Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Escitalopram is an oral drug that is used
for treating depression and
generalized anxiety disorder. Chemically,
escitalopram is similar to citalopram (Celexa). Both are in the class of drugs
called selective serotonin reuptake inhibitors (SSRIs), a class that also
includes fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft). SSRIs
work by affecting neurotransmitters in the brain, the chemical messengers that
nerves use to communicate with one another. Neurotransmitters are made and
released by nerves and then travel to other nearby nerves where they attach to
receptors on the nerves. Some neurotransmitters that are released do not bind to
receptors and are taken up by the nerves that produced them. This is referred to
as "reuptake." Many experts believe that an imbalance of neurotransmitters is
the cause of depression. Escitalopram prevents the reuptake of one
neurotransmitter, serotonin, by nerves, an action which results in more
serotonin in the brain to attach to receptors. The FDA approved escitalopram in
August 2002.
PRESCRIPTION: Yes
GENERIC AVAILABLE: No
PREPARATIONS: Tablets: 5, 10, and 20 mg. Solution: 1 mg/ml
STORAGE: Escitalopram should be stored at room temperature, 15-30 C
(59-86 F)
PRESCRIBED FOR: Escitalopram is approved for the treatment of
depression and generalized anxiety disorder. Drugs in the SSRI class also have
been studied in persons with obsessive compulsive disorders and
panic disorders,
but escitalopram is not approved for this purpose.
DOSING: The usual starting dose of escitalopram is 10 mg once daily in
the morning or evening. The dose may be increased to 20 mg once daily after 1
week. Benefit may not be seen until treatment has been given for up to 4 weeks.
A daily dose of 20 mg may not be anymore effective than 10 mg daily for
treatment of depression. Escitalopram can be taken with or without food.
DRUG INTERACTIONS: All SSRIs, including escitalopram, should not be
combined with drugs in the monoamine oxidase (MAO) inhibitor class of
antidepressants such as isocarboxazid (Marplan), phenelzine (Nardil),
tranylcypromine (Parnate), selegiline (Eldepryl) and
procarbazine (Matulane).
Such combinations may lead to confusion,
high blood pressure,
high fevers,
tremor or muscle rigidity, and increased activity. At least 14 days should
elapse after discontinuing escitalopram before starting an MAO inhibitor.
Conversely, at least 14 days should elapse after discontinuing an MAO inhibitor
before starting escitalopram.
Tryptophan can cause headaches, nausea, sweating,
and dizziness when taken with any SSRI.
Use of selective serotonin inhibitors may increase the risk of
gastrointestinal bleeding in patients taking
aspirin,
nonsteroidal
antiinflammatory drugs, and other drugs that cause bleeding.
PREGNANCY: The safety of escitalopram during
pregnancy and
breastfeeding has not been established. Therefore, escitalopram should not be used
during pregnancy unless, in the opinion of the physician, the expected benefits
to the patient outweigh unknown hazards to the fetus.
Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.
Panic attacks are sudden feelings of terror that strike without warning. These episodes can occur at any time, even during sleep. A person experiencing a panic attack may believe that he or she is having a heart attack or that death is imminent. The fear and terror that a person experiences during a panic attack are not in proportion to the true situation and may be unrelated to what is happening around them. Most people with panic attacks experience several of the following symptoms: racing heartbeat, faintness, dizzyness, numbness or tingling in the hands and fingers, chills, chest pains, difficulty breathing, and a feeling of loss or control. There are several treatments for panic attacks.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Bipolar disorder (or manic depression) is a mental illness characterized by depression, mania, and severe mood swings. Treatment may incorporate mood stabilizer medications, antidepressants, and psychotherapy.
Obsessive compulsive disorder (OCD) is an anxiety disorder that causes a person to suffer repeated obsessions and compulsions. Symptoms include irresistible impulses despite a person's realization that the thoughts are irrational, excessive hand washing, skin picking, lock checking, or repeatedly rearranging items. People with OCD are more likely to develop trichotillomania, muscle or vocal tics, or an eating disorder. Treatment for OCD includes psychotherapy, behavioral therapy, and medication.
Attention deficit hyperactivity disorder (ADHD) is a behavioral disorder characterized by the symptoms hyperactivity, impulsivity, and inattention. Treatment for ADHD may involve behavioral therapy and psychostimulant or antidepressant medication.
Phobias are unrelenting fears of activities (social phobias), situations (agoraphobia), and specific items (arachnophobia). There is thought to be a hereditary component to phobias, though there may be a cultural influence or they may be triggered by life events. Symptoms and signs of phobias include having a panic attack, shaking, breathing troubles, rapid heart beat, and a strong desire to escape the situation. Treatment of phobias typically involves desensitization, cognitive behavioral therapy, and medications such as selective serotonin reuptake inhibitors and beta blockers.
Separation anxiety disorder is a common childhood anxiety disorder that has many causes. Infants, children, older kids and adults can suffer from symptoms of separation anxiety disorder. Common treatment methods include therapy and medications.
Childhood depression can interfere with social activities, interests, schoolwork and family life. Symptoms and signs include anger, social withdrawal, vocal outbursts, fatigue, physical complaints, and thoughts of suicide. Treatment may involve psychotherapy and medication.
Dysthymia is a less severe form of chronic depression. Symptoms and signs include insomnia, suicidal thoughts, guilt, empty feeling, loss of energy, helplessness, sluggishness, and persistent aches and pains. Treatment may involve psychotherapy, electroconvulsive therapy, and antidepressants.
Postpartum depression is a form of depression that occurs within a year after delivery. It is thought that rapid hormone changes after childbirth may lead to depression. Symptoms of postpartum depression include crying a lot, headaches, chest pains, eating too little or too much, sleeping too little or too much, withdrawal from friends and family, and feeling irritable, sad, hopeless, worthless, guilty, and overwhelmed. Treatment typically involves talk therapy and medication.
Depression in teenagers may be caused by many factors. Symptoms of teen depression include apathy, irresponsible behavior, sadness, sudden drop in grades, withdrawal from friends, and alcohol and drug use. Treatment of depression in adolescents may involve psychotherapy and medications.
Depression in the elderly is very common. That doesn't mean, though, it's normal. Treatment may involve antidepressants, psychotherapy, or electroconvulsive therapy.
To understand separation anxiety disorder, it is important to first recognize the normal difficulty that infants and toddlers have with strangers and in separating from parents and caretakers. Infants show stranger anxiety by crying when someone unfamiliar to them approaches. This normal stage of development is connected with the baby learning to distinguish his or her parents or other familiar caretakers from people they don't know. Stranger anxiety usually starts at about 8 months of age and ends by 2 years of age, according to the American Academy of Pediatrics.
Separation anxiety as a normal life stage first develops at about 7 months of age, once a baby understands that his or her caregivers do not disappear when out of sight (object permanence). That leads to the baby developing a true attachment to those adults. Normal separation anxiety is
most commonly at its strongest at 10-18 months of age and gradually subsides, us...
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