Is Lexapro Sedating?
Lexapro (escitalopram) is not considered a sedating antidepressant and is not recommended for treating insomnia. In fact, insomnia is one of the common side effects of escitalopram rather than sedation.
Classification in Sleep Medicine Guidelines
The American Academy of Sleep Medicine explicitly categorizes antidepressants used for insomnia into "sedating" versus "non-sedating" classes. Escitalopram is notably absent from the list of sedating antidepressants recommended for comorbid insomnia and depression/anxiety. 1
The sedating antidepressants specifically recommended for insomnia include:
- Trazodone
- Amitriptyline
- Doxepin
- Mirtazapine 1
Side Effect Profile
Escitalopram commonly causes insomnia rather than sedation. 2
- Insomnia is listed as one of the expected adverse events with escitalopram, occurring at rates generally comparable to or higher than placebo in clinical trials 2
- The drug has minimal affinity for histamine H1 receptors (six times less potent than citalopram at H1 receptors), which are responsible for sedating effects 3
- Escitalopram has almost no significant affinity to receptors other than the serotonin transporter, meaning it lacks the antihistaminic properties that cause sedation 4
Clinical Implications
For patients with comorbid insomnia and depression/anxiety, escitalopram may show some superiority over citalopram, though evidence is limited. 5 However, this does not mean escitalopram is sedating—rather, it may be less likely to worsen insomnia compared to its racemic parent compound.
If a patient on escitalopram requires treatment for insomnia, the American Academy of Sleep Medicine recommends:
- First-line: Short-intermediate acting benzodiazepine receptor agonists (zolpidem, eszopiclone, zaleplon, temazepam) or ramelteon 1
- Second-line: Adding a sedating antidepressant (trazodone, mirtazapine, doxepin) to the existing escitalopram regimen 1
Common Pitfall to Avoid
Do not prescribe escitalopram expecting sedation or sleep improvement. If sedation is desired, choose mirtazapine (which produces statistically faster onset of therapeutic effect than escitalopram and has sedating properties) or add a dedicated sleep medication to escitalopram. 5