Lexapro is the brand name medication of the generic drug escitalopram, which is FDA-approved to treat major depressive disorder and generalized anxiety in adults and depression in adolescents aged 12-17. Most people respond well to treatment, making Lexapro a viable option for first-line treatment for these disorders. Still, it is important to understand that taking Lexapro carries a black box warning for increased suicidal thoughts (in patients under 25 years old) and additional risks for serotonin syndrome, seizures, and activation of manic episodes.1,2
What Is Lexapro (Escitalopram)?
Lexapro (escitalopram) is a part of the selective serotonin reuptake inhibitor (SSRI) drug family that includes other medications like citalopram, fluoxetine, and sertraline. It is frequently used as the first drug of choice for treating depression and anxiety disorders.3 Like other SSRI drugs, Lexapro will help improve impacted processes involved with improving sleep, appetite, and energy and reduce symptoms such as fear and anxiety.
The FDA has approved Lexapro to treat major depressive disorder (MDD) in adults and children aged 12-17 and general anxiety disorder (GAD) in adults. Lexapro has also been used as an off-label medication in special cases for other mental health disorders like obsessive-compulsive disorder (OCD), panic disorder, PTSD, and some eating disorders such as binge eating disorder or bulimia nervosa.1,2 An off-label medication is one that is not FDA approved for the indication. Prescribers may prescribe a medication off-label based on their professional judgment that the medication may offer a benefit to patients.
Lexapro can be taken as a tablet or a liquid. The most common starting Lexapro dosage for adults and children is 10 mg, taken once daily. Depending on the disorder Lexapro is being used to treat, your doctor may increase the dose after a maintenance period of two weeks. You can expect the full effects of the medication to be felt after 4 to 6 weeks of taking it regularly.1
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Side Effects of Lexapro (Escitalopram)
While Lexapro is well tolerated by most people when taken as prescribed, there is still a risk of side effects, both mild and severe. In the same way that Lexapro helps to treat mental health conditions, it will cause physiological changes in the body that can come with unwanted side effects. Some mild side effects include changes in sleep, appetite, or concentration. Some severe side effects can include heart and blood-related problems, changes in mental status, and rare but serious serotonin syndrome.2
Mild side effects usually go away with time or can be minimized with changes in dosage. Severe side effects can happen unexpectedly, without warning, and can be life-threatening, requiring immediate attention. Knowing the difference between mild and severe risks and how to act when either occurs is important. In both cases, you should contact your doctor or care team to discuss how to best respond. However, if a severe side effect happens, you should find your closest emergency department or contact 911 immediately. Reviewing your complete medical history with your doctor can address potential risks of severe side effects before starting Lexapro.5
Common Side Effects of Escitalopram
Common side effects of Lexapro usually happen within the first weeks after starting the medication. In most cases, these side effects are mild and may remain for as long as a person takes Lexapro. Sexual side effects from Lexapro may be among the discomforting impacts of taking this medication.
Your doctor will prescribe a starting dose for a few weeks and if needed will increase your dose.5 Most effects last no more than a few days or weeks, but if they last longer, it is vital to reach out to your doctor as it could signify something more serious.
Common side effects of (Lexapro) escitalopram that don’t require medical attention immediately may include:1,6
- Nausea, heartburn, stomach pain, diarrhea, & constipation
- Dry mouth
- Increased sweating
- Sexual problems in males and females
- Drowsiness, yawning
- Difficulty falling or staying asleep
- Excessive tiredness, muscle weakness
- Decreased appetite, weight loss
- Dizziness
- Shaking
Severe Side Effects of Escitalopram
Lexapro is primarily safe when appropriately used, but there are still risks of severe 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 integral to safely using Lexapro.
Severe side effects of Lexapro that may require immediate attention can include:1
- Serotonin syndrome: 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: Signs of abnormal bleeding 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 addressed immediately to prevent permanent damage.
- Manic episodes: Episodes 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 appropriately addressed. Headaches, problems with thinking, concentration, or memory, and difficulty urinating are all signs of low salt in the body.
- Suicidal thoughts: Any mood changes or plans to harm yourself 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. Any fast, slow, skipping, or irregular heartbeat should be addressed.
Additional Side Effects of Lexapro
The common and more severe side effects of Lexapro have been studied through extensive clinical studies and are well understood. Other side effects occurred during clinical trials in smaller numbers of patients, so they are not considered as common. While the prevalence of these side effects is not fully understood, they can still pose serious health risks. It is essential to pay attention to changes in your body while taking Lexapro. Communicating any changes in health with your doctor can help determine if the medication is the cause of a rare side effect.
Rare side effects of Lexapro may include:
- Coma
- Decreased urine output
- Increased eye sensitivity
- Painful urination
- Problems with concentration or memory
- Joint pain
- Teeth grinding
- Muscle cramp
- Increased thirst
- Increased sun sensitivity
Allergic Reactions to Lexapro
An allergic reaction to your medication can be very dangerous. If you are allergic to escitalopram 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
Severe allergic reactions to Lexapro can include:
- Skin rash that covers a large area of the body
- Swelling or itching of the face and neck
- Trouble breathing
The above side effects outline many possible risks while taking Lexapro. Each person can experience side effects differently, more commonly, or only feel just a few. Knowing if a side effect is severe or not and what to do in each case is an integral part of safely using Lexapro. Talking with your doctor before and during treatment helps to reduce the risk of harmful side effects.
Long-Term Effects of Lexapro
Lexapro is generally safe when taken long-term.2 When taking any long-term medication, problems can pop up in other areas of our health. Lexapro can have side effects like memory problems, weight fluctuations, and bleeding problems that can cause long-term health complications. As a person gets older and other aging issues arise, Lexapro can worsen their development. Continuing to see your doctor regularly and sharing all medical information can help prevent and recognize long-term adverse side effects.
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Interactions with Lexapro (Escitalopram)
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.
Some substances that can interact with Lexapro include:1
- Blood thinners: Increase your risk of bleeding, requiring careful monitoring when used with Lexapro.
- NSAIDs: Increases your risk of bleeding, requiring careful monitoring when used with Lexapro.
- Depression medications: Increases risk for serotonin syndrome. Only in exceptional cases will you be prescribed two different drugs that increase the development of serotonin.
- Water pills: Diuretics, like furosemide, can increase the risk of developing hyponatremia or low salt in the body.
- MAOIs: A specific type of monoamine oxidase inhibitor can cause a severe reaction with Lexapro. Tell your doctor if you are taking or have recently taken any of these medications. They include isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), selegiline (Emsam, Zelapar), and Tranylcypromine.
- Benzodiazepines: These medications can increase the side effect of the drowsiness of Lexapro.
- Migraine drugs: Also known as ‘triptans,’ can increase your serotonin syndrome risk.
- Alcohol: This can increase the side effect of drowsiness from Lexapro.
- Cimetidine: This medication can increase the amount of Lexapro that is active in your body, thus increasing the chance of side effects.
Who Experiences Side Effects More?
Certain groups of people are at a higher risk for worse side effects. It is important to discuss your entire health history with your care team when deciding if Lexapro is right for you.3
Health conditions and additional side effects to consider before taking Lexapro include:
- 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.
- Teen or Young Adults: An increase in teen suicidal thoughts and behavior has been seen in patients up to 24 years old taking antidepressants. It is essential to seek medical attention immediately if you notice any negative mood changes or thoughts.
- Seizures: Lexapro and other SSRI medications can cause seizures in high doses or with other similar drugs. It is crucial to alert your doctor if you have a history of seizures.7
- MAOI Drugs: Patients who have taken MAOI within 14 days before or 14 days after taking Lexapro are at a high risk of serotonin syndrome.
- Liver conditions: Certain people with low levels of specific liver enzymes can make Lexapro side effects worse. These individuals should have their liver enzymes tested to decide if Lexapro is safe for them.
- Bipolar Disorder: Taking SSRIs can increase the chances of triggering a manic episode.
If any of the above apply to you, bring it up with your care team immediately.3
Lexapro Side Effects on Pregnancy & Breastfeeding
If you are pregnant or planning to become pregnant, it is important to discuss this with your doctor and OBGYN before taking Lexapro. Those who take Lexapro during the late stages of pregnancy potentially put the baby at a small risk of developing pulmonary hypertension, which can be fatal. It is also known that Lexapro is passed through breast milk to nursing babies. Caution must be taken if breastfeeding individuals decide to take Lexapro.1
Withdrawal Symptoms from Lexapro
After taking Lexapro for a few months, your body will become used to the medication. While this is not an addiction, it is your body’s dependence on the drug. It is important not to stop taking Lexapro too quickly since this can cause adverse side effects of antidepressant discontinuation syndrome.
Examples of withdrawal symptoms may include:2
- Irritability
- Nausea
- Feeling dizzy
- Vomiting
- Nightmares
- Headache
- Tingling sensation on the skin
If you feel you are dependent on Lexapro or would like to stop taking Lexapro, it is important to talk to your doctor before doing so. Your doctor will work with you to make a plan to slowly lower and eventually stop the medication. This process reduces the risk of your body experiencing withdrawal symptoms.
Questions to Ask Your Health Team About Lexapro Side Effects
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. Taking the time to speak with your doctor about the risks of side effects will help determine if Lexapro may 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.
Questions to ask your care team when considering the side effects of Lexapro are:2
- Is it safe to take Lexapro with my other medications?
- How long will it take for me to adjust to taking Lexapro?
- 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?
- Am I at risk for more severe symptoms if I am already taking other anxiety or depression medications?
- What should I do if I want to stop taking Lexapro?
- Will a previous history of addiction make me more susceptible to dependency?
- What should I do if I have thoughts of suicide or harming myself?
- Are there any other medications I should not take with Lexapro?
- When should I reach out to you if I am experiencing side effects?
- How do side effects of Lexapro vs Cymbalta compare?
Final Thoughts
Lexapro is commonly used for anxiety and depression and may be used ‘off-label.’ It is important to be aware of the severe side effects and risks it can have. Common side effects include changes in sleep and appetite, as well as mild sweating or dizziness. More severe side effects can include seizures, suicidal thoughts, and risks of serotonin syndrome. Understanding the risk for side effects is vital in deciding if Lexapro is a good treatment option for each individual.
Additional Resources
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For Further Reading
Lexapro Vs. Zoloft: Choosing Which Is Right for You
Lexapro Vs. Prozac: Choosing Which Is Right for You
Lexapro & Weight Gain: Everything You Need to Know
Lexapro Vs. Wellbutrin: Choosing Which Is Right for You
Celexa Vs. Lexapro: Choosing Which Is Right for You
Lexapro for OCD: Everything You Need to Know
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