thoughtscape NP Psychiatry · Patient education
Escitalopram
Lexapro
An SSRI for depression and anxiety. Improvement builds over time; the aim is better function, not feeling numb.
Draft for review · Clinical content has not been revalidated for this website.
Keep follow-ups, especially early on and after dose changes. Report new or worsening mood symptoms at any age.
What it is used for
Lexapro is approved for depression from age 12 and generalized anxiety disorder from age 7, including adults.
Panic, OCD, social anxiety, PTSD, and PMDD are off-label uses with differing evidence. Ask what your prescription is intended to treat.
How it works
Blocks the serotonin transporter, slowing serotonin reuptake between nerve cells. This is thought to contribute to mood and anxiety benefits.
Serotonin signaling changes early, but clinical benefit takes time. The full explanation is still uncertain; the drug is not a direct serotonin-receptor agonist.
What to expect over time
FIRST DAYS
Nausea, headache, jitteriness, or sleep changes may come before benefit. Report marked agitation or severe effects; do not simply wait them out.
OVER WEEKS
Mood and anxiety often improve gradually over several weeks. Keep the agreed review date; response does not follow a fixed deadline.
AT REVIEW
Compare sleep, worry, mood, and daily function. Review dose, adherence, and side effects before changing treatment; higher is not always better.
Taking your medication
Take once daily at a consistent time, morning, or evening, with or without food. Food may ease nausea. Follow your prescribed dose and increase schedule.
Ask about timing for insomnia or drowsiness. For liquid, confirm the concentration and measure with an oral syringe or pharmacy device.
Avoid alcohol. Do not drive or do hazardous work until you know its effects, and never while impaired. Ask before adding medicines or supplements.
When to get help
Emergency: seizure, collapse, breathing trouble, major bleeding, or immediate self-harm danger. Fever with confusion and muscle stiffness needs urgent care.
Urgent care: fainting, irregular heartbeat, acute eye pain, or vision changes, blistering rash, or severe confusion, weakness, or unsteadiness.
Call promptly: suicidal thoughts, worsening mood, severe restlessness, unusual high energy, or much less need for sleep. Report unusual bruising or bleeding.
Early side effects
Nausea, loose stools, headache, sweating, or sleep changes can occur. Food may ease nausea; persistent symptoms or dehydration need review.
Other effects to discuss
Sexual effects, weight change, or emotional blunting deserve discussion. Feeling flat may reflect medication effects or remaining depression.
What to keep track of
Review mood, activation, sleep, weight, and sexual function; monitor growth in children. Routine blood tests are not needed for every healthy adult. Sodium, ECG, and electrolytes depend on symptoms and risks, including age, heart disease, diuretics, and interacting medicines.
Before you start
Discuss bipolar disorder, suicidal thoughts, seizures, low sodium, bleeding, eye-angle problems, heart disease, fainting, liver/kidney disease, and pregnancy or feeding plans. Report allergies to escitalopram or citalopram. Ten mg/day is recommended for older adults or liver impairment; do not change your own dose. Children's increase intervals differ by indication.
Medicines & interactions
MAOIs, linezolid, and methylene blue
Never combine with an antidepressant MAOI; allow at least 14 days between treatments in either direction. Do not start during linezolid or IV methylene blue treatment; urgent use needs a supervised plan.
Other serotonin medicines
Check antidepressants, tramadol, dextromethorphan cough remedies, triptans, lithium, buspirone, stimulants, and St. John's wort. Avoid duplicate citalopram treatment. These combinations may cause serotonin syndrome.
Blood thinners and pain relievers
Aspirin, ibuprofen, naproxen, and anticoagulants increase bleeding risk. Ask which pain treatment is suitable; do not automatically add a substitute or stomach-protecting medicine.
Heart rhythm and drug levels
Pimozide must not be combined. Review other QT-prolonging medicines, omeprazole, cimetidine, and some heart drugs or antidepressants. Higher exposure can increase risks; an ECG or dose adjustment may be needed.
Everyday tips
Use a refill reminder and a steady daily routine. Tell your clinician if doses are hard to remember.
Track a few symptoms and practical goals. Therapy, regular sleep, and activity can support recovery.
Discuss sexual or emotional effects. Balance side effects with relapse risk before changing treatment.
Tell each doctor, dentist, and pharmacist you take it. Secure your medicine and never share it.
Your questions, answered
What if I miss a dose?
Take it when remembered unless the next dose is nearly due; then skip it. Never double. Several missed doses may trigger symptoms; call if unsure how to restart after a longer gap.
Can I stop once I feel better?
Agree on treatment duration and a gradual taper; do not stop abruptly. Withdrawal may include dizziness, nausea, shock-like sensations, or anxiety and is not always harmless or brief.
Pregnant or breastfeeding?
Discuss treatment and relapse risks; do not stop on your own. Late exposure may affect newborn breathing or adaptation and postpartum bleeding. If breastfeeding, monitor infant alertness, fussiness, feeding, and growth.
What if too much is taken?
Get help immediately. In the US call Poison Help, 1-800-222-1222. Call 911 for collapse, seizure, breathing difficulty, inability to wake, or immediate self-harm danger. Elsewhere use local emergency services.
Storage & safety
Keep the original container tightly closed at room temperature, away from excess heat and moisture. Secure it out of sight and reach of children and pets; use pharmacy take-back for unused medicine.
About this information
For general information only; not a substitute for individualized medical advice. This sheet does not cover every risk or interaction. Ask your prescriber or pharmacist before changing how you take this medication.
Sources
Educational inclusion does not mean this medication or its indications are treated at this practice. Review the guide for your exact product with your prescriber or pharmacist.