Medically reviewed by Katelyn Hagerty, FNP
Written by Our Editorial Team
Last updated 8/11/2022
Antidepressant dosages can change over time, and that’s no different when it comes to the antidepressant Lexapro®. Whether you’re starting an antidepressant for the first time or altering your dosage after years, changes to your effective dosage aren’t uncommon. They also may come with some unexpected side effects, so many people may be concerned with what to expect when increasing Lexapro dosage.
Every worry is fair game when it comes to changes in antidepressant dosage. Will you experience mood swings? Will your mood become temporarily unmanageable? Will you gain temporary superpowers? So many things are possible (not the superpowers thing, of course) that it can be hard to know what to expect.
There’s plenty of information out there on anecdotal experiences that people have when changing Lexapro dosage, but it can be hard to tell fact from fiction.
Lexapro is the brand name for a medication called escitalopram, which is itself an effective antidepressant called in the selective serotonin reuptake inhibitor (SSRI) family.
These medications are generally used to help people with mood and psychiatric disorders (like generalized anxiety disorder, for instance). They work by helping regulate certain neurotransmitters that are critical to proper brain chemistry — namely, serotonin levels and norepinephrine levels.
In a nutshell, your healthcare provider might change raise or lower your dosage of Lexapro (or its generic version, escitalopram) for one reason: to make sure you’re getting the most out of this medication to support your mental health.
If you’re not taking enough Lexapro and your depression symptoms either don’t improve or get worse, your provider may raise your dosage.
If, on the other hand, you’re experiencing harsh side effects like dizziness, nausea, fatigue or trouble sleeping (among others, which we’ll get to in a moment!), your provider may give you a lower dose in order to keep you comfortable.
And if you have a pre-existing medical condition like kidney, heart or liver disease, your provider may modify your dosage so as not to worsen those conditions.
There are also some potential drug interactions that healthcare professionals will ask about if you’re experiencing certain adverse reactions to Lexapro.
You shouldn’t use it concurrently with other SSRIs, SNRIs or Tryptophan, and should talk to your healthcare provider if you’re using any NSAIDs, aspirin or any drugs that may affect your body’s hemostasis.
We know — it sounds a little arbitrary. But you have remember that every single person is different.
Consequently, so is every single person’s mental health treatment, every single person’s brain chemistry, every single person’s tolerance to the effects of prescription drugs like Lexapro or other SSRIs, etc.
These medications help people with psychiatric disorders and mood disorders — they’re an acute treatment engineered to help regulate certain aspect of individual brain chemistry in order to help effectively treat some of the symptoms of depression. .
Essentially, escitalopram is a maintenance treatment for your mental health that helps your brain never run out of serotonin, where normally it will reabsorb its own supply throughout the day. More on-hand supply means more on-demand supplies of this specific neurotransmitter, which, in turn, means your brain doesn’t have to struggle as much to stabilize your mood.
SSRIs like Lexapro are generally better tolerated than other antidepressants like monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs).
These medications are approved by the Food and Drug Administration for depression treatment, and unlike the herbal supplements, illegal drugs and over-the-counter drugs some people may use in lieu of prescription medication, they’re actually considered both safe and effective.
Lexapro is generally considered effective in the daily dose range of 10mg to 20mg, give or take. Chances are, if you’re on the low end of that spectrum and still seeing overwhelming or unmanageable symptoms of major depression or another mood disorder, you may indeed be in need of a dosage adjustment.
When your dose increases, however, so do the effects of escitalopram—and so do the possibilities and risks for adverse effects or side effects even from a single dose.
Lexapro is known to cause sexual side effects for both male and female patients, for instance, and affect your sexual function. There are cases in which elderly patients can experience heart issues, and depressed both adolescent patients and adult patients with depressive symptoms may also experience withdrawal symptoms by sudden discontinuation of treatment.
And in regards to higher doses, you’re just inviting more extreme versions of existing side effects.
The common side effects of Lexapro are similar to other SSRIs. They include:
Anorgasmia or difficulty orgasming
Experiencing any of these side effects as a result of an increase in Lexapro dosage isn’t necessarily a cause for alarm. Generally, side effects are expected when dosage changes, and they are likely to go away with time.
It’s when they don’t go away — or when you far exceed the recommended maximum dosage — that you have cause to worry.
As we mentioned, there’s a top line to the safety of Lexapro, generally considered to be around 20mg orally. Luckily, you would have to exceed that several times over to cause substantial risk of life-threatening issues.
An overdose of escitalopram can cause more of those same adverse effects we listed above, but it can also cause heart issues and blood pressure problems, not to mention the risk of serotonin syndrome (and the symptoms of serotonin syndrome can be fatal).
Symptoms of overdose regardless of the risk for serotonin syndrome may include dizziness, vomiting, nausea, drowsiness, seizures, a fast or pounding heartbeat and potential loss of consciousness and coma. If you overdose yourself, seek medical attention.
These are serious issues, and if you believe you have or another person has overdosed on Lexapro or another SSRI, you should call the poison control center or an emergency line immediately, especially if the above symptoms are occurring.
It is common to question whether or not your Lexapro dosage is working, or even if Lexapro is the right medication for you.
The reality is that very few people end up with the perfect medication and the perfect dose on the first try. Even then, it can take weeks or months for someone to adjust to a medication to the point of having an impact on their quality of life.
When starting Lexapro or another course of antidepressant medication, your healthcare provider usually sets expectations — namely, that the drugs can take a few weeks to begin alleviating symptoms, and that side effects may come or go, especially when beginning or changing to a higher dosage.
If you’ve been on the medication for some time and don’t yet notice the therapeutic effects — or have bothersome or serious side effects — seek guidance from your healthcare provider.
At the end of the day, they’re the ones who can ultimately help you decide what your path to recovery looks like.
If you’re not seeing adequate results with Lexapro, it may be time to have a conversation with a mental health professional or health care provider, but it may also be time to take a larger, more holistic look at your mental health.
At some point, there’s no higher dose, and other tools may be useful for your mental health.
If you’ve ever considered therapy, it might be time to give it a try — our online psychiatry offerings can help you clarify questions and get the answers you need.
It can all start right now, so whether you’re unhappy with current medications or just looking for guidance, consider talking to a professional today.