# Escitalopram is by far the most effective SSRI



## crayzyMed (Nov 2, 2006)

Ive allways been skeptical of the SSRI's due to the low remission rates, however it appears that escitalopram is alot more effective then the other SSRI's with less side effects.



> Curr Med Res Opin. 2010 Nov 1. [Epub ahead of print]
> Comparison of escitalopram vs. citalopram and venlafaxine in the treatment of major depression in Spain: clinical and economic consequences.
> 
> Sicras-Mainar A, Navarro-Artieda R, Blanca-Tamayo M, Gimeno-de la Fuente V, Salvatella-Pasant J.
> ...





> Int J Neuropsychopharmacol. 2010 Sep 29:1-8. [Epub ahead of print]
> Efficacy of escitalopram compared to citalopram: a meta-analysis.
> 
> Montgomery S, Hansen T, Kasper S.
> ...





> Encephale. 2010 Oct;36(5):425-432. Epub 2010 Oct 12.
> [Efficacy of escitalopram vs paroxetine on severe depression with associated anxiety: Data from the "Boulenger" study.]
> 
> [Article in French]
> ...





> J Sex Marital Ther. 2005 May-Jun;31(3):257-62.
> Improvements in SSRI/SNRI-induced sexual dysfunction by switching to escitalopram.
> 
> Ashton AK, Mahmood A, Iqbal F.
> ...


Source


----------



## Kon (Oct 21, 2010)

Thanks for the studies. I'm kinda glad I'm taking escitalopram because zoloft gave me major headaches. My psychiatrist also thinks that on average escitalopram is the best SSRI for people with anxiety but just to post some skeptical views on those reviews:

"Finally, just for a sense of perspective, here's what happened in a couple of other recent antidepressant beauty contests. As you can see, they don't really agree on much...


Gartlehner et. al. (2008) concluded that _"Second-generation antidepressants did not substantially differ in efficacy or effectiveness for the treatment of major depressive disorder on the basis of 203 studies; however, the incidence of specific adverse events and the onset of action differed."_ 
Montgomery et. al. (2007) said that _"[in "moderate-to-severe depression"] three antidepressants met these criteria [for superiority to any other drug]: clomipramine, venlafaxine, and escitalopram. Three antidepressants were found to have probable superiority: milnacipran, duloxetine, and mirtazapine." _Note that clomipramine is an older drug not considered in the Lancet paper. 
Papakostas et. al. (2008) report that _"These results suggest that the NRI reboxetine and the SSRIs differ with respect to their side-effect profile and overall tolerability but *not their efficacy* in treating MDD"_
http://neuroskeptic.blogspot.com/2009/02/whats-best-antidepressant.html

"The search phrase that most often leads people to this blog is "best antidepressant". People really want to know which antidepressant is most likely to help them. In truth, everyone responds differently to every drug, so there is no one best treatment. But Cipriani et al are quite right that even a _roughly_ correct ranking could help improve the treatment of people with depression, even if the differences are tiny. If Drug X helps 1% more people than Drug Y on average, that's a lot of people when 30 million Americans take antidepressants every year.

So, what _is _the best antidepressant, on average? I don't know. But maybe it's escitalopram or sertraline. Stranger things have happened."

http://neuroskeptic.blogspot.com/2009/10/more-antidepressant-debates.html


----------



## crayzyMed (Nov 2, 2006)

> ESC-treated patients achieved higher remission rates compared to CIT (58.0% vs. 38.3%) or VEN patients (32.4%)


Good thing you switched to escitalopram, i would say that this is absolutely the best SSRI to start with since i would consider the remission rates of the others completely pathetic, according to the last meta analysis ive read thats 25% better then placebo.

The reviews that blog talk about only looked at marginal differences AFAIK, however we see here that remission with lexapro is allmost 60%, while the others have a remission rate around the 30%, a big difference and i think its safe to conclude lexapro is far superior.


----------



## Charzar (Oct 24, 2010)

Lexapro is superior? Hmm ok now I've lost all faith in medications. 

I was on Lexapro, but it did absolutely nothing for me.


----------



## BrightLight (Nov 6, 2010)

Everyone responds differently to different medications. Some (like me) respond well to Lexapro, but some don't and should try something else.

The good thing about Lexapro is that its side effect profile is quite favorable compare to other SSRIs. It causes little to no weight gain and sexual dysfunction. It always has fewer drug-drug interactions compared to other SSRIs. The downside is no generic version of Lexapro is available on the market yet, so the drug is very expensive and may not be covered by some insurance plans.


----------



## Charzar (Oct 24, 2010)

BrightLight said:


> Everyone responds differently to different medications. Some (like me) respond well to Lexapro, but some don't and should try something else.
> 
> The good thing about Lexapro is that its side effect profile is quite favorable compare to other SSRIs. It causes little to no weight gain and sexual dysfunction. It always has fewer drug-drug interactions compared to other SSRIs. The downside is no generic version of Lexapro is available on the market yet, so the drug is very expensive and may not be covered by some insurance plans.


You're right about the side effects....I experienced none (compared to the Seroquel XR my wacky doc put me on when I was suicidal). One of the reasons why I stopped (in addition to it not working) was finances. I simply could not afford something that did not work.

My shrink tells me that he does not think medications work for me. (I guess because Lexapro didn't...since it is one of the best?)

So I continue attending therapy....which does not work for me either.

Throwing away money for therapy and medications that only worsen my situation by increasing my hopelessness....all a vicious and pointless cycle.


----------



## Noca (Jun 24, 2005)

Lexapro never seemed to do anything bad nor much good for me even at 20mg for 8 months or more.


----------



## jim_morrison (Aug 17, 2008)

Lexapro never seemed to work for me either, and it had the worst sexual side effects of any SSRI/SNRI that I've ever been on.


----------



## crayzyMed (Nov 2, 2006)

Splexin said:


> My shrink tells me that he does not think medications work for me. (I guess because Lexapro didn't...since it is one of the best?)


What nonesense, find a new schrink ASAP.


----------



## newboki (Sep 13, 2009)

what about pristig newer med too maybe meta anylasis will come in a few years and pristiq is going to be the most effective lol.

I started pristiq 15 days ago and i can see it is helping me with social anxiety but i have some side effect that shrink said it will pass once my body get used to it and that is i have more energy and find it hard to stay or lay still like anxiety through out my body but it helps my social anxiety weird lol.


----------



## redtogo72 (Jun 7, 2008)

Lexapro didn't help me either. From what I remember, I had bad weight gain, but less sexual dysfunction than some of the other SSRIs.


----------



## peaceandlove09 (Aug 10, 2010)

The problem is, 20mg of lexapro might help with depression, but it will probably destroy any sembalance of libido you may have. Lexapro is a potent med, and if you check out askpatient.com the large majority will report a total loss of libido at that dosage. 

I've heard that even 5mg of lexapro can totally destroy libido :blank

The question for people to ask, whats better? To be depressed and horny? Or to be happy and sterile? It's a tough decision. But for me, i'd rather be depressed and horny because at least I can have sex and that makes me happy  

OTOH, if I was happy but I couldn't be intimate with my gf, that would freakin' suck balls. No pun intended!!!!! 

I have prescriptions for both lexapro and celexa but i only gave 'em about a week because even in just a week, my d*ck felt numb and i lost my libido. That was enough for me to quit it. 

I'm on Wellbutrin now, and although it doesn't boost my libido it doesn't destory it either. 


Cheers,


----------



## antonina (Oct 25, 2008)

Splexin said:


> You're right about the side effects....I experienced none (compared to the Seroquel XR my wacky doc put me on when I was suicidal). One of the reasons why I stopped (in addition to it not working) was finances. I simply could not afford something that did not work.
> 
> My shrink tells me that he does not think medications work for me. (I guess because Lexapro didn't...since it is one of the best?)
> 
> ...


I know how you feel. I am a lot older and have had to deal with many different meds and therapies. For me the meds help somewhat but are not a cure. The therapy also seems to make me feel worse if I can't accomplish the task. Anyway, keep hanging on they keep developing new treatments like TMS transcranial magnetic stimulation and new meds. Don't give up hope.


----------



## Charzar (Oct 24, 2010)

Eric69 said:


> The question for people to ask, whats better? To be depressed and horny? Or to be happy and sterile? It's a tough decision. But for me, i'd rather be depressed and horny because at least I can have sex and that makes me happy


I am incredibly horny all the time (I have high levels of testosterone, so that may attribute to that), and when I am depressed I get my mind off my depression by finding someplace quiet and...well you get the idea.

Lexapro did not decrease my libido at all. In fact, I got so scared after hearing all the stories of delayed ejaculation that I jerked-off more frequently to keep myself in check.


----------



## Charzar (Oct 24, 2010)

antonina said:


> I know how you feel. I am a lot older and have had to deal with many different meds and therapies. For me the meds help somewhat but are not a cure. The therapy also seems to make me feel worse if I can't accomplish the task. Anyway, keep hanging on they keep developing new treatments like TMS transcranial magnetic stimulation and new meds. Don't give up hope.


I dread getting older without a cure or major alleviation. I just can't imagine living the rest of my life like this. I hate being this way.

Magnetic stimulation....I have heard of electro shock therapy, is it the same? Electro shock therapy is supposedly effective but here in Texas we have the worst success rate.


----------



## peaceandlove09 (Aug 10, 2010)

Splexin said:


> I am incredibly horny all the time (I have high levels of testosterone, so that may attribute to that), and when I am depressed I get my mind off my depression by finding someplace quiet and...well you get the idea.
> 
> Lexapro did not decrease my libido at all. In fact, I got so scared after hearing all the stories of delayed ejaculation that I jerked-off more frequently to keep myself in check.


Yeah i think guys with high testosterone will be fine on SSRis. But guys with lower testosterone :blank SSris will probably destroy their already fragile libidos.

I'm in the later category. Unfortunately.

Cheers,


----------



## crayzyMed (Nov 2, 2006)

Guys, if SSRI's dont work there are things that can be tried like dopaminergics, when those dont work it doesnt mean AT ALL that medication wont work, far from it actually.


----------



## Area88 (Oct 4, 2010)

Yeah It doesn't matter how good someone responds to an SSRI, the SSRI can never perform as well and as powerful, as an unselective MAOI. People need to get this in mind before claiming SSRI A, B or C is the holy grail.

The SSRI's are a lottery in which most patients have to go on a merry go round to find the right one for them. This is costly and takes a lot of time. Sometimes patients don't respond to any of them, this happened to me.

If doctors were smarter, they would go back to prescribing the far more effective medications like Tricyclics and the MAOI's almost straight away.

Unfortunately the medicine industry has educated doctors away from these drugs since the 1980's when Prozac first appeared.


----------



## crayzyMed (Nov 2, 2006)

Yeah MAOI's work very well for social anxiety, or amphetamine is another excellent option.


----------



## gordonjohnson008 (Nov 2, 2008)

I found Lexapro and Paxil to both be effective SSRIs for me for SA. Zoloft less so, and St John's Wort did about nothing for anxiety. All were effective for depression. Lexapro made me more tired, and Paxil seemed slightly more effective for me; it is a dirtier SSRI, maybe that's why.


----------



## crayzyMed (Nov 2, 2006)

gordonjohnson008 said:


> I found Lexapro and Paxil to both be effective SSRIs for me for SA. Zoloft less so, and St John's Wort did about nothing for anxiety. All were effective for depression. Lexapro made me more tired, and Paxil seemed slightly more effective for me; it is a dirtier SSRI, maybe that's why.


Lexapro also appears to be very effective in doses of 2,5mg, this is the best dose to start with, isntead of 10mg, many side effects can be avoided.


----------



## Noca (Jun 24, 2005)

crayzyMed said:


> Yeah MAOI's work very well for social anxiety, or amphetamine is another excellent option.


ditto +1


----------



## introvert33 (Jun 23, 2010)

I'm liking my 20mg of Lexapro, no side effects. But of course just because its working for me, doesn't mean its the most effective one out there. Its sounds like the numbers are there however to show it might be the best starting point for doctors to prescribe, then move on to try others if its not the right fit. MAOIs I thought have greater risks? so wouldn't you start with the safer and then try the MAOI's? And I think the point/hope is to narrow down the best few SSRI's so you don't have to try a million for years before trying the other class of drugs.


----------



## equilib (Sep 15, 2010)

Has anyone had a COMPLETELY different experience with different SSRI's? Not talking about small/big differences in effectiveness (or lack of), anxiety relief, stimulation etc, but about a totally different feeling/perception. Like a "wow, now this is something _else_" feeling?
(and leaving out side effects)


----------



## crayzyMed (Nov 2, 2006)

Also i think remember study's showing that lexapro starts showing its antidepressant effects after 2 weeks allready and you dont have to wait the full 4 weeks as with others, i'l try to dig them up again, without a doubt lexapro should be the first SSRI tried.


----------



## newboki (Sep 13, 2009)

By far i think pristiq is good medication helped my social anxiety after two weeks and and my side effect are much less now after two days so i like this drug more than lexapro i give it 9 out of 10 for social anxiety and better mood more energized. I think anyone who did't respond to ssri to try snri you have nothing to loose and i added abilify so i am pretty pleased with the two drugs.


----------



## Canadian4Life (Sep 27, 2010)

I took celexa..similar to lexapro. It didn't help me at all. It numbed me sorta but that was it. I have read zoloft and lexapro are the 2 superior ones and have started zoloft 50mg 5 weeks ago. I knew the feeling celexa gave me and feel lexapro would make me just more numb..a zombie. But anyways so far zoloft week 5.. social anxiety is better..nothing major but definetly significant...depression I am not too sure about I feel there is a slight benefit but feel depression takes more time than 5 weeks.


----------



## jim_morrison (Aug 17, 2008)

equilib said:


> Has anyone had a COMPLETELY different experience with different SSRI's? Not talking about small/big differences in effectiveness (or lack of), anxiety relief, stimulation etc, but about a totally different feeling/perception. Like a "wow, now this is something _else_" feeling?
> (and leaving out side effects)


I doubt it, the SSRI's seem to be a rather lackluster treatment for SA unfortunately.


----------



## Kon (Oct 21, 2010)

equilib said:


> Has anyone had a COMPLETELY different experience with different SSRI's? Not talking about small/big differences in effectiveness (or lack of), anxiety relief, stimulation etc, but about a totally different feeling/perception. Like a "wow, now this is something _else_" feeling?(and leaving out side effects)


Not me but I've seen it in my friend who suffered from GAD for his whole life. He tried Paxil. It made his anxiety worse. He tried Zoloft for a few years. He felt only slightly better. Then he tried lexapro (only 5 mg). He's been on it for few years. For him, it's been a miracle drug. He said he's felt like a champ and close to 100% normal. His words.


----------

