Medication Monday: Off-Label and Megadosing

I recently had an appointment with my psychiatrist where he decided to try me on a new dosage of Lexapro. The reason this is noteworthy is because I was already at the highest FDA approved level and was now going beyond that. This actually is not an uncommon practice, which is why for this week’s Medication Monday post I want to talk about off-label use and megadosing.

Off-label use means taking an FDA approved medication for an unapproved reason. One example of off-label use is megadosing, where a doctor prescribes higher than the approved dose of mental health medications. The basic idea, as my psychiatrist explained, is that the FDA sets the highest approved level based on the fact that above that limit, many people might to start experience increased side effects, including side effects related to serotonin syndrome, a potentially serious consequence of taking to many or too much of a selective serotonin reuptake inhibitor of SSRI. However, the FDA also recognizes that doctors, in their professional judgment, can recognize that a patient may benefit from such uses of specific medications.

For me, my psychiatrist explained that based on how I was tolerating the Lexapro at 20 mg/d, which is the highest approved dose, he felt confident that I could tolerate an increase to my medication. When I asked, like the knowledgeable mental health advocate I strive to be, about serotonin syndrome, the psychiatrist said the symptoms of serotonin syndrome generally include shakiness in the limbs, sweating, skin flushing, muscle rigidity, and confusion. He then said that if you get a little skin flushing or slightly shaky hands, that is not the emergency that you often hear about serotonin syndrome being, and that even those side effects were unlikely for me given how I tolerated my current dose. So after explaining the rest of the risks and side effects, we decided to go ahead with the plan.

Some of the other medications I’ve discussed in this series also have known off-label uses as well. This demonstrates that there can be many different options to try when finding the right medication. Questions about medications should be directed to one’s doctor. Medication Monday is not meant as a substitute for medical advice, but rather as a brief introduction to mental health medications and some of the issues associated with that. As such, I hope this post has been helpful if going off label is something you or someone you care about might be considering. And as always, thanks for reading.

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