Can a patient who has been on Lexapro (escitalopram) 10mg for 5 days be increased to 15 or 20mg?

Can Lexapro Be Increased from 10mg to 15 or 20mg After 5 Days?

No, a patient on Lexapro 10mg for only 5 days should not be increased to 15 or 20mg yet—the FDA-approved prescribing information specifies a minimum waiting period of one week before increasing from 10mg to 20mg in adults, and three weeks in adolescents. 1

Recommended Titration Timeline

For Adults with Major Depressive Disorder

• Starting dose: 10mg once daily 1
• Minimum wait before dose increase: One week 1
• Target dose if needed: 20mg once daily 1
• At 5 days, the patient has not yet reached the minimum one-week interval required before considering dose escalation 1

For Adolescents with Major Depressive Disorder

• Starting dose: 10mg once daily 1
• Minimum wait before dose increase: Three weeks 1
• Maximum dose: 20mg once daily 1

For Generalized Anxiety Disorder

• Starting dose: 10mg once daily 1
• Minimum wait before dose increase: One week 1
• Maximum dose: 20mg once daily 1

Clinical Rationale for Waiting

Escitalopram requires 7-10 days to reach steady-state plasma concentrations, meaning the full pharmacological effect of the current 10mg dose has not yet been achieved at day 5 2. The elimination half-life is 27-33 hours, which necessitates this waiting period for drug accumulation 2.

Symptom improvement can begin within 1-2 weeks of starting treatment, so assessing response at 5 days is premature 3. Clinical trials demonstrate that escitalopram shows separation from placebo within the first 1-2 weeks, but optimal assessment of therapeutic response requires adequate time at the current dose 3, 4.

Important Dosing Considerations

The 15mg Dose

• 15mg is not a standard FDA-approved dose for escitalopram 1
• The approved doses are 10mg and 20mg daily 1
• While some clinical scenarios may warrant non-standard dosing, this should only be considered after adequate trial at standard doses

Evidence for 10mg vs 20mg Efficacy

• Fixed-dose trials in major depression demonstrated effectiveness of both 10mg and 20mg, but failed to show greater benefit of 20mg over 10mg 1
• In generalized anxiety disorder, patients maintained at 10mg/day showed significant improvement compared to placebo 4
• Many patients achieve remission at 10mg without requiring dose escalation 4

When to Consider Dose Increase

After a minimum of one week at 10mg (three weeks in adolescents), consider increasing to 20mg only if: 1

• The patient has inadequate symptom response at 10mg
• The 10mg dose is well-tolerated without significant adverse effects
• There are no contraindications to dose escalation

Common adverse effects that may limit tolerability include: nausea (usually mild and transient), insomnia, ejaculatory problems, diarrhea, and somnolence 3, 5. These should be assessed before increasing the dose.

Clinical Pitfalls to Avoid

• Do not increase dose prematurely before steady-state is achieved, as this increases risk of adverse effects without additional therapeutic benefit 2
• Do not use 15mg as a routine dose—stick to FDA-approved 10mg or 20mg increments 1
• Monitor for activation symptoms in the first 1-2 weeks, particularly in patients with undiagnosed bipolar disorder 1
• Ensure adequate monitoring of response before concluding that 10mg is insufficient 1