What are the potential risks and symptoms I should monitor while taking Lexapro (escitalopram) for mental health issues after 4 months?

Monitoring Lexapro (Escitalopram) After 4 Months of Treatment

After 4 months on Lexapro, you should continue monitoring for suicidal thoughts, serotonin syndrome symptoms, sexual dysfunction, and discontinuation symptoms if you miss doses, while being aware that most common side effects like nausea typically resolve early in treatment. 1

Critical Safety Concerns to Monitor Ongoing

Suicidal Thoughts and Behavioral Changes

• Watch for new or worsening depression, anxiety, panic attacks, agitation, irritability, or suicidal thoughts - these can emerge even after months of treatment, particularly if your dose changes 1
• Contact your healthcare provider immediately if you experience sudden mood changes, aggressive behavior, or thoughts about self-harm 1
• This risk persists throughout treatment, not just in the first few weeks 1

Serotonin Syndrome Risk

Be vigilant if you're taking any other medications, as combining Lexapro with certain drugs can cause life-threatening serotonin syndrome 2, 1:

• Avoid completely: MAOIs, St. John's Wort, tryptophan supplements 2
• Use with extreme caution: Pain medications (tramadol, fentanyl, meperidine), migraine medications (triptans), stimulants, cough medicines containing dextromethorphan, other antidepressants 2, 1

Symptoms requiring immediate emergency care 1:

• Mental status changes (confusion, agitation, hallucinations)
• Racing heartbeat, high or low blood pressure
• Muscle rigidity, tremors, twitching
• Fever, sweating
• Nausea, vomiting, diarrhea

Sexual Dysfunction

Sexual problems are common and often persist throughout treatment 1:

• In males: delayed ejaculation, erectile dysfunction, decreased libido 1
• In females: delayed or absent orgasm, decreased libido 1
• Discuss these symptoms with your provider - treatments may be available 1

Common Ongoing Side Effects

Persistent Symptoms to Expect

After 4 months, you may still experience 1:

• Nausea (though typically improves after initial weeks)
• Sleepiness or insomnia
• Dizziness
• Dry mouth
• Constipation
• Sweating
• Weakness

Bleeding Risk

Lexapro increases bleeding risk, especially if you take 2, 1:

• Blood thinners (warfarin/Coumadin)
• NSAIDs (ibuprofen, naproxen)
• Aspirin

Watch for unusual bruising, nosebleeds, or any abnormal bleeding 2, 1

Critical Discontinuation Warning

Never stop Lexapro abruptly - escitalopram can cause significant discontinuation syndrome 2, 3:

Discontinuation Symptoms

If you miss doses or stop suddenly, expect 1, 3:

• Dizziness, electric shock-like sensations
• Headache, confusion
• Anxiety, irritability, mood changes
• Nausea, sweating
• Sleep disturbances

Higher doses and plasma concentrations increase discontinuation syndrome risk - patients on higher doses experience more severe withdrawal symptoms 3

Proper Discontinuation

• Requires gradual dose reduction over time 1
• Never stop without consulting your provider 1
• Very slow tapering is recommended for all patients 3

Less Common But Serious Risks

Hyponatremia (Low Sodium)

Elderly patients and those on diuretics are at higher risk 1:

• Symptoms: headache, confusion, weakness, unsteadiness, memory problems 1
• Can lead to falls 1

Seizures

• Lexapro should be used cautiously if you have any seizure history 1
• Report any convulsions immediately 1

Mania/Hypomania

Watch for 1:

• Greatly increased energy
• Severe insomnia
• Racing thoughts
• Reckless behavior
• Excessive happiness or irritability
• Talking more or faster than usual

Visual Problems

Rare but serious 1:

• Eye pain
• Vision changes
• Swelling or redness around the eye
• May require preventative ophthalmologic treatment 1

Drug-Specific Advantages of Escitalopram

Escitalopram has the least effect on CYP450 enzymes compared to other SSRIs, resulting in lower propensity for drug interactions than paroxetine, fluoxetine, sertraline, or fluvoxamine 2

This makes it relatively safer when combining with other medications, though caution is still required 2

When to Contact Your Provider

Call immediately if you experience 1:

• New or worsening suicidal thoughts
• Severe allergic reactions (trouble breathing, swelling, rash)
• Signs of serotonin syndrome
• Seizures
• Manic symptoms
• Abnormal bleeding
• Severe visual changes

Schedule routine follow-up for 1:

• Sexual dysfunction concerns
• Persistent side effects
• Questions about continuing treatment
• Any dose adjustments needed