Lexapro (Escitalopram) Side Effects: What You Should Know

Lexapro (escitalopram) is a type of antidepressant medication known as a selective serotonin reuptake inhibitor or SSRI. It is prescribed for the treatment of depressive disorders, anxiety disorders, and other mood disorders, sometimes in combination with other medications.

If you or someone you love is taking Lexapro or escitalopram (the generic version), you should be aware of the common and serious side effects of Lexapro. People who use Lexapro may also experience withdrawal symptoms when stopping this medication, as well as a risk of overdose if it is taken in too-high doses.

Your First Week on Lexapro

You may experience Lexapro side effects during the first week you take it. During your first week of taking Lexapro, some of the most common side effects you might experience include:

• Anxiety
• Constipation and gastrointestinal issues
• Decreased sexual desire
• Difficulty sleeping
• Dizziness or shakiness
• Drowsiness
• Dry mouth
• Fatigue
• Headaches
• Increased sweating
• Nausea

However, these side effects will likely dissipate after your first week of taking the medication.

If your symptoms persist after your first week on Lexapro, be sure to talk to a doctor. In some cases, a doctor will adjust your dosage so that side effects are eliminated, or, they may prescribe you a different medication altogether.

Mental health symptoms, such as depressed mood or lack of interest in activities, for instance, may take longer to improve (between six and eight weeks).

Common Lexapro Side Effects

Most antidepressants cause some type of adverse effects, with four in five people taking these types of drugs reporting at least one side effect, but often more. Your doctor may still prescribe this medication if they feel that the benefits outweigh the risks.

The following is a comprehensive list of the common side effects you may experience while taking Lexapro:

• Nausea
• Headache
• Trouble sleeping (insomnia)
• Dry mouth
• Sexual side effects (inability to orgasm, decreased libido, ejaculatory delay)
• Diarrhea
• Fatigue
• Flu-like symptoms
• Increased sweating
• Constipation
• Dizziness
• Involuntary shaking (tremors)
• Indigestion

Children and adolescents taking Lexapro or escitalopram may also experience side effects including:

• Increased thirst
• Muscle twitching
• Nose bleeding
• Heavy menstruation
• Trouble urinating
• Slowed growth rate and weight changes

Additionally, if your Lexapro dosage is increased at a later date, side effects that went away prior to the increase are unlikely to reoccur.

Serious Lexapro Side Effects

If you experience any of the following side effects, contact your healthcare provider immediately or seek emergency medical care.

• Bleeding or bruising (more likely to occur if you are also on a blood thinner or non-steroidal anti-inflammatory drug [NSAID])
• Manic episode: Greatly increased energy, trouble sleeping, racing thoughts, reckless behavior like excessive gambling or shopping, inflated sense of self, rapid speech, or feeling extremely happy or irritable
• Serotonin syndrome: Agitation, hallucinations, confusion, coma, coordination or balance problems, muscle twitching, racing heartbeat, high or low blood pressure, sweating, fever, nausea, vomiting, or diarrhea
• Severe allergic reaction: Rash, difficulty breathing, fever, joint pain, or swelling of the mouth, lips, eyes, or tongue
• Other serious side effects: Seizures, change in appetite or weight, low blood sodium levels, teeth grinding, and angle-closure glaucoma
• Suicidal thoughts or actions (more a concern in people under the age of 25, and also of greater concern during the first two months of treatment)
  

Black Box Warning

According to the black box warning (the strictest warning for prescription drugs issued by the FDA), taking Lexapro can result in an increased risk of suicidal thoughts and behaviors, particularly in children, adolescents, and young adults—especially when beginning treatment or changing the dosage. Warning signs include new or sudden changes in mood, behavior, actions, thoughts, or feelings.

Lexapro Drug Interaction Side Effects

The following drugs have been known to interact with Lexapro and should be used with caution.

Blood Thinners

Lexapro can increase the risk of bleeding when used with blood thinners such as NSAIDs, aspirin, and warfarin. Warfarin has the potential to interact with several different types of antidepressants.

A study in the Journal of the American Osteopathic Association found that patients taking SSRIs are 40% more likely to develop severe gastrointestinal bleeding, especially if they are also taking NSAIDs. Talk to your doctor before taking NSAIDs such as Motrin (ibuprofen) or Aleve (naproxen).

Serotonergic Medication

Serotonin syndrome is a dangerous complication caused by excessive serotonin levels. Symptoms can be mild, but they can also be life-threatening, which is why this condition is sometimes referred to as serotonin toxicity.

Medications that may increase the risk of serotonin syndrome include:

• Other SSRIs, such as Celexa (citalopram)
• Monoamine oxidase inhibitors (MAOIs), which are used to treat psychiatric disorders
• Pimozide (an antipsychotic)
• Linezolid (an antibiotic)
• Intravenous methylene blue (used to treat methemoglobinemia)
• St. John's wort
• Tricyclic antidepressants, such as Pamelor (nortriptyline)
• Triptans used for treating migraines, such as sumatriptan
  

Coping With Lexapro Side Effects

Generally, Lexapro's side effects are mild and can be managed. Your doctor may recommend strategies such as:

• Changing the timing of doses to reduce the effects; for example, taking your medication after meals if you experience gastrointestinal symptoms, before bed if it gives you insomnia, or after sex if you're experiencing sexual side effects
• Increasing physical activity to help manage side effects related to anxiety, sleep problems, or constipation
• Practicing relaxation techniques like yoga or meditation to improve anxiety or insomnia
• Using lubricants to make sex more comfortable

Taking Lexapro Safely

Escitalopram is considered one of the safest antidepressants. That said, as with any kind of treatment, it is important to follow your doctor’s instructions for medication use, including when to take the medication, whether it's okay to increase the dose, what to do if you miss a dose, and medications, foods, and substances to avoid.

Use As Directed

It's important to follow your doctor's instructions for taking Lexapro. The usual recommended daily dosage of Lexapro is 10 milligrams (mg). Doses higher than 20 mg are not approved by the FDA. You may take Lexapro as tablets or an oral solution once daily, in the morning or evening, with or without food.

Depending on your diagnosis, your doctor may prescribe Lexapro for a defined period (between six months and one year) or for an extended period (over many years). Ask your doctor or pharmacist if you have any questions about this medication.

If you miss a dose, take it as soon as you remember, unless it's close to the time for your next dose. In that case, don't double up. Just skip the missed dose and make plans to take your next dose as usual.

Precautions

You can reduce potential risks by being aware of who should not take this medication. The safety and effectiveness of Lexapro in children younger than 12 years of age have not been established, so this medication is not generally recommended for this age group.

The medication's side effects may be more severe in older adults. If you are in this group, your physician will need to carefully monitor your dose.

Prior to starting escitalopram or Lexapro, tell your doctor if you are allergic or hypersensitive to escitalopram oxalate or if are pregnant or breastfeeding. It's also important to alert your doctor if you have a history of any of the following medical conditions, which may be exacerbated by this medicine:

• Bipolar disorder
• Glaucoma
• Low salt levels (hyponatremia)
• Seizures
• Severe renal impairment
• Suicidal thoughts and behaviors

People taking Lexapro should avoid drinking alcohol and taking illicit drugs, as these substances can reduce the effectiveness of the medication and increase its toxicity.

Lexapro Withdrawal Side Effects

You should only discontinue Lexapro under the guidance of your doctor. It's never a good idea to stop your medication abruptly as this may cause you to experience withdrawal symptoms, such as:

• Alteration in sleep habits
• Anxiety
• Confusion
• Dizziness
• Electric shock-like sensations (paresthesia)
• Headache
• High or low mood
• Irritability
• Nausea
• Restlessness
• Shaking
• Sweating

To reduce the risk of these effects, your doctor may reduce your dosage over the course of several days before discontinuing the medicine altogether.

Signs of Lexapro Overdose

If you or a loved one has accidentally or intentionally overdosed on escitalopram, the symptoms will typically start out mild and non-specific, worsening over time. Signs of Lexapro overdose include:

• Dizziness
• Drowsiness
• Fast heartbeat or pounding heart
• Loss of consciousness
• Nausea
• Seizures
• Vomiting

Toxic and potentially life-threatening complications that can later emerge due to taking too much Lexapro can include:

• Coma
• Confusion
• Delirium
• Hallucinations
• Increasingly worsening heart rate (dysrhythmia)
• Involuntary eye movement
• Respiratory distress
• Seizures
• Tremors
• Unconsciousness

When to Call Your Doctor

While most Lexapro side effects usually do not require medical intervention, you should report them to your healthcare provider if they continue for longer than one week or if they interfere with your daily routine. Your doctor may decide to adjust your dosage or switch you to another medication entirely.

Also, while there are several fairly common side effects associated with escitalopram, you may find that you experience other less common side effects as well. If you do, alert your doctor. You should never stop or change the dosage of your medication on your own.

Remember to consult your healthcare provider any time you’re unsure about any symptoms that you experience while taking any medication. Most of the time, particularly in the case of antidepressants, other medication options are available.