I am 39 years old. Have been on Lexapro for 2 years now. This medication had an almost immediate positive effect on my life. Within 2 to 3 days of starting Lexapro, there was a noticeable lift in my general mood. A WARNING ABOUT STOPPING OR WEANING OFF LEXAPRO: I started taking 10 mg daily a couple of years ago for about 2 months, then decided I just didn’t want to take medicine every day. So I weaned myself off over a 2-wk period, first reducing the dose to 5 mg/day, then 5 mg every other day before I stopped altogether. I figured I would be able to tell if my mood was going downhill and I would just restart if it did. Well, there was no gradual decline. I was careful to monitor my mood and thoughts every day and everything went great for about 3 months, then C.R.A.S.H!!! I mean it hit me like a WALL, very very suddenly! Despite exercising 4-5x per week, healthy eating, etc., I hit an all-time low.

I have experienced some of these side effects-
Constant dull headache, jittery in the morning if taken before bed, dizziness. These negative side effects subsided within a week or two. Other side effects have continued, including sleepiness and yawning, apathy, vivid (but great) dreams. My libido died and never came back.

I hope this information will be useful to others,
Lisa Carter

• I know very few primary care physicians (PCPs) willing to diagnose and treat bipolar comfortably – so I am wondering how many PCPs they actually surveyed.
• Since the diagnosis is actually pretty complex, I wonder how much of this is related to diagnostic problems – missed bipolar (patients with bipolar presenting with only depression or other symptoms) – as much as poor prescribing.
• I wonder about over diagnosis of bipolar disorder – especially in unsophisticated diagnosticians. (Do these patients who’ve been diagnosed bipolar really have bipolar?)
• It would also be helpful to know what percentage of patients in the study were truly diagnosed Bipolar I. If a person really just had unipolar depression or something besides a true Bipolar I – then antidepressants alone wouldn’t necessarily be so bad.

I just can’t tell you how many psychologists and social workers call to tell me about a patient we share that they’re “sure” must be bipolar just because the patient has rage outbursts or erratic moods over the course of a day. This is not the same as bipolar but lots of people – and I am sure primary care physicians included (because lots of psychiatrists are even confused about this) – don’t understand the difference. And those people with mood regulation problems, but not bipolar, often do really well on SSRI’s alone.

The information in the study also doesn’t say anything about rates of negative consequences to these prescribing patterns – it just lists these patterns without any real context of what really happens out in the world.

I think it is a worthy discussion – primary care docs are getting more involved in this because of inadequate availability of psychiatrists and poor reimbursement for mental health care – so it is important, but I’m just not sure this study gives us a great deal of useful info.