When treating depression or general anxiety disorder (GAD), Selective Serotonin Reuptake Inhibitors (SSRI) are the preferred psychiatric treatment method. At Cognito, after an initial mental health assessment we prescribe our clients Cognitive Behavioral Therapy (CBT) with SSRI’s when appropriate.
Our preferred SSRI medication is Escitalopram, because of its efficacy and having less side effects and drug interactions. For example, alcohol can still be consumed in moderation while taking Escitalopram which is one of the main drug interactions that inhibit people from taking other medications.
Escitalopram is so effective because its chemical makeup has been modified to only contain its S-isomer, the isomer responsible for blocking the serotonin reuptake, and not the R-isomer that is less effective and causes side effects.
All chemical compounds contain isomers, including SSRI’s. Isomers are like a chemical anagram. If a literary anagram is rearranging the letters of “RACE” to make “CARE'', an S-isomer is the rearranged mirrored image of the R-Isomer in a chemical compound. Mental health treatment is always about care, and never a race.
At Cognito our job is to provide our clients with facts, and to present a range of treatment options. We work together with each client to navigate what works best for individual patient needs. During monthly check-ins, we watch the upward trajectory wave of emotions that people go through when starting Escitalopram and then checking in again after the first and second months and on an ongoing basis in perpetuity. Though everyone is different, it’s empirical reviews from people like Bill (name changed for anonymity) that really shed light on what Cognito Health treatment and Escitalopram can do for you.
Bill was one of the earliest adopters of the Cognito health program and has been working with us for almost one year. When Bill first started the program he was experiencing intense anxiety that was getting in the way of enjoying his life, every day. After completing a mental health intake assessment and onboarding meetings with our team of clinicians: psychiatric nurse and physician, Bill was diagnosed with general anxiety disorder.
At Cognito, we are believers in combined treatment but we never want to push medication onto anyone, and medication is often not required for people with more manageable symptoms - many of our clients find success with therapy and CBT training. In Bill’s instance, he was very proactive with researching mental health and understanding his own requirements prior to meeting with us which is why we decided together to start with combined treatment consisting of CBT and 10mg Escitalopram daily (common dosage). To be prepared like Bill, take our medication matching quiz here:
Bill’s first week
“After understanding the benefits of combined treatment, I was excited to get started on the plan that I worked together with my care team on,” said Bill. However, when Bill checked in two weeks later, the side effects of Escitalopram were making continuing treatment difficult.
“I was experiencing such bad nausea during the first week that I had to stay home from work, which seemed very counterintuitive and made my symptoms spiral.”
“My physician told me about the side effects but I didn’t think they’d be this bad.”
Our Cognito care team assured Bill that this reaction is normal, and it will subside as the medication starts to do its job. Cognito further recommended that Bill cut his daily pill in half (5mg), to build up tolerance over the course of a week before resuming the full dose. Cognito also recommended Bill take his medication in the evenings, as to not let nausea interfere with his work day. Helping Bill to reduce the severity of side effects, while reinforcing that they are an indicator that the medication is working, helped him work through the discomfort and progress towards his goal of reduced anxiety.
Common Escitalopram early side effects:
Bill’s second month
Reviewing Bill’s CBT journal each visit showed that he struggled with side effects for his entire first month and into his second, even with consistent timing of taking his medication, and by working his way up to a full dose. After approximately 45 days, Bill’s feelings towards his treatment started to shift.
“After almost two months, the side effects from Lexapro were finally subsiding.”
“I didn’t know if I was “happier” or even less anxious overall, but I felt more regulated. I didn’t have as low of lows, or the highs that bordered on being manic.”
Lexapro is a brand name of Escitalopram, but it can be found under many other names worldwide.
Common brand names for Escitalopram:
Cognito and Bill after 6 months
After Bill’s second month is when things started to really improve for him. One of the biggest breakthrough moments we have had with a client was when Bill shared this revelation with us:
“Prior to starting this medication I thought I generally had a sensitive stomach. I was always drinking pepto or taking a gastro pill before going out to eat and drink. Obviously the first few months of Lexapro made this worse with the side effects, but around 4-5 months into treatment I’ve noticed ALL of my previous stomach problems are gone?”
Bill had been living with intestinal issues that were really just a symptom of his anxiety. By blocking the reuptake of serotonin back into neurons, and allowing for more free flowing serotonin to use as needed, Bill’s anxiety was regulated and in turn his anxiety symptoms of stomach pain was alleviated.
“Not having to worry about what I eat or if I am going to feel alright when I’m out with friends has literally changed my life.”
Comments like this, and client success stories like Bill’s are what drive us forward with the passion to help more people, every single day.
Now, almost a year into treatment, Escitalopram is just a small pill that Bill takes with his other vitamins, and mental health is no longer consuming his life, but rather a small manageable part of it.
So, is Escitalopram right for you?
Everyone's mental health journey is different, from symptoms to treatment method we approach every client differently and cater our plan to work with each individual's specific needs.
For Bill, and many others, combined treatment with therapy and a daily dose of Escitalopram was very effective. However, escitalopram may not have the same results for everyone which is why it’s important to become informed to have agency in working with your care team to find the treatment plan that works best for you.
If you’re considering SSRIs to treat your mental health, because of efficiency, lower side effects and less drug interactions Escitalopram is our preferred medication.
If Escitalopram or SSRIs in general don’t work for you, there are always other SSRIs or anti anxiety medications in other classes that can be prescribed.
Take the first step towards feeling like yourself again by taking a free mental health assessment today, researching our knowledge and resource centre, our blog, or taking advantage of other local mental health resources in your area.