From the Guidelines
Lexapro (escitalopram) is a highly effective and relatively safe antidepressant medication, with a favorable side effect profile compared to other SSRIs, and is commonly prescribed for depression and anxiety disorders. The typical starting dose is 10mg once daily, which may be increased to 20mg daily if needed after at least one week 1. Lexapro works by increasing serotonin levels in the brain, which helps regulate mood, but it usually takes 2-4 weeks to experience the full therapeutic benefits. Common side effects include nausea, headache, insomnia, dry mouth, fatigue, dizziness, and sexual dysfunction, with a weighted mean incidence of sexual effects of 40% across observational studies 1. Most side effects are temporary and diminish within the first few weeks of treatment.
Key Considerations
- Lexapro has a lower propensity for drug interactions compared to other SSRIs, such as fluoxetine, paroxetine, and sertraline, which may interact with drugs metabolized by CYP2D6, and fluvoxamine, which may interact with drugs metabolized by CYP1A2, CYP2C19, CYP2C9, CYP3A4, and CYP2D6 1.
- Patients should avoid alcohol while taking Lexapro and inform their doctor about all other medications they're taking to prevent potential interactions, including concomitant administration of any of the SSRIs with any of the monoamine oxidase inhibitors (MAOIs), which is contraindicated due to increased risk of serotonin syndrome 1.
- Pregnant women or those planning pregnancy should discuss risks and benefits with their healthcare provider, as SSRIs may have some risks during pregnancy, although there is little evidence to support any causal link between antidepressant use in breastfeeding mothers and adverse effects in infants 1.
Special Precautions
- A discontinuation syndrome characterized by dizziness, fatigue, lethargy, general malaise, myalgias, chills, headaches, nausea, vomiting, diarrhea, insomnia, imbalance, vertigo, sensory disturbances, paresthesias, anxiety, irritability, and agitation has been reported following missed doses or acute discontinuation of shorter-acting SSRIs, notably paroxetine but also (to a lesser extent) fluvoxamine and sertraline, so tapering is recommended when discontinuing 1.
- Medical education, training, and experience are necessary to safely and effectively prescribe antidepressant medications, and a conservative medication trial for mild to moderate anxiety presentations may entail increasing the dose as tolerated within the therapeutic dosage range in the smallest available increments at approximately 1- to 2-week intervals when prescribing shorter half-life SSRIs, such as sertraline, citalopram, to approximately 3- to 4-week intervals when prescribing longer half-life SSRIs, such as fluoxetine 1.
From the FDA Drug Label
Escitalopram tablets may cause serious side effects, including all of those described in the section entitled “What is the most important information I should know about Escitalopram tablets? ” Common possible side effects in people who take Escitalopram tablets include: • Nausea • Sleepiness • Weakness • Dizziness • Feeling anxious • Trouble sleeping • Sexual problems • Sweating • Shaking • Not feeling hungry • Dry mouth • Constipation • Infection • Yawning Other side effects in children and adolescents include: • increased thirst • abnormal increase in muscle movement or agitation • nose bleed • difficult urination • heavy menstrual periods • possible slowed growth rate and weight change.
The effectiveness of Escitalopram is not explicitly stated in the provided text, but it is mentioned that Escitalopram is used for the treatment of major depressive disorder. The side effects of Escitalopram include common possible side effects such as nausea, sleepiness, weakness, dizziness, and feeling anxious, as well as other side effects in children and adolescents, such as increased thirst and abnormal increase in muscle movement or agitation 2. Key points to consider when taking Escitalopram include:
- Taking the medication exactly as prescribed
- Not driving or operating heavy machinery until you know how Escitalopram affects you
- Not drinking alcohol while using Escitalopram
- Monitoring weight and growth in children and adolescents treated with Escitalopram 2. It is also important to note that Escitalopram is excreted in human breast milk and caution should be exercised when administering Escitalopram to a nursing woman 2. The mechanism of action of Escitalopram is presumed to be linked to potentiation of serotonergic activity in the central nervous system (CNS) resulting from its inhibition of CNS neuronal reuptake of serotonin (5-HT) 2.
From the Research
Effectiveness of Lexapro
- Lexapro (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) used for the treatment of major depressive disorder (MDD) and anxiety disorder 3, 4, 5, 6, 7.
- Studies have shown that escitalopram is effective in improving symptoms of depression and anxiety, with a rapid onset of action 4, 7.
- Escitalopram has been found to be superior to placebo and comparable to or more effective than other SSRIs and serotonin-noradrenaline reuptake inhibitors (SNRIs) in the treatment of MDD 3, 4, 7.
- Long-term administration of escitalopram has also shown a preventive effect on MDD relapse and recurrence 3, 4.
Side Effects of Lexapro
- The most common adverse event associated with escitalopram is nausea, which occurs in approximately 10% of patients 6.
- Other common side effects include sexual dysfunction, which is similar in frequency to that of citalopram but higher than that of paroxetine 6.
- Escitalopram is generally well tolerated, with most adverse events being mild to moderate in severity 3, 4, 6.
- Discontinuation symptoms are milder with escitalopram than with paroxetine 3, 6.
- There is no significant difference in the incidence of suicidal behavior or suicidal thoughts between escitalopram and placebo 6.