From the FDA Drug Label
The recommended dose of Escitalopram tablets is 10 mg once daily. Adults The recommended dose of Escitalopram tablets is 10 mg once daily.
The initial dose of Lexapro (escitalopram) can be 10 mg once daily. There is no direct information in the label that supports starting with 5 mg.
From the Research
Starting Lexapro (escitalopram) at 10mg is the most appropriate initial dose for most adults with depression, as it is the standard starting dose and has been shown to be effective in numerous studies, including a recent systematic review and meta-analysis published in 2023 1. When considering the initial dose of Lexapro, it is essential to weigh the potential benefits and risks, prioritizing morbidity, mortality, and quality of life as the primary outcomes. The most recent and highest quality study, a systematic review and meta-analysis published in 2023 1, provides strong evidence for the efficacy and tolerability of escitalopram in the treatment of major depressive disorder. Some key points to consider when starting a patient on Lexapro include:
- Maintaining the initial dose for at least 1-2 weeks before considering any increase, as side effects typically emerge early while therapeutic benefits may take 2-4 weeks to become apparent.
- Common initial side effects include nausea, headache, insomnia, and increased anxiety, which often diminish within the first two weeks.
- Patients should take Lexapro at the same time each day, with or without food.
- If starting at 5mg, the dose can be increased to 10mg after 1-2 weeks if well-tolerated but insufficient response, with a maximum recommended dose of 20mg daily.
- Patients should be advised not to abruptly discontinue the medication and to report any concerning side effects promptly. It is also important to note that escitalopram has been shown to be more effective than other antidepressants, including citalopram, in achieving acute response and remission, and has a better tolerability profile, with lower all-cause withdrawals from study and lower withdrawals due to adverse events 2, 3. Overall, the evidence suggests that starting Lexapro at 10mg is a reasonable and effective approach for most adults with depression, and that escitalopram is a valuable treatment option for this condition.