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Anxiety and Lexapro

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Here's the short version:

I've been having a hard time with anxiety for a long time. A previous attempt at medication didn't work. But starting last November, I've been taking Lexapro, and it's been great; in particular, it reduces my anxiety and lets me feel more like my old self again.

Much longer and more detailed version follows, including some explicit notes on sexual side effects.

Backstory

In the past, my default baseline mood was cheerful.

I thought of it as sort of like a ship; stormy weather could rock me, but I would eventually return to that cheerful and optimistic state.

As I noted in a post in 2013, I've always been a little bit socially anxious, and it got worse after my father's death. But I wasn't aware of it as anxiety per se until a friend posted about taking meds for anxiety. And I thought, wait, that's a thing you can do?

So in 2013, my doctor prescribed Zoloft. As described in another 2013 post, I tried it for a couple of months, but it had no positive effects, and it had several minor negative side effects. I eventually told the doctor that I was going to stop taking it; she said okay, but didn't offer any further suggestions or alternatives.

I saw another doctor in 2014 (at work), who prescribed another medication in the same family as Zoloft. It took me a long time to stop avoiding filling the prescription, but I finally filled it in 2015, and then I stalled; I didn't actually take any of the pills, because the doctor had said it would probably have the same effects as Zoloft, and I couldn't bring myself to do that again for a low chance of positive effects.

Lexapro

But the second doctor had also given me the name and number of a psychiatrist who had experience working with patients with anxiety. So after a particularly stressful day (I've never had a real panic attack, but that was about as close as I've come to one), I called up the psychiatrist and made an appointment.

And I went to see him in early November of 2015, and he told me that he liked to start people off on Lexapro. And I like the name Lexapro because it sounds appropriate for an editor and/or writer; and I think at least half a dozen of my friends have said good things about it. And so I gave it a try.

I started at 5mg/day. In the first week, I developed a very dry mouth, and some minor GI issues, and I started waking up abruptly after too little sleep. But none of those were significant problems, so I kept going. I was also having a sexual side effect: My libido was unabated, but it was taking me a long time to reach orgasm, and wasn't as satisfying when I did.

Around the end of the first week, I wrote, in an APA:

It hasn't really had time to take full effect, so I'm not sure whether my mental state is due to the drug or not. On the plus side, I haven't had as much anxiety per se lately; that ongoing current of fear under everything doesn't seem to be there. On the minus side, I'm still engaging in a lot of avoidance behavior, and I'm in kind of a weird headspace—maybe some flattening of affect, maybe subconscious difficulty around the anniversary of my mother's death (which also would've been my father's birthday).

...And then suddenly, a few days ago, things got a lot better. I feel like the Lexapro started by removing the constant background fear that was behind everything I was doing, but for a week or so it didn't replace it with anything; I just felt kind of empty. Not really flattened affect, just—I can't describe it any better than an emptiness. But then about twelve days into taking the meds, that emptiness was replaced by background cheerfulness. I still have a full emotional range; I can still get irritated or angry or sad. But when I stop being acted upon by an outside force, my emotional ship rocks back into a default cheerful position.

And this is how I've always thought of myself. It's how I used to be. But it hasn't been true for a while, and I've missed it.

I'm not certain it's the Lexapro. It could be the warm California sunshine; it could be due to happening across cheerful songs like “Good Day Sunshine”; it could be the virtuous cycle of starting to make progress at work, which is making me feel better, which is helping me to make more progress, which makes me feel more better.

And it's only been a few days; it could all change.

But right now, part of what's making me cheerful is just the fact that there's a bit of a smile lurking around the corners of my mouth these days. My default is back to optimism, and I'm really glad of that.

By the end of week two, the sleep issue and the upset stomach mostly or entirely went away, though the sexual issue continued.

Around the end of that second week, I wrote, in my personal meds journal (there's some overlap with the above):

For most of the past week or so, I wasn't really feeling anxious much, but I also wasn't doing all that well. I continued to avoid things, and when I felt for the anxiety/fear, like probing a loose tooth, it didn't seem to be there, but nothing else did either. Just sort of blank. Not completely flat affect; I was still having emotions. But my reaction to the thought of doing various things that needed doing was just neutral. I kind of felt that way about the bookcasewarming party, too, in the week that followed it: I didn't have any real sense of whether it had gone well or not, or of whether I had enjoyed it. Which made me stressed.

But yesterday I woke up cheerful, and sang "Good Day Sunshine" to myself as I biked to work in the chilly autumn sunlight, and it felt like things had finally shifted into what I was hoping for with this medication: the fear replaced with cheerfulness/happiness/optimism. The same seems to be true so far today as well.

I'm still avoiding various things. But I've made more progress in the past few days at work than I had made in the three weeks or so previous; and that's a virtuous cycle, because making progress on stuff relieves some of the anxious pressure, which makes it more feasible for me to make progress.

And I think that may be a little bit new, too: there was a while when it felt like making progress didn't reduce the anxiety.

So ... right at the moment I feel like the Lexapro is working really well. But it's only been just under two weeks, at a very low dosage; we'll see how things develop.

On November 20, 2015, I wrote:

Same as last report: continuing to be cheerful as a baseline. It's like being myself again. I've missed it.

But after a couple of weeks of being cheerful, it went away again. And the side effects stopped. (And the start of the cheerful period had been November 15, 2015, exactly the same date as when the same thing happened in 2013 (without meds), making me wonder if the temporary cheerfulness had had more to do with coming out of being sad about Peter's birthday (on the 11th) than with the meds.)

So a couple weeks later, around the end of 2015, I raised my daily dosage to 10mg, with my doctor's OK. (He had told me from the start that the plan was to start at a very low dosage and then increase it if needed.)

On February 2, 2016, I wrote:

For about two weeks after [the increase in dosage], there was no change. But then around January the cheerfulness came back. [The sexual side effect also came back, so I was again] having trouble maintaining an erection and taking a long time to [reach orgasm]; but I wasn't as distressed about it as I normally might be. And yesterday and today I was smiling at odd moments, even today when the sun wasn't out, and happy cheerful songs were running through my head. I still lose the cheerfulness pretty easily when work stresses and such happen, but it feels like it may be back as the baseline. Which is really nice. I hope it lasts.

And in another context, I wrote:

The anxiety isn't entirely gone, and I'm still engaging in some avoidance behavior. But everything is a little easier, a little more relaxed, a little less stressful. I can take setbacks a little more in stride. It's really nice.

On March 5, I wrote:

For the past month or so, libido has been normal, but same [sexual side effect] has been happening as happened in November [...]. The upside is that the Lexapro also helps me not mind any of that so much. When I was first considering anxiety meds, the idea of sexual dysfunction was a serious barrier for me; it seemed clear that if I had to choose between the two, I would choose anxiety. But now I'm not so sure. If I think of this as a lifelong thing, it's still pretty offputting; but in the moment, at any given time, the improvement in cheerfulness and ability to cope with life seems very much worth the tradeoff.

April:

Pretty much steady-state since last time I wrote: am more cheerful more often, and less anxious, and still having an annoying sexual side effect but still not minding it as much as I would without the Lexapro.

Oh, and there seem to be two other prominent side effects:

  • Tunes run through my head. A lot. Almost all the time. Earworm after earworm.
  • I'm forgetting things a lot. Might just be ordinary aging, but I feel like I'm losing track of more things than I usually do.

In theory, part of the point of the Lexapro is to ease the tension enough that I can get started on things like talk therapy and/or mindfulness meditation, things to help deal with the underlying issues. In practice, I'm still being pretty avoidant about all sorts of things, and making the calls I need to make to pursue the therapy and meditation options is not high on my to-do list.

But in May, things got bad again. Not so much anxiety as general grumpiness, irritability, and unhappiness. I wrote:

I thought it was probably due to external factors. I got a mediocre performance review at work, despite doing more and harder work than I've probably ever done before, and we had our big annual developer conference [...], and I spent three weeks reviewing three document sets that I hadn't known were in the works until they showed up on my plate. [...]

But a few days after [the conference], my mood wasn't doing any better. So my doctor agreed to raise my Lexapro prescription from 10mg a day to 15.

I was reluctant about that. I don't want to get into an endless cycle of habituating and raising the dosage; and my doctor told me that they don't normally prescribe over 30mg a day of Lexapro, so if my dosage does keep going up, then at some point we'll have to switch drugs. And I really like Lexapro.

But I was clearly in need of a change, and so I switched to 15, and things got better almost immediately. And now I'm back to my baseline-cheerful self.

Current status

It's now been about three months since the increase to 15mg, and things continue to go well. Almost all of the side effects have gone away entirely, except for the sexual issue, which I've found isn't really getting in the way of my enjoyment of sexual activity; it's mildly disappointing once in a while, but not deeply frustrating/upsetting the way it might've been a year ago.

I'm still engaging in some avoidance behavior, and I can still get stressed or frustrated or angry. And I still haven't signed up for talk therapy or mindfulness meditation. And I'm hoping that I won't habituate to the new dosage and need to increase it again.

But for now, it's going very well. I've become a big fan of Lexapro. I've encountered a few people for whom it hasn't done anything, but a bunch of people for whom it's greatly improved their quality of life. Good stuff.

(See also Facebook thread for this post.)

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