Recommended Dosing for Escitalopram (Lexapro) in Adults with Depression or Generalized Anxiety Disorder
For adults with depression or generalized anxiety disorder (GAD), the recommended starting dose of escitalopram is 10 mg once daily, with the option to increase to 20 mg after a minimum of one week if needed. 1
Initial Dosing
- For major depressive disorder (MDD) in adults, the recommended starting dose is 10 mg once daily 1
- For generalized anxiety disorder (GAD) in adults, the recommended starting dose is also 10 mg once daily 1
- Escitalopram can be administered in the morning or evening, with or without food 1
Dose Adjustments
- If the initial dose is not providing adequate response, the dose may be increased to 20 mg daily after a minimum of one week on the starting dose 1
- A fixed-dose trial demonstrated effectiveness of both 10 mg and 20 mg doses for depression, but failed to demonstrate greater benefit of 20 mg over 10 mg in all patients 1
- For elderly patients and those with hepatic impairment, 10 mg/day is the recommended dose 1
- No dosage adjustment is necessary for patients with mild or moderate renal impairment, but escitalopram should be used with caution in patients with severe renal impairment 1
Treatment Duration
- For MDD: Several months or longer of sustained pharmacological therapy beyond response to the acute episode is generally recommended 1
- For GAD: The efficacy of escitalopram in the treatment of GAD beyond 8 weeks has not been systematically studied, but long-term treatment is often needed 1
- In a 24-week relapse prevention study for GAD, escitalopram recipients showed significantly longer time to relapse and reduced risk of relapse compared to placebo 2
- The risk of relapse was 4.04 times higher in the placebo group than in the escitalopram group in long-term GAD treatment 2
Efficacy Considerations
- In clinical studies, escitalopram has demonstrated continued efficacy in both depression and anxiety disorders with long-term treatment 3
- For GAD, escitalopram 10-20 mg/day has shown efficacy in multiple controlled studies 4
- In long-term GAD treatment, 92% of patients completing 24 weeks of treatment were considered responders 3
Discontinuation
- Abrupt discontinuation may lead to discontinuation symptoms including dizziness, fatigue, lethargy, headaches, nausea, insomnia, and anxiety 5
- A gradual reduction in dose rather than abrupt cessation is recommended whenever possible 1
- If intolerable symptoms occur following a decrease in dose or upon discontinuation, resuming the previously prescribed dose may be considered before continuing with a more gradual taper 1
Monitoring and Side Effects
- Most adverse events are typically mild and tend to diminish after the first few weeks of treatment 4
- Common side effects include fatigue, somnolence, nausea, and dry mouth 4
- Regular monitoring of treatment response using standardized scales is recommended to assess efficacy 4
- Prior to initiating treatment, screen patients for personal or family history of bipolar disorder, mania, or hypomania 1