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Reviewed by Katelyn Hagerty FNP
Written by Our Editorial Team
Major depression is a common form of mental illness that affects millions of people of all ages and backgrounds every year. In fact, an estimated 19.4 million adults in the United States had one or more major depressive episodes in 2019.
Despite being relatively common, depression and other mental health issues can often carry a stigma. It can be hard to ask for help when you’re suffering emotionally, but taking that difficult first step can change everything.
If you’ve been diagnosed with depression, your healthcare provider may suggest escitalopram to reduce the severity of your symptoms and help you make progress towards recovery.
Below, we’ve explained what escitalopram is and how it works. We’ve also discussed the side effects and drug interactions that are associated with escitalopram, as well as some steps that you can take to use this medication safely.
Finally, we’ve listed some other treatment options that you may want to consider if you have a form of depression or anxiety.
Escitalopram is an antidepressant medication. It belongs to a class of medications referred to as selective serotonin reuptake inhibitors, or SSRIs.
Today, escitalopram is available as Lexapro as a generic medication. Escitalopram is one of the most commonly used prescription drugs in the United States.
Escitalopram is a selective serotonin reuptake inhibitor, or SSRI. Like other SSRIs, it works by preventing the reuptake of serotonin -- a naturally-occurring chemical called a neurotransmitter that’s involved in certain functions within your brain and body.
Serotonin is one of several neurotransmitters that plays a key role in regulating your moods and feelings. Experts believe that it helps to regulate feelings of happiness and anxiety. It also helps to stimulate parts of your brain that control sleeping and waking.
In addition to its effects on moods and sleep, serotonin also has numerous other functions, from supporting proper wound healing to controlling your bowel and stomach function.
When serotonin levels are normal, people typically feel mentally healthy. However, research has found that low levels of serotonin are linked with depression, anxiety and other common mental health issues.
By inhibiting the reuptake of serotonin, SSRIs such as escitalopram increase serotonin levels in your brain and body. This group of medications is referred to as “selective” because they work specifically on serotonin, not on other neurotransmitters.
For many people, this increase in serotonin levels can make the symptoms of major depression, generalized anxiety and other mental disorders less severe, allowing them to live a more normal life and work towards recovery.
Escitalopram isn’t the only SSRI that’s used to treat depression and anxiety. Other medications in this class of antidepressants include:
Our full list of antidepressants provides more information about how these medications work as treatments for major depression and other mood disorders.
Escitalopram is approved by the FDA to treat major depressive disorder and generalized anxiety disorder. As a medication for depression, it’s approved for use in adults and adolescents 12 or older.
Both major depressive disorder and generalized anxiety disorder are common mental illnesses that affect millions of people every year.
An estimated 7.8 percent of all US adults experienced at least one major depressive episode in 2019. Depressive episodes are most common in younger adults, such as those aged between 18 and 25.
Anxiety disorders are more common. In fact, according to the Anxiety & Depression Association of America, approximately 40 million adults, or 18.1% of the entire adult population of the United States, are affected by some form of anxiety disorder every year.
Common symptoms of depression include:
Persistent feelings of sadness, emptiness or anxiety
A pessimistic, hopeless outlook on life
A belief that you’re guilty, worthless or that you can’t be helped
Irritability and a shorter-than-normal temper
Reduced interest in your usual hobbies and sources of pleasure
Difficulty focusing on tasks and/or remembering information
Slowed speech and/or physical movement
A reduced ability to make decisions
Aches, pains, digestive issues and other physical symptoms
Changes in your appetite and/or weight
Suicidal thoughts and/or behavior
To be diagnosed with depression, you’ll generally need to have several of these symptoms that persist for a period of two weeks or longer.
Common symptoms of generalized anxiety disorder include:
Feelings of restlessness, being wound up or “on-edge”
Difficulty focusing and a feeling that your mind is blank
Persistent feelings of worry that are difficult to control
Difficulty falling asleep, staying asleep or feeling properly rested
Irritability, fatigue and muscle tension
Other mental health conditions, such as bipolar disorder, may cause symptoms similar to those of depression or anxiety.
If you think you might be affected by depression or generalized anxiety disorder, you should talk to your healthcare provider.
Like other medications, escitalopram may also be prescribed “off-label” by healthcare providers to treat some mental health conditions. Prescribing a drug for off-label use means prescribing it for a purpose other than the ways approved by the drug’s FDA labeling.
Escitalopram may be prescribed off-label to treat the following conditions:
Social anxiety disorder (SAD)
Obsessive-compulsive disorder (OCD)
Posttraumatic stress disorder (PTSD)
Premenstrual dysphoric disorder (PMDD)
Vasomotor symptoms during menopause
If you’re prescribed escitalopram for use off-label, your healthcare provider will explain how to use your medication safely.
Escitalopram is available as a tablet and as a liquid solution. Most people who are prescribed escitalopram take their medication one time per day, either with or without food.
Your healthcare provider will inform you about how to use escitalopram. Make sure to follow the prescription instructions provided with your medication and ask your healthcare provider if there are any aspects of using your medication that you’d like to know more about.
If you’re prescribed escitalopram for use once per day, try to take your medication at around the same time every day. This helps to maintain a steady level of the medication in your body and may make it easier to remember your medication.
If you forget to take your dose of escitalopram, take the missed dose as soon as possible. If it’s close to the time for your next dose, skip the missed dose and use escitalopram as normal. Do not take two doses of escitalopram at once to make up for a missed dose.
Store escitalopram inside its original container in a safe, room temperature location out of reach of children.
It may take four weeks or longer before you notice the effects of escitalopram. You may notice your appetite, sleep and ability to concentrate improving before you experience any changes in your moods and feelings.
Make sure to continue using escitalopram even if you don’t notice any immediate improvements in your depression or anxiety symptoms. Talk to your healthcare provider if you don’t experience any improvements after taking escitalopram for several weeks.
If you want to stop using escitalopram, it’s important to talk with your healthcare provider before adjusting your dosage or stopping use of your medication.
Stopping escitalopram or other SSRIs abruptly may cause withdrawal symptoms referred to as antidepressant discontinuation syndrome. These withdrawal symptoms may include:
Changes in your mood
Irritability and/or agitation
Tingling or numbness in your hands or feet
Difficulty falling or staying asleep
Sudden discontinuation of treatment with escitalopram may also cause your depression and/or anxiety symptoms to return. Escitalopram can stay in your system for several days, meaning it may take a while for you to notice withdrawal symptoms or a relapse of depression.
To reduce your risk of experiencing withdrawal symptoms, your healthcare provider may advise you to gradually reduce your dosage as you stop using this medication.
For most adults and adolescents with depression or anxiety, escitalopram is a safe and effective medication that causes only minor side effects.
In fact, SSRIs such as escitalopram are commonly used as first-line medications for depression specifically because they’re less likely to produce side effects, interactions and other issues than older medications, such as tricyclic antidepressants or monoamine oxidase inhibitors (MAOIs).
Like all medications, escitalopram can cause adverse effects. These can range from mild issues that go away over time to more serious side effects that may require medical attention.
Many people prescribed escitalopram experience mild side effects during treatment. These side effects are often transient, meaning they may gradually pass with time. Common side effects of escitalopram include:
Difficulty falling asleep or staying asleep
Ejaculation disorder (difficulty ejaculating or ejaculatory delay)
Decreased sex drive
Of these side effects, nausea is the most common, with 15 percent of people given escitalopram in trials for depression reporting it as a side effect. Insomnia and ejaculation difficulties are also common side effects, with both reported by nine percent of escitalopram users in clinical trials.
Less common side effects of escitalopram reported in clinical trials include:
Loss of appetite
Rhinitis and sinusitis (nose and/or sinus inflammation)
Anorgasmia (difficulty reaching orgasm during sex or masturbation)
Like more common side effects of escitalopram, these issues may fade over time as your body gets used to the effects of the medication.
Although uncommon, escitalopram may cause serious side effects. These include angle closure glaucoma (a serious eye condition that can involve eye pain, swelling of the eyes, blurred vision, redness and other changes in vision), teeth grinding and seizures.
In addition to these side effects, escitalopram may cause more serious complications and health issues in people with existing medical conditions or when used with other medications. You can find more information about these interactions and risks in the section below.
Perhaps the most well-publicized risk of antidepressant medications, including escitalopram, is a possible increased risk of suicidal thoughts and behavior.
It’s counterintuitive that a medication designed to treat suicidal thoughts could potentially make them worse. However, according to the FDA, this risk is only increased in children, adolescents and young adults aged 24 or younger prescribed antidepressants.
If you notice any unusual changes in your behavior after starting treatmen with escitalopram or any other antidepressant, such as an increase in suicidal thoughts, it’s important to seek expert help.
You can do this by contacting your mental health provider. In an urgent situation, call 911 or the National Suicide Prevention Lifeline (1-800-273-8255), or use the resources in our list of mental health crisis hotlines to seek immediate care.
Most people prescribed escitalopram are able to use their medication without major issues. Like with other medications, there are certain safety issues that you should be aware of before taking escitalopram.
Take the following precautions to keep yourself and others safe while using escitalopram:
Inform your healthcare provider about preexisting conditions. Make sure to let your healthcare provider know if you have heart disease, high blood pressure, have a history of seizures, previous cardiovascular events or liver or kidney issues. Based on your health history, your healthcare provider may give you special instructions for using escitalopram safely.
Understand that Lexapro may worsen bipolar disorder. Antidepressants may cause an elevated risk of mixed/manic episodes in people with bipolar disorder. Escitalopram is not approved by the FDA as a treatment for bipolar disorder. Your healthcare provider may ask you to complete a screening for bipolar disorder if you show certain depressive symptoms or have family risk factors.
Seek immediate help for allergic reactions. Although uncommon, some ingredients in Lexapro and escitalopram can cause allergic reactions. Signs of an allergic reaction include difficulty breathing, rash, blisters and swelling of the face, tongue, eyes and/or mouth. Seek emergency medical help if you or another person show signs of an allergic reaction after taking escitalopram or any other antidepressant.
Pay attention to weight changes. Escitalopram can affect your appetite, causing you to eat more or less than normal. The FDA recommends that children and adolescents have their height and weight monitored while using escitalopram.
Be aware that escitalopram may affect bleeding. Escitalopram and other SSRIs may increase your risk of bleeding or bruising. Your risk may be especially high if you use the blood thinner warfarin, nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin.
Tell your healthcare provider about escitalopram before surgery. Escitalopram may affect bleeding, bruising and general recovery, making it important to inform your doctor or dentist about this medication before any surgical procedure.
Be careful operating a car after starting treatment with escitalopram. Escitalopram and other antidepressants can cause drowsiness. Avoid driving a car or operating any heavy machinery until you’re familiar with the effects of escitalopram on your alertness.
Avoid consuming alcohol with escitalopram. In general, alcohol and antidepressants don’t go well together. Drinking alcohol while using escitalopram may increase your risk of experiencing side effects such as drowsiness and loss of coordination.
Like with other medications, it’s always best to ask your healthcare provider for help if you have any questions or concerns while using escitalopram or other medications to treat depression or anxiety.
Escitalopram can interact with other medications and substances, including prescription drugs, medications sold over the counter and certain herbal or dietary supplements.
When escitalopram is used with other medications that increase serotonin levels, it may cause serotonin syndrome -- a potentially life-threatening syndrome caused by excessively high levels of the chemical serotonin in your body.
Symptoms of serotonin syndrome include high blood pressure, pupil dilation, shivering, tremors, sweating, hyperthermia (high temperature), tachycardia (fast heart rate), overactive reflexes and muscle stiffness.
If you think you may have serotonin syndrome, it’s important to seek assistance from a medical professional as soon as possible.
Serotonin syndrome can occur when escitalopram is taken with other antidepressants, such as SSRIs, SNRIs, tricyclic antidepressants and MAOIs, as well as triptans, lithium, amphetamines, buspirone, fentanyl and other medications.
Using escitalopram with the herbal supplement St. John’s wort may also contribute to elevated serotonin levels and serotonin syndrome.
To reduce your risk of serotonin syndrome, it’s important to tell your healthcare provider about all prescription or over-the-counter medications you currently use or have recently used before starting treatment with escitalopram.
Some other antidepressants, such as MAOIs, can remain in your body for several weeks after you stop treatment. Make sure to inform your healthcare provider if you have taken any MAOI medications or other antidepressants within the last 14 days.
If you have recently stopped taking Lexapro, do not use any MAOIs until at least 14 days have passed.
Escitalopram may also interact with other medications, including drugs that affect hemostasis, medications that act on the central nervous system and medications that inhibit CYP3A4 and CYP2C19 enzymes.
Escitalopram is one of several common medications available to treat depression and anxiety disorders. It’s often used in combination with psychotherapy to target mental health disorders from multiple angles and achieve better results.
If you think you may have depression or anxiety, you can connect with a licensed psychiatrist online to take part in an evaluation via our telehealth service. If appropriate, you may receive escitalopram or similar medication, as well as private, ongoing follow-up care.
You can also connect with a therapy provider online using our counseling service and access one-on-one, personalized therapy as needed.
Finally, if you feel more comfortable learning at your own pace, you can learn more about the best ways to deal with depression, anxiety and other common mental health issues using our free online mental health resources and content.
Kate Hagerty is a board-certified Family Nurse Practitioner with over a decade of healthcare experience. She has worked in critical care, community health, and as a retail health provider.