Can Lexapro Cause Decreased Appetite?
Yes, Lexapro (escitalopram) can cause decreased appetite, occurring in approximately 3% of patients with major depressive disorder and generalized anxiety disorder in controlled trials, which is three times the rate seen with placebo. 1
Evidence from FDA-Approved Labeling
The FDA label for escitalopram clearly documents decreased appetite as a treatment-emergent adverse reaction:
- In major depressive disorder trials: Decreased appetite occurred in 3% of escitalopram-treated patients versus 1% of placebo patients 1
- In generalized anxiety disorder trials: Decreased appetite occurred in 3% of escitalopram-treated patients versus 1% of placebo patients 1
- Pediatric populations: Regular monitoring of weight and growth is specifically recommended in children and adolescents treated with escitalopram due to observed decreased appetite and weight loss with SSRIs 1
Clinical Significance and Monitoring
The appetite suppression effect appears dose-independent and is generally mild to moderate in severity. 1 Unlike some other adverse effects that show clear dose-dependency (such as insomnia and diarrhea at 20 mg/day), decreased appetite maintains a consistent 3% incidence across the 10-20 mg/day dosing range 1
Special Populations Requiring Closer Monitoring:
- Pediatric patients: The FDA label explicitly states that "decreased appetite and weight loss have been observed in association with the use of SSRIs" and mandates "regular monitoring of weight and growth" in children and adolescents 1
- Elderly patients: While not specifically highlighted for appetite changes, elderly patients may be more sensitive to SSRI effects generally 1
- Breastfeeding infants: Infants exposed through breast milk should be monitored for "poor feeding and poor weight gain" among other symptoms 1
Mechanism and Context
The appetite-reducing effect of escitalopram aligns with the broader pharmacology of SSRIs, which enhance serotonergic neurotransmission—a mechanism known to reduce appetite and carbohydrate craving 2. This is in direct contrast to many other psychotropic medications (such as tricyclic antidepressants, antipsychotics, and mood stabilizers) that antagonize serotonin receptors and commonly cause weight gain and increased appetite 2, 3
Clinical Management Considerations
For patients where appetite suppression becomes problematic, clinical guidelines suggest considering dose adjustment, regular weight monitoring, and potentially switching to alternative medications if the effect is severe. 4 The National Comprehensive Cancer Network specifically notes that escitalopram would not be a preferred agent in patients with pre-existing anorexia or cachexia due to its appetite-reducing properties 4
Important Caveats:
- The 3% incidence means that most patients (97%) do not experience clinically significant appetite reduction 1
- Weight changes overall were not clinically significant in controlled trials, with escitalopram and placebo groups showing no meaningful differences in body weight 1
- The effect is typically transient and mild to moderate when it does occur 5