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Suggest Ways To Wean Off Lexapro
Question: I am a physician with a patient taking Lexapro at 10mg and pramspexole 0.5mg at this time having recently, on his own reduced the doses of medicnes from 20 mg to 10mg and 0.75mg to 0.5mg respectively. He is not having any untoward withdrawal and has been on the reduced regimen for a week. His motivation comes from the failure of pramepexole and years ago Requip to adequately treat his marked RLS. He knows that Lexapro may worsen RLS and increase his appetite especially at night when the RLS wakes him. He is aerobically and physically fit and has recently completed a triathlon. He also knows that buproprion will help his bad nicotine addiction. He chews tobacco which upsets his wife and four boys as well as me. He will see me tomorrow in my office and get a full boat of fasting blood and urinalysis. Our thought together was to switch to sertraline at 50mg, start buproprion at 150mg once a day, keep the pramepexole at 0.5mg for the present and watch closely. He is anxious to get control of the RLS as it is messing up his life. So, as the saying goes "Other than that Mrs XXXXXXX how did you enjoy the show". Please help us. Thanks, XXXXXXX XXXX at YYYY@YYYY
Brief Answer:
Some suggestions.
Detailed Answer:
I read your question carefully and I understand your concern and how difficult it is to treat a family member.
One thing that is a little difficult to understand from your account is what is he taking Lexapro for. You seem to mention only the RLS syndrome as a diagnosis, it is unclear whether the SSRI use is for depression, anxiety or some other indication. I am also not sure what you are hoping to achieve by switching to sertraline, it is a SSRI like Lexapro, so similar side effects profile and both Lexapro as well as Sertraline may exacerbate RLS. So would use only if really necessary.
As for Bupropion apart from the purpose of helping his nicotine addiction I would add that it is the one antidepressant which is considered as safe in RLS patients, has been shown not to exacerbate symptoms. So I have nothing against starting it, actually it may be considered to try it instead of SSRI, perhaps by gradually switching from Lexapro to Bupropion you may achieve the same efficacy against depression or whatever you're using Lexapro for, without any negative effects on RLS.
Finally regarding Pramipexole, if neither it nor a drug of the same class such as Requip have shown any benefit, then perhaps some other alternative may be tried for RLS treatment, dopaminergic agents are not the only option. I would consider trying an anticonvulsant like Pregabalin or Gabapentin.
I remain at your disposal for other questions.
Some suggestions.
Detailed Answer:
I read your question carefully and I understand your concern and how difficult it is to treat a family member.
One thing that is a little difficult to understand from your account is what is he taking Lexapro for. You seem to mention only the RLS syndrome as a diagnosis, it is unclear whether the SSRI use is for depression, anxiety or some other indication. I am also not sure what you are hoping to achieve by switching to sertraline, it is a SSRI like Lexapro, so similar side effects profile and both Lexapro as well as Sertraline may exacerbate RLS. So would use only if really necessary.
As for Bupropion apart from the purpose of helping his nicotine addiction I would add that it is the one antidepressant which is considered as safe in RLS patients, has been shown not to exacerbate symptoms. So I have nothing against starting it, actually it may be considered to try it instead of SSRI, perhaps by gradually switching from Lexapro to Bupropion you may achieve the same efficacy against depression or whatever you're using Lexapro for, without any negative effects on RLS.
Finally regarding Pramipexole, if neither it nor a drug of the same class such as Requip have shown any benefit, then perhaps some other alternative may be tried for RLS treatment, dopaminergic agents are not the only option. I would consider trying an anticonvulsant like Pregabalin or Gabapentin.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you-very helpful. He was started on the SSRI we presume for depression back in 1993--4 after he had a blindside tackle ruin his knees and NFL career after he earned. Super Bowl ring in 1991-2. Happily he uses his knees (5 surgeries later) very well. That being said we are going to carefully increase bupropion and taper off all SSRI'S then see how he is and taper off the pramepexole after we have full doses of bupropion. We will wait on the. Gabapentin until we see how all this is going. I believe this is close to what you have advised us to do. Thanks again Dr. Taki You have set us on a path we all pray succeeds. I'll keep you posted. Dr. XXXX
Dr. Taka sorry about my misspelling of your name above. XXXXXXX XXXX
Dr. Taka sorry about my misspelling of your name above. XXXXXXX XXXX
Brief Answer:
Completely agree.
Detailed Answer:
Thank you for the additional information and no worry about the misspelling.
I completely agree with the course of action. He has been taking Lexapro for such a long time so it may not be easy and should be a gradual tapering.
In the meanwhile it is wise to wait about Gabapentin as if two new drugs are started at the same time it would be hard to assess potential side effects.
Let me know if I can further assist you.
Completely agree.
Detailed Answer:
Thank you for the additional information and no worry about the misspelling.
I completely agree with the course of action. He has been taking Lexapro for such a long time so it may not be easy and should be a gradual tapering.
In the meanwhile it is wise to wait about Gabapentin as if two new drugs are started at the same time it would be hard to assess potential side effects.
Let me know if I can further assist you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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