From the Guidelines
Yes, Lexapro (escitalopram) can sometimes cause anxiety, particularly during the first few weeks of treatment. This paradoxical reaction occurs because SSRIs like Lexapro initially increase serotonin levels, which can temporarily worsen anxiety symptoms before the therapeutic effects begin. These initial side effects typically peak within the first 1-2 weeks and gradually subside as your body adjusts to the medication, usually within 2-4 weeks. According to the study published in the Journal of the American Academy of Child and Adolescent Psychiatry 1, the best-fitting model for SSRI response may be a logarithmic model demonstrating statistically significant improvement in anxiety symptoms within 2 weeks of treatment initiation, clinically significant improvement by week 6, and maximal improvement by week 12 or later.
Some key points to consider when taking Lexapro for anxiety include:
- Starting with a lower dose (such as 5mg daily instead of 10mg) and gradually increasing can help minimize the initial anxiety effect
- If you experience increased anxiety when starting Lexapro, it's essential to consult your healthcare provider rather than stopping the medication abruptly
- Your healthcare provider might recommend temporarily adding a short-acting anti-anxiety medication like lorazepam (0.5-1mg as needed) to manage symptoms during this adjustment period
- Adjusting your dosage or switching to a different medication if the anxiety persists beyond several weeks may also be considered
- The study published in American Family Physician 1 notes that SSRIs, including Lexapro, can have adverse effects such as gastrointestinal bleeding, hepatotoxicity, hyponatremia, QT prolongation, sexual effects, and suicidality, although the risk of these effects varies depending on the specific medication and patient population.
It's crucial to work closely with your healthcare provider to monitor your response to Lexapro and adjust your treatment plan as needed to minimize potential side effects and maximize the therapeutic benefits.
From the FDA Drug Label
New or worse anxiety or panic attacks Anxiety, irritability, high or low mood, feeling restless or changes in sleep habits Patients should be monitored for the emergence of serotonin syndrome. Symptoms may include mental status changes (e.g., agitation, hallucinations, delirium, and coma), autonomic instability (e.g., tachycardia, labile blood pressure, dizziness, diaphoresis, flushing, hyperthermia), neuromuscular symptoms (e.g., tremor, rigidity, myoclonus, hyperreflexia, incoordination) seizures, and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea). Dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesias such as electric shock sensations), anxiety, confusion, headache, lethargy, emotional lability, insomnia, and hypomania.
Yes, lexapro (escitalopram) can cause anxiety, as evidenced by the reported adverse reactions of new or worse anxiety or panic attacks, and anxiety as a symptom of serotonin syndrome and discontinuation symptoms 2, 2, 2.
From the Research
Lexapro and Anxiety
- Lexapro, also known as escitalopram, is a selective serotonin reuptake inhibitor (SSRI) commonly used to treat anxiety disorders and major depressive disorder.
- According to studies, escitalopram has been shown to be effective in reducing anxiety symptoms in patients with generalized anxiety disorder (GAD) 3, 4, 5.
- In a meta-analytic review, SSRIs, including escitalopram, were found to be moderately effective in treating GAD, with a combined effect size of 0.33 6.
- Escitalopram has been compared to other SSRIs, such as paroxetine, and has been found to be at least as effective in reducing anxiety symptoms 3, 4.
- In terms of safety and tolerability, escitalopram has been found to be well-tolerated, with a low risk of adverse events and discontinuation symptoms 3, 7.
Potential for Anxiety as a Side Effect
- While escitalopram is commonly used to treat anxiety disorders, it can also cause anxiety as a side effect in some patients.
- However, the studies provided do not specifically address the question of whether lexapro can cause anxiety as a side effect.
- It is worth noting that SSRIs, including escitalopram, can cause activation symptoms, such as anxiety and agitation, in some patients, particularly during the initial treatment period 7.