Lexapro is a medication used to treat depression and anxiety in adults and treat depression in adolescents aged 12-17. Lexapro is a brand name and contains the active drug escitalopram. It can also treat eating disorders, OCD, and PTSD. Most people respond well to treatment; therefore, it is usually the first-line treatment. It is essential to understand that taking Lexapro carries risks, including increased suicidal thoughts (for patients under 25 years old), serotonin syndrome, seizures, and the activation of manic episodes.1, 2
What Is Lexapro (Escitalopram) & How Is It Used?
Lexapro is a selective serotonin reuptake inhibitor (SSRI) that works in the nervous system to increase the amount of active serotonin. Serotonin is responsible for many behaviors, including regulating mood, fear, stress response, appetite, addiction, and sexuality.3
Lexapro is a part of the SSRI drug family that includes other medications like citalopram (Celexa), fluoxetine (Prozac), and sertraline (Zoloft). Lexapro is the brand name for the active drug escitalopram. Escitalopram is also a generic medication with the same uses and risks as Lexapro. Like other SSRI drugs, Lexapro may help improve symptoms like sleep, appetite, and energy and reduce fear and anxiety. It is important to remember that Lexapro takes time to work, and its benefits may take 4 to 6 weeks before full effect.
Lexapro is FDA approved to treat the following conditions:
- Major Depressive Disorder (MDD), as either short-term relief or long-term maintenance treatment in adults and children 12-17.
- Generalized Anxiety Disorder (GAD), as a short-term treatment in adults
It is sometimes also used off-label* to treat:
- Obsessive-compulsive disorder (OCD)
- Eating disorders such as binge eating disorder or bulimia nervosa
- Panic disorder
- Post-traumatic stress disorder (PTSD)
- Premenstrual dysphoric disorder (PMDD)
*Off-label is when a prescriber uses medication for a non-FDA approved use because they believe it may be clinically appropriate.
Prescribers may start treatment for major depression (MDD) with Lexapro if someone experiences a persistent depressed mood (nearly every day for at least two weeks) that interferes with daily functioning. Prescribers may start medication treatment for anxiety (GAD) with Lexapro if someone experiences excessive anxiety and worry that continues for at least six months and is difficult to control. In each case, additional specific symptoms must also be met as criteria to start treatment. It will always be a decision made with your care team to create a prescription for Lexapro.1
Lexapro works well for many people but carries a significant risk of suicidal thoughts in younger users. Studies have shown that patients 24 and younger risk developing suicidal thoughts, so users of Lexapro should talk with their doctor about any changes in thinking or behavior immediately.2 This is a serious risk with all medications that are SSRIs.
What Are Common Lexapro Dosages and Delivery Methods?
Lexapro is available as a tablet or a liquid. Most patients will receive the tablet, but users can take the liquid solution in cases where a specific, lower dose is needed, or a patient cannot swallow pills.
Lexapro is available in the following strengths:
- Oral solution
- 1mg/ml
- Tablets
- 5 mg
- 10mg
- 20mg
The most common dose for adults and children is 10 mg, taken once daily. Depending on the condition Lexapro is used to treat and your response to the medication, your doctor may increase the dose after at least one week. This process gives your body time to adjust to the medication and helps reduce any side effects from starting with too high of a dose.
Lexapro is not affected by food, so people can take it with or without food. Still, it is essential to take the medication every day at the same time. Let your doctor know if you have trouble swallowing pills so that taking Lexapro is not a hassle and you can use an oral solution.5 It is important to remember that Lexapro takes time to work in your body. You can expect the full effect after 4 to 6 weeks of taking medicine regularly.1
Lexapro Warnings & Associated Risks
Lexapro can put certain people at a higher risk for worse side effects, so it may not be best for everyone. It is essential to discuss your complete health history with your care team when deciding if Lexapro is right for you.
Health conditions to mention to your doctor before taking Lexapro include:3
- Pregnancy & Depression: Lexapro may have risks in newborns when taken by mothers in the last few months of pregnancy. Also excreted in breast milk, Lexapro can negatively impact a nursing newborn.
- Bipolar Disorder: Lexapro can increase the chances of mania in people without bipolar disorder, making mood swings even higher for those with bipolar disorder.
- Liver Complications: Some people have low levels of specific liver enzymes that can worsen Lexapro’s side effects, so ask your doctor if you need to test your liver enzymes.
- Glaucoma: Lexapro may cause angle-closure glaucoma, which can develop suddenly and lead to vision loss. If you have eye problems or a family history of glaucoma, your doctor may recommend an eye exam before taking Lexapro.
- Heart Conditions: Lexapro can cause an irregular heartbeat. If you have any previous heart or heart-related conditions, your doctor may perform an EKG test before taking Lexapro.
- Seizures: Lexapro and other SSRI medications can cause seizures when taken in high doses or with other similar drugs. It is crucial to alert your doctor if you have a history of seizures.
- Taking Certain Medications: Taking other medications such as monoamine oxidase inhibitors (MAOIs), triptans, other antidepressants, opioid pain medications, St. John’s Wort, or amphetamines can cause a severe reaction with Lexapro, known as serotonin syndrome. Tell your doctor if you are taking or have recently taken any of these medications. A few examples of these medications include isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), selegiline (Emsam, Zelapar), and tranylcypromine (Parnate). This is not a comprehensive list, talk with your prescriber about any medications you are taking before starting Lexapro.
Side Effects of Lexapro
While Lexapro is well tolerated by most when taken as prescribed, there is still a risk of mild and severe side effects. Most people taking antidepressants will feel mild side effects usually go away with time or can be resolved through dose changes. Severe side effects, however, require immediate attention and can be life-threatening. Knowing the difference between mild and severe risks and how to act when either occurs is essential. In both cases, you should contact your doctor or care team, but if a powerful side effect happens, you should contact 911 immediately.
The best strategy is to prevent side effects from happening in the first place. Reviewing your complete medical history with your doctor can address potential risks before starting Lexapro. While taking Lexapro, taking it exactly as prescribed is vital to give your body time to adjust to the medication. Your doctor will prescribe a low dose for a few weeks and then increase your quantity as needed to prevent initial mild side effects.5
Some severe side effects of Lexapro that require immediate attention include:
- Serotonin syndrome: A potentially life-threatening side effect. It can present as fever, sweating, confusion, fast or irregular heartbeat, severe muscle stiffness or twitching, agitation, hallucinations, loss of coordination, nausea, vomiting, or diarrhea.
- Abnormal bleeding: This can include bruising under the skin, a cut that does not stop bleeding, discolored stool, nose bleedings, or vomiting blood.
- Seizures: A seizure is dangerous and can cause permanent injury or death if prolonged.
- Vision changes: Any pain in the eye or loss of vision should be immediately addressed to prevent permanent damage.
- Manic episodes: Mood episodes characterized by increased activity or agitation, exaggerated self-confidence or euphoria, racing thoughts, and a lack of need for sleep.
- Low salt levels: This condition can be life-threatening if not appropriately addressed. Headaches, problems with thinking, concentration, or memory, and difficulty urinating are all signs of low salt in the body.
- Suicidal thoughts: Any changes in mood or ideas or plans to harm yourself are severe, and you should seek help immediately. Stay with someone if possible until you can receive care.
- Irregular heartbeat: Lexapro can cause a dangerous irregular heartbeat from QT prolongation. Any fast, slow, skipping, or irregular heartbeat should be addressed.
More common Lexapro side effects include:
- Nausea, heartburn, or stomach pain
- Diarrhea or constipation
- Sexual problems in males (i.e., decreased sex drive, inability to get or keep an erection, or delayed or absent ejaculation)
- Sexual problems in females (i.e., reduced sex drive, delayed orgasm, or unable to have an orgasm)
- Drowsiness, dizziness, yawning, or excessive tiredness
- Difficulty falling asleep or staying asleep
- Increased sweating
- Decreased appetite and weight loss
- Flu-like symptoms
Severe Allergic Reactions to Lexapro
An allergic reaction to your medication can be dangerous and usually presents as hives on the skin, facial swelling, and trouble breathing. If you are allergic to Lexapro or any ingredients in the medication, you should not take Lexapro. You can ask your pharmacist for a specific list of all ingredients in your Lexapro tablet or liquid. It is important to note that Lexapro is identical to parts of Celexa (citalopram). Therefore if you are allergic to Celexa, you should not take Lexapro.1
Interactions with Lexapro
Disclaimer: Taking certain medications, herbs, or supplements alongside Lexapro can change how Lexapro works in your body or increase the risk for serious side effects. This article does not consider all the possible interactions. Please let your doctor, psychiatrists, and pharmacists know about all the products you currently use, such as prescription medication, nonprescription drugs, and herbal supplements. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.
Lexapro is an SSRI and can interact with many other medications and supplements. Certain medications can make the side effects of Lexapro worse, while others can prevent Lexapro from working correctly. It is crucial to keep a list of all your medicines (including supplements and vitamins) and share this list with your doctor and pharmacist.
Some substances that negatively interact with Lexapro include:1
- Blood thinners: Increases your risk of bleeding; careful monitoring is required.
- NSAIDs: Increases your risk of bleeding; careful monitoring is required.
- Depression medications: Increases risk for serotonin syndrome. Only in exceptional cases will you be prescribed two different medications for depression
- Water pills: Diuretics like furosemide can increase the risk of developing hyponatremia or low salt in the body.
- MAOIs: Increases risk for serotonin syndrome. You should not take MAOIs for 14 days before or 14 days after taking Lexapro.
- Benzodiazepines: These medications can increase the side effect of the drowsiness of Lexapro.
- Migraine drugs: Known as ‘triptans,’ these drugs can increase your serotonin syndrome risk.
- Alcohol: This can increase the side effect of the drowsiness of Lexapro, similar to how alcohol and Xanax affect the body.
- Cimetidine: This medication can increase the amount of Lexapro in your body and worsen side effects.
- St. John’s Wort Supplement: This can increase your risk of serotonin syndrome.
- Pain Medications: Certain pain medications, including fentanyl and tramadol, can increase your risk of serotonin syndrome.
What to Do If You Overdose
Lexapro does not have a significant risk of dependence/addiction or substance use disorders. Lexapro overdose can happen when too much Lexapro is taken in a short time. It can also occur if too much Lexapro is taken with other antidepressants or SSRI medications.
Symptoms of overdose can include:
- Serotonin syndrome
- Excessive sweating
- Chills
- Confusion
- Hallucinations
- Loss of coordination
- Seizures
- Irregular heartbeat (QT Prolongation)
If you notice any of these symptoms, you must get help immediately by calling 911. You should also contact your provider and can contact poison control for additional assistance at 800-222-1222.6
What if I Miss a Dose of Lexapro?
Lexapro is a medication that works best when taken simultaneously every day. It is not a medication taken when you feel you need it. If you miss a dose, you should take the missed dose as soon as you remember. If a whole day or more has passed, do not take a double amount. Instead, skip the missed dose and continue taking Lexapro as prescribed.5
After a few weeks of taking Lexapro, many people feel better and report fewer symptoms of anxiety or depression. It is essential not to stop taking Lexapro without first speaking with your care team. Stopping too quickly can cause harmful side effects and even more severe symptoms of depression and anxiety than in the first place. When it is time to stop taking Lexapro, your doctor will work with you to establish a plan to decrease and eventually taper off the medication slowly to avoid potential for antidepressant discontinuation syndrome.
Questions to Ask Your Health Team About Lexapro
Lexapro can treat anxiety or depression and may help manage symptoms of other mental health illnesses. It is a medication that works well for many people but not everyone. Speaking with your doctor about your health goals, previous health conditions, and health history will help determine if Lexapro can be right for you. Your care team will facilitate the proper use of Lexapro and provide you with the tools to manage any side effects.
15 questions to ask your care team before taking Lexapro include:2
- Is it safe to take Lexapro with my other medications?
- Will my insurance cover Lexapro or escitalopram?
- Does my medical history increase my risk of side effects?
- How long can I expect side effects to last?
- What side effects should I seek immediate medical attention for?
- How often should I see you for checkups while taking Lexapro?
- Should I let my therapist know I am taking this medication?
- What should I do if I want to stop taking Lexapro?
- How long can I expect to be taking Lexapro?
- How long does it take for antidepressants to work?
- What should I do if I have thoughts of suicide or harming myself?
- Are there any other medications that I should not take with Lexapro?
- What non-medication treatment can I do in addition to taking Lexapro?
- When should I discuss if I am pregnant, plan to become pregnant, or am breastfeeding?
- When should I tell you I want to drink alcohol or use drugs while on Lexapro?
History of Lexapro
Lexapro is unique because it is a purified form of another medication, Celexa. Celexa, another SSRI, was developed by the company Lundbeck and first approved in the US by the FDA in 1998. Lundbeck and Forest Laboratories Inc. then worked together to purify Celex into only the active form of the drug. In 2003, the FDA approved Lexapro in the US. Lundbeck and Forest Labs Inc were the sole producers of the medication until 2012, when the patent expired, and other pharmaceutical companies began producing the generic form of escitalopram.
The close relation that Lexapro has to Celexa gives it some of the same properties, with others improved properties. Lexapro is more potent and requires less than is needed of Celexa to achieve clinical results. Also, since Lexapro is purer than Celexa, there are fewer side effects.7 This close relation between the two medications can be seen in the generic names of the medicines; citalopram and escitalopram.
Final Thoughts
Lexapro is beneficial for treating anxiety and depression and many other ‘off-label’ uses. Most people respond well to the medication, and it provides many benefits. It is essential to be aware of the severe side effects and risks it can have. It is also important to remember that you should not take many other non-discussed medications and over-the-counter products or herbs and supplements simultaneously with Lexapro. If you feel Lexapro can help, speak with your doctor or care team about the risks and benefits.
For Further Reading
- Escitalopram (Lexapro) | NAMI: National Alliance on Mental Illness
- MedWatch Online Voluntary Side Effect Reporting Form – U.S. Food & Drug Administration
- Support Groups | Anxiety and Depression Association of America, ADAA
- Does Depression Go Away? Treatment vs. On Its Own
- How to Get Antidepressants: Everything You Need to Know
- 18 Best Online Psychiatrists for 2022
- Hers Mental Health Review 2022
