What are the side effects of Lexapro (escitalopram)?

From the Guidelines

Lexapro (escitalopram) can cause a range of side effects, including nausea, headache, insomnia, and sexual dysfunction, and it is essential to monitor patients closely for these effects, especially during the initial treatment phase and when adjusting doses 1. When considering the side effects of Lexapro, it is crucial to prioritize the patient's morbidity, mortality, and quality of life. The most common side effects of Lexapro include:

• Nausea
• Headache
• Insomnia
• Drowsiness
• Dry mouth
• Dizziness
• Sexual dysfunction These effects typically appear within the first few weeks of treatment and often improve with time. However, some patients may experience more severe side effects, such as serotonin syndrome, abnormal bleeding, or suicidal thoughts, particularly in young adults and adolescents 1. It is also important to note that Lexapro, like other SSRIs, can interact with various medications, including monoamine oxidase inhibitors (MAOIs), and can cause discontinuation syndrome if stopped abruptly 1. Therefore, it is recommended to start with a low dose, gradually increase the dose as tolerated, and monitor patients closely for side effects, especially during the first few weeks of treatment 1. Regular follow-up with a healthcare provider is essential to monitor for side effects and adjust treatment as needed, especially during the first few months of therapy.

From the FDA Drug Label

What are the possible side effects of Escitalopram tablets? Escitalopram tablets may cause serious side effects, including all of those described in the section entitled “What is the most important information I should know about Escitalopram tablets? ” Common possible side effects in people who take Escitalopram tablets include: • Nausea • Sleepiness • Weakness • Dizziness • Feeling anxious • Trouble sleeping • Sexual problems • Sweating • Shaking • Not feeling hungry • Dry mouth • Constipation • Infection • Yawning Other side effects in children and adolescents include: • increased thirst • abnormal increase in muscle movement or agitation • nose bleed • difficult urination • heavy menstrual periods • possible slowed growth rate and weight change.

The possible side effects of Lexapro (Escitalopram) include:

• Common side effects:
  • Nausea
  • Sleepiness
  • Weakness
  • Dizziness
  • Feeling anxious
  • Trouble sleeping
  • Sexual problems
  • Sweating
  • Shaking
  • Not feeling hungry
  • Dry mouth
  • Constipation
  • Infection
  • Yawning
• Side effects in children and adolescents:
  • Increased thirst
  • Abnormal increase in muscle movement or agitation
  • Nose bleed
  • Difficult urination
  • Heavy menstrual periods
  • Possible slowed growth rate and weight change 2.

Note: The FDA drug label provides a comprehensive list of possible side effects, and it is essential to consult the label or a healthcare professional for a complete understanding of the potential side effects of Lexapro (Escitalopram) 2 2.

From the Research

Side Effects of Lexapro

• Lexapro, also known as escitalopram, is a selective serotonin reuptake inhibitor (SSRI) used to treat depression and anxiety disorders.
• Studies have investigated the side effects of Lexapro, particularly with regards to suicidal ideation and behavior.
• A study published in 2009 3 found that suicidal ideation decreased during antidepressant treatment with escitalopram, but rates of treatment-emergent suicidal ideation (TESI) and treatment-worsening suicidal ideation (TWOSI) peaked in the fifth week of treatment.
• Another study published in 2019 4 identified five distinct classes of suicidal ideation trajectories during 12 weeks of escitalopram treatment, including a persistent-low class, a persistent-high class, and a fast-response class.
• A genome-wide association study published in 2012 5 found that a single-nucleotide polymorphism (SNP) located near the guanine deaminase (GDA) gene was associated with increasing suicidal ideation during escitalopram treatment.
• A population-based cohort study published in 2022 6 found that SSRI treatment, including escitalopram, was associated with a reduced risk of suicidal behavior compared to the period before treatment initiation.
• A pharmacovigilance study published in 2024 7 analyzed data from the EudraVigilance database and found that psychiatric adverse drug reactions (ADRs), including suicidal ideation and behavior, accounted for a substantial portion of total reported ADRs for escitalopram and other SSRIs.

Suicidal Ideation and Behavior

• Suicidal ideation and behavior are significant concerns in patients treated with SSRIs, including Lexapro.
• Studies have shown that the risk of suicidal ideation and behavior is highest in the first few weeks of treatment 3, 4.
• However, other studies have found that SSRI treatment, including escitalopram, may reduce the risk of suicidal behavior compared to the period before treatment initiation 6.
• The relationship between SSRIs and suicidal behavior is complex and may depend on various factors, including the patient's age, gender, and medical history 7.

Age and Gender Differences

• Studies have found that the risk of suicidal ideation and behavior associated with SSRIs, including Lexapro, may vary by age and gender.
• A pharmacovigilance study published in 2024 7 found that suicide attempts were prevalent in patients aged 18-64, with notable incidence in the 0-17 age group.
• The same study found that ADRs occurred more frequently in women, particularly for duloxetine and sertraline.
• Another study published in 2009 3 found that men treated with nortriptyline were at higher risk of suicidal ideation compared to those treated with escitalopram.