What is Lexapro?

Escitalopram

Lexapro is an antidepressant medication that works in the brain. It is approved for the treatment of major depressive disorder (MDD) in adults and adolescents aged 12-17. Lexapro is also approved for the treatment of generalized anxiety disorder (GAD) in adults.

Major depression occurs when a person experiences several of the following symptoms concurrently, for at least two weeks: "low" or depressed mood (for example, sad, empty, tearful), decreased interest in most or all activities, changes in appetite (usually decreased), changes in sleep (usually poor sleep), loss of energy, feeling worthless/guilty/hopeless/helpless, psychomotor agitation or retardation (i.e., thoughts/movements speeding up or slowing down), difficulty concentrating, and thoughts of death (suicidal thinking).

GAD occurs when a person experiences excessive anxiety or worry for at least six months along with restlessness, fatigue, difficulty concentrating, irritability, muscle tension or sleep disturbance.

What is the most important information I should know about Lexapro?

After starting Lexapro, symptoms of depression and anxiety gradually decrease over a period of weeks. Sleep and other physical symptoms of depression or anxiety may improve before there is noticeable improvement in other symptoms of depression (such as mood or interest in activities) or anxiety. Once symptoms are under control, MDD and anxiety usually require long-term to help prevent the return of depressive or anxious symptoms. Only your healthcare provider can determine the length of escitalopram treatment that is right for you.

Do not stop taking Lexapro or change your dose without talking to with your healthcare provider first.

Stopping Lexapro abruptly may result in one or more of the following withdrawal symptoms: irritability, nausea, dizziness, vomiting, nightmares, headache and paresthesias (prickling, tingling sensation on the skin).

Depression is also a part of bipolar illness. People with bipolar disorder who take antidepressants may be at risk for "switching" from depression into mania. Symptoms of mania include "high" or irritable mood, very high self esteem, decreased need for sleep, pressure to keep talking, racing thoughts, being easily distracted, frequently involved in activities with a large risk for bad consequences (for example, excessive buying sprees).

Are there specific concerns about Lexapro and pregnancy?

If you are planning on becoming pregnant, notify your healthcare provider so that he/she can best manage your medications. People living with MDD and anxiety who wish to become pregnant face important decisions, each with risks and benefits as it relates to how the illness, medications and the risks to the fetus may interact. This is a complex decision as untreated MDD and anxiety have risks to the fetus as well as the mother. There are many dimensions to these choices, so be sure to confer with your doctor and caregivers.

For mothers who have taken SSRIs during their pregnancy, there appears to be less than a 1% chance of infants developing persistent pulmonary hypertension. This is a potentially fatal condition that is associated with use of the antidepressant in the second half of pregnancy. However, women who discontinued antidepressant therapy were five times more likely to have a depression relapse than those who continued their antidepressant. If you are pregnant, please discuss the risks and benefits of antidepressant use with your healthcare provider.

Regarding breast-feeding, caution is advised since Lexapro does pass into breast milk.

What should I discuss with my healthcare provider before taking Lexapro?

The most bothersome symptoms of your condition

How should I take Lexapro ?

Lexapro is usually taken once per day with or without food.

While the dose usually ranges from 10 mg to 20 mg, your healthcare provider will determine the dose that is right for you based upon your response.

What happens if I miss a dose of Lexapro?

If you miss a dose of Lexapro, take it as soon as you remember it, if it is not too close to when your next dose is due-discuss this with your healthcare provider. Do not double your next dose or take more what is prescribed.

What should I avoid while taking Lexapro?

Avoid drinking alcohol or using illegal drugs while you are taking antidepressant medications because the beneficial effects of the medication may be decreased and adverse effects may be increased (for example, sedation).

What happens if I overdose with Lexapro?

If an overdose occurs, whether intentional or accidental, immediate medical attention may be necessary. Call your doctor or emergency medical service (911). You may also contact the poison control center (1-800-222-1222). Symptoms of overdose include drowsiness, nausea, vomiting, abdominal pain, tremor, slow heart rate, and seizures. A specific antidote for Lexapro does not exist.

What are the possible side effects of Lexapro?

Common

Side effects with Lexapro are generally mild and are similar to those reported with other SSRI antidepressants. The most commonly reported side effects are headache, nausea, diarrhea, insomnia, sleepiness, dry mouth, increased sweating, fatigue, yawning, and flatulence. If you experience side effects after starting Lexapro they will often improve over the first week or two as you continue to take the medication. Sexual side effects, such as problems with orgasm or ejaculatory delay, may also occur, and often do not diminish over time.

Rare

Other side effects which occur infrequently with Lexapro include mania in those with bipolar disorder, suicidal thoughts or behavior (see boxed warning), seizure, increase or decreased heart rate, low blood pressure, irregular menstrual cycle, increased frequency of urination, changes in taste, increased bleeding (for example, gums may bleed more easily), low sodium blood levels (signs of low sodium levels may include headache, weakness, difficulty concentrating and remembering), and teeth grinding.

Are there any risks for taking Lexapro for long periods of time?

To date, there are no known problems associated with long term use of Lexapro. It is a safe and effective medication when used as directed.

What other drugs may interact with Lexapro?

Lexapro should not be taken with or within two weeks of taking monoamine oxidase inhibitors (MAOIs). These include Nardil, Parnate, Marplan and Emsam.

Although rare, there is an increased risk of serotonin syndrome when Lexapro is used with other medications that increase serotonin activity, such as other antidepressants, migraine medications called "triptans" (e.g., Imitrex, some pain medications (e.g., Ultram, Demerol, and the antibiotic Zyvox.

Lexapro is not recommended to be given with Orap due to possible increase in QTc which can result in serious irregular heart rhythm.

Lexapro may increase the concentration of clozapine. Monitoring carefully for side effects is recommended. Lexapro may increase the concentration of tricyclic antidepressants, such as desipramine, and beta blockers, such as metoprolol. Monitoring carefully for side effects is recommended.

Tagamet may increase the concentration of Lexapro. Monitoring carefully for side effects is recommended.

Non-steroidal anti-inflammatory agents, such as ibuprofen (e.g., Motrin), aspirin, or the "blood thinner" Coumadin) may increase the risk of bleeding when used in combination with Lexapro.

How long does it take for Lexapro to work?

While depressed mood and lack of interest in activities may need up to 4-6 weeks to improve, disturbances in sleep, energy, or appetite may show some improvement within the first 1-2 weeks. Improvement in these physical symptoms can be an important early signal that the medication is working.

Like other medications used for anxiety disorders (e.g., GAD) Lexapro may take several weeks before it is fully effective. It is important to give the medication enough time before judging whether or not it will work for a given person.

Increments for Lexapro

Tablets: 5 mg, 10 mg, 20 mg
Oral Solution: 1 mg per mL

Updated by
L. M. Mican, Pharm.D., BCPP
(March 2011)

FDA Alerts

Suicidal Thoughts or Actions in Children and Adults

Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients with major depressive disorder (MDD), both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressant medications. This risk may persist until significant remission occurs.

In short-term studies, antidepressants increased the risk of suicidality in children, adolescents and young adults when compared to placebo. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24. Adults ages 65 and older taking antidepressants have a decreased risk of suicidality.

Patients, their families and caregivers should be alert to the emergence of anxiety, restlessness, irritability, aggressiveness and insomnia. If these symptoms emerge, they should be reported to the patients prescriber or healthcare professional. All patients being treated with antidepressants for any indication should watch for and notify their healthcare provider for worsening symptoms, suicidality and unusual changes in behavior, especially during the first few months of treatment.