One of the most “popular” antidepressants among doctors. According to our data, this medicine is one of the ten most frequently prescribed drugs by psychiatrists.
Escitalopram
is produced under many names: cipralex (considered the original, since it was the very first), elicea, esipi, escitalopram, selectra, lenuxin, miracitol, etc.
All of these are analogues, that is, drugs with the same active ingredient, but produced at different factories by different manufacturers.
The drug was obtained as a result of a “modification” of another antidepressant from the group of selective serotonin reuptake inhibitors (SSRIs) - citalopram.
The mechanism of action is associated with a decrease in the flow of the neurotransmitter serotonin back into the neuron after it has entered the intercellular space - the synapse.
The drug promotes the accumulation of serotonin in the synapse (the junction of neurons), and if the painful condition caused the depletion of serotonin, then long-term use of escitalopram leads to the restoration of serotonin metabolism and a decrease in the symptoms of the disease. The main effect is antidepressant and anti-anxiety.
Available in the form of film-coated tablets in a dosage of the active substance of 10 milligrams.
Indications for taking escitalopram
- Endogenous depression of mild to moderate severity.
- Panic attacks, panic disorder, generalized anxiety disorder, phobias.
- Organic anxiety and depressive disorders.
- Neuroses, neurasthenia, mixed anxiety and depressive disorder, somatoform disorders, psychosomatic diseases, prolonged reactive states (mental trauma, adaptation disorders).
- Alcohol and drug addiction, substance abuse.
The convenience of taking ecitalopram is that you do not need to adjust the dose (recommended - 10 mg / 1 tablet once a day
), rarely have side effects, according to psychiatrists it gives a positive effect in the vast majority of cases of use.
The disadvantages include the slow onset of the therapeutic effect over the course of a month, and a slight increase in anxiety in the first days of use (which is very inconvenient when treating panic attacks, phobias and anxiety disorders).
How to take it correctly
Grandaxin is a small, round, disc-shaped tablet with the GRANDAX logo. They are white or gray in color and have virtually no odor. Located on a blister of 10 pieces.
The dosage of 1 tablet is 50 mg. The package contains 20 or 60 tablets.
Once in the digestive tract, Grandaxin is quickly absorbed into it. Undergoing transformation in the liver, it enters the blood. Here it reaches its maximum concentration 2 hours after administration. It is excreted by the kidneys and does not accumulate in the body.
The dose of the drug depends on the severity of the condition. It is calculated and prescribed only by a doctor. Self-medication is unacceptable. Usually the scheme is as follows: 1–2 tablets. from 1 to 3 times a day.
The maximum dose per day is 300 mg, in children – 200 mg.
Due to the fact that the drug accumulates in the liver and is evacuated through the kidneys, the drug is prescribed to patients with renal and liver failure with caution. In such patients, the severity and duration of the effect may change, as well as the development of side effects. In this regard, their dose is reduced by half. The same scheme is used for elderly people.
In case of an overdose of the drug, complications such as vomiting, changes in consciousness, coma, seizures and impaired respiratory function are possible.
Grandaxin is not used in parallel with cyclosporine and immunosuppressants such as tacrolimus, sirolimus.
Tablets can intensify the effect of drugs that depress the activity of the central nervous system: analgesics, sedatives and hypnotics, etc.
The use of Grandaxin along with alcohol, smoking, barbiturates, along with antiepileptic therapy reduces its activity.
It is strongly recommended to take Grandaxin before 17.00 to avoid insomnia.
The drug is available with a doctor's prescription. The average cost of 20 tablets is 400 rubles, 60 tablets - 900 rubles.
The most frequently asked questions about the use of escitalopram
Is escitalopram addictive?
The drug does not cause dependence. Those cases when painful symptoms went away while taking escitalopram, but returned after discontinuation of the drug, do not indicate the formation of addiction, but about too early cessation of treatment or insufficient therapy.
Can I take it on my own?
No. Only after prescription by a doctor.
Can a psychologist prescribe escitalopram?
No. Like any antidepressant, like any medicine, this drug can only be prescribed by a doctor - a person with a higher medical education, then completed specialization (internship or residency) and has a valid doctor’s certificate.
Psychiatrists are the most knowledgeable about the treatment of depression and anxiety disorders and the effects of antidepressants. But doctors of other specialties can also prescribe antidepressants. The psychologist does not have a medical education and therefore cannot make such appointments. Read more about the difference between a psychologist, psychotherapist and psychiatrist here.
How and where can I purchase it? What does this require?
It is sold in pharmacies. To purchase it you will need to present a prescription from a doctor.
Does escitalopram contribute to suicidal behavior?
There is no such data. The described isolated cases of suicide while taking this drug were explained by the fact that there were risks of suicide even before the start of treatment. Suicide was a consequence of illness (depression, psychosis), and not the effect of the drug.
Is it possible to drink alcohol during treatment with escitalopram?
Drinking alcohol neutralizes the therapeutic effect of the medicine and worsens the general condition of the brain. Therefore, drinking alcohol during treatment is not advisable.
How long to take escitalopram?
Treatment with this antidepressant takes several months. The therapeutic effect usually develops in the first 3 months of treatment; further use usually prevents the recurrence of symptoms.
If indicated, long-term use is possible. Even if there are no complaints about the condition during therapy with escitalopram, you need to see a doctor at least once every 2-3 months. The duration and regimen of administration is determined by the attending physician. On average it is about 6 months.
Is it possible to replace escitalopram with a similar drug with a different name during treatment?
This question often arises due to the large difference in price for the same drug, produced by different manufacturers and having a different name. As experience shows, no changes occur with such a change. But if such a question arises, it is best to consult your doctor.
What is better: the original drug Cipralex or its cheaper generic analogues?
According to the author of this material, there is no fundamental difference.
Selectra
Antidepressants should not be prescribed to children and adolescents under 18 years of age due to an increased risk of suicidal behavior (suicide attempts and suicidal thoughts), hostility (with a predominance of aggressive behavior, confrontational behavior and irritation). If a decision is made to initiate antidepressant therapy based on clinical assessment, the patient should be closely monitored.
When using drugs belonging to the SSRI therapeutic group, including escitalopram,
the following should be considered
: some patients with panic disorder may experience increased anxiety when starting treatment with antidepressants. This paradoxical reaction usually disappears within two weeks of treatment. To reduce the likelihood of an anxiogenic effect, it is recommended to use low initial doses.
The drug should be discontinued in the event of the primary development of convulsive seizures or in the event of an increase in their frequency (in patients with previously diagnosed epilepsy). SSRIs should not be used in patients with unstable epilepsy; Controlled seizures require careful monitoring.
Escitalopram should be used with caution in patients with a history of mania/hypomania. If a manic state develops, escitalopram should be discontinued.
In patients with diabetes mellitus, treatment with escitalopram may change blood glucose concentrations. Therefore, dose adjustments of insulin and/or oral hypoglycemic drugs may be required.
Depression is associated with an increased risk of suicidal ideation, self-harm, and suicide (suicidal events). This risk persists until significant remission occurs. Since improvement may not be observed during the first few weeks of therapy or even longer, patients should be closely monitored until their condition improves.
General clinical practice shows that in the early stages of recovery the risk of suicide may increase.
Other psychiatric conditions for which escitalopram is prescribed may also be associated with an increased risk of suicidal events and events. In addition, these conditions may be a comorbidity in relation to a depressive episode. When treating patients with other mental disorders, the same precautions should be taken as when treating patients with a depressive episode.
Patients with a history of suicidal behavior or patients with a significant level of suicidal thoughts before treatment are at greater risk for suicidal ideation or suicide attempts and should be closely monitored during treatment. A meta-analysis of placebo-controlled clinical trials of antidepressants in adult patients with mental disorders found that there is an increased risk of suicidal behavior in patients under 25 years of age when taking antidepressants compared with placebo. Drug treatment of these patients, and in particular those at high risk for suicide, should be accompanied by careful monitoring, especially early in treatment and during dose changes.
Patients and caregivers should be cautioned to monitor for any signs of clinical worsening, suicidal behavior or ideation, or unusual changes in behavior, and to seek immediate medical advice if these symptoms occur.
SSRI/SNRI use is associated with the development of akathisia, characterized by the development of subjectively unpleasant or distressing restlessness and a need for constant movement, often combined with an inability to sit or stand quietly. This most often occurs during the first few weeks of treatment. In patients with such symptoms, increasing the dose may lead to worsening.
Hyponatremia, possibly associated with impaired antidiuretic hormone (ADH) secretion, occurs rarely with SSRIs and usually disappears when therapy is discontinued. Caution should be exercised when prescribing escitalopram and other SSRIs to persons at risk of developing hyponatremia: the elderly, patients with cirrhosis, and those taking drugs that can cause hyponatremia.
Cases of skin hemorrhages (ecchymosis and purpura) have been reported when taking SSRIs. Escitalopram should be used with caution in patients with a tendency to bleed, as well as those taking oral anticoagulants and medications that affect blood clotting.
Because clinical experience with the concomitant use of SSRIs and electroconvulsive therapy (ECT) is limited, caution should be used when escitalopram and ECT are used concomitantly.
Combining escitalopram and MAO A inhibitors is not recommended due to the risk of developing serotonin syndrome.
Escitalopram should be used with caution concomitantly with drugs that have serotonergic effects, such as sumatriptan or other triptans, tramadol and tryptophan. Patients taking escitalopram and other SSRIs concomitantly with serotonergic drugs have rarely developed serotonin syndrome. Its development may be indicated by a combination of symptoms such as agitation, tremor, myoclonus and hyperthermia. If this occurs, concomitant treatment with SSRIs and serotonergic drugs should be discontinued immediately and symptomatic treatment initiated.
Alcohol
Escitalopram does not interact pharmacodynamically or pharmacokinetically with alcohol. However, as with other psychotropic drugs, the simultaneous use of escitalopram and alcohol is not recommended.
