Can Lexapro Cause Frequent Urination?
Yes, Lexapro (escitalopram) can cause urinary symptoms including frequent urination, though this is an uncommon adverse effect that occurs in approximately 9.4% of patients. 1
Evidence for Urinary Side Effects
The most robust evidence comes from a randomized controlled trial in older adults with generalized anxiety disorder, which specifically identified urinary symptoms as a statistically significant adverse effect of escitalopram compared to placebo (9.4% vs. lower rates in placebo, P < .05). 1 This study is particularly relevant as it was conducted in a real-world primary care setting with rigorous methodology.
Additionally, a case report documented escitalopram-associated acute urinary retention, demonstrating that SSRIs like escitalopram can cause urinary difficulties that resolve upon discontinuation of the medication. 2 In this case, normal micturition resumed only after stopping escitalopram, without further need for catheterization. 2
Common Adverse Effects Profile
The broader adverse effect profile of escitalopram includes: 3
- Most common: Nausea, diarrhea, dizziness, dry mouth, fatigue, headache, sexual dysfunction, sweating, tremor, and weight gain 3
- Leading to discontinuation: Nausea and vomiting are the most frequent reasons patients stop treatment 3
- In older adults specifically: Fatigue/somnolence (41.1%), sleep disturbance (14.1%), and urinary symptoms (9.4%) 1
Mechanism and Clinical Context
While urinary symptoms are not among the most commonly reported adverse effects of SSRIs, they can occur through serotonergic effects on bladder function. 4 The relationship between anxiety disorders and urinary symptoms is bidirectional—chronic psychological stress can cause urinary frequency and urgency, and SSRIs may occasionally exacerbate these symptoms. 4
Clinical Recommendations
- Monitor for urinary symptoms during the first months of treatment and following dosage adjustments, as most adverse events emerge within the first few weeks. 5
- Rule out other causes including anticholinergic medications, medical conditions (prostate issues, urinary tract infections), and the underlying anxiety disorder itself, which can independently cause urinary frequency. 2
- Consider dose adjustment or medication change if urinary symptoms are bothersome and persist beyond the initial adjustment period. 5
- Discontinuation typically resolves symptoms if escitalopram is determined to be the cause, as demonstrated in case reports. 2
Important Caveats
Escitalopram remains a well-tolerated first-line treatment for anxiety and depression with a favorable adverse effect profile compared to other antidepressants. 3, 6 The incidence of urinary symptoms is relatively low (under 10%), and most adverse events are mild to moderate in severity. 1, 7 However, when urinary symptoms do occur, they should not be automatically dismissed as unrelated to SSRI therapy. 2