What are the side effects of escitalopram (Lexapro)?

From the Guidelines

Escitalopram can cause several side effects, including nausea, drowsiness, insomnia, headache, dry mouth, increased sweating, and sexual dysfunction, with most being mild and improving after the first few weeks of treatment. When considering the side effects of escitalopram, it's essential to weigh the benefits against the potential risks, particularly in terms of morbidity, mortality, and quality of life. According to a clinical practice guideline from the American College of Physicians 1, the most commonly reported adverse events associated with second-generation antidepressants, including escitalopram, are constipation, diarrhea, dizziness, headache, insomnia, nausea, sexual adverse events, and somnolence. Some key points to consider about escitalopram side effects include:

• Nausea and vomiting are among the most common reasons for discontinuation in efficacy studies 1.
• Sexual dysfunction is a significant concern, with some antidepressants having higher rates of sexual adverse events than others 1.
• The risk of suicidality, including suicidal thinking or behavior, has been evaluated in patients, showing no significant differences among second-generation antidepressants, but an increased risk for nonfatal suicide attempts has been noted in some meta-analyses 1.
• Other severe adverse events, such as serotonin syndrome, abnormal bleeding, and low sodium levels, are less common but can be serious. Given the potential side effects, it's crucial for patients to be closely monitored by their healthcare provider, especially when starting or adjusting escitalopram treatment. Gradually reducing the dosage under medical supervision is recommended to avoid withdrawal symptoms. If severe side effects or concerns about symptoms arise, patients should contact their healthcare provider immediately to discuss adjustments to their treatment plan.

From the FDA Drug Label

What are the possible side effects of Escitalopram tablets? 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 possible side effects of escitalopram include:

• Common side effects:
  • Nausea
  • Sleepiness
  • Weakness
  • Dizziness
  • Feeling anxious
  • Trouble sleeping
  • Sexual problems
  • Sweating
  • Shaking
  • Not feeling hungry
  • Dry mouth
  • Constipation
  • Infection
  • Yawning
• Side effects in children and adolescents:
  • Increased thirst
  • Abnormal increase in muscle movement or agitation
  • Nose bleed
  • Difficult urination
  • Heavy menstrual periods
  • Possible slowed growth rate and weight change 2 Additionally, the following adverse reactions were reported in clinical trials:
• Major Depressive Disorder:
  • Insomnia
  • Ejaculation disorder
  • Nausea
  • Sweating increased
  • Fatigue
  • Somnolence
• Generalized Anxiety Disorder:
  • Nausea
  • Ejaculation disorder
  • Insomnia
  • Fatigue
  • Decreased libido
  • Anorgasmia 2

From the Research

Side Effects of Escitalopram

• The side effects of escitalopram, an SSRI, include gastrointestinal disturbances, headache, sedation, insomnia, activation, weight gain, impaired memory, excessive perspiration, paresthesia, and sexual dysfunction 3.
• A study comparing escitalopram with other antidepressants found that escitalopram was more effective than citalopram in achieving acute response and remission, with fewer patients withdrawing from trials due to adverse effects 4.
• A meta-review of 78 adverse effects of psychotropic medications in children and adolescents found that escitalopram had a safer profile among antidepressants, with nausea/vomiting and discontinuation due to adverse events being the most frequently associated side effects 5.
• A systematic review and network meta-analysis of augmentation strategies for treatment-resistant major depression found that escitalopram was not specifically mentioned as an augmentation agent, but the study did find that some antidepressants had significant efficacy and acceptability in treating depression 6.
• A systematic review of the comparative effectiveness of second-generation antidepressants for accompanying anxiety, insomnia, and pain in depressed patients found that the strength of the evidence was moderate or low, and that escitalopram was not specifically compared to other antidepressants for these symptoms 7.