*An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone.
Common Lexapro side effects in the first week include nausea, fatigue, changes in sleep and appetite, increased sweating, and constipation. These occur as your body starts to process the medication. After a week or two of taking Lexapro these side effects typically go away, as your body gets used to the medication. If side effects persist, a prescriber can help you determine next steps, which may include a change in dosage, timing of dosage, or to a different medication.
If you are considering Lexapro or want to discuss your current medication treatment with a provider, online psychiatry platforms, such as Talkiatry and Brightside Health are a good place to start. Their providers offer assessments and prescription consultation, and can answer any questions you have about Lexapro’s side effects in the first week.
Boxed Warning: Escitalopram (Lexapro) - Risk of suicidal thoughts and behaviors in certain people
Escitalopram, the active ingredient in Lexapro, has a black box warning. These are the most serious types of warnings from the Food and Drug Administration (FDA). Escitalopram can increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults. Regardless of your age, you should talk with your doctor about serious risks with escitalopram and any other medications before starting treatment.
Key Takeaways
Common Lexapro side effects during the first week can impact your digestive system, sleep patterns, appetite, and sexual functioning.
Initial side effects may last for a week or two as your body adjusts to the medication. If they persist longer than this, a prescriber can help you determine next steps, which may include a change in dosage, timing of dosage, or medication.
There are several ways to cope with Lexapro side effects, including self care practices, medication adjustments, and therapy.
If you are considering Lexapro or an alternative, a good place to start is with an evaluation from a medical provider. Many online psychiatry platforms offer online assessments and medication management, such as Talkiatry, or Circle Medical.
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What Are Lexapro’s Side Effects During the First Week?
Individuals taking Lexapro may experience side effects that impact their digestive system, sleep, and sexual functioning during the first week of treatment.
Common side effects of Lexapro during the first week may include:*
- Nausea
- Diarrhea
- Difficulty sleeping
- Dry mouth
- Sleepiness
- Headache
- Fatigue or drowsiness
- Constipation
- Decreased sex drive
- Weight gain
- Dizziness
- Loss of appetite
- Increased sweating
*All medications, including Lexapro, can cause side effects that can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and understand the potential side effects and benefits of any medication.
How Soon Will I Start Feeling Lexapro Side Effects?
Side effects from Lexapro and other SSRIs can emerge during the first week or two of taking the medication, with some people feeling side effects as early as within the first few days.2 Drowsiness, insomnia, nausea, and loss of sexual interest are common right away.
How Long Do Lexapro Side Effects Last?
Some side effects of Lexapro will go away on their own after a few days or weeks as your body adjusts to the medication. However, other effects may persist for as long as you take Lexapro. If side effects last longer than a few weeks or worsen, talk to your doctor as soon as possible.
Should I Stop Taking Lexapro If I Start Feeling Side Effects?
Do not stop taking Lexapro unless you have been advised to do so by your provider. Doing so can cause uncomfortable symptoms, including dizziness, fatigue, irritability, and nausea. For some people who have been taking antidepressants over a long course of time, abruptly stopping Lexapro can lead to antidepressant discontinuation syndrome, also known as antidepressant withdrawal.
If you are experiencing side effects from your medication, tell your provider. They will help you determine the best course for continued treatment, which may include changing your dosage, the time for your dosage, or your medication. If your doctor determines discontinuing your medication is the best option, they will provide a plan for stopping your medication gradually, which can minimize your risk of developing withdrawal symptoms.
What Side Effects Should I Be Most Worried About When Starting Lexapro?
Although most first-week side effects of Lexapro are mild and resolve over time, there is a risk for side effects to be severe or persistent. If these side effects appear in the first week or two of treatment, it is important to seek immediate medical attention if they occur.
Serious side effects of Lexapro that may occur during the first week and require immediate medical attention include:*
- Suicidal thoughts or actions
- Bruising or unusual bleeding
- Symptoms of mania or hypomania
- Seizures or convulsions
- Allergic reactions
- Muscle rigidity, fever, and/or seizures (Could be a sign of serotonin syndrome)
*All medications, including Lexapro, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.
When Should I Call My Doctor About Lexapro Side Effects?
Side effects are one of the most common reasons people choose to stop taking medication. While some effects can be managed and may fade away, some do not go away unless a person stops taking the medication. Side effects can occur even if you are taking your medication correctly.
Contact your provider as soon as possible if side effects persist or become hard to tolerate so you can consider other treatment options. While not common, some people taking Lexapro may experience serious side effects. These effects often require immediate medical care and some may be life-threatening. If you notice any of the serious side effects listed above, seek medical care immediately.
Important Things to Know When Starting Lexapro
Before starting Lexapro, it’s important to understand what to expect during your first weeks of treatment. Your prescriber will discuss your dosage, how to take your medication, precautions for the medication, potential side effects you may experience, and what to do if side effects become a problem.
How Long Does It Take for Lexapro to Work?
Lexapro can take about 4-8 weeks to become fully effective, but some individuals may start to feel better after the first week or two. Each person may have a different response time based on how their body absorbs and processes the medication.
Can Lexapro Worsen Symptoms at First?
Yes, some people may experience changes in sleep such as insomnia or drowsiness when they begin taking Lexapro, which may make some people feel worse initially.1 Lexapro can also increase the risk of suicidal thoughts and behaviors in some people. If you experience worsened symptoms or side effects of any kind, contact your provider immediately.
What Happens If I Miss a Dose?
If you forget to take your Lexapro dose, take it as soon as you remember. If your next dose is due soon, skip the missed one and take your next scheduled dose. Never take two doses at once, and continue taking your medication as prescribed unless your prescriber directs you to do otherwise.1
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*Includes copayment, deductible, coinsurance, and $0 Visits. Excludes no shows. **On average. Actual appointment times vary by state and individual patient.
Precautions For Starting Lexapro
When starting Lexapro, be aware of the several warnings and precautions associated with its use. Some individuals may be at a higher risk for serious side effects from Lexapro, and they may need to take caution when starting this medication. Speak to your provider about these precautions and warnings to understand if Lexapro may be a fit for you.
Warnings and precautions for taking Lexapro include*:
Drug Interactions
Lexapro can interact with many medications, including some antidepressants, mood stabilizing, and antianxiety drugs as well as with various heart, blood pressure, or blood thinner drugs. It may worsen the side effects of both. Speak with your doctor about other medications you are taking. Based on this, they may reduce your Lexapro dose or prescribe a different drug to avoid any drug interactions.
Allergic Reactions
While not common, allergic reactions to Lexapro are possible. Symptoms of an allergic or anaphylactic reaction may include trouble breathing, swelling, or hives. If you experience any of these symptoms, seek immediate medical care.
Suicidal Thoughts & Behaviors
Lexapro may worsen depression and increase the risk of suicidal ideation. The risk is higher for individuals 24 years of age or younger, during the first few weeks of treatment or when the dose is changed. If you or someone else shows signs of suicidal thoughts or behaviors, seek medical help right away.
Antidepressant Discontinuation Syndrome (Lexapro Withdrawal)
People discontinuing Lexapro abruptly may have symptoms of Lexapro withdrawal, also called antidepressant discontinuation syndrome. These symptoms can include dizziness, nausea, upset stomach, tiredness, anxiety, shaking, sweating, agitation, restlessness, sleep problems, seizures, electric shock sensations, confusion, and headaches. Speak with your doctor if you experience these symptoms.
Mania or Hypomania
Lexapro can trigger manic or hypomanic symptoms. Before starting Lexapro, your doctor will confirm if you have or are at risk for bipolar disorder.
*This is not a comprehensive list of all warnings and precautions for Lexapro. You should talk with your doctor about any questions you have and to understand the potential warning and precautions of any medication.
How to Cope With Lexapro Side Effects in the First Week
Managing antidepressant side effects involves a combination of strategies tailored to the specific symptoms experienced. For common side effects like nausea, taking medication with food or adjusting the timing of doses can often alleviate discomfort. Addressing insomnia may involve taking antidepressants in the morning or using sleep aids under medical guidance. Contact your provider if side effects persist or worsen.
Practice Good Sleep Hygiene
Following good sleep hygiene practices can help you get better sleep while your body adjusts to the medication. Try to wake up and go to bed about the same time each day, and make sure your sleeping environment is relaxing and comfortable to you. If you experience drowsiness, avoid doing activities that require alertness, such as driving or operating machinery.
Healthy Lifestyle Activities
Eating well, sleeping enough, and getting adequate exercise are all parts of a healthy lifestyle. These activities are important for all aspects of your physical and mental health and can help you endure the impact of side effects.
Follow a Daily Routine
Following your normal routine is important whether or not the medication is working yet. Doing your regular daily activities can keep life more predictable and reduce stress as you adjust to the medication. Also, be sure you are taking your medication as prescribed and at a consistent time each day.
Consider Therapy
Psychotherapy can support you by addressing the impact of side effects and helping you develop strategies to manage them. For in-person treatment, your primary care provider or insurance company can provide a referral, or you may get one from family or friends.
To find an online therapist, an online therapist directory is a great starting point. Many online psychiatry platforms, such as Talkiatry and Brightside Health, also offer therapy services.
What If My Side Effects Persist After a Few Weeks?
If your side effects continue and they are impacting your overall quality of life, speak with your doctor. They may help you consider a change in dosage, timing of dosage, or change to another medication.
When Should I Seek an Alternative to Lexapro Due to Side Effects?
Initial side effects of Lexapro typically subside after a few weeks. If after some time you are looking to change your medication due to continued side effects, work with a doctor to find an alternative. There are many Lexapro alternatives available. All classes of antidepressants can help reduce depression symptoms, though potential risks and benefits can vary.
Other SSRIs and serotonin norepinephrine reuptake inhibitors (SNRIs) are usually the first antidepressants considered as Lexapro alternatives because of their safety and effectiveness.
Atypical antidepressants work differently to improve symptoms and don’t fit into a formal category. Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are older medications with more side effects. However, they may be helpful for those who need to avoid or can’t tolerate other types of antidepressants.
Online Psychiatry and Medication Management Covered by Insurance
Talkiatry can match you with a real psychiatrist who takes your insurance and is seeing new patients. They’re in-network with major insurers and offer medication management. Get started with a short online assessment
How to Get a Prescription for Lexapro or Alternative Medications
To get a prescription for Lexapro or an alternative in person, start with an evaluation for your symptoms. Your primary care provider, who may be a physician, nurse practitioner, or physician assistant, can help you get the process started. They may make a referral to a psychiatrist or specialist to determine if a prescription Lexapro alternatives should be included in your treatment plan.
To get an online prescription for a Lexapro alternative, you will also start by getting evaluated by an online psychiatric provider. We have thoroughly reviewed platforms like Talkiatry or Circle Medical that prescribe non-controlled substances such as antidepressants and some anti-anxiety medications.
Benzodiazepines are controlled substances that may be used to treat anxiety symptoms. To get prescribed benzodiazepines, you must do your evaluation with an online psychiatry provider that can and will prescribe controlled substances.
We have thoroughly evaluated online providers like Talkiatry that can and will prescribe benzodiazepines and found them each to be a good place to get started with an evaluation. If your provider feels a benzodiazepine is a good fit for your anxiety symptoms, they may offer you a benzodiazepine prescription online.
Questions to Ask Your Provider
It is important to discuss the potential side effects of Lexapro with your doctor, psychiatrist, or therapist you may experience immediately after starting the treatment. Ask them whether these side effects will go away on their own or if any intervention is needed.
Also, many online psychiatry services are available with convenient access to mental health care for depression and anxiety problems. Individuals may even change prescribers and get a mental health evaluation, diagnosis, and personalized treatment plan.
Questions to ask your care team about Lexapro side effects in the first week may include:
- How long will it take for me to adjust to taking Lexapro?
- How does Lexapro make you feel the first week?
- When do Lexapro side effects start?
- What are the first days of Lexapro side effects like?
- What is the best dosage to ensure fewer side effects, especially in the first week?
- When should I reach out to you if I am experiencing side effects?
- If I’m not able to tolerate the side effects, are there Lexapro alternatives to consider?
- How should I cope with side effects?
- What to do if the side effects do not disappear after the first week?
- Can I skip or lower a dose to avoid the side effects?
- Can I switch the drug if the side effects last longer or get worse?
- What to do if I have serious side effects?
Prescriber’s Tips
Your prescriber will share important information about your Lexapro prescription. They will explain how to take and store your medication, what to avoid when taking it, and what to do about side effects. Follow these tips for safe and effective use of Lexapro.
- Take your medication as prescribed, do not change your dose or stop taking it unless your prescriber tells you to. Keeping a consistent dosing schedule reduces the chance of unwanted side effects. When taking antidepressants, this approach can prevent withdrawal symptoms such as dizziness, brain zaps, and flu-like symptoms.1
- Take your medication at the same time each day. Doing so can help you remember to take it, making it as effective as possible. Your healthcare provider can help determine the optimal timing based on your sleep patterns and initial medication response.
- Tell your prescriber right away if you or your child have any worsening mental health symptoms. Antidepressants have a boxed warning for increased risk of suicidal thoughts and behaviors in children under age 18 and young adults.
- You should take your first dose while you are home and not needing to drive. Lexapro has been known to cause drowsiness in some patients, and you should avoid driving after taking Lexapro until you know how it affects you.1
- Ask your doctor whether it is safe to drink alcohol while taking Lexapro.
- Tell your prescriber about all medications and supplements you take, including over-the-counter treatments. Many over-the-counter medications and supplements can interact with prescription medications. This is because they are processed by the same gut enzymes, cytochrome P450 (CYPs). These interactions can lead to unwanted side effects or reduce the effectiveness of your prescription medication.3
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A few questions from Talkiatry can help you understand your symptoms and give you a recommendation for what to do next.
Best Online Psychiatry Services
Online psychiatry, sometimes called telepsychiatry, platforms offer medication management by phone, video, or secure messaging for a variety of mental health conditions. In some cases, online psychiatry may be more affordable than seeing an in-person provider. Mental health treatment has expanded to include many online psychiatry and therapy services. With so many choices, it can feel overwhelming to find the one that is right for you.
Frequently Asked Questions
What Is Lexapro & What Is It Used to Treat?
Lexapro (escitalopram) is an antidepressant in the selective serotonin reuptake inhibitors (SSRI) drug class.1 It works by boosting serotonin levels, a chemical that improves the mindset in the brain (regulating perspective, personality, and wakefulness). The dose and improvement time may vary according to health conditions.
What Does Lexapro Do?
Lexapro is a selective serotonin reuptake inhibitor that works by increasing serotonin levels in the brain. Serotonin is a body chemical involved in mood regulation.1
How Does Lexapro Make You Feel the First Week?
During the first week of taking Lexapro, the medication is building up in your body. This may trigger side effects for some people. It takes several weeks for Lexapro to start working and you may not notice any difference in your symptoms yet.
Which Antidepressants Cause the Fewest Side Effects?
SSRIs and serotonin norepinephrine reuptake inhibitors (SNRIs) are antidepressants that cause the least side effects. These are newer classes of antidepressants and are often preferred for their milder side effects.
Which Antidepressants Cause the Most Side Effects?
Monamine oxidase inhibitors (MAOIs), tetracyclic, and tricyclic antidepressants (TCAs) cause the most side effects. These are older classes of medication and are not first-line treatments for depression because they have more side effects than newer antidepressants.
Should I Stop Taking Lexapro If I Experience Side Effects?
Do not stop taking Lexapro unless you have been advised to do so by your provider. Doing so can lead to antidepressant discontinuation syndrome, also known as antidepressant withdrawal. This can cause uncomfortable symptoms, including dizziness, fatigue, irritability, and nausea.
What’s the Number One Side Effect of Lexapro?
In the clinical trials for Lexapro, the most commonly reported side effect was insomnia.1
Additional Resources
To help our readers take the next step in their mental health journey, Choosing Therapy has partnered with leaders in mental health and wellness. Choosing Therapy is compensated for marketing by the companies included below.
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Circle Medical – Anxiety and Depression Treatment. Meet with an online doctor today! All prescriptions are based on necessity determined by a medical professional. Diagnosis and prescription over video. Insurance accepted. No membership or hidden fees. Same day appointments. Visit Circle Medical
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ChoosingTherapy.com strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.
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Lexapro- escitalopram tablet, film coated, Lexapro- escitalopram solution. (August 8, 2023). DailyMed.nlm.nih.gov. Retrieved from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm
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Warden, D., Trivedi, M. H., Wisniewski, S. R., Kurian, B., Zisook, S., Kornstein, S. G., Friedman, E. S., Miyahara, S., Leuchter, A. F., Fava, M., & Rush, A. J. (2010). Early adverse events and attrition in selective serotonin reuptake inhibitor treatment: a suicide assessment methodology study report. Journal of clinical psychopharmacology, 30(3), 259–266. Retrieved from https://doi.org/10.1097/JCP.0b013e3181dbfd04
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Marken, P. A., & Munro, J. S. (2000). Selecting a Selective Serotonin Reuptake Inhibitor: Clinically Important Distinguishing Features. Primary Care Companion to the Journal of Clinical Psychiatry. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181142/
We regularly update the articles on ChoosingTherapy.com to ensure we continue to reflect scientific consensus on the topics we cover, to incorporate new research into our articles, and to better answer our audience’s questions. When our content undergoes a significant revision, we summarize the changes that were made and the date on which they occurred. We also record the authors and medical reviewers who contributed to previous versions of the article. Read more about our editorial policies here.
Author: No Change
Reviewer: No Change
Condensed “What is Lexapro & What Is It Used to Treat?” and moved to FAQs. Retitled “Can Lexapro Make You Feel Worse at First?” to “Can Lexapro Worsen Symtoms at First?”, retitled and revised “Warnings & Precautions for Taking Lexapro” to “Precautions for Starting Lexapro”. Retitled and revised “Questions to Ask Your Healthcare Provider About Lexapro Side Effects in the First Week” to “Questions to Ask Your Provider”, retitled and revised “In My Experience” to “Prescriber’s Tips”. Added sections “When Should I Call My Doctor About Lexapro Side Effects?”, “What If My Side Effects Persist After a Few Weeks?”, “When Should I Seek an Alternative to Lexapro Due to Side Effects?”, “How to Cope With Lexapro Side Effects in the First Week” and several subsections. Removed “For Further Reading”, Added FAQs.
Author: Zachery Reale, PharmD
Reviewer: Heidi Moawad, MD
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