Can escitalopram (Lexapro) cause urinary frequency?

Can Lexapro 10mg Cause Frequent Urination?

Escitalopram (Lexapro) does not typically cause urinary frequency; in fact, it may paradoxically cause urinary retention, particularly in elderly men with benign prostatic hyperplasia (BPH). 1, 2

Understanding the Urinary Effects of Escitalopram

Primary Concern: Urinary Retention, Not Frequency

• Escitalopram is associated with acute urinary retention (AUR) rather than increased urination, especially in elderly men with known or latent BPH 1
• Case series document AUR developing after starting standard doses of escitalopram in men with previously diagnosed or unknown prostatic hyperplasia 1
• In documented cases, urinary retention resolved after escitalopram discontinuation, though one case required emergent prostatectomy 1
• A comparative study showed escitalopram actually increased maximum urinary flow rate (Q_max) in elderly males aged 55-75 years, suggesting improved rather than worsened voiding 3

Mechanism and Risk Factors

• SSRIs like escitalopram have minimal anticholinergic properties compared to tricyclic antidepressants, making urinary frequency an unlikely side effect 4
• The mechanism for SSRI-associated urinary retention remains unclear but may involve serotonergic effects on bladder sphincter tone 2
• Elderly men with compromised or marginal urinary outflow should be monitored closely when starting escitalopram 1
• Pre-existing BPH—whether diagnosed or latent—represents a significant risk factor for developing urinary complications 1

Clinical Approach When Urinary Symptoms Occur

Immediate Assessment

• Determine whether the symptom is truly frequency (increased voiding episodes) versus urgency, hesitancy, or incomplete emptying 4
• Evaluate for urinary retention by checking post-void residual volume, as retention can paradoxically present with frequency-like symptoms 1
• Review all concurrent medications, particularly anticholinergics, antihistamines, and other agents that affect bladder function 2
• In men over 55 years, assess for BPH symptoms using validated tools like the American Urological Association symptom index 3

Management Strategy

• If true urinary retention develops, discontinue escitalopram immediately and consider catheterization if retention is acute 1, 2
• Normal micturition typically resumes within days of stopping escitalopram without need for ongoing catheterization 2
• If urinary frequency is the actual complaint and not related to retention, investigate alternative causes including overactive bladder, urinary tract infection, or other medications 4
• Consider switching to sertraline if an SSRI is still needed, as it may have a different urinary side effect profile 4

Important Caveats

• Do not confuse frequency with retention-related overflow symptoms, where patients void small amounts frequently due to incomplete bladder emptying 1
• Escitalopram-induced urinary problems are rare and often overlooked because of limited reporting in the literature 2
• The paucity of cases suggests this is an uncommon adverse effect, but vigilance is warranted in high-risk populations 1, 2
• Medical causes of urinary symptoms must be ruled out before attributing them to escitalopram 2