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Using the Antidepressant Escitalopram (Lexapro, Cipralex)

Escitalopram is the generic name of an antidepressant medication commonly marketed under brand names like Lexapro and Cipralex. This prescription drug is a selective serotonin reuptake inhibitor (SSRI), which means that it affects how much of the neurotransmitter serotonin is available in the brain to help neurons communicate. Escitalopram can also be prescribed to treat generalized anxiety disorder (GAD).

Escitalopram Approval and Manufacture in the US

Lexapro, one of the first brand name versions of escitalopram, was approved for use by the Food and Drug Administration (FDA) in 2002. It was manufactured by Forest Laboratories. Generic escitalopram was approved for prescription use in 2012 and is made by Teva Pharmaceuticals.

Further Reading

Average Dosage of Escitalopram

Doctors typically start with the lowest possible dose of escitalopram and work their way up as needed to effectively help the patient. As prescribed, a person will typically take a dose of escitalopram once per day; however, it could take between one and four weeks for the dose to begin to take effect, so it is important to stay with the regular dose during that time.

In tablet form, escitalopram doses can come in 5 mg, 10 mg, or 20 mg. The medication can also be prescribed as a liquid, with about 1 mg of escitalopram per mL. Most people begin their dose at 10 mg per day, although if there is no effect after a week, the overseeing physician or therapist can increase the dose to 20 mg. Maximum improvement is often seen within 4-6 weeks.

It is important not to self-administer or quit escitalopram without medical supervision. Consult a doctor before changing the prescribed dose. Serious side effects can occur with too much, or sudden cessation of, escitalopram.

How Escitalopram Helps Mood Disorders

Escitalopram increases the release and slows the reuptake of the neurotransmitter serotonin. This important chemical is related to mood regulation. When a person’s brain does not produce enough serotonin, or it is absorbed too quickly by neurons, the individual can experience depression, anxiety, or both.

Because SSRIs work on serotonin, and do not affect other neurotransmitters, they have fewer side effects and are tolerated better by more people in the general population. This makes them a very effective tool in the treatment of mood disorders, especially depression.

Side Effects of Escitalopram

General side effects associated with escitalopram include:

  • Gastrointestinal changes, including nausea, diarrhea, vomiting, and constipation
  • Stomach pain
  • Heartburn
  • Changes in sex drive or function
  • Sleepiness or drowsiness
  • Unusual sweating
  • Dizziness
  • Dry mouth
  • Increased appetite
  • Sneezing, runny nose, or cold or flu-like symptoms

One of the most serious side effects of escitalopram, like with other SSRI antidepressants, is the increased risk of suicidal thinking or actions. Although antidepressants should improve mood and reduce thoughts of death or worthlessness, the medications can have the opposite effect in some people, particularly adolescents or young adults. People who are younger than 24 years old are especially at risk of this side effect. It is important for people taking SSRIs like escitalopram to inform their therapist or physician immediately if they begin to have thoughts about suicide.

There are some serious side effects that can occur, and a person taking escitalopram should inform their doctor immediately if they begin experiencing them. These include:

  • Unusual excitement
  • Irritability for no reason
  • Extreme restlessness or agitation
  • Panic attacks
  • Aggressive behavior
  • Worsening depression or anxiety
  • Confusion
  • Fever
  • Rapid heartbeat
  • Serious stiffness in muscles
  • Difficulty sleeping
  • Hallucinations
  • Impulsiveness
  • Mania, characterized by increased activity and chattiness
  • Other changes in behavior or mood

Withdrawal

People who take SSRIs like escitalopram may experience withdrawal symptoms if they stop taking the medication suddenly. This is because the brain begins to rely on the presence of the prescription drug to regulate its chemistry, which can lead to dependence. People who wish to stop taking escitalopram should consult their doctor first, to develop a taper that will successfully detox the body from the substance.

Withdrawal symptoms associated with escitalopram include:

  • Mood swings
  • Irritability
  • Anxiety or agitation
  • Dizziness
  • Numbness or tingling, especially in the extremities
  • Confusion
  • Exhaustion or fatigue
  • Headache
  • Insomnia
  • Trouble falling or staying asleep

Escitalopram Overdose

It is possible to overdose on escitalopram, although if the medication is taken as prescribed, overdose is unlikely. However, when combined with other prescription or recreational drugs, the potential for overdose on escitalopram increases.

An overdose on any drug or medication is very serious, so it is important to call 911 to get the person emergency medical help as soon as possible.

Symptoms of overdose include:

  • Sweating
  • Dizziness
  • Nausea or vomiting
  • Shaking or tremors
  • Sleepiness, drowsiness, or exhaustion
  • Rapid or pounding heartbeat
  • Confusion
  • Forgetfulness
  • Rapid or shallow breathing
  • Seizures
  • Coma

Escitalopram’s Interaction with Other Medical Conditions

People who have heart conditions or who have had a heart attack in the past should speak with their doctor before beginning a prescription for escitalopram. Additionally, people who have experienced seizures, liver or kidney problems or failure, or who have a diagnosed thyroid condition should also speak with their physician before taking this prescription medication. Escitalopram could interfere with these conditions as well as medicines used to treat the conditions.

Escitalopram can increase the intensity of bipolar disorder if this condition has been initially misdiagnosed as major depression. Manic episodes can be longer-lasting and more serious.

SSRIs like escitalopram can cause developmental issues in a fetus or breastfeeding infant. Women who are breastfeeding, pregnant, or who wish to become pregnant should talk to their doctor about this potential risk. In 2014, some medical studies indicated that prenatal exposure to escitalopram may be linked to autism spectrum disorder. The risk was higher among newborns whose mothers took escitalopram earlier in the pregnancy.

People who take antidepressants, including escitalopram, are more likely to experience weight gain related to the medication. While medical researchers do not fully understand this link, the issue could be due to a combination of reduced exercise, increased appetite, and fluid retention.

Escitalopram and Other Medications

It is important not to take multiple antidepressants at the same time. SSRIs like escitalopram interact strongly with MAO inhibitors, an earlier and very potent class of prescription antidepressants. Escitalopram and citalopram, another SSRI medication, are also very similar and should not be taken in combination. Mixing antidepressants can cause several side effects, including serotonin syndrome. Symptoms of serotonin syndrome include hallucinations, agitation, confusion, irritability, tremors, rigid muscles, and seizures.

Other medications that can interact with escitalopram include:

  • Anticoagulants, especially warfarin
  • Antihistamines
  • Aspirin, ibuprofen, naproxen, and other NSAID painkillers
  • Lithium
  • Anti-anxiety medications
  • Anti-seizure medications
  • Prescription medications used to treat other mental illnesses
  • Sedatives and tranquilizers
  • Pills to help sleep
  • Tramadol
  • Herbal or dietary supplements

It is important to moderate drinking, including social drinking, while taking this medication. Escitalopram can increase the effects of alcohol, especially fatigue or sleepiness. This could cause a person to pass out or alter body control and reflexes, making for unsafe walking or driving.

Help for Mental Health and Substance Abuse Problems

People who struggle with mood disorders like depression, anxiety, and bipolar disorder are more likely to develop a substance use disorder, often to self-medicate the symptoms of their mental health condition. Although nonmedical substances like alcohol, marijuana, tobacco, narcotics, or cocaine may alleviate some of the symptoms of depression or anxiety temporarily, these intoxicating substances are more likely to make the mental health problem worse in the long-term.

When a person struggles with both a mental health and a substance abuse problem, treatment for co-occurring disorders is needed.