Escitalopram (Lexapro): uses, side effects and precautions

Escitalopram is the generic name of Lexapro. It is a selective serotonin reuptake inhibitor (SSRI): it increases the serotonin available in the brain, a chemical that helps regulate mood and anxiety. It comes as tablets and an oral solution, taken once a day, morning or evening, with or without food.

It is not a controlled substance. In the official label database (DailyMed), escitalopram has no DEA schedule. It still needs a prescription after a medical evaluation.

The dose is set by the physician. Per the label, the usual adult dose is 10 mg once daily, and the maximum recommended dose is 20 mg a day.

According to its FDA-approved label, escitalopram is indicated for:

• Major depressive disorder in adults and adolescents 12 and older. Read more about depression.
• Generalized anxiety disorder in adults and in children and adolescents 7 and older. Read more about anxiety.

It is not approved for children under 7. Physicians sometimes use it for other conditions, but those are the two labeled indications. The medicine works best as part of a plan that also includes support, talk therapy when needed, and follow-up.

According to MedlinePlus, it can take several weeks to feel the full benefit. Blood levels settle in about a week, and in the label's studies the outcome was measured at 8 weeks.

Some people first notice better sleep or appetite, and later a better mood or less worry. Keep taking it even if you feel well, and talk with the doctor if you notice no change after several weeks or if side effects bother you.

According to the label and MedlinePlus, the most common side effects of escitalopram are:

Like every antidepressant, escitalopram carries an FDA boxed warning: in short-term studies, antidepressants increased the risk of suicidal thoughts and behaviors in children, adolescents and young adults. MedlinePlus describes it in people younger than 24.

The risk is highest in the first months and when the dose changes. If you or your family notice worse mood, new anxiety or agitation, panic attacks, impulsive behavior, severe irritability or thoughts of harming yourself, get help right away: call Línea PAS at 1-800-981-0023 or 988.

This is a rare but serious reaction to too much serotonin. Per the label, the risk rises when escitalopram is combined with other medicines that raise serotonin: triptans for migraine, other antidepressants, tramadol, fentanyl, methadone, meperidine, lithium, buspirone, tryptophan, amphetamines and St. John's wort.

Signs include agitation, confusion or hallucinations; fast heartbeat, sweating, fever or unstable blood pressure; tremor, stiff or twitching muscles, poor coordination; and nausea, vomiting or diarrhea. If you have them, go to the ER.

After approval, cases of QT prolongation (a change on the electrocardiogram) and a dangerous arrhythmia called torsade de pointes were reported in people taking escitalopram. Per the label, an overdose can also cause them.

So tell the doctor if you have an arrhythmia, long QT syndrome or other heart disease, or if you take other medicines that affect heart rhythm. Combining escitalopram with pimozide is contraindicated, in part because of QT risk. If you faint or feel strong palpitations or an irregular heartbeat, get urgent care.

Before you start, tell the doctor everything you take, including supplements. Per the label:

Stopping escitalopram abruptly can cause discontinuation symptoms. Per the label, they include dizziness, irritability, agitation, anxiety, headache, confusion, tiredness, mood swings, insomnia and “electric shock” sensations.

If you want to stop or switch, do it with the doctor: the dose is usually lowered gradually. If your prescription is running out, do not wait until you have no pills left: see prescription refills. The doctor reviews how you have been doing and decides whether a refill is appropriate.

Both are SSRIs and work in a similar way. The main difference is what the FDA approved on each label:

• Escitalopram (Lexapro): major depressive disorder and generalized anxiety disorder.
• Sertraline (Zoloft): major depressive disorder, obsessive-compulsive disorder, panic disorder, PTSD, social anxiety disorder and premenstrual dysphoric disorder. Read the sertraline (Zoloft) guide.

Neither is “better” for everyone. The choice depends on your symptoms, other medicines, health conditions, how you did before on an antidepressant and the side effects that concern you most. Fluoxetine (Prozac) is another SSRI, and so is citalopram (Celexa), from which escitalopram is derived.

If you have thoughts of harming yourself or ending your life, you are not alone: call Línea PAS at 1-800-981-0023 or call or text 988. In an emergency, call 911.