Lexapro & DS

Hey folks, how's everyone?  Been a while, but I'm still around, usually lurking.  He, he, he.  I was doing some research on the site about Lexapro and DS and really couldn't find one that answered my question.  So here goes. 

I've been dealing wih Generalized Anxiety Disorder off and on for years.  Dealing with it again, only this time I'm quite concerned that my malabsorption won't allow for proper absorption of the med.  The psychiatrist prescribed half of 20mg of Lexapro for the 1st week and the full 20mg thereafter.  If no results then she'll increase it further in a month.  I remember that when I was taking Xanax my then psychiatrist back then told me to put the Xanax pill under my tongue for quick absorption directly into the blood stream.  This was BEFORE I had surgery and it worked.  Remembering this I've been doing this with the Lexapro, but honestly, it tastes like horse sh*t...well, what I imagine it would taste like anyway. 

Funny thing is I'm in the field but really don't want the folks I work with to know I'm dealing with my own anxiety issues as it will create an issue for me to self-disclose that much information about myself.  In other words, don't really want to ask the psychiatrists I work with what I should do.  And I want to make sure I request a different med for anxiety if this one doesn't really work for our type of surgery when I go back to see her in 3 weeks.   My new psychiatrist is aware that I had DS surgery, but not quite sure she understands the full impact of my malabsorption so if there is any literature that you have that I can put under her nose, I'd appreciate that as well.  Thanks guys, I appreciate any input you have.

Maria

I'm on Paxil for GAD, and I could tell that after surgery I definitely was not absorbing it. I called my PCP and she doubled my dose, so now I take 40 in the AM and 40 in the PM. My anxiety is back under control now.

Thank you Leigh.  I'll keep this one in mind if Lexapro doesn't work.  I appreciate your input.  Stay healthy. -Maria

I really wondered about that too as I really dont think I am getting all my Effexor but I haven't talked to my doctor yet about it and I wondered also if there was some blood test to determine how much was in my system. I might have discussed it with her but I have had such trouble taking pills since the surgery I know I am also not getting it all in yet so it wouldnt help much. I will watch this thread with curiosity now.

Hey Zuzu, it definitely is worth bringing it up again because to begin with the meds have to cross the blood/brain barrier and that takes a while.  With our malabsorption as another factor, well, it makes it even more of a challenge to have the full benefits of psychotropic meds at times.  Sigh. I hope we find solutions.  I'm sure we will, there are some amazing informed people in this forum.  I have faith.

I called my PCP as well and he doubled it and because I take Ambien to sleep that was doubled as well.. he did do a lab to see what i did absorb and he saw it was not as strong as it should be.... good luck and just call...

Thanks dtabor5.  I will ask for a blood test then to see if they can determine what I am absorbing.  I'll have to ask my PCP as well. I appreciate your input as well...thanks!!!

Unfortunately, there is SCANT literature out there regarding management of psychiatric medications following DS. I am a psychiatrist (in residency) myself and had DS in December. I did a big lecture on this topic for my colleagues back in March and reviewed all of the available literature (there are fewer than 10 studies, most of them pertaining to RNY, and none specifically investigating DS). There's just not much of anything out there. The general recommendations are that doses may need to be increased to compensate for malabsorption. There are no specific recommendations for drugs that are better absorbed, except to avoid using sustained-release preparations. Alternatives include drugs that have blood levels that can be measured or drugs that can be administered parenterally (that is, not absorbed in the gut).

Of course I couldn't give you specific advice about your personal situation, but you are generally correct that your absorption of your medication is very likely to be less than it was before the surgery.

With respect to the Lexapro, there is no evidence that it can be absorbed through the oral mucosa, so letting it sit under your tongue probably won't do much for you, other than give you a bad taste.

Thanks dbaldes, it really is a nasty taste!!!  Do you have a link to the available literature?  I will explain to her that the malabsorption is higher than an RNYer.  I really appreciate your insight into this.  I think your lecture needs to be given more often as like you said, there really isn't much out there for the DS population.  Good luck on that!  Thanks a bunch!!!

Hey Maria,

I've been making adjustments to my GAD meds for several months now, so this is an interesting & timely topic for me.  I took Lexapro (2 x 20mg every morning) pre-op for years, and was really hoping that could be reduced post-op.  Well, it was reduced to zero when I couldn't afford any meds at all.  I seemed to be doing OK for the first year --- but whammo!  Back on the meds I went.  Lexapro, Klonopin, and Buspar.  My Iron is extremely low, so we've added in Wellbutrin to off-set the Klonopin and increased the Buspar for the increased anxiety, but I am still in need of another tweak.

Three plus years out, and the 2 x 20mg isn't working for me.  I am so scared to try something new, but xanax really is the only thing that really keeps the anxiety at bay, and the medical community is really against using that on a daily basis these days.

Sorry that I can't be of any help.  Now that I am back in the work force full fledge, the Lexapro just isn't cutting it for me, even after adjusting other things, so that is the next thing to change.