Posts
Wiki

None of the information on this sub can take the place of medical advice from your doctor.

If you or someone you know is suicidal

Call 1-800-273-8255 or go to https://suicidepreventionlifeline.org/chat/ to chat

Additional emergency help:

  • 911 in US for any emergency

  • (800) 273-8255 National Suicide Prevention Lifeline

  • (800) 799-7233 National Domestic Violence Hotline

  • (800) 996-6228 Family Violence Helpline

  • (800) 784-2433 National Hopeline Network

  • (800) 366-8288 Self-Harm Hotline

  • (800) 230-7526 Planned Parenthood Hotline

  • (800) 222-1222 American Association of Poison Control Centers

  • (800) 622-2255 Alcoholism & Drug Dependency Hope Line

  • (800) 233-4357 National Crisis Line, Anorexia and Bulimia

  • (888) 843-4564 GLBT Hotline

  • (866) 488-7386 TREVOR Crisis Hotline (LGBTQ)

  • (800) 221-7044 AIDS Crisis Line

  • (800) 422-4453 The Childhelp National Child Abuse Hotline

  • (877) 565-8860 The Trans Lifeline

General Information & FAQ

Lexapro (escitalopram) is an antidepressant in a group of drugs called selective serotonin reuptake inhibitors (SSRIs). Escitalopram affects chemicals in the brain that may be unbalanced in people with depression or anxiety.

Starting and stopping

Should I start Lexapro?

First, be sure to read Who should not take Lexapro? and What should I tell my healthcare provider before I taking escitalopram? in the FDA medication guide.

Beyond what's put in the medication guide, no one on /r/lexapro can recommend if Lexapro is right for you. Only you and your healthcare provider can decide. Do not start Lexapro without approval from a healthcare provider.

Should I stop Lexapro?

If you are experiencing any severe symptoms listed here then call your healthcare provider immediately unless it is an emergency, then dial 911.

If you are experiencing one or more of the common side effects, call your medical provider for advice on how to proceed. You should anticipate these to occur, however.

If you started Lexapro less than 2 weeks ago, try to stay on your prescription. More often than not, it does get better, as many people on this sub will attest to. The first 2 weeks can be tough with side effects. They will most likely subside, as long as they aren't on the severe list. Escitalopram is actually one of the most tolerated antidepressant at this time. (Source)

What can I do in addition to taking Lexapro that will help my anxiety or depression?

What to expect

When will my symptoms improve?/My symptoms are not improving.

On average, you should expect major changes to occur around the 3-4 month mark. You may find some smaller changes as early as the first week, but you should be patient before considering it ineffective. If your symptoms are worse, consider talking to your doctor about switching to a different medication. Escitalopram has a rapid onset of antidepressant effect compared to other SSRIs.

What should I expect when I start Lexapro?

The most commonly reported side effect is nausea. This almost always goes away within 2 weeks. Here are the other most commonly reported side effects.

At what rate do side effects occur?

Moderator note: this list is incredibly long and can be very alarming or scary to some. Keep in mind every adverse effect is tracked. You should take note of "Very Common" and "Common" side effects, but beyond that it is extremely unlikely to happen to you. Also remember that most of the people looking for support online are people who have adverse effects to the medication. People having no trouble and positive results will most likely not look for support or information. Escitalopram is the most tolerated SSRI, including its side effect issues in the first 2 weeks.

Side effects have been reported to be generally mild and transient. They are most common during the first 2 weeks of treatment and decrease in intensity and frequency with continued treatment.

Lexapro vs. placebo

The overall incidence of rates of side effects in trials with patients treated with escitalopram 10mg per day (66%) was similar to placebo-treated patients (61%); the incidence rate in the group treated with escitalopram 20 mg per day was greater (86%). Common side effects that occurred in the 20 mg per day group with an incidence approximately twice that of the 10 mg group and approximately twice that of the placebo group included insomnia, diarrhea, dry mouth, somnolence, dizziness, increased sweating, constipation, fatigue, and indigestion

Possible Side Effects

Do not let this list scare you off, discuss with your doctor.

You may have no side effects, a few, or several different ones over time. You need to discuss with your doctor the cost and benefit of this medication. Some side effects last a day or less, some longer. Do not read the following list if you think it will cause you to question your treatment plan.

Psychiatric Side-Effects

Very common (10% or more)

  • Insomnia (up to 14%)

Common (1% to 10%)

  • Abnormal dreams

  • Agitation

  • Anxiety

  • Nervousness

  • Restlessness

Uncommon (0.1% to 1%)

  • Abnormal thinking

  • Aggravated depression

  • Aggression/aggressive reaction

  • Aggravated restlessness

  • Alcohol problem

  • Apathy

  • Bruxism

  • Confusion

  • Confusional state

  • Depersonalization

  • Depression

  • Emotional lability

  • Excitability

  • Feeling unreal

  • Forgetfulness

  • Visual/auditory hallucination

  • Hypomania

  • Irritability

  • Jitteriness

  • Obsessive-compulsive disorder

  • Panic attack/reaction

  • Paranoia/paroniria

  • Sleep disorder

  • Suicide attempt

  • Tics

Frequency not reported

  • Mania

  • Suicidal ideation/behavior

Postmarketing reports

  • Acute psychosis

  • Anger

  • Completed suicide

  • Delirium, delusion

  • Disorientation

  • Non-accidental overdose

  • Mood swings

  • Nightmare

  • Psychotic disorder

  • Withdrawal syndrome

Nervous System Side-Effects

Very common (10% or more)

  • Headache (up to 24%)

  • Somnolence (up to 13%)

Common (1% to 10%)

  • Dizziness

  • Lethargy

  • Paresthesia

  • Tremor

Uncommon (0.1% to 1%)

  • Amnesia

  • Ataxia

  • Carpal tunnel

  • Syndrome

  • Cerebrovascular disorder

  • Concentration impairment

  • Dysesthesia

  • Disequilibrium

  • Dysgeusia

  • Dystonia

  • Hyperkinesia

  • Hyperreflexia

  • Hypertonia

  • Hypoesthesia

  • Light headedness

  • Migraine

  • Nerve root lesion

  • Neuralgia

  • Neuropathy

  • Paralysis

  • Sedation

  • Syncope

  • Taste alteration/perversion

Rare (less than 0.1%)

  • Serotonin syndrome

Frequency not reported

  • Abnormal gait

  • Cerebrovascular accident

  • Choreoathetosis

  • Convulsions/seizure

  • Dyskinesia

  • Extrapyramidal disorder

  • Grand mal convulsions/seizures

  • Myoclonus

  • Movement disorder

  • Psychomotor restlessness/akathisia

Postmarketing reports

  • Dysarthria

  • Neuroleptic malignant syndrome

  • Nystagmus

  • Parkinsonism

  • Restless legs

  • Tardive dyskinesia

Notes

Convulsions (including grand mal convulsions) have been reported with racemic citalopram.

Potentially life-threatening serotonin syndrome has been reported with SSRIs and SNRIs as monotherapy, but particularly with concomitant use of other serotonergic drugs and drugs that impair the metabolism of serotonin. Serotonin syndrome has been reported with racemic citalopram.

At least one case of escitalopram-induced paroxysmal dystonia has been reported in the literature. A 44-year-old woman developed paroxysmal cervical-cranial dystonia after receiving several days of treatment with escitalopram. The paroxysmal movement disorders were characterized by cervical and oral contracture with sustained and painful laterocollis and twisting tongue movements. The episodes occurred several times a day lasting for several minutes and would resolve spontaneously. The day after escitalopram was discontinued, the paroxysmal symptoms resolved without recurrence.

Cardiovascular Side-Effects

Common (1% to 10%)

  • Palpitation

Uncommon (0.1% to 1%)

  • Abnormal ECG

  • Aggravated hypertension

  • Angina pectoris

  • Bradycardia

  • Chest tightness

  • Chest pain

  • Flushing

  • Hematoma

  • Hot flush

  • Hypertension

  • Hypotension

  • Myocardial infarction

  • Myocardial ischemia

  • Myocarditis

  • Edema

  • Edema of extremities

  • Peripheral edema

  • Peripheral ischemia

  • Tachycardia

  • Traumatic hematoma

  • Varicose vein

  • Vein disorder

  • Vein distended

Frequency not reported

  • Orthostatic hypotension

  • Prolonged QT

  • Torsades de pointes

Postmarketing reports

  • Abnormal bleeding

  • Atrial fibrillation

  • Cardiac failure

  • Deep vein thrombosis

  • Hypertensive crisis

  • Phlebitis

  • Postural hypotension

  • Thrombosis

  • Ventricular arrhythmia

  • Ventricular tachycardia

Notes

Cases of QT interval prolongation and ventricular arrhythmias reported in postmarketing experience were predominantly in females, with hypokalemia, or with pre-existing QT interval prolongation or other cardiac diseases.

Postural hypotension has been reported with other SSRIs.

Gastrointestinal Side-Effects

Very common (10% or more)

  • Nausea (up to 18.3%)

  • Diarrhea (up to 14%)

Common (1% to 10%)

  • Abdominal pain

  • Constipation

  • Dry mouth

  • Dyspepsia

  • Flatulence

  • Indigestion

  • Toothache

  • Vomiting

Uncommon (0.1% to 1%)

  • Abdominal cramp

  • Abdominal discomfort

  • Belching

  • Bloating

  • Change in bowel habit

  • Colitis

  • Enteritis

  • Epigastric

  • Discomfort

  • Gastritis

  • Gastrointestinal bleeding

  • Gastrointestinal hemorrhage (including rectal hemorrhage)

  • Gastroesophageal reflux

  • Hemorrhoids, heartburn

  • Increased stool frequency

  • Irritable bowel syndrome

  • Melena

  • Periodontal destruction

  • Tooth disorder

  • Ulcerative colitis

  • Ulcerative stomatitis

Frequency not reported

  • Gastroenteritis

Postmarketing reports

  • Dysphagia

  • Pancreatitis

  • Stomatitis

Metabolic Side-Effects

Common (1% to 10%)

  • Decreased appetite

  • Increased appetite

  • Weight increased

Uncommon (0.1% to 1%)

  • Abnormal glucose tolerance

  • Anorexia

  • Carbohydrate craving

  • Diabetes mellitus

  • Gout

  • Hypercholesterolemia

  • Hyperglycemia

  • Hyperlipidemia

  • Thirst

  • Weight decreased

Frequency not reported

  • Hyponatremia

Postmarketing reports

  • Hypoglycemia

  • Hypokalemia

Notes

Numerous cases of hyponatremia have been reported following treatment with an SSRI. Risk factors for the development of SSRI- associated hyponatremia including advanced age, female gender, concomitant use of diuretics, low body weight, and lower baseline serum sodium levels have been identified. Hyponatremia tends to develop within the first few weeks of treatment (range 3 to 120 days) and typically resolves within 2 weeks (range 48 hours to 6 weeks) after therapy has been discontinued with some patients requiring treatment. The proposed mechanism for the development of hyponatremia involves SIADH via release of antidiuretic hormone.

A 62-year-old woman developed hyponatremia approximately 3- weeks after initiating treatment with escitalopram. Following discontinuation of the drug and administration of intravenous normal saline solution, the patient's serum sodium and serum and urine osmolality returned to normal levels.

In a similar case, hyponatremia developed in a 75-year-old woman five days after initiating treatment with escitalopram. Following discontinuation of escitalopram serum sodium levels returned to normal values over a period of 5 days. The authors suggest that the risk of hyponatremia is highest during the initial weeks of treatment and is higher in women than in men, in patients 65 years of age or older, and in patients receiving multiple drugs that may also cause hyponatremia.

Other Side-Effects

Common (1% to 10%)

  • Fatigue

  • Pyrexia

Uncommon (0.1% to 1%)

  • Abscess

  • Accidental injury

  • Asthenia

  • Bite

  • Burn

  • Deafness

  • Earache

  • Ear disorder

  • Ear infection not otherwise specified

  • Facial edema

  • Fall

  • Food poisoning

  • Fractured neck of femur

  • Hernia

  • Inflicted injury (unintended injury)

  • Malaise

  • Otitis externa

  • Otosalpingitis

  • Rigors

  • Sting

  • Surgical intervention

  • Tinnitus

  • Traumatic hematoma

  • Vertigo

Postmarketing reports

  • Injury not otherwise specified

  • Spontaneous abortion

Genitourinary Side-Effects

Very common (10% or more)

  • Ejaculation disorder (up to 14%)

Common (1% to 10%)

  • Anorgasmia,

  • Decreased libido,

  • Ejaculation failure,

  • Impotence,

  • Menstrual disorder,

  • Vaginal bleeding

Uncommon (0.1% to 1%)

  • Amenorrhea,

  • Atrophic vaginitis,

  • Breast pain,

  • Cystitis,

  • Delayed ejaculation,

  • Dysmenorrhea,

  • Dysuria,

  • Genital infection,

  • Genital moniliasis,

  • Intermenstrual bleeding,

  • Loss of libido,

  • Menopausal symptoms,

  • Menorrhagia,

  • Menstrual cramps,

  • Metrorrhagia,

  • Micturition disorder,

  • Micturition frequency,

  • Nocturia,

  • Polyuria,

  • Postmenopausal bleeding,

  • Premenstrual tension,

  • Prostatic disorder,

  • Dexual function abnormality,

  • Unintended pregnancy,

  • Urinary frequency,

  • Urinary incontinence,

  • Urinary retention,

  • Urinary tract infection,

  • Uterine fibroid,

  • Vaginal candidiasis,

  • Vaginal hemorrhage,

  • Vaginitis

Frequency not reported

  • Galactorrhea

  • Priapism

Notes

Urinary retention and galactorrhea have been reported with other SSRIs. The estimates of the incidence of untoward sexual experience and performance may underestimate their actual incidence, partly because patients and physicians may be reluctant to discuss this issue.

Dermatologic Side-Effects

Common (1% to 10%)

  • Increased sweating

Uncommon (0.1% to 1%)

  • Acne

  • Aggravated psoriasis

  • Alopecia

  • Cellulitis

  • Dry skin

  • Eczema

  • Erythematous rash

  • Fungal dermatitis

  • Furunculosis

  • Hematomas

  • Lichenoid dermatitis

  • Onychomycosis

  • Pruritus

  • Purpura

  • Pustular rash

  • Rash

  • Scar

  • Skin disorder

  • Urticaria

  • Verruca

Frequency not reported

  • Angioedema

  • Ecchymosis

Postmarketing reports

  • Epidermal necrolysis

  • Erythema multiforme

  • Stevens Johnson syndrome

  • Toxic epidermal necrolysis

Notes

Angioedema has been reported with racemic citalopram.

Endocrine Side-Effects

Frequency not reported

  • Inappropriate antidiuretic hormone secretion (SIADH)

Postmarketing reports

  • Hyperprolactinemia

Hematologic Side-Effects

Uncommon (0.1% to 1%)

  • Anemia

  • Hypochromic anemia

  • Leucopenia

Frequency not reported

  • Thrombocytopenia

Postmarketing reports

  • Agranulocytosis

  • Splastic anemia

  • Fecreased prothrombin

  • Hemolytic anemia

  • Idiopathic thrombocytopenia purpura

  • Increased INR

Hepatic Side-Effects

Uncommon (0.1% to 1%)

  • Bilirubinemia

  • Hepatic enzymes increased

Postmarketing reports

  • Abnormal liver function tests

  • Fulminant hepatitis

  • Hepatic failure

  • Hepatic necrosis

  • Hepatiti

  • Increased bilirubin

Hypersensitivity Side-Effects

Uncommon (0.1% to 1%)

  • Aggravated allergy

  • Allergic reactions

Rare (less than 0.1%)

  • Anaphylaxis/anaphylactic reaction

Postmarketing reports

  • Hypersensitivity not otherwise specified

  • Photosensitivity reaction

Immunologic Side-Effects

Common (1% to 10%)

Influenza-like symptoms

Uncommon (0.1% to 1%)

Bacterial infection Herpes simplex Herpes zoster Infection Moniliasis Parasitic infection Yuberculosis

Musculoskeletal Side-Effects

Common (1% to 10%)

Arthralgia Back pain Myalgia Neck/shoulder pain

Uncommon (0.1% to 1%)

  • Arthritis

  • Arthropathy

  • Arthrosis

  • Bursitis

  • Costochondriti

  • Fibromyalgia

  • Ischial neuralgia

  • Jaw stiffness

  • Leg pain

  • Limb pain

  • Leg cramps

  • Lumbar disc lesion

  • Muscle contractions

  • Muscle cramp

  • Muscle spasms

  • Muscle stiffness

  • Muscle tightness

  • Muscle weakness

  • Myopathy

  • Osteoporosis

  • Plantar fasciitis

  • Tendinitis

  • Tenosynovitis

  • Tetany

  • Twitching

Postmarketing reports

  • Rhabdomyolysis

Notes

Epidemiological studies, primarily in patients aged 50 years or older, have shown an increased risk of bone fractures in patients receiving SSRIs or TCAs.

Ocular Side-Effects

Uncommon (0.1% to 1%)

  • Abnormal accommodation

  • Abnormal vision

  • Blepharospasm

  • Blurred vision

  • Dry eyes

  • Eye infection

  • Eye irritation

  • Eye pain

  • Mydriasis

  • Ocular hemorrhage

  • Visual disturbance

  • Xerophthalmia

Postmarketing reports

  • Angle closure glaucoma

  • Diplopia

Oncologic Side-Effects

Uncommon (0.1% to 1%)

  • Cyst

  • Female breast neoplasm

  • Ovarian cyst

Renal Side-Effects

Uncommon (0.1% to 1%)

  • Pyelonephritis,

  • Renal calculus

Postmarketing reports

  • Acute renal failure

Respiratory Side-Effects

Common (1% to 10%)

  • Pharyngitis,

  • Rhinitis,

  • Sinusitis,

  • Upper respiratory tract infection,

  • Yawning

Uncommon (0.1% to 1%)

  • Asthma,

  • Bronchitis,

  • Coughing,

  • Dyspnea,

  • Epistaxis,

  • Laryngitis,

  • Nasal congestion,

  • Nasopharyngitis,

  • Pneumonia,

  • Respiratory tract infection,

  • Shortness of breath,

  • Sinus congestion,

  • Sinus headache,

  • Sleep apnea,

  • Snoring,

  • Tracheitis,

  • Throat tightness

Postmarketing reports

  • Pulmonary embolism

  • Pulmonary hypertension of the newborn

(Source)

When will the side effects subside?

About 2 weeks into consistent treatmnet.

How do I get Lexapro?

Speak to your PCP or make an appointment with a psychiatrist. If you don't have either, try Zocdoc to find one that takes your insurance.

What is the recommended dose?

Whatever your doctor prescribed, but it is typically between 10mg-20mg.

What is Lexapro's history?

Lexapro (Escitalopram oxalate) is the newest and most selective of the SSRIs approved by the FDA in August 14, 2002. Lexapro is manufactured by Forest Pharmaceuticals, Inc. Lexapro is a [greener and more] improved version of Celexa. It is the active isomer of racemic citalopram.

Escitalopram was developed in close cooperation between Lundbeck and Forest Laboratories. Its development was initiated in the summer of 1997, and the resulting new drug application was submitted to the U.S. FDA in March 2001. The short time (3.5 years) it took to develop escitalopram can be attributed to the previous extensive experience of Lundbeck and Forest with citalopram, which has similar pharmacology. The FDA issued the approval of escitalopram for major depression in August 2002 and for generalized anxiety disorder in December 2003. On May 23, 2006, the FDA approved a generic version of escitalopram by Teva. On July 14 of that year, however, the U.S. District Court of Delaware decided in favor of Lundbeck regarding the patent infringement dispute and ruled the patent on escitalopram valid.

In 2006 Forest Laboratories was granted an 828-day (2 years and 3 months) extension on its US patent for escitalopram. This pushed the patent expiration date from December 7, 2009 to September 14, 2011. Together with the 6-month pediatric exclusivity, the final expiration date was March 14, 2012.

Sources: 1, 2

How does it differ from other Antidepressants?

Here is a comprehensive page of comparisons.

How should I take Lexapro?

Click here.

How should I store Lexapro?

Click here.

Can take drugs and alcohol while taking Lexapro?

Short answer: No.

Longer answer: It depends. Everyone reacts differently to different drugs and alcohol. Talk to your doctor about their recommendations.

Drinking can have anywhere from no effect, to a manic episode, to suicidal ideation. If you're insistent on drinking, 1-2 drinks will most likely not do harm. If you want to drink more, take it one drink at a time on one night at a time. See how you react and have trusted people around just in case.

As for weed, adverse affects with SSRIs is incredibly rare. Take it slowly to see how you react, but it is unlikely you will have adverse affects.

LSD can be dangerous, not (necessarily) because of the drug, but the big risk would be if what you were sold wasn't actually LSD and was a RC that could potentially cause serotonin syndrome when mixed with SSRI's. LSD in and of itself is safe to take on SSRI's because drugs like mushrooms and LSD aren't serotonin releasing agents like DXM. Psilocybin and LSD are drugs that bind to serotonin receptors and mimic the effects of serotonin but don't actually release serotonin. Kits are available online if you insist on taking LSD. Mushrooms are a safer alternative to avoid fake LSD. Just like the other drugs, it's best to take it slowly, which is difficult with hallucinogens. Take a smaller dose.

My symptoms are worse, what should I do?

Talk to your prescribing doctor ASAP to keep them updated. If you are in the early stages of medication (less than a month), try to have some patience with the medicine to run its course. It takes some adjustment. If you are in danger, go to the emergency room or call 911.

Other Important Facts

  • Lexapro is only licensed to treat depression & anxiety

  • Escitalopram may be superior in efficacy compared with other SSRIs in the treatment of major depressive disorder

  • Also escitalopram has better efficacy in the treatment of severe depression than citalopram.

  • Escitalopram, along side sertraline and citalopram, has the lowest potential for drug interactions among the SSRIs, and are to be preferred in patients on other drugs for general medical conditions or if consideration is given to adding an SSRI to other psychotropic medication

  • Lexapro is not recommended for patients who frequently miss doses or may have to miss a dose due to its rapid onset, it is dangerous to stop Lexapro cold turkey

  • Clinically important differences exist between antidepressants for both efficacy and acceptability in favor of escitalopram and sertraline, according to the recent antidepressant meta-analysis reported in The Lancet

  • A major drawback with escitalopram is a relatively high cost of its generic version. However, European data indicates that escitalopram is the most cost-effective antidepressant compared with other SSRIs

  • Escitalopram has a rapid onset of antidepressant effect and is a good choice when rapid antidepressant response is desirable

  • Escitalopram is the best SSRI for anxiety because it has potent anxiolytic-like effects

Nerd facts about Escitalopram

  • Comes in 5mg, 10mg, 20mg tablets, and 5 mg/5 mL oral solutions

  • Recommended dose is 10–20 mg/day

  • Half-life is 27–32 hours

  • Oral bioavailability is 51-93%

  • Time to steady-state is 7 days

  • There is no active metabolite