Escitalopram (Lexapro®): What It Is, How It Works, Uses & More

A few facts for you according to the folks from The Anxiety and Depression Association of America and the National Institute of Mental Health: In 2020, an estimated 14.8 million U.S. adults aged 18 or older experienced at least one major depressive episode over the last year. And generally, more than 40 million Americans (that’s almost 20 percent of the adult population!) are affected by an anxiety disorder of some kind.  

It’s no surprise then that Lexapro® is one of the most recognizable drug names of our modern era. Escitalopram, a less recognizable term, is the generic name for this common prescription antidepressant. 

Used correctly over the long term, escitalopram may wind up being one of your best friends. But like your actual best friends, your relationship with it will depend on what we in the mental health business like to call “gained experiences” — the good ones and the not-so-good ones, too.

Like other antidepressants — and medications in general — it can cause a range of side effects that you should be aware of before using this medication. Below, we dive into the how, what, and why of escitalopram to help you understand if it’s the right path.

Both brand name Lexapro® and generic escitalopram are considered SSRIs, or selective serotonin reuptake inhibitors, a class of medications commonly used to treat major depressive disorder, anxiety disorders and other psychological conditions.

Other popular SSRIs include:

• Citalopram (Celexa®)

• Fluoxetine (Prozac®)

• Paroxetine (Paxil®, Pexeva®)

• Sertraline (Zoloft®)

As an SSRI antidepressant, escitalopram is commonly prescribed to treat depression. The FDA also approves it for the treatment of generalized anxiety disorder (GAD). 

It’s sometimes prescribed off-label to treat conditions such as bulimia, obsessive-compulsive disorder, bipolar disorder, premenstrual dysphoric disorder (PMDD), post-traumatic stress disorder (PTSD) and panic disorder (characterized by frequent panic attacks).

Compared to older antidepressants like monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs), SSRIs like escitalopram tend to be safer and less likely to cause side effects or dangerous drug interactions. 

And whereas  serotonin norepinephrine reuptake inhibitors (SNRIs, like duloxetine) impact both serotonin and norepinephrine levels, SSRIs focus specifically on serotonin.

Your body naturally produces chemicals that make you feel good (thanks, brain!). One particular chemical, serotonin, is believed to be especially important in the regulation of our moods — which is why you may have heard it referred to as the “feel good” neurotransmitter. 

In fact, “normal” levels of serotonin are not only important for maintaining a stable mood, but also for regulating appetite and our ability to sleep. 

While there’s no one definitive “cause” of depression, one thing researchers have picked up on over time is that low serotonin levels may be associated with it.

Escitalopram works like other SSRIs — by inhibiting your brain’s reuptake of the neurotransmitter serotonin. In other words, it stops your brain from absorbing serotonin after it’s released. The result is higher levels of serotonin in your brain, which are believed to be associated with less doom and gloom, and more sunshiney days. 

Escitalopram Onset of Action: How Long Does It Take To Work?

As is often the case with medications, escitalopram doesn’t start working immediately. 

It’s possible that escitalopram can take several weeks to start working as a treatment for depression and anxiety disorders and you may not notice any improvements right away. 

When and How To Take Escitalopram

You can take escitalopram at any time of day — morning or night — but it’s best to be consistent. Find the best time of day for you and try to stick to it.  

If you're wondering, "Should you take Lexapro with food?" the answer — according to the FDA — is, essentially, “do your thing.” You can take escitalopram after eating a meal or on an empty stomach. 

If you forget to take escitalopram (it happens!) and remember on the same day, take the next dose as soon as you remember. If you forget and only remember the next day, it’s best to just skip the missed dose and take the medication once per day, as normal. So, no doubling up!
Store your meds in a closed container at room temperature and away from heat, moisture and direct light. 

Escitalopram Half-Life

Escitalopram has a half-life of 27 to 32 hours. In other words, if you take a dose of 10mg of Lexapro, only 5mg will remain in your bloodstream after 27 to 32 hours. 

Suppose you’re prescribed escitalopram at a normal dose for treating depression or an anxiety disorder and stop taking it (with the guidance of your healthcare provider!). In that case, it’ll take approximately seven to nine days to exit your body completely.

Escitalopram comes in tablet and liquid oral solution form. In tablet form, it’s available in three different strengths: 5mg, 10mg and 20mg tablets. For depression, escitalopram is normally prescribed at a dosage of 10mg to 20mg, taken one time per day.

For generalized anxiety disorder and other anxiety disorders, escitalopram is prescribed from 10mg to 20mg per day. 

Based on your symptoms and individual response to the medication, your provider will decide the correct dose of escitalopram for you — and may adjust your dosage of escitalopram over time. 

If you ever accidentally take too much escitalopram and experience symptoms such as an overly fast heart rate, vomiting, dizziness, seizures, sedation or shaking, seek help immediately. 

If, after a few weeks, it feels like escitalopram isn’t “working,” don’t just stop taking the medication suddenly. Never stop taking the medication or adjust your dosage without speaking to your healthcare provider first.

Reach out to your provider, tell them what’s going on and make a decision together. They’ll either work with you to find a different dosage of escitalopram or may even recommend another medication entirely — not only is that okay, but it’s also common. Finding the right treatment for your unique situation can take some time and patience, but trust us when we say this: it’s worth it.

As with any medication, escitalopram may cause a range of potential side effects. These side effects are common to all SSRIs, and most are minor and temporary. But some can be serious — especially during the first weeks of use, and doubly especially for those under the age of 25 or those with a history of seizures or mania.

The most important thing is keeping an open line of communication with your healthcare provider — not just in the first weeks of taking Lexapro, but throughout your treatment.

During the first week of taking escitalopram, your healthcare provider will likely want to monitor Lexapro side effects. 

Potential side effects of escitalopram include:

• Dry mouth

• Increased sweating

• Dizziness

• Nausea

• Diarrhea

• Constipation

• Indigestion

• Abdominal pain

• Flu-like symptoms

• Fatigue 

• Insomnia or trouble sleeping

• Somnolescence (drowsiness)

• Reduced appetite

• Sexual problems like decreased libido (reduced interest in sex)

• Rhinitis and sinusitis

• Eye pain and angle-closure glaucoma

Of these side effects, more common ones include nausea, insomnia, tiredness and decreased libido. 

Often, they improve over several weeks as your body gets used to taking something new. Symptoms like insomnia can be mediated by making a few smart adjustments to your routine. For example, if you’re prone to insomnia, try taking escitalopram in the morning.
In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to escitalopram.

In rare cases, people taking escitalopram may be advised to take a benzodiazepine along with the medication for the first few weeks, as benzodiazepines can help reduce the early adverse effects of SSRIs and make the adjustment period easier. 

According to a 2008 study, taking an SSRI with a benzodiazepine can help regulate anxiety quickly. It can also help patients deal with the agitation that can occur when you first start taking an SSRI.

Some research also suggests that SSRIs and benzodiazepines can be paired to treat GAD and help you adjust to taking an SSRI. Benzodiazepines are not intended for long-term use because of the potential for addiction. So, after a few weeks, your healthcare provider will likely wean you off of any benzodiazepines.

It’s worth noting, however, that this isn’t standard practice and only applies to a small number of people who take escitalopram or Lexapro.

Other Common Side Effects of Escitalopram You May Be Wondering About

• Weight gain. In general, large-scale studies do tend to show that long-term use of antidepressants is associated with weight gain side effects.
  However, study data on escitalopram and weight changes is very limited, with no definitive studies showing that it does or doesn’t cause changes in weight. 
  Some research, such as this small-scale study conducted in 2007, has found that escitalopram is effective in reducing weight in obese and overweight people with eating disorders.

• Sexual side effects. Anorgasmia (difficulty experiencing orgasm) is a noted sexual side effect of Lexapro. In women, clinical trials of escitalopram for depression found that roughly two to six percent of users reported experiencing it. 

Withdrawal Symptoms Associated with Escitalopram

The most important thing to remember about taking escitalopram or any prescription medication, really, is to make sure not to make any sudden changes to your dosage and to let your healthcare provider know how you’re feeling as you begin treatment. 

The most common withdrawal symptoms associated with escitalopram include:

• Paresthesias (prickling, tingling sensation on the skin)Irritability

• Headache

• Nausea

• Feeling dizzy

• Vomiting

What About Serotonin Syndrome?

In rare cases, there is a risk of serotonin syndrome when you increase the dose of certain medications or start taking a new drug. 

Serotonin syndrome is a potentially life-threatening drug reaction that causes the body to have too much serotonin. It can be caused by certain drug interactions, as well as drinking alcohol while taking a medication like Lexapro.

The signs and symptoms of Serotonin Syndrome include:

• Agitation or restlessness

• Insomnia

• Dilated pupils

• Loss of muscle coordination or twitching muscles

• Muscle rigidity

• Tremor

• Heavy sweating

• Diarrhea

• Headache

• Shivering

• Goosebumps

Severe serotonin syndrome can be life-threatening. Signs include:

• High fever

• Confusion

• Seizures

• High blood pressure

• Irregular heartbeat

• Rapid heart rate

• Unconsciousness

If you experience any signs or symptoms that might indicate you have serotonin syndrome, you need to seek medical treatment immediately.

Lexapro Black Box Warning

All antidepressants, including Lexapro (escitalopram), carry a “black box” warning from the FDA that lists potentially serious side effects and provides important safety information about the medication. 

This warning states that antidepressant medications are associated with an increased risk for suicidal thoughts and/or behavior in children and/or young adults. For many antidepressants, this risk is highest during the first few weeks and months of treatment.

If you’re prescribed escitalopram or any other type of antidepressant and experience a worsening of symptoms or an increase in suicidal thoughts, contact your healthcare provider as soon as possible. 

Escitalopram Interactions

Escitalopram can interact with a variety of medications, including both over-the-counter medications and prescription drugs. It’s also possible for escitalopram to interact with certain supplements, herbal products and vitamins. 

To avoid interactions, tell your healthcare provider about any medications, supplements, vitamins and other health products you use before taking escitalopram. Pay close attention to the safety instructions provided with escitalopram regarding drug interactions. 

Common medications it may interact with include:

• Monoamine oxidase inhibitors, or MAOIs, including phenelzine, isocarboxazid, tranylcypromine, selegiline and others. 

• Other antidepressants, including other SSRIs, SNRIs and tricyclic antidepressants

• Antipsychotic and antianxiety medications such as pimozide and benzodiazepines, and anticonvulsants like gabapentin 

• Sleep aids such as zolpidem

• Lithium

• Opioid painkillers, like tramadol.

• Amino acids, such as tryptophan

• Stimulants

• Linezolid

• Over-the-counter treatments for depression such as St. John’s wort 

• NSAIDs, naproxen and aspirin

• Blood thinners and anticoagulants, like warfarin, due to risk of abnormal bleeding

• Triptans and medications used to treat migraines like sumatriptan

• Water pills

• Methylene blue

If you have a history of heart problems — such as QT prolongation and heart rhythm disturbance — you should talk to your healthcare provider before taking escitalopram.

You should also speak to your healthcare provider if you’re pregnant or trying to get pregnant. 

Escitalopram has a category C rating from the FDA, which means animal studies have found that it may cause problems for unborn children, but that there is insufficient study data regarding its effects on a human fetus during pregnancy. There are also considerations regarding Lexapro andbreastfeeding. A small amount of escitalopram may pass into your breast milk, which may be hazardous to your baby, although in most studies, the small amount of escitalopram that may be present in breast milk appears unlikely to cause any long-term harmful effects for babies. 

Still, depending on your needs and overall health, your healthcare provider may recommend making changes to your use of escitalopram during pregnancy.

A few things to remember as you consider whether escitalopram is right for you:

• To avoid any dangerous interactions, be sure to disclose all of your current medications to your medical provider.

• Similarly, make sure to tell your provider if you’re pregnant, might become pregnant, or are breastfeeding.

• Once prescribed, escitalopram may take some time to start working. Don’t go rogue and start adjusting your dosage. Always speak to your doctor before making any changes.

• During the first several weeks of taking escitalopram, as your body is getting used to the new medication, you may experience an array of side effects. 

• While serious side effects exist, most are mild and tend to subside after several weeks.

Ready to take the next step? Schedule a consultation with a mental health provider now and find out if you might benefit from escitalopram.