Lexapro (Escitalopram): What You Should Know

Lexapro is an SSRI used to treat depression, anxiety, and some other conditions

What Is Lexapro?

Lexapro is the trademark name for the generic drug escitalopram, an antidepressant medication. Like Zoloft (sertraline), it is a selective serotonin reuptake inhibitor (SSRI) that was introduced in the late 1980s. Available in pill or liquid form, it's prescribed to treat a variety of mental health conditions, such as depression and anxiety.

SSRIs like Lexapro are generally effective and have fewer side effects than older antidepressants, such as monoamine oxidase inhibitors (MAOIs). They also lack the addictive potential of Xanax (alprozolam) and other benzodiazepines.

In the UK, escitalopram is sold under the name brand name Cipralex.

Uses of Lexapro

Verywell / JR Bee

Escitalopram, the generic form of Lexapro, is primarily used to treat depression and generalized anxiety disorder (GAD). Initially, it was used only to treat depression, but research has shown that it is effective for treating both mood disorders and anxiety disorders.

A doctor may prescribe Lexapro for other uses if they believe it might be of benefit. For example, they might prescribe Lexapro for conditions such as obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), social anxiety disorder, and even migraines.

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.

How Lexapro Works

Scientists aren't sure exactly how Lexapro works. One theory is that Lexapro helps balance serotonin levels in the brain, which can reduce anxiety and enhance mood. Serotonin is a neurotransmitter involved in mood, sleep, and other functions.

Before Taking Lexapro

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

Your primary care physician can write a prescription for Lexapro. But a mental health professional can prescribe medications and handle other your treatment needs, such as by combining medication with psychotherapy.

Mental health professionals who can prescribe medications include psychiatrists, mental health nurse practitioners, and psychiatric pharmacists.

Prior to starting Lexapro for anxiety or depression, tell your doctor if you are allergic or hypersensitive to escitalopram or if you are pregnant or breastfeeding. Also alert your doctor if you have a history of any of these medical conditions, which may be exacerbated by Lexapro:

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

Precautions and Contradictions for Lexapro

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

Who Should Not Take Lexapro

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

  • People with escitalopram allergies:You should not take Lexapro if you're hypersensitive to escitalopram oxalate. This means that you have a known allergy to the medication and experience symptoms of allergic reaction when taking it, such as difficulty breathing or swelling of the face, mouth, or tongue.
  • Children: The safety and effectiveness of Lexapro for children under 12 years of age have not been well-established. Some smaller studies have found that this drug may be helpful for young children with anxiety disorders, and with minimal side effects, but more research is needed to know for sure.
  • 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. The FDA also reports that SSRIs taken after the 20th week of pregnancy have been found to increase the risk of persistent pulmonary hypertension in infants by six times. Your doctor should discuss this with you; if not, be sure to ask about potential risks.
  • Older adults: Side effects of this medication can be more severe in older adults, such as by causing blood sodium levels to lower to dangerous levels. Your doctor should monitor your dose and adjust as necessary to reduce the severity of its effects.

Lexapro Black Box Warning

A boxed warning, also referred to as a black box warning, is the strictest warning for prescription drugs. It is issued by the Food and Drug Administration (FDA) to help draw consumers' attention to serious or life-threatening risks of taking that medication.

Lexapro has a black box warning as taking it 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 when taking Lexapro, particularly if you are a younger person.

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

Lexapro Dosage

Lexapro tablets are available in 5 milligram (mg), 10mg, and 20mg strengths. The 10mg and 20mg 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 10mg, but you may begin at a lower dose that is increased slowly if needed. The manufacturer recommended doses for Lexapro based on condition and age are:

  • Major depressive disorder, ages 12 to 18: 10mg per day; can increase dosage to 20mg per day after three weeks if necessary
  • Major depressive disorder, over age 18: 10mg per day; can increase dosage to 20mg per day after one week if necessary
  • Generalized anxiety disorder, adults only: 10mg per day; can increase dosage to 20mg per day after one week if necessary

If you are experiencing your first episode of depression or anxiety, you may take Lexapro for a defined period—such as between six months and one year. For individuals with 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

Dosage modifications may be required in people with severe kidney impairment. Your doctor can provide guidance in these situations to help you take this drug safely.

How to Take and Store Lexapro

Taking and storing Lexapro properly helps keep the medication both safe and effective. Lexapro is typically taken as a tablet or oral solution once daily, in the morning or evening, with or without food.

If you miss a dose, take your prescribed dose as soon as you remember unless it is very close to your next dose. In that case, take your regular dose instead. Never take two or more doses of Lexapro 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.

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 this drug.

You might notice improvements in your sleep, energy levels, and appetite within the first week or two. But 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. Ask your doctor or pharmacist if you have any questions about this medication.

Storage

Lexapro should be stored at room temperature, away from light and moisture. Do not store it 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.

Lexapro Side Effects

Lexapro is generally well-tolerated and effective. As your body adjusts to taking the medication, the side effects should gradually go away.

If you notice that side effects are getting worse or interfering with your quality of life, talk to your doctor. 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 of Lexapro or escitalopram are:

Severe

Seek immediate help if you experience any of the following unusual but severe 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

Lexapro Warnings and Interactions

Caution should be used when taking Lexapro along with other medications. The following serotonergic medications should not be used at all or only with significant caution and close monitoring when combined with Lexapro due to the increased risk of serotonin syndrome:

Other drugs that can negatively interact with Lexapro include blood thinners; taking NSAIDs, aspirin, and warfarin can increase the risk of bleeding in people taking Lexapro. While rare, there have been reports of people developing a life-threatening reaction after combining escitalopram with linezolid, a drug used to treat infections like pneumonia.

To help avoid any possible drug interactions, let your doctor know about any other prescription and over-the-counter medications you are currently taking. Avoid drinking alcohol when taking Lexapro as well since it can reduce the effectiveness of the medication and also may increase its toxicity.

Discontinuing Lexapro Use

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 to minimize any withdrawal effects.

If you stop taking escitalopram suddenly, you may experience withdrawal symptoms, including:

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

If you are discontinuing Lexapro to try another SSRI, it is recommended that your dosage be reduced over a 4-week period when making the switch.

Frequently Asked Questions

  • When is the best time to take Lexapro for anxiety?

    The answer to this question depends, in part, on any side effects that you experience. If the medication makes you drowsy, for instance, you would be better off taking it at night. Conversely, if it makes you feel more alert, taking it in the morning can help you avoid trouble sleeping. Talk to your doctor to determine the best time of day to take Lexapro for you.

  • How does Lexapro make you feel the first week?

    You probably won't notice any real improvement in your depression or anxiety during the first week of taking Lexapro. However, you may experience some side effects, such as headaches, nausea, diarrhea, dry mouth, nervousness, restlessness, fatigue, insomnia, and increased sweating. These side effects should go away within a week or two. If they don't, talk to your doctor to determine whether this medication is right for you or if the dosage needs to be adjusted.

  • How long does it take Lexapro to work?

    While you may notice some improvements in the first couple of weeks—such as sleeping better, having more energy, or an increase in your appetite—it can take up to eight weeks to get the full benefits of this medication. So, you might not notice major improvements in your depressive or anxious feelings for a couple of months.

  • What should you expect when increasing Lexapro dosage?

    If your doctor increases your Lexapro dosage, you may notice side effects similar to when first starting this drug for a day or two. Your doctor will also likely want to monitor you closely to make sure your condition doesn't worsen or that you don't experience major negative side effects.

  • How do you know if Lexapro is working?

    Lexapro isn't likely to create a monumental change from one day to the next. So, you can tell if it's working by looking back at how you've felt the last couple of days. If it seems like you feel less depressed or anxious than before, the Lexapro is working. Mark on your calendar to check in with yourself once a week and compare how you feel. If you notice no change over time or your condition starts to worsen, contact your doctor immediately to discuss any necessary changes.

  • Why does Lexapro cause weight gain?

    There are many reasons why Lexapro may cause you to gain weight. One is that it impacts your serotonin levels, which affects your appetite. Research further indicates that certain people are at greater risk of gaining weight when taking this drug, including those with a lower body mass index when Lexapro was started, people with a lower education status, and individuals with a family history of obesity.

  • What happens if you overdose on Lexapro?

    One of the most notable effects of overdosing on Lexapro is the development of a heart rhythm issue in which there are extended intervals between contraction and relaxation. In cases such as this, a single dose of activated charcoal may be advised. If you or someone you know has overdosed on Lexapro, get immediate medical attention or call 911.

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, be sure to follow the instructions carefully. If you have additional questions, speak to a healthcare provider.

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Additional Reading

By Arlin Cuncic
Arlin Cuncic, MA, is the author of "Therapy in Focus: What to Expect from CBT for Social Anxiety Disorder" and "7 Weeks to Reduce Anxiety."