How to explain Lexapro (escitalopram) to an adult patient with depression or anxiety?

How to Explain Lexapro (Escitalopram) to a Patient

Lexapro is an antidepressant medication that works by increasing serotonin levels in your brain to help improve mood, reduce anxiety, and restore your ability to function in daily activities. 1

What Lexapro Treats

Lexapro is FDA-approved for two main conditions: 1

• Depression (Major Depressive Disorder): When you experience persistent sadness, loss of interest in activities, changes in sleep or appetite, fatigue, feelings of worthlessness, difficulty concentrating, or thoughts of suicide for at least 2 weeks 1
• Generalized Anxiety Disorder: When you experience excessive worry that's difficult to control for at least 6 months, along with restlessness, fatigue, difficulty concentrating, irritability, muscle tension, or sleep problems 1

How Lexapro Works

Lexapro is the most selective serotonin medication available, meaning it specifically targets serotonin in your brain with minimal effects on other systems. 2, 3 This selectivity contributes to its effectiveness and tolerability profile. The medication increases serotonin availability between nerve cells, which helps regulate mood and anxiety over time. 2

What to Expect During Treatment

Timeline for Improvement

• Early changes (1-2 weeks): You may notice some initial improvements in sleep, energy, or anxiety symptoms 3
• Significant improvement (4-8 weeks): Most patients experience meaningful reduction in depression and anxiety symptoms within this timeframe 4
• Full response: Maximum benefit typically occurs after 8-12 weeks of consistent treatment 4

Typical Dosing

• Starting dose: Usually 10 mg once daily 4, 1
• Maximum dose: 20 mg once daily (higher doses increase side effects without additional benefit) 4, 1
• Timing: Can be taken at any time of day, with or without food 2

Common Side Effects

Most side effects are mild, temporary, and occur within the first few weeks of treatment. 1, 2 The most common include:

• Nausea (occurs in >10% of patients but typically resolves within 1-2 weeks) 2, 3
• Insomnia or drowsiness 1, 3
• Sexual side effects (delayed ejaculation in men, decreased libido) 1, 3
• Diarrhea or dry mouth 2, 3
• Dizziness or headache 3

Only 6-8% of patients stop taking Lexapro due to side effects, which is similar to placebo rates. 1, 2

Critical Safety Information

Suicidal Thoughts Warning

During the first 1-2 months of treatment, particularly in younger adults, there is an increased risk of suicidal thoughts or behaviors. 4 Contact your doctor immediately if you experience:

• New or worsening thoughts of suicide or self-harm 4
• Unusual agitation, restlessness, or irritability 4
• Panic attacks or severe anxiety 4
• Impulsive or dangerous behaviors 4

When to Contact Your Doctor

Seek immediate medical attention if you develop: 5

• Confusion, agitation, or unusual behavior changes
• Rapid heartbeat or chest pain
• Severe dizziness or fainting
• Muscle stiffness or tremors
• High fever or sweating

Duration of Treatment

If this is your first episode of depression or anxiety, you should continue treatment for 4-12 months after feeling better to prevent relapse. 4

• First episode: 4-12 months of continued treatment after remission 4
• Second episode: Consider longer-term treatment (years) as relapse risk increases to 70% 4
• Three or more episodes: May benefit from indefinite maintenance treatment as relapse risk reaches 90% 4

Do not stop Lexapro abruptly without discussing with your doctor, as this can cause withdrawal symptoms including dizziness, anxiety, irritability, and flu-like symptoms. 5

Monitoring Your Progress

Your doctor should assess your response using standardized questionnaires at: 4

• 4 weeks: To evaluate early response and side effects 4
• 8 weeks: To determine if the medication is adequately effective 4
• End of treatment: To confirm sustained remission 4

If symptoms haven't improved after 8 weeks at an adequate dose, your doctor should adjust your treatment plan (such as increasing the dose to 20 mg, adding therapy, or switching medications). 4

Combining with Therapy

Cognitive-behavioral therapy (CBT) combined with Lexapro is more effective than medication alone for both depression and anxiety. 4, 5 Consider asking your doctor about adding therapy to your treatment plan, as this combination provides superior outcomes and may reduce relapse rates. 4

Drug Interactions and Precautions

Lexapro has minimal drug interactions compared to other antidepressants, making it safer when taking multiple medications. 5, 2 However, inform your doctor about all medications you take, particularly:

• Other antidepressants or psychiatric medications 5
• Blood thinners 5
• Medications that affect heart rhythm 5
• St. John's Wort or other supplements 5

What Makes Lexapro Different

Lexapro is the purified active component of an older medication (citalopram), providing the same benefits at half the dose with potentially fewer side effects. 2, 3 It demonstrates earlier separation from placebo than its predecessor and has robust evidence for treating both depression and anxiety simultaneously. 3, 6