Can Lexapro Cause Frequent Urination?
Yes, Lexapro (escitalopram) can cause frequent urination even though it is listed as an uncommon side effect, and this symptom should be taken seriously when it occurs. 1
Understanding the Urinary Side Effects of Escitalopram
The FDA-approved prescribing information for escitalopram specifically lists "difficult urination" as a documented side effect in children and adolescents, indicating that urinary symptoms are a recognized adverse effect of this medication. 1 While the labeling describes urinary difficulties rather than frequency specifically, the broader category of drug-induced urinary symptoms encompasses both retention and frequency patterns.
Mechanism and Clinical Presentation
SSRIs like escitalopram can affect bladder function through multiple mechanisms, including serotonergic effects on bladder smooth muscle and potential anticholinergic-like properties, even though they are not primarily anticholinergic agents. 2, 3
Urinary retention is the more commonly reported urinary side effect with SSRIs, but this can paradoxically present as frequent urination with small volumes as the bladder attempts to empty against increased resistance. 4, 3
Case reports document acute urinary retention specifically with escitalopram, demonstrating that this SSRI can significantly impact lower urinary tract function. 4
Clinical Evaluation When This Occurs
When a patient on escitalopram develops frequent urination, you should:
Evaluate for other causes of urinary frequency including urinary tract infection, diabetes, overactive bladder, and other medications the patient may be taking. 5
Distinguish between true frequency (normal volumes, frequent voids) versus overflow incontinence (small frequent voids due to retention), as SSRIs are more commonly associated with retention that may present as frequency. 4, 3
Assess post-void residual urine if retention is suspected, as incomplete emptying can manifest as urinary frequency rather than classic retention symptoms. 3
Review the temporal relationship between medication initiation/dose increase and symptom onset, as drug-induced urinary symptoms typically develop within weeks to months of starting therapy. 4, 6
Management Approach
If urinary symptoms significantly impact quality of life, consider switching to a different antidepressant with potentially fewer urinary side effects. 5 This recommendation is particularly important because:
The therapeutic benefits must be weighed against urinary symptoms that can substantially affect daily functioning and quality of life. 5
Alternative antidepressants exist that may have different side effect profiles regarding urinary function. 5
Elderly patients are at higher risk for drug-induced urinary problems due to existing conditions like benign prostatic hyperplasia in men and age-related bladder changes. 3
Important Caveats
"Uncommon" does not mean "impossible" - rare side effects still occur in real patients, and individual susceptibility varies considerably. 1, 3
Do not dismiss patient reports of urinary symptoms simply because they are listed as uncommon; the FDA labeling acknowledges urinary difficulties as a documented adverse effect. 1
Monitor for worsening symptoms as continued exposure may exacerbate urinary dysfunction, and early intervention prevents progression to more severe retention. 4, 3
Consider drug interactions as patients taking multiple medications with anticholinergic or alpha-adrenergic effects face compounded risk for urinary symptoms. 3