Astral Codex Ten

escitalopram

4 min read

escitalopram

Article

escitalopram is a recurring brand in the Astral Codex Ten archive, appearing 2 times across 2 issues between March 31, 2021 and May 25, 2021. The archive places it in contexts such as “Lexapro (escitalopram) is a derivative of the older drug Celexa”; “the purely sinister escitalopram is more than twice as effective as the racemic mixture”; “Most patients will want either escitalopram or bupropion as first-line treatment”. It most often appears alongside FDA, imipramine, SSRIs.

Metadata

  • Category: Brands
  • Mention count: 2
  • Issue count: 2
  • First seen: March 31, 2021
  • Last seen: May 25, 2021

Appears In

Source Context

Recovered passages from the original issue text. When the raw archive preserved outbound links inside the source passage, they are listed directly under the quote.

Oh, The Places You'll Go When Trying To Figure Out The Right Dose Of Escitalopram
March 31, 2021 · Original source
What is the right dose of Lexapro (escitalopram)?
Because Lexapro (escitalopram) is a derivative of the older drug Celexa (citalopram). Sometime around 2011, the FDA freaked out that high doses of citalopram might cause a deadly heart condition called torsade de pointes, and lowered the maximum dose to prevent this. Since then it's been pretty conclusively shown that the FDA was mostly wrong about this and kind of bungled the whole process. But they forgot to ever unbungle it, so citalopram still has a lower maximum dose than every other antidepressant. When escitalopram was invented, it inherited its parent chemical's unusually-low maximum dose, and remains at that level today [edit: I got the timing messed up, see here]
Inline links: freaked out, pretty, conclusively, shown, here
Now that we know the heart risk was overblown, should we increase the maximum dose to something closer to other SSRIs? Maybe not. Right now, escitalopram keeps showing up in studies and head-to-head comparisons as the most effective SSRI.
Inline links: the most effective SSRI
Peer Review Request: Depression
May 25, 2021 · Original source
The short version: Depression has a combination of biological, psychological, and social causes. You can address the social causes by changing your life circumstances (and research suggests people underestimate the potential benefits of making major life changes). You can address the psychological causes with therapy; possible therapies are diverse and complicated but I especially recommend “behavioral activation” therapy (where you try to keep a schedule and also do new, interesting things) and David Burns’ book Feeling Good. You can address the biological causes with a combination of lifestyle changes, medications, and supplements. Consider exercising more and adapting a modified Mediterranean diet. Consider taking antidepressants like escitalopram and bupropion, and supplements like l-methylfolate. Other non-chemical biological options include light therapy (safe and easy), transcranial magnetic stimulation (more complicated), and electroconvulsive therapy (difficult but extremely effective last-ditch solution). If something treats your depression, continue it for some length of time depending on the type of intervention, then consider withdrawing it to see if you can maintain your mood without it.
Most patients will want either escitalopram or bupropion as first-line treatment. These medications are easy to use and have fewer side effects than most others.
Advantages of escitalopram: it’s slightly better at dealing with anxiety, rumination, and obsessive thoughts, although some studies have challenged this. Disadvantages of escitalopram: it frequently decreases sex drive/ability/performance, and occasionally causes tiredness, weight gain, or emotional flatness. Read more at my page on SSRIs.
Inline links: SSRIs