Lexapro 10mg Dose Increase
Yes, you can start Lexapro 10mg tomorrow, as this is the FDA-approved standard starting dose for major depressive disorder and generalized anxiety disorder in adults. 1
FDA-Approved Dosing for Adults
- The recommended starting dose of escitalopram (Lexapro) is 10 mg once daily for both major depressive disorder and generalized anxiety disorder 1
- This dose can be administered in the morning or evening, with or without food 1
- If dose escalation to 20 mg is needed, this should occur after a minimum of one week at the 10 mg dose 1
Clinical Evidence Supporting 10mg Starting Dose
- Fixed-dose trials demonstrated that both 10 mg and 20 mg doses are effective, though the 20 mg dose did not show greater benefit over 10 mg in the initial studies 1
- Multiple placebo-controlled trials confirm robust efficacy at 10 mg daily for depression and anxiety symptoms 2, 3
- Statistically significant improvement over placebo is typically observed within 1-2 weeks of starting treatment 3, 4
Expected Timeline for Response
- Patients should show measurable clinical improvement (≥20% reduction in depression rating scales) within 2 weeks 4
- If no improvement is seen by week 2, consider dose escalation at that time rather than waiting longer 4
- Of patients showing early response at 2 weeks who continue treatment, 63% achieve remission by week 8 4
- Full therapeutic effect typically manifests within 2-4 weeks, with steady-state plasma concentrations achieved within 7-10 days 5
Important Monitoring Parameters
- Screen for personal or family history of bipolar disorder, mania, or hypomania before initiating treatment 1
- Monitor for worsening depression, suicidality, or unusual behavior changes, particularly in the first few weeks 1
- Assess for serotonin syndrome if the patient is taking other serotonergic medications 1
Common Pitfalls to Avoid
- Do not start at doses lower than 10 mg in typical adult patients unless they are elderly or have hepatic impairment (in which case 10 mg is still the recommended dose, but it becomes the maximum rather than starting dose) 1
- Avoid premature dose escalation before 1 week has elapsed, as this increases side effect burden without additional benefit 1
- Do not wait longer than 2 weeks to reassess if there is no response, as early non-response predicts poor ultimate outcome 4
- Ensure at least 14 days have elapsed if switching from an MAOI, and vice versa 1
Tolerability Profile
- The most common adverse events include nausea (typically mild and transient), insomnia, ejaculatory problems, diarrhea, dry mouth, and somnolence 2, 3
- Only nausea occurs in >10% of patients, and discontinuation rates due to adverse events are similar to placebo 2
- The drug has a favorable pharmacokinetic profile with linear, dose-proportional kinetics and minimal drug-drug interaction potential 5