Kris asked
My doctor put me on 10 mg of Lexapro for anxiety. She told me to start at 5 on Monday. I have never felt worse in my life and yesterday (day four) she agreed to switch me from Lexapro to Zoloft. I was told that since I had only taken four days of Lexapro at 5 mg that I didn't need to taper off, I could just stop. So I did...and now I feel terrible. Was this the right thing to do? I realize a lot of people quit after years, and this is probably much worse, but how long does this last? My sisters best friend is a nurse and she told me that a LOT of people switch from Lexapro to Zoloft. Any advice?
Answer
It's pretty common that individuals diagnosed with depression fail to achieve remission with the first antidepressant they take. This may be due to the medication itself being ineffective or adverse effects. In fact, one study reports that over 1/3 of patients will need to switch antidepressants after therapy with the first is unsuccessful.
Per the Practice Guidelines For The Treatment of Patients With Major Depressive Disorder, there are a few options to try if your first antidepressant medicaiton does not work or is not well toerlated
- Try to optimize your dose by either increasing or decreasing your current dose.
- If dose optimization does not work, switching antidepressants is likely your best option.
Most studies report that individuals are likely to respond to a switch of antidepressant medication, even if it is in the same class. Once someone has failed 2 drugs from one class (e.g. SSRIs), at that point, it is recommended to try a drug from a different class.
Switching From Lexapro To Zoloft
Lexapro (escitalopram) and Zoloft (sertraline) are both classified as SSRIs (selective serotonin reuptake inhibitors) and therefore work via the same mechanism. However, as stated above, it is often worth trying a switch from one SSRI to another as you may see benefits and the new medicaiton may be better tolerated.
Switching from one SSRI to another, such as from Lexapro to Zoloft, is easy. One study recommends to simply:
- Stop your previous medication (Lexapro in this case) and start the new SSRI (Zoloft) at a low dose. For Zoloft, a low dose is considered 25mg.
- After the low dose is initiated, increase your dose slowly over 4-6 weeks until your target dose is reached.
There are variations to the above however and you should speak to your doctor about the best method to switch for your particular situation. Some practitioners may recommend to taper your old SSRI if you were on a high dose. In addition, if you are switching from Prozac, you typically need stop taking it and wait for 7 days since it has a very long half-life, and therefore lasts a long time in the body.
Lexapro Withdrawal Reactions
In terms of withdrawal reactions, they typically occur if you have been taking your SSRI for longer than 6 weeks according to studies but can occur with shorter durations of therapy. Potential withdrawal reactions include:
- Flu-like symptoms
- Insomnia
- Imbalance
- GI upset
- Sensory disturbances
- Hyperarousal
If symptoms do occur, they typically begin & peak within one week, and can last anywhere from a few days to a few weeks. Tapering your medicaiton slowly, or initiating a new SSRI, can help to mitigate these side effects.
