What is the recommended treatment and dosage for Lexapro (escitalopram) in patients with major depressive disorder or generalized anxiety disorder?

From the Guidelines

Lexapro (escitalopram) is typically prescribed at an initial dose of 10 mg once daily for adults with major depressive disorder (MDD) or generalized anxiety disorder (GAD), with the option to increase to 20 mg daily after at least one week if needed, as recommended by the American College of Physicians 1.

Key Considerations

• For elderly patients or those with hepatic impairment, starting at 5 mg daily is recommended.
• Treatment should continue for at least 6 months after symptom improvement to prevent relapse, and discontinuation should involve gradual tapering to avoid withdrawal symptoms, as suggested by the American College of Physicians 1.
• Lexapro works by increasing serotonin levels in the brain by selectively inhibiting serotonin reuptake.
• Patients should take it at the same time each day, with or without food, and should be aware that therapeutic effects may take 2-4 weeks to become noticeable.

Monitoring and Adjustments

• Clinicians should assess patient status, therapeutic response, and adverse effects of antidepressant therapy on a regular basis beginning within 1 to 2 weeks of initiation of therapy, as recommended by the American College of Physicians 1.
• If the patient does not have an adequate response to pharmacotherapy within 6 to 8 weeks of the initiation of therapy for major depressive disorder, clinicians should modify treatment, as suggested by the American College of Physicians 1.

Potential Interactions and Side Effects

• Common side effects include nausea, insomnia, sexual dysfunction, and increased anxiety during the first few weeks.
• Patients should avoid alcohol while taking Lexapro and inform their healthcare provider about all other medications they're taking to prevent potential drug interactions, particularly with MAOIs, which can cause dangerous serotonin syndrome.

From the FDA Drug Label

Escitalopram tablets should be administered once daily, in the morning or evening, with or without food. The recommended dose of Escitalopram tablets is 10 mg once daily. If the dose is increased to 20 mg, this should occur after a minimum of three weeks for adolescents and one week for adults. Maintenance Treatment It is generally agreed that acute episodes of major depressive disorder require several months or longer of sustained pharmacological therapy beyond response to the acute episode The recommended starting dose of Escitalopram tablets is 10 mg once daily for generalized anxiety disorder. If the dose is increased to 20 mg, this should occur after a minimum of one week.

The recommended treatment and dosage for Lexapro (escitalopram) in patients with major depressive disorder or generalized anxiety disorder is:

• Initial treatment: 10 mg once daily
• Dose increase: up to 20 mg once daily, after a minimum of one week for adults and three weeks for adolescents
• Maintenance treatment: 10 mg or 20 mg once daily, for several months or longer, as needed 2 Key considerations:
• The dose should be increased gradually, if necessary
• Patients should be periodically reassessed to determine the need for maintenance treatment
• The physician should periodically re-evaluate the long-term usefulness of the drug for the individual patient 2

From the Research

Recommended Treatment and Dosage for Lexapro (Escitalopram)

The recommended treatment and dosage for Lexapro (escitalopram) in patients with major depressive disorder or generalized anxiety disorder are as follows:

• The initial dosage of escitalopram is 10 mg/day, which can be increased to 20 mg/day after a minimum of 1 week based on clinical response and tolerability 3, 4, 5.
• Escitalopram has been shown to be effective in the treatment of major depressive disorder (MDD) and generalized anxiety disorder (GAD) in several clinical trials 3, 4, 6, 5, 7.
• The efficacy of escitalopram in MDD has been demonstrated in short-term and long-term trials, with significant improvements in depressive symptoms and prevention of relapse 3, 6, 5.
• In patients with GAD, escitalopram has been shown to be effective in reducing anxiety symptoms, with significant improvements in Hamilton Anxiety Scale (HAMA) scores 4.

Efficacy and Safety of Escitalopram

The efficacy and safety of escitalopram have been established in several clinical trials:

• Escitalopram has been shown to be superior to placebo in the treatment of MDD and GAD 3, 4, 6, 5, 7.
• The safety profile of escitalopram is predictable and similar to that of other SSRIs, with common adverse events including nausea, ejaculatory problems, diarrhea, and insomnia 3, 4, 5.
• Escitalopram has a low propensity for drug interactions, which is a potential benefit in the management of patients with comorbidities 3, 7.

Patient Acceptability and Cost-Effectiveness

Escitalopram has been shown to be well-tolerated and acceptable to patients:

• Patient acceptability of escitalopram is high, with a low rate of discontinuation due to adverse events 6.
• Escitalopram has been shown to be cost-effective in the treatment of MDD, with a low cost per quality-adjusted life year (QALY) gained 5.