From the Guidelines
For a 67-year-old female experiencing anxiety and trembling while on Lexapro and Wellbutrin, I recommend considering a short-term benzodiazepine such as lorazepam (Ativan) 0.5mg once or twice daily as needed for acute anxiety symptoms while waiting for the Lexapro to reach full effectiveness. According to the study by 1, SSRIs like Lexapro typically take 4-6 weeks to achieve maximum therapeutic benefit, so her current two weeks of treatment is insufficient to judge its full effect. The trembling she's experiencing could be a side effect of either medication or a manifestation of her anxiety, as stated in the study by 1, which highlights that most adverse effects emerge within the first few weeks of treatment.
If benzodiazepines are not appropriate due to her age or other factors, buspirone (BuSpar) starting at 5mg twice daily and gradually increasing to 10mg twice daily could be a non-addictive alternative, as suggested by the study by 1. Additionally, non-pharmacological approaches like cognitive behavioral therapy, deep breathing exercises, and progressive muscle relaxation techniques should be incorporated into her treatment plan. Her medication regimen should be reassessed in 2-4 weeks to evaluate the need for dose adjustments or medication changes, particularly if the trembling persists, as this could indicate medication-induced tremor requiring adjustment of her Wellbutrin or Lexapro dosage. It's also crucial to monitor for potential serious adverse effects, such as suicidal thinking and behavior, as warned by the study by 1.
The choice of medication should be informed by side effect profiles, interactions, response, patient age, and preference, as recommended by the study by 1. Regular monitoring for adherence, side effects, and adverse events is also essential, as emphasized by the study by 1. By considering these factors and incorporating a combination of pharmacological and non-pharmacological approaches, the patient's anxiety and trembling can be effectively managed while minimizing the risk of adverse effects.
From the FDA Drug Label
Common possible side effects in people who take Escitalopram tablets include: • Nausea • Sleepiness • Weakness • Dizziness • Feeling anxious • Trouble sleeping • Sexual problems • Sweating • Shaking • Not feeling hungry • Dry mouth • Constipation • Infection • Yawning
The patient is experiencing tremors and nervousness while taking Lexapro (escitalopram). These side effects are listed in the drug label as possible side effects of escitalopram, specifically shaking and feeling anxious.
- The patient should be monitored for these symptoms.
- The healthcare provider may consider adjusting the dose or switching to a different medication if the side effects are severe or intolerable.
- It is essential to weigh the benefits of continuing escitalopram against the risks of discontinuing treatment, considering the patient's improved anxiety symptoms 2.
From the Research
Patient's Current Condition
The patient is a 67-year-old female with anxiety, depression, and hyperlipidemia, who has been taking Lexapro (escitalopram) for 2 weeks, in addition to ongoing Wellbutrin (bupropion) and Activated (possibly an activated form of a medication or supplement). She has experienced improved anxiety but also tremors and nervousness.
Treatment Options
- The patient is seeking alternative treatment for nervousness, which may be a side effect of escitalopram 3.
- Escitalopram is an effective treatment for depression and anxiety, with a relatively fast onset of action and minimal interactions with other drugs 4.
- Bupropion, which the patient is already taking, has been shown to be effective in treating generalized anxiety disorder (GAD) and may be a viable alternative or addition to escitalopram 5.
- Combination therapy with escitalopram and bupropion may be superior to monotherapy in terms of speed of onset and remission rate 6.
Potential Side Effects
- Escitalopram may induce or exacerbate restless legs syndrome (RLS), a sensorimotor disorder characterized by distressing sensations in the limbs 3.
- The patient's tremors and nervousness may be related to escitalopram or another medication, and should be monitored and addressed by a healthcare professional.