Lexapro Side Effects – Overview
Feeling sad is a natural emotion, but when it lasts for a long time, with no energy and the loss of interest in the things we enjoyed before, then it is probably depression. Depressed people have difficulties concentrating and a changed ability to think; the solution they might be looking for is antidepressants. Lexapro (escitalopram) can improve mood and increase energy levels. (1-2)
However, escitalopram may increase the risks of life-threatening conditions like the risk of suicide or serotonin syndrome. (2) Severe side effects are rare but could happen to you too, and is a reason to worry. Almost one out of three adults in the U.S. feel depressed or anxious and share the same concern as you. (3)
No matter how down you are and concerned about possible side effects, keep reading to learn about it. To get the full benefit of escitalopram, you should know what to do if an event occurs. You may also find out other ways to improve your depression and anxiety naturally.
Why and How is Lexapro Used?
Lexapro and other selective serotonin reuptake inhibitors (SSRIs) increase the activity of serotonin in the brain by inhibiting the serotonin reuptake. Serotonin is a hormone of happiness and good mood; when the levels in the body are low, the feeling of depression comes.
Escitalopram can increase the level of serotonin again and will boost your mood and the positive look of the world. (2, 4) Therefore, Lexapro is used for major depressive disorder (MDD) and generalized anxiety disorder (GAD) treatment in adults. Adolescents as young as 12 years of age can use escitalopram for depression. (2)
The initial treatment dose is 10mg once daily. After a week, the doctor can increase the dose to 20mg. The recommended dose for the maintenance treatment is 10mg. (2)
Escitalopram Side Effects
While Escitalopram improves mood, at the same time may cause mild to severe side effects. Many side effects come from SSRI medications (fluoxetine, sertraline, paroxetine, and citalopram). SSRIs are relatively safe, with fewer side effects than older antidepressants: monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs). (1, 5)
For 20 years, since escitalopram became available in 2002, doctors and health authorities have monitored its safety and efficacy, as with any other drug. As a result, you may find all the side effects in the Medication Guide. Therefore, before starting therapy, you and the family should read the Medication Guide carefully, get well-informed about side effects and discuss any of them with the prescriber.
The following possible side effects have been reported so far for this antidepressant:
- Feeling anxious;
- Trouble sleeping;
- Sexual problems;
- Not feeling hungry;
- Dry mouth;
- Yawning. (2)
In children and adolescents, the following side effects are possible:
- increased thirst;
- abnormal increase in muscle movement or agitation;
- nose bleed;
- difficult urination;
- heavy menstrual periods;
- possible slowed growth rate and weight change. (2)
As with any other medicine, escitalopram may cause an allergic reaction; rash, itching, fever, joint pain, trouble breathing, and swelling of the face, tongue, eyes, or mouth are symptoms of an allergic reaction. Escitalopram may increase the risk of bleeding, especially if taken with blood thinners (warfarin, ibuprofen, or naproxen). (2)
If you take escitalopram and notice any changes or adverse event that bothers you and doesn’t go away, tell your doctor. The doctor will know if your adverse event is linked to the medication you use or not. If so, the doctor might change your treatment. You may also report a side effect to the FDA. (2)
Suicidality: A Consequence of The Illness or Medication?
While treating depression and anxiety, escitalopram may cause several psychiatric disorders: acute psychosis, aggression, anger, apathy, confusion, disorientation, feeling unreal, hallucinations, mood swings, panic reactions, or paranoia.
The doctor should warn every patient on escitalopram of the increased risk of suicidal thinking. Using this drug may initiate self-harm or have thoughts of self-harm, suicide attempt, tendency, or completed suicide. Such behavior changes might happen in the initial few months of the therapy or when the dose is changed. (2, 6)
All manufacturers put a suicidality warning on the SSRI boxes as per the FDA request from 2004. (5) Yet, some experts are concerned about being too conscious, which limits the usage of a helpful intervention. Doctors must weigh the suicidality risk well because depression increases the risk of suicide if left untreated. (5, 6)
Be self-aware of behavior changes. Family and caregivers should monitor the patient to notice any worsening. Symptoms might appear suddenly and be severe, so report behavior changes to the healthcare professional immediately. Medication change is an option to overcome suicidality. (2, 6)
The escitalopram’s primary aim is to increase the level of serotonin in the body. But too much serotonin is not good. In some people, excess serotonin levels are due to this antidepressant being taken alone or in combination with other medications that cause a similar effect. This life-threatening condition is a side effect of other SSRIs and serotonin and norepinephrine reuptake inhibitors (SNRIs).
The symptoms of this syndrome that may occur are:
- Changes in mental status – agitation, hallucinations, delirium, and coma;
- autonomic instability – tachycardia, high or low blood pressure, dizziness, hyperthermia, etc.;
- neuromuscular symptoms – tremor, rigidity, overactive reflexes, incoordination, seizures, etc.;
- gastrointestinal symptoms – nausea, vomiting, or diarrhea.
The treatment should be discontinued immediately if serotonin syndrome occurs with signs such as high fever, tremors, irregular heartbeat, seizures, or unconsciousness. However, if it is a mild form, symptoms will go away after a day or two of stopping the medicine.
If you begin with the treatment or increase the dose and recognize these signs, call your doctor immediately or go to an emergency room. In such cases, doctors will initiate supportive symptomatic treatment. (2, 7)
Sexual Disorder and its Effect on Reproductive System
The physical disorder often results in changes in sexual desire, sexual performance, and sexual satisfaction. However, there is evidence that medications like SSRI, including escitalopram, can impact the sexual experience. Decreased libido, delay in ejaculation, untoward performance, and satisfaction are some of them. (2)
In men, this antidepressant can cause prolonged erection and delay in ejaculation. This rare condition (priapism) can be painful but can also damage the tissue in the penis because the blood is trapped and the tissue lacks oxygen. (2, 8) In women, escitalopram may cause prolonged menstrual bleeding (menorrhagia), heavy bleeding, or spontaneous abortion. (2, 9)
While physicians are more focused on depression improvement, they might not regularly discuss the impact of sexual dysfunction. Therefore, the actual incidence might be higher than described in a Medication Guide of the medicine. (2) If you experience any of the effects above, talk to your doctor.
Useful Tips on How to Use Lexapro
When your doctor prescribes Lexapro, pay attention to the following:
- Take your medication exactly as prescribed by your doctor; it takes weeks to feel better;
- If you miss the dose, take it as soon as you remember; if it is too close to the next one, wait to take the dose at the regular time;
- Don’t take a double dose; if it happens to take too much escitalopram, call your healthcare provider or poison control center right away, or get emergency consultation;
- Don’t stop taking escitalopram until you talk to your doctor; sudden therapy discontinuation may cause serious symptoms such as anxiety, irritability, high or low mood, headache, nausea, dizziness, shaking, confusion, and others;
- Don’t drive or operate with heavy machinery until you find out how escitalopram affects you; you may be sleepless or have difficulties in making decisions, thinking clearly, or reacting fast;
- If you take escitalopram, you should not take any other medicines that contain escitalopram oxalate or citalopram hydrobromide;
- Monitor the child’s height and weight during treatment;
- Don’t drink alcohol. (2)
Natural Ways to Increase Serotonin Levels
Medication treatment can be effective and taken for months or even years before the doctor decides that it is time to take off. Therefore, you should find other workable ways to regulate serotonin levels in the long run.
Dietary changes from high-calorie and processed food to a Mediterranean diet full of vegetables, fruits, whole grains, fish, and olive oil are beneficial for mental health. For example, eating food rich in polyphenols (plant substances present in dark chocolate, tea, grape, and berries) is associated with a reduction of depression risk and symptoms severity, a systematic literature review for 2020 reported. (10)
Having at least five portions of fruit and vegetables a day may add value to your mental health; most clinical studies published till 2019 reported the positive influence of fruits and vegetables. (11)
Work-out is a natural way to increase serotonin levels. By riding a bike or lifting weights, you initiate your body to produce tryptophan; your body uses tryptophan to produce serotonin. Sun exposure is another natural way to boost serotonin. (4)
Regular meals, mindful eating, proper sleep, and physical activities should be embedded as a lifestyle and can help to overcome depression and anxiety.
The battle with depression and anxiety is long and requires considerable effort. Lexapro can help relieve symptoms and bring back energy and motivation, overcoming the condition you have been struggling with for a long time. In addition, this drug is easy to take and can prevent another depression episode.
But remember, medications are not magic sticks and the only solution. Possible side effects might limit high expectations of the medication. Be aware of the possible side effects and be conscious of any symptoms that might occur and are associated with suicidal thoughts or serotonin syndrome.
Call your doctor and talk about any adverse event you experience. Don’t let it be too late.
Depression is not a one-size-fits-all illness. It’s up to you to find inner power and motivation every day. Use available natural ways to boost serotonin levels. Strong willingness, medications, talk therapy, and regular exercise may be your winning formula that will bring your happy life and satisfaction back.
1. Depression, Harvard Medical School, https://www.health.harvard.edu/topics/depression
2. Lexapro® (escitalopram oxalate) Tablets and Oral Solution, Full prescribing information and Medication Guide, January 2017, https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021323s047lbl.pdf
3. Felix Richer, Impact of Covid-19 pandemic on mental health, Statista, February 15, 2022, https://www.statista.com/chart/21878/impact-of-coronavirus-pandemic-on-mental-health/
4. Serotonin: The natural mood booster, Harvard Medical School, July 20, 2021, https://www.health.harvard.edu/mind-and-mood/serotonin-the-natural-mood-booster
5. Andrew Chu and Roopma Wadhwa, Selective Serotonin Reuptake Inhibitors, May 8, 2022, https://www.ncbi.nlm.nih.gov/books/NBK554406/
6. Escitalopram (Oral Route), Mayo Clinic, November 1, 2022, https://www.mayoclinic.org/drugs-supplements/escitalopram-oral-route/side-effects/drg-20063707?p=1
7. Serotonin Syndrome, Mayo Clinic, January 22, 2022, https://www.mayoclinic.org/diseases-conditions/serotonin-syndrome/symptoms-causes/syc-20354758
8. What is Priapism?, Urology Care Foundation, August 2022, https://www.urologyhealth.org/urology-a-z/p/priapism
9. Heavy Menstrual Bleeding, Centers for Disease Control and Prevention, August 17, 2022, https://www.cdc.gov/ncbddd/blooddisorders/women/menorrhagia.html
10. Bayes J., Schloss J. and Sibbritt D., Advances in Nutrition. 2020 May; 11(3): 602–615. Published online 2019 Nov 5. doi: 10.1093/advances/nmz117, PMCID: PMC7231605PMID: 31687743 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231605/
11. Głąbska D, Guzek D, Groele B, Gutkowska K. Fruit and Vegetable Intake and Mental Health in Adults: A Systematic Review. Nutrients. 2020 Jan 1;12(1):115. doi: 10.3390/nu12010115. PMID: 31906271; PMCID: PMC7019743. https://pubmed.ncbi.nlm.nih.gov/31906271/