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Lexapro or any SSRI long term and on/off.


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10 years, been on and off Lexapro. Well, generic.  For health anxiety.  Ya me, I'm always dying of something.

Anyways,  I know the start up side effects and the withdrawl side effects.  Been there, done that, have a shit ton of t-shirts.  Anyone ever have NEW standing side effects from the same medication.  For example I never really had the sexual side effects of Lex, but this newest restart of the medication (4 months ago) has me having trouble reaching the big O.  Never had that before.  I feel like a few other side effects that usually go away are sticking around.  Anyone experience this.

What about vision issues?  Obviously, because Health Anxiety is my flavor of crazy, I am overly sensitive to symptoms.  However, I've had some vision issues on and off for years and I'm starting to wonder if it's from the Lexapro.  I get blurry vision on the TV at night or like digital clocks, but have 20/15 vision, perfect eye sight.  I have this odd permanent visual aura in my peripheral, very faint and mild but it's always there.  Light sensitivity, I also have a bit of ear ringing and get a little dizzy and heat intolerant often.  I'm racking my brain thinking this is something totally different, but maybe it's just the Lex?  I am only on 10mg, a low dose so I would think after months of being on it these symptoms would go away.

What long term side effects do you get from your SSRI/SRNI?

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Is it typical to have been on and of the same SSRI for years and get different side effects?

Also, the biggest concern for me is the faint persistant visual aura.  I know the side effects say visual disturbances, but it's not specific.  Could this be caused from the medication?

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2 hours ago, juliehypo said:

Is it typical to have been on and of the same SSRI for years and get different side effects?

Is it possible that your generic manufacturer was changed by the pharmacy between the times you went back on the Lexapro?

If you are concerned about the visual problem, I think it's worth a trip to the eye doctor.

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Yes, the generic manufacturer is different.  I didn't realize that would matter much!  I've never been on brand Lexapro, but would be willing to pay the extra if it is more consistent.  I use mail order now which makes the pills free, yay, but it's def. a different manufacter.  I don't remember the name of the old one, but I noticed it was different.  Hmmm

I've been to the eye doctor, my eyes are fine.  Which makes me worry it's more brain related.  Kind of like migraines.  I need to go talk to a neurologist, but I've been putting it off.  I didn't realize the difference in generics would make much difference at all.  Hmmm  Could I expect less side effects with Brand name or do I need to try to hunt down my old generic?

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Some people are sensitive to changes in the generic manufacturer. Certain meds like Lamictal are more notorious than others, but it can happen with any med. I'm experiencing a problem with citalopram (Celexa) at the moment. I think the generic that I have now is less effective because I keep getting symptoms of SSRI withdrawal.

All generics are supposed to be bioequivalent to the original med, but they are usually not subjected to follow-up testing. If you are getting more side effects, it would suggest to me (and I'm not a doctor) that you are getting more of the med in your bloodstream than with the older generic. That is just a shot in the dark and I can't prove anything. I do know that eventually these side effects will subside. 

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while I don't have much to contribute here, I can say that this medication in particular (I took Cipralex for a few months) did give me persistent ringing in the ears. I already suffer greatly from tinnitus, but the SSRI seemed to make it worse.

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On 6/20/2016 at 9:25 PM, juliehypo said:

10 years, been on and off Lexapro. Well, generic.  For health anxiety.  Ya me, I'm always dying of something.

Anyways,  I know the start up side effects and the withdrawl side effects.  Been there, done that, have a shit ton of t-shirts.  Anyone ever have NEW standing side effects from the same medication.  For example I never really had the sexual side effects of Lex, but this newest restart of the medication (4 months ago) has me having trouble reaching the big O.  Never had that before.  I feel like a few other side effects that usually go away are sticking around.  Anyone experience this.

What about vision issues?  Obviously, because Health Anxiety is my flavor of crazy, I am overly sensitive to symptoms.  However, I've had some vision issues on and off for years and I'm starting to wonder if it's from the Lexapro.  I get blurry vision on the TV at night or like digital clocks, but have 20/15 vision, perfect eye sight.  I have this odd permanent visual aura in my peripheral, very faint and mild but it's always there.  Light sensitivity, I also have a bit of ear ringing and get a little dizzy and heat intolerant often.  I'm racking my brain thinking this is something totally different, but maybe it's just the Lex?  I am only on 10mg, a low dose so I would think after months of being on it these symptoms would go away.

What long term side effects do you get from your SSRI/SRNI?

It would depend on how long you were off of Lexapro, but the reason for these new side effects could be because after quitting the last time, for some reason, your 5-HT2A and 5-HT2C receptors just upregulated like a wildfire, and have a higher density of those receptors this time around than when starting it the last few times, so when you start it, and the serotonin begins to raise, indiscriminately stimulating all serotonin receptors, perhaps the stimulation of the excessive 5-HT2A and/or 5-HT2C receptors could be contributing to your new, troublesome sexual side effects.

As for the vision issues, I was going to say perhaps you just so happen to be developing an astigmatism and/or slight myopia, but then when I read you describe a permanent visual aura in your peripheral, that kinda made the astigmatism/myopia possibility seem less likely. The only thing I can remotely think of that would do  that could be a retinal detachment, but you're not predisposed for that since you're not really nearsighted, or nearsighted at all (lucky! :P you and your 20/15 vision...). But just a quick Google search shows that "blurred vision" and "abnormal vision" are listed as "uncommon side effects (0.1% to 1%)." It's not very anticholinergic-y at all, so it couldn't be that.

20 hours ago, juliehypo said:

I've been to the eye doctor, my eyes are fine.  Which makes me worry it's more brain related.  Kind of like migraines.  I need to go talk to a neurologist, but I've been putting it off.  I didn't realize the difference in generics would make much difference at all.

That is really concerning. 

If you don't mind, I have some questions about the aura. Would you mind answering them?

  • Does it move around or stay in one place?
    • If it moves, does it depend on your eye's movement or any bodily movement in general? 
  • What shape is it?
  • How much of your periphery does it cover?
    • How far over into the front of your vision does it cover?
  • What color or colors is it?
    • Do(es) the color(s) change? 
  • Is it opaque, translucent, or transparent?
  • If you try to "look over at it," does it disappear?
  • Is it in one eye or both?
    • If in both eyes, does it cover the same proportion of your vision per eye, or different in each eye?
    • Are they the same shape in each eye?
    • Same color in each eye?

One last possibility, which I'm really reaching in the dark for this one, is it may be the result of increased 5-HT2A receptor activation by serotonin (psychedelics' actions are mediated through this receptor with serotonin), and very well may be a benign, visual hallucination that will resolve itself once your 5-HT2A receptors are downregulated enough (takes about 4-6 weeks I believe for most people, or sooner if you've more recently been on a serotonergic antidepressant).

It is not my intention to tell you how you ought to take your medicines, so please don't take this like that—just offering some possibly helpful suggestions.  

  • One thing you could try is cut the 10 mg dose in half for 5 mg for a little while and see how and/or if that fixes things. Maybe that's all you need for now, and maybe later if you need, you can move back up to 10 mg.
  • Another option would be to try a 5-HT2A antagonist.
    • This could be an antidepressant, like an SARI like trazodone (which you could take at night for sleep) or nefazodone (as an augmenter for Lexapro, 5-HT2A antagonism more potent than trazodone's—Ki = 8.6 nM NFD vs Ki = 35.8 nM TZD), the tetracyclic antidepressant amoxapine (mostly a NRI with "built-in" atypical antipsychotic properties, including potent 5-HT2A antagonism (Ki = 0.5 nM) and mild D2 antagonism (Ki = 20.8 nM), the TCA nortriptyline (which has pretty decent 5-HT2A antagonism (Ki = 5 nM) too), trimipramine (5-HT2A Ki = 19.5 nM), or protriptyline (5-HT2A Ki = 26 nM).
    • Or this could be an atypical antipsychotic, preferably with a larger ratio of 5-HT2A-to-D2 antagonism to reduce the possibility of extrapyramidal side effects like tremor or akathisia, or even tardive dyskinesia, and one that doesn't antagonize the M3 muscarinic receptor, like Zyprexa, which is thought to be one of the diabetogenic mechanisms of action of this medicine. AAP's of choice (with 5-HT2A:D2 ratio) would be Saphris (21.667:1), I hate to mention it because of its bad side effects, but Zyprexa (14.69:1), Geodon (6.667:1), Clozaril (47.1:1) (only for treatment resistant cases though), Seroquel (1.0779:1 with its major metabolite, norquetiapine having a ratio of 4.08333:1), Fanapt (1.125:1), Risperdal (10.187:1), and Invega (4.947:1). There is also a typical antipsychotic that is sometimes described as an atypical antipsychotic for its binding properties, which is Loxitane (2.283:1).
      • Low doses of all of these agents can be used specifically to antagonize the 5-HT2A (and 5-HT2C) and thereby reduce some of the negative side effects from SSRIs, without employing too much D2 antagonism, since you're not using it for bipolar mania or schizophrenia.
  • The antihistamine/anticholinergic drug cyproheptadine is a potent 5-HT2A antagonist (Ki = 1.67 nM) and 5-HT2C antagonist (Ki = 2.23 nM), beware of this med as it will stimulate your appetite and possibly make you gain weight, much like Remeron.

I hope this is of some help. You don't have to answer all those questions about the aura, but I am really quite curious about it. I'd like to know more if possible. I hope you get relief as soon as possible!

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  • 2 months later...
On 6/22/2016 at 11:23 AM, mikrw33 said:

 

If you don't mind, I have some questions about the aura. Would you mind answering them?

  • Does it move around or stay in one place?
    • If it moves, does it depend on your eye's movement or any bodily movement in general? 
  • What shape is it?
  • How much of your periphery does it cover?
    • How far over into the front of your vision does it cover?
  • What color or colors is it?
    • Do(es) the color(s) change? 
  • Is it opaque, translucent, or transparent?
  • If you try to "look over at it," does it disappear?
  • Is it in one eye or both?
    • If in both eyes, does it cover the same proportion of your vision per eye, or different in each eye?
    • Are they the same shape in each eye?
    • Same color in each eye?

One last possibility, which I'm really reaching in the dark for this one, is it may be the result of increased 5-HT2A receptor activation by serotonin (psychedelics' actions are mediated through this receptor with serotonin), and very well may be a benign, visual hallucination that will resolve itself once your 5-HT2A receptors are downregulated enough (takes about 4-6 weeks I believe for most people, or sooner if you've more recently been on a serotonergic antidepressant).

It is not my intention to tell you how you ought to take your medicines, so please don't take this like that—just offering some possibly helpful suggestions.  

  • One thing you could try is cut the 10 mg dose in half for 5 mg for a little while and see how and/or if that fixes things. Maybe that's all you need for now, and maybe later if you need, you can move back up to 10 mg.
  • Another option would be to try a 5-HT2A antagonist.
    • This could be an antidepressant, like an SARI like trazodone (which you could take at night for sleep) or nefazodone (as an augmenter for Lexapro, 5-HT2A antagonism more potent than trazodone's—Ki = 8.6 nM NFD vs Ki = 35.8 nM TZD), the tetracyclic antidepressant amoxapine (mostly a NRI with "built-in" atypical antipsychotic properties, including potent 5-HT2A antagonism (Ki = 0.5 nM) and mild D2 antagonism (Ki = 20.8 nM), the TCA nortriptyline (which has pretty decent 5-HT2A antagonism (Ki = 5 nM) too), trimipramine (5-HT2A Ki = 19.5 nM), or protriptyline (5-HT2A Ki = 26 nM).
    • Or this could be an atypical antipsychotic, preferably with a larger ratio of 5-HT2A-to-D2 antagonism to reduce the possibility of extrapyramidal side effects like tremor or akathisia, or even tardive dyskinesia, and one that doesn't antagonize the M3 muscarinic receptor, like Zyprexa, which is thought to be one of the diabetogenic mechanisms of action of this medicine. AAP's of choice (with 5-HT2A:D2 ratio) would be Saphris (21.667:1), I hate to mention it because of its bad side effects, but Zyprexa (14.69:1), Geodon (6.667:1), Clozaril (47.1:1) (only for treatment resistant cases though), Seroquel (1.0779:1 with its major metabolite, norquetiapine having a ratio of 4.08333:1), Fanapt (1.125:1), Risperdal (10.187:1), and Invega (4.947:1). There is also a typical antipsychotic that is sometimes described as an atypical antipsychotic for its binding properties, which is Loxitane (2.283:1).
      • Low doses of all of these agents can be used specifically to antagonize the 5-HT2A (and 5-HT2C) and thereby reduce some of the negative side effects from SSRIs, without employing too much D2 antagonism, since you're not using it for bipolar mania or schizophrenia.
  • The antihistamine/anticholinergic drug cyproheptadine is a potent 5-HT2A antagonist (Ki = 1.67 nM) and 5-HT2C antagonist (Ki = 2.23 nM), beware of this med as it will stimulate your appetite and possibly make you gain weight, much like Remeron.

I hope this is of some help. You don't have to answer all those questions about the aura, but I am really quite curious about it. I'd like to know more if possible. I hope you get relief as soon as possible!

I'm sorry it's taken me so long to respond, I didn't get an email that I had another reply to this post.  So since I posted, I've actually began to slowly wean off Lexapro.  I've been to a bunch of CBT therapy and it's help a ton.  I am currently on 5mg and doing find so far.  Weaning very slow as we all know going off SSRI's is like death if you're not careful and slow.

To answer your questions about the persistant aura...  I do have a nueroopthalmologist appointment in November.  It keeps getting rescheduled, so maybe someday I'll actually get to visit her.

 

  • Does it move around or stay in one place?
    • No, it does not move around.  It is mainly in the peripheral to my right, though it is minorly in my lower peripheral and left, but I have to really look for it at those locations.
  • What shape is it?
    • It is like a fan spinning.  But you only see the top half of the fan.  The blades are white and spin counter clockwise, in a bit of a strobing effect.  Do you have migraines with auras by any chance?  It is a similiar, but very different at the same time.
  • How much of your periphery does it cover?
    • I would say it is in about 30% of my right sided peripheral and only 10 percent in my lower and left peripheral.
    •  
    • What color or colors is it?
    • It is white and black.  No the colors do not change.
    • Do(es) the color(s) change? 
  • Is it opaque, translucent, or transparent?
  • I would say translucent.  I usually catch it out of the corner of my eye when there is a solid surface to my right.  I see the aura, but still see the color of the wall inbetween the 'fan blades.'
  • If you try to "look over at it," does it disappear?
    • Yes, it moves out of my sight if I try to look at it.  I know it is brain related and not vision as it's like my migraines auras in that i can see it eyes opened, closed, one eye or bother eyes.  And it moves with my vision.  You can't look directly at it.
  • Is it in one eye or both?
    • If in both eyes, does it cover the same proportion of your vision per eye, or different in each eye?
      • It appears to be in my eyes, but like I said about its in my brain like a migraine aura, so I see a larger fan blade to my right, but the
    • Are they the same shape in each eye?
      • No, smaller in my left visual field.
    • Same color in each eye?
      • Yes.  both black and white

 

Now here the kicked you may find interesting.  I have having daily neck pain and headaches.  I ended up at a chiropractor.  Around this same time I started to reduce my lexapro.  While the aura is not gone it is not as 'bright' as before, like it's starting to fade.  Could this be related to the neck and spinal adjustments I've been having OR could it be related to reducing the lexapro?  Interesting to say the least.  The only other medical condition I have, if you can call it that, is a pineal cyst measuing 11mm in the center of my brain.  It is causing mild mass effect on my tectal plate.  Most Neuros will tell you these are incidental findings (which mine was) and they rarely cause symptoms.  I know that is not true as I am a member of a facebook group with many others who have serious symptoms and travel to the few doctors in the US who will remove them and they get better.  However, I think it's a stretch to think mine is causing any of this as no one else in that group as an aura, instead it's more like double vision, and upward gaze issues.  But I just wanted to add that here as it's really the only other thing going on in my brain as I'd have numerous MRI's to check on it over the years.

I'm curious to see as I continue to wean off the Lexapro and give my brain time to readjust off meds, how it 'heals' from being on them.  I'm in a good place now, but if I relapse it is time to try a new medication.  10 years on and off one seems to be pooping it out a bit.  I also had that genesight testing done and have a list of some nice options that will supposedly work well with my genes.

I have attached a picture I made to help show my nueroopthamologist what I see.  I'm no artist, but I think you can get the general idea. The yellow represents the part of the fan i actually see.  They show up as white and spin in a strobing fashion.  The other ones do the same thing but are much fainter.  Keep in mind my brain tends to ignore these for the most part while I am busy, I have to stop and really look for them, especially now since it faded a bit.

I like what you said about a  astigmatism, too.   I think I have some corneal something or another going on and it's minor enough the docs don't bother, especially when you have great vision like I do, they just kind of push you along.  I can live with it, but I'm the type of person that wants a reason for it.

 

 

14322589_10153913689893595_4323240208989434085_n.jpg

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For sexual problems you can try not taking your med the day before/of sex, sometime this drops the level down enough to relieve sexual symptoms temporarily without affecting mood. The old antihistamine cyproheptadine has some research behind it and works:                                                               

And then there is wellbutrin. Usually you take a low dose all the time, like 150 mg. It seems to work on several different sexual problems caused by AD's. The is research behind it and some people report it does work.

 

 

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