Restarting Lexapro After Symptom Recurrence
Yes, it is safe and appropriate to restart Lexapro (escitalopram) after depressive symptoms recur, and you should resume the previously effective dose that achieved remission. 1
Immediate Restart Strategy
If intolerable symptoms occur following discontinuation or if depression recurs, resume the previously prescribed dose that was effective. 1 The FDA label explicitly supports this approach, indicating that returning to the prior therapeutic dose is the recommended strategy when symptoms return after stopping treatment.
- Restart at the same dose that previously achieved remission rather than starting at a lower dose 1
- This approach minimizes the time to symptom control and avoids the delay associated with dose titration 2
Duration of Continued Treatment After Restart
Once restarted, continue escitalopram for a minimum of 9-12 months after achieving recovery to prevent another relapse. 3, 4
- For patients with recurrent depression (2 or more episodes), treatment duration should extend to years or potentially lifelong, as recurrence risk escalates dramatically: 50% after first episode, 70% after two episodes, and 90% after three episodes 5
- The greatest relapse risk occurs in the first 8-12 weeks after any future discontinuation 5
Monitoring Requirements After Restart
Assess the patient in person within 1 week of restarting treatment, then continue monthly monitoring for 6-12 months after achieving full symptom resolution. 5
At each visit, evaluate:
- Ongoing depressive symptoms and functional status 5
- Suicide risk assessment 5
- Adverse effects and tolerability 5
- Treatment adherence 5
- Environmental stressors 5
Safety Profile Upon Restart
Escitalopram demonstrates a predictable and favorable safety profile with generally mild to moderate, transient adverse events 2, 6:
- No new types of adverse events emerge with long-term treatment, and incidence actually declines over time 6
- The drug has minimal clinically relevant drug interactions due to multiple metabolic pathways 7
- It is generally better tolerated compared to other antidepressants with a relatively fast onset of action 7
Critical Pitfall to Avoid
Do not discontinue treatment prematurely when symptoms improve after restarting. 5 This dramatically increases relapse risk and perpetuates a cycle of recurrence. Many patients who stop after only one prescription fail to complete an adequate treatment course—only 29.3% of those who restart after early discontinuation continue for 6 months or more 8.
Special Populations
- For elderly patients or those with hepatic impairment, the recommended dose is 10 mg/day 1
- Use with caution in severe renal impairment, though no adjustment is needed for mild to moderate renal impairment 1
- Screen for personal or family history of bipolar disorder prior to restarting, as antidepressants can precipitate mania 1
Drug Interaction Precautions When Restarting
Allow at least 14 days between discontinuation of any MAOI and restarting escitalopram, and vice versa. 1 Do not start escitalopram in patients receiving linezolid or intravenous methylene blue due to serotonin syndrome risk 1.