Escitalopram (Lexapro): Uses, Dosage, Side Effects, and What to Expect

Escitalopram (brand name: Lexapro) is a selective serotonin reuptake inhibitor (ssri). Escitalopram is the S-enantiomer of citalopram and is considered the most selective SSRI available. It blocks serotonin reuptake with minimal effects on other neurotransmitter systems, which contributes to its favorable side effect profile. Its high selectivity means fewer off-target effects compared to older SSRIs.

• Major Depressive Disorder (MDD)
• Generalized Anxiety Disorder (GAD)

Common off-label uses:

• Social Anxiety Disorder
• Panic Disorder
• Obsessive-Compulsive Disorder
• PTSD
• Premenstrual Dysphoric Disorder

Adults typically start at 10 mg once daily. May increase to 20 mg/day after at least one week if needed. Older adults and those with hepatic impairment should start at 5 mg. Most patients respond at 10 mg. Taking it in the morning or evening is equally effective.

Some improvement in anxiety may occur within 1-2 weeks. Full antidepressant response typically takes 4-6 weeks.

• Nausea
• Headache
• Insomnia or somnolence
• Sexual dysfunction
• Increased sweating
• Fatigue
• Dry mouth

• QT prolongation at doses above 20 mg (avoid exceeding 20 mg/day)
• Serotonin syndrome
• Suicidal ideation in young adults (FDA black box warning)
• Hyponatremia
• Abnormal bleeding

Contraindicated with MAOIs and pimozide. Doses above 20 mg are contraindicated due to QT prolongation risk. Use caution with other QT-prolonging medications. Escitalopram has fewer CYP450-mediated drug interactions than most other SSRIs, making it a good choice for patients on multiple medications.

FDA Pregnancy Category C. Similar considerations as other SSRIs. Discuss risk-benefit with prescriber.

Taper gradually. Despite being an SSRI, discontinuation symptoms are generally milder than paroxetine or venlafaxine but more notable than fluoxetine.