Lexapro (Escitalopram): Uses, Dosage, Side Effects and More

By Jenell Decker, MD
Medically reviewed checkmarkMedically reviewed
February 12, 2020

Lexapro (escitalopram) is a commonly prescribed medication for treating depression and anxiety. Nearly 26 million Americans take Lexapro to help improve their energy levels and well-being and feel less nervous.

What Is Lexapro?

Lexapro is a commonly prescribed antidepressant used to treat clinical depression and anxiety. These are not just feelings you can always “snap out” of, and millions of Americans with these mental problems feel better with this medication. Lexapro belongs to a class of drugs called selective serotonin reuptake inhibitors or SSRIs. These types of medicines act on chemical messengers or neurotransmitters in the brain that may be unbalanced in people with depression or anxiety.

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Lexapro Generic Name

Lexapro is a brand name for the generic drug called escitalopram oxalate or escitalopram for short. The Food and Drug Administration (FDA) approved the first generic version of Lexapro in 2012.

Escitalopram Uses

Escitalopram (Lexapro) has two main uses: to treat people who are at least 12 years old for major depressive disorder in the short-term (acute) or long-term (maintenance), and to treat adults who have generalized anxiety disorder.

According to the National Institute of Mental Health (NIMH), both of these disorders are common in America:

  • Major depressive disorder (MDD): More than 7% of American adults have at least one major depressive episode a year, with more women than men reporting experience this disorder. Depression most often occurs in young adults aged 18-25 years old.
  • Generalized anxiety disorder (GAD): Almost 6% of American adults have had GAD at some point in their lifetime. What’s more, nearly one in three people with GAD experience severe anxiety and mental illness.

Lexapro and depression

Major depressive disorder, also called clinical depression, is a common and serious mood disorder where you have a persistent feeling of sadness and loss of interest, and you may feel as if life isn’t worth living. You lose interest in activities you once enjoyed and you are unable or find it hard to carry out your day-to-day tasks. Apart from these emotional problems, you may also have physical symptoms such as chronic pain or digestive issues.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, also known as the DSM-5, to be diagnosed with major depressive disorder, you will have at least five of the following symptoms where at least one of the symptoms is either a depressed mood or a loss of interest/pleasure. You will have have had these symptoms persistently nearly every day for at least two weeks:

  • A depressed mood
  • A loss of interest in your usual activities
  • A significant change in appetite and/or weight
  • A slowing-down of thought and a visible slowing-down of movements, and physical and emotional reactions (psychomotor retardation)
  • Fatigue or loss of energy
  • Feelings of excessive or inappropriate guilt or worthlessness
  • Difficulty thinking and concentrating, or indecisiveness
  • Suicidal thoughts, recurrent suicidal ideation, or a suicide plan or attempt

Lexapro and anxiety

Generalized anxiety disorder is where you have excessive anxiety and worry that is difficult to control. This anxiety and worry can be about various activities in your life, reducing your ability to cope with everyday tasks and causing you a lot of distress. GAD occurs on more days than not for at least six months.

According to the DSM-5, GAD is associated with at least three of the following symptoms:

  • Restlessness or feeling keyed up or on edge
  • Being easily fatigued
  • Difficulty concentrating or your mind going blank
  • Irritability
  • Muscle aches or soreness
  • Difficulty sleeping

Escitalopram may also be helpful for some people when their doctor prescribes it for “off-label” use. “Off-label” means that it hasn’t been approved by the FDA for other conditions. Escitalopram is sometimes prescribed off-label for conditions including obsessive compulsive disorder (OCD), panic disorder, and premenstrual dysphoric disorder. Your doctor should have justifiable, good reasons and be up-to-date on the medical research before prescribing escitalopram for these conditions.

How Does Escitalopram Work?

Escitalopram is a selective serotonin reuptake inhibitor or SSRI, which means it acts in the brain to prevent the reuptake or absorption of serotonin by neurons (brain nerve cells). This results in increased levels of serotonin in the brain because it is kept around for longer before being absorbed by neurons. Since serotonin is a chemical that helps to regulate your mood, this is how it is thought to relieve depression.

Before You Take Escitalopram

Escitalopram is not a medication that is ideal for everyone with MDD or GAD. You should not take it if you are aware of an allergy or hypersensitivity to escitalopram or citalopram (Celexa) or if you also take pimozide (Orap). Before you take escitalopram, your doctor will need to go through your medical history and check that you do not have any other health issues which would affect how well this medicine will work. For example, your doctor will not prescribe escitalopram if you have bipolar depression and the FDA recommends caution in prescribing escitalopram if you have a seizure disorder or bipolar mania.

Make sure your doctor knows if you have liver or kidney disease because this can affect how well your body can break down and eliminate escitalopram from your body. Your doctor should also be aware if you have heart disease, high blood pressure, or a bleeding or clotting disorder. Moreover, if you’re pregnant or nursing a baby, escitalopram should be avoided since there is a risk it could harm the fetus and it can be passed through breast milk to a newborn baby.

Escitalopram can potentially interact with numerous medications, increasing or decreasing its concentration in the blood or how well it works. Such escitalopram interactions can also cause preventable side-effects. It is very important that your doctor knows what other medications you are currently taking before prescribing escitalopram. You also need to make sure you notify your doctor if you start or stop taking over-the-counter (OTC) medications or off-the-counter supplements while on escitalopram.

Do not use escitalopram if you have taken a monoamine oxidase inhibitor (MAOI) in the last 14 days or are about to take an MAOI within the next 14 days because this can result in dangerously increased blood pressure and serotonin syndrome.

Other medications that can interact with escitalopram include:

Avoid drinking alcohol with escitalopram as this can cause unpleasant but preventable side effects. Escitalopram can impair your thinking and reactions so make sure while you are taking this medicine that you are especially careful while driving or carrying out other activities where you need to be alert.

Escitalopram Dosage

You will need to take escitalopram once a day by mouth as a tablet or liquid with or without food. Try to take the medicine at the same time each day. Your doctor will start you on a low dose and slowly increase it if needed.

Most people taking escitalopram will take it as a dose in the range of 10-20 mg.

If taking escitalopram as a liquid, make sure to measure it accurately with a dosing spoon or oral syringe. This should come with your medicine and if not, you can get it from your pharmacy.

Store your medicine at room temperature away from moisture and heat.

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What happens if I miss a dose?

Always take your medication according to your doctor’s instructions and what it says on the information sheet that comes with your tablets. If you miss a dose, take it as soon as possible. However, if it is nearly time for your next dose, skip the missed dose and continue with your regular dosing schedule. Never double your dose to compensate for your missed dose.

How long does it take for escitalopram to take effect?

You will need to be patient when you first start taking escitalopram since it is slow acting and it can take up to four weeks before you feel any effects. You will need to make regular follow-up appointments with your doctor to make sure you are continuing on the best dosage for you.

Can you stop escitalopram cold turkey? Does escitalopram cause withdrawal symptoms?

Do not stop taking escitalopram, even if you feel better, without discussing it first with your doctor. If you and your doctor find that it is time to stop taking escitalopram, it is not a good idea to cease the medication suddenly. This is because you can end up with some unpleasant escitalopram withdrawal symptoms. These can include irritability, nausea, dizziness, vomiting, nightmares, headaches, and/or tingling prickly skin. Instead, discuss with your doctor how you can slower reduce your dose to avoid any unwanted withdrawal effects.

Common Side Effects

Common escitalopram side effects include but are not limited to:

  • Dizziness, drowsiness, weakness
  • Sweating, feeling shaky or anxious
  • Sleep problems (insomnia)
  • Dry mouth
  • Nausea
  • Constipation
  • Yawning
  • Decreased sex drive, impotence, or difficulty having an orgasm
  • Weight gain

Lexapro and weight gain

You may gain a little bit of weight when taking escitalopram. Experts are not sure why this happens but it may be that SSRIs cause changes in your body’s metabolism so that you are not as efficiently using up the calories you take in through your food. It could also be because the drug increases your appetite.

Escitalopram Alternatives

Escitalopram is not for everyone who is diagnosed with MDD or GAD. If for whatever reason escitalopram is not alleviating your anxiety and/or depression, or you cannot take escitalopram due to a pre-existing medical condition or medication that would interact with escitalopram, there are other treatments that may help you.

Talk with your doctor to see whether you can try other medications such as sertraline (Zoloft) and bupropion (Wellbutrin), or various therapies such as cognitive-behavioral therapy, psychotherapy, acceptance and commitment therapy (ACT), or other ‘talk therapies’. Many people experiencing depression and GAD find such therapies to be of great benefit. K Health offers K Therapy, a text-based therapy program that includes unlimited messaging with a licensed therapist, plus free resources designed by mental health experts to use on your own.

Lexapro vs. Zoloft

Both escitalopram and Zoloft are SSRIs which means they work in the brain to combat depression and anxiety in a similar way. However, Zoloft is also FDA approved to treat obsessive compulsive disorder, panic disorder, and premenstrual dysphoric disorder (PMDD), while escitalopram is only used off-label for these conditions.

Concerning side effects, the two drugs have some side effects in common such as, drowsiness, nausea, feeling shaky, changes in appetite, headache, diarrhea, difficulty sleeping (insomnia), dry mouth, increased sweating, weight changes, sexual difficulties, and upset stomach/indigestion. However, Zoloft can also cause other side effects including nervousness, dizziness, skin rash, or constipation.

Zoloft is taken at a higher dosage than escitalopram. Namely, 25-200 mg once daily for all approved conditions except for PMDD which is at 50-150 mg daily. Both drugs have interactions with MAOIs and can cause unpleasant withdrawal symptoms if you stop taking them suddenly.

Lexapro vs. Wellbutrin

Wellbutrin and escitalopram are both antidepressants that are used to treat major depressive disorder. As we have discussed, escitalopram is also used to treat anxiety. Whereas Wellbutrin is also used to treat seasonal affective disorder (SAD). SAD is another mood disorder where people have depressive symptoms at only a particular time each year, most often during the winter. The two medicines belong to different drug classes; while escitalopram is an SSRI, Wellbutrin is an aminoketone. This means that Wellbutrin works in the brain to prevent the reuptake or absorption of dopamine and norepinephrine. By preventing their uptake, Wellbutrin increases their levels in the brain.

The two drugs have side effects in common and some different side effects. Both drugs interact with MAOIs. Wellbutrin should not be taken if you have a history of seizures.

Which antidepressant has the least side effects?

Each antidepressant can have different side effects and different people will react to antidepressants differently. It is always worth discussing possible major side effects with your doctor or pharmacist. Doctors usually start by prescribing an SSRI, such as escitalopram and Zoloft, because these medications tend to cause fewer side effects and are less likely to cause problems at higher therapeutic doses than other types of antidepressants. If your doctor thinks it is worth you trying Zoloft or Wellbutrin instead of starting or continuing on escitalopram, feel free to ask questions and discuss any concerns you have.

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When to See a Doctor

Major depressive disorder

If you’ve been feeling down, depressed or hopeless and feeling for at least a couple of weeks little interest or pleasure in things you normally enjoy, it is time to see your primary-care doctor or a mental-health specialist for an evaluation. This is particularly important if you’ve also been having trouble sleeping or concentrating, notice changes in your appetite and energy, and have thoughts of death. If you have people in your family with clinical depression this may be a clue to some genetic cause of how you’re feeling.

At your first visit to the doctor or mental-health specialist, he or she will ask you about your feelings and symptoms, how long you’ve had them, and whether you’re changing or limiting your activities as a result. You may also be asked to answer a short questionnaire called the PHQ-9 which will further help your doctor determine whether you have depression and if yes, the severity of your symptoms. Depending on the type of depression you may have, your doctor may suggest psychotherapy and/or prescribe you medication. Normally you will be on such antidepressant medication for at least half a year. Be warned that stopping early can put you at a high risk of relapse. You will need regular follow up appointments with your doctor to check all is going as it should.

Many people find psychotherapy is as effective as medication and it may be even more effective than medication in the long-term. K Health offers K Therapy, a text-based therapy program that includes unlimited messaging with a licensed therapist, plus free resources designed by mental health experts to use on your own.

Your family and close friends should be aware you’re on medication so they can support you and also because some young people can have thoughts of suicide when first taking an antidepressant. If you notice mood changes or suicidal ideation, especially in the beginning of treatment, notify your doctor or seek medical attention right away.

Generalized anxiety disorder

If you are finding that your anxiety is giving you feelings of not being able to cope or feeling overwhelmed, that it is interfering with your daily life, or you have the feeling it is caused by an underlying mental health problem, it’s time to see your doctor. This is particularly important if you have experienced an anxiety attack with mental and physical symptoms such as:

  • Feelings of danger, panic, or dread
  • Nervousness or restlessness
  • Rapid heart rate
  • Sweating
  • Trembling or chills
  • Tiredness or weakness
  • Gastrointestinal problems
  • Difficulty focusing
  • Hyperventilation

Your doctor may refer you to a mental health practitioner who will work with you to discuss your concerns, find ways of coping you may have not considered before, recommend a form of psychotherapy, and if needed, see if you can benefit from medication. Anxiety is not something that needs to take over your life. Seeking professional help can guide you to a treatment that works best for you. Once suitable treatment is found, you will feel much more in control and find life more enjoyable.

Severe side effects and overdosing

Be sure to immediately seek emergency medical assistance if you have signs of a rare allergic reaction to escitalopram. Look out for:

  • Skin rash or hives
  • Difficulty breathing
  • Swelling of your face, lips, tongue, or throat

Also call your doctor straight away if you have any of the following serious side effects:

  • Vision or eye problems: blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights
  • Mental symptoms: racing thoughts, unusual risk-taking behavior, feelings of extreme happiness or sadness
  • Signs of low salt levels: headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady
  • Severe nervous system reactions: very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out
  • Signs of serotonin syndrome: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea

If you suspect an overdose, seek emergency medical attention (by calling 911), or call the poison help line at 1-800-222-1222. Symptoms of overdose can include:

  • Low blood pressure
  • Insomnia
  • Dizziness
  • Sweating
  • Nausea
  • Vomiting
  • Tremor
  • Drowsiness

If you’re having a mental health emergency, call 911 or go to the nearest emergency room. You can also get free 24/7 support from a suicide and crisis expert by calling or texting 988. If you’d prefer to chat online, you can chat with a suicide and crisis expert by visiting the Lifeline Chat.

How K Health Can Help

Think you might need a prescription for Lexapro (Escitalopram)?

K Health has clinicians standing by 24/7 to evaluate your symptoms and determine if Lexapro is right for you.

Get started with our free assessment, which will tell you in minutes if treatment could be a good fit. If yes, we’ll connect you right to a clinician who can prescribe medication and have it shipped right to your door.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Jenell Decker, MD

Dr. Decker is a family medicine physician who completed her residency at East Carolina University School of Medicine. She graduated medical school from Marshall University School of Medicine.

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