What Is Lexapro?

Lexapro is a prescription medication belonging to a class of medications called selective serotonin reuptake inhibitors or SSRIs. It’s often dispensed in its generic form, escitalopram oxalate. Lexapro is often referred to as an antidepressant, which does have the potential to confuse. Many antidepressants have also shown support for anxiety symptoms and are used very commonly for this purpose.

Lexapro has FDA approval for managing:

• Generalized Anxiety Disorder, or GAD
• Major Depressive Disorder, or MDD

It has become common practice to use SSRIs like Lexapro to support the management of various other conditions as well:

• Social Anxiety Disorder, or SAD
• Panic Disorder
• Vasomotor symptoms of menopause, i.e. hot flashes
• Premenstrual Dysphoric Disorder, or PMDD
• Post-traumatic Stress Disorder, or PTSD
• Obsessive Compulsive Disorder, or OCD

Regular sessions with a therapist are also effective, and help individuals become more aware of management strategies. Therapy is often recommended along with medications.

How Does Lexapro Work?

Your body relies on neurotransmitters like serotonin to send signals and information in your brain. These signals play a pivotal role in shaping our mood, how we respond to stress, and how we feel.

Lexapro works by slowing down the reuptake of serotonin released by nerve cells, leading to an accumulation of serotonin downstream. The increase in serotonin levels helps you manage the symptoms of anxiety and depression by promoting calm.

Lexapro Has A Delayed Effect

When you start taking a medication like Lexapro for the first time, it’s important to understand that it may take several weeks for you to experience the full effect. Recent research also indicates that your individual genetics can influence both the medication’s efficacy and the likelihood of experiencing side effects. Giving Lexapro at least four to six weeks to begin working will give your body a chance to adapt and begin fully regulating serotonin activity.

Lexapro Dosage

Your initial dose of Lexapro to treat anxiety will be defined by your doctor. Typically, the approach is to “start low and go slow,” so lower doses are often used early and may be increased later depending on your feedback. Having good communication with your doctor is essential.

Lexapro is provided in 5 mg, 10 mg, and 20 mg tablets.

• 10 mg is often the starting dose for anxiety, but 5 mg may be used in some cases, i.e. individuals over the age of 65.
• 20 mg is the maximum recommended dose.

The manufacturers of Lexapro suggest waiting at least one week prior to increasing the dose. In practice, it will be more likely to schedule a follow-up with your doctor after about one month to discuss how you are feeling. If you are uncomfortable, you should feel free to reach out sooner.

Side Effects of Lexapro

In general, Lexapro has been considered a well-tolerated medication. There are some important potential side effects to be aware of though. These effects have been associated with Lexapro over time, but do not occur for everyone using the medication:

• Drowsiness: Drowsiness and sometimes dizziness can occur but often get better as your body adjusts to Lexapro. If you feel as though you may fall or if these effects persist for longer than a week, it is time to contact your doctor.
• Insomnia, or difficulty sleeping: If you are having trouble sleeping, it is okay to consider taking Lexapro in the morning. This may help reduce the impact the medication has on your sleep.
• Gastrointestinal effects, like nausea or diarrhea: These effects are most common early in therapy and may go away on their own after an adjustment period. If these effects are unbearable or last longer than a week, it’s time to talk with your doctor.
• Sexual Dysfunction: Lexapro has been associated with decreased libido or sexual desire in some individuals. It has also been linked to delayed orgasms or the inability to achieve orgasm. These effects have a tendency to be more easily missed when discussing your treatment with your doctor. If you have a concern, it’s important to make sure you voice it!
• Suicidal Thoughts: Use of Lexapro has been associated with suicidal thoughts. It is important to note that the conditions Lexapro is being used to treat are also associated with suicidal ideation, particularly when left untreated. Regardless of whether or not you are using a medication, it is important that you know that you and the people you care about are not alone. Confidential, professional support is available for free 24 hours a day, 7 days a week in the United States by dialing 988 or visiting 988lifeline.org.

What to do if You Miss A Dose

Taking Lexapro consistently on a daily basis is important to make sure it remains effective, but also prevents potential sudden withdrawal symptoms. Missing doses or stopping the medication abruptly is associated with insomnia, difficulty concentrating, dizziness, and other symptoms. If you do miss a dose do not attempt to double up, simply take your next normal dose at the usual time.

Drug Interactions With Lexapro

It’s also helpful to be aware of potential interactions with Lexapro. This can help guide your choices at home, and highlights the importance of discussing your medical history with every prescribing healthcare professional.

• Smoking: Smoking can lower concentrations of Lexapro in your body, which can make the medication less effective. Nicotine products — including vaping — are also associated with increased anxiety in some individuals.
• Alcohol: The overall impact of drinking while taking antidepressants is not well-defined, but caution should still be exercised. Evidence shows that alcohol combined with antidepressants causes individuals to become more heavily intoxicated. This can cause more concerns with coordination and executive function, like decision-making. Discussing how alcohol interacts with Lexapro is helpful if you do plan to drink.
• Serotonin Syndrome: When Lexapro is combined with other medications that also increase serotonin, these levels can begin to build up more than intended. This can cause symptoms like heart palpitations (feeling like your heart is racing or pounding), confusion, and sweating, among others. If you are taking other medications for behavioral health, including sleep aids, it’s helpful to be aware of this.
• Over-the-counter pain medications: Taking Tylenol (acetaminophen) is okay, but mixing NSAIDs like Advil (ibuprofen), Aleve (naproxen) or aspirin can increase your risks of bleeding. NSAIDs have been associated with a particularly higher risk of stomach ulcers when combined with SSRIs like Lexapro.

References

1. Forest Laboratories. “Lexapro Package Insert.” January 2017. Accessed October 12, 2023.
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4. Marjoribanks, Jane; et al. “Selective serotonin reuptake inhibitors for premenstrual syndrome.” Cochrane Database of Systematic Reviews, June 2013. Accessed October 12, 2023.
5. Carpenter, Joseph K.; et al. “Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials.” Depression and Anxiety, January 2018. Accessed October 12, 2023.
6. Radosavljevic, Milica; et al. “The Role of Pharmacogenetics in Personalizing the Antidepressant and Anxiolytic Therapy.” Genes, May 2023. Accessed October 12, 2023.
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8. Scherf-Clavel, Maike; et al. “Smoking Is Associated With Lower Dose–Corrected Serum Concentrations of Escitalopram.” Journal of Clinical Psychopharmacology, September 2019. Accessed October 12, 2023.
9. Menkes, David B.; Herxheimer, Andrew. “Interaction between antidepressants and alcohol: Signal amplification by multiple case reports.” International Journal of Risk & Safety in Medicine, July 2014. Accessed October 12, 2023.
10. Scotton, William J.; et al. “Serotonin Syndrome: Pathophysiology, Clinical Features, Management, and Potential Future Directions.” International Journal of Tryptophan Research, September 2019. Accessed October 12, 2023.
11. Ju-Young, Shin; et al. “Differential Risk of Peptic Ulcer Among Users of Antidepressants Combined With Nonsteroidal Anti-inflammatory Drugs.” Journal of Clinical Psychopharmacology, April 2017. Accessed October 12, 2023.