Lexapro causing an anxiety attack

[raptor5]

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Has anyone ever heard of Lexapro or other SSRIs causing an Anxiety Attack. Pt last week was given 10mg samples of lexapro for minor depression, sleep disturbances, and IBS. Pt came back today reporting that w/in 6 hours after taking 10mg for first time minor anxiety, and restlessness, followed by cold clammy hands, cold tingling in legs which lasted for about 2 hours. Pt said he/she tried to remain as calm as poosible b/c they knew it was an anxiety attack b/c the same thing happened a few years ago after taking zoloft. Anxiety continued off/on for 24 hours and never took another pill since and is mostly OK today. Attending says Lexapro did not cause symptoms but does not offer Anxiolytics. Hard to understand the logic. Can some people just not handle the extra Serotonin dump.

 

[Poety]

sounds liek they have a pre-existing panic d/o - i wouldn't say it was the lexapro either but thats just my $.02

 

[Anasazi23]

It's not that uncommon. Some people have paradoxical reactions to SSRIs. They have been known to increase anxiety, especially after first starting them. Normally we lower the dose, and retitrate slowly. These symptoms usually abate with a couple weeks use.

 

[Poety]

wow, how common is this sazi? Ive never read anything about this or seen it! I have so much to learn in residency 🙂

<bowing to the upperclassman>

 

[watto]

Don't know her ethnicity, but if she had a bad reaction to Zoloft as well, she might be one of the 3% of Caucasians (and 20% of Japanese) who don't express CYP2C19...not sure if this would result in anxiety as an adverse effect but an anomaly of metabolism is an idea.

 

[OldPsychDoc]

It's not that uncommon. Some people have paradoxical reactions to SSRIs. They have been known to increase anxiety, especially after first starting them. Normally we lower the dose, and retitrate slowly. These symptoms usually abate with a couple weeks use.

Ditto--I've found Lexapro to be highly "activating" in certain patients. Makes some of them (especially somatic middle-aged ladies) crawl right out of their skin. The reps hate me for it, but I probably prescribe more plain citalopram now than their fancy-schmancy escitalopram. Plus it's WAY cheaper!

 

[50960]

I have seen the same. I think the stereoisomer of citalopram is a more more potent SSRI than we knew..

 

[raptor5]

Pt was a White Male. The thing that bothered me most is that the attending was so dismissive as if the pt. did not get an euphoric state and was pushing for xanax on followup.

Funny thing is that not 10 minutes before this pt was seen the Lexapro rep was in the office spouting about low side effects. Too bad I probably won't see that rep again to ask about it.

 

[OldPsychDoc]

Pt was a White Male. The thing that bothered me most is that the attending was so dismissive as if the pt. did not get an euphoric state and was pushing for xanax on followup.

Funny thing is that not 10 minutes before this pt was seen the Lexapro rep was in the office spouting about low side effects. Too bad I probably won't see that rep again to ask about it.

Sounds like the Lexapro in the patient may be interacting with some major counter-transference issues in the attending!

 

[Anasazi23]

People can be pretty savvy and manipulative when it comes to scoring benzos. Your attending's suspicions may not have been far off. Besides, a benzo may not necessarily be the treatment for this, even if it were true. Doesn't sound like a true panic-attack per se. Rather, more like the akithetic reaction known to occur with SSRIs. Truth is, we won't know b/c we didn't see the patient and examine him.