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.

What Is Escitalopram(Lexapro)?

Escitalopram is an antidepressant that the Food and Drug Administration has approved to treat depression and generalized anxiety disorder (GAD). 

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® and Pexeva®)

• Sertraline (Zoloft®)

Lexapro Uses

Aside from depression and anxiety, healthcare providers also sometimes prescribe Lexapro off-label for conditions like:

• Bulimia

• Obsessive-compulsive disorder

• Bipolar disorder

• Premenstrual dysphoric disorder (PMDD)

• Post-traumatic stress disorder (PTSD)

• Panic disorder (which is 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 are less likely to cause severe side effects or dangerous drug interactions. 

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

How Does Lexapro Work?

Your body naturally produces chemicals that make you feel good (thanks, brain!). One key chemical, serotonin, is crucial in regulating our moods. It’s often referred to as the “feel-good” neurotransmitter.

Maintaining "normal" serotonin activity is essential for stabilizing mood, regulating appetite, and promoting healthy sleep patterns.

While there’s no single definitive cause of depression, researchers have observed a potential link to low serotonin activity.

So, how does Lexapro fit into this picture?

Escitalopram works like other SSRIs. It inhibits your brain’s reuptake of the neurotransmitter serotonin. In other words, it prevents serotonin from being absorbed back into the brain cell that produced and released it.

This results in modified serotonin activity in your brain, which is thought to reduce or eliminate symptoms of anxiety and depression.

How Long Does It Take for Escitalopram to Work?

Escitalopram often has a longer onset of action. That means it doesn’t start working immediately after you take it.

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. 

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

If you’re prescribed escitalopram at a standard dose for treating depression or an anxiety disorder and decide to stop (with guidance from your healthcare provider!), it would take approximately seven to nine days to leave your body completely.

In some cases, healthcare providers may advise people taking escitalopram to also take a benzodiazepine during the first few weeks. Benzodiazepines can help reduce the early adverse effects of SSRIs and ease the adjustment period. It’s important to limit the duration of benzodiazepine use, however. Long-term use can result in tolerance, dependence, and a worsening of the underlying anxiety.

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

It’s important to note that this practice isn’t standard and applies only to a small subset of individuals prescribed escitalopram or Lexapro. In many cases, the risks of using a benzodiazepine outweighs the potential benefits.

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 time that works best for you and stick to it.

Should you take Lexapro with food? You can take escitalopram after eating a meal or on an empty stomach — either works.

If you forget to take escitalopram (it happens!) and remember on the same day, take the dose as soon as you remember. If you forget and only remember the next day, it’s best to skip the missed dose and resume your regular once-a-day schedule. No need to double up.

Also, be sure to store your meds in a closed container at room temperature and away from heat, moisture, and direct light.

Escitalopram Dosages

Escitalopram comes in tablet and liquid oral solution forms. In tablet form, it’s available in three different strengths: 5 mg, 10 mg, and 20 mg.

Doctors typically prescribe escitalopram at a dosage of 10 mg to 20 mg per day for depression, generalized anxiety disorder, and other anxiety disorders.

Your provider will determine the appropriate dose of escitalopram based on your symptoms and how you respond to the medication and may adjust it accordingly.

Accidentally taking too much escitalopram can result in:

• An overly fast heart rate

• Vomiting

• Dizziness

• Seizures

• Sedation

• Shaking

If you ever accidentally take too much escitalopram and experience these symptoms, seek help immediately.

Also, if, after a few weeks, it feels like it isn’t “working,” it’s important that you don’t stop taking the medication suddenly. You’ll want to speak with your healthcare provider first before making any kind of adjustments. Sometimes it can take four or even eight weeks to experience the full effect of the medication.

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 — which is plenty common. Finding the right treatment for your unique situation can take some time and patience, but it will be worth it.

Escitalopram (Lexapro) Side Effects 

As with any medication, escitalopram may cause a range of potential side effects. These side effects are common to all SSRIs.

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)

• Eye pain and angle-closure glaucoma

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

Most are minor and temporary. Often, they improve over several weeks as your body gets used to taking something new.

Symptoms like insomnia can be managed by making a few smart adjustments to your routine. For example, if you’re prone to insomnia, try taking escitalopram in the morning.

But in some cases, the side effects can be serious, especially for those under the age of 25 or those with a history of seizures or mania.

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to escitalopram.

Your healthcare provider will likely want to monitor Lexapro's side effects during the first week of taking escitalopram. 

Other Common Side Effects of Escitalopram:

• Weight gain. In general, large-scale studies show that long-term use of many antidepressants is associated with weight gain. However, specific study data on escitalopram and weight changes is very limited, with no definitive studies showing that it does or doesn’t cause weight changes. One small study found that people with obesity and overweight who also have eating disorders experienced weight reduction with escitalopram.

• Sexual side effects. Anorgasmia (difficulty experiencing orgasm) is a noted sexual side effect of Lexapro.

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.

Escitalopram Precautions

In rare cases, taking certain medications along with escitalopram can increase the risk of serotonin syndrome.

Serotonin syndrome is a potentially life-threatening drug reaction that causes the body to have too much serotonin activity. It can be caused by certain drug interactions.

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 symptoms suggesting serotonin syndrome, seek immediate medical attention.

Also, the FDA requires all antidepressants, including Lexapro (escitalopram), to carry a 'black box' warning that describes an increased risk of suicidal thoughts or behavior in children and young adults. This risk is most pronounced during the initial weeks and months of treatment.

If you’re prescribed escitalopram or any other antidepressant and notice worsening symptoms or increased 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 and herbal products. 

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 the risk of abnormal bleeding

• Triptans and medications used to treat migraines, like sumatriptan

• Water pills

• Methylene blue

It’s important to note that escitalopram is often used with some of the medications and supplements listed above, but extra caution and monitoring are required. Also, 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 before taking escitalopram. The same is true if you’re breastfeeding, or if you will be soon. Many women who are pregnant and breastfeeding use this medication, but it requires careful consideration of the risks and potential benefits.

Escitalopram Withdrawal

Abruptly stopping treatment may lead to withdrawal symptoms. Don’t change your dosage suddenly, and let your healthcare provider know how you’re feeling as you begin treatment so they can help you taper off escitalopram or Lexapro safely.

The most common withdrawal symptoms associated with escitalopram include:

• Paresthesias (prickling, tingling sensation on the skin)

• Irritability

• Headache

• Nausea

• Feeling dizzy

• Vomiting

Stopping escitalopram does not cause craving for the drug, so despite the potential for withdrawal symptoms, it’s not an addictive drug.

Final Thoughts on Escitalopram (Lexapro)

Lexapro is one of the most commonly prescribed antidepressants, and it’s considered an effective treatment for depression and anxiety disorders. Here a few things to remember as you consider whether escitalopram is right for you:

• Escitalopram is an SSRI that works by regulating serotonin activity in your brain to improve your mood.

• Take escitalopram at the same time every day, and be sure to store your meds in a closed container at room temperature and away from heat, moisture, and direct light.

• To avoid any dangerous interactions, disclose all your current medications and nutritional supplements to your medical provider. Similarly, tell your provider if you’re pregnant, might become pregnant, or are breastfeeding.

• Once prescribed, escitalopram may take some time to start working. Try to be patient, and 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, mild side effects are more common, and they tend to subside after several days or weeks.

Do you feel ready to take the next step? We offer online access to a full range of medications for anxiety and depression following a consultation with a psychiatry provider who will determine if a prescription is appropriate.

You can schedule a consultation with a mental health provider now and find out if you might benefit from escitalopram.