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Lexapro vs Remeron
Introduction
For patients diagnosed with major depressive disorder (MDD) or other forms of depression, certain medications can help manage their symptoms and stabilize mood by altering the concentrations of neurotransmitters in the brain. Lexapro and Remeron are two such drugs prescribed for this purpose. Both these drugs impact different neurotransmitters but have mood-stabilizing effects on patients suffering from depression.
Lexapro, also known as Escitalopram, belongs to a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs), primarily affecting levels of serotonin in the brain. On the other hand, Remeron, known generically as Mirtazapine is classified as a noradrenergic and specific serotonergic antidepressant (NaSSA). It acts by increasing norepinephrine and serotonin while blocking specific serotonin receptors to achieve its therapeutic effect.
What is Lexapro?
Escitalopram (the generic name for Lexapro) is a drug of the SSRI class of antidepressants, representing a significant advancement from the older class of tricyclic antidepressants. It was first approved by the FDA in 2002. Lexapro increases levels of free serotonin by preventing its reabsorption, effectively "trapping" it in the brain longer than usual. This medication is commonly prescribed for treating various forms of depression and generalized anxiety disorder.
On the other hand, Mirtazapine (Remeron) belongs to a newer group known as NaSSAs (Noradrenergic and Specific Serotonergic Antidepressant). Unlike SSRIs that mainly affect serotonin levels, Remeron works on both norepinephrine and specific serotonergic receptors. While this dual action can make it more effective for some individuals, it may also result in more side effects compared to those who take Lexapro which primarily influences serotonin with minimal impact on norepinephrine.
What conditions is Lexapro approved to treat?
Lexapro is approved for treating the following types of conditions:
- Generalized anxiety disorder (GAD)
- Major depressive disorder (MDD)
On the other hand, Remeron is also used to treat:
- Major depressive disorder (MDD)
- Various types of sleep disorders due to its sedative properties
How does Lexapro help with these illnesses?
Lexapro works to manage depression by increasing the amount of serotonin available in the synapses of the brain. It does this by blocking it from being reabsorbed by neurons, which allows for levels to be maintained higher for longer periods. This is similar to Prozac but differs as Lexapro specifically inhibits serotonin and has minimal effects on norepinephrine and dopamine neuronal reuptake. Serotonin plays an important role in mood regulation, cognition, memory, sleep patterns, hunger, and body temperature among other things. It's believed that individuals with depression have relatively lower levels of serotonin. Therefore, by increasing serotonin availability in the brain through inhibition of its reuptake into presynaptic cells using Lexapro can limit depressive symptoms thus providing relief for patients managing their condition.
What is Remeron?
Remeron, a brand name for mirtazapine, is an atypical antidepressant that increases the levels of norepinephrine and serotonin in the brain by antagonizing specific adrenergic and serotonergic receptors. It was first approved by the FDA in 1996. As Remeron is not a selective serotonin reuptake inhibitor (SSRI), it does not work primarily by inhibiting the reuptake of serotonin like Lexapro or other SSRIs do. Its different mechanism of action means that its side-effect profile also differs from that of SSRIs: it tends to cause sedation as well as weight gain - common side effects not typically associated with SSRI medications such as Lexapro. The effects on norepinephrine and serotonin can be beneficial for treating depression, particularly in patients who do not respond well to standard SSRI antidepressants like Lexapro.
What conditions is Remeron approved to treat?
Remeron, also known as mirtazapine, is approved by the FDA for a range of conditions such as:
- Major depressive disorder (MDD), which includes symptoms like persistent sadness or lack of interest in previously enjoyed activities.
- Insomnia related to depression. Remeron can help regulate sleep patterns and improve quality of rest due to its sedative effects.
How does Remeron help with these illnesses?
Remeron, known generically as mirtazapine, is an antidepressant that operates by increasing the availability of serotonin and norepinephrine in the brain. These neurotransmitters are involved in mood regulation and responses to stress. In contrast to Lexapro, which primarily boosts serotonin levels, Remeron works on both pathways thereby enhancing mood elevation effects. Moreover, it also antagonizes specific histamine receptors which can lead to increased appetite and weight gain but also results in a pronounced sedative effect useful for patients with insomnia related issues. Hence, Remeron might be chosen over typical SSRIs like Lexapro when additional symptoms such as sleep disturbances or lack of appetite accompany depression.
How effective are both Lexapro and Remeron?
Both escitalopram (Lexapro) and mirtazapine (Remeron) have established histories of success in treating patients with depression, and they were initially approved by the FDA within a few years of each other. As they act on different neurotransmitters, they may be prescribed under different circumstances. The effectiveness of escitalopram and mirtazapine in alleviating depression was directly studied in various clinical trials; both drugs exhibited similar efficacy in managing symptoms of depression as well as comparable safety profiles.
A 2009 meta-analysis showed that escitalopram is effective from the first week of treatment for major depressive disorder (MDD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), obsessive-compulsive disorder (OCD), panic disorder, and more. Its side effect profile is favorable over many other antidepressants, particularly older ones like tricyclics, due to less risk for cardiac-related side effects or overdose toxicity. Further, there's evidence suggesting its superior efficacy compared to citalopram - an almost identical drug but containing two isomers instead of one.
On the other hand, a review published in Cochrane Database Systematic Reviews 2011 indicated that mirtazapine appears more effective than placebo at treating depression while being similarly efficacious when compared against SSRIs or Tricyclic Antidepressants(TCAs). Mirtazapine might cause lesser sexual dysfunction relative to SSRI's which can make it attractive for certain patient populations. However significant research has focused on mirtazapine co-prescribed alongside an SSRI or SNRI because data confirming its efficacy as stand-alone treatment is less robust than that for Lexapro. Nonetheless due to its unique pharmacology involving augmentation with noradrenaline serotonin specific action it may offer benefit where conventional strategies have failed especially among those dealing with insomnia or weight loss issues associated commonly with depressive disorders.
At what dose is Lexapro typically prescribed?
Oral dosages of Lexapro range from 10–20 mg/day, but research suggests that 10 mg/day is usually adequate for treating major depressive disorder in most adults. Adolescents and elderly patients may be started on 5 mg/day. In either population, the dosage can be increased after a few weeks if there is no significant response. It's important to note that the maximum daily dosage should not exceed 20 mg under any circumstances.
On the other hand, Remeron is typically prescribed at an initial dose of 15 mg/day for adults with depression and this could be gradually increased by your healthcare provider to a maximum of 45mg per day depending upon individual patient response. Dosage adjustments are often made based on clinical response and tolerability of the individual patient.
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At what dose is Remeron typically prescribed?
Remeron treatment typically begins at a dosage of 15 mg/day, usually administered as a single dose before sleep. The dosage can then be increased to 30-45 mg/day, again as a single dose taken in the evening or at bedtime. A maximum dose may reach up to 60mg per day, based on patient response and tolerance after consultation with your healthcare provider. This higher dosage might be considered if there is no noticeable improvement in symptoms after several weeks of treatment at the lower doses.
What are the most common side effects for Lexapro?
Common side effects of Lexapro may include:
- Nausea, diarrhea and constipation
- Decreased libido (sex drive)
- Dry mouth
- Drowsiness/sleepiness
- Sweating
- Fatigue, general weakness and fatigue
- Insomnia or difficulty sleeping
In comparison, Remeron often results in:
- Increased appetite leading to weight gain
- Dizziness
- Constipation
- Dry mouth -Somnolence (sleepiness/drowsiness) which can be severe at times.
Please note that while these are some common side effects both medications can present with a unique profile for each individual. It is always best to discuss potential risks and benefits with your healthcare provider before making a decision on medication.
Are there any potential serious side effects for Lexapro?
Both Lexapro and Remeron are medications used in the treatment of depression, but they do have different potential side effects. For instance:
- Increased suicidal thoughts or tendencies: This is a common risk associated with many antidepressants, especially for those under 25. If you notice this symptom while taking either drug, seek immediate medical attention.
- Allergic reaction signs: Symptoms such as hives, difficulty breathing, swelling of your face or throat could indicate an allergic reaction to either medication.
- Vision problems: Both drugs can cause blurred vision. However, if you experience tunnel vision, eye pain or swelling or see halos around lights while on these medications, contact your doctor immediately.
- Cardiovascular issues: Fast or pounding heartbeats and shortness of breath may occur with both drugs. Feelings of sudden dizziness should be addressed promptly with your healthcare provider.
- Hyponatremia (low sodium levels): This condition can cause headaches confusion slurred speech severe weakness vomiting loss of coordination feeling unsteady and it's important to get help right away if you suspect this complication
- Severe nervous system reactions are rare but serious side effects that need immediate medical attention.
Remember that both medications also carry a risk of developing serotonin syndrome – symptoms including fever sweating shivering fast heart rate muscle stiffness twitching loss of coordination nausea vomiting diarrhea should not be ignored.
It's crucial to remember everyone reacts differently to these medications; what works best will depend on individual health histories and present conditions which is why working closely with healthcare providers during treatment is key.
What are the most common side effects for Remeron?
Common side effects associated with Remeron include:
- Dry mouth
- Constipation, stomach pain
- Increased appetite and potential weight gain
- Drowsiness or sleep problems (insomnia)
- Lightheadedness or dizziness
- Shaking or tremors
- Unusual sensations such as tingling in the hands or feet
- A slower heartbeat than usual. It's crucial to note that while some individuals may experience these side effects, not everyone will. Each person reacts differently to medication. Always consult with your healthcare provider about any concerns you have when taking a new medication like Remeron.
Are there any potential serious side effects for Remeron?
When taking Remeron, it's important to be aware of the potential side effects. These can include:
- Signs of an allergic reaction: hives; difficulty breathing; swelling in your face or throat
- Increased suicidal thoughts or feelings
- Unusual changes in mood or behavior, including confusion and restlessness
- Blurry vision, tunnel vision, eye pain or seeing halos around lights
- Rapid heartbeat or irregular pulse
- Signs of a manic episode such as racing thoughts, increased energy levels, reckless behavior, excessive happiness or irritability and severe sleep disturbances
If you experience any of these symptoms while on Remeron therapy, seek immediate medical attention. It's crucial to remember that everyone responds differently to medication and what works for one patient may not work for another. Always consult with a healthcare professional before starting any new drug regimen.
Contraindications for Lexapro and Remeron?
Both Lexapro and Remeron, like many other antidepressant medications, could potentially exacerbate symptoms of depression in certain individuals. If you notice a worsening of your depression, or an increase in suicidal ideation, thoughts or behavior while taking either drug, please seek immediate medical attention.
Neither Lexapro nor Remeron should be taken if you are currently using or have recently used monoamine oxidase inhibitors (MAOIs). It is vital to always inform your physician about all medications that you are taking; MAOIs will require a period of roughly 14 days to clear from the system to prevent dangerous interactions with both Lexapro and Remeron.
How much do Lexapro and Remeron cost?
For the brand name versions of these drugs:
- The price for 30 tablets of Lexapro (10 mg) averages around $350, which works out to roughly $11.60/day.
- The price for 30 tablets of Remeron (15 mg) is approximately $250 or about $8.33/day.
So, if you are on a higher dosage range for Lexapro i.e., 20 mg/day, then branded Remeron tends to be less expensive on a per-day treatment basis. However, it's important to note that cost should not be the primary consideration when determining which drug is right for you.
As with most medications, generic versions offer significant savings:
- Escitalopram (the generic form of Lexapro), costs about $0.25 - $2 per tablet depending upon your dose and where you get it filled.
- Mirtazapine (generic version of Remeron), ranges from as low as about $.50 - $.90 per tablet also dependent on dose and pharmacy choice.
These prices can vary based on location and any insurance coverage but in general terms, both generics provide a more affordable alternative than their brand-name counterparts while offering similar therapeutic benefits.
Popularity of Lexapro and Remeron
Escitalopram, also known by its brand name Lexapro, was estimated to have been prescribed to about 27.7 million people in the US in 2020. Escitalopram accounted for just over 17% of SSRI prescriptions and nearly 12% of overall antidepressant prescriptions in the country. The use of escitalopram has seen an upward trend since 2013.
On the other hand, Mirtazapine (Remeron) had a relatively lower prescription rate at around 4 million people in the USA during the same year. It represents approximately less than 10% of all antidepressant prescriptions. Despite being classified as an “atypical” antidepressant like bupropion, it does not fall into broad categories like SSRIs or SNRIs but is preferred due to its unique action mechanism and fewer sexual side effects associated with usage compared to other classes of drugs used for depression treatment. The prevalence of mirtazapine has shown a steady increase over the last decade.
Conclusion
Both Lexapro (escitalopram) and Remeron (mirtazapine) have been widely used for the treatment of depression, with numerous clinical studies and meta-analyses indicating their effectiveness compared to placebo. At times, these drugs may be combined, but this requires careful consideration by a physician due to potential interactions. The two medications work differently; Lexapro is an SSRI that primarily affects serotonin levels in the brain while Remeron works on both serotonin and norepinephrine receptors.
Lexapro is commonly considered as a first-line therapy for depression due to its efficacy and tolerability profile, whereas Remeron might usually be added if patients do not respond well to SSRIs or need additional help with sleep or appetite issues often associated with depression.
Both medications are available in generic form which can significantly cut costs for those paying out of pocket. It should also be noted that both Lexapro and Remeron require time before their full effects become noticeable.
While side effects are generally mild with both drugs, they differ slightly: Lexapro has fewer tendencies towards weight gain but may contribute more towards sexual dysfunction than Remeron. Importantly, like many antidepressants, patients taking either drug should closely monitor any changes in mood or behavior when starting treatment especially worsening of depressive symptoms or emergence of suicidal thoughts—medical assistance should be sought immediately under such circumstances.