How Long Does Lexapro (Escitalopram) Take to Work?
Lexapro (escitalopram) typically begins showing initial effects within 1-2 weeks, with measurable clinical improvement often seen at 2 weeks, and full therapeutic effects developing over 6-8 weeks. 1
Timeline of Escitalopram's Effects
Initial Response (1-2 weeks)
- A statistically significant difference between escitalopram and placebo in Montgomery-Asberg Depression Rating Scale (MADRS) total scores can be observed as early as week 1 1
- Core symptoms of depression (apparent sadness, reported sadness, inner tension, concentration difficulties, inability to feel, pessimistic thoughts, and suicidal thoughts) show improvement earliest, often within the first week 1
Early Response (2-4 weeks)
- The 2-week mark is critical - patients who show at least a 20% reduction in MADRS scores at 2 weeks have a 63% chance of achieving remission by week 8 1
- For moderate depression, clinically significant response (standardized effect size >0.40) can be seen after 2 weeks with 10mg escitalopram 2
- For severe depression, clinically significant response may take 4 weeks with 20mg escitalopram 2
Full Response (6-8 weeks)
- Maximal response is typically achieved within 8-12 weeks of treatment 3
- Some symptoms like reduced sleep, reduced appetite, and lassitude may take longer to improve (6-8 weeks) 1
Factors Affecting Response Time
Severity of Depression
- Patients with moderate depression (MADRS scores 22-29) may respond faster to lower doses (10mg) 2
- Patients with severe depression (MADRS scores ≥30) may require higher doses (20mg) and longer time to respond 2
Dosage Considerations
- Standard starting dose is 10mg once daily for most adults 3
- If no measurable clinical improvement is seen within 2 weeks, a dose increase to 20mg should be considered 1
- Maximum recommended dose is 20mg once daily 3
Long-term Treatment Outcomes
- The percentage of patients in remission (MADRS total score ≤12) increases from 46% at baseline to 65% by week 8 and 86% by week 52 in long-term treatment 4
- Continued improvement in depression scores occurs with ongoing treatment - mean MADRS scores decrease from 14.2 at baseline to 10.5 after 8 weeks and 7.2 after 52 weeks 4
Important Clinical Considerations
- Patients should be advised to continue therapy as directed even if they notice improvement within 1-4 weeks 5
- Treatment should be continued for at least 6-12 months after remission to prevent relapse 3
- Monitor closely for suicidal thoughts and behaviors, especially during treatment initiation and dose changes 5
- Common side effects include headache, nausea, insomnia, and sexual dysfunction 5, 6
Key Takeaway
Early response at 2 weeks is a strong predictor of eventual remission. If patients don't show measurable improvement after 2 weeks of treatment, consider increasing the dose from 10mg to 20mg daily 1. Full therapeutic effects typically develop over 6-8 weeks, with continued improvement possible with longer-term treatment.