Lexapro and Urinary Frequency in BPH
Lexapro (escitalopram) is not documented to cause urinary frequency in established medical literature or guidelines, and there is no evidence that SSRIs like escitalopram exacerbate lower urinary tract symptoms in patients with BPH.
Why This Misconception Exists
The confusion likely stems from misattribution of symptoms or conflation with other medication classes. The comprehensive guidelines on lower urinary tract symptoms (LUTS) and BPH management do not identify SSRIs as contributing factors to urinary frequency 1.
What Actually Causes Urinary Frequency in BPH
Storage symptoms (including daytime frequency and nocturia) in older men with BPH result from:
- Bladder outlet obstruction from prostatic enlargement causing secondary bladder dysfunction 1
- Detrusor overactivity characterized by involuntary bladder contractions during filling phase 1
- Age-related changes independent of medication effects 2
The American Urological Association explicitly states that LUTS may result from structural/functional abnormalities of the lower urinary tract, peripheral/central nervous system dysfunction, or secondary to cardiovascular, respiratory, or renal disease—but does not list antidepressants as causative agents 1.
Medications That DO Affect Urinary Function in BPH
The evidence-based culprits for worsening urinary symptoms include:
- Anticholinergic medications (antihistamines, tricyclic antidepressants) that impair bladder contractility 1
- Diuretics that increase urine production and frequency 1
- Alpha-agonists (decongestants) that increase bladder outlet resistance 1
SSRIs like escitalopram are not included in this list 1.
Clinical Approach to Your Patient
When evaluating urinary frequency in a BPH patient on Lexapro:
- Attribute symptoms to the underlying BPH pathophysiology rather than the SSRI, as BPH directly causes storage symptoms through mechanical obstruction and detrusor overactivity 3
- Assess disease progression markers: prostate volume, PSA level, and maximum flow rate, as these predict symptom severity and natural history 2
- Consider standard BPH treatments rather than discontinuing escitalopram:
Common Pitfall to Avoid
Do not discontinue effective psychiatric medication based on unsubstantiated side effect claims. The extensive BPH treatment literature, including comprehensive reviews of drug effects and comorbidities, does not identify SSRIs as problematic for urinary function 6, 7, 8. The urinary frequency is almost certainly due to the documented BPH rather than the escitalopram 3.