Can I increase my Lexapro (escitalopram) dose from 5mg to 15mg?

Increasing Lexapro from 5mg to 15mg

You should not increase Lexapro directly from 5mg to 15mg; instead, increase to 10mg first and wait at least 1-3 weeks before considering further dose escalation to 20mg if needed. 1

FDA-Approved Dosing Guidelines

The FDA label for escitalopram provides clear guidance on dose escalation 1:

• Standard starting dose: 10mg once daily for adults with major depressive disorder or generalized anxiety disorder 1
• Dose increases: If increasing to 20mg, this should occur after a minimum of one week at 10mg for adults 1
• Adolescents: Require a minimum of three weeks at 10mg before increasing to 20mg 1

Your current 5mg dose is below the standard therapeutic starting dose, suggesting either you're being started cautiously (possibly due to tolerability concerns, elderly age, or hepatic impairment) or you're in an initial titration phase 1.

Why Gradual Titration Matters

Jumping from 5mg to 15mg skips critical dose levels and increases the risk of adverse effects 1, 2:

• Escitalopram demonstrates linear, dose-proportional pharmacokinetics in the 10-30mg range, meaning plasma levels increase predictably with dose 3
• Steady-state concentrations are achieved within 7-10 days of administration 3
• The elimination half-life is 27-33 hours, consistent with once-daily dosing 3

Common adverse events that may worsen with rapid dose escalation include nausea (>10% of patients), insomnia, diarrhea, dry mouth, and somnolence 2.

Recommended Dose Escalation Strategy

Follow this stepwise approach 1:

1. Increase to 10mg daily and maintain for at least 1 week (3 weeks if adolescent)
2. Assess response and tolerability at 10mg
3. Only if inadequate response after sufficient time at 10mg, consider increasing to 20mg
4. Maximum FDA-approved dose is 20mg daily 1

Special Populations Requiring Caution

10mg/day is the recommended maximum dose for 1:

• Elderly patients (>65 years)
• Patients with hepatic impairment
• Patients with severe renal impairment (use with caution)

If you fall into any of these categories, 15mg would exceed recommended dosing.

Higher Doses: Limited Evidence

While one pilot study explored escitalopram doses up to 50mg in treatment-resistant depression, this was in a highly selected population of patients who had failed adequate citalopram treatment 4. In that study:

• Only 35% achieved remission, with 38% of responders requiring 50mg 4
• Tolerability declined above 40mg, with 26% unable to tolerate 50mg 4
• 20% discontinued due to adverse events 4

This does not support routine use of doses above 20mg, and certainly not without first optimizing at standard doses 4.

Clinical Bottom Line

Increase to 10mg and wait at least one week before considering any further dose adjustment. The standard therapeutic dose range is 10-20mg daily, and there is no evidence supporting 15mg as a target dose 1, 5. If 10mg proves insufficient after adequate trial duration (typically 4-8 weeks for full effect), discuss with your prescriber whether increasing to 20mg is appropriate based on your individual response and tolerability 1, 5.