From the Guidelines
When initiating Escitalopram (Lexapro), follow-up should occur within 1 to 2 weeks of initiation of therapy. This recommendation is based on the American College of Physicians' clinical practice guideline, which suggests assessing patient status, therapeutic response, and adverse effects of antidepressant therapy on a regular basis beginning within 1 to 2 weeks of initiation of therapy 1.
Key Considerations for Follow-up
- The initial follow-up is crucial to assess for side effects, which commonly emerge early in treatment, and to evaluate for any worsening mood or suicidal thoughts, which can occasionally occur when starting SSRIs like Lexapro.
- During these initial appointments, your healthcare provider will likely ask about side effects such as nausea, headache, insomnia, sexual dysfunction, and any changes in mood or anxiety levels.
- Dosage adjustments may be made during these early visits, as the standard starting dose of 10mg daily may need to be increased to 20mg for optimal effect in some patients.
Ongoing Monitoring
- It's essential to continue monitoring the patient's response to treatment, as Lexapro typically takes 4-6 weeks to reach full therapeutic effect.
- 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, treatment should be modified, as recommended by the American College of Physicians 1.
- Once stabilized on an effective dose, less frequent monitoring is generally sufficient unless new concerns arise, with the American College of Physicians recommending continuation of treatment for 4 to 9 months after a satisfactory response in patients with a first episode of major depressive disorder 1.
From the Research
Frequency of Follow-up for Escitalopram (Lexapro)
- The frequency of follow-up when initiating Escitalopram (Lexapro) is not directly addressed in the provided studies 2, 3, 4, 5, 6.
- However, study 3 examines the association between provider specialty and guideline-concordant care after the initiation of antidepressant treatment, including follow-up visits.
- Study 5 describes follow-up by general practitioners and specialists in mental healthcare for patients with depression starting antidepressant medication, including Escitalopram, and finds that only 27.8% of patients were followed up within 2 weeks of the first drug dispensing, and 67.1% within 90 days.
- Guidelines recommend follow-up within 2 weeks for patients starting medication for depression, as mentioned in study 5.
- Study 4 investigates the timing of first postdischarge follow-up and medication adherence after acute myocardial infarction, and finds that delayed follow-up beyond 6 weeks is associated with lower medication adherence.
- The provided studies do not specify the optimal frequency of follow-up for Escitalopram (Lexapro) initiation, but suggest that regular follow-up is important for medication adherence and effective treatment 3, 4, 5.