What to Know about Escitalopram (Lexapro)

Having anxiety or depression can feel frustrating, even overwhelming, if you can’t find the right treatment. For many people, taking medication is a significant step in allowing them to improve their mental health.

One common medication often used to treat anxiety and depression is escitalopram (often known by the brand name Lexapro). On this page, we’ve outlined some important information about the popular drug.

What is escitalopram?

What is escitalopram? How does it work?

Escitalopram is an antidepressant used to treat conditions such as major depressive disorder (MDD) and anxiety. Also called Lexapro, it may sometimes be used to treat OCD, eating disorders, panic disorders, PTSD, and premenstrual dysphoric disorder. 

Escitalopram belongs to a class of medications called Selective Serotonin Reuptake Inhibitors, or SSRIs. SSRIs like escitalopram work by increasing the amount of serotonin in the brain. Serotonin is a neurotransmitter that affects mood, pain, and anxiety. 

How should escitalopram be used?

Escitalopram comes in both a solid and liquid form. If you have been prescribed liquid escitalopram, make sure to measure your dose accurately, with a dosing syringe or a medicine dose-measuring device. It is important to have a precise dose in order to ensure effectiveness and reduce the risk of side effects. 

Standard dosages differ depending on the condition and person being treated. 10 mg orally once a day is a common starting dose for adults with anxiety or depression. The maximum daily dose for escitalopram is considered to be 20 mg per day, but do not take more or less than your prescribed dose without consulting your doctor. Your doctor may decide to start you lower and increase your dosage as you continue with the medication, depending on your response. 

If you take escitalopram and have been feeling better for several months, your doctor might suggest coming off of the medication, though a longer course of treatment may be appropriate. This process often involves gradually reducing the dose over several weeks (sometimes longer, if you have been taking the medication for a long time). This process—also called “tapering”—helps reduce any negative reactions associated with coming off of SSRIs too quickly. This is also referred to as “SSRI discontinuation syndrome”. 

What are some possible side effects?

Some common side effects of escitalopram include:

  • Nausea
  • Increased sweating
  • Changes in sex drive or ability 
  • Fatigue or drowsiness 
  • Constipation

Some serious (but uncommon side effects) include:

  • Swelling of the face, throat, tongue, lips, or eyes
  • Fever 
  • Unusual excitement
  • Hallucinations
  • Problems with thinking, concentrating, or memory 

Call 911 or seek emergency care if you notice any severe side effects. 

Why do these side effects occur? 

Any medication can potentially lead to side effects, and a person’s likelihood of having side effects depends on many factors, including age, lifestyle, and the type of medication itself. Side effects may occur because drugs often have broad or poorly targeted effects, or the drug target itself may have many downstream effects on the body. For example, though escitalopram targets the neurotransmitter serotonin to help improve mood, there are other areas affected by serotonin, and unusual changes in serotonin levels can lead to side effects. As pharmaceutical research develops, medicines are often refined to have fewer side effects. 

Many non-serious side effects of mental health medications like escitalopram go away after a few weeks as your body gets used to the medication. However, if a side effect persists, is intolerable, or severely hinders your ability to go about your daily life, talk to your doctor, because this might be a sign of a deeper problem. 

How do your genes relate to escitalopram? 

Genetics can affect your body’s response to medication. Escitalopram is primarily metabolized by the CYP2C19, CYP3A4, and CYP2D6 enzymes. This means that people with certain variations of these genes may metabolize escitalopram more slowly or quickly than others. Being a slow metabolizer means your body will break down the medication more slowly than others, which means the drug sticks around for longer than intended and may lead to side effects. For slow metabolizers, a doctor might opt to prescribe a different medication or prescribe a lower dosage. Being a fast metabolizer means the drug will be broken down to work and may be less effective at the standard dosage. Doctors may adjust the prescription accordingly. 

One way to predict whether you’ll have a positive outcome while taking escitalopram is by taking a genetic test to determine what genetic variations you have and how they affect medication metabolization. Your DNA can help your doctor rule out less suitable medications and make more informed decisions so that you can get better, faster.

Special Precautions

  • Escitalopram may cause some teenagers and young adults to be agitated, irritable, or display abnormal behaviors. Others may have trouble sleeping, get upset easily, have a big increase in energy, or start to act recklessly. Let a doctor know if you feel any of these effects, as they may be linked to bipolar disorder.
  • Escitalopram may cause drowsiness, difficulty thinking, or difficulty controlling meetings. Be careful when driving or using machinery while taking escitalopram. 
  • Patients taking escitalopram are recommended to modulate alcohol use. 

If you show signs of an allergic reaction to escitalopram (hives, difficulty breathing, rash, swelling), call 911 or go to the nearest emergency department.

Some medications, vitamins, and herbs may interfere with how escitalopram works. Make sure to tell your doctor about all other medications you are taking before starting escitalopram to avoid negative interactions. For full details, see the FDA’s full list of precautions

Looking to find the right medication for your mental health? Join Prairie today to connect to expert providers and affordable medication options. 

Authors

  • Dr. Mike Hoaglin is a practicing mental health physician, advisor, and digital health expert passionate about clinical transformation and the microbiome. Dr. Hoaglin earned his medical degree from the Perelman School of Medicine at the University of Pennsylvania, with residency training at The Brooklyn Hospital Center and Duke University Medical Center.

  • Prairie Health is an online psychiatry service focused on reducing all barriers to mental healthcare and modernizing treatment. Prairie specializes in helping adults with depression or anxiety get better through online psychiatry appointments, genetics-informed medication plans and ongoing support, all from the comfort of home.

Published
Categorized as Medication

By Mike Hoaglin

Dr. Mike Hoaglin is a practicing mental health physician, advisor, and digital health expert passionate about clinical transformation and the microbiome. Dr. Hoaglin earned his medical degree from the Perelman School of Medicine at the University of Pennsylvania, with residency training at The Brooklyn Hospital Center and Duke University Medical Center.