What is the starting dose of Lexapro (escitalopram) for adults with depression or generalized anxiety disorder?

Starting Dose of Lexapro (Escitalopram)

The standard starting dose of escitalopram is 10 mg once daily for most adult patients with depression or generalized anxiety disorder. 1, 2

Standard Adult Dosing

• Initiate treatment at 10 mg once daily, taken in the morning or evening, with or without food for both major depressive disorder and generalized anxiety disorder 2
• The dosage range is 10-20 mg per day for outpatient treatment 1
• If dose escalation to 20 mg is needed, wait a minimum of one week before increasing (for adults with depression or GAD) 2
• The maximum recommended dose is 20 mg daily 3

Special Population Adjustments

For elderly patients (≥65 years) and those with hepatic impairment, start at 5 mg daily (50% of the standard adult dose) due to significantly greater risk of adverse drug reactions 1, 2. This lower starting dose minimizes adverse effects like agitation or dizziness, with escitalopram preferred over paroxetine and fluoxetine due to fewer anticholinergic effects 3

• No dosage adjustment is necessary for patients with mild or moderate renal impairment 3, 2
• Use with caution in patients with severe renal impairment 2

Adolescent Dosing (Depression Only)

• For adolescents with major depressive disorder, start at 10 mg once daily 2
• If increasing to 20 mg, wait a minimum of three weeks 2

Important Clinical Considerations

• Screen all patients for personal or family history of bipolar disorder, mania, or hypomania before initiating treatment 2
• Monitor for behavioral activation or agitation early in treatment, particularly in younger patients, which supports slow up-titration when necessary 3
• At the standard 10 mg daily dose, expected plasma levels are approximately 27-28 ng/mL, within the therapeutic range of 15-80 ng/mL 3

Discontinuation Protocol

When stopping escitalopram, use gradual dose reduction rather than abrupt cessation to minimize discontinuation symptoms including dizziness, fatigue, lethargy, headaches, nausea, insomnia, and anxiety 4, 1, 2. This is particularly important with escitalopram as a shorter-acting SSRI 4