Lexapro® (generic name: escitalopram) is prescribed as a treatment for people suffering from depression and anxiety. It is one of a group of drugs called selective serotonin reuptake inhibitors (SSRIs) that also includes Paxil (paroxetine), Prozac (fluoxetine), Celexa (citalopram) and Zoloft / Lustral (sertraline).
Lexapro is generally taken once a day at a starting dose of 10mg and may be prescribed up to the maximum allowed dose of 40mg a day.
What is Lexapro prescribed for?
Patients who have been diagnosed with one or more of the following conditions may be prescribed Lexapro:
- Generalized Anxiety Disorder (GAD)
- Major depressive disorder (MDD)
What are the side effects of Lexapro?
Along with its needed effects, Lexapro may cause some unwanted effects. Although not all of these side effects may occur, if they do occur, they may need medical attention.
Lexapro, as with most SSRI antidepressants, can cause some of the following mild side effects:
- For teenagers and young adults, they may become agitated, irritable, or display some other unusual behaviors
- People may start to:
- have suicidal thoughts and tendencies or
- become more depressed
- have trouble sleeping
- get upset easily
- suddenly have a significant increase in energy, or start to act recklessly
- Have bleeding problems, or bruise easily. You should not be taking any prescribed or OTC blood-thinning medications like aspirin.
- Experience confusion, headache, memory problems, trouble concentrating, weakness, or instability. This may be a sign of low sodium. These are more common in older patients also taking diuretics.
If you notice any of these unwanted effects, consult with your healthcare professional or pharmacist. Don’t stop taking Lexapro without checking first with your doctor. They might want you to gradually reduce the dosage before stopping it completely. This is done to reduce the chance of withdrawal symptoms, which may include increased anxiety, confusion, dizziness, headache, irritability, nausea, or unusual tiredness or weakness.
More serious unwanted effects
Tell your doctor immediately if you develop signs of bipolar (manic-depressive) disorder or have thought about committing suicide.
Get help right away if you have any of the following side effects:
- Black or tarry stools
- A fast or irregular heartbeat
- Vomit that looks like ground coffee
- Pain, swelling or redness of your eyes, widened pupils or vision changes (like halos around lights at night or blurred vision)
- Symptoms of sexual dysfunction, such as:
- Decreased interest in sexual intercourse
- Delay or inability to have an orgasm in women
- Inability to achieve or sustain an erection in men
- Loss in sexual ability, desire, drive, or performance.
Before you drive, use heavy machinery or do anything else that could be dangerous if you are not alert or well-coordinated, try to delay these activities until you have become used to the effects of Lexapro. It may cause you to feel drowsy, have trouble concentrating, or control your movements.
One specific side effect that requires special attention is directly related to the nature of SSRIs. It is referred to as serotonin syndrome, which is caused by excessive serotonin levels due to an overreaction to how SSRIs affect serotonin uptake. Too much serotonin can cause mild symptoms like diarrhea or shivering and more severe ones like muscle rigidity, fever and seizures. If untreated, severe serotonin syndrome can cause death.
Avoid drinking alcohol while taking Lexapro (see our entry under FAQ below).
If you are taking any over-the-counter (OTC) medicines or herbal or vitamin supplements (eg, St. John’s wort), tell your doctor or pharmacist before taking Lexapro.
How does Lexapro’s SSRI work?
Serotonin is a chemical essential in transmitting signals inside the brain and along nerve paths to muscles and organs, known as a neurotransmitter. The levels of serotonin regulate mood, sleep, appetite, and digestion. Low levels will aggravate any feelings of anxiety, anger and depression.
For people suffering from mood swings and depression, boosting serotonin levels can significantly reduce these feelings.
Lexapro affects the levels of serotonin, which generally is produced inside nerve cells, and is released to travel along nerve fibers and to nearby synapses, where they can pass the signal to adjacent nerves. In this sense, neurotransmitters can be thought of as the messengers inside the brain’s communication system. Some experts believe that an imbalance in levels of neurotransmitters is the cause of depression.
Lexapro works by preventing the reuptake of serotonin after it has been released by a nerve cell. (Uptake works to remove released serotonin and restricts its action on adjacent nerves.) Reducing uptake increases free serotonin, which can then stimulate nerve cells.
For serotonin to effectively lower anxiety levels, SSRIs should be taken daily for at least a few weeks. Its effect is to eventually cause changes in the structure of neurons and the number of serotonin receptors throughout the brain. The higher serotonin levels boosted by SSRIs increase the brain’s capacity to restructure itself, making it more amenable to adaptation and remodeling.
The best effects of Lexapro will begin to kick in once the process of neuroplasticity has had an opportunity to work. This is why you are usually advised to stick to the prescribed dosage routines for at least a few months. You may have to wait to feel the benefits.
Recommended routines for Lexapro – day or night?
Every person can respond differently to Lexapro. There are no rules as to whether it’s better to take Lexapro in the morning or at night time. It’s mainly a question of your own reaction to the drug, especially the side effects it has on you.
If the side effects for you are insomnia or restless sleep; urinary problems (mostly in young adults) or sexual problems like reduced libido or erectile dysfunction, then it’s generally better to take it in the morning, so that the effects will have had a chance to wear off.
If you experience some common side effects like nausea, loss of appetite, headaches, diarrhea, tired or weak, drowsy, unable to concentrate, then it may be better to take the dosage at night.
In the end, the decision to take it in the morning or evening will be one you should take after consultation with your doctor, based mainly on your experience with Lexapro.
What is vital is to be consistent with whichever routine you have decided on. Try to keep to the same time of day or night at which you take Lexapro. If you miss a dose, try to make up for it within a few hours, but do not double-dose the following day.
Improvements to your levels of anxiety and depression may take a few weeks. Stick to the plan even if you do not see the benefits immediately.
Does Lexapro affect waking and sleeping routines?
The tiny pineal gland regulates the brain’s circadian rhythm, which sets your sleep-wake cycle by reacting to ambient light levels. These signals control the production of a hormone that induces sleepiness, called melatonin, as well as of two other hormones – serotonin and dopamine. Brighter light will produce more dopamine and reduce melatonin levels.
Dopamine keeps you awake. Drugs that increase dopamine levels, such as cocaine, nicotine, caffeine and amphetamines increase alertness. Serotonin, which is the product of Lexapro, has a more complex role in the circadian cycle. While it induces drowsiness, it can also stop you from falling asleep and cause restless and unsatisfactory sleep.
What about Lexapro and alcohol?
As a general rule, doctors will advise against drinking alcohol when taking medication. In the case of Lexapro, there are specific reasons why you should not drink any alcohol when on Lexapro.
Alcohol has some basic effects on your body that mimic Lexapro. It is a depressant that slows down message traffic in the brain. Even in small quantities, it can cause problems like reduced power of judgment, fatigue, anxiety, impaired sight, or decreased motor skills. Lexapro acts to slow down and reduce movement and alertness, just as alcohol does.
In combination, Lexapro and alcohol can lead to sedation, even with one drink. This can lead to poor decision-making. It will almost certainly impair driving skills, and can increase the risk of falls.
You may not get the good benefits of Lexapro, and the symptoms can worsen. In more extreme cases, alcohol and Lexapro in combination can also lead to side effects like deeper bouts of depression and suicidal thoughts. On top of that, alcohol will also prevent Lexapro from working correctly.