Can Lexapro Cause Frequent Urination?
Lexapro (escitalopram) can cause urinary retention and hesitancy rather than frequent urination, though these urinary side effects are rare. The mechanism involves serotonergic effects on bladder function, and the risk appears higher in elderly men with underlying prostatic conditions 1, 2.
Urinary Side Effects Profile
Documented Urinary Problems with Escitalopram
- Acute urinary retention (AUR) has been reported in case series, particularly in elderly men with known or latent benign prostatic hyperplasia 2.
- The retention typically develops after initiating standard doses of escitalopram and resolves upon discontinuation 1.
- In one case series of three elderly men, urinary retention receded after stopping escitalopram in two patients, but required emergent prostatectomy in the third 2.
Mechanism and Clinical Presentation
- SSRIs like escitalopram are not typically suspected as causes of urinary problems, which may lead to underrecognition and underreporting 1.
- The urinary retention can persist for several days even after discontinuing other suspected medications, resolving only after escitalopram cessation 1.
- Normal micturition typically resumes without further need for catheterization once escitalopram is stopped 1.
Risk Factors to Assess
High-Risk Populations
- Elderly men with benign prostatic hyperplasia (diagnosed or latent/asymptomatic) are at substantially increased risk 2.
- Patients with compromised or marginal urinary outflow may represent a potential contraindication for escitalopram treatment, though further studies are needed 2.
Clinical Monitoring
- Monitor all patients on escitalopram for new-onset urinary difficulties, particularly hesitancy or retention rather than frequency 1, 2.
- Medical causes of urinary retention should be ruled out, but don't overlook escitalopram as a potential cause even when other medications seem more likely 1.
Comparison with Other Antidepressants
- Antidepressants that are potent norepinephrine reuptake inhibitors (like levomilnacipran) have higher rates of urinary hesitancy compared to SSRIs 3.
- SSRIs generally have lower rates of urinary side effects compared to SNRIs, though escitalopram cases have been documented 3.
Management Approach
If Urinary Problems Develop
- Discontinue escitalopram immediately if acute urinary retention or significant hesitancy develops 1, 2.
- Consider dose reduction as an alternative if symptoms are mild and the antidepressant benefit is substantial 3.
- Alpha-1A antagonists (e.g., tamsulosin) may relieve antidepressant-induced urinary hesitancy within hours to days, allowing continued treatment 3.
Prevention Strategy
- Screen elderly male patients for prostatic symptoms before initiating escitalopram 2.
- Consider alternative antidepressants in patients with known urinary outflow obstruction 2.
Important Caveats
Frequent urination specifically is not a documented side effect of escitalopram—the urinary problems reported are retention and hesitancy (difficulty initiating urination), which represent the opposite problem 1, 2. If a patient reports true urinary frequency on escitalopram, investigate other causes including diabetes, urinary tract infection, or overactive bladder rather than attributing it to the medication.