoned" to ) Trimipramine may not knock you out but it has been found to reduce sleep quality (abstract) via H1 antagonism. Interestingly, Wikipedia notes no effect on sleep architecture (Wiki article) There's a bit more action on noradrenaline than serotonin reuptake, so there may not be as much anti-sex, anti-motivation, effects as a doubled SSRI dose might land you. From some of the references I see, there might be some anti-psychotic effect too. Maybe not as good as a standard AP/AAP, but enough for milder wierdness in the course of depression. That might put it in the category of "It won't make you feel good, but you won't severely depressed either." Link to comment Share on other sites More sharing options...
Unregistered Posted January 24, 2007 Share Posted January 24, 2007 Thanks for that - fascinating stuff. Zzzzzz is good because I've been running on 1-3 hours sleep a night for two weeks or more. The celexa is supposed to be doing the anti-d bit (big time reactive depression right now), but I took the first dose mid morning and I feel like I was hit by a truck. Link to comment Share on other sites More sharing options...
Guest me Posted January 28, 2007 Share Posted January 28, 2007 Celexa and Lexapro are basically the same chemical, complex enough to have two mirror-image forms even with the same basic atoms-stuck-together-with-sticks structure. Apparently one of the two forms provides more AD effect with less side-effects, so the parent company figured out how to separate the two from the production stream (not as easy as it sounds) and markets that as Lexapro. My understanding is that they figured this out JUST before the patent ran out... lucky them. FWIW, I found the ghetto Celexa to be more effective than the Lexapro... but maybe I should give Lex another shot. Do you sometimes get the same euphoria from lex? And how the hell do you get rid of the sexual side effects... not that I'm getting any, but... Link to comment Share on other sites More sharing options...
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