Escitalopram (Lexapro)

This article provides an overview of escitalopram, including the benefits, side effects, interactions, and how it fits into individualized mental health treatment plans.

Key Takeaways:

• Escitalopram is a common antidepressant medication within the SSRI category. It works by increasing the effects of serotonin in the brain, which can help with mood and overall mental health.

• Escitalopram is primarily used to treat depression and anxiety in both adults and children. The typical dose is 10-20 mg per day.

• There are several side effects and drug interactions with escitalopram, some of which may be severe. Consulting with your doctor is essential to ensure the safest and most effective treatment for your individual needs.

Escitalopram overview

Escitalopram is a selective serotonin reuptake inhibitor (SSRI). It is one of the most commonly prescribed antidepressant medications and is used primarily for depression and anxiety disorders.

In the United States, escitalopram is FDA-approved for treating major depressive disorder (MDD) in adults and children over 12. And it is also FDA-approved for treating generalized anxiety disorder (GAD) in adults and children over the age of 7. It is used very similarly in countries outside of the US as well. ^{[1] [2]}

Brand Names

The most common brand name of escitalopram is Lexapro®, particularly in the United States. Another common brand name of escitalopram is Cipralex®, which is more common in countries outside of the US.

How does escitalopram work?

Escitalopram works by binding to the serotonin transporter protein (SERT), which in turn inhibits the reuptake of serotonin by the nerve cells that released it. In turn, this allows more serotonin to be available in the brain. ^{[1] [2]}

Serotonin is an essential neurotransmitter with key roles in mood, stress, appetite, sexual function, fear, and other key functions related to overall mental health and well-being. Therefore, increasing levels of serotonin is thought to improve many symptoms associated with depression and anxiety. ^{[1] [3]}

When is it prescribed?

Escitalopram is most often prescribed for individuals suffering from moderate to severe symptoms of depression or anxiety.

Symptoms of depression include: ^[4]

• Feeling significantly down, sad, or depressed

• Loss of interest or pleasure in activities and hobbies

• Significant changes in eating or sleeping habits

• Fatigue and lack of energy

• Suicidal thoughts or behaviors

• Feelings of guilt, shame, or worthlessness

Symptoms of anxiety include: ^[4]

• Excessive worry

• Difficulty concentrating

• Restlessness/inability to relax

• Trouble sleeping

• Irritability

• Muscle tension

In addition to MDD and GAD, escitalopram is sometimes used off-label for other conditions, such as: ^[4]

• Obsessive-compulsive disorder (OCD)

• Panic disorder

• Post-traumatic stress disorder (PTSD)

• Social anxiety disorder (SAD)

• Eating disorders

• Vasomotor symptoms within menopause (i.e. hot flashes and night sweats)

What to know before taking escitalopram

As with any prescription medication, it’s important to understand the relevant factors and characteristics to determine if it’s right for your situation. You want to make sure that you’re getting the correct dose for your needs, and to ensure that all precautions are taken to minimize the chance of risks and side effects.

Dosage

In relation to MDD and GAD, the dosing is similar for both adult and pediatric treatment (for approved pediatric indications, with careful monitoring). Specifically, for any instances of MDD or GAD, the recommended doses are as follows: ^{[1] [2]}

• Initial dose: 10 mg

• Recommended dose: 10 mg

• Maximum dose: 20 mg

Doses for off-label uses are similar, with the following guidelines:

• OCD: 10-20 mg/day

• Menopausal symptoms: 10-20 mg/day

Escitalopram is taken once daily. It can be taken in the morning or evening, with or without food. ^[2]

Precautions

Individuals who are pregnant or nursing should be monitored very carefully if taking escitalopram. In these situations a lower dose is typically recommended. ^{[1] [2]}

Also, a dose of no more than 10 mg per day is recommended for older adults and people with liver impairment, due to reduced clearance abilities. ^{[1] [2]}

Caution is also advised when taking escitalopram for individuals with the following conditions or symptoms: ^[2]

• Seizures

• Hyponatremia (low blood sodium)

• Bipolar disorder

• Angle closure glaucoma

Side effects

Escitalopram is generally safer than older forms of antidepressants, but it still has several possible side effects. This is because it can affect many areas of the body, including areas outside of the brain and nervous system. ^[1]

If you take escitalopram, it’s important to always contact your provider about any side effects you’re experiencing.

Common side effects

The most common side effects of escitalopram are: ^{[1] [2] [5]}

• Insomnia

• Sexual dysfunction

• Reduced libido

• Inability to orgasm

• Delayed ejaculation

• Nausea

• Sweating

• Fatigue

• Sleepiness

Other relatively common side effects include: ^{[3] [4] [5]}

• Yawning

• Shaking

• Constipation

• Stomach pain

• Dry mouth

• Decreased appetite

• Nervousness

• Weight loss

• Flu-like symptoms

• Runny nose

• Sneezing

Rare and severe side effects

There are several rare side effects of escitalopram, too, some of which may be severe. One major rare side effect to be aware of is an increased risk of suicidal thoughts and behaviors, particularly in children and young adults under age 25. This risk is greatest when these individuals initially start taking escitalopram or when the dose is changed. ^{[1] [2]}

If you or your child is taking escitalopram, make sure to watch out for any warning signs of suicidality and contact your healthcare provider immediately.

Other rare side effects include: ^{[1] [2] [3]}

• Hyponatremia (low sodium levels in the blood)

• Risk is greater in older adults

• QT prolongation: a heart rhythm abnormality that can potentially be fatal

• Abnormal bleeding or bruising

• Hallucinations

• Rash, hives, or blisters

• Itching

• Fever

• Joint pain

• Allergic reactions

• Unsteadiness

• Seizures

• Difficult or painful urination

• Problems concentrating, thinking, or with memory

Serotonin syndrome

Another rare but very important side effect to be aware of is serotonin syndrome. This occurs when too much serotonin builds up in the nervous system.

Symptoms of serotonin syndrome include nausea, vomiting, diarrhea, agitation, delirium, tremors, muscle rigidity, and rapid heart rate, among other mental, physical, and neurological effects. Severe cases can lead to seizures, coma, and death. ^{[1] [2]}

The risk of serotonin syndrome is greater when escitalopram is combined with other drugs that increase serotonin, such as monoamine oxidase inhibitors (MAOIs) and other antidepressants. ^[1]

Drug interactions with escitalopram

Escitalopram may interact with several different drugs. This includes prescription and over-the-counter medications, as well as certain herbs, supplements, and recreational drugs.

Specific prescription medications that may interact with escitalopram include: ^{[1] [2] [3] [4]}

• MAOIs (e.g. phenelzine, selegiline)

• Serotonin-norepinephrine reuptake inhibitors (SNRIs)

• Tricyclic antidepressants (e.g. desipramine)

• Certain antipsychotics, such as pimozide

• Certain antiseizure medications, such as carbamazepine

• Methadone

• Lithium

• Methylene blue

Other drugs and supplements that may interact with escitalopram include: ^{[1] [2] [3] [4]}

• Ibuprofen

• Warfarin

• Aspirin

• St. John’s wort

• Tryptophan

• Fentanyl

• Amphetamines

Cessation and withdrawal

If the decision is made to stop taking escitalopram, it must be done gradually under medical supervision. This process typically takes several weeks or longer, depending on how long you’ve used escitalopram and what your current dose is. ^[2]

Abruptly stopping escitalopram or lowering the dose too quickly increases the risk of antidepressant discontinuation syndrome, which leads to withdrawal-like effects. This is especially important with escitalopram, which can have a more pronounced discontinuation effect when compared to other antidepressants. Withdrawal symptoms of escitalopram include nausea, diarrhea, anxiety, dizziness, irritability, nightmares, trouble sleeping, mood changes, headache, and paresthesia (tingling, burning, or electric shock-like sensation on the skin). Furthermore, you may experience a worsening of depressive symptoms and an increase in suicidality. ^{[1] [2] [4]}

When to stop taking escitalopram

The decision to stop taking escitalopram should only be made after consulting with the doctor who initially prescribed it. Some individuals may be able to stop taking escitalopram if their symptoms improve significantly and have remained improved for a long enough period of time.

Typically, escitalopram should be taken for at least 6 months, after which a decision can be made. Some individuals may only require escitalopram for a relatively shorter period of time, such as 6 months to 1 year, while others may require long-term treatment.