How does escitalopram (Lexapro) affect appetite?

Effects of Escitalopram on Appetite

Escitalopram commonly causes decreased appetite in approximately 3% of patients, which is significantly higher than the 1% rate observed with placebo. 1

Primary Effects on Appetite

• Escitalopram (Lexapro) is associated with appetite reduction as a documented side effect in both major depressive disorder and generalized anxiety disorder clinical trials 1
• In FDA clinical trials, decreased appetite was reported in 3% of escitalopram-treated patients compared to 1% of placebo-treated patients 1
• The effect appears to be dose-dependent, with higher doses (20mg/day) potentially causing more pronounced appetite reduction than lower doses (10mg/day) 1

Mechanism and Clinical Significance

• As a selective serotonin reuptake inhibitor (SSRI), escitalopram increases serotonin levels in the brain, which plays a role in appetite regulation 2
• Serotonergic activity is associated with decreased carbohydrate craving and reduced consumption of carbohydrate-rich foods, which may explain the appetite-reducing effects 3
• Unlike some psychotropic medications (such as antipsychotics and tricyclic antidepressants) that antagonize serotonin receptors and increase appetite, SSRIs like escitalopram typically have the opposite effect 3

Special Populations and Considerations

• In elderly patients, decreased appetite may be of particular concern due to already reduced appetite and nutritional risk 1
• In pediatric patients, regular monitoring of weight and growth is recommended due to the potential for decreased appetite and weight loss with SSRI treatment 1
• For breastfeeding mothers, there are reports of poor feeding and poor weight gain in infants exposed to escitalopram through breast milk 1

Clinical Management

• For patients experiencing problematic appetite reduction:
  • Consider dose adjustment if clinically appropriate 1
  • Monitor weight regularly, especially in vulnerable populations such as elderly or underweight patients 1
  • If appetite suppression is severe or causing significant weight loss, alternative medications may need to be considered 4

Exceptions and Unique Cases

• While escitalopram typically reduces appetite, there are rare case reports where it has been used to help manage hyperphagia (excessive eating) in specific neurological conditions 5
• In a study of binge-eating disorder with obesity, high-dose escitalopram (mean dose 26.5 mg/day) was associated with weight reduction, suggesting potential therapeutic applications in certain eating disorders 6

Important Caveats

• Individual responses to escitalopram may vary significantly 1
• The appetite-suppressing effects may diminish over time as tolerance develops 1
• If decreased appetite leads to significant weight loss or nutritional deficiencies, especially in vulnerable populations, clinical intervention may be necessary 1
• For patients with anorexia or cachexia, escitalopram would not be a preferred agent due to its appetite-reducing properties 7, 4