Escitalopram (Lexapro) Dosing for Major Depressive Disorder and Generalized Anxiety Disorder
For adults with major depressive disorder (MDD) or generalized anxiety disorder (GAD), the recommended dosing of escitalopram is 10 mg once daily initially, with the option to increase to 20 mg once daily after a minimum of one week if clinically indicated. 1
Initial Dosing Recommendations
Major Depressive Disorder
- Starting dose: 10 mg once daily 1
- Maximum dose: 20 mg once daily 1
- Timing of dose increase: If increasing to 20 mg, wait at least one week after starting treatment 1
- Administration: Can be taken in the morning or evening, with or without food 1
Generalized Anxiety Disorder
- Starting dose: 10 mg once daily 1
- Maximum dose: 20 mg once daily 1
- Timing of dose increase: If increasing to 20 mg, wait at least one week after starting treatment 1
- Administration: Can be taken in the morning or evening, with or without food 1
Special Populations
- Elderly patients: 10 mg/day is the recommended dose 1
- Hepatic impairment: 10 mg/day is the recommended dose 1
- Renal impairment:
Efficacy Considerations
- A fixed-dose trial demonstrated effectiveness of both 10 mg and 20 mg for MDD, but failed to show greater benefit of 20 mg over 10 mg 1
- For moderate depression (MADRS score 22-29), 10 mg/day appears to be the optimal dose 2
- For severe depression (MADRS score ≥30), 20 mg/day may be more effective 2
- In GAD, escitalopram has shown continued efficacy in 24-week extension studies and in relapse prevention studies 3, 4
Duration of Treatment
- MDD: Several months or longer of sustained pharmacological therapy beyond response to the acute episode is generally recommended 1
- GAD: While efficacy beyond 8 weeks has not been systematically studied in controlled trials, open-label studies support continued effectiveness for up to 24 weeks 3
- Maintenance treatment has demonstrated benefit in preventing relapse in both MDD and GAD 1, 4
Discontinuation
- Gradual dose reduction rather than abrupt cessation is recommended to minimize discontinuation symptoms 1
- Monitor for symptoms associated with discontinuation (dizziness, sensory disturbances, anxiety, sleep disturbances) 1
- If intolerable symptoms occur during discontinuation, consider resuming the previously prescribed dose and decreasing more gradually 1
Monitoring and Safety
- Screen for bipolar disorder prior to starting treatment 1
- Common adverse effects include headache, nausea, diarrhea, dizziness, dry mouth, fatigue, and sexual dysfunction 5, 6
- Weight gain may occur with long-term treatment (mean increase of 3.0 lb over 24 weeks reported in one study) 3
- Allow at least 14 days between discontinuing MAOIs and starting escitalopram, and vice versa 1
Escitalopram has demonstrated a favorable safety and tolerability profile in long-term treatment, with continued improvement in patient response over time 5, 3.