Starting Dose of Lexapro (Escitalopram) for Anxiety

The recommended starting dose of Lexapro for anxiety is 10 mg once daily, taken in the morning or evening with or without food. 1

Standard Adult Dosing

Start with 10 mg once daily for generalized anxiety disorder (GAD) as per FDA labeling 1
If dose escalation is needed, increase to 20 mg only after a minimum of one week at 10 mg 1
Clinical trials demonstrate that both 10 mg and 20 mg doses are effective for anxiety disorders, with the 10-20 mg range showing sustained efficacy in long-term treatment 2, 3

Reduce starting dose to 10 mg daily, which is the maximum recommended dose for elderly patients 1
Do not exceed 10 mg daily in elderly patients due to increased sensitivity and risk of adverse effects 1

Start with 10 mg daily, which is also the maximum recommended dose for patients with hepatic impairment 1
No further dose escalation should be attempted in this population 1

No dosage adjustment is necessary for mild or moderate renal impairment 1
Use with caution in severe renal impairment, though specific dose reduction is not mandated by FDA labeling 1
Note that patients with declining renal function (eGFR <90 mL/min/1.73 m²) have increased risk of depression and suicidal ideation, requiring closer monitoring 4

Screen all patients for personal or family history of bipolar disorder, mania, or hypomania before initiating treatment 1
Patients with severe depression, drug abuse history, or melancholic features are at higher risk for treatment-emergent suicidal ideation 5
Approximately 7% of patients without baseline suicidal ideation may experience emergence during early treatment, with highest risk at first post-baseline visit 5
Maintain careful surveillance throughout treatment, particularly in the first few weeks 5

Allow at least 14 days between discontinuation of an MAOI and initiation of escitalopram 1
Conversely, wait at least 14 days after stopping escitalopram before starting an MAOI 1
Do not start escitalopram in patients receiving linezolid or intravenous methylene blue due to serotonin syndrome risk 1

Anxiolytic effects may begin as early as 2 weeks, particularly for anxiety symptoms, though full antidepressant response typically requires 6 weeks 6
Continue treatment for at least 8-12 weeks to adequately assess response 2, 3

GAD is recognized as a chronic condition requiring extended treatment 1, 2
Long-term studies demonstrate continued efficacy and tolerability at 10-20 mg daily for up to 24 weeks and beyond 3
Relapse prevention studies show that maintaining escitalopram treatment significantly reduces relapse risk compared to discontinuation 2
Periodically reassess the need for continued treatment, but expect most patients will require several months or longer of therapy 1

Gradually taper the dose rather than stopping abruptly to minimize discontinuation symptoms 1
If intolerable symptoms occur during taper, resume the previous dose and decrease more gradually 1
Monitor patients closely for withdrawal symptoms including mood changes, irritability, agitation, dizziness, and sensory disturbances 1

Do not escalate dose prematurely: Wait the full minimum period (1 week for adults, 3 weeks for adolescents) before increasing from 10 mg to 20 mg 1
Do not exceed 10 mg daily in elderly or hepatically impaired patients, even if response seems inadequate 1
Do not use 20 mg as a starting dose in any population, as this increases side effect burden without improving initial efficacy 6
The 20 mg dose produces comparable side effects to higher doses but with lower initial tolerability than 10 mg 6