Content

Side Effects of Lexapro (Escitalopram)

Wafaa Amjad Dar
Written by:
Wafaa Amjad Dar
Pharm-D
Dr. Michael Chichak
Medical Reviewer:
Dr. Michael Chichak
MD
The medications listed on this website are provided for informational purposes only.
Their inclusion does not guarantee they will be prescribed to any individual, as treatment decisions are ultimately at the discretion of healthcare providers. Healthcare providers may prescribe other medications or recommend non-pharmacological treatment based on the patient’s unique health circumstances and needs. Read more

Lexapro has a boxed warning, the most serious type of warning from the Food and Drug Administration (FDA). Lexapro’s active ingredient escitalopram has an increased risk of suicidal thoughts in young adult patients. Remember to discuss the risks with your healthcare provider.

Highlights

  • Lexapro (escitalopram) is commonly prescribed for depression and generalized anxiety disorder and has proven effective but may still cause side effects.
  • Common side effects of Lexapro include nausea, headaches, dry mouth, etc., most of which subside over time. Serious effects like serotonin syndrome, abnormal heart rhythms, and increased suicidal thoughts require immediate medical attention.
  • Lexapro has several contraindications and potential for drug interactions, so it’s essential to discuss your health history with a medical provider before starting the medication.
  • Stopping Lexapro abruptly can lead to withdrawal symptoms such as dizziness, brain zaps, mood swings, and insomnia. Tapering off under medical supervision is recommended.

Lexapro (escitalopram) is one of the most common medications used to help with depression and generalized anxiety disorder. It works by blocking the reabsorption of the neurotransmitter serotonin [1*] in the brain, which helps improve communication between neurons and therefore elevate mood and overall emotional well-being.

According to the WHO, around 5% of the adult population [2*] have depression. Not all people with this condition need pharmacological treatment, but some can benefit from medications like Lexapro. However, although it has proven effective, escitalopram can also cause adverse reactions ranging from common and easily managed to rare and serious. Below, let’s get into the details of side effects, their probability, and the signs indicating the need to see a physician.

Get personalized treatment for depression. Our medical team is here to guide you every step of the way.

Common Side Effects of Lexapro

Many people starting Lexapro don’t experience significant improvement in their symptoms for at least a week or two (main effects occur in 6 to 8 weeks) — but they may experience side effects during this period. Some common and most frequently reported ones are:

  • Nausea
  • Diarrhea
  • Headaches
  • Dry mouth
  • Increased sweating
  • Insomnia
  • Excessive sleepiness
  • Feeling tired or weak
  • Nervousness
  • Sexual dysfunction
  • Flu-like symptoms

Most of these side effects are short-lived and tend to resolve within a few weeks as your body becomes accustomed to the medication. However, if adverse side effects of Lexapro continue or interfere with quality of life, consult your healthcare provider.

"When it comes to treating anxiety, medications that affect serotonin are the medications that attain the best long-term effects at improving the symptoms. Sometimes patients can be thrown off at the mere mention of side effects. However, the vast majority of patients that take medications such as Lexapro have great results without experiencing much in the way of side effects. There are exceptions to every rule so it is important to have an in-depth conversation with your health care provider to make sure that you pick the best medication for your situation."
Dr. Michael Chichak, MD
Medical Director at MEDvidi

Serious Side Effects and Precautions

Aside from the common side effects of escitalopram, some individuals may also face serious, major side effects. These include:

If you experience any of the above or other serious negative side effects, get medical help immediately. It is important to always be transparent with your healthcare provider: inform them about your diagnosis and the medications you are taking to help them find an appropriate solution faster.

Seek professional guidance on the treatment of depression or anxiety and receive a prescription online, if deemed necessary.

Side Effects of Lexapro in Specific Groups

Adults

Adults commonly experience side effects such as nausea, headache, dry mouth, sleeplessness, muscle aches, and sexual dysfunction. These may be mild to moderate and subside as the body gets accustomed to the medication. Older adults [7*] may experience more pronounced side effects such as sedation and confusion along with dizziness. This may lead to a higher risk of falls and fractures.

Children and Adolescents

Increased risk of suicidal thoughts [8*] in children and adolescents, especially early in treatment. This is why escitalopram and other medications from the SSRI class (selective serotonin reuptake inhibitors) carry a black box warning. This may also be accompanied by agitation, irritability, or aggression.

If you’re experiencing suicidal or self-harming thoughts and require immediate assistance, contact crisis hotlines, such as 911, 988 Suicide & Crisis Lifeline (toll-free), or Samaritans (116-123 or via chat).

Pregnancy and Breastfeeding

Escitalopram is classified as a category C for pregnancy [9*] . Although it might be considered safe during pregnancy [10*] , there may be a risk of perinatal complications or withdrawal. As escitalopram passes into breast milk, it may cause sedation or feeding issues in infants. So, this medication can only be prescribed if the benefits significantly outweigh the risks.

Individuals With Substance Use Disorders

Escitalopram can lower the seizure threshold. If an individual has a history of substance abuse, caution is advised when prescribing escitalopram.

Patients Taking Other Medications

Other antidepressant medications (such as SSRIs and SNRIs), some painkillers, herbal supplements, and antipsychotics interact with Lexapro. Patients taking other medications must discuss that with the healthcare provider beforehand and refer to the official Lexapro label [11*] .

People With Certain Medical Issues

Certain medical conditions may make individuals more susceptible to some side effects of Lexapro. In patients with health issues [12*] taking escitalopram, the medication may cause increased heart rate and palpitations. Also, there is an increased risk of unusual bleeding in patients with bleeding disorders. In individuals with bipolar disorder, it may trigger mood side effects or periods of mania [13*] . To learn more about more specific contraindications, consult with your healthcare provider before starting escitalopram.

Contraindications

The key contraindications to taking Lexapro are the following: 

  • The Use of Monoamine Oxidase Inhibitors (MAOIs):  The use of escitalopram with MAOIs, or within 14 days after stopping them, is contraindicated because it can lead to serotonin syndrome. As serotonin is not reabsorbed and accumulates in the synaptic cleft in our brain, it may cause symptoms ranging from shivering and diarrhea to more serious ones such as muscle rigidity, fever, and seizures. 
  • The Use of Pimozide: Using pimozide along with Lexapro could increase the risk of irregular heart rhythm (arrhythmia) and palpitations. Patients with prior cardiac issues should be cautioned further. Remember to inform your healthcare provider about any medications you are taking before starting Lexapro.
  • Liver or Renal Problems: Since escitalopram breaks down in the liver, patients with kidney or liver impairment may require dose adjustment and continuous monitoring to prevent the medication’s buildup in the body.
  • Hypersensitivity to Escitalopram: Individuals sensitive to escitalopram or other Lexapro ingredients should be cautious before taking this medication and inform a medical provider in advance.
See a licensed medical provider online to receive a personalized treatment plan for depression or anxiety.

Factors That Affect the Duration and Intensity of Side Effects

The duration and severity of Lexapro side effects vary significantly from one individual to another. Knowing the factors can help adjust your expectations and provide you with an insight into the occurrence of side effects and how to deal with them. Some factors include: 

  • Age: Younger adults may experience specific bad side effects, like suicidal thoughts, more intensely due to higher serotonin sensitivity. However, side effects like hyponatremia or dizziness may last longer in older adults due to slower medication clearance.
  • Dosage: A higher dose may be linked with a higher risk of side effects and withdrawal symptoms. It should be kept in mind that the dosage is based on each individual’s history. 
  • Abrupt Discontinuation: Discontinuing the medicine suddenly without slowly tapering off the dose increases the likelihood as well as the severity of withdrawal symptoms.
  • Prolonged Use: Individuals taking escitalopram for a prolonged period may be more likely to experience withdrawal symptoms.

What to Expect After Stopping Lexapro?

Lexapro is not advised to be stopped abruptly as this may cause withdrawal symptoms, such as:

  • Brain zaps, dizziness, and nausea.
  • Flu-like symptoms, such as fatigue, muscle pain, chills, and headaches.
  • Mood fluctuations like irritation, anxiety attacks, sadness, mood swings, and increased depression.
  • Insomnia, inability to get deep sleep, and vivid dreams.
  • Sensory disturbances, such as tingling sensations in feet, hands, or face.
  • Random episodes of night flashes or sweating.
  • Difficulty concentrating and “brain fog”.

Symptoms may be short-term or long-term depending on the individual, dose, and duration of treatment. Short-term symptoms tend to subside within 1-2 weeks after discontinuation while long-term symptoms may persist for several weeks.

Is Taking Lexapro Worth It?

Whether Lexapro is worth it depends on an individual’s needs, health history, and the body’s response to the medication. Like any medication, Lexapro can have both benefits and potential side effects. Also, its effectiveness may vary from one individual to another.

Potential benefits

Potential drawbacks

Shown effectiveness for depression and anxiety.

Potential side effects, including stomach issues, weight changes, drowsiness, and sexual dysfunction.

Better tolerance compared to some other antidepressants. 

Risk of discontinuation syndrome [14*] .

Fewer side effects as compared to older antidepressants as well as safer long-term use.

After starting the treatment, some people may face an initial worsening of symptoms of depression and anxiety.

Improved mood as well as better sleep and concentration.

Effectiveness may vary from one person to another.

Lexapro can be helpful for many struggling with anxiety or depression; often, the potential for symptom relief outweighs manageable side effects. Also, rather than being used alone, antidepressants like Lexapro are usually a part of a comprehensive treatment plan, including lifestyle adjustments, therapy, and self-care to increase the effectiveness of treatment [15*] . If you have any questions or concerns regarding the use of Lexapro and its efficacy for you, discuss it with your healthcare provider.

When to Contact Healthcare Provider About Side Effects

If you notice any irregular changes in your health status, or the side effects become severe and don’t resolve gradually, it is important to inform your healthcare practitioner. Reach out to your provider in the following cases:

  • Severe side effects, such as cardiac issues, dizziness, confusion, tremors, and muscle rigidity.
  • Increased initial worsening symptoms of depression and anxiety; agitation, extreme mood swings, and suicidal thoughts.
  • Symptoms of bipolar disorder, such as mania or hypomania, more energy than usual, impulsive behaviors, racing thoughts, and reduced need for sleep.
  • Rash, itching, seizures, swelling, or difficulty breathing may be symptoms of an unusual or allergic reaction to Lexapro and require medical attention.
  • Severe sexual dysfunction.
  • Severe withdrawal symptoms; it is important to contact your healthcare provider so they can tell you how to taper off the medication.

Preventing Side Effects

While it may not always be possible to completely avoid side effects, with careful strategies, the likelihood of side effects can be reduced. Some of the ways are the following:

  • Follow the prescribed dose; typically, your medical provider will start by prescribing the lowest effective dose and may increase it gradually when needed, according to your response to the medication.
  • Take Lexapro at the same time every day: it helps maintain the levels of the medication in your body consistent, minimizing side effects.
  • Communicate with your healthcare practitioner if you experience side effects; some of them, such as sleep disturbance, can be managed by adjusting the time you take the medication.
  • Avoid discontinuing the medicine abruptly to lower the risk of withdrawal symptoms.
  • Taking Lexapro with food may help reduce gastrointestinal side effects.
  • Supplement Lexapro with lifestyle changes, such as proper hydration, a balanced diet, as well as regular exercise.
  • Avoid alcohol to prevent interactions.
  • Inform your healthcare provider regarding any other medications and over-the-counter supplements.

Conclusion

Knowing the risks and potential side effects of Lexapro will make you more aware of what to expect and how to better handle the situation. If you’re experiencing discomfort or have concerns about taking Lexapro, discuss them with your healthcare provider.

If you are seeking online treatment for depression or anxiety, schedule a video appointment with our licensed healthcare providers at MEDvidi. They will evaluate your symptoms and provide you with an individualized treatment plan, including an online prescription if deemed clinically appropriate.

"It's best to go into the conversation with your healthcare provider with an open mind. Remember that your healthcare provider has not only years of education but likely years of experience as well. If you're struggling with anxiety or other Mental Health issues, it may be time to reach out and start the conversation today."
Dr. Michael Chichak, MD
Medical Director at MEDvidi

FAQs

When taking Lexapro, don’t drink alcohol because it may exacerbate the sedative effects and diminish judgment ability. Avoid taking Lexapro with MAOIs, St. John’s Wort, or other serotonergic medications because this increases the chances of serotonin syndrome. Do not stop the medication abruptly without first speaking to your doctor. Also, avoid activities that demand concentration, including driving, when you feel drowsy. Remember to discuss this in more detail with your medical provider.

Lexapro (escitalopram) may not be suitable for individuals with severe liver or kidney impairments, hypersensitivity to the medication, epilepsy, a history of QT interval prolongation, and more. For pregnant or breastfeeding women, it should be prescribed with caution and under certain conditions. Remember to discuss your health history with a healthcare provider to find the most suitable medication for depression or anxiety.

Common side effects of escitalopram may last approximately two to four weeks during which the body adjusts to the medication. Severe and persistent side effects require medical attention.
The most appropriate time for you to take Lexapro depends on the side effects you may be experiencing. If you experience restlessness or insomnia because of Lexapro, it’s best to take it in the morning. If it causes drowsiness, it’s recommended to take it during bedtime. As consistency is key, stick to the same time daily for optimum results.
Some may experience worsening symptoms during the adjustment period, which may last for a couple of weeks. However, this might not be the case with everyone. If the symptoms are severe or persist, seek medical attention for further advice.
Many side effects, including nausea or fatigue, improve within weeks as your body adjusts to the medication. Some, like sexual dysfunction, may persist. It is important to communicate with your doctor to address any side effects that may linger, and determine the best plan for managing them.

Typically, it takes two to four weeks to adjust to Lexapro, during which time initial side effects tend to resolve. Complete therapeutic benefits can take four to six weeks to develop. Remember to follow-up with your healthcare provider to monitor your health dynamics and adjust your treatment plan timely if needed.

Sources

hide
15 sources
  1. Bræstrup C, Sanchez C. Escitalopram: a unique mechanism of action. Int J Psychiatry Clin Pract. 2004;8 Suppl 1:11-3. doi: 10.1080/13651500410005496. PMID: 24930683.
    Source link
  2. World Health Organization. Depressive disorder (depression). World Health Organization. Published March 31, 2023.
    Source link
  3. Petimar J, Young JG, Yu H, Rifas-Shiman SL, Daley MF, Heerman WJ, Janicke DM, Jones WS, Lewis KH, Lin PD, Prentice C, Merriman JW, Toh S, Block JP. Medication-Induced Weight Change Across Common Antidepressant Treatments : A Target Trial Emulation Study. Ann Intern Med. 2024 Aug;177(8):993-1003. doi: 10.7326/M23-2742. Epub 2024 Jul 2. PMID: 38950403; PMCID: PMC11819980.
    Source link
  4. Ah-Kee EY, Egong E, Shafi A, Lim LT, Yim JL. A review of drug-induced acute angle closure glaucoma for non-ophthalmologists. Qatar Med J. 2015 May 10;2015(1):6. doi: 10.5339/qmj.2015.6. PMID: 26535174; PMCID: PMC4614311.
    Source link
  5. Badar A. Serotonin syndrome: An often-neglected medical emergency. J Family Community Med. 2024 Jan-Mar;31(1):1-8. doi: 10.4103/jfcm.jfcm_236_23. Epub 2024 Jan 8. PMID: 38406216; PMCID: PMC10883429.
    Source link
  6. AlJhani SA. Escitalopram-induced epistaxis: A case report. J Taibah Univ Med Sci. 2021 Jul 8;16(6):938-942. doi: 10.1016/j.jtumed.2021.06.004. PMID: 34899137; PMCID: PMC8626811.
    Source link
  7. Lenze EJ, Rollman BL, Shear MK, Dew MA, Pollock BG, Ciliberti C, Costantino M, Snyder S, Shi P, Spitznagel E, Andreescu C, Butters MA, Reynolds CF 3rd. Escitalopram for older adults with generalized anxiety disorder: a randomized controlled trial. JAMA. 2009 Jan 21;301(3):295-303. doi: 10.1001/jama.2008.977. PMID: 19155456; PMCID: PMC2840403.
    Source link
  8. Khan F, Bernadt M. Intense suicidal thoughts and self-harm following escitalopram treatment. Indian J Psychol Med. 2011 Jan;33(1):74-6. doi: 10.4103/0253-7176.85400. PMID: 22021958; PMCID: PMC3195160.
    Source link
  9. Escitalopram (Lexapro) Use During Pregnancy. Drugs.com.
    Source link
  10. Bellantuono C, Bozzi F, Orsolini L, Catena-Dell'Osso M. The safety of escitalopram during pregnancy and breastfeeding: a comprehensive review. Hum Psychopharmacol. 2012 Nov;27(6):534-9. doi: 10.1002/hup.2265. Epub 2012 Oct 9. PMID: 23044635.
    Source link
  11. HIGHLIGHTS of PRESCRIBING INFORMATION. LEXAPRO.
    Source link
  12. Thase ME, Larsen KG, Reines E, Kennedy SH. The cardiovascular safety profile of escitalopram. Eur Neuropsychopharmacol. 2013 Nov;23(11):1391-400. doi: 10.1016/j.euroneuro.2013.05.011. Epub 2013 Aug 6. PMID: 23928296.
    Source link
  13. Parker S, Nagarsekar BB. Escitalopram induced mania. Indian J Psychiatry. 2007 Apr;49(2):121-2. doi: 10.4103/0019-5545.33260. PMID: 20711395; PMCID: PMC2917077.
    Source link
  14. Yasui-Furukori N, Hashimoto K, Tsuchimine S, Tomita T, Sugawara N, Ishioka M, Nakamura K. Characteristics of Escitalopram Discontinuation Syndrome: A Preliminary Study. Clin Neuropharmacol. 2016 May-Jun;39(3):125-7. doi: 10.1097/WNF.0000000000000139. PMID: 27171568.
    Source link
  15. Pampallona S, Bollini P, Tibaldi G, Kupelnick B, Munizza C. Combined Pharmacotherapy and Psychological Treatment for Depression. Archives of General Psychiatry. 2004;61(7):714.
    Source link
Show more
Wafaa Amjad Dar
Written by:
Wafaa Amjad Dar
Pharm-D
Dr. Michael Chichak
Medical Reviewer:
Dr. Michael Chichak
MD
Share

Content

Recommended Articles

Join our newsletter

Sign up to receive mental health news and tips delivered right in your inbox every month.

Take the first step today:

book an appointment to get your symptoms assessed and obtain a prescription online.

Evidence Based

This article is based on scientific evidence, written by experts and fact checked by experts.

Our team of experts strive to be objective, unbiased, honest and to present both sides of the argument.

This article contains scientific references. The numbers
in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers.