What is the recommended prescription dosage of escitalopram (Lexapro) for mild anxiety?

Escitalopram Dosing for Mild Anxiety

For mild anxiety in adults, start escitalopram at 10 mg once daily, which is the recommended initial and often sufficient dose for generalized anxiety disorder. 1

Initial Dosing Strategy

• Start with 10 mg once daily (morning or evening, with or without food) for adults with mild anxiety 1
• For mild to moderate anxiety presentations, consider starting with a subtherapeutic "test" dose to minimize initial anxiety or agitation that can occur as an adverse effect of SSRIs 2
• The 10 mg dose has demonstrated effectiveness as monotherapy without requiring dose escalation in many patients 3

Dose Titration Approach

• Maintain 10 mg for at least one week before considering any increase 1
• If dose escalation is needed, increase to 20 mg after a minimum of one week at 10 mg 1
• For mild anxiety specifically, increase the dose slowly in the smallest available increments at approximately 1- to 2-week intervals until the benefit-to-harm ratio is optimized 2
• Higher doses are not clearly associated with greater response magnitude and can increase adverse effects 2

Therapeutic Considerations

• Many patients respond adequately to 10 mg daily without requiring dose escalation to 20 mg 3
• The pooled analysis of controlled trials showed significant improvement with escitalopram 10 mg/day maintained at that dose compared to placebo 3
• Escitalopram has demonstrated efficacy beginning at week 1-2 and continuing through 8 weeks of treatment 3

Special Populations

• Elderly patients: 10 mg/day is the maximum recommended dose 1
• Hepatic impairment: 10 mg/day is the recommended dose 1
• Severe renal impairment: Use with caution 1

Important Safety Considerations

• Screen for bipolar disorder before initiating treatment 1
• Escitalopram/citalopram has the least effect on CYP450 isoenzymes compared to other SSRIs, resulting in lower propensity for drug interactions 2
• Avoid exceeding 40 mg/day of citalopram (escitalopram's parent compound) due to QT prolongation risk, though escitalopram maximum is 20 mg 2
• Monitor closely during the first few weeks for worsening anxiety, agitation, or suicidal ideation 1

Discontinuation Protocol

• Taper gradually rather than stopping abruptly to avoid discontinuation syndrome 1
• While escitalopram has less discontinuation syndrome risk than paroxetine, sertraline, or fluvoxamine, gradual dose reduction is still recommended 2

Duration of Treatment

• Generalized anxiety disorder is recognized as a chronic condition requiring long-term treatment 1
• Long-term studies demonstrate continued efficacy at 24 weeks with 10-20 mg daily 4
• Periodically reassess the need for continued treatment 1