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Jun 25, 2021
6 min read

Escitalopram (Lexapro): dosage, uses, side effects

Escitalopram oxalate (brand name Lexapro) is a prescription drug approved to treat major depression and generalized anxiety disorder. Common side effects include dry mouth, trouble sleeping, sexual dysfunction, and nausea. The FDA has a black box warning for generic escitalopram: People taking generic escitalopram or brand name Lexapro have an increased risk of suicidal thoughts and behaviors, especially children, teenagers, or young adults. Families and caregivers should be aware of this risk and watch out for suicidal thoughts, attempts, other mood changes (including depression and mania), or changes in behavior.

linnea zielinski

Reviewed by Chimene Richa, MD

Written by Linnea Zielinski

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Escitalopram, or Lexapro, has been on the market since 2002. It’s one of several prescription drugs used to treat depression, anxiety, or both. Before starting this medication, you should be aware of Lexapro’s uses, side effects, and other information to ensure you are making the right treatment choice. 

What is escitalopram (Lexapro)?

Escitalopram (brand name Lexapro; see Important Safety Information) is a prescription drug known as a selective serotonin reuptake inhibitor or SSRI. These drugs raise your serotonin levels and help in the treatment of depression and anxiety. Serotonin is a neurotransmitter in the brain and nervous system essential for a healthy mood. 

SSRIs are one of the first-line options for treating depression symptoms. Lexapro and generic escitalopram are also used to treat anxiety. Other SSRIs include citalopram (brand name Celexa), fluoxetine (brand name Prozac; see Important Safety Information), paroxetine (brand name Paxil), and sertraline (brand name Zoloft; see Important Safety Information) (Chu, 2021). 

Escitalopram uses

Escitalopram is FDA-approved to treat (FDA, 2017):

  • Major depressive disorder (MDD) in adults and adolescents over age 12: MDD or unipolar depression is a mental health condition where you have symptoms of persistently sad moods, a lack of desire to do anything, a sense of hopelessness or guilt, and other symptoms that affect your ability to function. Escitalopram is approved for both short-term and long-term depression treatment (Bains, 2021).
  • Generalized anxiety disorder (GAD) in adults: With GAD, people feel excessive worry about many things, to the point where it can interfere with aspects of daily life. Escitalopram is approved for short-term anxiety treatment (Munir, 2021).

Healthcare providers often use medications to treat conditions other than the FDA-approved ones—this is called using a drug “off label.” Many of these “off-label” uses of escitalopram are widely researched and include (UptoDate, n.d.):

Escitalopram side effects

The U.S. Food and Drug Administration (FDA) has a black box warning for both generic escitalopram and brand name Lexapro, indicating that people taking this drug and their families should watch for any behavioral or mental health changes. Concerning changes include worsening depression, panic attacks, and suicidal thoughts when starting escitalopram or after a dose change. Adolescents are at an increased risk of these side effects when taking antidepressant medications (FDA, 2018).

If you or someone in your family experiences these symptoms, get medical help right away.

Most of the common side effects of Lexapro appear to be dose-dependent, meaning there’s a higher chance of experiencing these side effects if you’re on 20 mg than 10 mg. Some of the most common side effects include (FDA, 2017): 

  • Diarrhea
  • Nausea
  • Ejaculation problems
  • Drowsiness
  • Headache 
  • Trouble sleeping
  • Decreased sex drive (libido)

Less often, people may experience other adverse effects like weight gain, blurry vision, muscle stiffness, and joint pain (FDA, 2017).

SSRIs have a reputation for causing weight changes—studies show that they may increase your risk of weight gain. The association between SSRIs, including Lexapro, and weight gain, is most significant during the second and third years of treatment (Gafoor, 2018).

Sexual side effects can also occur in men and women taking escitalopram. Men may experience ejaculatory disorder (delayed ejaculation), lower sex drive, impotence, and priapism (a painful and persistent erection). Women may experience lower sex drive as well as an inability to orgasm (FDA, 2017). Tell your healthcare provider about any sexual side effects you may be having—alternative treatments, like bupropion (see Important Safety Information), mirtazapine (see Important Safety Information), and serotonin-norepinephrine reuptake inhibitors (SNRIs) like duloxetine (brand name Cymbalta; see Important Safety Information) and venlafaxine (brand name Effexor; see Important Safety Information) may be potential options for you (Jing, 2016).

If you’re experiencing side effects on Lexapro, it’s important to talk to your healthcare provider before discontinuing the medicine. If you stop taking it suddenly, you may experience Lexapro withdrawal symptoms such as nightmares, irritability, headache, nausea, feeling dizzy, or vomiting (Hirsch, 2020).

Escitalopram dosage

Lexapro and generic Lexapro are available in three different tablet strengths: 5 mg, 10 mg, and 20 mg. They’re also both made as an oral solution with a concentration of 1 mg/mL. Both adults and adolescents typically start at a dose of 10 mg once daily. For adults, this dose may be increased after a minimum of one week, depending on symptoms, side effects, etc. (FDA, 2017). 

That waiting window is longer for young adults, though—they need to take their starting dose for at least three weeks before making changes to dosage. Though providers may use generic Lexapro for the long-term management of MDD, it’s generally not prescribed for long-term or maintenance use when treating GAD. Although escitalopram is approved for adolescents with major depression, its safety has not been established for anyone younger than 12 years old (FDA, 2017).

Escitalopram drug interactions

Tell your healthcare provider about any medications or over-the-counter supplements you may be taking to avoid potential drug interactions. Drug interactions can lead to serious side effects. One of the most severe drug interactions with escitalopram is serotonin syndrome. With this condition, too much serotonin builds up in the body, leading to shivering, high blood pressure, elevated heart rate, fever, and diarrhea. Serotonin syndrome can even cause more severe symptoms like seizures, coma, or death (Simon, 2021). 

Since escitalopram increases serotonin levels in the body, you should not take it with other drugs that do the same thing. Other medications that affect serotonin levels (serotonergic drugs) include triptans, tricyclic antidepressants (like amitriptyline), fentanyl, lithium, tramadol, tryptophan, buspirone (see Important Safety Information), amphetamines, and even over-the-counter supplements containing St. John’s Wort (Simon, 2021). 

A build-up in serotonin can also happen because your body isn’t breaking down the neurotransmitter appropriately. Certain prescription medications affect how your body metabolizes serotonin, especially monoamine oxidase inhibitors (MAOIs) such as linezolid, phenelzine, isocarboxazid, selegiline, and tranylcypromine. Combining MAOIs with SSRIs like escitalopram increases your risk of serotonin syndrome; avoid taking escitalopram within 14 days of using MAOI medications (FDA, 2017).

You should also be careful when taking Lexapro with any medication with a blood-thinning effect, whether prescription blood thinners such as warfarin (brand name Coumadin) or over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen. Taking these medications with Lexapro may put you at an increased risk of bleeding (FDA, 2017).

Avoid combining alcohol with escitalopram. 

This SSRI antidepressant is known for making you feel tired and interfering with your ability to make decisions. It may take some time to feel the full effects of escitalopram and figure out how it affects you. For that reason, avoid driving or operating heavy machinery until you understand just how this antidepressant affects you. Alcohol has similar effects on your ability to make decisions and react to events. Clinical trials have not shown that Lexapro makes these alcohol effects worse, but standard medical advice is to avoid alcohol while taking escitalopram (FDA, 2017).

Escitalopram warnings

As mentioned, escitalopram carries a black box warning from the FDA. Some people taking this medication, especially children, teenagers, and young adults up to 24, can develop worsening depressions and suicidal thoughts or tendencies. If you are having suicidal thoughts, consult a healthcare professional immediately.

There are times when you should avoid escitalopram or use it with caution, including: 

  • Do not take escitalopram if you have had an allergic reaction to the medication or any other SSRI.
  • Use with caution if you are prone to seizures or have a history of a seizure disorder.
  • If you are pregnant, plan to become pregnant, or are breastfeeding, talk to your healthcare provider about the risks of taking this medication. 

This list is not exhaustive. Consult with your healthcare provider regarding any medical conditions you have before starting treatment with escitalopram.

References

  1. Bains, N. et al. (2021). Major depressive disorder. [Updated Apr 20, 2021]. In StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK559078/
  2. Chu, A. & Wadhwa, R. (2021). Selective serotonin reuptake inhibitors. [Updated May 10, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK554406/
  3. Food and Drug Administration (FDA). (2017, Jan). Lexapro (escitalopram oxalate). Retrieved June 21, 2021 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021323s047lbl.pdf
  4. Food and Drug Administration (FDA). (2018). Suicidality in children and adolescents being treated with antidepressant medications. Retrieved June 21, 2021 from https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/suicidality-children-and-adolescents-being-treated-antidepressant-medications
  5. Gafoor, R., Booth, H. P., & Gulliford, M. C. (2018). Antidepressant utilisation and incidence of weight gain during 10 years’ follow-up: population based cohort study. BMJ (Clinical Research Edition), 361, k1951. doi: 10.1136/bmj.k1951. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29793997/
  6. Hirsch, M. & Birnbaum, R. J. (2020). Discontinuing antidepressant medications in adults. In UptoDate. Roy-Byrne, P.P. & Solomon, D. (Eds.). Retrieved from https://www.uptodate.com/contents/discontinuing-antidepressant-medications-in-adults
  7. Jing, E., & Straw-Wilson, K. (2016). Sexual dysfunction in selective serotonin reuptake inhibitors (SSRIs) and potential solutions: A narrative literature review. Mental Health Clinician, 6(4), 191-196. doi: 10.9740/mhc.2016.07.191. Retrieved June 21, 2021 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007725/
  8. Munir, S. & Takov, V. (2021). Generalized anxiety disorder. [Updated May 8, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK441870/
  9. Simon, L. V., & Keenaghan, M. (2021). Serotonin syndrome. [Updated Jul 22, 2021]. In StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK482377/
  10. UptoDate. (n.d.). Escitalopram: drug information. Retrieved on June 21, 2021 from https://www.uptodate.com/contents/escitalopram-drug-information