Escitalopram (Lexapro)

Escitalopram, commonly sold under the brand name Lexapro, is used to treat major depressive disorder and anxiety disorders in adults and children over the age of 12. Escitalopram belongs to a type of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). These work by increasing the levels of serotonin uptake in the brain.^[1]

What is escitalopram prescribed for?

Escitalopram is a medication that is often used to treat depression and generalized anxiety disorder. It can be prescribed for anyone over the age of 12, although there is less research about its effectiveness in people under the age of 18.^[1][2]

Escitalopram also helps with panic attacks and other symptoms of anxiety disorders. Off-label, the medication can also be used for panic disorder, dysphoric disorder, social anxiety disorder, PTSD, and obsessive-compulsive disorder.^[1]

How does escitalopram work?

Escitalopram works by increasing levels of serotonin in your brain. Widely believed to have a positive impact on your mood, sleep and general well-being, serotonin is a neurotransmitter that passes signals between nerve cells in your brain.

As an SSRI, escitalopram inhibits the absorption of serotonin. This allows for improved regulation of serotonin within the brain.

It can take between 4-6 weeks for escitalopram to start working. You should not skip doses or stop taking escitalopram suddenly as this could lead to negative side effects.^[3]

How is escitalopram usually taken?

Escitalopram comes in a tablet form or as a liquid solution. You take it orally once a day for the duration of the course, as prescribed by your doctor.

The typical dose of escitalopram in tablet form is 10mg a day. However, your doctor can alter this to anywhere between 5 and 20mg. One drop of the oral solution contains the active ingredient escitalopram oxalate, equal to 1mg/mL escitalopram base.

Take escitalopram exactly as instructed by your doctor. Do not stop taking escitalopram prematurely, even if you feel your mood has improved.

If you and your doctor decide to stop your escitalopram treatment, your doctor will recommend steadily reducing your dosage. This process is known as ‘tapering’ and minimizes the risk of withdrawal symptoms by allowing your mind and body time to adapt to the absence of escitalopram.^[4]

How long does escitalopram stay in your system?

After 6.1 days, 99% of escitalopram will have left your system.^[5]

According to new research, sleep, energy, or appetite may show signs of improvement within the first 2 weeks of treatment. This can be a key indicator that escitalopram is working for you. However, remedying low mood and regaining interest in previously enjoyed activities may need up to 8 weeks.^[6]

Escitalopram common side effects

Book a consultation with your doctor to discuss next steps if you experience any of the following:

• Drowsiness
• Shaking
• Dizziness
• Decreased sex drive
• Weight Loss
• Chest pain
• Eye pain
• Loss of appetite
• Nausea
• Bloating
• Cramps
• Constipation
• Diarrhoea
• Sleeping problems
• Erectile dysfunction ^[7]

Major adverse effects of escitalopram 

Get medical attention immediately if:

• You begin to cough blood, there is blood in your phlegm or there is blood in your urine/stool.
• Your gums begin to bleed profusely – this could be a sign of a bleeding disorder.
• You have persistent confusion, headaches, all body fatigue – this could be a sign of low sodium levels, which need to be tended to by a doctor.
• You have any suicidal thoughts or violent impulses.
• Develop a high fever, hallucinations, or bouts of losing consciousness – this could indicate a risk of Serotonin Syndrome. Speak to your doctor if you develop any symptoms of serotonin syndrome. ^[7]

Escitalopram precautions

Before taking escitalopram, you ought to consider the following:

Allergies

Whilst very uncommon, it is possible to suffer a serious allergic reaction to escitalopram. You should seek immediate medical help if you experience a skin rash, difficulty breathing, face swelling, or any sort of tightness in the chest or respiratory tract.^[7]

You should let your doctor know anything you’re allergic to before taking escitalopram.

Your Medical History

Prior to taking escitalopram, share your full medical history with your doctor. Disclose any heart problems, liver problems, kidney problem, blood pressure issues, stomach ulcers, glaucoma, and any other long-term conditions you may suffer from.

Also, disclose any personal or family history of mental health issues such as bipolar disorder, suicidal feelings, eating problems, borderline personality disorder, schizophrenia, and any other psychiatric disorder.

Your doctor will give you medical advice on how to use escitalopram safely.

Pregnancy & Breastfeeding

If you are pregnant or breastfeeding, you may wonder how taking escitalopram affects both yourself and your child.

Studies have found that escitalopram usage during pregnancy does not lead to a higher risk of undesirable outcomes for the mother and child (Orsolini et al., 2013).

However, research has also cautioned that “considering the low number of cases and lack of controls in this series, it is prudent not to draw definitive conclusions on its safety during pregnancy and breastfeeding”. ^[8]

Escitalopram is readily prescribed to both pregnant and breastfeeding women. Your dosage might be altered due to your circumstances. This should be discussed with your doctor.

Bleeding Problems

Escitalopram may increase your risk of developing bleeding issues. Inform your doctor if you are taking any other blood thinning medications, including aspirin and ibuprofen.

Escitalopram drug interactions

Alcohol

It is advisable to avoid drinking alcohol when you are taking escitalopram. When mixed, you have a greater risk of drowsiness, lack of coordination, and reduced awareness.

Combining any antidepressant with alcohol is not recommended. However, if you do want to drink alcohol occasionally, discuss this with your doctor.^[9]

Monoamine oxidase inhibitors

You should not take escitalopram alongside any Monoamine oxidase inhibitors (MAO inhibitors), or at least within 14 days of taking any MAO inhibitors. You should tell your doctor if you are taking (or have recently finished taking) any of the following:

• Tranylcypromine (Parnate)
• Phenelzine (Nardil)
• Linezolid (Zyvox)
• Isocarboxazid (Marplan)
• Methylene blue
• Selegiline (Emsam, Zelapar) ^[10]

St John’s wort

Do not take St John’s wort in conjunction with escitalopram. St John’s wort is a herbal remedy used to treat depression. Taking both together will increase your risk of side effects. ^[10]

If taken alongside a variety of different substances, escitalopram can cause dangerous side effects. Always schedule regular consultations with your doctor to assess the impact of your treatment and manage any side effects as and when they appear. Do not alter the dosage prescribed without being instructed to by your doctor.

Escitalopram storage

Store escitalopram at room temperature sealed in its original container. Too much heat, moisture, air, or light could damage the escitalopram, inhibiting it from work effectively. ^[10]

Ensure escitalopram is kept in a safe location outside the reach of children. It is recommended to lock the cabinet, drawer, or container you store any medicine.^[10]

Dispose of any outdated medication as directed by your doctor or another qualified medical professional. For further information, consult the FDA’s page on the safe disposal of unused medicines

When travelling, always keep your escitalopram on your person. Do not leave it in checked luggage. Ensure your escitalopram is kept in its original container with the pharmacy label it came with. This can be shown to transport staff who request to see it.

What to do if you overdose on escitalopram

If you take too much escitalopram, you may suffer the effects of an overdose. These can include vomiting, nausea, palpitations, dizziness, blurred visions, and blood pressure problems. You should seek immediate medical help. ^[10]

Frequently asked questions about escitalopram

Is escitalopram addictive?

Escitalopram, like all SSRIs, are not considered to be addictive. This is because you do not develop a compulsion to take escitalopram to experience a ‘high’.

However, some people may experience withdrawal symptoms when stopping treatment with escitalopram. This does not mean there is an addiction, but rather that the body and brain has become accustomed to the drug.

Are there any alternatives to escitalopram?

Whilst there are alternative treatments, SSRIs such as escitalopram are often regarded as one of the most effective medications when treating depression. Your doctor will decide which SSRI is suitable for your needs. Do not stop your prescribed course of escitalopram without consulting your doctor.

Herbal remedies such as St John’s Wort are used by some to alleviate symptoms of depression. However, these treatments have less scientific research available in terms of their effectiveness.

Cognitive behavioral therapy (CBT) has been shown to reduce symptoms of depression and allow people to manage their mood. Exercise has also been shown to have a positive impact on treating depression, due to the release of endorphins and the positive effect on sleep and appetite.

Is there any food or drink I should avoid when taking escitalopram?

You should avoid drinking alcoholic drinks when taking escitalopram, or at least drink within moderation. SSRI’s can make your tolerance to alcohol a lot lower than usual. Otherwise, you can eat and drink as you would normally.

When will escitalopram start working?

It takes between 4 and 6 weeks to experience the full benefit of escitalopram. ^[3]