I'm an adult with a history of depression or anxiety, taking escitalopram (Lexapro), and I'm experiencing an annoying feeling in my urethra, could this be a side effect of the medication?

Urethral Discomfort While Taking Escitalopram

Yes, escitalopram can cause urethral discomfort and urinary symptoms, though this is an uncommon side effect that warrants evaluation to rule out other causes before attributing it solely to the medication. 1

Evidence for Escitalopram-Related Urinary Symptoms

• Escitalopram has been documented to cause acute urinary retention (AUR) in case reports, where normal micturition resumed only after discontinuing the medication without further need for catheterization 1
• The urethral discomfort you're experiencing may represent a milder manifestation along the same spectrum of serotonergic effects on bladder and urethral function 1
• SSRIs are not typically suspected as causes of urinary symptoms, which means this side effect is often overlooked due to limited reporting in the literature 1

Mechanism and Related Concerns

• Escitalopram is the most selective SSRI with minimal anticholinergic activity (six times less potent than citalopram at muscarinic receptors), which makes direct anticholinergic urinary retention less likely but doesn't eliminate serotonergic effects on the genitourinary system 2, 3
• Related SSRIs like citalopram have been associated with other genitourinary effects including priapism, suggesting serotonergic modulation of lower urinary tract function 4

Immediate Evaluation Steps

• Rule out urinary tract infection, urethritis, or sexually transmitted infections with urinalysis, urine culture, and appropriate STI testing if sexually active 1
• Assess for benign prostatic hyperplasia (BPH) if male or pelvic floor dysfunction if female, as these conditions can be unmasked or worsened by medications 4
• Review all concomitant medications for anticholinergic properties (antihistamines, overactive bladder medications, antipsychotics) or alpha-blockers that could interact 1, 4
• Verify adequate hydration status and rule out diabetes or other metabolic causes of urinary symptoms 1

Management Algorithm

If Medical Causes Are Ruled Out:

1. Consider dose reduction of escitalopram from your current dose to the lowest effective dose (5-10 mg daily), as urinary symptoms may be dose-dependent 1

2. If symptoms persist after dose reduction for 1-2 weeks, switch to an alternative SSRI with different pharmacologic properties:

   • Sertraline 50-200 mg daily has a lower risk of certain side effects and extensive safety data 5
   • Avoid paroxetine due to higher anticholinergic activity that could worsen urinary symptoms 5

3. If switching SSRIs doesn't resolve symptoms, consider switching to a non-SSRI antidepressant:

   • Bupropion SR 150-300 mg daily has no serotonergic activity and minimal genitourinary effects 5
   • SNRIs (venlafaxine, duloxetine) are alternatives but may have their own urinary side effects 5

Critical Monitoring Points

• Document the temporal relationship between escitalopram initiation/dose changes and symptom onset 1
• Monitor for progression to urinary retention (inability to void, bladder distension, overflow incontinence) which would require immediate discontinuation 1
• Allow 4-7 days after medication discontinuation to assess symptom resolution, as this was the timeframe in documented cases 1

Common Pitfalls to Avoid

• Don't assume the symptom is unrelated to escitalopram simply because urinary effects are rarely reported with SSRIs 1
• Don't add anticholinergic medications (like oxybutynin for overactive bladder) without first addressing the potential SSRI contribution, as this could worsen your depression/anxiety 6
• Don't abruptly discontinue escitalopram without medical supervision due to discontinuation syndrome risk; taper over 1-2 weeks minimum 5

When to Seek Urgent Care

• Inability to urinate for >6-8 hours 1
• Severe suprapubic pain or bladder distension 1
• Fever, flank pain, or hematuria suggesting infection or other acute pathology 1