Precautions of substance Escitalopram
In short-term studies of major depressive disorder by the criteria of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders (4th ed.) - Handbook of Diagnosis and Statistics of Mental Disorders, 4th Edition) and other mental diseases, an increased risk of suicidality (suicidal or suicide attempts) when taking antidepressants compared with placebo in children, adolescents and young people (18 to 24 years). When prescribing escitalopram or any other antidepressant to patients of these age groups, the possible risk should be evaluated. In short-term studies in adults over 24 years of age, it has been shown that the risk of suicidality when taking antidepressants does not increase compared with placebo, and in patients over 65 years of age it decreases.
Depression and some other mental illnesses are associated with an increased risk of suicide. At the beginning of antidepressant therapy, careful monitoring of patients of any age is necessary for the timely detection of clinical deterioration, suicidality, or unusual behavior changes. Relatives of patients and caregivers need to be aware of the need for close monitoring of patients and timely informing the doctor. Escitalopram is not indicated for use in patients under 18 years of age.
When co-administration of drugs from the group of serotonin reuptake inhibitors in combination with MAO inhibitors, serious and sometimes fatal reactions have been reported in patients, including hyperthermia, rigidity, myoclonus, instability of vital signs with possible rapid fluctuations, changes in mental state (including excessive agitation, up to delirium and coma). It was reported about the same reactions in patients who began taking MAO inhibitors soon after stopping the treatment of SSRIs. In some cases, the symptoms were similar to neuroleptic malignant syndrome.
In addition, limited information on the joint use of SIOZS and MAO inhibitors obtained in animals indicates a synergistic effect of these drugs in relation to increased pressure and behavioral arousal. Therefore, it is not necessary to combine estsitalopram with MAO inhibitors or to prescribe it during the first 2 weeks after their cancellation. At the end of the course of treatment with escitalopram, you should also take a break of at least 2 weeks before taking MAO inhibitors.
It was reported on the development of serotonin syndrome in 2 patients who received both linezolid - an antibiotic, which is a reversible non-selective MAO inhibitor.
Although the effectiveness of escitalopram for maintenance therapy in the treatment of depression was demonstrated in a 36-week placebo-controlled study, a physician prescribing escitalopram for long-term therapy should periodically evaluate the usefulness of this drug for each patient.
Patients have been reported to have effects due to discontinuation of treatment with escitalopram or other SSRIs or serotonin and noradrenaline reuptake inhibitors, especially with abrupt withdrawal. These symptoms include: dysphoria, irritability, agitation, dizziness, impaired sensitivity (including paresthesia, sensation of electric shock), anxiety, confusion, headache, stupor, emotional lability, insomnia, hypomania. In this regard, the cancellation of escitalopram should be carried out gradually, by reducing the dose to reduce the risk of withdrawal syndrome, while monitoring the patient’s condition is recommended.
There are reports of cases of bleeding in patients with psychotropic drugs that affect the reuptake of serotonin (see. "Interaction"). Patients should be warned about the need to use caution when sharing escitalopram with NSAIDs, including with acetylsalicylic acid or other drugs that affect coagulation.
One case of hyponatremia was reported with escitalopram treatment. Several cases of hyponatremia or syndrome of inadequate secretion of ADH have been noted during treatment with Citalopram, the racemate. In all patients, the condition returned to normal after the cancellation of escitalopram or citalopram and / or medical intervention.
According to the placebo-controlled trials in patients with depression, mania / hypomania was observed in 1 (0.1%) of 715 patients treated with escitalopram, and not a single case was recorded in the placebo group (592 patients). Like other antidepressants, escitalopram should be used with caution in patients with a history of mania. With the development of a manic state, escitalopram should be abolished.
During clinical trials of escitalopram, there have been cases of seizures. In this regard, it is necessary to carefully assign escitalopram to patients with an indication of convulsive seizures in history. With the development of seizure should stop taking the drug.
In the study on healthy volunteers who received doses of 10 mg / day, there was no decrease in intellectual activity and the speed of psychomotor reactions. However, since any psychoactive drug may impair judgment, the thinking process, motor skills, patients must be warned of the need to exercise caution when working with potentially dangerous machinery and when driving.
Clinical experience with escitalopram in patients with concomitant diseases is limited. Care must be taken in diseases involving metabolic disorders or hemodynamics.
There were no systematic observations in patients with myocardial infarction or unstable heart disease, because these patients were excluded from clinical premarketing studies.
Studies conducted on animals, talk about the low ability of citalopram to cause dependence. Systematic observations in humans to assess the potential ability of escitalopram to cause abuse, tolerance, physical dependence is not carried out. However, careful monitoring of patients with a history of drug abuse is required.
In the controlled trials of the efficacy of escitalopram in patients with depression and GAD, approximately 6% of 1144 patients were aged 60 or older. In these studies, elderly patients received a daily dose of escitalopram between 10 and 20 mg. The number of elderly patients was not sufficient to adequately assess the dependence of the efficacy and safety of drugs on age. However, the possibility of hypersensitivity in some patients to this drug cannot be ruled out.
Safety information for using Lexapro
-Lexapro may cause drowsiness and dizziness. These effects may be worse if you take it with alcohol or certain medications. Use Lexapro with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
-Do not drink alcohol while you are using Lexapro.
-Check with your doctor before using medicines that may cause drowsiness (eg, sleep with aids, muscle relaxers) while you are using Lexapro. It can add to their consequences. Ask your pharmacist if you have questions about which medicines may cause drowsiness.
1 to 4 weeks may pass before your symptoms improve. Do NOT take more than the recommended dose, change your dose, or use Lexapro for longer than prescribed without checking with your doctor.
-Children, teenagers and young people who take Lexapro may be at increased risk of suicidal thoughts or actions. See all patients using Lexapro closely. Contact your doctor right away if new, worsening or sudden symptoms such as depressed mood occur; anxious, restless, or irritable behavior; panic attacks; or any unusual changes in mood or behavior. Contact any doctor immediately if any signs of suicidal thoughts or actions occur.
-If your doctor tells you to stop taking Lexapro, you will need to wait for a few weeks before you start taking some other medicines. Ask your doctor when you should start taking your new medicine after you have stopped taking Lexapro.
Lexapro can rarely cause a long, painful erection. This can happen even when you are not having sex. If this is not treated immediately, it can lead to persistent sexual problems such as impotence. Contact your doctor right away if this happens.
Neuroleptic Malignant Syndrome (NMS) is a possibly fatal syndrome that can be caused by Lexapro. Symptoms may include fever; stiff neck; confusion; abnormal thinking; fast or irregular heartbeat; and sweating. Contact your doctor right away if you have any of these symptoms.
Use Lexapro with caution in the ELDERLY. They may be more sensitive to its effects, especially low blood sodium.
How to recognize depression: 6 non-obvious signs
According to research, more than half of the inhabitants of large cities are subject to depressive states of varying degrees of severity. Information noise, the frantic pace of life and work, the desire to get "everything and at once" in each field of activity leads us to fatigue, lethargy, apathy or, on the contrary, hypersensitivity and irritability.
You are probably closer to depression than you think. “People expect depression to be manifested by something obvious. For example, if a loved one starts to cry or get angry on a regular basis, ”says family psychiatrist Rebecca Parrish, Prevention.com. In this material - more subtle symptoms of depression, which can easily go unnoticed.
Insulation. Depressed people tend to look for loneliness, because they want to understand themselves and their feelings, and it is rather difficult to do this in society. “If your friend has always been sociable, but suddenly became withdrawn and indecisive, this may well be a sign of depression,” comments psychotherapist Irina Firstein at Prevention. Other signs: the constant desire to sleep and watch TV instead of outdoor activities, which has always been a good tradition.
Fatigue. Depression is a rather debilitating thing. That is why people who constantly analyze themselves and their actions, trying to understand what is happening with their lives, always feel tired. “Depression takes a huge amount of energy, so it does not remain to solve important everyday tasks,” Firshtein continues. “I always tell my patients that experiencing depression is no less difficult than pushing a stone up a hill.”
Fatigue can also cause sleep disturbances (or changes in its structure and depth). Studies show that people suffering from insomnia are 10 times more likely to develop deep depression.
Lack of motivation. Always a punctual colleague suddenly become late for meetings and do it with enviable regularity? Perhaps this is not just a change of habits. “Many depressed people lose motivation. This concerns not only work, but the desire to put up in the mornings and in general to do something, ”warns the family psychotherapist Kat Van Kirk in an interview with Prevention.
Polar temperament. When always calm and positive-minded person suddenly begins to behave in the opposite way (nervous, angry and arguing with everyone who does not agree with his point of view), this can also be a sign of depression. Why it happens? Depression is stress, which overloads the emotional background, so that it can shift, effort, or, rarely, weaken the expression of emotions. In the latter case, depression obviously takes too much energy, as a result of which the person stops responding to any events, taking them for granted.
Change in appearance. If your loved one suddenly loses or gains weight without rational reasons, you should think about it. In both cases, we can talk about eating disorders, but anorexia, bulimia and ortorexia are invariably accompanied by depressive moods. Weight fluctuations are a surprisingly common symptom of people who are depressed. This also should be attributed to inattention to the appearance: especially in cases where usually a person always watched himself and tried to make a pleasant impression.
Sexual dysfunction.“Lack of interest in sex can be a sign of depression,” says Kat Van Kirk. This symptom is difficult to identify, as the partner may refuse you sexual intercourse for other reasons. However, in the case of sexual dysfunction, it is quite obvious that the problem should be sought in the mood.
The fact is that the brain is directly connected with our reproductive system. Thus, attraction to a partner originates in the brain, and only then this signal is transmitted through the neurotransmitters to the genitals by stimulating the flow of blood to them. When a person is depressed, neurotransmitters lose the ability to effectively transmit "information." In addition to this, depression can cause partners to distance themselves from each other, which will make intimacy even more difficult.
Depression in Neurology and Neurosurgery
In the case of localization of the tumor in the right hemisphere of the temporal lobe, there is a dreary depression with motor slowness and inhibition.
Sad depression can be combined with olfactory as well as vegetative disturbances and taste hallucinations. Those who are ill are very critical to their condition, they seriously endure their illness. Patients suffering from this state have lowered self-esteem, their voice is quiet, they are in a depressed state, their speech speed is slowed down, patients get tired quickly, speak with pauses, complain of a decrease in memory, but they accurately reproduce events and dates.
Localization of the pathological process in the left temporal lobe is characterized by the following depressive states: anxiety, irritability, motor restlessness, tearfulness.
Symptoms of anxiety depression are combined with aphasic disorders, as well as delusional hypochondriacal ideas with verbal auditory hallucinations. The diseased constantly change their position, sit down, rise, and rise again; look around, sigh, gaze into the faces of the interlocutors. Patients talk about their fears of foreboding troubles, can not arbitrarily relax, have a bad dream.
Depression with traumatic brain injury
When a traumatic brain injury occurs, a depressing depression occurs, characterized by slow speech, a disturbance in the rate of speech, attention, and the appearance of asthenia.
When a moderate craniocerebral injury occurs, anxious depression occurs, which is characterized by motive anxiety, disturbing utterances, sighs, throwing around.
When bruises of the frontal frontal brain regions, apathetic depression occurs, which is characterized by the presence of indifference with a touch of sadness. Patients are characterized by passivity, monotony, loss of interest to others, and to themselves. They look indifferent, lethargic, hypomimic, indifferent.
Concussion of the brain in the acute period is characterized by hypotension (steady decrease in mood). Often, 36% of patients in the acute period have an alarming subdepression, and asthenic subdepression in 11% of people.
Early detection of cases of disease makes it difficult for patients to keep silent about the onset of symptoms, since most people are afraid of prescribing anti-depressants and side effects from them. Some patients mistakenly believe that it is necessary to control emotions and not to transfer them onto the shoulders of a doctor. Individuals fear that information about their condition will be leaked to work, others are terrified of being sent for counseling or treatment to a psychotherapist, as well as to a psychiatrist.
Diagnosis of depression includes tests for the identification of symptoms: anxiety, anhedonia (loss of pleasure from life), suicidal tendencies.