Fatigue, Headaches, and GI Upset When Restarting Escitalopram

Yes, restarting escitalopram (Lexapro) commonly causes fatigue, headaches, and gastrointestinal upset as side effects. 1, 2

Common Side Effects When Starting/Restarting Escitalopram

About 63% of patients receiving second-generation antidepressants (including SSRIs like escitalopram) experience at least one adverse effect during treatment 1
The most common side effects specifically associated with escitalopram include:
- Fatigue (reported in 5% of patients vs 2% with placebo) 2
- Headache (common side effect, though specific rates vary) 2
- Gastrointestinal disturbances:
  - Nausea (15% vs 7% with placebo) 2
  - Diarrhea (8% vs 5% with placebo) 2
  - Constipation (3% vs 1% with placebo) 2
  - Abdominal pain (2% vs 1% with placebo) 2

Most adverse effects emerge within the first few weeks of treatment 1
For those experiencing GI adverse effects specifically:
- 70-80% occur within the first 2 weeks of starting/restarting treatment 3
- 75-80% are mild in severity 3
- 60-65% resolve within the first month of continued treatment 3

Escitalopram works by inhibiting serotonin reuptake in the central nervous system 4
The sudden increase in serotonergic activity when restarting the medication can cause these side effects until the body readjusts 4, 5
Pharmacokinetic studies show escitalopram reaches maximum plasma concentrations in approximately 3-4 hours after dosing 4
Steady-state concentrations are achieved within 7-10 days of administration 4

Starting with a lower dose and gradually increasing it can help minimize side effects 1
Most side effects are transient and resolve within the first few weeks of treatment 3, 6
Taking escitalopram with food may help reduce GI side effects, though absorption is not affected by food 4
If side effects are severe or persistent, consulting with a healthcare provider is recommended 1

Discontinuing escitalopram abruptly can cause withdrawal symptoms; a gradual reduction is recommended when stopping 2
When restarting, similar gradual titration is advised to minimize side effects 1
Rare but serious side effects can include serotonin syndrome, hyponatremia, and increased risk of bleeding 2
Monitoring for worsening depression or suicidal thoughts is important, especially in the first few weeks 2

If side effects are severe, persistent beyond 2-4 weeks, or significantly impacting quality of life 1, 3
If experiencing signs of more serious reactions such as severe headache with confusion, severe nausea/vomiting, or significant mood changes 2
If experiencing symptoms of serotonin syndrome (agitation, hallucinations, rapid heart rate, fever, muscle stiffness) 2