Side Effects of Escitalopram (Lexapro)

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Lexapro (escitalopram) is an SSRI antidepressant medication related to Celexa. It may be prescribed for the treatment of depressive disorders, anxiety disorders, and other mood disorders, sometimes in combination with other medications.

If you or someone you love is taking Lexapro or escitalopram (the generic version), you should be aware of the potential common and serious side effects, as well as the symptoms of withdrawal and overdose.

Common Escitalopram Side Effects

Common side effects of Lexapro include:

  • Nausea
  • Headache
  • Trouble sleeping (insomnia)
  • Dry mouth
  • Sexual side effects (anorgasmia, decreased libido, ejaculatory delay)
  • Diarrhea
  • Fatigue
  • Flu-like symptoms
  • Increased sweating
  • Constipation
  • Dizziness
  • Involuntary shaking (tremor)
  • Indigestion

Side effects may be different in children and adolescents than adults and may also include:

  • Increased thirst
  • Muscle twitching
  • Nose bleeding
  • Heavy menstruation
  • Trouble urinating
  • Slowed growth rate and weight changes

It's important to know that many side effects will appear within the first two weeks of taking the medicine and may subside as your body adjusts to the medicine.

Managing Common Side Effects

Generally, these common side effects are mild and can be managed with your doctor who may recommend strategies like:

  • Changing the timing of doses—for example, taking your medication after meals if you experience gastrointestinal symptoms, before bed if you have insomnia, or after sex if you're experiencing sexual side effects.
  • Increasing your physical activity to help manage, anxiety, sleep problems, or constipation.
  • Practicing relaxation techniques, like yoga or meditation, to improve anxiety or insomnia.
  • Using lubricants to make sex more comfortable.

When to Notify Your Doctor

While these side effects usually do not require medical intervention, you should report them to your healthcare provider if they continue for over one week, or interfere with your daily routine. Your doctor may decide to adjust your dosage or switch you to another medication entirely.

Also, you may experience other less common side effects. If you do, alert your doctor. You should never stop or change the dosage of your medication on your own.

Serious Side Effects

If you experience any of the following side effects, you should contact your healthcare provider immediately, or seek emergency medical care.

  • Bleeding or bruising: These symptoms are more likely to occur if also on a blood thinner or nonsteroidal anti-inflammatory (NSAID).
  • Manic episode: Severely increased energy, trouble sleeping, racing thoughts, reckless behavior like excessive gambling or shopping, inflated sense of self, rapid speech, or feeling extremely happy or irritable.
  • Serotonin syndrome: Agitation, hallucinations, confusion, coma, coordination or balance problems, muscle twitching, racing heartbeat, high or low blood pressure, sweating, fever, nausea, vomiting, or diarrhea.
  • Severe allergic reaction: Rash, difficulty breathing, fever, joint pain, or swelling of the mouth, lips, eyes, or tongue.
  • Additional side effects: Seizures, change in appetite or weight, or low blood sodium levels.
  • Suicidal thoughts: Thinking of suicide or making attempts at suicide seek treatment right away.

Black Box Warning

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.

If you or someone you love is 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.

For more mental health resources, see our National Helpline Database.

Taking Lexapro Safely

As with any kind of treatment, it is important to follow your doctor’s instructions for medication use, including when to take the medication, whether it's okay to increase the dose, what to do if you miss a dose, and medications, foods, and substances to avoid. If you want to deviate from your treatment plan for any reason, get in touch with your doctor.

Use As Directed

It's important to follow your doctor's instructions for taking Lexapro. The usual recommended daily dosage of Lexapro is 10 mg; doses higher than 20 mg are not approved by the FDA. You may take Lexapro as tablets or an oral solution once daily, in the morning or evening, with or without food.

Depending on your diagnosis, your doctor may prescribe Lexapro for a defined period (between six month and one year) or for an extended period (over many years). Ask your doctor or call your pharmacist if you have any questions about this medication.

If you miss a dose, go ahead and take it as soon as you remember, unless it's close to time for your next dose. In that case, don't double up; just skip the missed dose and take your next dose as usual.

Precautions

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

Prior to starting the medication, tell your doctor if you are allergic or hypersensitive to escitalopram oxalate 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 escitalopram:

  • Bipolar disorder
  • Glaucoma
  • Low salt levels
  • Seizures
  • Suicidal thoughts behaviors

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. The medication side effects may be more severe in older adults, and your dose will need to be monitored closely by your physician.

People taking Lexapro should avoid drinking and taking illicit drugs, as these substances can reduce the effectiveness of the medication and increase its toxicity.

Interactions

The best way to avoid any possible drug interactions is to provide your doctor with a list of other prescription and over-the-counter medications you are currently taking.

The following drugs have been known to interact with Lexapro and should be used with caution:

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

A recent study in the Journal of the American Osteopathic found that patients take SSRIs are 40% more likely to develop severe gastrointestinal bleeding, especially if they are also taking NSAIDs. Talk to your doctor before taking NSAIDs such as Motrin (ibuprofen) or Aleve (naproxen).

Serotonergic medications: Medications that may increase the risk of serotonin syndrome include:

  • Other SSRIs such as Celexa (citalopram)
  • Monoamine oxidase inhibitors (MAOIs), which are used to treat psychiatric disorders
  • Pimozide (an antipsychotic)
  • Linezolid (an antibiotic)
  • Intravenous methylene blue (used to treat methemoglobinemia)
  • St. John's Wort
  • Tricyclic antidepressants such as Pamelor (nortriptyline)
  • Triptans used for treating migraines such as sumatriptan

Side Effects of Withdrawal

You should only discontinue Lexapro under the guidance of your doctor at an appropriate time (such as when symptoms have been stable for a certain period). It's never a good idea to stop your medication abruptly. Stopping Lexapro may cause some withdrawal symptoms, such as:

  • Alteration in sleep habits
  • Anxiety
  • Confusion
  • Dizziness
  • Electric shock-like sensations
  • Headache
  • High or low mood
  • Irritability
  • Nausea
  • Restlessness
  • Shaking
  • Sweating

Signs of Overdose

Whether you or a loved one has accidentally or intentionally overdosed on escitalopram, the symptoms will typically be mild and non-specific and worsen over time. One of the earliest signs is tachycardia, or rapid and irregular heartbeat.

Other early signs of Lexapro overdose include:

  • Agitation
  • Diarrhea
  • Drowsiness
  • Dry mouth
  • Headache
  • Nausea
  • Vomiting

If an overdose is suspected, the combination of these symptoms warrants a call to 911 or an immediate visit to the emergency room.

Toxic and potentially life-threatening complications that later emerge may include:

  • Coma
  • Confusion
  • Delirium
  • Hallucinations
  • Increasingly worsening heart pace (dysrhythmia)
  • Involuntary eye movement
  • Respiratory distress
  • Seizures
  • Tremors
  • Unconsciousness

Disclaimer

This list is not intended to be all-inclusive or to replace information provided by your doctor. A number of other side effects for both usage and withdrawal have been reported by the public. If you notice any other effects, check with your doctor.

Remember to consult your healthcare provider anytime you’re unsure about any symptoms that you experience while taking any medication. Most of the time, particularly in the case of antidepressants, other medications are available when serious or bothersome side effects occur. Be good to yourself. Take your medications and be safe.

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Article Sources
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  1. U.S. Food and Drug Administration. Escitalopram (marketed as Lexapro) Information. Updated December 16, 2014.

  2. U.S. Food and Drug Administration. Lexapro: Highlights of Prescribing Information. Updated January 2017.

  3. Yuet WC, Derasari D, Sivoravong J, Mason D, Jann M. Selective serotonin reuptake inhibitor use and risk of gastrointestinal and intracranial bleedingJ Am Osteopath Assoc. 2019;119(2):102. doi:10.7556/jaoa.2019.016

  4. Landy K, Estevez R. Escitalopram. StatPearls. Updated May 6, 2020.