Wellbutrin SR and Lexapro dosage increased

[CrazyRedhead]

I had the first appointment with a new pdoc yesterday   (I had to change docs because my pdoc of 5 years moved away)........Right away my new doc prescribed me increased doses of Wellbutrin SR and Lexapro.

He increased my WB from 300mg to 400mg, and increased my Lexapro from 20mg to 30mg. (I thought max dose of Lexapro was 20mg?)

He explained to me that higher doses of anti-depressants are needed in order to treat OCD.

I told him I was nervous about increasing the WB because of my anxiety issues.......But he said we'll try it and see what happens....

I'm supposed to fill the new scripts tomorrow, and start the increased dosages........I have no idea what to expect.......Does anyone think his plan makes any sense at all?

[notloki]

People with OCD have found they need higher doses of an AD, like prozac at 60 mg, to control symptoms. Often this dose is higher than the max. suggested dose. This is standard treatment and no cause for alarm.

[CrazyRedhead]

Thanks, @notloki.....!!

[browri]

Yeah, and I've seen Prozac get prescribed up to 80mg before. With Lexapro though, the real concern with a 30mg dose is prolonged QT interval, which could be very pronounced at that dose. You would simply be prone to fainting if startled like if someone were to creep up behind you and scare you. There are other symptoms though and it can be serious so just be mindful.

However, what your pdoc is saying falls in line pretty much with what I read. OCD requires a lot more kick than depression does.

[CrazyRedhead]

15 hours ago, browri said:

With Lexapro though, the real concern with a 30mg dose is prolonged QT interval, which could be very pronounced at that dose. You would simply be prone to fainting if startled like if someone were to creep up behind you and scare you. There are other symptoms though and it can be serious so just be mindful.

Now I'm scared a bit--my new doc did not tell me about this......Should I have an ECG done after I've been on the 30mg Lexapro for awhile?........Other than fainting, what other serious symptoms should I look out for?.........

My former pdoc put me on Lexapro last year, and I was taking 20mg for almost a year with no problems..

Edited April 24, 2018 by CrazyRedhead

[browri]

From the research that I've done, the major symptoms are:

1. Unexplained fainting. Usually caused by sudden physical or emotional stress. You may or may not notice your heart fluttering in your chest before this happens.

2. Unexplained drowning or near-drowning. Basically, while you're holding your breath, your heart can't keep up and pump enough oxygen, so you faint underwater.

3. Unexplained SCA (sudden cardiac arrest). Can be very serious, but isn't as common as the other symptoms. In about 1 out of 10 people this is the first sign of the disorder. So less common.

Also, from what I'm reading the heart arrhythmia would likely be more prominent/noticeable while you are asleep which is why it can be a completely silent issue. Obviously you wouldn't be aware of any fluttering in your chest while you are asleep. So doing an ECG while you are asleep could be useful.

https://www.nhlbi.nih.gov/health-topics/long-qt-syndrome

I would also like to point out to you that risperidone prolongs the QT interval as well. Theoretically, taking a dose that high of escitalopram combined with even a normal dose of risperidone could have additive effects. You can run your medications through an interactions checker online and take the results to your doctor so that you have hard evidence off of which to base your concerns.

[CrazyRedhead]

2 hours ago, browri said:

So doing an ECG while you are asleep could be useful.

https://www.nhlbi.nih.gov/health-topics/long-qt-syndrome

I would also like to point out to you that risperidone prolongs the QT interval as well. Theoretically, taking a dose that high of escitalopram combined with even a normal dose of risperidone could have additive effects. You can run your medications through an interactions checker online and take the results to your doctor so that you have hard evidence off of which to base your concerns.

Thanks so much......I guess doing an ECG during sleep would involve a sleep study?.......I've had a sleep study before, so I know what to expect.

I was aware of risperdone and long QT, but because I was taking such a relatively low dose, I wasn't too concerned.

It seems there are quite a few meds that could prolong the QT interval, from what I have read.

Yes, I will definitely do a meds interaction check and print it off for my new doc.....Hopefully he will have an open mind.....I don't really know him well yet, so can't predict how he'll react.........Some docs don't like it when you question them about things....**SIGH**

[browri]

6 minutes ago, CrazyRedhead said:

Thanks so much......I guess doing an ECG during sleep would involve a sleep study?.......I've had a sleep study before, so I know what to expect.

I was aware of risperdone and long QT, but because I was taking such a relatively low dose, I wasn't too concerned.

It seems there are quite a few meds that could prolong the QT interval, from what I have read.

Yes, I will definitely do a meds interaction check and print it off for my new doc.....Hopefully he will have an open mind.....I don't really know him well yet, so can't predict how he'll react.........Some docs don't like it when you question them about things....**SIGH**

Normally I wouldn't be concerned about combining meds that cause LQTS (long QT syndrome), it's just that in your case we're talking about a supratherapeutic dose of Lexapro and a modest but not minimalist dose of Risperdal. I would personally want to get the ECG done. And just keep an eye out for any fluttering in your chest. I've had it happen to me before, you'll notice. It's not painful or anything, it just makes you catch your breath a bit. Don't worry about it too much. I'm sure he has experience prescribing this high. Most pdocs that don't have experience with supratherapeutic/"heroic" dosing don't typically tread outside of their comfort zone lest they get a malpractice suit.