Do Antidepressants Like Lexapro Raise Blood Pressure?

Certain antidepressants can increase blood pressure, prompting those with prehypertension to develop high blood pressure and those who already have it to have a harder time managing their condition. This is because of the drugs' effect on a chemical messenger that regulates mood and the narrowing of blood vessels.

Selective serotonin reuptake inhibitors (SSRIs) like Prozac (fluoxetine) and Lexapro (escitalopram) may raise blood pressure, though these drugs are less likely to do so than other classes of antidepressants. And some antidepressants are more likely to have this affect than others.

This doesn't mean you should avoid antidepressants, but simply that your treatment may need to be adjusted if you need tighter control of your blood pressure.

This article explains how SSRIs and other antidepressants affect blood pressure and which drugs pose the greatest risk of increased blood pressure.

Measuring blood pressure
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How Antidepressants Affect Blood Pressure

All antidepressants act on the nervous system and alter the biochemical functions that influence moods. Most antidepressants work by increasing the amount of serotonin or dopamine available in the brain.

These neurotransmitters, or chemical messengers, act on the "pleasure center" of the brain to elevate moods, albeit in different ways. But this is not their only function.

Serotonin also regulates bodily functions such as digestion, body temperature, hormone production, and the sleep-wake cycle. Dopamine is similarly tasked with regulating sleep, urine output, and muscle movement and coordination.

Both serotonin and dopamine participate in the regulation of blood flow. Serotonin activates nerves that trigger vasoconstriction (narrowing of blood vessels) in order to slow blood flow. Dopamine is mainly involved in vasodilation (widening of blood vessels) to increase blood flow.

When antidepressants increase the availability of serotonin, they can inadvertently trigger vasoconstriction. This, in turn, causes blood pressure to rise.

The effect on blood pressure can increase and decrease in tandem with the concentration of antidepressants in the bloodstream.

Effect of SSRIs vs. Other Antidepressants

Antidepressants like selective serotonin reuptake inhibitors (SSRIs) increase the amount of serotonin in the brain by preventing reabsorption of the neurotransmitter.

Serotonin is mainly produced by nerve cells in the brainstem. It works by carrying signals between nerve cells in the brain, after which it is reabsorbed by nerve cells.

When reabsorption is blocked, there is more serotonin available to stimulate the pleasure center of the brain. With this comes the increased risk of high blood pressure.

With that said, not all antidepressants increase serotonin to levels where blood pressure is affected.

The antidepressants most commonly linked to high blood pressure include:

Of all the classes of antidepressants currently available, SSRIs are among the least likely to cause hypertension, according to a 2021 review published in Frontiers in Cardiovascular Medicine.

Can You Still Use an Antidepressant?

You can still use antidepressant medications if you have high blood pressure. Finding the right medication—or combination of medications—can be a trial-and-error process. The goal of any treatment plan is for the benefits to outweigh the risks.

Your healthcare provider may choose to avoid certain types of antidepressants, though, and will likely want to monitor your blood pressure carefully during the initial stages of treatment.

Many people with high blood pressure are able to use the most common antidepressants with no problem, but some may require adjustments to their high blood pressure treatment program. Lifestyle changes may also be recommended.

This includes routine exercise to improve your cardiovascular health and help lower your blood pressure while stimulating the production of dopamine and endorphins, both of which elevate moods.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Yekehtaz H, Farokhnia M, Akhondzadeh S. Cardiovascular considerations in antidepressant therapy: an evidence-based reviewJ Tehran Heart Cent. 2013;8(4):169–176.

  2. Peixoto MF, Cesaretti M, Hood SD, Tavares A. Effects of SSRI medication on heart rate and blood pressure in individuals with hypertension and depression. Clin Exp Hypertens. 2019;41(5):428-433. doi:10.1080/10641963.2018.1501058

  3. Calvi A, Fischetti I, Verzicco I, et al. Antidepressant drugs effects on blood pressure. Front Cardiovasc Med. 2021;8:704281. doi:10.3389/fcvm.2021.704281

By Craig O. Weber, MD
Craig O. Weber, MD, is a board-certified occupational specialist who has practiced for over 36 years.