Escitalopram: Uses, side effects, warnings, and interactions

Escitalopram is the generic version of Lexapro. It belongs to a class of antidepressants called selective serotonin reuptake inhibitors, or SSRIs. These drugs can help the body balance naturally occurring serotonin levels in the brain.

Doctors prescribe escitalopram to treat clinical depression or general anxiety disorder.

Generic and branded versions of escitalopram are available by prescription. The medical community generally considers escitalopram safe, but there is a risk of side effects, which can range from mild to severe.

Uses

A doctor may prescribe escitalopram for depression or generalized anxiety disorder.
Image credit: Tom Varco, 2006

Doctors typically prescribe escitalopram to treat either depression or generalized anxiety disorder. Some healthcare providers prescribe escitalopram alongside other medications and therapies to treat these conditions.

Researchers have shown that escitalopram is safe and effective for treating depression in adolescents aged 12–17, but not in children younger than 12.

Doctors do not use escitalopram to treat general anxiety disorder in people younger than 18.

Some doctors also prescribe escitalopram, off-label, for conditions such as:

  • panic disorder with or without agoraphobia
  • social anxiety disorder, sometimes called social phobia
  • obsessive-compulsive disorder, or OCD


Forms, how to take them, and dosages

Escitalopram is available as a pill or a liquid. A person can take either form orally, with or without food.

People take escitalopram at the same time each day, either in the morning or at night before bed. Escitalopram can make some people drowsy and others more energized. This effect can help determine when a person should take the drug.

It is important to take escitalopram exactly as directed, without skipping or changing doses.

Initially, a doctor usually prescribes an adult a low dosage for 1 week, then gradually increases the dosage over time if they believe that it is necessary. For adolescents, doctors will wait for 3 weeks before increasing the dosage.

As with other antidepressants, it may take some time before a person feels the effects of escitalopram. A person should continue the treatment, even after they feel better.

It is important not to stop the treatment suddenly, without consulting a doctor. Doing so can cause side effects, such as extreme sleepiness and dizziness. We discuss these effects in depth below.

If a person misses a dose, they can take it as soon as they remember. However, it is not a good idea to double up on doses. If a person realizes that they have missed a dose close to the time of the next dose, they should skip the missed dose and continue as usual.

The Food and Drug Administration (FDA) have approved two dosages of escitalopram:

  • 10 milligrams (mg), the typical starting dosage
  • 20 mg

Escitalopram is also available in pills of 5 mg. A person can also cut a pill in half to form a different dosage, as a doctor advises.

The liquid form of escitalopram comes in a strength of 1 mg per milliliter.


Side effects

Some side effects of escitalopram include yawning, sweating, and dry mouth.

In adults, some common side effects of escitalopram include:

  • yawning
  • sweating
  • dry mouth
  • constipation
  • sleepiness
  • trouble sleeping
  • changes in appetite
  • dizziness
  • anxiousness
  • nausea
  • sexual dysfunction

In adolescents and children, some common side effects of escitalopram include:

Common side effects are often mild, and they typically go away over time as the person gets used to the medication. However, if they persist or get worse, speak to the doctor.

More severe side effects can also occur. A person who experiences any of these should consult their doctor immediately or seek emergency medical assistance.

Some severe side effects include:

  • a severe allergic reaction
  • low sodium in the blood
  • possible slowed growth rate and weight change in children and adolescents
  • changes in vision
  • bleeding more easily than usual
  • manic episodes
  • serotonin syndrome
  • seizures
  • suicidal thoughts or actions

Serotonin syndrome is a reaction that occurs when the central nervous system receives too much stimulation. It is most common when a person takes additional medication that either increases their serotonin levels or decreases their metabolism.

Serotonin syndrome can result in agitation, a racing heartbeat, coordination issues, and low or high blood pressure.


Adverse effects when stopping

There are several potential adverse effects if a person stops taking escitalopram. The risk is greater when a person stops the treatment suddenly.

Some possible adverse effects of stopping escitalopram include:

To help prevent these effects, a doctor will often wean a person off of the treatment slowly.

Warnings

Escitalopram carries a warning label from the FDA indicating that the drug can increase the risk of suicidal thoughts or actions. This reaction is most common in children, teens, and young adults.

However, a doctor may still recommend the use of escitalopram in younger people if there is a need that outweighs the potential risk.


Escitalopram also comes with the following warnings, aside from those dealing with possible side effects:

  • Escitalopram may increase depression symptoms.
  • A person may experience withdrawal symptoms after stopping treatment.
  • It is unclear whether it is safe for pregnant women to use escitalopram. Laboratory studies have shown adverse effects in mice, but there have been no conclusive findings in humans.
  • Abnormal bleeding can occur while taking the drug. Anyone who also takes medication that affects the blood, such as blood thinners, should use caution.
  • People should not drink alcohol while using escitalopram.
  • Escitalopram can interact with treatment for other health conditions, particularly those that alter metabolism or blood flow.

Discuss these warnings with a doctor before starting a course of escitalopram.

Learn more about why doctors do not recommend mixing escitalopram with alcohol here.


Drug interactions

A person should tell their doctor about any other medication they are taking to avoid any negative drug interactions.

Several drugs interact with escitalopram. These interactions can be harmful and cause medications to work less well. A person should tell their doctor about any other medicines, vitamins, and supplements that they take.

Also, a doctor should monitor anyone who is taking escitalopram. The doctor can help identify changes in mood and help ensure that the person does not take any other treatments that may interact with escitalopram.

Some treatments to avoid while taking escitalopram include:

  • blood thinners
  • drugs to treat migraines
  • acid reducers
  • water pills
  • psychiatric drugs, including other antidepressants, unless a doctor prescribes them
  • drugs that also increase levels of serotonin

Cost

The cost of escitalopram depends on the dosage, whether a person has health insurance, and whether a person is taking a generic or branded version.

People without insurance may receive discounted treatment. Most insurance plans cover at least a generic version of escitalopram.


Alternatives

There are several possible alternatives to escitalopram. It is important to note, however, that all antidepressant medications carry similar risks.

Anyone who believes that they would benefit from taking an antidepressant should talk to a doctor or another healthcare provider about the options.

Learn more about antidepressant medications here.


Summary

Escitalopram is an antidepressant drug that is generally safe. Doctors typically use it to treat depression and general anxiety disorders.

Before starting a course of escitalopram, discuss any personal or family history of suicidal thoughts or actions with a doctor.

The doctor should also review all medications, supplements, and vitamins that a person is taking before they prescribe this drug.

If a person experiences any mild side effects, they should let their doctor know. If side effects are persistent or severe, seek immediate medical attention.

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