Lexapro is one of the most commonly prescribed antidepressants, and most people tolerate it well, especially after the first couple of weeks. But it has effects worth understanding, including a boxed warning about suicidal thoughts in younger people, the risk of serotonin syndrome, and discontinuation symptoms if it is stopped too quickly. This guide explains what to expect and when to seek help. It is educational and not a substitute for your doctor or pharmacist.
What Lexapro Is and What It Treats
Lexapro (escitalopram) is a selective serotonin reuptake inhibitor, or SSRI, which works by increasing the activity of serotonin in the brain. It is FDA-approved for major depressive disorder and generalized anxiety disorder, and it is approved for depression in adolescents aged 12 and older. Doctors also prescribe it off-label for other anxiety and panic conditions. Like other antidepressants, it usually takes time to work: some people notice effects within one to two weeks, but the full benefit often takes four to six weeks, so patience during the early period matters.
Common Side Effects
Most common side effects are mild and often ease over the first couple of weeks as your body adjusts. They include nausea, dry mouth, increased sweating, drowsiness or, conversely, insomnia, headache, dizziness, tremor, and nervousness. Some people have diarrhea or constipation, reduced appetite, or fatigue. Sexual side effects, such as reduced libido or delayed orgasm, are common and can persist while you take the drug; they are worth discussing with your prescriber rather than quietly enduring, since options exist.
Serious Side Effects and Warnings
Lexapro carries an FDA boxed warning about an increased risk of suicidal thoughts and behavior in children, adolescents, and young adults under 25, especially in the first few months of treatment or after a dose change. This risk was not seen to increase in adults over 24, and appears reduced in those 65 and older, but families and caregivers should watch closely for worsening mood, agitation, or emerging suicidal thoughts, particularly early on.
If you or someone you know is having thoughts of suicide or self-harm, help is available. In the US you can call or text the 988 Suicide and Crisis Lifeline at any time.
Serotonin syndrome is a potentially life-threatening reaction from too much serotonin activity, with agitation, hallucinations, fast heartbeat, fever, muscle stiffness or twitching, sweating, shivering, and loss of coordination; it is more likely when Lexapro is combined with other serotonergic drugs and is a medical emergency. Other serious effects include abnormal heart rhythm (QT prolongation), low sodium (more common in older adults and those on diuretics), increased bleeding risk, and, rarely, angle-closure glaucoma with sudden eye pain and vision changes. In people with bipolar disorder, an antidepressant can trigger mania.
Key Interactions
MAO inhibitors are contraindicated: Lexapro must not be used within 14 days of an MAOI, including linezolid and intravenous methylene blue, because of serotonin syndrome risk. Other serotonergic drugs, including other antidepressants, triptans for migraine, tramadol, some opioids like fentanyl, lithium, and the supplement St. John’s wort, raise the risk of serotonin syndrome. Drugs that increase bleeding, such as NSAIDs, aspirin, and anticoagulants, add to bleeding risk. Combining with other QT-prolonging drugs, and with alcohol, is generally discouraged.
How to Take Lexapro Safely
Take it at the same time each day, and give it several weeks before judging whether it is working. Do not stop it suddenly. If you and your doctor decide to stop, it should be tapered gradually, because abruptly quitting can cause a discontinuation syndrome with dizziness, “brain zaps” or electric-shock sensations, irritability, anxiety, nausea, and flu-like feelings. Keep every prescriber aware that you take it, especially before starting any new drug, and mention any migraine, pain, or supplement products.
Who Should Be Cautious
Lexapro is contraindicated with MAOIs, with the antipsychotic pimozide, and in anyone with a known hypersensitivity. Caution applies with a history of seizures, bipolar disorder, bleeding disorders, liver impairment, heart rhythm problems, or low sodium, and in older adults. In pregnancy and breastfeeding, the decision should weigh the benefits of treating depression against potential risks, in discussion with your clinician.
What to Do About Side Effects and When to Get Help
Mild early side effects like nausea, headache, and sleep changes often improve; report them if they persist or bother you. Call your doctor for worsening depression or anxiety, persistent sexual side effects, or unusual bleeding or bruising. Seek emergency care for signs of serotonin syndrome, a severe allergic reaction, fainting or an irregular heartbeat, or any suicidal thoughts.
Lexapro Side Effect FAQs
How long does Lexapro take to work?
Some effects appear within one to two weeks, but the full benefit often takes four to six weeks. Give it time before concluding it is not working.
Will Lexapro cause weight gain?
Weight changes can occur but vary from person to person. Discuss any significant change with your prescriber.
Can I drink alcohol on Lexapro?
It is generally not recommended, since alcohol can worsen drowsiness and mood effects. Talk to your doctor.
Is Lexapro addictive?
It is not addictive like a controlled substance, but it should not be stopped abruptly because of discontinuation symptoms. Taper with your doctor.
Can I take Lexapro during pregnancy?
It is an individualized decision that weighs the benefits of treatment against possible risks. Discuss it with your doctor.
What are “brain zaps”?
Brief electric-shock sensations some people feel when an SSRI is stopped or reduced too quickly. A gradual taper helps avoid them.
