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

    Kristin Hall, FNP
    Medically reviewed by Kristin Hall, FNP Written by Our Editorial Team Last updated 7/19/2020

    Escitalopram, commonly sold under the brand name Lexapro®, is a prescription antidepressant that’s used to treat depression, as well as a range of anxiety disorders. 

    Escitalopram is part of a class of antidepressants called selective serotonin reuptake inhibitors, or SSRIs. These medications work by raising the concentration of certain neurotransmitters in the brain, particularly those responsible for regulating mood and mental health. 

    If you’ve been diagnosed with depression or an anxiety condition such as generalized anxiety disorder (GAD), your healthcare provider may prescribe you escitalopram as a treatment.

    Used correctly over the long term, escitalopram can be highly effective at treating depression and certain anxiety disorders. Like other antidepressants, it can cause a range of side effects that you should be aware of before using this medication.

    Below, we’ve explained what escitalopram is, how it works and why it’s prescribed. We’ve also listed the potential side effects and interactions that can occur with escitalopram. Finally, we’ve answered some of the most frequently asked questions about this medication. 

    What Is Escitalopram (Lexapro)?

    Escitalopram is an antidepressant that belongs to the SSRI class of medications.

    As an antidepressant, escitalopram is mostly commonly prescribed to treat depression. It’s also approved by the FDA for the treatment of generalized anxiety disorder. 

    In some cases, healthcare professionals may also prescribe escitalopram off-label as a treatment for conditions such as social anxiety disorder (SAD), obsessive-compulsive disorder (OCD), panic disorder and premenstrual syndrome. 

    Escitalopram was developed in the late 1990s and first approved in 2002 by the FDA. Over the years, it’s been widely prescribed to treat depression and anxiety disorders, with tens of millions of prescriptions every year in the U.S.

    Compared to many older antidepressants, such as monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs), SSRIs such as escitalopram tend to be safer and less likely to produce side effects or harmful drug interactions. 

    In the United States, escitalopram is commonly sold under the brand name Lexapro. It’s also available as a generic medication under a variety of different names. 

    How Escitalopram Works

    Escitalopram works in the same way as other SSRIs, by inhibiting your brain’s reuptake of the neurotransmitter serotonin.

    Serotonin is one of numerous important neurotransmitters used by the brain to transmit signals between neurons. It’s responsible for a diverse range of biological functions in the brain and in numerous other organs.

    You may have heard of serotonin as the “feel good” neurotransmitter. This is because serotonin is responsible for, amongst other things, regulating your mood. 

    Normal levels of serotonin are important for maintaining a stable mood. Serotonin also plays an important role in regulating your appetite and ability to sleep. 

    People with depression often have low serotonin levels. By stopping your brain from absorbing serotonin after it’s released, SSRI medications like escitalopram increase the level of serotonin in your brain, helping to improve your mood and treat the symptoms of depression. 

    Escitalopram Dosages

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

    Based on your symptoms and response to the medication, your healthcare provider may adjust your dosage of escitalopram over time. The maximum normal dosage of escitalopram for depression is 20mg per day. 

    Escitalopram Side Effects and Interactions

    Escitalopram may cause a range of potential side effects. These side effects are common to all SSRI. Most of the side effects of escitalopram are minor and temporary, although there are also several rare, potentially serious side effects that you should be aware of.

    Common side effects of escitalopram include:

    • Dry mouth
    • Increased sweating
    • Dizziness
    • Nausea
    • Diarrhea
    • Constipation
    • Indigestion
    • Abdominal pain
    • Flu-like symptoms
    • Fatigue
    • Insomnia
    • Somnolescence (drowsiness)
    • Reduced appetite
    • Decreased libido (reduced interest in sex)
    • Rhinitis and sinusitis

    Of these side effects, the most common are nausea, insomnia, fatigue and decreased libido. In many cases, these side effects are transient and improve over several weeks as your body gets used to the medication. 

    Escitalopram may cause sexual side effects. In women, the most common sexual side effect is anorgasmia (difficulty achieving orgasm). In clinical trials of escitalopram for depression, about two percent of users reported experiencing this side effect. 

    In men, escitalopram may cause ejaculation disorder (affecting nine percent of users in clinical trials) and impotence (three percent of users). 

    Some people prescribed escitalopram for anxiety may experience anxiety symptoms after starting this medication. Like other side effects, this is usually a temporary issue that gets better over the course of several weeks as your body adjusts to the medication.

    If you experience persistent anxiety, or any other side effects, after you start using escitalopram, contact your healthcare provider for assistance. 

    Although uncommon, escitalopram can potentially cause serious side effects. We’ve listed these and provided more information in our full guide to the side effects of escitalopram. 

    FDA “Black Box” Warning: Suicidal Thoughts and/or Behavior

    All antidepressants, including 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 people. 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 change in your thoughts, mood, feelings or behavior, contact your healthcare provider or healthcare professional as soon as possible for assistance. 

    Interactions Between Escitalopram and Other Medications

    Escitalopram can interact with other 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.

    Potentially serious interactions can occur if you take escitalopram with, or shortly after using, a range of other antidepressants.

    If you currently use or have used a monoamine oxidase inhibitor (MAOI) in the last 14 days, you must inform your healthcare provider of this before discussing escitalopram. 

    MAOIs can cause severe interactions when used within escitalopram, including serious health conditions such as serotonin syndrome. Commonly prescribed MAOIs that could interact with escitalopram include phenelzine, isocarboxazid, tranylcypromine, selegiline and others. 

    Other antidepressants, including other SSRIs, SNRIs and tricyclic antidepressants, can interact with escitalopram. Escitalopram can also interact with antipsychotic and antianxiety medications such as pimozide, benzodiazepines, gabapentin and sleep aids such as zolpidem. 

    Other medications that increase serotonin, including opioid painkillers, triptans, anxiolytics such as buspirone, amino acids such as tryptophan, stimulants and even over-the-counter treatments for depression such as St. John’s wort can potentially interact with escitalopram.

    Escitalopram may also interact with certain blood thinners, medications used to treat migraines, water pills and other medications. 

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

    Escitalopram and Pregnancy

    Escitalopram has a category C rating from the FDA. This means that 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. 

    If you’re prescribed escitalopram, contact your healthcare provider if you believe that you could be pregnant or if you’re planning to become pregnant.

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

    If you’re breastfeeding, a small amount of escitalopram may pass into your breast milk. In most studies, the small amount of escitalopram that can be present in breast milk does not appear to cause any harmful effects for babies. 

    Nevertheless, if you’re currently breastfeeding or plan to breastfeed your child and also use escitalopram, talk to your healthcare provider for expert advice. 

    Learn More About Depression Medications

    If you’ve been diagnosed with depression, your healthcare provider may recommend escitalopram or one of several other medications.

    A diverse range of medications are used to treat depression, from SSRIs to other medications such as SNRIs, MAOIs, TCAs and more. 

    Our guide to depression medications goes into more detail on how these classes of medication differ, as well as their unique advantages, side effects and other information that you should be aware of if you’re being treated for depression. 

    Frequently Asked Questions About Escitalopram (Lexapro)

    What Is Escitalopram (Lexapro) Used For?

    Escitalopram (Lexapro) is used to treat depression. It’s also used to treat a range of anxiety disorders and other conditions, including social anxiety disorder (SAD), panic disorder and obsessive-compulsive disorder (OCD).

    How Long Does It Take for Escitalopram (Lexapro) to Start Working?

    Escitalopram can take several weeks to start working as a treatment for depression and anxiety disorders. You may not notice any improvements for several weeks. In some cases, it can take up to eight weeks for escitalopram to start working effectively. 

    If you don’t experience any improvements after using escitalopram for several weeks, don’t stop taking the medication suddenly. 

    Instead, talk to your healthcare provider. Depending on your symptoms, they may recommend adjusting your dosage of escitalopram or using a different medication. 

    How and When Should You Take Escitalopram (Lexapro)?

    You can take escitalopram at any time of day, morning or night. It’s best to take escitalopram at approximately the same time every day. You can take escitalopram after eating a meal or on an empty stomach.

    Some people experience difficulty sleeping after they start using escitalopram. If you’re prone to insomnia, you may experience better results taking escitalopram in the morning. 

    If you forget to take escitalopram and remember on the same day, take the late dose as soon as you remember. If you forget and only remember the next day, skip the missed dose and take the medication one time per day as normal. 

    If you accidentally take too much escitalopram and experience symptoms such as an overly fast heart rate, vomiting, dizziness, seizures, sedation or shaking, call 911 for emergency assistance as soon as you can. 

    How Should You Stop Taking Escitalopram (Lexapro)?

    Like other SSRIs, escitalopram may potentially cause withdrawal side effects if you stop taking it suddenly. These can include agitation, irritability, anxiety, sleep difficulties, mood changes and a range of other effects.

    If you want to stop using escitalopram, do not suddenly stop taking the medication without first talking to your healthcare provider. They will likely advise you to gradually taper down your dosage of escitalopram to reduce your risk of experiencing withdrawal side symptoms.

    How Long Does Escitalopram (Lexapro) Stay in Your System?

    Escitalopram has a half-life of 27 to 32 hours. If you’re prescribed escitalopram at a normal dose for treating depression or an anxiety disorder and stop taking it, it will take approximately seven to nine days to completely exit your body.

    As mentioned above, you should not suddenly stop taking escitalopram or adjust your dosage of this medication without talking to your healthcare provider. 

    Can Escitalopram (Lexapro) Cause Weight Gain?

    In general, large-scale studies tend to show that long-term use of antidepressants is associated with weight gain. 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. 

    In general, escitalopram doesn’t appear to cause the dramatic changes in weight that can often occur with older antidepressants. However, more research is necessary to determine exactly what affect this medication may have on weight fluctuations. 

    How Long Do the Side Effects of Escitalopram (Lexapro) Last?

    Like other SSRI medications, escitalopram can cause a range of side effects, some of which are common during the first few weeks. 

    A small percentage of people who use escitalopram experience nausea and headaches during the first few weeks of using the medication. Most of the time, these side effects will go away on their own over the course of several weeks as your body adjusts to the medication. 

    If you have persistent side effects after starting escitalopram, or experience serious side effects from this medication, contact your healthcare provider. 

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    This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.