What to Know About Lexapro (Escitalopram)

An Antidepressant and Antianxiety Medication

In This Article

Lexapro (escitalopram) is an oral prescription medication used for treating depression in adults and adolescents age 12 and older and for treating anxiety in adults age 18 and older. It is a selective serotonin reuptake inhibitor (SSRI) that is also used off-label for treating hot flashes, post-traumatic stress disorder (PTSD), agitation, and several neuropsychiatric issues.

Lexapro tablets
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Uses

Lexapro is used for preventing the symptoms of major depressive disorder and generalized anxiety disorder. This medication must be taken on an everyday basis to have its effect and it generally starts working after several weeks.

Approved indications: 

  • Major depressive disorder: When it’s used for treating major depressive disorder, Lexapro can be used for management of acute or chronic symptoms. It is approved for treating major depressive disorder for adults and adolescents aged 12-17 years.
  • Generalized anxiety disorder: When it’s used for treating generalized anxiety disorder, Lexapro is used for acute treatment and it not recommended that you take it for longer than eight weeks. It is approved for treating generalized anxiety disorder for adults over age 18. 

Lexapro is approved for acute treatment of depression or anxiety. This means that it can be used to prevent symptoms that have been present for a few months. Lexapro does not relieve symptoms immediately or within a few hours. It has to be taken daily for the prevention of symptoms.

Lexapro is classified as an SSRI. It allows the neurotransmitter serotonin to remain active in the body. Serotonin regulates mood and pain. A deficiency in serotonin activity is believed to be part of the cause of depression and anxiety.

Lexapro prevents the termination of serotonin’s action by inhibiting the reuptake of this neurotransmitter from its area of activity.

Off-Label Uses 

Lexapro and its generic version is used off-label for the treatment of several conditions. 

Off label uses include:

  • Social anxiety disorder
  • Obsessive-compulsive disorder
  • Panic disorder
  • Post-traumatic stress disorder
  • Premenstrual dysphoric disorder
  • Hot flashes due to menopause
  • Agitation due to Alzheimer’s disease and other types of dementia 

Before Taking

If you have had any allergic or other reaction due to Lexapro or any form of escitalopram or Celexa (citalopram), it may not be safe for you to use Lexapro. 

If you are pregnant, nursing, or might become pregnant when using Lexapro, you and your doctor need to discuss the risks and potential benefits of this medication. 

Precautions and Contraindications 

Certain conditions can predispose you to side effects from taking Lexapro. If you have a predisposition to adverse effects, your doctor will monitor you closely for these problems. 

  • Seizures: Taking Lexapro can predispose you to seizures if you have epilepsy.
  • Mania/hypomania: Lexapro can trigger mania of you have had mania in the past or if you have bipolar disorder. 
  • Hyponatremia (low sodium level): If you have a tendency to have low sodium or if you have been diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH), Lexapro can contribute to low sodium levels.
  • Angle closure glaucoma: You can experience sudden worsening of glaucoma, especially if your glaucoma is not diagnosed and not being treated. 
  • Medical illness: The manufacturer recommends using Lexapro with caution if you have a chronic or severe medical illness.

Lexapro can interfere with your thinking and reaction time and it can make you feel groggy. When you first start using it, be cautious when driving or using potentially dangerous equipment.

Other SSRIs

Lexapro is a brand name medication. It is also available as escitalopram, the generic version. And Cipralex is another brand of escitalopram.

Other SSRIs include:

Dosage

Lexapro comes in tablets and an oral solution. The tablets are available in 5 milligram (mg), 10 mg, and 20 mg strengths. The 10 and 20 mg tablets are scored and can be cut in half.

The oral solution comes in a strength of 1 mg per milliliter (mL). 

The manufacturer recommended dose of Lexapro:

  • Major depressive disorder over age 18: Recommended dose of 10 mg per day and can increase to 20 mg per day after three weeks if necessary.
  • Major depressive disorder age 12 to 18: Recommended dose of 10 mg per day and can increase to 20 mg per day after one week if necessary.
  • Generalized anxiety disorder: Recommended dose of 10 mg per day.

It is not standard to check the Lexapro level in the blood, and treatment adjustments are made based on symptoms and side effects. However, higher blood levels of Lexapro are associated with a better therapeutic effect.

Modifications

There are no specific modified dose recommendations for Lexapro, but it should be taken with caution if you are elderly or have a major medical illness that affects your metabolism, such as kidney or liver disease.

How to Take and Store 

You can take Lexapro with or without food, and you can take it in the morning or at night.

Store at 25 C (77 F); excursions permitted to 15 to 30 C (59 to 86 F).

Side Effects

Lexapro is generally considered safe if you don’t have any contraindications or a predisposition to adverse effects. However, it can cause a number of side effects.

Common 

The common side effects of Lexapro may subside after several months of use. Discuss any side effects with your doctor.

Common side effects of Lexapro include:

  • Insomnia
  • Ejaculation problems
  • Nausea
  • Sweating
  • Fatigue
  • Decreased libido
  • Anorgasmia 

Severe 

While rare, Lexapro can cause severe or life-threatening side effects. You should get prompt medical attention if you begin to experience these side effects.

  • Worsening symptoms: You may experience worsening depression or anxiety or a lack of improvement of your symptoms.
  • Serotonin syndrome: This condition is characterized by a rapid heartbeat, confusion, agitation, sweating, muscle twitching, and irregular body temperature.

Lexapro can trigger suicidal thoughts, especially in young people. If you start to have thoughts of harming yourself, seek medical help immediately.

Warnings and Interactions

Do not abruptly stop taking Lexapro. Talk to your doctor if you want to stop taking Lexapro, and follow instructions for gradually reducing your medication dose before stopping it.

Withdrawal can cause symptoms of mood changes, agitation, headaches, dizziness, tiredness, and trouble sleeping.

Lexapro can interact with other medications and may cause adverse effects. especially when it’s used with other antidepressants. Be sure to tell your doctor and pharmacist the names and doses of all medications that you are taking.

The most common Lexapro drug interactions:

Blood thinners: When used with blood thinners such as non-steroidal anti-inflammatories (NSAIDs), aspirin, and warfarin, Lexapro can increase the risk of bleeding.

Serotonergic medications: Other medications that interact with serotonin can cause serotonin syndrome when used with Lexapro. Serotonergic medications that increase the risk of serotonin syndrome include:

  • Other SSRIs such as Celexa (citalopram)
  • Monoamine oxidase inhibitors (MAOIs), which are used to treat psychiatric disorders
  • Tricyclic antidepressants such as Pamelor (nortriptyline)
  • Triptans used for treating migraines such as sumatriptan

Medications that potentially cause serotonin syndrome when used with Lexapro include:

  • Pimozide, an antipsychotic
  • Linezolid (an antibiotic)
  • Intravenous methylene blue (used to treat methemoglobinemia)
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