What we’ve said about Escitalopram

“to me, the first two antidepressants anyone should be using to me are always, it's either sertraline or escitalopram”

“I typically consider there to be four first line in how I practice. I have pretty much four first line antidepressants that I use. As you said, it's Zoloft and Lexapro. If I'm choosing an SSRI, how I choose between those depends on how I'm feeling that day”

“I like to use Zoloft or Lexapro because they tend to have less med-med interactions, but really any SSRI is fine. I avoid Paxil because Paxil tends to cause weight gain”

“Zoloft 50 milligrams is my minimum effective dose for the average patient. And then Lexapro, I have somewhere between 5 and 10 as the minimum effective dose”

“Lexapro, if I'm not in any sort of rush, I usually do the same thing with a 5 milligram. So I'll say take 2.5 for one week and then go up to 5. And that's just because I've had a lot of patients have more difficulty tolerating Lexapro if I go 5 to 10”

“I get them to 10 pretty fast. It's just it's almost psychological on my part in that, you know, it's I've had problems with getting five milligram tablets from pharmacies locally. So often I don't have that option”

“it only has four titration steps, unfortunately, which I don't like. I like to have more steps. I think that works psychologically. Physiologically”

“Zoloft and Lexapro are my favorites. I generally prefer Zoloft. Why? Because more room for titration. You have four steps up to 100 and four steps up to 200 rather than two steps up to 10 and two steps up to 20. It's just a little easier to work with in that sense and tends to have less medication interactions”

“Sertraline has a bunch of different sips that metabolize it. For patients that have ultra-slow or ultra-fast metabolization of whatever escitalopram is metabolized by, you will get patients who have really bad response to escitalopram more often than with sertraline”

“I find that sertraline has less side effects overall and sertraline is a little bit better tolerated even though it is the quote unquote most pure SSRI. I've had patients who tolerate citalopram better than escitalopram which goes against what we're taught”

“I never use Celexa citalopram. There is no point. The active enantiomer is Lexapro, okay? There is no point. Well, there's one point. If you want to prolong someone's QTC, you should use Celexa over Lexapro. If you actually look at the FDA data, Lexapro up to its... 20 milligram dose did not significantly increase QTC”

“she's seen a ton of patients that had tried Lexapro in the past and had completely different response to Celexa. She brought up one case that like the patient felt super uncomfortable on Lexapro, had terrible sexual side effects, and then Celexa worked great for them”

“a lot of people's different responses at different times to the same medications, and you see this all the time with many different medications, It's more because there's a lot more going on with patients, with people than a single medication”