How to Increase Lexapro from 10mg
Increase Lexapro from 10mg to 20mg after a minimum of one week for adults, or after a minimum of three weeks for adolescents, administered once daily in the morning or evening with or without food. 1
Dosing Algorithm by Indication
Major Depressive Disorder
Adults:
- Current dose: 10mg once daily
- Wait minimum 1 week at 10mg before increasing 1
- Increase to 20mg once daily if needed 1
- Both 10mg and 20mg doses are effective, though 20mg did not demonstrate greater benefit than 10mg in fixed-dose trials 1
Adolescents:
- Current dose: 10mg once daily (recommended starting dose) 1
- Wait minimum 3 weeks at 10mg before increasing 1
- Increase to 20mg once daily if needed 1
Generalized Anxiety Disorder
Adults:
- Current dose: 10mg once daily 1
- Wait minimum 1 week before increasing to 20mg 1
- Consider adjunctive hydroxyzine during the 4-8 week period required for escitalopram to reach full therapeutic effect, as it provides rapid anxiolytic action while the SSRI dose is being optimized 2
Monitoring During Dose Escalation
Initial Weeks After Increase:
- Monitor closely for behavioral activation or increased anxiety, particularly in younger patients, which typically manifests within the first few days to weeks 3
- Evaluate response every 2-4 weeks after dose increase 3
- Allow 4-8 weeks at the increased dose to evaluate full clinical response before considering alternative strategies 3
Common Pitfall: Increasing the dose too rapidly can trigger early activation syndrome or increased anxiety 2. The combination of hydroxyzine with escitalopram can help manage this potential complication 2.
Special Populations Requiring Dose Adjustment
Do NOT increase beyond 10mg daily in:
- Elderly patients 1
- Patients with hepatic impairment 1
- Patients with severe renal impairment (use with caution) 1
Beyond Standard Dosing
If 20mg is inadequate after 8-12 weeks:
- Research supports doses up to 30mg may be beneficial for non-remitters, with significantly greater reduction in MADRS scores compared to continuing 20mg (p=0.046) 4
- Pilot data suggests doses up to 50mg can be used, with 38% of remitters requiring 50mg, though tolerability declines above 40mg with 26% unable to tolerate 50mg 5
- Consider switching to an SNRI (venlafaxine) or another SSRI (sertraline) rather than exceeding FDA-approved maximum 3
Pharmacokinetic Considerations
- Steady-state concentrations are achieved within 7-10 days of administration 6
- Escitalopram exhibits linear and dose-proportional pharmacokinetics in the 10-30mg/day range 6
- Elimination half-life is 27-33 hours, consistent with once-daily dosing 6
- Some patients may require higher doses to maintain therapeutic blood levels over time due to individual pharmacokinetic variability 3
Discontinuation Precautions
When reducing or stopping escitalopram: