What is the recommended dosing for Lexapro (escitalopram) in adults with depression or generalized anxiety disorder?

From the Guidelines

The recommended dosing for Lexapro (escitalopram) in adults with depression or generalized anxiety disorder is 10 to 20 mg per day. According to the study published in the American Family Physician in 2015 1, the dosage range for escitalopram is 10 to 20 mg per day, with no requirement to decrease the dose in patients with renal or hepatic disease.

Key Considerations

• The dose may be increased to the maximum recommended dose of 20 mg once daily if needed for better symptom control after 1-2 weeks of treatment.
• Some patients, particularly elderly individuals or those with hepatic impairment, may benefit from starting at a lower dose, but this is not explicitly stated for escitalopram in the provided evidence.
• Lexapro should be taken consistently at the same time each day, with or without food.
• When discontinuing treatment, the dose should be gradually tapered over at least 1-2 weeks to minimize withdrawal symptoms.

Monitoring and Side Effects

• Patients should be monitored for side effects such as nausea, insomnia, sexual dysfunction, and increased anxiety, especially during the initial weeks of treatment.
• Improvement in symptoms may begin within 1-4 weeks, but full therapeutic effects often take 6-8 weeks to develop.
• Escitalopram is considered a preferred agent due to its favorable adverse effect profile, as noted in the study 1.

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 one week. The recommended starting dose of Escitalopram tablets is 10 mg once daily. If the dose is increased to 20 mg, this should occur after a minimum of one week.

The recommended dosing for Lexapro (escitalopram) in adults with depression or generalized anxiety disorder is 10 mg once daily, with the option to increase to 20 mg once daily after a minimum of one week if needed 2.

• Initial Treatment: 10 mg once daily
• Dose Increase: up to 20 mg once daily after a minimum of one week
• Maintenance Treatment: 10 mg or 20 mg once daily, with periodic re-evaluation of the need for continued treatment.

From the Research

Lexapro Dosing for Adults with Depression or Generalized Anxiety Disorder

• The recommended dosing for Lexapro (escitalopram) in adults with depression or generalized anxiety disorder is typically in the range of 10-20 mg per day 3, 4, 5, 6.
• Studies have shown that escitalopram is effective and well-tolerated in the treatment of generalized anxiety disorder (GAD) and depression, with a significant reduction in symptoms and improvement in quality of life 3, 4, 5.
• The efficacy and tolerability of escitalopram have been demonstrated in several clinical trials, including a 24-week relapse-prevention study in patients with GAD, where escitalopram 20 mg/day significantly reduced the risk of relapse compared to placebo 5.
• Escitalopram has also been shown to be effective in the treatment of comorbid depression and anxiety in elderly patients, with significant improvements in symptoms of depression and anxiety 4.
• The safety and tolerability of escitalopram have been evaluated in several studies, with nausea being the only adverse event with an incidence greater than or equal to 10% and 5 percentage points greater than with placebo during short-term treatment 6.

Dosing Considerations

• The dose of escitalopram may need to be adjusted based on individual patient response and tolerability 3, 4, 5, 6.
• Escitalopram is generally well-tolerated, with a low incidence of discontinuation symptoms and no significant changes in clinical laboratory values 6.
• The risk of adverse events is no higher in special patient populations, such as the elderly or those with hepatic dysfunction 6.