What to Know About Lexapro (Escitalopram)

An SSRI Approved to Treat Mood and Anxiety Disorders

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Lexapro is the trademark name for the generic drug escitalopram, which is a type of antidepressant medication. It belongs to a group of antidepressants called selective serotonin reuptake inhibitors (SSRI) that were first introduced in the 1980s.

These medications are generally effective and have fewer side effects than some of the older antidepressants such as monoamine oxidase inhibitors (MAOIs). Lexapro, which comes in pill or liquid form, is used today to treat a variety of mental health conditions.

conditions lexapro is used to treat
Verywell / JR Bee

Uses

It is not known exactly how Lexapro works to reduce symptoms of depression and anxiety. However, we know that this medication has an effect on serotonin, which is a brain neurotransmitter involved in mood, sleep, and other bodily functions.

It is thought that Lexapro helps balance serotonin levels in the brain. This can reduce anxiety and enhance mood. Lexapro was initially used only to treat depression. However, research showed that it was also effective for other mood disorders as well as for anxiety disorders.

Off-Label Uses

While Lexapro is currently only approved by the Food and Drug Administration (FDA) for the treatment of depression and generalized anxiety disorder (GAD), it is prescribed for many other conditions. Doctors sometimes prescribe Lexapro off-label for:

Before Taking

Lexapro is prescribed for the treatment of anxiety disorder, depressive disorders, and other mood disorders, sometimes in combination with other medications. Generally, you must have a diagnosis of a mental health disorder before your doctor prescribes Lexapro for you.

Your primary care physician can write a prescription. But the process may be better handled by a mental health professional who can also prescribe medication, such as a psychiatrist.

Prior to starting the medication, tell your doctor if you are allergic or hypersensitive to escitalopram or are pregnant or breastfeeding. It's also important to alert your doctor if you have a history of any of the following medical conditions, which may be exacerbated by Lexapro:

Talk to your doctor about all medications, supplements, and vitamins that you currently take. While some drugs pose minor interaction risks, others may outright contraindicate use or prompt careful consideration as to whether the pros of treatment outweigh the cons in your case.

Precautions and Contradictions

There are many precautions involved when taking Lexapro. You can reduce potential risks by being aware of who should not take this medication, potential medication interactions, and the black box warning.

Lexapro is not safe for everyone. Certain people should not take Lexapro or take with caution, including:

  • People with allergies: You should not take Lexapro if you're hypersensitive to escitalopram oxalate, meaning that you have a known allergy to the medication and experience symptoms of allergic reaction, such as difficulty breathing or swelling of the face, mouth, or tongue.
  • Children: The effectiveness of Lexapro in children younger than 18 years of age has not been established, and it's not generally recommended for kids under the age of 12.
  • People who are pregnant or breastfeeding: Use Lexapro with caution if you're pregnant or breastfeeding as the medication can be passed to your child. Your doctor should discuss this with you; if not, be sure to ask about potential risks.
  • Older adults: The side effects of the medication can be more severe in older adults. In this case, your doctor should monitor your dose and adjust as necessary to reduce the severity of side effects.
  • People who are taking blood thinners: Taking NSAIDs, aspirin, and warfarin can increase the risk of bleeding in people taking Lexapro.
  • People who are taking serotonergic medications: Taking Lexapro with other serotonergic drugs as well as St. John's wort can increase the risk of serotonin syndrome.

According to a black box warning (the strictest warning for prescription drugs issued by the FDA), taking Lexapro can result in an increased risk of suicidal thoughts and behaviors, particularly in children, adolescents, and young adults. Close monitoring by your psychiatrist or doctor is important particularly if you are an adolescent or young adult taking Lexapro.

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

Other SSRIs

Lexapro is an allosteric serotonin reuptake inhibitor, which differentiates it from other SSRIs. It is generally well-tolerated and effective. Other commonly prescribed, FDA-approved SSRIs that treat issues similar to Lexapro include:

Dosage

Lexapro 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 usual recommended daily dosage of Lexapro is 10 mg, but you may begin at a lower dose and increased slowly if needed. The manufacturer recommended doses of Lexapro are:

  • Major depressive disorder over age 18: 10 mg per day and increased to 20 mg per day after three weeks if necessary
  • Major depressive disorder age 12 to 18: 10 mg per day and increased to 20 mg per day after one week if necessary
  • Generalized anxiety disorder: 10 mg per day

If you are experiencing the first episode of depression or anxiety, you may take Lexapro for a defined period such as between six months and one year. However, for individuals experiencing a chronic mental health condition, it may be necessary to take Lexapro for an extended period over many years.

All listed dosages are according to the drug manufacturer. Check your prescription and talk to your doctor to make sure you are taking the right dose for you.

Modifications

While there are not specific modified dose recommendations for Lexapro, the medication should be take with caution if you are older or have a major medical illness that affects your metabolism, such as kidney or liver disease. If this is the case, your health care provider may adjust your dose as necessary to reduce any related side effects.

How to Take and Store

Follow your doctor's instructions for taking Lexapro. Ask your doctor or pharmacist if you have any questions about this medication.

  • Lexapro is typically taken as a tablet or oral solution once daily, in the morning or evening, with or without food.
  • Missed doses should be taken as soon as you remember unless it is very close to your next dose, in which case you should take your regular dose instead. Never take two or more doses of Lexapro together at the same time.
  • Doses higher than 20 mg are not approved by the FDA. Staying within the recommended dose helps to reduce the risk of side effects or adverse reactions.
  • Lexapro should be stored at room temperature, away from light and moisture. Do not store in the bathroom.
  • If you're traveling with Lexapro, be sure to carry your medication in its original packaging in your carry-on luggage and have your prescription with you.

It's important to recognize that you will not experience immediate relief from taking Lexapro. It can take anywhere from one to four weeks to feel better once you start taking Lexapro, and you may not experience the full benefits of the medication until you've been following a recommended treatment plan for a couple of months.

Taking your medication as prescribed will ensure that you experience its full effectiveness.

Side Effects

As your body adjusts to taking the medication, the side effects should gradually go away. If you notice that they are getting worse or are interfering with your quality of life, talk to your doctor about your concerns. Side effects can be minimized by carefully following the dosage directions given by your doctor and reporting any negative effects.

Common

The most common side effects are:

  • Sleep disturbances
  • Nausea
  • Headaches
  • Blurred vision
  • Dry mouth
  • Diarrhea
  • Stomach pain
  • Constipation
  • Heartburn
  • Lightheaded and faintness
  • Irritability and nervousness
  • Dizziness
  • Changes in weight and appetite
  • Fatigue
  • Excessive sweating
  • Flu-like symptoms
  • Sexual side effects

Severe

Seek immediate help if you experience any of the following unusual side effects of Lexapro:

  • Difficulty breathing or swallowing
  • Swelling of the face, mouth, or tongue
  • Fever
  • Stiff muscles
  • Fast heartbeat
  • Vomiting
  • Seizures
  • Rash
  • Confusion
  • Hallucinations
  • Suicidal thoughts or behaviors

Warnings and Interactions

Caution should be used when taking Lexapro along with other medications. To help avoid any possible drug interactions, let your doctor know about any other prescription and over-the-counter medications you are currently taking.

When taking Lexapro, the following serotonergic medications should not be used or only be used with significant caution and close monitoring due to the increased risk of serotonin syndrome:

  • 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
  • St. John's wort

Avoid drinking alcohol when you are taking Lexapro, as it can reduce the effectiveness of the medication and also may increase its toxicity.

If Lexapro is not effective for you, your doctor will work to find another medication that may help, such as another SSRI or a different class of antidepressant medication. You may also find psychotherapy helpful if that has not already been implemented.

You should only discontinue taking Lexapro under the guidance of your doctor at an appropriate time (such as when symptoms have been stable for a certain period). Your doctor will help you to taper off the medication, so as to minimize any withdrawal effects.

If you stop taking it suddenly, you may notice withdrawal symptoms, including:

  • Dizziness
  • Muscle tension 
  • Chills
  • Confusion
  • Trouble concentrating
  • Trouble remembering things
  • Crying

A Word From Verywell

This overview of the use of Lexapro for mental health conditions does not cover every possible outcome of taking this medication. If you have been prescribed this medication by your doctor, be sure to follow the instructions carefully. If you have additional questions, they are best answered by a medical professional.

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Article Sources
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