What is the indication for Lexapro (escitalopram)?

From the Guidelines

Lexapro (escitalopram) is primarily used to treat depression and anxiety disorders, with a recommended starting dose of 10mg once daily for adults, which may be increased to 20mg daily if needed after at least one week, as supported by the most recent study 1.

Key Points

• Lexapro belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRIs) that work by increasing serotonin levels in the brain, a neurotransmitter that helps maintain mental balance.
• The medication usually takes 1-4 weeks to begin showing therapeutic effects, though full benefits may take 6-8 weeks to develop, as noted in the guidelines for adolescent depression in primary care 1.
• Common side effects include nausea, headache, insomnia, dry mouth, and sexual dysfunction.
• Patients should not stop taking Lexapro abruptly as this can cause withdrawal symptoms; dosage should be gradually reduced under medical supervision, as recommended by the American College of Physicians 1.
• Lexapro should not be combined with monoamine oxidase inhibitors (MAOIs) and caution is needed when taking it with other medications that affect serotonin levels to avoid serotonin syndrome, a potentially dangerous condition.

Dosage and Administration

• Typical dosing starts at 10mg once daily for adults, which may be increased to 20mg daily if needed after at least one week.
• For older adults or those with liver problems, lower starting doses of 5mg may be recommended, as suggested by the guidelines for adolescent depression in primary care 1.
• The effective dosages for antidepressants in adolescents are lower than would be found in adult guidelines, with only fluoxetine approved by the FDA for use in children and adolescents with depression, and only escitalopram approved for use in adolescents aged 12 years and older 1.

Important Considerations

• All SSRIs should be slowly tapered when discontinued because of the risk of withdrawal effects, as noted in the guidelines for adolescent depression in primary care 1.
• The patient and family should be informed about the possible adverse effects, including possible switch to mania or the development of behavioral activation or suicide-related events, as recommended by the American College of Physicians 1.
• Contact should take place after the initiation of treatment to review the patient’s and family’s understanding of and adherence to the treatment plan, as suggested by the guidelines for adolescent depression in primary care 1.

From the FDA Drug Label

1.1 Major Depressive Disorder Escitalopram is indicated for the acute and maintenance treatment of major depressive disorder in adults and in adolescents 12 to 17 years of age 1.2 Generalized Anxiety Disorder Escitalopram is indicated for the acute treatment of Generalized Anxiety Disorder (GAD) in adults Lexapro (escitalopram) is used for:

• Major Depressive Disorder in adults and adolescents 12 to 17 years of age
• Generalized Anxiety Disorder in adults 2

From the Research

What is Lexapro Used For

Lexapro, also known as escitalopram, is a selective serotonin reuptake inhibitor (SSRI) used for the treatment of:

• Major depressive disorder (MDD) 3
• Anxiety disorder, including generalized anxiety disorder (GAD) 4, 5, 6
• Accompanying symptoms of depression, such as anxiety, insomnia, and pain 7

Mechanism of Action

Lexapro works by:

• Inhibiting the reuptake of serotonin into presynaptic nerve endings, enhancing the activity of serotonin in the central nervous system 3
• Exerting a highly selective, potent, and dose-dependent inhibitory effect on the human serotonin transport 3
• Having allosteric activity 3

Efficacy and Tolerability

Studies have shown that Lexapro is:

• Effective in treating MDD and GAD, with significant improvements in symptoms and quality of life 3, 4, 5, 6
• Well-tolerated, with low rates of reported adverse events and discontinuation due to adverse events 4, 5
• Comparable to other SSRIs in terms of efficacy and tolerability 3, 7