What does Lexapro (escitalopram) do for anxiety?

Lexapro (Escitalopram) for Anxiety

Lexapro (escitalopram) effectively treats anxiety disorders by inhibiting serotonin reuptake in the brain, reducing anxiety symptoms with demonstrated efficacy in generalized anxiety disorder (GAD) and other anxiety conditions. 1

FDA-Approved Indications for Anxiety

• Escitalopram is FDA-approved for the acute treatment of Generalized Anxiety Disorder (GAD) in adults 1
• GAD is characterized by excessive anxiety and worry that persists for at least 6 months, with symptoms including restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance 1

Mechanism of Action

• Escitalopram is the S-enantiomer of citalopram and functions as a selective serotonin reuptake inhibitor (SSRI) 2
• It is the most selective SSRI available, with a potent and highly specific action on serotonin transporters 2
• This selectivity may contribute to its favorable efficacy and tolerability profile compared to other SSRIs 2

Efficacy in Anxiety Disorders

• Multiple 8-week, placebo-controlled studies have demonstrated escitalopram's effectiveness in reducing anxiety symptoms in GAD 3
• Studies show escitalopram is at least as effective as paroxetine in treating GAD and social anxiety disorder 3
• Long-term studies (24-76 weeks) show continued efficacy and significantly reduced relapse rates compared to placebo 3
• Symptom improvement often begins within 1-2 weeks of starting treatment 4

Dosing for Anxiety

• The American Psychiatric Association recommends starting with 10mg daily for anxiety disorders 5
• Dose may be increased to 20mg after 4-6 weeks if response is inadequate 5
• Treatment should continue for at least 8-12 weeks to properly evaluate efficacy 5
• Long-term treatment (6 months or longer) is recommended after remission to prevent relapse 5

Important Considerations When Starting Treatment

• Initial paradoxical increase in anxiety may occur in the first few days to weeks of treatment 6
• The American Academy of Child and Adolescent Psychiatry recommends gradual dose titration to minimize initial adverse effects like anxiety and agitation 6
• Starting with a subtherapeutic "test" dose may be advisable since an initial adverse effect can be anxiety 7
• Close monitoring is essential during the first months of treatment and following dosage adjustments 6

Side Effects

• Common side effects include nausea, insomnia, ejaculation disorder, diarrhea, dry mouth, and somnolence 8
• Most adverse events are mild to moderate and emerge within the first few weeks of treatment 5
• Nausea is the most common side effect (>10% of patients) but is typically mild and transient 8
• Escitalopram has a favorable pharmacokinetic profile permitting once-daily administration 2

Combination Therapy

• Combining escitalopram with cognitive-behavioral therapy (CBT) has demonstrated greater efficacy than medication alone for anxiety disorders 5
• The American Academy of Child and Adolescent Psychiatry suggests that combination treatment could be offered preferentially over monotreatment 7

Safety Considerations

• Escitalopram may interact with drugs metabolized by CYP2D6, though it has less effect on CYP450 isoenzymes compared to other SSRIs 7
• Caution should be exercised when combining with other serotonergic medications due to risk of serotonin syndrome 1
• Escitalopram is contraindicated with MAOIs due to risk of serotonin syndrome 1
• Monitor for signs of suicidality, especially in younger patients 1

Discontinuation

• Abrupt discontinuation may lead to withdrawal symptoms including anxiety, irritability, high or low mood, headache, sweating, nausea, dizziness, and electric shock-like sensations 1
• Gradual tapering is recommended when stopping treatment 1