Most people respond well to Lexapro (escitalopram) as a treatment for depression or anxiety, but the first few weeks of use can cause unwanted side effects, such as headache, nausea, and fatigue. Understanding these potential side effects in the first weeks can help you prepare for and manage the effects.1,2
What Is Lexapro (Escitalopram)?
Lexapro (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) that works in the nervous system to increase the amount of active serotonin. Serotonin is involved in a wide range of behaviors including mood, fear, stress response, appetite, addiction, and sexuality.3
This medication is used to treat a range of mental health conditions including major depressive disorder (MDD) and general anxiety disorder (GAD). It is also used as an off-label treatment for obsessive-compulsive disorder (OCD), eating disorders, panic disorder, and post-traumatic stress disorder (PTSD).
Lexapro is a part of the SSRI drug family that includes other medications like Citalopram, Fluoxetine, and Sertraline. Compared to citalopram, Lexapro is more potent and may be less likely to have side effects. 3 Like other SSRI drugs Lexapro will help improve symptoms like sleep, appetite, and/or energy, as well as reduce fear and anxiety.1,2
How Is Lexapro Used?
Lexapro is commonly used as the first-line treatment for different types of depression and anxiety disorders. Treatment is started when anxiety or depression interferes with daily functioning for a prolonged time.1 It is taken by mouth once daily with or without food.
When starting Lexapro, you will likely be directed to take a half dose every day for the first week or two. After one or two weeks at a low dose, your doctor may recommend increasing the dose to double the original dose, still just taken once per day. This slow start and gradual increase in dose is an important part of reducing unwanted side effects when starting the medication.
Lexapro takes time to work and full effects may take 4 – 8 weeks to be felt. Most patients will continue treatment with Lexapro for about 6 months. At that time, you and your doctor will reevaluate to determine if continuing Lexapro treatment is right for you.1,4
How Will I Feel the First Week Starting Lexapro?
The first two weeks of taking Lexapro are crucial to a successful treatment. It is this window of time that people are most likely to experience unwanted side effects from using Lexapro. It is also when patients are likely to stop taking the medication because of these unwanted side effects. Each person will experience slightly different side effects, but the most common side effects are drowsiness, headache, insomnia, nausea, and vomiting.4
These effects may emerge during the first weeks of starting Lexapro. If the starting dose of Lexapro is too high, these side effects may be even worse. This is why most patients will gradually increase the dose over the first few weeks. Be sure to follow your doctor’s directions closely.
Here are some medical conditions that may exacerbate side effects in the first week:
- History of sleep disturbances
- Bipolar disorder
- Low salt levels
- History of suicidal thoughts
- History of eating disorders
How Long Will It Take for Me to Adjust to Lexapro?
While the first two weeks of taking Lexapro can come with bothersome side effects, the symptoms often go away on their own. As your body becomes used to the medication, the symptoms might decrease. If symptoms persist longer than four weeks or worsen, you should contact your doctor right away for additional direction.
How Will I Know Lexapro is Working?
It can take time for antidepressants to work, often between 2-6 weeks. After this initial period of taking Lexapro, some people experience a reduction of side effects. This will also be around the time when you start noticing improvements in the symptoms of your condition. It is important to remember the medication is not to be used ‘as needed’ and works best taken every day. This means taking the medication on days even when you don’t feel like you need the medication.1,2
Side Effects of Lexapro (Escitalopram)
The specific timeline of experiencing side effects varies for each person, but the side effects will usually start in the first few days. There is usually another round of increased side effects if the dose of Lexapro is increased after a week or two. This may seem counterintuitive but this strategy can lessen the overall intensity of Lexapro’s side effects. Since the effects of Lexapro take time to develop, the side effects may seem to worsen before they get better. If side effects interrupt regular sleep, appetite, or concentration, you should reach out to your doctor for direction.
Common Side Effects of Lexapro in the First Week
Here are some common side effects of Lexapro effects in the first week that don’t usually require medical attention:1
- Stomach pain
- Sexual problems in males like decreased sex drive, inability to get or keep an erection, or delayed or absent ejaculation
- Sexual problems in females like decreased sex drive, or delayed orgasm or unable to have an orgasm
- Dry mouth
- Yawning or excessive tiredness
- Difficulty falling asleep or staying asleep
- Increased sweating
- Decreased appetite
- Weight loss
Severe Side Effects of Lexapro in the First Week
Lexapro is usually safe when used properly but there are still risks of serious side effects. These side effects require immediate medical attention to prevent further harm or injury. Being aware of severe side effects and knowing when to seek help is an important part of safely using Lexapro.
Here are some of the potentially severe side effects of Lexapro in the first week that require immediate medical attention:
- Serotonin syndrome: This condition 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: Abnormal bleeding include bruising under the skin, a cut that does not stop bleeding, discolored stool, nose bleeding, or vomiting blood.
- Seizures: A seizure is dangerous and can cause permanent injury or death if it is prolonged.
- Changes in vision: Any pain in the eye or loss of vision should be addressed immediately to prevent permanent damage.
- Manic episodes: Manic episodes in bipolar disorder are 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 addressed properly. Headaches, problems with thinking, concentration, or memory, and low amount of urine are all signs of low salt in the body.
- Suicidal thoughts: Any suicidal thoughts you may have while taking this medication are serious 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. Increased dizziness or passing out may be signs of an irregular heartbeat, which should be addressed.1
Interactions with Lexapro (Escitalopram)
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 properly. It is crucial to keep an updated list of all your medications (including supplements and vitamins) and share this list with your doctor and pharmacist.
Here are 9 examples of drugs you should avoid using while taking Lexapro:1
- Blood thinners: Because using Lexapro increases your risk of bleeding, careful monitoring is required.
- Non-steroidal anti-inflammatory drugs (NSAIDs): Using NSAIDs, such as ibuprofen and aspirin, while taking Lexapro increases your risk of bleeding.
- Antidepressants: Using other antidepressants with Lexapro increases the risk for serotonin syndrome, a serious condition that requires immediate medical care. Only in special 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.
- Monoamine oxide inhibitors (MAOIs): Using MAOIs with Lexapro increases the risk for serotonin syndrome, a serious condition requiring immediate medical care. MAOIs should not be taken for 14 days before or 14 days after taking Lexapro.
- Benzodiazepines: Benzodiazepine use can increase the drowsiness side effect that can occur from taking Lexapro.
- Migraine drugs: Also known as ‘triptans’, these medications can increase your risk for serotonin syndrome.
- Alcohol: Using alcohol while taking Lexapro can increase drowsiness, a side effect some people experience from taking Lexapro.
- Cimetidine: This medication can increase the amount of Lexapro in your body and make side effects worse.
What Happens if I Take More Lexapro Than Prescribed?
Taking more Lexapro than prescribed is dangerous and not recommended. This can cause side effects to be much worse and lead to severe discomfort. Taking more than the prescribed dose can also significantly increase the risk of experiencing an adverse effect. Adverse effects can be dangerous, even life-threatening.1 If too much Lexapro is taken at once by you or someone you know, call the poison control helpline at 1-800-222-1222.5
What if I Miss a Dose of Lexapro?
Missing doses may result in antidepressant discontinuation syndrome, a condition where a person taking an antidepressant for at least a month may experience withdrawal symptoms after suddenly reducing or stopping their medication use. Lexapro is a medication that works best when taken at the same time every day. It is not a medication to be taken only if you feel you need it. If a dose is missed you should take the missed dose as soon as you remember. If a whole day or more has passed do not take a double dose. Instead, skip the missed dose and continue taking Lexapro as prescribed.5
After a few months of taking Lexapro, many people feel better and report fewer symptoms of anxiety or depression. To avoid Lexapro withdrawal symptoms, do not to stop taking Lexapro without first speaking with your care team. Stopping too quickly can cause negative 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 slowly decrease and eventually stop the medication.5
Questions to Ask Your Healthcare Team About Lexapro Side Effects
One of the best ways to navigate the start of taking Lexapro is to fully understand the risk of experiencing side effects. Creating a plan with your doctor is crucial to successful treatment with Lexapro. You and your doctor should determine which side effects are okay to work through on your own and which would require immediate medical attention. Ask your healthcare lots of questions so that you feel ready to deal with side effects if they arise.6
Here are some questions to ask your care team when considering the side effects of Lexapro:5
- How should I take Lexapro for the first month?
- Can I use Lexapro to treat depression or as part of my anxiety treatment?
- How long will it take for me to adjust to taking Lexapro?
- Am I at risk for more severe symptoms if I am already taking other anxiety /depression medications?
- Will a previous history of addiction make me more susceptible to dependency?
- What is the best dosage to ensure fewer side effects?
- Are there drugs I am taking that could have negative interactions?
- When should I reach out to you if I am experiencing side effects?
- Is there anything I should tell my therapist about this new medication?
- Are there other medications that will have fewer side effects in the first week?
- When can I expect side effects to go away if at all?
Taking a new medication or starting a new treatment always comes with risk. Knowing what to expect when starting Lexapro can help you feel prepared and ready to deal with negative side effects as they happen. It is important to remember that Lexapro can cause some negative side effects in the first few weeks, but they usually go away on their own. It is also important to remember that Lexapro takes time to work and consistently taking the medication is key to successful treatment with Lexapro.