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Lexapro(Escitalopram) working perfectly but not able to tolerate!


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I take
clozapine 175mg
paroxetine cr 37.5mg
clobazam 10mg
escitalopram 10mg

10mg lexapro(escitalopram) at 8am is working so damn well for ocd but I'm so tired/sleepy that i wake up at 3-4pm on it. 

I have tried all the different timings of taking the meds like divided dosing, all dose at bedtime etc - they don't work.  I believe bedtime dosing doesnt work cuz clozapine decreases serotonin and lexapro increases it, so they prolly cancel each other out ? Only 10mg at 8am works perfectly.

What should i do about tiredness and being sleepy ? Modafinil and coffee worsens my psychosis.

My next option would be to stop lexapro and add prozac - but it inhibits 2d6 and 3A4 - which would further increase clozapine and paroxetine blood levels. Increasing clozapine is bad - cuz it worsens ocd and anxiety and makes me less likely to tolerate any SSRI.

Edited by clinic
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On 4/20/2020 at 1:08 AM, notloki said:

How long have you been taking Lexepro ?

Its been a month, but i experimented different doses and timings of the med during this time. So i guess steady state of lexapro has not developed consistently.

I'm not feeling tired right now.

But since past couple of days ocd has been super bad. Im thinking if my meds are fake, cuz ocd was better few weeks ago.

Edited by clinic
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Update: My meds were not fake. Lexapro 10mg is not working for OCD, and 15mg makes me cry. I will ask pdoc to reduce clozapine to 150 and add risperidone. After reducing clozapine to 150, i will try increasing lexapro again. If that fails, i will try prozac.

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